Text_summarization/task83_mimic_ct_chest_summarization.json

{
    "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."
        }
    ]
}