Compared to most recent exam from 7/20/2015, there is stable to perhaps very minimal decreased caliber of the dysmorphic ventricles. A right parietal approach ventriculostomy catheter is again identified, although with evidence of interval revision as there is subcutaneous emphysema within the scalp as well as soft tissue swelling. The catheter tip remains in the midline along the anterior lateral ventricles. Compared to the exam from 7/18/2015, ventricles are slightly increased in prominence. For example, the posterior right lateral ventricle measures 2.0 cm transverse compared to previous 1.7 cm. There is also slight widening of the tips of the anterior body of the lateral ventricles. There is no midline shift or mass effect. There is no evidence of acute intracranial hemorrhage. There is unchanged dysmorphic appearance of the cerebral hemispheres and cerebellum related to congenital abnormalities. Diffusely thickened calvarium is also stable. There is scattered mucosal thickening in the paranasal sinuses, with partial opacification of the frontal sinuses with possible small air-fluid levels in the maxillary sinuses. There is severe opacification of the right middle ear and mastoid air cells, with moderate patchy opacification of left mastoid air cells.
clinical findings_fin: {'recent exam from 7/20/2015 , there is stable to perhaps very minimal decreased caliber': {'clinical finding': 'recent exam from 7/20/2015 , there is stable to perhaps very minimal decreased caliber', 'change_term': 'stable - decreased'}}anatomical entity_fin: {'scalp': {}}location descriptor_fin: ['right']object_fin: ['catheter']procedure_fin: ['ventriculostomy']clinical findings_fin: {'subcutaneous emphysema': {'clinical finding': 'subcutaneous emphysema', 'cf_snomed': {'subcutaneous emphysema': 3830001}, 'existence': 'pos_dx', 'descriptive_term': 'subcutaneous', 'observation': 'emphysema'}, 'soft tissue swelling': {'clinical finding': 'soft tissue swelling', 'cf_snomed': {'soft tissue swelling': 298349001}, 'existence': 'pos_dx', 'descriptive_term': 'soft tissue', 'observation': 'swell'}}anatomical entity_fin: {'lateral ventricles': {'location descriptor': 'anterior'}}location descriptor_fin: ['midline', 'anterior']object_fin: ['catheter']clinical findings_fin: {'increased': {'clinical finding': 'increased', 'existence': 'pos_dx', 'observation': 'increase'}}size_fin: [{'size': '2.0 cm'}, {'size': '1.7 cm'}]anatomical entity_fin: {'right lateral ventricle': {'location descriptor': 'posterior'}}location descriptor_fin: ['posterior']anatomical entity_fin: {'body': {'location descriptor': 'anterior'}, 'lateral ventricles': {}}location descriptor_fin: ['anterior']clinical findings_fin: {'slight widening': {'clinical finding': 'slight widening', 'cf_snomed': {'widening': 90522003}, 'existence': 'pos_dx', 'descriptive_term': 'slight', 'observation': 'widening'}}location descriptor_fin: ['midline']clinical findings_fin: {'mass': {'clinical finding': 'mass', 'existence': 'neg_dx', 'observation': 'mass'}}clinical findings_fin: {'acute intracranial hemorrhage': {'clinical finding': 'acute intracranial hemorrhage', 'cf_snomed': {'intracranial hemorrhage': 1386000}, 'existence': 'neg_dx', 'descriptive_term': 'acute intracranial', 'observation': 'hemorrhage', 'strength_term': 'acute', 'temporal_term': 'acute'}}anatomical entity_fin: {'cerebral hemispheres': {}, 'cerebellum': {}}clinical findings_fin: {'congenital abnormalities': {'clinical finding': 'congenital abnormalities', 'existence': 'pos_dx', 'descriptive_term': 'congenital', 'observation': 'abnormality'}}clinical findings_fin: {'diffusely thickened': {'clinical finding': 'diffusely thickened', 'existence': 'pos_dx', 'descriptive_term': 'diffusely', 'observation': 'thickened'}}anatomical entity_fin: {'paranasal sinuses': {}, 'fluid': {}}clinical findings_fin: {'scattered mucosal thickening': {'clinical finding': 'scattered mucosal thickening', 'existence': 'pos_dx', 'descriptive_term': 'scattered mucosal', 'observation': 'thickening'}, 'partial opacification': {'clinical finding': 'partial opacification', 'existence': 'pos_dx', 'descriptive_term': 'partial', 'observation': 'opacification', 'strength_term': 'partial'}, 'possible small air-fluid levels': {'clinical finding': 'possible small air-fluid levels', 'existence': 'pos_dx', 'descriptive_term': 'possible small air-fluid', 'observation': 'level', 'strength_term': 'small'}}anatomical entity_fin: {'middle ear': {'location descriptor': 'right'}, 'mastoid air cells': {'location descriptor': 'left'}}location descriptor_fin: ['right', 'left']clinical findings_fin: {'severe opacification': {'clinical finding': 'severe opacification', 'existence': 'pos_dx', 'descriptive_term': 'severe', 'observation': 'opacification', 'strength_term': 'severe'}, 'right middle ear and mastoid air cells': {'clinical finding': 'right middle ear and mastoid air cells', 'existence': 'pos_dx', 'descriptive_term': 'right middle ear and mastoid air', 'observation': 'cell'}, 'moderate patchy opacification': {'clinical finding': 'moderate patchy opacification', 'existence': 'pos_dx', 'descriptive_term': 'moderate patchy', 'observation': 'opacification', 'strength_term': 'moderate'}, 'left mastoid air cells': {'clinical finding': 'left mastoid air cells', 'existence': 'pos_dx', 'descriptive_term': 'left mastoid air', 'observation': 'cell'}}
<s>[INST] Write the finding section for a radiology report based on the following information: clinical findings_fin: {'recent exam from 7/20/2015 , there is stable to perhaps very minimal decreased caliber': {'clinical finding': 'recent exam from 7/20/2015 , there is stable to perhaps very minimal decreased caliber', 'change_term': 'stable - decreased'}}anatomical entity_fin: {'scalp': {}}location descriptor_fin: ['right']object_fin: ['catheter']procedure_fin: ['ventriculostomy']clinical findings_fin: {'subcutaneous emphysema': {'clinical finding': 'subcutaneous emphysema', 'cf_snomed': {'subcutaneous emphysema': 3830001}, 'existence': 'pos_dx', 'descriptive_term': 'subcutaneous', 'observation': 'emphysema'}, 'soft tissue swelling': {'clinical finding': 'soft tissue swelling', 'cf_snomed': {'soft tissue swelling': 298349001}, 'existence': 'pos_dx', 'descriptive_term': 'soft tissue', 'observation': 'swell'}}anatomical entity_fin: {'lateral ventricles': {'location descriptor': 'anterior'}}location descriptor_fin: ['midline', 'anterior']object_fin: ['catheter']clinical findings_fin: {'increased': {'clinical finding': 'increased', 'existence': 'pos_dx', 'observation': 'increase'}}size_fin: [{'size': '2.0 cm'}, {'size': '1.7 cm'}]anatomical entity_fin: {'right lateral ventricle': {'location descriptor': 'posterior'}}location descriptor_fin: ['posterior']anatomical entity_fin: {'body': {'location descriptor': 'anterior'}, 'lateral ventricles': {}}location descriptor_fin: ['anterior']clinical findings_fin: {'slight widening': {'clinical finding': 'slight widening', 'cf_snomed': {'widening': 90522003}, 'existence': 'pos_dx', 'descriptive_term': 'slight', 'observation': 'widening'}}location descriptor_fin: ['midline']clinical findings_fin: {'mass': {'clinical finding': 'mass', 'existence': 'neg_dx', 'observation': 'mass'}}clinical findings_fin: {'acute intracranial hemorrhage': {'clinical finding': 'acute intracranial hemorrhage', 'cf_snomed': {'intracranial hemorrhage': 1386000}, 'existence': 'neg_dx', 'descriptive_term': 'acute intracranial', 'observation': 'hemorrhage', 'strength_term': 'acute', 'temporal_term': 'acute'}}anatomical entity_fin: {'cerebral hemispheres': {}, 'cerebellum': {}}clinical findings_fin: {'congenital abnormalities': {'clinical finding': 'congenital abnormalities', 'existence': 'pos_dx', 'descriptive_term': 'congenital', 'observation': 'abnormality'}}clinical findings_fin: {'diffusely thickened': {'clinical finding': 'diffusely thickened', 'existence': 'pos_dx', 'descriptive_term': 'diffusely', 'observation': 'thickened'}}anatomical entity_fin: {'paranasal sinuses': {}, 'fluid': {}}clinical findings_fin: {'scattered mucosal thickening': {'clinical finding': 'scattered mucosal thickening', 'existence': 'pos_dx', 'descriptive_term': 'scattered mucosal', 'observation': 'thickening'}, 'partial opacification': {'clinical finding': 'partial opacification', 'existence': 'pos_dx', 'descriptive_term': 'partial', 'observation': 'opacification', 'strength_term': 'partial'}, 'possible small air-fluid levels': {'clinical finding': 'possible small air-fluid levels', 'existence': 'pos_dx', 'descriptive_term': 'possible small air-fluid', 'observation': 'level', 'strength_term': 'small'}}anatomical entity_fin: {'middle ear': {'location descriptor': 'right'}, 'mastoid air cells': {'location descriptor': 'left'}}location descriptor_fin: ['right', 'left']clinical findings_fin: {'severe opacification': {'clinical finding': 'severe opacification', 'existence': 'pos_dx', 'descriptive_term': 'severe', 'observation': 'opacification', 'strength_term': 'severe'}, 'right middle ear and mastoid air cells': {'clinical finding': 'right middle ear and mastoid air cells', 'existence': 'pos_dx', 'descriptive_term': 'right middle ear and mastoid air', 'observation': 'cell'}, 'moderate patchy opacification': {'clinical finding': 'moderate patchy opacification', 'existence': 'pos_dx', 'descriptive_term': 'moderate patchy', 'observation': 'opacification', 'strength_term': 'moderate'}, 'left mastoid air cells': {'clinical finding': 'left mastoid air cells', 'existence': 'pos_dx', 'descriptive_term': 'left mastoid air', 'observation': 'cell'}} [/INST] Compared to most recent exam from 7/20/2015, there is stable to perhaps very minimal decreased caliber of the dysmorphic ventricles. A right parietal approach ventriculostomy catheter is again identified, although with evidence of interval revision as there is subcutaneous emphysema within the scalp as well as soft tissue swelling. The catheter tip remains in the midline along the anterior lateral ventricles. Compared to the exam from 7/18/2015, ventricles are slightly increased in prominence. For example, the posterior right lateral ventricle measures 2.0 cm transverse compared to previous 1.7 cm. There is also slight widening of the tips of the anterior body of the lateral ventricles. There is no midline shift or mass effect. There is no evidence of acute intracranial hemorrhage. There is unchanged dysmorphic appearance of the cerebral hemispheres and cerebellum related to congenital abnormalities. Diffusely thickened calvarium is also stable. There is scattered mucosal thickening in the paranasal sinuses, with partial opacification of the frontal sinuses with possible small air-fluid levels in the maxillary sinuses. There is severe opacification of the right middle ear and mastoid air cells, with moderate patchy opacification of left mastoid air cells. </s>