Instruction: Generate impression based on medical findings.

Input: Ms. Oxley is a 22-year-old female presenting with a tender palpable mass in the right axillary region that intermittently increases in size. However, on today's examination, patient states that the mass has disappeared. She has no family history of breast cancer. Upon physical exam at the patient's area of concern, no discrete mass is palpable. Targeted right axillary ultrasound is performed.In the right axillary region, at site of patient's area of concern, no suspicious cystic or solid mass is appreciated.

Output: No sonographic evidence of malignancy. Should patient's symptoms return, a repeat right axillary ultrasound can be performed if clinically desired. Patient should also follow up with her primary care physician. All results and recommendations were relayed to the patient. BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on medical findings.

Input: 76-year-old male with history of equivocal left renal lesion on CT. Hematuria. RIGHT KIDNEY: The right kidney is within normal limits.LEFT KIDNEY: Although the left kidney is normal in size, there are several small tiny cysts. Additionally, there is an approximately 1 cm hypoechoic focus with internal echoes in the upper pole that may represent a hemorrhagic/complex cyst. No definite internal vascularity.OTHER: No hydronephrosis, no hydroureter. Bilateral renal jets are seen. Prostate enlargement.

Output: 1.Left renal upper pole complex cystic focus may represent a hemorrhagic/complex cyst, although this is nonspecific and should be followed up in 6 months with ultrasound.2.Prostate enlargement.


Instruction: Generate impression based on medical findings.

Input: Reason: 2yo M with Neuroblastoma s/p chemotherapy and stem cell transplant undergoing immunotherapy with history of abscesses now with new buttock swelling History: erythematous induration on R buttock Soft tissue swelling without discrete fluid collection.

Output: Soft tissue swelling without discrete fluid collection.


Instruction: Generate impression based on medical findings.

Input: 76-year-old female with a history of hepatitis C presents for evaluation of liver. LIVER:Measures 4.6 cm. There is increased and coarse echogenicity of the parenchyma. No focal mass or ascites. There is a dirty shadowing arising from the biliary system, consistent with pneumobilia.GALLBLADDER, BILIARY TRACT: The gallbladder is absent. As above, there is dirty shadowing arising from the biliary system consistent with pneumobilia. The common bile duct measures 5.1 mm.PANCREAS: Evaluation the pancreas is limited due to overlying bowel gas.SPLEEN: Measures 6.7 cm without sonographic abnormalities. Of note, much of the spleen is shadowed out.KIDNEYS: Right kidney measures 8.5 cm. Left kidney measures 8.0 cm. The kidneys are echogenic bilaterally. No shadowing calculi, hydronephrosis, or focal mass. OTHER: No significant abnormality noted.

Output: 1. Coarse echogenic liver consistent with chronic liver disease/parenchymal dysfunction. No mass or ascites.2. Echogenic kidneys consistent with medical renal disease/parenchymal dysfunction. No hydronephrosis.3. There is dirty shadowing arising from biliary system consistent with pneumobilia, which was also seen on prior CT.4. Surgical changes of a prior cholecystectomy.


Instruction: Generate impression based on medical findings.

Input: 31-year-old male with pancreatitis, elevated bilirubin. LIVER: Measures 21.1 in length. Increased hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: No cholelithiasis. No gallbladder wall thickening, pericholecystic fluid, or biliary ductal dilation. PANCREAS: Enlarged hypoechoic pancreas consistent with the clinical history of pancreatitis. Portions of the pancreatic tail are not well visualized due to bowel gas. No peripancreatic fluid collections are identified.SPLEEN: Unremarkable in size and echogenicity. KIDNEY: No hydronephrosis, nephrolithiasis, or solid mass. OTHER: No significant abnormalities noted.

Output: 1.Hypoechoic enlarged pancreas consistent with the clinical history of pancreatitis.2.No cholelithiasis or evidence of cholecystitis.3.Hepatomegaly and increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease.


Instruction: Generate impression based on medical findings.

Input: Reason: RUQ pain, evaluate for cholecystitis LIVER: The liver measures 17.0 cm in length. Normal hepatic parenchymal echogenicity and echotexture. The portal vein is patent with normal directional hepatopedal flow, peak velocity 19.4 cm/s.GALLBLADDER, BILIARY TRACT: The gallbladder is distended, however there are no shadowing stones or intraluminal sludge. No pericholecystic inflammation or fluid. No biliary ductal dilatation. Gallbladder wall measures 0.2 cm and the common bile duct measures 0.2 cm. Negative sonographic Murphy's sign.PANCREAS: No significant abnormalities noted. The pancreatic duct measures 0.13 cm.KIDNEYS: The right kidney measures 8.7 cm in length. The left kidney measures 9.7 cm in length. Echogenic renal parenchyma. No shadowing stones or hydronephrosis.OTHER: No ascites.

Output: 1. Distended gallbladder without evidence of cholelithiasis, sludge, or acute inflammation.2. Echogenic kidneys, consistent with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: 66-year-old female who is intubated for evaluation of liver and gallbladder. LIVER: The liver is normal in echogenicity and measures 13.8 cm in length. The main portal vein is patent with peak systolic velocity measuring 13.5 cm/s.BILIARY TRACT: The gallbladder is not visualized. No intra or extrahepatic biliary ductal dilatation with the common bile duct measuring 2 mm in diameter.PANCREAS: No significant abnormalities noted.SPLEEN: Spleen is normal in echotexture and measures 8 cm in length.RIGHT KIDNEY: Right kidney measures 10.1 cm in length and the left kidney measures 10 cm in length. No hydronephrosis.OTHER: No significant abnormalities noted.

Output: Limited examination given patient intubation. Gallbladder is not visualized. No intra or extrahepatic biliary duct dilatation.


Instruction: Generate impression based on medical findings.

Input: Asymptomatic female with dense breasts presents for whole breast ultrasound for dense breast screening. 3-D whole breast ultrasound was performed for both breasts and images were reviewed on an independent workstation. A few scattered round anechoic lesions are seen bilaterally, compatible with simple cysts. No suspicious cystic or solid mass is identified .

Output: Bilateral simple breast cysts. No sonographic evidence for malignancy.BIRADS: 2 - Benign.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: Chronic viral hepatitis B, HCC screening LIVER: Increased echogenicity of the liver noted, liver measures 18.5 cm. No intrahepatic biliary ductal dilatation. No focal lesions noted. Portal vein demonstrates normal flow directionality and patency.BILIARY TRACT: Gallbladder is well-distended without any focal lesions. Gallbladder wall thickness measures up to 2 mm. Common hepatic duct measures up to 2 mm. No pericholecystic fluid noted.PANCREAS: Head of the pancreas visualized appears unremarkable. Body and tail of pancreas not visualized due to overlying bowel gas.SPLEEN: 10.3 cm in length without any focal lesions.RIGHT KIDNEY: Right kidney measures 9.7 cm and left kidney measures 10.5 cm. No hydronephrosis or hydroureter. No suspicious focal lesion. OTHER: No ascites

Output: Increased hepatic echogenicity compatible with hepatic steatosis. No focal hepatic lesions noted.No ascites


Instruction: Generate impression based on medical findings.

Input: Male 36 years old; Reason: 36 yo with HCV please eval for HCC History: none LIVER: The liver measures 13.0 cm in length. There is increased and coarse echogenicity of the liver parenchyma. No focal hepatic lesions. No intrahepatic ductal dilation is seen. The main portal vein is patent with normal hepatopetal flow measured at 16.2 cm/s. GALLBLADDER/BILIARY TRACT:The gallbladder wall measures 1.0 mm.No stones are seen, however debris and two subcentimeter hyperechoic nondependent lesions are seen, consistent with gallbladder polyps. The largest of these measures approximately 0.5 x 0.3 x 0.4 cm.No pericholecystic fluid.The common bile duct measures 2.0 mm in diameter.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 8.4 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 10.4 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 10.6 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: No significant abnormality noted.

Output: 1. Coarse echogenic texture of the liver consistent with chronic liver disease/parenchymal dysfunction. No masses or ascites.2. Gallbladder polyps; the largest of these is approximately 0.5 cm in the largest dimension.


Instruction: Generate impression based on medical findings.

Input: 71 female with right upper quadrant pain, chills, CVA tenderness. History of cholecystectomy and reported renal cyst. LIVER: Increased echogenicity of the liver measuring 14.4 cm in length. No focal hepatic lesions. Main portal vein is patent with appropriate directional flow; peak velocity measures 0.2 m/s. GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. The common duct measures 7 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Tail of the pancreas is obscured by overlying bowel gas. Visualized portions of the pancreas are unremarkable. RIGHT KIDNEY: Normal echogenicity of the right kidney measuring 10.8 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Normal echogenicity of the spleen measuring 7.8 cm in length. Normal echogenicity of the left kidney measuring 11.2 cm in length. No hydronephrosis or shadowing calculi are noted.

Output: Increased echogenicity of the liver suggestive of parenchymal dysfunction/fatty infiltration. No focal hepatic lesions.


Instruction: Generate impression based on medical findings.

Input: Evaluate vessels. Known medial and lateral lymphocele status post IR drainage of the lateral lymphocele. Evaluate compression of the iliac vein either by the allograft or lymphocele. Leg swelling. RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: Since prior examination, the superior collection has undergone percutaneous drainage and is no longer visible. The inferior collection appears unchanged. KIDNEY: No significant abnormality notedCOLLECTING SYSTEM/URETER: No significant abnormality notedURINARY BLADDER: No significant abnormality notedVASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vesselsPatent vasculature without evidence for inflow or outflow compromise. Both main renal arteries and veins appear patent.OTHER: No significant abnormality noted

Output: Status post percutaneous drainage of superior lymphocele. Patent vasculature without evidence for inflow or outflow compromise. No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 52 year-old male with history of acute injury. Assess for stones or hydronephrosis. RIGHT KIDNEY: Mild cortical thinning, without hydronephrosis or nephrolithiasis. The right kidney measures 10.75 cm.LEFT KIDNEY: Mild cortical thinning, without hydronephrosis or nephrolithiasis. The left kidney measures 11.9 cm.OTHER: Bladder is relatively decompressed.

Output: Mild bilateral cortical thinning, without hydronephrosis or nephrolithiasis, which may represent medical renal disease.


Instruction: Generate impression based on medical findings.

Input: 71-year-old male with cirrhosis and hepatitis C. Evaluate for hepatocellular carcinoma. LIVER: Liver is relatively small and coarsely echogenic consistent with parenchymal disease. No focal mass identified. Color and spectral Doppler demonstrates patency and for direction in the main portal vein with low velocities.BILIARY TRACT: Gallbladder is collapsed with stones. The biliary tract is normal in caliber.PANCREAS: Limited due to bowel gasSPLEEN: Marked splenomegaly.RIGHT KIDNEY: No significant abnormalities noted. OTHER: Small left renal cyst.

Output: Stable examination without evidence for solid hepatic mass.


Instruction: Generate impression based on medical findings.

Input: 19-year-old female patient with history of right lumpectomy for fibroadenoma. Patient complains of new/increasing right breast mass immediately inferior to the nipple. A targeted right ultrasound was performed for the palpable area of concern. Physical examination demonstrated a small palpable lump in the inferior right breast just below the nipple. Targeted ultrasound of this area at the 6:00 position 1 cm from the nipple showed a 1.7 x 1.1 x 1.4 cm (previously 1.8 x 0.9 x 1.3) parallel circumscribed oval hypoechoic mass with internal vascularity.

Output: No significant interval change in inferior right breast benign morphology mass, likely representing a fibroadenoma. Recommend continued surgical consultation follow-up.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation.


Instruction: Generate impression based on medical findings.

Input: Reason: Assess for stability in size of nodules, unable to biopsy, as on Plavix History: see above RIGHT LOBE MEASUREMENTS: 4.7 x 1.5 x 1.7 cmLEFT LOBE MEASUREMENTS: 4.9 x 1.9 x 1.7 cmISTHMUS MEASUREMENTS: 0.2 cm in the AP dimensionRIGHT LOBE: Hypoechoic spongiform nodule in the right mid pole measures 0.7 x 0.6 x 0.6 cm, previously 0.7 x 0.6 x 0.7 cm, stable in size and appearance.Mixed cystic and solid in the inferior pole measures 1.6 x 0.6 x 0.9 cm, previously 1.9 x 0.9 x 1 cm, stable in size and appearance.No new nodules or masses.LEFT LOBE: Previously described as two separate nodules, the mixed cystic and solid lesions with small calcified focus in the mid pole have not changed in size or appearance and measure as a whole 3.5 x 2.5 x 1.7 cm, previously measured at 2.0 x 0.6 x 1.5 cm and 2.1 x 2.1 1.9 cm.No new nodules or masses.ISTHMUS: No new nodules or masses.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Several benign appearing nonenlarged cervical lymph nodes.OTHER: No significant abnormality noted.

Output: No significant interval change in size and morphology of bilateral thyroid nodules.


Instruction: Generate impression based on medical findings.

Input: Asymptomatic female with dense breasts presents for whole breast ultrasound for dense breast screening. 3-D whole breast ultrasound was performed for both breasts and images were reviewed on an independent workstation. There is a hypoechoic mass at 9:30 position, 9 cm from nipple, in the right breast. There is no solid or cystic mass identified in the left breast.

Output: A hypoechoic mass at 9:30 position, 9 cm from nipple, in the right breast for which hand-held ultrasound study is recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on medical findings.

Input: Female 73 years old Reason: hepatocellular injury, assess for vascular abnormalities and liver architecture, patient with AKI, please assess kidneys History: as above ABDOMENLIVER: Liver is normal in morphology and measures 15.8 cm in length. The hepatic parenchyma is homogenously increased echotexture. No focal mass lesion is evident.BILIARY TRACT: No intrahepatic or extrahepatic biliary ductal dilatation. The common bile duct measures 4 mm in diameter.PANCREAS: No significant abnormalities noted.SPLEEN: The spleen is normal in size measuring 11.8 cm in length. RIGHT KIDNEY: The right kidney is normal in size measuring 11.5 cm in length. The renal parenchyma is mildly echogenic but normal in thickness. No hydronephrosis or shadowing stones.LEFT KIDNEY: The left kidney is normal in size measuring 9.2 cm in length. Evaluation of the parenchyma is mildly limited due to technical factors, however the renal parenchyma appears mildly echogenic. No hydronephrosis.OTHER: No significant abnormalities noted.

Output: 1.Mildly echogenic hepatic parenchyma which can be seen in hepatic steatosis.2.Mildly echogenic renal parenchyma bilaterally compatible with medical renal disease. No hydronephrosis or stones are evident.3.Normal Doppler examination of the abdomen.


Instruction: Generate impression based on medical findings.

Input: Bilateral findings from screening presents for further evaluation. ML views and spot compression views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Asymmetry in the right outer breast disperses with spot compression. Mass in the left upper inner breast persists partially with spot compression but has an appearance more of focal breast tissue rather than a true mass. ULTRASOUND

Output: Highly likely benign findings on today's mammogram and ultrasound. It would be best if stability could be proven for this finding by comparison to prior mammograms. The patient has signed paperwork so that her studies from Mercy Hospital can be submitted. If for some reason these cannot be submitted, then a short-term 6 month follow-up mammogram should be performed. If the old studies are submitted and the finding is stable, then a return to routine screening would be reasonable.BIRADS: 3 - Probably benign finding.RECOMMENDATION: O - Old Study For Comparison.


Instruction: Generate impression based on medical findings.

Input: Chronic kidney disease, stage V Ultrasound guidance was provided for a native kidney biopsy.

Output: Ultrasound guidance for native kidney biopsy.


Instruction: Generate impression based on medical findings.

Input: Reason: Hyperparathyroidism History: Tertiary hyperparathyroidism a RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 3.8 x 1.4 x 2.0 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 2.0 cm x 3.8 x 1.4 cm.ISTHMUS MEASUREMENTS: 0.5 cm.RIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: There is a round, hypoechoic vascular mass at the inferior aspect of the lower pole of left thyroid lobe measuring 2.0 x 1.8 x 1.9 cm which appears extrathyroidal and is consistent with parathyroid adenoma.LYMPH NODES: Multiple benign appearing borderline to mildly enlarged lymph nodes measuring up to 1.34 cm in the long axis.OTHER: No significant abnormalities.

Output: 2.0 x 1.8 x 1.9 cm probable extrathyroidal mass at the inferior aspect of the left thyroid lobe appears consistent with parathyroid adenoma.


Instruction: Generate impression based on medical findings.

Input: Cirrhosis of liver LIVER: Coarse echogenic liver echotexture again noted without mass. Liver length 17.4 cm. Limited Doppler interrogation of main portal vein demonstrates a patent main portal vein with normal directional flow.BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 9.6 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 10.4 cm in lengthOTHER: Left kidney 10.1 cm in length. No ascites

Output: Coarse echogenic liver echotexture again noted consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites.


Instruction: Generate impression based on medical findings.

Input: Recurrent UTIs RIGHT KIDNEY: Echogenic parenchyma again noted without mass, stone, or hydronephrosis. Right kidney 10.7 cm in lengthLEFT KIDNEY: Echogenic parenchyma again noted without mass, stone, or hydronephrosis. 10.6 cm in lengthOTHER: Bladder nondistended

Output: Echogenic renal parenchyma again noted consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction.


Instruction: Generate impression based on medical findings.

Input: Alcoholic cirrhosis LIMITED ABDOMENLIVER: Cirrhotic morphology. 1.5 x 1.5 x 1.3 cm hypoechoic focus within segment 2 of the left lobe of the liver. Liver length 15 cmBILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 12.6 cm in length RIGHT KIDNEY: Right renal cyst. Right kidney 13.4 cm in length.OTHER: Left kidney 13.2 cm in length. Nonobstructing left renal stone again noted. Spleen length 12.6 cm Moderate ascites.

Output: Cirrhotic morphology. Hypoechoic lesion segment 2 left lobe of the liver; a neoplastic process including malignancy cannot be excluded. Strongly recommend correlation with contrast cross sectional imaging. Cholelithiasis without ductal dilatation. Moderate ascites.Patent hepatic vessels with normal directional flow.


Instruction: Generate impression based on medical findings.

Input: Thyroid cancer status post resection RIGHT LOBE: Status post thyroidectomy without massLEFT LOBE: Status post thyroidectomy without massISTHMUS: Status post thyroidectomy without massPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Status post thyroidectomy without mass or regional adenopathy.


Instruction: Generate impression based on medical findings.

Input: 24-year-old with physician palpated nodularity of both breasts. Patient reports no significant change in nodularity with self breast examinations. Family history of breast cancer in her mother diagnosed at 44 years of age. A bilateral breast ultrasound was performed for the patient’s area of concern. There is no solid or cystic mass identified. Normal glandular tissue was seen bilaterally.

Output: No sonographic evidence for malignancy.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: 79-year-old male with elevated LFTs and history of alcohol abuse. Evaluate liver for portal hypertension and cirrhosis LIVER: The liver is normal in echotexture without evidence of nodular contour or other specific findings to suggest cirrhosis. Portal vein is patent with peak systolic velocity of 0.2 m/s.GALLBLADDER, BILIARY TRACT: Gallbladder wall measures 0.2 cm with the common bile duct measuring 0.2 cm.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Kidneys are normal in echotexture with the right kidney measuring 9.4 cm and left kidney measuring 10.4 cm in length.OTHER: Small bilateral pleural effusions, right greater than left

Output: 1.No sonographic evidence of cirrhosis or portal hypertension as clinically questioned.2.Small bilateral pleural effusions, right greater than left.


Instruction: Generate impression based on medical findings.

Input: 56-year-old female with cholangiocarcinoma, now with abnormal renal function. RIGHT KIDNEY: Right kidney measures 11 cm in length. Echotexture is mildly increased and heterogeneous. The hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: The left kidney measures 10.7 cm in length. Echotexture is mildly increased and heterogeneous. The hydronephrosis, shadowing calculus or mass.OTHER: Collateral vessels seen near the liver hilum consistent with cavernous transformation. Patient's known liver masses not evaluated.Bladder appears unremarkable.

Output: Mildly echogenic kidneys without hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: HBV LIVER: Coarse echogenic liver again noted without mass. Liver length 13.1 cm.GALLBLADDER, BILIARY TRACT: Adenomyomatosis again noted without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Stable subcentimeter upper pole echogenic focus; favor benign etiology. Right kidney 9.9 cm in length.OTHER: Left kidney 9.8 cm in length. Spleen 8.6 cm in length. No ascites.

Output: Stable coarse echogenic liver consistent with chronic liver disease without mass or ductal dilatation. No ascites.


Instruction: Generate impression based on medical findings.

Input: 41-year-old male patient with right upper quadrant abdominal pain, positive Murphy. Evaluate for fatty liver disease. LIVER: The liver measures 19.3 cm in length and has increased echogenicity. No focal hepatic lesion is identified. The main portal vein flow is hepatopetal and measures 0.4 m/sec.GALLBLADDER, BILIARY TRACT: There are no gallstones, gallbladder wall thickening, or pericholecystic fluid. There is no intra- or extrahepatic biliary ductal dilatation. The common hepatic duct measures 1 mm in diameter. Sonographic Murphy's sign is negative.PANCREAS: The head of the pancreas is normal in echogenicity. The tail is obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 11.4 cm in length. No evidence of hydronephrosis.OTHER: The left kidney measures 12.2 cm in length. No evidence of hydronephrosis. There is a 2.3 x 2.3 cm left lower pole simple renal cyst.The spleen measures 10.6 cm in length.

Output: 1. Hepatic steatosis.2. No cholelithiasis or sonographic evidence of acute cholecystitis.3. Left renal cyst.


Instruction: Generate impression based on medical findings.

Input: 36-year-old with palpable right breast mass for the last several weeks. A targeted right ultrasound was performed for the palpable area of concern. There is a mixed echogenicity but predominately hypoechoic mass at the right breast 10:00 position measuring 0.9 x 0.9 cm. Peripheral vascularity is noted.

Output: 9 mm right breast mass. At this point, bilateral diagnostic mammography and referral to a breast surgeon for consideration of palpably guided sampling are recommended. The patient declined mammography today despite extensive discussions regarding its potential benefits for her. The patient voiced understanding that mammography may detect breast cancer that is not seen on ultrasound in this setting.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: B - Surgical Consultation.


Instruction: Generate impression based on medical findings.

Input: 72-year-old male with recurrent hyperparathyroidism after two prior parathyroid operations. Status post partial thyroidectomy. Please evaluate for adenoma. RIGHT LOBE MEASUREMENTS: Again seen are changes consistent with the patient's history of right lobe thyroidectomy. There is interval development of a focus of hypoechoic tissue in the right thyroid bed, measuring 1.5 x 0.9 x 1.1 cm. LEFT LOBE MEASUREMENTS: 2.9 x 1.4 x 1.6 cmISTHMUS MEASUREMENTS: 4 mmRIGHT LOBE: Again seen are changes consistent with the patient's history of right lobe thyroidectomy. There is interval development of a focus of heterogenous but predominately hypoechoic tissue with internal vascularity in the right thyroid bed, measuring 1.5 x 0.9 x 1.1 cm. Additionally, note is made of an round, hypoechoic focus along the inferior margin of the right thyroid bed, measuring 6 x 4 x 4 mm without internal vascularity.LEFT LOBE: The left lobe is again noted to be diffusely heterogeneous and lobulated, appearing slightly decreased in size when compared to the prior study.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Note is made of an round, hypoechoic focus along the inferior margin of the right thyroid bed, measuring 6 x 4 x 4 mm without internal vascularity.LYMPH NODES: Normal appearing right level IV cervical lymph nodes are identified.OTHER: No significant abnormality noted.

Output: Heterogenous left lobe of the thyroid with interval development of a 6 mm hypoechoic focus along the inferior margin of the surgical bed of the right lobe of the thyroid gland which may represent a parathyroid adenoma candidate. Further evaluation with a parathyroid nuclear medicine scintigraphic examination could be considered if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female presents for ascites check. A large amount of ascites is present in all 4 quadrants.Liver with cirrhotic morphology and splenomegaly, incompletely assessed on this study.

Output: 1. Large amount of ascites in all 4 quadrants.2. Liver with cirrhotic morphology and splenomegaly as above.


Instruction: Generate impression based on medical findings.

Input: Male; 69 years old. Reason: hematuria History: hematuria history of prostate cancer RIGHT KIDNEY: The right kidney measures 9.2 cm in length. The renal cortex is normal in echogenicity. No shadowing stone, hydronephrosis or worrisome renal mass is identified. LEFT KIDNEY: The left kidney measures 9.5 cm in length. The renal cortex is normal in echogenicity. There is a 1.5 x 1.3 x 1.8 cm simple renal cyst. No shadowing stone, hydronephrosis or worrisome renal mass is identified. URINARY BLADDER: Bladder is nondistended.

Output: 1.Left simple renal cyst. 2.No nephrolithiasis or hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Hypothyroidism RIGHT LOBE MEASUREMENTS: 5 x 2.3 x 2.4 cmLEFT LOBE MEASUREMENTS: 5.2 x 2.3 x 1.9 cmISTHMUS MEASUREMENTS: 0.9 cmRIGHT LOBE: Heterogeneous gland. 0.6 x 0.6 x 0.6 cm calcified mid pole nodule.LEFT LOBE: Heterogeneous gland. 0.9 x 0.8 x 1.3 cm mostly cystic nodule lower pole left thyroidISTHMUS: Heterogeneous glandPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Heterogeneous thyroid gland. Subcentimeter calcified right thyroid nodule. Mostly cystic left thyroid nodule as described. No regional adenopathy.


Instruction: Generate impression based on medical findings.

Input: 80 yo female with past history of left breast cancer, has benign feeling mass in the right breast. Prior ultrasound on 7/24/2014 demonstrated no mass in the palpable area of abnormality in the 3 o'clock position of the right breast. A targeted right ultrasound was performed for the palpable area of concern, previously denoted as the 3 o'clock position. There is no solid or cystic mass identified 4 cm from the nipple, the previous location examined sonographically. In the 3 o'clock position, 2 cm from the nipple, there is a small simple cyst, measuring 3 x 1 x 3 mm.

Output: No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: Preoperative planning. Based on ultrasound examination from yesterday the patient has a left arm mass. There is tenting of the anterolateral skin of the upper arm presumably represents the subcutaneous lesion seen on yesterday's ultrasound. I see no soft tissue calcification. The underlying bone appears normal.

Output: Left arm mass better depicted on yesterday's ultrasound examination.


Instruction: Generate impression based on medical findings.

Input: Reported history of hepatic hemangiomas seen on outside CT including one 2 cm hemangioma at the dome and a 1 cm hemangioma in the left inferior liver. LIVER: The liver measures 15.6 cm in length. The liver parenchymal echotexture is normal. There is a hyperechoic structure within the inferior right liver with faceted margins which measures 0.8 x 0.6 x 0.7 cm and which is nonspecific but compatible with a hemangioma. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.2 m/s.BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. The sonographic Murphy's sign is negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 4 mm in diameterPANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. The spleen measures 8.2 cm in length. RIGHT KIDNEY: Kidney measures 10.5 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 10.3 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.

Output: Single subcentimeter hypoechoic lesion within the right inferior liver which is nonspecific but in the absence of underlying liver disease or history of malignancy most likely represents a benign hemangioma. Correlation with prior outside imaging would be helpful.


Instruction: Generate impression based on medical findings.

Input: Reason: elevated liver enzymes LIVER: Normal liver echogenicity and echotexture. The portal vein is patent. Normal hepatopedal portal venous blood flow, 34.7 cm/s. The liver measures 17.6 cm in length.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted. Negative sonographic Murphy sign. The gallbladder wall measures 0.3 cm. The common hepatic duct measures 0.2 cm. No intrahepatic or extrahepatic biliary ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 10.1 cm in length. 5.5 x 4.8 x 4.5 anechoic right renal cyst. Additional complex 2.2 x 1.9 x 2.7 cyst with multiple septations. Echogenic renal cortex. No hydronephrosis.LEFT KIDNEY: The left kidney measures 13.9 cm in length. Echogenic renal cortex. No hydronephrosis.SPLEEN: The spleen is prominent, measuring 14.0 cm in length.OTHER: No significant abnormalities noted.

Output: Echogenic kidneys may reflect medical renal disease/parenchymal dysfunction.


Instruction: Generate impression based on medical findings.

Input: 36-year-old female with increase in creatinine and potassium. Limited examination secondary to patient body habitus and surgical bandages.RIGHT KIDNEY: Measures 9.1 cm in length. No hydronephrosis. No nephrolithiasis identified.LEFT KIDNEY: Measures 9.6 cm in length. No hydronephrosis. No nephrolithiasis identified.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.

Output: Limited study as detailed above. No hydronephrosis or evidence of nephrolithiasis.


Instruction: Generate impression based on medical findings.

Input: Hematuria RIGHT KIDNEY: Normal parenchymal echogenicity without mass, stone, or hydronephrosis. Right kidney 12.2 cm in lengthLEFT KIDNEY: Normal parenchymal echogenicity without mass, stone, or hydronephrosis. Left kidney 13.7 cm in lengthOTHER: Bladder nondistended

Output: Negative renal ultrasound. Normal parenchymal echogenicity without mass, stone, or obstruction.


Instruction: Generate impression based on medical findings.

Input: 44-year-old with right breast cellulitis. Right breast ultrasound was performed. There is an irregularly-shaped hypoechoic lesion with increased vascularity, measuring 36 x 23 mm at two o'clock retroareolar region, consistent with abscess formation. Diffuse skin thickening and edema is seen in the right breast.

Output: Abscess formation at two o'clock retroareolar region in the right breast. Diffuse skin thickening and edema in the right breast.BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation.


Instruction: Generate impression based on medical findings.

Input: Hepatitis C LIVER: Measures 13.1 cm in length. No focal mass.GALLBLADDER, BILIARY TRACT: Gallbladder is sonographically normal in appearance without wall thickening or biliary dilation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Measures 8.8 cm in length. Bilateral subcentimeter renal cysts.OTHER: Spleen measures 8.4 cm in length. Left kidney measures 9.4 cm in length.

Output: No focal hepatic lesions.


Instruction: Generate impression based on medical findings.

Input: Ms. Lebeau is a 54 year old female with a known history of right breast cancer. She presents today for skin marking prior to surgery. Targeted right breast ultrasound was performed at the location of the known right breast cancer. No sonographic correlate was seen for the known right breast cancer nor was any sonographic correlate seen for the biopsy clip placed within the cancer. Thus, a decision to proceed with mammographically guided localization was made.DIAGNOSTIC MAMMOGRAPHIC

Output: Successful localization of the clip at the site of known malignancy in the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Abnormal LFTs and thrombocytopenia LIVER: Mildly coarse echotexture without mass. Liver length 12.2 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.4 cm in lengthOTHER: Left kidney 11.3 cm in length. Spleen 10 cm in length. No ascites.

Output: Mildly coarse liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites. Cholelithiasis without acute inflammation.


Instruction: Generate impression based on medical findings.

Input: Male; 60 years old. Reason: 60 y/o M with PMH of SVT with likely lipoma on upper back, please ultrasound and evaluate On the right upper back at the site of the palpable abnormality is a 6.2 x 1.6 x 4.5 cm intramuscular, ovoid structure which is isoechoic to the adjacent muscle with thin internal striations that are parallel to the long axis of the structure itself. Portions of the border of this lesion are not easily discernible from the adjacent muscle. There is no internal vascularity seen on color Doppler.

Output: 6.2 x 1.6 x 4.5 cm intramuscular structure is most compatible with a lipoma. Other benign etiologies such as normal variant of the musculature are also considered.


Instruction: Generate impression based on medical findings.

Input: 35-year-old female with right breast cancer presents for imaging follow-up of the lesion. A targeted right ultrasound was performed at the areas of the known breast cancer. At 10:00 location, posterior right breast, 12 cm from the nipple, there is a 12 x 7 x 10 mm hypoechoic irregular mass with spiculated margin and a centrally located biopsy clip, compatible with the known cancer, which previously measured 11 x 12 x 12 mm on 9/16/2015 and 19 x 17 mm on 6/30/2015.

Output: Slightly decreased in size of the known malignancy in the right breast. Continued follow-up with surgery team is recommended. Results and recommendations were discussed with the patient. BIRADS: 6 - Known cancer.RECOMMENDATION: B - Surgical Consultation.


Instruction: Generate impression based on medical findings.

Input: Right upper quadrant tenderness. Food intolerance. LIVER: Non-cirrhotic liver morphology. Heterogeneous liver echotexture. 15.7 cm in length. Multiple hepatic cysts noted. No suspicious hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Normal appearance of the gallbladderPANCREAS: No sonographic abnormality evident in the visualized pancreatic head and neck. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney is 11.5 cm in length, with a 7.6 cm benign-appearing cyst.. The left kidney is 9.6 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 9.8 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites identified.

Output: Normal sonographic appearance of the gallbladder, per clinical query. No specific findings to account for the patient's symptoms.Heterogeneous hepatic echotexture, may reflect underlying hepatic steatosis/parenchymal dysfunction.


Instruction: Generate impression based on medical findings.

Input: Liver and renal failure of unknown known cause LIVER:Coarse echogenic liver echotexture with irregular contour suggestive for cirrhotic morphology without mass. Liver length 19.4 cmGALLBLADDER, BILIARY TRACT: Gallbladder absent. No ductal dilatation.PANCREAS: No significant abnormality noted.SPLEEN: Moderately severe splenomegaly. 20 cm in length.KIDNEYS: Echogenic renal parenchyma without mass, stone, or hydronephrosis. Right kidney 18.7 cm in length ABDOMINAL AORTA: No significant abnormality noted.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: Trace ascites.

Output: Enlarged cirrhotic liver without mass or ductal dilatation. Mid main portal vein stenosis/thrombosis with velocity gradient as described. Main portal vein flow remains pedal. Hepatic arteries and veins patent. Trace ascites. Moderately severe splenomegaly. Echogenic renal parenchyma suggestive for medical renal disease/parenchymal dysfunction without mass, stone, or obstruction.


Instruction: Generate impression based on medical findings.

Input: 39-year-old female with thyroid nodule identified on MR imaging of the cervical spine, please evaluate. RIGHT LOBE MEASUREMENTS: 4.1 x 1.7 x 1.3 cmLEFT LOBE MEASUREMENTS: 5.5 x 1.7 x 1.5 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Mixed cystic and solid nodule in the right lower pole measures 0.6 x 0.5 x 0.3 cm.LEFT LOBE: No significant abnormality noted.ISTHMUS: Cystic lesion in the left isthmus measures 0.5 x 0.5 x 0.2 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Subcentimeter thyroid nodules without suspicious features.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with hepatitis C and known liver mass for follow-up. LIVER: Liver parenchyma is mildly coarsened without significant change. Hepatic size is within normal limits. There is again noted a rounded, echogenic and minimally heterogeneous right lobe mass measuring approximately 1.4 x 1.4 x 1.6 cm without significant change from prior exams. Prior pathology of biopsy of this nodule demonstrated regenerative nodule. No other mass is identified. GALLBLADDER, BILIARY TRACT: The gallbladder is well-visualized and appears normal without cholelithiasis, wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Highly echogenic consistent with parenchymal disease. No hydronephrosis.OTHER: Left kidney is highly echogenic consistent with parenchymal disease. No hydronephrosis. Splenic size normal.

Output: Coarsely echogenic liver with stable, echogenic mass. No new mass identified.


Instruction: Generate impression based on medical findings.

Input: Male 64 years old Reason: at the site of port-a-cath, check for abscess/ hematoma History: swelling at the site of port-a-cath There is a complex fluid collection the port pocket. This may represent hematoma, however, an abscess cannot be excluded. The collection measures 3.4 x 1.9 cm.

Output: Complex hematoma sepsis surrounding the port.


Instruction: Generate impression based on medical findings.

Input: 64-year-old female with a history of recurrent ovarian cancer and abdominal distention. Evaluate for ascites. Targeted ultrasound was performed of the 4 abdominal quadrants to assess for ascites. There is a very small amount of fluid in the abdomen and at least small bilateral pleural effusions.

Output: Minimal ascites and at least small bilateral pleural effusions partially seen.


Instruction: Generate impression based on medical findings.

Input: Palpable area of concern appreciated by the patient's massage therapist in the right axilla. Personal history of left breast cancer status post lumpectomy in 2012. A targeted right ultrasound was performed for the area of concern. Several normal morphology right axillary lymph nodes are present. There is no suspicious solid or cystic mass identified.

Output: No sonographic evidence for malignancy. Normal right axillary lymph nodes. Correlation with physical exam is recommended, and the patient will see Dr. Jaskowiak today for that.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on medical findings.

Input: 41 year old female who was recalled from screening mammogram for multiple focal asymmetries, some with calcifications, in both breast presents for additional workup. Mammogram: 2 ML view and 8 spot magnification views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. 2 cm partially circumscribed mass in the left retroareolar region with multiple pleomorphic calcifications need further evaluation with ultrasound. A subcentimeter partially circumscribed mass is also identified in the left central slightly lateral breast.Another partially circumscribed mass with few calcifications is noted in the right upper outer quadrant approximately measuring 18 mm. These calcifications have coarse morphology.Few other benign morphology masses identified within the right breast.Ultrasound:A parallel oriented hypoechoic mass measuring 1.6 x 1.1 cm with few calcifications within it is identified in the right breast 11:00 position 2 cm from the nipple. Located slightly superior to it is another solid hypoechoic mass that measures 0.8 x 0.5 cm. Both these masses most likely correspond to the masses seen on mammogram.In the left breast 12:00 position there is an oval hypoechoic mass with multiple hyperechoic areas consistent with calcifications that measures 2.2 x 1 x 2.1 cm. This lesion demonstrates peripheral and central blood flow and most likely corresponds to the largest mass with indeterminate calcifications as seen on mammogram. Another small most likely benign morphology mass is identified at 3:00 position that measures 1.3 x 0.6 cm.

Output: The largest mass in the left breast 12:00 position with multiple pleomorphic calcifications needs further evaluation with ultrasound-guided core biopsy. Specimen radiograph should be obtained to confirm suspicious calcifications within them.Multiple other most likely benign morphology masses in both breast. If the above-mentioned biopsies benign, annual diagnostic mammogram is recommended.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on medical findings.

Input: 46 year old woman with history of cysts and fibroadenomas seen in left breast on prior ultrasound. A targeted left ultrasound was performed for the previously seen masses on ultrasound. Left breast implant is noted.In the left breast, 8'o clock position 2 cm from the nipple, 2 contiguous anechoic masses with posterior acoustic enhancement are seen measuring 8 x 5 x 5 mm, unchanged in size and appearance from the prior examination.In the left breast, 8'o clock position 4 cm from the nipple, 3 contiguous hypoechoic circumscribed masses are seen measuring 3 x 3mm, 3 x 3mm, and 2 x 2mm, unchanged in size and appearance from the prior examination.

Output: Stable cysts and fibroadenomas of the left breast. No evidence of malignancy. Followup with annual diagnostic mammogram and possible ultrasound is recommended and due in about 6 months. Results and recommendations discussed with patient. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: 63-year-old male with cirrhosis screening for HCC LIVER:The liver has cirrhotic morphology, with coarse echogenicity. Liver measures 15.7 cm in length. No new worrisome masses are noted. The portal vein is hepatopetal in flow and is patent. Flow within the portal vein is measured at 19.7 cm/s.GALLBLADDER, BILIARY TRACT: The gallbladder is visualized with two subcentimeter stones and very minimal sludge. Sonographic Murphy's sign was negative. The gallbladder wall measures 0.2 cm, this is normal thickness. No evidence of acute cholecystitis. There is one area along the superior wall of the gallbladder that may represent adenomyomatosis vs. stone. The common bile duct measures 0.3 cm which is normal caliber.PANCREAS: No significant abnormality noted.SPLEEN: The spleen measures 11.1 cm in length. No significant abnormality noted.KIDNEYS: The right kidney measures 12.9 cm in length. There are several subcentimeter nonobstructing stones in the right kidney. No worrisome masses or hydronephrosis is seen in the right kidney. The left kidney measures 13.1 cm in length. A nonobstructing stone is seen within the left kidney measuring 0.8 cm x 0.5 cm. No new worrisome masses or hydronephrosis is seen on the left kidney.

Output: 1. The liver has cirrhotic morphology, no worrisome masses are noted.2. Several subcentimeter nonobstructing stones are visualized within the kidneys bilaterally.3. Several small subcentimeter stones are seen within the gallbladder, but no evidence of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: 35-year-old male with right upper quadrant pain. LIVER: Liver is normal in size and echotexture. No focal hepatic abnormality is identified. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: Unfortunate, gallbladder is contracted in a postprandial state. On this limited study there are no definite shadowing gallstones and there is no pericholecystic fluid.PANCREAS: Not imagedRIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.

Output: Examination gallbladder limited by postprandial state. No gross abnormality.


Instruction: Generate impression based on medical findings.

Input: 36-year-old female for follow-up thyroid nodules. RIGHT LOBE MEASUREMENTS: 4.7 x 1.3 x 1.6 cmLEFT LOBE MEASUREMENTS: 5.1 x 2.5 x 2.4 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: In the right lobe there is again noted a predominantly hypoechoic but mildly heterogeneous solid nodule measuring 1 x 1.1 x 1.4 cm without interval change. This appears slightly less spongiform than on the prior exam. No new nodules are identified.LEFT LOBE: Again noted in the left lobe is a large complex nodule with a slightly greater than 50% solid component. Remainder is complex cystic. There are at least 2 large shadowing calcifications within this nodule, and smaller calcifications as well. The nodule measures 2.2 x 2.3 x 3.6 cm without significant interval change. No new nodules are identified.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable, bilateral thyroid nodules.


Instruction: Generate impression based on medical findings.

Input: Cirrhosis with history of TIPS LIVER: Cirrhotic morphology again noted. No mass. Liver length 12.1 cm. Limited Doppler interrogation of the TIPS demonstrates a patent TIPS. Patent main portal vein with normal directional flow. Main portal vein velocity 48 cm/s. GALLBLADDER, BILIARY TRACT: Cholelithiasis again noted. Moderate bilobar and extrahepatic ductal dilatation again noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.8 cm in lengthOTHER: Left kidney 11.2 cm in length. Spleen 8.8 cm in length. No ascites.

Output: Technically limited study. Patent main portal vein with normal directional flow. Patent TIPS. Cirrhotic morphology without obvious mass. Moderate bilobar and hepatic ductal dilatation again noted. No ascites.


Instruction: Generate impression based on medical findings.

Input: 20-year-old male with right upper quadrant pain. LIVER:Measures 14.6 cm. Normal echogenicity. No focal mass, ascites, or intrahepatic biliary dilation. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: Gallbladder is nondistended with an anechoic lumen. Gallbladder wall measures 1.7 mm. No pericholecystic fluid, sludge, or stones. Common bile duct measures 2.2 mm. Negative sonographic Murphy's sign.PANCREAS: Evaluation the pancreas limited due to overlying bowel gas.SPLEEN: Measures 13.5 cm without sonographic abnormalities.KIDNEYS: Right kidney measures 10.8 cm. Left kidney measures 10.6 cm. Normal echogenicity. No shadowing calculi, hydronephrosis, or focal mass. OTHER: No significant abnormality noted.

Output: 1. Normal ultrasound of the abdomen without signs of cholelithiasis or cholecystitis.


Instruction: Generate impression based on medical findings.

Input: 44-year-old male patient with CVID, persistent left anterior cervical node. Evaluate thyroid and left anterior cervical lymph node. RIGHT LOBE MEASUREMENTS: 3.9 x 1.2 x 1.3 cm.LEFT LOBE MEASUREMENTS: 4.0 x 1.1 x 1.3 cm.ISTHMUS MEASUREMENTS: 2 mm in thickness.RIGHT LOBE: The right thyroid lobe is homogeneous in echogenicity without thyroid lesion.LEFT LOBE: The left thyroid lobe is homogeneous in echogenicity without thyroid lesion.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There is a 2.3 x 1.2 x 0.5 cm right level two lymph node and a 2.1 x 1.0 x 0.4 cm right level three lymph node. There is an enlarged node in the region of the left submandibular gland measuring 2.2 x 1.4 x 3.0 cm.OTHER: No significant abnormality noted.

Output: 1. Enlarged left submandibular region lymph node.2. No dominant thyroid lesion.


Instruction: Generate impression based on medical findings.

Input: Elevated creatinine. Congenital solitary left kidney. RIGHT KIDNEY: Not present.LEFT KIDNEY: 11.4 cm in length. Increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.BLADDER: Collapsed.OTHER: No significant abnormality noted.

Output: Solitary left kidney with echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: 48-year-old female with right upper quadrant pain, chills. LIVER: Measures 18.0 cm in length. Unremarkable echogenicity and morphology.GALLBLADDER, BILIARY TRACT: Cholelithiasis with marked gallbladder wall thickening measuring up to 12 mm and a positive sonographic Murphy's sign, consistent with acute cholecystitis. No biliary ductal dilation.PANCREAS: Portions of the pancreas not well visualized due to bowel gas.KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.

Output: Findings consistent with acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: 87 year-old female with tachycardia and abnormal thyroid function tests. Evaluate for multinodular goiter. RIGHT LOBE MEASUREMENTS: 3.3 x 2.4 x 5.2 cmLEFT LOBE MEASUREMENTS: 2.3 x 2.3 x 5.9 cmISTHMUS MEASUREMENTS: 3 mm.RIGHT LOBE: There is a 2.1 x 2.4 x 2.7 cm hypoechoic interpolar solid nodule with small cystic components. There is mild internal vascularity and no definite associated calcifications. The margins are well-defined. There are numerous additional sub-5-mm nodules in the right thyroid lobe. LEFT LOBE: There is a 0.8 by 0.8 x 1.2 cm inferolateral left thyroid hypoechoic nodule with peripheral vascularity. The margins are well-defined. Punctate intralesional punctate echogenic foci, nonspecific, nonshadowing, no definite comet tail artifact. No definite flow seen within this nodule. Additional sub-5-mm nodules are scattered throughout the left thyroid lobe.ISTHMUS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.

Output: 1. Indeterminate dominant 2.7 cm right thyroid nodule. Given the large size of the right thyroid nodule, further evaluation with fine needle aspiration may be considered. 2. Numerous other smaller nodules seen bilaterally.


Instruction: Generate impression based on medical findings.

Input: Thyroid cancer status post thyroidectomy RIGHT LOBE: Status post thyroidectomy without mass.LEFT LOBE: Status post thyroidectomy without massISTHMUS: Status post thyroidectomy without massPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Status post thyroidectomy without worrisome mass or regional adenopathy.


Instruction: Generate impression based on medical findings.

Input: 57-year-old female with biopsy-proven left papillary thyroid carcinoma. Evaluate for nodal disease. RIGHT LOBE MEASUREMENTS: 3.6 x 2.2 x 1 cmLEFT LOBE MEASUREMENTS: 3.9 x 1.8 x 1 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Within the right lobe there is a hypoechoic and at least partly cystic mass measuring 0.6 x 0.7 x 0.8 cm without change.LEFT LOBE: Within the left lobe, there is a hypoechoic and poorly marginated mass with internal calcification consistent with papillary thyroid cancer measuring 0.9 x 0.8 x 0.8 cm without change.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign appearing lymph nodes on the right.Benign appearing lymph node at level 2 on the left. At level for there is a rounded 0.6 x 0.8 x 0.9 cm lymph node with internal calcification and abnormal flow consistent with metastatic papillary thyroid carcinoma. A second level 4 lymph node is normal in morphology.OTHER: No significant abnormality noted.

Output: Left papillary thyroid carcinoma with a metastatic level 4 lymph node on the left.Small cystic nodule right lobe.


Instruction: Generate impression based on medical findings.

Input: 71-year-old male with HCV cirrhosis. Evaluate for hepatocellular carcinoma. LIVER: Liver is very mildly and coarsely echogenic. No focal hepatic mass is identified. Overall hepatic size is within normal limits. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein although the flow is low velocity.BILIARY TRACT: Gallbladder appears unremarkable without cholelithiasis, wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: The pancreatic head and body are normal. The tail is less well-visualized due to bowel gas.SPLEEN: In the midportion noRIGHT KIDNEY: Right renal cyst again identified. OTHER: No significant abnormalities noted.

Output: Stable examination without liver mass.


Instruction: Generate impression based on medical findings.

Input: Female 57 years old Reason: Eval anterior abdominal soft tissue mass (just above umbilicus); R/o lipoma vs cyst vs abscess vs malignancy History: Anterior soft tissue mass (just above umbilicus) Ultrasound demonstrates an irregular contoured fluid collection with mural nodules. Mural nodules or hypovascular on color Doppler imaging. Overall dimension is measured as 4.7 x 3.3 x 4.4 cm. There is no evidence of peristalsis. No definite connection to the peritoneal cavity.

Output: Irregular shape fluid collection with mural soft tissue nodularity is nonspecific. Neoplasm cannot be excluded. Infected fluid collection cannot be excluded. Although less likely something related to abdominal wall herniation containing infarcted omentum or fluid in the hernia sac cannot be excluded. If clinically warranted further evaluation to be obtained with CT.


Instruction: Generate impression based on medical findings.

Input: Goiter RIGHT LOBE MEASUREMENTS: 5.8 x 1.6 x 2 cmLEFT LOBE MEASUREMENTS: 9 x 5.8 x 3.8 cm ISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Relatively stable subcentimeter hypoechoic right thyroid nodules. The largest within the lower pole measures 0.6 x 0.8 x 0.7 cmLEFT LOBE: Interval decrease in size of cystic nodule measuring 1.1 x 1.1 x 1.2 cm. Slight interval increase in size of solid dominant left thyroid nodules. The largest within the lower pole now measures 4.8 x 3.7 x 4.9 cm; this is in comparison to 4.5 x 3 cm on 8/25/2011.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval decrease in size of cystic left lobe nodule. Slight interval increase in size of solid dominant left thyroid nodules. No regional adenopathy.


Instruction: Generate impression based on medical findings.

Input: Reason: Right Hip Mass There is a heterogeneous hypoechoic solid mass in the subcutaneous soft tissues overlying the right hip, measuring approximately 7.3 x 4.3 x 5.8 cm. The lesion demonstrates limited internal vascularity. No other lesions are identified.

Output: Soft tissue mass overlying the right hip could represent a lipoma, however follow-up imaging with MRI is recommended.


Instruction: Generate impression based on medical findings.

Input: Evaluate for ascites. Hep C cirrhosis. Minimal ascites, markedly less than prior, located predominantly in the upper abdomen. Cirrhotic liver noted incidentally.

Output: Minimal ascites, predominantly in the upper abdomen.


Instruction: Generate impression based on medical findings.

Input: 70-year-old female with proteinuria for biopsy of right kidney. Ultrasound guidance was provided for biopsy of right kidney

Output: Ultrasound guidance was provided for biopsy of right kidney


Instruction: Generate impression based on medical findings.

Input: Pain and tenderness to palpation in the lower lumbar/sacral region. There is a circumscribed cystic mass measuring 3.3 x 3.7 x 2.9 cm situated approximately 3 mm below the skin surface in the lower lumbar/sacral region. This cystic mass has a thick vascular rim and internal septations demonstrating vascularity. No connection to the skin surface or deeper structures is seen. No definite solid nodule/mass is seen.

Output: Cystic mass in the lower lumbar/sacral region. Although the appearance is slightly atypical, an abscess is most likely. Follow-up imaging is recommended after medical treatment to evaluate for improvement/resolution. If improvement is not seen, MRI should be considered.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old. Hx of kidney cancer s/p right partial nephrectomy, evaluate for metastatic disease. RIGHT KIDNEY: Status post right partial nephrectomy. The right kidney measures 10.9 cm in length, with normal echotexture. No focal lesions or hydronephrosis. No perinephric collections.LEFT KIDNEY: The left kidney measures 12.9 cm in length, with normal echotexture. No focal lesions or hydronephrosis. No perinephric collections.OTHER: The bladder is decompressed. Increased hepatic echogenicity is noted.

Output: 1.Status post right partial nephrectomy without evidence of local disease recurrence.2.Increased liver echogenicity, compatible with fatty infiltration.


Instruction: Generate impression based on medical findings.

Input: 53 years old, Male, Reason: transaminitis. please evaluate for evidence of cirrhosis vs. fatty liver etc History: transaminitis LIVER: The liver is enlarged measuring 20.1 cm cm in length. Increased echogenicity of the hepatic parenchyma is consistent with fatty infiltration. No focal hepatic lesion identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.2 m/s. Hypoechoic area adjacent to the gallbladder likely represents focal fatty sparing. No surface nodularity of the liver to suggest cirrhosis.BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. Per ultrasound technologist, sonographic Murphy's sign is negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 5 mm in diameter.PANCREAS: Hypoechoic focus in region of pancreatic body is nonspecific on this ultrasound examination and may be further evaluated with dedicated cross-sectional imaging.SPLEEN: No significant abnormalities noted. The spleen measures 12.5 cm in length. RIGHT KIDNEY: Kidney measures 11.8 cm in length. Normal echotexture. No evidence of hydronephrosis or shadowing calculus.LEFT KIDNEY: Kidney measures 12.3 cm in length. Normal echotexture. No evidence of hydronephrosis or shadowing calculus.OTHER: No evidence of ascites.

Output: 1.Hepatomegaly with fatty infiltration of the liver. No definite evidence of cirrhosis.2.Nonspecific hypoechoic focus in the area of the body of the pancreas. Recommend dedicated cross-sectional imaging with IV contrast to further evaluate this lesion.


Instruction: Generate impression based on medical findings.

Input: Elevated lactic acid. Concern for cholangitis or cholecystitis. LIVER: Diffuse metastatic disease throughout the liver. 17 cm in length. There is reversed flow in the main portal vein, measuring approximately 18 cm/s.GALLBLADDER, BILIARY TRACT: Common bile duct at the upper limits of normal in width at 7 mm. The gallbladder is collapsed, with several small gallstones. Minimal gallbladder wall thickening is non-specific in the setting of ascites.PANCREAS: No sonographic abnormality evident in the visualized pancreatic head and neck. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney is 10.6 cm in length. The left kidney is not well visualized. The renal parenchyma is echogenic bilaterally. No suspicious renal lesions are evident. No hydronephrosis is seen. SPLEEN: 10.2 cm in length, without focal lesions evident.OTHER: Moderate ascites is noted.

Output: 1. Diffuse metastatic disease throughout the liver, with reversal of portal venous flow.2. Moderate ascites.3. Cholelithiasis without specific evidence of cholecystitis.4. Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Hematuria. History of bladder diverticulum status post repair. Right-sided nephroureteral stent. RIGHT KIDNEY: The nephroureteral stent is imaged within the right renal pelvis. The pigtail portion of it is not well seen. There is new moderate right-sided hydroureteronephrosis. The right kidney measures 10.9 cm in length. No shadowing nephrolithiasis. The cortex is mildly echogenic and thinned.LEFT KIDNEY: The left kidney measures 10.7 cm in length without hydronephrosis or shadowing nephrolithiasis. The renal cortex is echogenic and mildly thinned. Color Doppler demonstrates hilar blood flow.URINARY BLADDER: The urinary bladder is normally distended with anechoic urine. Previously seen bladder diverticulum is not seen. The nephroureteral stent is noted coiled within the bladder lumen. A left-sided ureteral jet is seen.OTHER: No significant abnormalities noted.

Output: New moderate right-sided hydroureteronephrosis suggestive of nephroureteral stent malfunction. Although the nephroureteral stent tip is seen within the renal pelvis, the pigtail portion cannot be demonstrated.Findings were paged to urology service 9772 at 1345 on 12/15/2015.


Instruction: Generate impression based on medical findings.

Input: Status post left ureteral reimplant RIGHT KIDNEY: Normal echogenicity without mass, stone, or hydronephrosis. 11.2 cm in lengthLEFT KIDNEY: Normal echogenicity without worrisome mass, stone, or hydronephrosis. Benign-appearing cyst. Left kidney 10.7 cm in length.OTHER: Bladder nondistended

Output: Negative renal ultrasound without evidence for worrisome mass, stone, or hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 65-year-old male patient status post completion thyroidectomy, papillary microcarcinoma evident on pathology. RIGHT LOBE: The remaining right thyroid tissue measures approximately 0.8 x 1.0 x 1.9 cm. Multiple subcentimeter hypoechoic solid and cystic nodules are noted. The largest nodule, which is cystic, measures approximately 0.6 x 0.3 x 0.4 cm. LEFT LOBE: Status post thyroidectomy without residual tissue identified.ISTHMUS: Status post thyroidectomy.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Status post partial right thyroidectomy with multiple subcentimeter nodules.2. Status post left thyroid lobectomy without evidence of residual tissue.


Instruction: Generate impression based on medical findings.

Input: Right upper quadrant and right flank pain LIVER: Unremarkable echogenicity without mass. Liver length 14.8 cmGALLBLADDER, BILIARY TRACT: Probable gallbladder polyp measuring 0.3 x 0.3 x 0.3 cm. No acute inflammation. No ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.2 cm in lengthOTHER: Left kidney 11.1 cm in length. Spleen 9.9 cm in length. No ascites.

Output: Probable subcentimeter gallbladder polyp. Otherwise unremarkable examination.


Instruction: Generate impression based on medical findings.

Input: 64-year-old female with chronic lymphocytic thyroiditis. RIGHT LOBE MEASUREMENTS: 6.9 x 3 x 2.3 cmLEFT LOBE MEASUREMENTS: 7.3 x 2.6 x 3.4 cmISTHMUS MEASUREMENTS: 0.7 cmRIGHT LOBE: Diffusely heterogeneous with echogenic and interspersed more hypoechoic areas. No dominant nodule other than one very small cystic area.LEFT LOBE: Diffusely heterogeneous with echogenic and interspersed more hypoechoic areas. No dominant nodule.ISTHMUS:Diffusely heterogeneous with echogenic and interspersed more hypoechoic areas. No dominant nodule.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Thyromegaly with appearance consistent with chronic thyroiditis. No dominant mass.


Instruction: Generate impression based on medical findings.

Input: Male; 68 years old. Reason: evaluate liver for portal venous flow and biliary tree patentcy History: transaminitis LIVER: The liver measures 18.3 cm in length. The liver contour is smooth. The parenchyma is increased in echogenicity with coarse echotexture. Within the left lobe of the liver is a 2.5 x 2.5 x 1.9 cm simple cyst. No worrisome masses identified. There is no ascites.The main portal vein is patent with a peak velocity of 0.3 m/sec.BILIARY TRACT: The gallbladder is normal in appearance. The common duct measures 5 mm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The pancreas is not well visualized due to overlying bowel gas.SPLEEN: The spleen measures 9.5 cm in length.RIGHT KIDNEY: The right kidney measures 13.2 cm in length. The cortex is normal in echogenicity. There is no hydronephrosis, shadowing renal stone, or worrisome mass. OTHER: The left kidney measures 13.4 cm in length. The cortex is normal in echogenicity. No hydronephrosis, shadowing stone, or worrisome mass.Small right pleural effusion.

Output: 1.Mild hepatomegaly. Course and echogenic liver compatible with parenchymal dysfunction.2.Patent main portal vein. No biliary ductal dilatation.3.Simple liver cyst.


Instruction: Generate impression based on medical findings.

Input: : History of bilateral prophylactic mastectomies due to family history breast cancer with new tender right upper outer quadrant mass over reconstruction/implant. A targeted right ultrasound was performed for the palpable area of concern. There is no solid or cystic mass at the 11:00 position. There is a hypoechoic focus without vascular flow at the 10:00 position, approximately 4 cm from the nipple measuring approximately 7 x 4 mm.

Output: Benign appearing subcentimeter hypoechoic lesion at palpable area of concern as above. BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on medical findings.

Input: 47 years old, Male, Reason: heavy alcohol -- liver and spleen appear ULN History: none LIVER: The liver size is within normal limits measuring 15.2 cm in length. Diffuse coarse increased echogenicity of the hepatic parenchyma is consistent with fatty infiltration. No definite nodularity of the liver to suggest cirrhosis. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.2 m/s.BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. The sonographic Murphy's sign is negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 5 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 10.8 cm in length. RIGHT KIDNEY: Kidney measures 11.7 cm in length. Normal echotexture. Nodular echogenic focus in the superior pole of the right kidney without posterior shadowing measures 1.6 x 1.8 x 1.8 cm and is favored to represent a angiomyolipoma. No hydronephrosis or shadowing calculus.LEFT KIDNEY: Kidney measures 10.9 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.

Output: 1.Diffusely coarsened increased echogenicity of the liver is consistent with fatty infiltration.2.Nodular echogenic focus in the superior pole of the right kidney likely represents an angiomyolipoma.3.No evidence of hepatosplenomegaly.


Instruction: Generate impression based on medical findings.

Input: Epigastric pain LIVER: Mildly coarse echogenic liver echotexture again noted without mass. Liver length 15.6 cm. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow.BILIARY TRACT: Diffuse gallbladder wall thickening with stable subcentimeter gallbladder polyps noted. Cholelithiasis and sludge. No Murphy's sign. No ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 10 cm in lengthRIGHT KIDNEY: Stable renal cyst. Right kidney 11.2 cm in lengthOTHER: Left kidney 10.6 cm in length.

Output: Diffuse gallbladder wall thickening with subcentimeter gallbladder polyps noted associated with cholelithiasis and sludge. Negative Murphy's sign. Findings suggestive for chronic inflammation. No ductal dilatation.Mildly coarse and echogenic liver echotexture suggestive for chronic liver disease/parenchymal dysfunction without mass.


Instruction: Generate impression based on medical findings.

Input: Evaluate for obstruction History: increased urine output, worsening creatinine. RIGHT KIDNEY: 11.2 cm in length, however with ill-defined borders similar to prior study. Several anechoic simple cysts measuring up to 2.3 cm. Markedly echogenic parenchyma, consistent with medical renal disease. No hydronephrosis hydroureter.LEFT KIDNEY: 11.6 cm in length, however with ill-defined borders similar to prior study. Several anechoic simple cysts measuring up to 1.5 cm. Markedly echogenic parenchyma, consistent with medical renal disease. No hydronephrosis hydroureter.OTHER: Anechoic fluid-filled bladder.

Output: Small echogenic kidneys consistent with medical renal disease. No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 40-year-old recalled from screening for focal asymmetry in the right upper-outer breast An ML view and two spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses(BiRads Density Category C), unchanged in pattern and distribution. ML view redemonstrates an asymmetry in the right upper breast posterior depth identified on screening mammogram. Spot compression views persistence of the mass with obscured margins. Targeted ultrasound of the right breast was then performed at the site of the patient's mammographic abnormality. In the right upper outer breast 10:00 radian 4 cm from the nipple there is a simple cyst which measures 6 x 5 x 8 mm. No suspicious mass lesions were identified.

Output: Simple cyst corresponding to the site of the patient's mammographic abnormality. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: Elevated creatinine RIGHT KIDNEY: Increased parenchymal echogenicity without worrisome mass, stone, or hydronephrosis. Multiple benign-appearing renal cysts. The largest measures 4.2 x 4.6 x 3.7 cm. Right kidney 10.4 cm in length.LEFT KIDNEY: Increased parenchymal echogenicity without worrisome mass, stone, or hydronephrosis. Multiple benign-appearing cysts. The largest measures 4.1 x 5 x 4.3 cm. Left kidney 10.2 cm in length.OTHER: Enlarged prostate. Bladder nondistended

Output: Increased parenchymal renal echogenicity suggestive for medical renal disease/parenchymal dysfunction without worrisome mass or stone. No hydronephrosis. Multiple bilateral benign-appearing renal cysts.


Instruction: Generate impression based on medical findings.

Input: 54 years old, Male, Reason: r/o masses, cirrhosis History: abdominal pain LIVER: The liver is enlarged measuring 21.6 cm in length. Coarse heterogeneous liver could be indication of chronic liver disease. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.3 m/s.BILIARY TRACT: Patient is status post cholecystectomy. The common bile duct measures 6 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: The spleen is difficult to visualize on this exam. The visualized spleen measures approximately 6.6 cm in length. RIGHT KIDNEY: Kidney measures 11.7 cm in length. Echogenic right kidney indicating medical renal disease without evidence of hydronephrosis. Simple appearing right renal cyst measures 1.2 x 1.2 x 1.3 cm.LEFT KIDNEY: Kidney measures 13.0 cm in length. Increased echogenicity of the left kidney is consistent medical renal disease. No evidence of hydronephrosis. Left renal cyst measures 1.5 x 1.4 x 1.0 cm.OTHER: No significant abnormalities noted.

Output: 1.Hepatomegaly with coarse heterogeneous liver which can be consistent with chronic liver disease. No hepatic mass.2.Increased echogenicity of the kidneys without hydronephrosis is consistent with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Right upper quadrant pain LIVER: Mild hepatomegaly with coarse echogenic parenchyma without mass. Liver length 19.6 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.8 cm in lengthOTHER: Left kidney 10.5 cm in length. Spleen 11.3 cm in length. No ascites.

Output: Cholelithiasis without acute inflammation or ductal dilatation. Mild hepatomegaly associated with coarse echogenic parenchyma consistent with fatty infiltration/parenchymal dysfunction without mass. No ascites.


Instruction: Generate impression based on medical findings.

Input: 29-year-old female with abdominal pain, question of common bile duct dilation on CT. LIVER: Measures 20.0 cm in length. Increased hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: No cholelithiasis. No gallbladder wall thickening, pericholecystic fluid, or biliary ductal dilation. PANCREAS: The pancreas is incompletely imaged due to bowel gas. The imaged portions of the pancreas appear unremarkable. SPLEEN: Unremarkable in size and echogenicity. KIDNEY: No hydronephrosis, nephrolithiasis, or solid mass. OTHER: No significant abnormalities noted.

Output: 1. Hepatomegaly with increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease, without discrete focal lesion. 2. No evidence of intrahepatic or extrahepatic biliary ductal dilation.


Instruction: Generate impression based on medical findings.

Input: 82 year-old female with HBV, evaluate for HCC. LIVER: Coarse echotexture and nodular contour of the liver measuring 13.5 cm in length. No focal hepatic lesions. Main portal vein is patent with appropriate directional flow; peak velocity measures 0.4 m/sec.GALLBLADDER, BILIARY TRACT: Normal echogenicity of the gallbladder. No gallbladder wall thickening. No pericholecystic fluid. Sonographic Murphy's sign is negative. Common duct measures 6 mm in caliber. No intra-or extrahepatic biliary duct dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Measures 6.6 cm in length and is increased in echogenicity. No hydronephrosis or shadowing calculi are noted. OTHER: Left kidney measures 8.5 cm in length and is increased in echogenicity. Multiple cysts are noted, one of which measures 1.3 cm x 1.0 cm x 0.7 cm. No hydronephrosis or shadowing calculi are noted. Normal echogenicity of the spleen measuring 7.9 cm in length.Small amount of perihepatic fluid and in Morrison's pouch.

Output: 1. Cirrhotic liver morphology with no focal hepatic lesions.2. Small amount of perihepatic fluid and in Morrison's pouch. 3. Increased echogenicity of the kidneys suggestive of or obstruction. Left renal cysts.


Instruction: Generate impression based on medical findings.

Input: NASH cirrhosis LIVER: Cirrhotic morphology again noted without mass. Liver length 22.3 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted..RIGHT KIDNEY: No significant abnormalities noted. 14.1 cm in lengthOTHER: Left kidney 16.6 cm in length. Spleen 19 cm in length. Recannulized umbilical vein again observed. No ascites.

Output: Cirrhotic morphology without mass or ductal dilatation. No ascites.


Instruction: Generate impression based on medical findings.

Input: Palpable left nodule RIGHT LOBE MEASUREMENTS: 4.5 x 1.8 x 1.4 cm. Normal in size with normal background echotexture and vascularity.LEFT LOBE MEASUREMENTS: 4.6 x 1.7 x 1.2 cm. Normal in size with normal background echotexture and vascularity.ISTHMUS MEASUREMENTS: 2 mm in AP dimension, within normal limits.RIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Benign-appearing cervical lymph nodes identified.OTHER: No significant abnormality noted.

Output: Normal sonographic appearance of the thyroid gland, without nodule.


Instruction: Generate impression based on medical findings.

Input: Ms. NAISHIA L WALKER is a 16 years old female with a personal history of palpable masses in the right breast. ULTRASOUND:On physical examination, palpable masses were noted in the low right axillary tail as well as in the right breast at the 11:00 position, approximately 3 cm from the right nipple.A targeted right ultrasound was performed for the palpable area of concern. A multilobulated well-circumscribed hypoechoic mass is present at the 11:00 position, approximately 3 cm from the nipple, which measures 15 x 13 x 17 mm. There is an additional well-circumscribed hypoechoic lesion superior to this mass, which may represent a lobulation or an additional mass. In the right axilla/lower axillary tail, there are two well-circumscribed hypoechoic lesions. The larger measures 17 x 10 x 19 mm, and the smaller, which is lateral and anterior measures 9 x 5 x 9 mm. The total extent of these two masses measures approximately 2.5 cm.

Output: Palpable circumscribed hypoechoic masses in the right axilla/lower axillary tail and right breast most consistent with benign fibroadenomas. Surgical consultation and short-term follow-up is recommended.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on medical findings.

Input: 31 year old female with history of epigastric pain and cramping. LIVER: The liver measures 11.8 cm in length, and is within normal limits.GALLBLADDER, BILIARY TRACT: No biliary dilatation, no gallstones and the findings of cholecystitis.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. The right kidney measures 8.9 cm.OTHER: No significant abnormalities noted. The left kidney measures 9.7 cm. Negative Murphy sign. Extensive bowel gas limits exam.

Output: No significant acute abnormality to explain the patient's pain.


Instruction: Generate impression based on medical findings.

Input: 46 year old female who was recalled from screening mammogram for bilateral breast masses. No family history of breast cancer. MAMMOGRAM: An ML view and 3 spot compression views of the right breast, and An ML view and two spot compression views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. There is redemonstration of a subcentimeter mass within the upper central right breast, which persists on spot compression imaging. Additionally, there is redemonstration of a subcentimeter mass in the upper outer left breast, which partially disperses on spot compression imaging. ULTRASOUND: Targeted right ultrasound was performed for the mammographic area of concern. At the 12 o'clock position of the right breast, 14 cm from the nipple there is a circumscribed hypoechoic mass with parallel orientation measuring 0.6 x 0.1 x 0.1 cm. A second 0.1 x 0.2 x 0.4 cm is noted adjacent to this. These likely represent simple cysts and account for findings on mammogram.Targeted left ultrasound was performed of the mammographic area of concern. Within the upper outer quadrant of the left breast, no solid or cystic mass is identified. Findings on mammogram likely represent superimposed glandular tissue.

Output: 1. High-probability benign right breast lesions most likely cysts, accounting for findings on mammogram. Six month follow-up right unilateral mammogram and possible ultrasound are recommended to assess stability.2. Partial dispersement of the left breast findings, with no sonographic correlate. The mammographic finding likely represents superimposition of normal glandular tissue. BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on medical findings.

Input: 70-year-old male with hyperparathyroidism, evaluate for parathyroid adenoma. RIGHT LOBE MEASUREMENTS: 5.5 x 2.5 x 1.8 cmLEFT LOBE MEASUREMENTS: 4.8 x 2.2 x 1.8 cmISTHMUS MEASUREMENTS: 2.2 cmRIGHT LOBE: Normal in echogenicity without discrete noduleLEFT LOBE: Normal in echogenicity without discrete noduleISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No discrete parathyroid lesions are identified.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No parathyroid adenoma identified.


Instruction: Generate impression based on medical findings.

Input: 89-year-old male with decreased appetite, abnormal LFTs, weight loss LIVER: Liver is normal in size and is mildly heterogeneously echogenic which may be due to irregular fatty infiltration. There is no focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: Gallbladder contains small amount of dependent sludge. No shadowing gallstones are identified. Although the gallbladder wall is mildly thickened, there is ascites associated and therefore the finding is not specific. Visualized portions of the biliary tract are normal in caliber.PANCREAS: Limited due to bowel gas. Body appears normal.SPLEEN: No significant abnormalities noted.KIDNEY: Right kidney is highly echogenic and small on limited views. Small right renal cyst. Limited views of the left kidney demonstrates likely mild increased echogenicity without hydronephrosis. Left kidney appears relatively small as well. OTHER: Mild ascites.

Output: Mildly heterogeneous increased liver echogenicity which may be due to fatty infiltration.Small amount of gallbladder sludge. Mild wall thickening associated with ascites. No stones.Highly echogenic right kidney and mildly echogenic left kidney. Both kidneys appear small.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: 17-year-old male patient with hematuria. BLADDER  Wall Thickness: Normal  Contents: Distended and normal. Distal Ureter -- SFU Grade**  Right: 0  Left: 0   Ureteral Jets Right: Not observed  Left: Observed.KIDNEYS  Cortical Echogenicity: Normal   Medullary Echogenicity: Normal   Pelvicaliceal System -- SFU Grade*  Right: 0 Left: 0  Length*** Right: 10.3 cm Left: 10.4 cm   Mean for age: 10.5 cm  Range for age: 10.0 - 11.1 cmADDITIONAL OBSERVATIONS: None.

Output: Normal examination.*SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning. **SFU grading system retrovesical ureter: Grade 0: No ureteral dilatation. Grade 1: Ureter less than 7 mm. Grade 2: Ureter is 7-10 mm. Grade 3: Ureter is over 10 mm. Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469


Instruction: Generate impression based on medical findings.

Input: 75-year-old female with postprandial discomfort. LIVER: No significant abnormalities noted.GALLBLADDER, BILIARY TRACT: Cholelithiasis and mild gallbladder wall thickening. Trace pericholecystic fluid. No sonographic Murphy's sign was elicited during the examination. There is no biliary ductal dilation.PANCREAS: No significant abnormalities noted.KIDNEY: 0.8 cm hypoechoic structure in the left kidney favored to represent a benign cyst however is incompletely visualized on this examination.OTHER: No significant abnormalities noted.

Output: 1. Cholelithiasis with associated findings described above are not specific for acute cholecystitis, however a chronic component of inflammation could account for this appearance. 2. 0.8 cm hypoechoic structure in the left kidney is favored to represent a benign cyst however is incompletely visualized on this examination. Continued attention to this region on subsequent studies is recommended.


Instruction: Generate impression based on medical findings.

Input: 49 year-old male with transaminase elevation and history of alcohol abuse. Evaluate for biliary distention or liver abnormality. LIVER: Increased echogenicity of the liver, suggestive of hepatic steatosis. The portal vein flow is hepatopetal. The liver contour is smooth.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted. The common duct measures 4 mm in diameter. No gallstones or common duct stones are seen.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.

Output: Increased echogenicity of the liver, suggestive of hepatic steatosis/parenchymal dysfunction. Otherwise, unremarkable ultrasound examination of the right upper quadrant.


Instruction: Generate impression based on medical findings.

Input: 56-year-old female with history of right breast asymmetry on screening mammography. No current breast complaints. Mammogram: Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density(BiRads Density Category B), unchanged in pattern and distribution. Again seen are two asymmetries in the right breast, one in the outer breast mid depth on the CC view, and one on the MLO view posterior depth. The asymmetry in the outer breast mid depth persists with spot compression views, possibly a benign intramammary lymph node. The asymmetry in the posterior breast disperses with spot compression.ULTRASOUND

Output: Benign appearing intramammary lymph node correlates with the outer breast asymmetry seen on the CC view on the prior screening study. The more posterior asymmetry disperses with spot compression and does not demonstrate a sonographic correlate, most likely representing superimposed glandular tissue. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male 70 years old Reason: BPH - H/O urinary retention, H/O urosepsis. Post-void residual. Please evaluate. The patient had voided immediately prior to the study. Distended images of the bladder were therefore not obtained. The residual urine within the bladder was measured at this time.RIGHT KIDNEY: The right kidney measures 12.3 cm. The renal cortex is normal in echogenicity. There is no hydronephrosis or shadowing renal stone.LEFT KIDNEY: The left kidney measures 12.6 cm. The renal cortex is normal in echogenicity. There is no hydronephrosis or shadowing renal stone. Previously identified renal cyst is poorly visualized today.BLADDER: The bladder is poorly distended.POSTVOID IMAGES: The residual urine was measured at 2.4 x 3.6 x 2.4 cm (volume is 7.8 mL).OTHER: The prostate gland is markedly enlarged measuring 4.2 x 4.7 x 5.0 cm.

Output: 1. No significant post void residual. 2. Prostatomegaly.


Instruction: Generate impression based on medical findings.

Input: 64-year-old female patient with abdominal pain, emesis. Question of cholecystitis. LIVER: The liver measures 16.0 cm in length and demonstrates increased, heterogeneous echogenicity. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: There is cholelithiasis without significant gallbladder wall thickening. Sonographic Murphy's sign is negative. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 4 mm in diameter.PANCREAS: The pancreas is not visualized on this examination.RIGHT KIDNEY: The right kidney measures 8.3 cm in length and demonstrates increased cortical echogenicity. No evidence of hydronephrosis. A right upper pole renal cyst measures 3.5 x 2.9 x 3.4 cm.OTHER: The left kidney measures 8.1 cm in length and demonstrates increased cortical echogenicity. No evidence of hydronephrosis. A left lower pole cyst measures 2.6 x 2.8 x 2.6 cm.The spleen measures 10.1 cm in length.There is mild ascites.

Output: 1. Coarsened, increased hepatic echogenicity likely related to chronic liver disease without focal hepatic lesion identified.2. Cholelithiasis without sonographic evidence of acute cholecystitis.3. Mild ascites.4. Medical renal disease and bilateral renal cysts.


Instruction: Generate impression based on medical findings.

Input: Check right thyroid nodule. Assess stability. RIGHT LOBE MEASUREMENTS: 3.4 x 1.3 x 1.3 cm.LEFT LOBE MEASUREMENTS: 3.9 x 1.3 x 0.8 cmISTHMUS MEASUREMENTS: 3 mmRIGHT LOBE: There is a 1.0 x 0.8 x 1.0 cm mildly hypoechoic, solid, interpolar nodule without increased vascularity or associated calcifications. The margins are well-defined. It appears stable. LEFT LOBE: The left thyroid lobe is mildly heterogeneous without a discrete nodule.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Morphologically unremarkable and normal sized bilateral cervical lymph nodes are present.OTHER: No significant abnormality noted.

Output: Stable right 1 cm solid nodule. No additional significant interval change.


Instruction: Generate impression based on medical findings.

Input: Acute kidney injury. Decreased urine output. LIVER: Cirrhotic liver morphology. Coarse parenchymal echogenicity. No focal hepatic lesions. Reversed portal venous blood flow direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Distended gallbladder with biliary sludge and some centimeter gallstones. No gallbladder wall thickening or sonographic Murphy's sign.PANCREAS: Obscured by bowel gas.KIDNEYS: The right kidney is 12.3 cm in length. The left kidney is 12.8 cm in length. The renal parenchyma is echogenic bilaterally. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 12.4 cm in length, without focal lesions evident.ABDOMINAL AORTA: Patent without aneurysm.INFERIOR VENA CAVA: Patent.OTHER: Moderate amount of ascites present.

Output: 1. Cirrhosis with reversed portal venous flow and moderate ascites.2. Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease.3. Cholelithiasis without specific evidence of cholecystitis.


Instruction: Generate impression based on medical findings.

Input: 22-year-old female with a left breast palpable mass for past 2 weeks. It is nontender. No family history of breast cancer. A targeted left ultrasound was performed for the palpable area of concern. On physical examination, a pea sized mobile nontender lump is palpated behind the left nipple. A simple cyst is identified behind the left nipple measuring 1.1 x 0.9 x 1 cm without peripheral blood flow. No suspicious solid mass noted.

Output: Palpable abnormality behind the left nipple corresponds to a simple cyst.No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on medical findings.

Input: Abnormal liver function tests. LIVER: Non-cirrhotic liver morphology. Mildly heterogeneous parenchymal echogenicity. 15 cm in length. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Contracted gallbladder, which limits visualization and evaluation. No sonographic Murphy's sign.PANCREAS: No sonographic abnormality evident in the visualized pancreatic head and neck. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney is 10.4 cm in length. The left kidney is 10.3 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 8.9 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites.

Output: Heterogeneous hepatic echogenicity, compatible with parenchymal dysfunction.


Instruction: Generate impression based on medical findings.

Input: Male; 49 years old. Reason: Patient with elevated creatinine, likely long standing CKD, rule out obstruction History: As above RIGHT KIDNEY: The right kidney measures 14.1 cm in length. The renal parenchyma is echogenic. There is no shadowing renal stone or hydronephrosis.LEFT KIDNEY: The left kidney measures 14.0 cm in length. The renal parenchyma is echogenic. In the lower pole there is a focal, hypoechoic tubular structure without vascularity. There is no hydronephrosis or shadowing renal stoneBLADDER: The bladder is nondistended. Bilateral ureteral jets are identified.

Output: 1.Bilateral echogenic kidneys compatible with medical renal disease.2.Focal, hypoechoic tubular structure in the lower pole of left kidney likely represents a small dilated calix. No hydronephrosis bilaterally.