Instruction: Generate impression based on medical findings.

Input: Female 57 years old Reason: evaluate source of RUQ tenderness History: RUQ tenderness LIMITED ABDOMENLIVER: Normal parenchymal echogenicity. No focal hepatic lesions.BILIARY TRACT: No ductal dilatation. Status post cholecystectomy.PANCREAS: Visualized portions are unremarkable.KIDNEYS: The right kidney measures 10 cm. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 10 cm. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 10 cm. in length. OTHER: No significant abnormalities noted.

Output: 1.No sonographic identifiable cause patient's right upper quadrant tenderness.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old. Reason: anuria, hx of renal tx in 2006 with abd pain. History: abd pain RENAL TRANSPLANT:LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No perinephric fluid collection.KIDNEY: Transplant kidney measures 11.1 cm in length with normal cortical echogenicity. Multiple simple renal cysts are present. Largest cyst measures 1.3 x 1.2 x 1.4 cm. No significant hydronephrosis, mass, or shadowing calculi.  COLLECTING SYSTEM/URETER: No significant abnormality notedURINARY BLADDER: Foley catheter in place within a decompressed urinary bladder.VASCULAR DOPPLER DATA: Limited color and spectral Doppler were performed on inflow and outflow vessels. Renal vessels are patent. OTHER: No significant abnormality noted

Output: No significant hydronephrosis or perinephric collection. Renal vessels are patent.


Instruction: Generate impression based on medical findings.

Input: Male 82 years old Reason: r/o hydronephrosis History: AKI RIGHT KIDNEY: The right kidney measures 11.4 cm. Mildly increased renal cortical echogenicity. No shadowing calculi or hydronephrosis is present. No perinephric free fluid. LEFT KIDNEY: The left kidney measures 12.4 cm. Renal cysts seen including septated upper pole one measuring up to 1.4 cm and additional mid pole cyst measuring up to 1.2 cm. Mildly increased renal cortical echogenicity. No shadowing calculi or hydronephrosis is present. No perinephric free fluid. BLADDER: OTHER: No significant abnormalities noted.

Output: Mildly increased renal cortical echogenicity, likely reflecting medical renal disease.Left-sided renal cysts as above.


Instruction: Generate impression based on medical findings.

Input: Female 65 years old Reason: r/o adenopathy. any growth of lesions? History: h/o thyroid cancer RIGHT LOBE MEASUREMENTS: Status post thyroidectomy. Two hypoechoic nodules are again seen in the right thyroid bed, one measuring 0.4 x 0.2 x 0.2 cm and the other measuring 0.4 x 0.2 x 0.2 cm. These appear slightly decreased in size compared to prior examination.LEFT LOBE MEASUREMENTS: Status post thyroidectomyISTHMUS MEASUREMENTS: Status post thyroidectomyRIGHT LOBE: Status post thyroidectomyLEFT LOBE: Status post thyroidectomyISTHMUS: Status post thyroidectomyPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy noted.OTHER: No significant abnormality noted.

Output: Patient status post thyroidectomy. Hypoechoic nodules in the right thyroid bed slightly decreased in size.


Instruction: Generate impression based on medical findings.

Input: 53-year-old male with AKI and decreased urine output. Reason: Evaluate for obstruction RIGHT KIDNEY: The right kidney is enlarged and measures 15.9 cm. The parenchyma is replaced by innumerable cysts, the largest of which measures 2.7 x 2.8 x 2.6 cm. No evidence of hydronephrosis or hydroureter. No shadowing calculi or hydronephrosis is present.LEFT KIDNEY: The left kidney is enlarged and measures 14 cm. The parenchyma is replaced by innumerable cysts, the largest of which measures 2.4 x 2 x 2 cm. No evidence of hydronephrosis or hydroureter. No shadowing calculi or hydronephrosis is present.OTHER: Moderate ascites. Foley is noted in the urinary bladder.

Output: Bilaterally enlarged kidneys with parenchyma replaced by innumerable cysts. Findings are most compatible with polycystic kidney disease.


Instruction: Generate impression based on medical findings.

Input: Female 65 years old; Reason: evaluate for etiology of persistently elevated creatinine History: acute kidney injury RIGHT KIDNEY: The right kidney measures 11 cm in length. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 11 cm in length. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. OTHER: No significant abnormalities noted.

Output: 1.No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Female 66 years old; Reason: screen for HCC History: history of cirrhosis LIVER: Hepatic parenchyma demonstrates coarse heterogeneous echotexture. No focal hepatic lesions or masses. Scattered hepatic cysts, with the largest within the right hepatic lobe measuring 1.8 x 1.5 x 1.7 cm and cyst in left lobe measuring 1.3 x 1 x 1 cm, unchanged from the prior exam. Hepatic length measures 14.5 cm. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of 18.5 cm/s. GALLBLADDER/BILIARY TRACT: There has been interval increase in size of gallbladder polyp near the fundus, measuring 0.8 x 0.8 x 0.7 cm as compared to 0.5 x 0.5 x 0.5 cm on the prior exam. There is a new additional polyp in the gallbladder measuring 0.5 x 0.3 x 0.2 cm. The gallbladder wall is normal in thickness, measuring 2 mm. The common bile duct measures 5 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 11.9 cm and has a normal echotexture.KIDNEYS: Atrophic echogenic right kidney measures 6.3 cm. Right renal cyst measuring 2.1 x 2 x 2 cm, unchanged. Small echogenic atrophic left kidney measures 6 cm, with a left renal cyst measuring 1 x 0.8 x 0.8 cm unchanged as compared to the prior exam.OTHER: Mild ascites is noted in the upper quadrants.

Output: 1.Coarse heterogeneous hepatic echotexture consistent with cirrhosis. No focal hepatic lesions.2.Interval increase in size of previously noted gallbladder polyp, with a new additional gallbladder polyp identified.


Instruction: Generate impression based on medical findings.

Input: Female 85 years old Reason: abdominal pain and elevated LFTs History: as above LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 13 cm in length. The parenchyma is moderately echogenic . No focal hepatic lesions. Main portal vein is patent.BILIARY TRACT: The gallbladder has echogenic calculi with posterior acoustic shadowing. Wall measures 2 mm in thickness. Common duct measures 3 mm. PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 9.8 cm. The cortex is echogenic. Mild right pelvocaliectasis.. The left kidney measures 9.8 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 8.8 cm. in length. OTHER: No ascites

Output: 1.Cholelithiasis without sonographic findings of cholecystitis.2.Mild right renal pelvocaliectasis.


Instruction: Generate impression based on medical findings.

Input: Ms. Morgan is a 52-year-old woman with positive BRCA1, status post bilateral mastectomies, who presents today with palpable mass and tenderness in the left breast 11:00 position. Targeted sonographic evaluation of the left breast 11:00 position was performed. Within the surveyed region, there is diffusely increased echogenicity of the subcutaneous fat with irregular shadowing. There is a 3 x 3 x 4 mm hypoechoic focus in the left breast 11:00 position 8 cm from the nipple, which does not feature internal vascularity as assessed with color Doppler interrogation.

Output: There is a 3 x 3 x 4 mm hypoechoic focus in the left breast 11:00 position 8 cm from the nipple with indeterminate sonographic characteristics, for which ultrasound-guided biopsy is recommended. Findings and recommendation were discussed with the patient. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on medical findings.

Input: 57-year-old female presents with elevated liver enzymes and nausea. LIVER: The liver is mildly enlarged measuring 18.5 cm and has a coarsened appearance, which is nonspecific, but may be seen in diffuse hepatic dysfunction/fatty infiltration. Increased echogenicity of the liver suggestive of fatty infiltration.GALLBLADDER, BILIARY TRACT: Debris is present within the gallbladder. No gallbladder wall thickening or pericholecystic fluid is identified. Common bile duct is within normal limits. Positive sonographic Murphy's sign.PANCREAS: The visualized portions of the pancreas are unremarkable.RIGHT KIDNEY: The right kidney measures 10.8 cm. Hyperechoic right kidney suggestive of medical renal disease. No shadowing to suggest renal calculi. No hydronephrosis.LEFT KIDNEY: The left kidney measures 11.4 cm. There is poor visualization of the left kidney due to limited patient mobility. No obvious hydronephrosis.SPLEEN: Poor visualization of the spleen due to limited patient mobility, however, no gross abnormalities are identified.OTHER: Partially visualized right pleural effusion.

Output: 1. Debris/sludge in the gallbladder with a positive sonographic Murphy's sign. Common bile duct is within normal limits and there is no gallbladder wall thickening/pericholecystic fluid. Findings may represent early acute acalculus cholecystitis. If further imaging is clinically warranted, a HIDA scan may be considered.2. Echogenic right kidney suggestive of medical renal disease.3. Mild hepatomegaly with a coarsened hepatic appearance which is nonspecific, but may be seen in diffuse hepatic dysfunction/fatty infiltration.


Instruction: Generate impression based on medical findings.

Input: Male 38 years old Reason: eval for cholecystitis History: RUQ pain LIMITED ABDOMENLIVER: Coarse echotexture and increased echogenicity. Focal hypoechoic area surrounding the gallbladder likely fatty sparing.BILIARY TRACT: No biliary dilatation. Gallbladder is mildly compressed. No obvious stones or sludge. No pericholecystic fluid. No abnormal wall thickening.PANCREAS: Visualized portions are unremarkable.KIDNEYS: The right kidney measures 11 cm. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 11 cm. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 8 cm. in length. OTHER: No significant abnormalities noted.

Output: 1.Morphologic changes of the liver can be seen with nonspecific diffuse parenchymal liver disease/fatty infiltration. No sonographic signs of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male with a history of hepatitis C, hepatocellular carcinoma evaluation. LIVER: Mild increase in hepatic parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions. Hepatic length measures 16 cm. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of 19 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 2 mm. The common bile duct measures 4 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance. The pancreatic duct is within normal limits.SPLEEN: The spleen measures 8 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 11 cm and has normal vascular flow. The left kidney measures 11 cm and has normal vascular flow. No hydronephrosis.OTHER: Porta hepatis lymph node measuring 1.5 x 1 x 1.3 cm.

Output: Mild increase in hepatic parenchymal echogenicity with coarsened echotexture consistent with fatty liver/hepatic parenchymal dysfunction, likely due to patient's underlying hepatitis C. No hepatic mass or ductal dilatation identified.


Instruction: Generate impression based on medical findings.

Input: Male 68 years old with pain in discomfort and lipoma/mass in upper back Well circumscribed and mildly hypoechoic oblong mass measuring 5.0 x 1.7 cm without increased vascularity.

Output: Well circumscribed and non-vascular soft tissue mass with characteristics suggestive of a lipoma; however, the specificity of ultrasound to diagnose lipoma in this age group is diminished. If clinical management is justified MR can be considered for better characterization.


Instruction: Generate impression based on medical findings.

Input: AITD. Thyroid disorder, unspecified. RIGHT LOBE MEASUREMENTS: 4.1 x 1.4 x 1.4 cmLEFT LOBE MEASUREMENTS: 4.1 x 1.5 x 1.5 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Heterogeneous, with no discrete nodule identified. Increased vascularity.LEFT LOBE: Heterogeneous, with no discrete nodule identified. Increased vascularity.ISTHMUS: Heterogeneous, with no discrete nodule identified. Increased vascularity.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Heterogeneity of the thyroid with increased vascularity, compatible with thyroiditis. No suspicious nodule identified.


Instruction: Generate impression based on medical findings.

Input: Female 28 years old Reason: left thyroid nodule, s/p right thyroidectomy in 2010 History: pls assess for changes of left thyroid nodule RIGHT LOBE MEASUREMENTS: Not applicable.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 1.3 cm in AP, 2.1 cm in transverse, and 5.7 cm in length.ISTHMUS MEASUREMENTS: The isthmus measures 0.3 cm in thickness.RIGHT LOBE: Status post right thyroidectomy. Small amount of residual thyroid tissue is suspected in the surgical bed, however this is only appreciated in the transverse plane.LEFT LOBE: The left thyroid lobe has a predominantly homogeneous echotexture. In the anterior left upper pole, there is a 0.8 x 0.4 x 0.8 cm isoechoic nodule (likely colloid based on sonographic appearance and results of prior biopsy) in the same location as the prior biopsy. In the left interpolar region, there is a cystic region consisting of either a septated single cyst versus 2 adjacent cysts with internal ring down artifacts compatible with colloid. The combined measurement is 0.8 cm in length.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Normal-appearing level 2 lymph node on the left.OTHER: No significant abnormality noted.

Output: 1. Status post right partial thyroidectomy. Small amount of residual thyroid tissue is suspected in the surgical bed, however this is only appreciated in the transverse plane.2. Left thyroid lobe with a similar appearing nodule (previously biopsied and found to be a colloid nodule) in the mid to upper pole and 2 adjacent suspected colloid cysts versus a single septated colloid cyst.


Instruction: Generate impression based on medical findings.

Input: Female 82 years old Reason: 82 yo female with weight loss and LUQ pain. History: LUQ pain LIMITED ABDOMENEvaluation markedly limited due to poor breath holding and poor penetration.LIVER: The liver has a smooth contour. Liver measures 14.2 cm in length. The parenchyma is mildly coarse and echogenic. No focal lesion identified. The portal vein is patent with normal directional flow.BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 1 mm in thickness. The common bile duct measures 1 mm.PANCREAS: The pancreatic head and body are normal in appearance. The pancreatic tail is obscured by gas.KIDNEYS: The right kidney measures 6.0 cm. A hypoechoic lesion within the right upper pole measures 1.3 x 1.1 x 1.1 cm, not well visualized. The left kidney measures 8.0 cm. No hydronephrosis is identified.SPLEEN: The spleen measures 7.5 cm in length. OTHER: No significant abnormalities noted.

Output: 1.The kidneys are not well-visualized due to poor penetration. Left renal lesion identified on CT in 2006 is not well visualized. If there is clinical concern, cross-sectional imaging with pre and post contrast sequences using renal protocol should be obtained.2.Mildly coarse and echogenic liver, may represent nonspecific fatty infiltration/parenchymal dysfunction.


Instruction: Generate impression based on medical findings.

Input: Reason: Examine thyroid nodule History: history of thyroid nodule RIGHT LOBE MEASUREMENTS: 5.7 x 2.1 x 2.2 cm.LEFT LOBE MEASUREMENTS: 6.9 x 2.6 x 3 cm.ISTHMUS MEASUREMENTS: 0.5 cm.RIGHT LOBE: Heterogenous gland. Multiple mixed cystic and solid, spongiform nodules are noted within the right lobe. There are multiple echogenic foci with associated comment artifact noted within these nodules suggestive of colloid.LEFT LOBE: Heterogenous gland. Multiple mixed cystic and solid, spongiform nodules are noted within the left lobe. There are multiple echogenic foci with associated comment artifact noted within these nodules suggestive of colloid. ISTHMUS: There is a solitary mixed cystic and solid, spongiform nodule within the isthmus. There are multiple echogenic foci with associated comment artifact noted within this nodule suggestive of colloid.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No regional adenopathy.OTHER: No significant abnormality noted.

Output: 1. Heterogenous thyroid with multiple mixed cystic and solid, spongiform nodules. Given the presence of multiple echogenic foci with associated comment artifact noted within these nodules, favor benign colloid nodules. There is no regional adenopathy.


Instruction: Generate impression based on medical findings.

Input: Female 40 years old; Reason: eval for enlarging nodules History: sore throat, h/o thyroid cancer RIGHT LOBE MEASUREMENTS: Residual right thyroid lobe measures 2.0 x 1.3 x 1.3 cmLEFT LOBE MEASUREMENTS: Status post left thyroid lobe resection. ISTHMUS MEASUREMENT: Isthmus has been resected.RIGHT LOBE: Residual right thyroid lobe is lobular with nodules; The dominant solid nodule with a thin hypoechoic rim measures 9 x 8 x 10 mm. Previously, 7 x 8 x 10 mm.LEFT LOBE: Hypoechoic nodule in the left thyroid bed measures 3 x 3 mm.ISTHMUS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Slight increase in the size of the solid right thyroid lobe nodule.


Instruction: Generate impression based on medical findings.

Input: Female 55 years old Reason: AKI with decreased UOP; assess for obstruction History: as above Slightly limited exam due to patient body habitus and limited mobility.RIGHT KIDNEY: The right kidney measures 13.5 cm. No shadowing calculi or hydronephrosis is present. At the upper pole of the right kidney is an anechoic lesion with posterior acoustic enhancement compatible with simple renal cyst measures 1.8 x 1.1 x 1.5 cm.LEFT KIDNEY: The left kidney measures 12.6 cm. No shadowing calculi or hydronephrosis is present. BLADDER: Bladder is decompressed with Foley in place. No significant abnormalities identified within these limitations.OTHER: No significant abnormalities noted.

Output: No evidence of hydronephrosis or shadowing renal calculus.


Instruction: Generate impression based on medical findings.

Input: Female 44 years old; Reason: obstruction? History: Acute kidney injury. History of metastatic breast cancer. RIGHT KIDNEY: The right kidney measures 11.5 cm in length. The cortex is echogenic. No worrisome mass, shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 12.6 cm in length. The cortex is echogenic. No worrisome mass, shadowing calculi or hydronephrosis is present. URINARY BLADDER: No significant abnormality noted.OTHER: Bilateral pleural effusions.

Output: 1.No hydronephrosis or evidence of obstruction. Kidneys are echogenic compatible with medical renal disease.2.Bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for change in left thyroid nodule history of tonsillar radiation as a child History: left thyroid nodule, follow RIGHT LOBE MEASUREMENTS: 5.9 x 4.8 x 1.6 cm.LEFT LOBE MEASUREMENTS: 5.3 x 2.1 x 2 cm.ISTHMUS MEASUREMENTS: 0.3 cm.RIGHT LOBE: Heterogenous gland. There is a small 0.3 x 0.3 x 0.2 cm hypoechoic, well-circumscribed nodule within the inferior portion of the right lobe of the thyroid. Unchanged from prior exam.LEFT LOBE: Heterogenous gland. There is a heterogenous, primarily solid lesion with some spongiform features which measures 2.6 x 1.8 x 2 cm noted within the midportion of the left lobe of thyroid. This appears unchanged from prior exam. There is a hypoechoic, well-circumscribed lesion with scattered echogenic foci with associated comet tail artifacts noted within the inferior portion of the left lobe of the thyroid which measures 1.2 x 0.7 x 0.4 cm. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Dominant left, primarily solid mass with some spongiform features noted within the left lobe of the thyroid.


Instruction: Generate impression based on medical findings.

Input: Reason: stones History: stones ULTRASOUND KIDNEYSRIGHT KIDNEY: The right kidney measures 11.7 cm in length. Normal echogenicity. There are multiple nonobstructing stones noted within the right kidney. The largest measures 0.9 x 0.6 x 1.4 cm. There is no hydronephrosis. There is a complex cyst noted within the upper pole of the right kidney which measures 1.9 x 1.4 x 1.8 cm.LEFT KIDNEY: The left kidney measures 11.9 cm in length. Normal echogenicity. There is a complex cyst noted within the left kidney which measures 2.5 x 2.4 x 1.9 cm. There is no hydronephrosis.OTHER:The bladder is visualized and is nondistended. The renal jets are visualized bilaterally.

Output: 1. Bilateral complex renal cysts. Recommend further characterization with dedicated cross-sectional imaging.2. Multiple nonobstructing stones within the right kidney. There is no hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Female 83 years old; Reason: worsened ckd stage 3, evaluate for abnormalities History: ckd stage 3 RIGHT KIDNEY: The right kidney measures 8.8 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 8.6 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. Cyst in lower pole measures 3.2 cm.URINARY BLADDER: The bladder is emptyOTHER: There is a soft tissue hypoechoic nodule superior to the upper pole of the right kidney measuring 2.3 x 1.7 cm.

Output: 1.Echogenic renal cortices compatible with medical renal disease.2.2.3-cm nodule near the upper pole of the right kidney is suspicious for a small adrenal lesion. This most commonly represents an adrenal adenoma however, further investigation with a cross-sectional study can be performed to further evaluate and categorize the lesion.


Instruction: Generate impression based on medical findings.

Input: Male 59 years old Reason: heart transplant workup LIMITED ABDOMENLIVER: The liver has a smooth contour, it measures 15.8 cm in length. The parenchyma is normal in echotexture. No focal liver lesion is identified. The main portal vein is patent and demonstrates normal directional flow with a velocity of 2.3 m/s. BILIARY TRACT: The gallbladder contains layering sludge, the wall measures 2 mm in thickness. There is no pericholecystic fluid. Common duct measures 4 mm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 10.8 cm. The cortex is mildly echogenic. No shadowing calculi or hydronephrosis is present. The left kidney is not well seen, it measures 11.8 cm. The cortex is mild discogenic. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen is not well seen, it measures 8.7 cm in length. ABDOMINAL AORTA: The abdominal aorta was not well seen due to overlying bowel gas.INFERIOR VENA CAVA: The inferior vena cava was not well seen due to overlying bowel gas.OTHER: There is a small right pleural effusion with adjacent atelectatic lung. There is a small about of echogenic debris within the urinary bladder. The hepatic veins are prominent consistent with a history of right heart failure.

Output: 1.Echogenic renal parenchyma compatible with medical renal disease.2.Gallbladder sludge but no evidence of acute cholecystitis.3.The abdominal aorta and inferior vena cava were not well seen due to overlying bowel gas.


Instruction: Generate impression based on medical findings.

Input: Female 64 years old Reason: R/O HCC History: HCV, cirrhosis LIMITED ABDOMENLIVER: The liver measures 14.1 cm in length. The liver has a mildly nodular contour. The parenchyma is coarse and echogenic, slightly progressed compared to the prior study. No suspicious mass is identified. There is no ascites. The portal vein is patent and demonstrates hepatopetal flow with a peak velocity of 0.26 m/sec. BILIARY TRACT: Status post cholecystectomy. There is no gross biliary ductal dilatation. Echogenic foci parallel the expected course of the intrahepatic biliary tract. This was also present on the prior study. PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 10.6 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. In the superior pole there is a 1.6 x 1.4 x 1.8 cm simple appearing renal cyst.The left kidney measures 12.8 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 9.2 cm. in length.

Output: 1.Cirrhotic liver. No suspicious lesion is identified.2.Echogenic foci are again seen paralleling the expected course of the intrahepatic biliary tract. Given that this finding is not acute, this likely represents gas within the biliary tree secondary to an incompetent sphincter from prior procedure or passed stone. Vascular calcifications are considered less likely.3.Simple appearing right renal cyst.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old. Reason: L groin cyst History: L groin pain RIGHT TESTIS: Tubular ectasia of the rete testes. The right testis measures 4.0 x 2.5 x 1.8 cm. LEFT TESTIS: Tubular ectasia of the rete testes. The left testis measures 4.1 x 2.5 x 2.1 cm. RIGHT EPIDIDYMIS: Right epididymis measures 1.4 x 1.4 to 1.2 cm. There are multiple subcentimeter right epididymal cysts. The largest measures 0.7 x 0.5 x 0.8 cm which is not significantly changed compared to prior study.LEFT EPIDIDYMIS: Left epididymis measures 5.0 x 4.6 x 2.3 cm. There is marked interval increase in the large left epididymal cyst which measures 3.8 x 4.0 x 2.3 cm, previously 2.1 x 1.4 x 1.8 cm. OTHER: No significant abnormalities noted.

Output: Marked interval increase in the size of the left epididymal cyst. Alternatively a spermatocele could have a similar imaging appearance.


Instruction: Generate impression based on medical findings.

Input: Female 29 years old Reason: r/o gallbladder pathology History: abdominal pain LIMITED ABDOMENLIVER: Liver measures 16.1 cm in length. The parenchyma is normal in echotexture. Portal vein flow is hepatopedal and measures 0.2 to 0.3 m/s.BILIARY TRACT: The gallbladder contains small layering sludge. Wall measures 2 mm in thickness. No biliary duct dilatation, CBD normal in size, measuring 3 mm. PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 10.2 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 10.4 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 9.2 cm. in length.

Output: Small gallbladder sludge, no evidence of acute cholecystitis.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 40 years old Reason: cirrhosis, small lesion. please follow. History: same LIMITED ABDOMENLIVER: Cirrhotic morphology. No definite mass or ductal dilatation.BILIARY TRACT: Cholelithiasis without gallbladder wall thickening or pericholecystic fluid. No ductal dilatation. . PANCREAS: Visualized portions are unremarkable.KIDNEYS: The right kidney measures 12 cm. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. A cortical defect in the left kidney likely represents recent partial nephrectomy. The left kidney measures 12 cm without shadowing calculi or hydronephrosis. Normal echogenicity.SPLEEN: The spleen measures 15 cm. in length. OTHER: No significant abnormalities noted.

Output: 1.Cirrhosis with sequela of portal hypertension (splenomegaly)2.Cholelithiasis without sonographic signs of acute cholecystitis. No ascites.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with elevated LFT. Reason: Evaluate for cholecystitis. LIVER: The liver measures 19.7 cm in length. Echogenic liver parenchyma without focal lesion or ductal dilatation. Portal vein is patent with normal hepatopetal directional flow and peak velocity of 25.2 cm/s.GALLBLADDER, BILIARY TRACT: Sludge-filled gallbladder without acute inflammation or ductal dilatation. Negative sonographic Murphy's sign.PANCREAS: The pancreas is not well-visualized due to patient's midline incision.RIGHT KIDNEY: The right kidney measures 13.8 cm. The cortex is of normal echogenicity. No shadowing calculi or hydronephrosis is present.LEFT KIDNEY: The left kidney measures 14.4 cm. The cortex is of normal echogenicity. No shadowing calculi or hydronephrosis is present.SPLEEN: The spleen measures 9.9 cm.OTHER: No ascites.

Output: 1. Sludge-filled gallbladder without acute inflammation or ductal dilatation.2. Echogenic liver parenchyma consistent with fatty infiltration/parenchymal dysfunction without focal lesion or ductal dilatation.


Instruction: Generate impression based on medical findings.

Input: Male 55 years old Reason: assess for cirrhosis, elevated LFT, ?biliary obstruction History: assess for cirrhosis, elevated LFT LIMITED ABDOMENLIVER: Coarse hepatic parenchyma. Mildly increased echogenicity. Patent portal vein. No definite focal hepatic lesion. Negative sonographic Murphy's signBILIARY TRACT: No gallbladder wall thickening or pericholecystic fluid some low-level echoes suggestive of sludge.PANCREAS: Visualized portions are unremarkable.KIDNEYS: The right kidney measures 10 cm. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. Simple right renal cyst.The left kidney measures 12 cm. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 13 cm. in length. OTHER: No significant abnormalities noted.

Output: 1.No biliary obstruction. Gallbladder sludge without sonographic evidence of cholecystitis.2.Coarse echogenic hepatic parenchyma is nonspecific, can be seen in diffuse hepatic dysfunction/fatty infiltration. Mild splenomegaly which may be related to portal hypertension in the setting of cirrhosis.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluating nodule in right neck just anterior to the right jaw angle. LN vs. cystic lesion History: mobile, well circumscribed nodule in right neck, just anterior to right jaw angle. Present x 3 wks. No significant changes. No other LAN. No systemic sxs. Hypoechoic lesions with central echogenicity were noted throughout the right mandibular area, the largest measuring 2.0 x 1.2 cm. This was also seen on the left, but to a lesser extent, the largest submandibular lesion measuring 1.1 cm.

Output: Sonographic appearance favors enlarged submandibular lymph nodes, largest on the right, as above.


Instruction: Generate impression based on medical findings.

Input: Female 89 years old Reason: HCV cirrhosis evaluate for HCC History: HCV cirrhosis LIVER: The liver measures 16.0 cm in length and demonstrates coarsened parenchymal echogenicity and a nodular surface contour. No intrahepatic or extrahepatic biliary ductal dilatation is evident and no focal mass lesions are seen. The main portal vein is patent and demonstrates hepatopedal flow with a velocity of 0.2 m/s. GALLBLADDER, BILIARY TRACT: The patient is status post cholecystectomy.. The common duct measures 0.7 cm in diameter. PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 9.2 cm in length and demonstrates normal parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen. Unchanged anechoic lesion in the superior pole the right kidney measuring 2.8 x 2.9 x 2.6 cm compatible with a simple renal cyst.LEFT KIDNEY: The left kidney measures 10.0 cm in length and demonstrates normal parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.SPLEEN: The spleen measures 10.6 cm in length.OTHER: There is no evidence of ascites.

Output: Cirrhotic morphology of liver, but no focal mass lesions identified.


Instruction: Generate impression based on medical findings.

Input: Male 16 years old Reason: Hydronephrosis History: UTI, hematuriaSONOGRAM KIDNEYS AND BLADDER 8/10/2015 BLADDER  Wall Thickness: Normal  Contents: Distended and normal. Distal Ureter -- SFU Grade**  Right: 0  Left: 0   Ureteral Jets Right: Not observed  Left: Not observedKIDNEYS  Cortical Echogenicity: Normal   Medullary Echogenicity: Normal   Pelvicaliceal System -- SFU Grade*  Right: 0 Left: 0  Length*** Right: 9.7 cm Left: 11.4 cm   Mean for age: 10.5 cm  Range for age: 9 - 12 cmADDITIONAL OBSERVATIONS: Discrepancies in between kidney measurements from previous and current sonogram, may be related to technique.

Output: Normal echogenicity with no evidence of hydronephrosis.*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: Female 77 years old; patient with history of liver cirrhosis, screening for HCC. EXAM: US ABDOMEN LTD, 5/31/2016 8:31 AM LIVER: Again noted is nodular liver contour and coarse echotexture compatible with chronic liver disease. No focal hepatic lesions. Hepatic length measures 17.6 cm. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of 21.4 cm/s. GALLBLADDER/BILIARY TRACT: Status post cholecystectomy. The common bile duct measures 6 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 12.8 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. Thr right kidney measures 10.8 cm and has normal vascular flow. The left kidney measures 10.4 cm and has normal vascular flow. OTHER: No significant abnormality noted. No ascites identified.

Output: Cirrhotic liver with no suspicious focal hepatic lesions.


Instruction: Generate impression based on medical findings.

Input: LIVER: The liver is normal in echogenicity and echotexture. No focal hepatic lesions. Hepatic length measures 16.8 cm. The main portal vein is patent with normal hepatopetal flow with a velocity of 35 cm/s. GALLBLADDER/BILIARY TRACT: Sludge is present within the gallbladder with the wall measuring 2 mm. The common bile duct measures 3 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 12.2 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 13 cm with no hydronephrosis. The left kidney measures 13.5 cm with no hydronephrosis. OTHER: No ascites present.

Output: Gallbladder sludge without sonographic evidence of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Female 76 years old; Reason: Episodic epigastric discomfort. Exclude pancreaticobiliary lesions History: Episodic epigastric discomfort. Exclude pancreaticobiliary lesions LIVER: Mild increase in hepatic parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions. Hepatic length measures 11.9 cm. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of 37.9 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 3 mm. The common bile duct measures 3 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: The pancreatic head and proximal body are normal in echotexture with the tail obscured by bowel gas.SPLEEN: The spleen measures 6.9 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 8.0 cm and has normal vascular flow. The left kidney measures 9.1 cm and has normal vascular flow. OTHER: No significant abnormality noted.

Output: 1. Mild increase in hepatic parenchymal echogenicity with coarsened echotexture consistent with fatty liver/hepatic parenchymal dysfunction. No hepatic mass or ductal dilatation identified.2. Pancreatic head and proximal body are normal in echotexture with the tail obscured by bowel gas.


Instruction: Generate impression based on medical findings.

Input: Male 55 years old; Reason: eval renal perfusion History: s/p aortic dissection, elevated creatinine RIGHT KIDNEY: The right kidney measures 11 cm in length. The cortex is slightly echogenic. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 10 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. OTHER: The urinary bladder is decompressed with a Foley catheter. Right pleural effusion.

Output: 1.Increased echogenicity of the kidneys can be seen in nonspecific medical renal disease. No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Female 76 years old; Reason: evaluate for renal recurrence or metastasis History: hx of renal cell carcinoma, sp partial nephrectomy RIGHT KIDNEY: The right kidney measures 5.9 cm in length. The cortex is mild echogenic. Mild right hydronephrosis. There are postsurgical changes in the right kidney with an echogenic focus likely representing postsurgical material. No perinephric fluid collections. No definite recurrent disease. LEFT KIDNEY: The left kidney measures 8.5 cm in length. The cortex is mild echogenic. No shadowing calculi or hydronephrosis is present. OTHER: No significant abnormalities noted.

Output: 1.Status post partial right nephrectomy with mild right hydronephrosis. No specific evidence for recurrent or residual disease.


Instruction: Generate impression based on medical findings.

Input: Reason: off immunosuppression RENAL TRANSPLANT: Right iliac fossaLOCATION: As abovePERITRANSPLANT TISSUES: No peritransplant fluid collections.KIDNEY: The right renal transplant kidney measures 10 cm. There is a 2 cm prominently anechoic cyst with thin septation. Mild hydronephrosis.COLLECTING SYSTEM/URETER: No significant abnormality notedURINARY BLADDER: Foley catheter in a partially decompressed urinary bladder, limiting evaluation. No gross abnormality.VASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels. Mildly elevated resistive indices at anastamosis, but intrarenal RI are normal. Additionally, the ratio of velocity between the iliac artery and at the anastamosis is appropriate. Otherwise patent renal vasculature.OTHER: No significant abnormality noted

Output: Mild hydronephrosis of a right renal transplant kidney. No peritransplant fluid collections. Patent renal transplant vasculature as above.


Instruction: Generate impression based on medical findings.

Input: Male 78 years old Reason: Renal failure History: As above RIGHT KIDNEY: The right kidney measures 11.0 cm in length and demonstrates slightly increased parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.LEFT KIDNEY: The left kidney measures 10.2 cm in length and demonstrates slightly increased parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.BLADDER: No significant abnormality noted.OTHER: No significant abnormalities noted.

Output: Slightly increased renal parenchymal echogenicity may reflect medical renal disease, but there is no evidence of hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Female 65 years old; Reason: AKI on CKD, history of nephrolithiasis with left ureteral obstruction 3/2015 History: AKI on CKD, history of obstructing renal calculi, s/p partial R nephrectomy RIGHT KIDNEY: The right kidney measures 10.9 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 12.5 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. URINARY BLADDER: No significant abnormality notedOTHER: No significant abnormalities noted.

Output: 1.No sonographic findings of nephrolithiasis or hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male with new elevation in LFTs and known ischemic cardiomyopathy, evaluate. LIVER: Increase in hepatic parenchymal echogenicity with coarsened echotexture and mildly nodular contour. No focal hepatic lesions. Hepatic length measures 15.1 cm. The main portal vein is patent with normal hepatopetal flow with a velocity of 28.4 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 2 mm. Cholelithiasis without acute cholecystitis is identified. The common bile duct measures 3.6 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 11.6 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 11.5 cm with no hydronephrosis. The left kidney measures 11.8 cm with no hydronephrosis. OTHER: No significant abnormality noted.

Output: 1.Increase in hepatic parenchymal echogenicity with coarsened echotexture and mildly nodular contour consistent with fatty liver/hepatic parenchymal dysfunction. No hepatic mass or ductal dilatation identified.2.Cholelithiasis without evidence of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Male 56 years old Reason: hemochromatosis, steatosis, cirrhosis History: hemochromatosis LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 17.7 cm in length. The parenchyma is severely echogenic. No suspicious hepatic lesions.Main portal vein is patent with normal directional flow.BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 2-mm in thickness. Common duct measures 3-mm. PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 11.8 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 12.2 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 10.4 cm. in length. OTHER: No ascites

Output: 1.Echogenic hepatic parenchyma possibly due to fatty infiltration. No definite focal hepatic lesion.


Instruction: Generate impression based on medical findings.

Input: Male 57 years old Reason: 57 y/o man w/ a hx of abdominal distention 2/2 liver cirrhosis History: 57 y/o man w/ a hx of abdominal distention 2/2 liver cirrhosis LIMITED ABDOMENLIVER: Cirrhotic morphology and echotexture. BILIARY TRACT: Sludge and stone filled gallbladder with no pericholecystic fluid or gallbladder wall thickening. No biliary dilatation.PANCREAS: Visualized portions are unremarkable.KIDNEYS: The right kidney measures 9 cm. The cortex is echogenic.. No shadowing calculi or hydronephrosis is present. The left kidney measures 9 cm. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 15 cm. in length. OTHER: Moderate to large amount of ascites.

Output: 1.Cholelithiasis without sonographic signs of acute cholecystitis.2.Cirrhosis with sequela of portal hypertension as above. Moderate ascites.3.Echogenic kidneys most compatible with nonspecific medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Female 48 years old Reason: early onset htn, hypertensive emergency, aki, concern for renal artery stenosis RIGHT KIDNEY: The right kidney measures 10.2 cm. Mildly increased renal cortical echogenicity. No shadowing calculi or hydronephrosis is present. Unable to assess for renal artery stenosis without Doppler spectral imaging.LEFT KIDNEY: The left kidney measures 10.4 cm. Mildly increased renal cortical echogenicity. No shadowing calculi or hydronephrosis is present. Unable to assess for renal artery stenosis without Doppler spectral imaging.BLADDER: Visualized bladder not well assessed secondary to underdistended state. OTHER: No significant abnormalities noted.

Output: Mildly increased renal cortical echogenicity, consistent with underlying medical renal disease.Unable to assess for renal artery stenosis without Doppler spectral imaging.


Instruction: Generate impression based on medical findings.

Input: Female 35 years old Reason: Concern for fatty liver in pregnancy History: Elevated LFTs LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 19.3 cm in length. The parenchyma is mildly coarse and echogenic. No suspicious hepatic lesion is identified.BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 2 mm in thickness. The common bile duct measures 3 mm. PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 12.8 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.The left kidney measures 13.3 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.SPLEEN: The spleen measures 12.8 cm in length. No splenic lesion is identified.OTHER: No significant abnormalities noted.

Output: Mildly coarse and echogenic liver, compatible with fatty infiltration/parenchymal disease. No other abnormality identified.


Instruction: Generate impression based on medical findings.

Input: 41 year-old female with neutropenic fever, signs of UTI and pyelonephritis on CT scan. Evaluate for hydronephrosis. Limited exam as patient is not able to hold breath and unable to lie in decubitus position.RIGHT KIDNEY: The right kidney measures 11.6 cm in length. The cortex is heterogeneous in echogenicity. No shadowing calculi or hydronephrosis is present.LEFT KIDNEY: The left kidney measures13.2 cm in length. The cortex is heterogeneous in echogenicity. No definite shadowing calculi or hydronephrosis is present.URINARY BLADDER: Nonvisualization of the bladder likely contracted which limits adequate evaluation. OTHER: Ascites. Incidentally noted mildly contracted gallbladder, which limits adequate evaluation.

Output: 1. Heterogeneous renal echogenicity suggestive of parenchymal dysfunction/pyelonephritis, which was better delineated on recent CT study. No hydronephrosis. 2. Ascites.


Instruction: Generate impression based on medical findings.

Input: Female 58 years old Reason: Evaluate for signs of cirrhosis History: New diagnosis of hepatitis C LIMITED ABDOMENLIVER: The liver measures 16.8 cm in length. The liver has a smooth contour. No focal hepatic lesion is identified. There is no ascites. The portal vein is patent and demonstrates hepatopetal flow with a peak velocity of 0.2 m/sec.BILIARY TRACT: The gallbladder has an anechoic lumen with a polypoid structure measuring 3 x 4 x 2 mm that is adherent to the wall. There is no gallbladder wall thickening or pericholecystic fluid. There is no intrahepatic biliary ductal dilatation. The common duct measures 5 mm. PANCREAS: The head and body of the pancreas are unremarkable. The tail is obscured by overlying bowel gas.KIDNEYS: The right kidney measures 10.6 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 10.8 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 8.6 cm. in length.

Output: 1.No evidence of cirrhosis. No focal hepatic lesion is identified.2.Small gallbladder polyp.


Instruction: Generate impression based on medical findings.

Input: Female 62 years old; Reason: Elevated Cr. Eval for hydronephrosis History: Elevated CR RIGHT KIDNEY: The right kidney measures 12.2 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 12.9 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present.  OTHER: Urinary bladder is only partially distended but unremarkable.

Output: 1.Echogenic renal cortices compatible with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: 72-year-old male presenting for preoperative examination before by our PEG placement. Please rule out ascites anterior to stomach. LIMITED ABDOMEN, ASCITES SEARCHNo evidence of ascites visualized within the abdomen.

Output: 1.No evidence of ascites.


Instruction: Generate impression based on medical findings.

Input: Male, 30 years old. Reason: R wrist mass ?vascular involvement History: R wrist mass, h/o bloody aspiration Sonographic images of the right wrist demonstrate a well-circumscribed, hypoechoic focus deep to the flexor tendons. There is a linear hyperechoic focus suggestive of a fatty hilum in the setting of a lymph node. The lesion measures 1.3 x 1.6 x 0.9 cm. No appreciable internal vascularity is present.

Output: Soft tissue mass in the right wrist deep to the tendons suspicious for a lymph node, however, given the size and location, a pre and postcontrast MRI of the wrist is recommended for further characterization.


Instruction: Generate impression based on medical findings.

Input: LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 13.7 cm in length. The parenchyma is normal in echotexture. Portal vein flow is hepatopetal.BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 2 mm in thickness. Common duct measures 2 mm.PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 9.3 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.The left kidney measures 9.2 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 9.7 cm. in length.OTHER: No significant abnormalities noted.

Output: Normal examination.


Instruction: Generate impression based on medical findings.

Input: Male 83 years old with ETOH cirrhosis, twice yearly screening for HCC LIVER: Mild increase in hepatic parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions. Hepatic length measures 11.7 cm. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of 22 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 2 mm. The common bile duct measures 5 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 6.9 cm and has a normal echotexture.RENAL TRANSPLANT: The transplant kidney has a normal corticomedullary differentiation and Doppler flow. Calcific focus within the renal pelvis is noted and measures 1.0 x 0.7 x 1.1 cm. No evidence of hydronephrosis.PERITRANSPLANT TISSUES: No perinephric fluid collections are noted.OTHER: No significant abnormality noted.

Output: 1. Mild increase in hepatic parenchymal echogenicity with coarsened echotexture consistent with chronic liver disease. No hepatic mass or ductal dilatation identified.2. Calcific focus within the pelvis of transplant kidney without evidence of hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 50-year-old female with elevated liver function tests LIVER: Echogenicity of the hepatic parenchyma is moderately increased. No hepatic mass. A simple hepatic cyst in the left lobe measures 1.3 x 0.8 x 0.9 cm. The liver measures 14.5 cm in length. The main portal vein is patent with normal hepatopedal flow and velocity of 38 cm/s.GALLBLADDER, BILIARY TRACT: The gallbladder contains a small amount of debris. There is no pericholecystic fluid. No cholelithiasis. The gallbladder wall is normal in appearance, measuring 0.1 cm in thickness. No dilatation or cystic changes are noted of the intrahepatic or extrahepatic biliary ducts. No choledocholithiasis.PANCREAS: The head and proximal body of the pancreas are normal. The tail is obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 10.3 cm in length and shows normal echotexture. No mass, stone or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.4 cm in length and shows normal echotexture. No mass, stone or hydronephrosis.SPLEEN: The spleen is normal in echogenicity and measures 1.4 cm in length. OTHER: There is no free or loculated fluid.

Output: Moderately increased echogenicity and coarse echotexture of the hepatic parenchyma, consistent with fatty liver/hepatic parenchymal dysfunction. No hepatic mass or ductal dilatation. A small simple hepatic cyst is seen in the left lobe of the liver.


Instruction: Generate impression based on medical findings.

Input: Thyroid cancer status post surgery and I-131 ablation RIGHT LOBE: Status post thyroidectomy.LEFT LOBE: Status post thyroidectomy. Ovoid focus in left bed measuring 6 x 5 x 4 mm with a peripheral/central echogenic focus visualized, overall appearance favors that of a benign lymph node with fatty hilum.ISTHMUS: Status post thyroidectomy.LYMPH NODES: Left-sided level 4 lymph node with increased vascularity, measures 11 x 5 x 5 mm, of uncertain clinical significance. Additional prominent lymph nodes with fatty hila, favoring benignity.OTHER: No significant abnormality noted.

Output: No definitive evidence of local tumor recurrence or metastatic disease, please refer to discussion above.


Instruction: Generate impression based on medical findings.

Input: Male 43 years old; Reason: right nodule History: right nodule RIGHT LOBE MEASUREMENTS: 3.7 x 2.2 x 3.2 cmLEFT LOBE MEASUREMENTS: 6.9 x 4.0 x 2.9 cmISTHMUS MEASUREMENT: 0.3 cmRIGHT LOBE: Right thyroid lobe is heterogeneous. There is a hypoechoic mostly solid nodule involving the inferior pole of the right lobe that measures 1.6 x 2.0 cm. There are multiple other smaller nodules.LEFT LOBE: Left thyroid lobe is heterogeneous. There are innumerable tiny subcentimeter cystic and solid nodules.ISTHMUS: No significant abnormality noted.LYMPH NODES: Small perivascular lymph nodes with benign morphology.OTHER: No significant abnormality noted.

Output: 1.Multinodular goiter.


Instruction: Generate impression based on medical findings.

Input: Reason: CKD, has not been evaluated History: CKD RIGHT KIDNEY: Right kidney measures 10.7 cm. No hydronephrosis. Echogenic parenchyma.LEFT KIDNEY: The left kidney measures 10.8 cm. No hydronephrosis. Echogenic renal parenchyma.OTHER: Bladder is unremarkable.

Output: Echogenic kidneys are nonspecific, but can be seen in medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old. Reason: Evaluate for hydronephrosis. History: Elevated creatinine RIGHT KIDNEY: Right kidney measures 12.8 cm in length with mildly increased cortical echogenicity. No hydronephrosis, shadowing calculi, or suspicious mass.LEFT KIDNEY: Left kidney measures 14.1 cm in length with mildly increased cortical echogenicity. No hydronephrosis, shadowing calculi, or suspicious mass.URINARY BLADDER: Urinary bladder is distended without significant abnormality noted.OTHER: No significant abnormality noted.

Output: Mildly echogenic cortical parenchyma bilaterally suggests medical renal disease/parenchymal dysfunction. No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Female 79 years old Reason: 79 y.o f, w hx of urinary retention (self caths at home) admitted for hyponatremia who is been complaining of left flank pain. UA on admission was negative, would like to r/o hydronephrosis. History: left flank pain RIGHT KIDNEY: The right kidney measures 11.4 cm. Right renal cyst measuring 4.1 x 3.5 x 3.4, adjacent cluster of smaller cysts also seen, not as well assessed due to smaller size. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 11 cm. Upper pole cyst measuring 1.9 x 1.8 x 1.6 cm. No shadowing calculi or hydronephrosis is present. BLADDER: Foley catheter in underdistended bladder.OTHER: No significant abnormalities noted.

Output: Renal cysts as above.


Instruction: Generate impression based on medical findings.

Input: Reason: worsening AKI History: uptrending creatinine RIGHT KIDNEY: No hydronephrosis. Normal cortical echogenicity. Right kidney measures 14.6 cm.LEFT KIDNEY: No hydronephrosis. Normal cortical echogenicity. Left kidney measures 14.3 cm.OTHER: Bladder is unremarkable.

Output: No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Reason: eval biliary esp for ductal dilation History: RUQ pain LIVER: The liver is enlarged, measuring 21 cm in length. Increased echogenicity. No focal lesions. No intrahepatic ductal dilation.GALLBLADDER, BILIARY TRACT: No cholelithiasis nor sludge within the gallbladder. The gallbladder wall is not thickened, measuring 0.2 cm. The common hepatic duct is not dilated, measuring 0.5 cm. The common bile duct is not dilated, measuring 0.4 cm.PANCREAS: The visualized portions of the pancreas reveal no significant abnormality.KIDNEYS: The right kidney measures 12.3 cm in length. No focal lesions. Normal echogenicity. No hydronephrosis. The left kidney measures 13.4 cm in length. No focal lesions. Normal echogenicity. No hydronephrosis.SPLEEN: The spleen is not enlarged, measuring 11.8 cm in length. No focal lesions. Normal echogenicity.OTHER: The main portal vein is patent with a normal waveform and hepatopetal flow. The velocity measures 0.3 m/s.

Output: 1. There is no evidence of intra nor extrahepatic ductal dilation.2. Hepatomegaly with fatty infiltration. No focal lesions.


Instruction: Generate impression based on medical findings.

Input: Male 50 years old Reason: hx of 4 renal lesion, evaluate change in size and characteristics. hx of kidney cancer History: see above RIGHT KIDNEY: The right kidney measures 12 cm. Midpole mass increased in size measuring 3.2 x 2.9 x 2.9 cm, previously measured 2.5 x 2.4 x 2.2 cm. Heterogeneous avascular mildly echogenic midpole lesion essentially unchanged measuring 1.4 x 1.4 x 1.1 cm, previously measured 1.6 x 1.3 x 1.2 cm. Upper pole echogenic focus measuring 1.2 x 1 x 1 cm without significant change accounting for differences in technique, differential considerations include a small angiomyolipoma given degree of echogenicity. Additional cystic appearing lower pole focus seen on prior study not definitely seen currently. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: Left kidney measures 12 cm. Postsurgical changes related to partial left nephrectomy. Not as well seen on prior exam is a rounded soft tissue lesion measuring 2. 2 x 2 x 1.9 cm, minimal internal vascularity seen, lesion is located above and adjacent to postoperative site. No shadowing calculi or hydronephrosis is present. BLADDER: Bilateral ureteral jets seen.OTHER: No significant abnormalities noted.

Output: Increased size of largest right-sided renal lesion, measuring up to 3.2 cm; additional lesions as above.Findings suspicious for new left-sided renal lesion, located near site of partial nephrectomy.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male with history of cirrhosis. Reason: Evaluate for HCC. LIVER: The liver measures 15.1 cm in length. Coarse echogenic liver parenchyma with a nodular contour. There is an echogenic focus in the right hepatic lobe, likely representing a small calcification. Otherwise, there is no focal lesion or ductal dilatation.Portal vein is patent with normal hepatopetal directional flow and peak velocity of 0.2 m/s. GALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatation. Negative sonographic Murphy's sign.PANCREAS: The visualized pancreas is without significant abnormalities.RIGHT KIDNEY: The right kidney measures 11.5 cm. Echogenic renal parenchyma. No shadowing calculi or hydronephrosis is present.LEFT KIDNEY: The left kidney measures 12.5 cm. Echogenic renal parenchyma. Redemonstrated are multiple shadowing calculi in the mid to lower pole of the left kidney. There is no hydronephrosis. SPLEEN: The spleen measures 12.3 cm.OTHER: No ascites.

Output: 1. Cirrhotic liver morphology. There is an echogenic focus in the right hepatic lobe, likely representing a small calcification. Otherwise, there is no focal lesion or ductal dilatation.2. Cholelithiasis without acute inflammation or ductal dilatation.3. Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction.4. Redemonstrated, stable nonobstructive left renal stones in the mid to lower poles.


Instruction: Generate impression based on medical findings.

Input: Male 78 years old Reason: r/o hydronephrosis, pyelonephritis History: AKI Per ultrasound technologist patient combative and not able to change position.RIGHT KIDNEY: The right kidney measures proximally 10.1 cm. No shadowing calculi or hydronephrosis is present. Increased renal cortical echogenicity. No perinephric free fluid.LEFT KIDNEY: The left kidney measures approximately 10.9 cm. Small fullness of renal collecting system. Renal cysts and largest simple appearing and measuring 2.9 x 2.5 x 2.1 cm. No shadowing calculi present. Increased renal cortical echogenicity. No perinephric free fluid. BLADDER: Moderate to marked bladder distention, bulb of apparent Foley catheter not well visualized but possibly at periphery of bladder (see last two submitted cine loops). In addition small focal soft tissue echogenicity measuring 2.6 x 0.9 cm seen at right dependent aspect of bladder, no corresponding flow delineated and may reflect postprocedural blood products but follow-up to resolution or cystoscopy recommended to exclude underlying neoplasm.OTHER: No significant abnormalities noted.

Output: 1. Findings suspicious for Foley catheter malfunctioning with moderate to marked bladder distention seen. Bulb of apparent Foley catheter not well visualized but possibly at periphery of bladder (see last two submitted cine loops). In addition small focal soft tissue echogenicity measuring 2.6 x 0.9 cm seen at right dependent aspect of bladder, no corresponding flow delineated and may reflect postprocedural blood products but follow-up to resolution or cystoscopy recommended to exclude underlying neoplasm.2. Echogenic kidneys compatible with underlying medical renal disease. Small fullness of left renal collecting system.


Instruction: Generate impression based on medical findings.

Input: Female 79 years old Reason: evaluate for hydronephrosis or kidney disease History: new kidney impairment RIGHT KIDNEY: The right kidney measures 11.3 cm. No hydronephrosis is present. Cortex is thinned and mildly increased renal cortical echogenicity present. Bilateral nonobstructing intrarenal nephrolithiasis seen, measuring up to 6 mm on right side.LEFT KIDNEY: The left kidney measures 13.3 cm. No hydronephrosis is present. Cortex is thinned mildly increased renal cortical echogenicity present. Bilateral nonobstructing intrarenal nephrolithiasis seen, measuring up to 6 mm on left side.BLADDER: Underdistended but visualized portions unremarkable.

Output: Bilateral nonobstructing nephrolithiasis.Mildly increased renal cortical echogenicity, likely reflecting underlying medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Female 48 years old; Reason: RUQ pain, liver span 14 cm. Evaluate for nonalcoholic fatty liver disease or other liver etiology. LIVER: Mild increase in hepatic parenchymal echogenicity with heterogeneity in echotexture. No focal hepatic lesions. Hepatic length measures 16.2 cm. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of 25.8 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 2 mm. The common bile duct is not visualized. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 10.1 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. Thr right kidney measures 11.0 cm and has normal vascular flow. The left kidney measures 11.6 cm and has normal vascular flow. OTHER: No significant abnormality noted.

Output: Mild increase in hepatic parenchymal echogenicity and mild heterogeneity of echotexture consistent with fatty liver/hepatic parenchymal dysfunction.


Instruction: Generate impression based on medical findings.

Input: Female 68 years old Reason: Patient has new onset incontinence request renal ultrasound of bladder and post void residual, has CKD History: urine frequency Suboptimal exam secondary to patient's body habitus.RIGHT KIDNEY: The right kidney measures 10.4 cm. Thinned renal cortex. Subcentimeter simple cyst, measuring up to 9 mm. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 10.1 cm. Thinned renal cortex. Previously visualized subcentimeter echogenic focus in left renal cortex not well seen on current study. No shadowing calculi or hydronephrosis is present. BLADDER: Prevoid volume of 23 mL, no significant post void residual volume.OTHER: No significant abnormalities noted.

Output: Renocortical thinning. No hydronephrosis.No significant postvoid residual seen.


Instruction: Generate impression based on medical findings.

Input: 66-year-old man with history of acute kidney injury, eval renal parenchyma. RIGHT KIDNEY: The right kidney measures 9.9 cm in length and shows increased echogenicity. A complex cystic lesion in the lateral aspect of the upper pole of the right kidney measures 4.9 x 4.7 x 4.9 cm (previously 3.8 x 3.8 x 4.4 cm) and contains internal debris and septations, without internal calcification. A smaller hypoechoic round structure in the right mid pole kidney measures 1.5 x 1.4 x 1.6 cm and is most compatible with a simple renal cyst. Note shadowing calculi or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.7 cm in length and shows increased echogenicity. No mass, shadowing calculi or hydronephrosis.URINARY BLADDER: The urinary bladder is normal in appearance. Bilateral ureteral jets are visualized.OTHER: There is no free or loculated fluid.

Output: 1.A right upper pole renal cyst is increased in size and complexity when compared to the abdominal ultrasound dated 8/25/2015. Given the previous imaging appearance, internal hemorrhage or proteinaceous material is favored. Cross-sectional imaging is recommended to exclude the possibility of underlying neoplasm.2.Increased echogenicity of the renal parenchyma consistent with medical renal disease/parenchymal dysfunction without shadowing calculi or hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 30-year-old male with painful swelling of the left scrotum. RIGHT TESTIS: No significant abnormalities noted. No mass lesions noted.LEFT TESTIS: No significant abnormalities noted. No mass lesions noted.RIGHT EPIDIDYMIS: No significant abnormalities noted. No mass lesions noted.LEFT EPIDIDYMIS: No significant abnormalities noted. No mass lesions noted.DOPPLER

Output: Within the left extratesticular scrotum is an area that appears heterogeneously echogenic, consistent with cellulitis without discrete fluid collection.


Instruction: Generate impression based on medical findings.

Input: Female 28 years old Reason: eval for cholelithiasis History: abd pain, N/V LIVER: There is no intrahepatic biliary duct dilatation or focal mass lesion within the hepatic parenchyma. The main portal vein is patent and demonstrates hepatopedal flow, which is pulsatile.BILIARY TRACT: The common bile duct measures 2 mm in diameter.PANCREAS: The imaged portions of the head and proximal body are unremarkable.SPLEEN: The spleen measures 10.6 cm in length.RIGHT KIDNEY: The right kidney measures 10.1 cm in length without evidence of hydronephrosis. OTHER: No significant abnormalities noted.

Output: No specific sonographic findings to account for the patient's abdominal pain, nausea or vomiting.


Instruction: Generate impression based on medical findings.

Input: Left thigh pain and swelling Ovoid lesion, measuring 4.8 x 4 x 1.7 cm. Central echogenic area that appears isoechoic to adjacent fat with surrounding hypoechoic rim visualized. No drainable fluid collection.

Output: 4.8 cm left groin predominantly fatty lesion, differential considerations include prominent reactive lymph node or an encapsulated lipoma.


Instruction: Generate impression based on medical findings.

Input: Male 78 years old Reason: RUQ ultrasound to evaluate for gallstones and cholecystitis History: RUQ pain, history of gallstones LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 12 cm in length. The parenchyma is moderately echogenic . No suspicious hepatic lesions. Main portal vein is patent. Hepatic veins appear dilated.BILIARY TRACT: The gallbladder has echogenic calculi with posterior acoustic shadowing. Wall measures 8mm in thickness. There is no pericholecystic fluid . Common duct measures 4mm. PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 10.5 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. There is a cyst at the interpolar region.The left kidney measures 11.1 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. 3.8 cm cyst is noted at the upper pole. It has some minimal complexity.SPLEEN: The spleen measures 7.5 cm. in length. OTHER: Probable left pleural effusion and/or ascites.

Output: 1.Thickened gallbladder wall without gallbladder distention, or pericholecystic fluid. Imaging findings are most suggestive of gallbladder wall edema which can be seen as sequelae of heart disease, liver disease or hypoalbuminemia. Given that the patient has gallstones further imaging with HIDA scan can be obtained if clinically needed.


Instruction: Generate impression based on medical findings.

Input: Goiter RIGHT LOBE: Moderately heterogeneous echotexture. Lobe measures 6.2 x 5.2 x 3.5 cm. Mixed cystic/solid dominant nodule seen measuring 3.6 x 3.2 x 2.9 cm. Upper pole predominantly solid-appearing hypovascular nodule visualized, measuring 1.8 x 1.5 x 1.5 cm. No internal calcifications delineated in either of these right-sided nodules.LEFT LOBE: Mildly heterogeneous echotexture. Lobe measures 5.1 x 2.6 x 2.3 cm. Lower pole echogenic mixed cystic/solid but predominantly solid nodule seen that measures 1.9 x 1.4 x 1.3 cm. Additional mixed echogenicity nodule seen in mid pole, measuring 1.7 x 1.5 x 1.3 cm. Another 1.1 x 0.8 x 0.7 cm mixed echogenicity nodule seen in upper pole. No intralesional calcifications delineated within these left-sided nodules.ISTHMUS: Thickened, measuring 0.5 cm.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Bilateral thyroid nodules as above.


Instruction: Generate impression based on medical findings.

Input: Proteinuria. RIGHT KIDNEY: The right kidney is normal in size measuring 10.6 cm. The cortex appears mildly thinned and echogenic suggesting underlying parenchymal dysfunction. No focal mass lesion. No nephrolithiasis. No hydronephrosis.LEFT KIDNEY: The left kidney is normal in size measuring 11.2 cm in length. The cortex appears mildly thinned and echogenic suggesting underlying parenchymal dysfunction. No mass lesion is evident. No nephrolithiasis. No hydronephrosis.BLADDER: The bladder is collapsed limiting evaluation. No ureteral chest are identified.

Output: Thin echogenic renal cortex suggesting underlying parenchymal dysfunction. No focal lesion or hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Upper abdominal pain for one year, elevated indirect bilirubin, assess for splenomegaly, biliary abnormality LIVER: Liver measures 14.8 cm with normal echogenicity. Portal vein is patent with normal direction and velocity of 0.27 m/s. No suspicious hepatic mass is noted.BILIARY TRACT: Common bile duct measures 3 mm. Gallbladder wall measures 2 mm. No pericholecystic fluid collection. No gallstones noted.PANCREAS: Distal pancreas is obscured by overlying bowel gas. Visualized part is within normal limits.SPLEEN: Spleen measures 10.2 cm and is normal in echogenicity and configuration.KIDNEYS: Right kidney measures 11.5 cm with normal echogenicity and without hydronephrosis. Left kidney measures 11.2 cm with normal echogenicity and without hydronephrosis. No renal calculi identified. OTHER: No significant abnormalities noted.

Output: Normal examination.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old. Metastatic breast CA. Elevated bili and ALK. Evaluate for biliary obstruction. History: ams Limited examination as this study was terminated prematurely. The technologist was unable to complete the exam due to patient's refusal to be further evaluated. LIVER: Liver is enlarged measuring 19.9 cm in length. Liver is heterogeneous with innumerable, diffuse masses present consistent with metastatic disease. Ascites is again seen. Main portal vein is patent with a normal direction of flow.BILIARY TRACT: The common bile duct measures 5 mm. No biliary ductal dilatation. Gallbladder was not visualized.RIGHT KIDNEY: Right kidney measures 8.6 cm in length with normal cortical echogenicity. No hydronephrosis, shadowing calculi, or mass. Pancreas, spleen, and left kidney were not evaluated as this study was terminated prematurely.

Output: Limited examination as this study was terminated prematurely. Hepatomegaly with diffuse metastatic disease. No definite evidence of biliary ductal dilatation.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with history of alcohol use, concern for cirrhosis. LIVER: The liver is normal in echogenicity and echotexture. No focal hepatic lesions. Hepatic length measures 18 cm, upper limits of normal in size. The main portal vein is patent with normal hepatopetal flow with a velocity of 36 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 1.5 mm. The common bile duct measures 3.2 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 10.1 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 10.7 cm and demonstrates mild increased cortical echogenicity with no hydronephrosis. The left kidney measures 11.1 cm and demonstrates mild increased cortical echogenicity with no hydronephrosis. ABDOMINAL AORTA: The abdominal aorta is normal in size and waveform.INFERIOR VENA CAVA: The inferior vena cava is patent.OTHER: Trace intra-abdominal ascites is present.

Output: 1.Normal morphology and echotexture of the liver. No hepatic mass or ductal dilatation identified.2.Mild increase in cortical echogenicity of bilateral kidneys, compatible with medical renal disease.3.Trace ascites.


Instruction: Generate impression based on medical findings.

Input: Male 28 years old Reason: evaluate for stability of gallbladder polyp History: diagnosed gallbladder polyp last year LIVER: Liver measures 12.8 cm in length. The parenchyma is increased in echogenicity. No focal liver lesion delineated. Main portal vein patent with normal directional flow, velocity measures 20 cm/sec.BILIARY TRACT: Gallbladder unremarkable. No evidence of gallbladder polyp. No evidence of intraluminal mobile echogenic foci to suggest underlying cholelithiasis. No significant gallbladder distention, wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Not well seen in entirety due to overlying bowel gas. KIDNEYS: The right kidney measures 11 cm. The left kidney measures 12.3 cm. No hydronephrosis.SPLEEN: The spleen measures 8.1 cm. in length.

Output: No gallbladder polyp seen.Echogenic liver, likely reflecting underlying hepatic steatosis/parenchymal dysfunction.


Instruction: Generate impression based on medical findings.

Input: Female 44 years old; Reason: 44 yo s/p ex lap, ARF History: anuric Limited exam due to patient body habitus and patient condition.RIGHT KIDNEY: The right kidney is poorly visualized, it measures 11.9 cm in length. There is no gross hydronephrosis. LEFT KIDNEY: The left kidney is poorly visualized, it measures 11.1 cm in length. There is no gross hydronephrosis. URINARY BLADDER: The bladder is not visualized due to overlying wound packing.

Output: Limited exam, no gross hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Female 66 years old; with abdominal pain during meals, assess for evidence of cholelithiasis LIVER: Coarsened hepatic echotexture. No focal hepatic lesions. Hepatic length measures 14.6 cm. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of 22.5 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 3 mm. The common bile duct measures 2 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 10.8 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 11.1 cm and has normal vascular flow. Right upper pole anechoic lesion measures 0.9 x 1.1 x 1.2, not significantly changed from prior exam. The left kidney is difficult to visualize and measures approximately 11.9 cm. OTHER: No ascites.

Output: 1. No evidence of cholecystitis.2. Stable probable right renal cyst.


Instruction: Generate impression based on medical findings.

Input: Male 48 years old; Reason: assess for hydronephrosis, obstruction, inflammation - any causes of acute renal injury History: acute renal injury Exam is extremely limited due to restrained patient/patient movement during examination.RIGHT KIDNEY: The right kidney measures 11.9 cm in length and demonstrates increased echogenicity. No shadowing calculi or hydronephrosis is present. No masses noted.LEFT KIDNEY: The left kidney measures 12.8 cm in length and demonstrates increased echogenicity. No shadowing calculi or hydronephrosis is present. No masses noted.URINARY BLADDER: Foley catheter is noted within the bladder.OTHER: No significant abnormalities noted.

Output: Increased echogenicity of bilateral kidneys suggestive of medical renal disease without evidence of hydronephrosis or obstructing shadowing calculi.


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old. Reason: kidney stone. History: stone RIGHT KIDNEY: Right kidney measures 10.3 cm in length with normal cortical echogenicity. No hydronephrosis, shadowing calculi, or mass.LEFT KIDNEY: Left kidney measures 10.4 cm in length with normal cortical echogenicity. Resolution of previously seen mild left hydronephrosis. Two nonobstructing left lower pole calculi are present. The largest calculus measures up to 0.8 mm.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.

Output: Nonobstructing left lower pole renal calculi with resolution of previously seen mild left hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Female, 21 years old. Reason: LUQ tenderness eval for splenomegaly. History: LUQ tenderness SPLEEN: Spleen measures is normal in size and measures 11.2 cm in length. Splenic echotexture is normal.OTHER: Limited images of the left kidney are unremarkable.

Output: No evidence of splenomegaly.


Instruction: Generate impression based on medical findings.

Input: Reason: Significant change in nodules? History: Multinodular RIGHT LOBE MEASUREMENTS: 4.6 x 1.6 x 1.8 centimetersLEFT LOBE MEASUREMENTS: 3.8 x 1.6 x 1.4 centimetersISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Nodule 1: Grossly unchanged 0.5 x 0.5 x 0.5 cm mid right thyroid nodule is hypoechoic with peripheral calcification.Nodule 2: Grossly stable 0.5 x 0.5 x 0.5 cm inferior right thyroid is predominantly iso to hyperechoic and solid with no internal vascularity or microcalcifications.LEFT LOBE: Nodule 1: Calcified mid left thyroid nodule measuring 1.0 x 0.8 x 0.8 cm, unchanged.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Partially calcified right lateral neck level 2 nodule/possible lymph node measuring 0.5 cm may been seen on prior scan, but not definitively measured.OTHER: No significant abnormality noted.

Output: Grossly stable examination. Attention to a partially calcified right lateral neck lymph node on subsequent exams is suggested to ensure stability as above.


Instruction: Generate impression based on medical findings.

Input: Female 23 years old Reason: generalized abdominal pain, please eval for gallstones or biliary obstruction History: generalized abdominal pain LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 15 cm in length. The parenchyma is normal in echotexture . No focal hepatic lesions. Main portal vein is patent.BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 2 mm in thickness. Common duct measures 3 mm. PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 9.2 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 10.5 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 8.6 cm. in length. OTHER: No ascites.

Output: 1.No sonographic findings of cholelithiasis or cholecystitis.2.No hydronephrosis or nephrolithiasis.


Instruction: Generate impression based on medical findings.

Input: Male 45 years old Reason: Left groin fluid collection? History: Left groin fluid collection There is an approximately 10.6 x 3.8 x 4.9 cm ill-defined poorly organized fluid collection in the left upper thigh with edema of the surrounding subcutaneous soft tissues suggestive of an abscess..

Output: Ill-defined fluid collection in the left upper thigh suggestive of an abscess.


Instruction: Generate impression based on medical findings.

Input: Female, 18 years old. Reason: Bilateral renal ultrasound due to acute kidney injury. History: acute kidney injury. Pre-eclampsia, delivered 9/22 RIGHT KIDNEY: Right kidney measures 11.8 cm in length with mildly increased cortical echogenicity. Mild pelvocaliectasis likely related to the patient's postpartum state. No shadowing calculus or mass.LEFT KIDNEY: Left kidney measures 11.2 cm in length with mildly increased cortical echogenicity. Mild pelvocaliectasis likely related to the patient's postpartum state. No shadowing calculus or mass.URINARY BLADDER: Foley catheter in place within a collapsed gallbladder.OTHER: Trace free fluid.

Output: Echogenic renal parenchyma bilaterally suggests medical renal disease/parenchymal dysfunction. Mild bilateral pelvocaliectasis likely related to the patient's postpartum state.Findings discussed by telephone with Dr. Byrne at 2:15 PM on 9/23/2016.


Instruction: Generate impression based on medical findings.

Input: Female 64 years old Reason: Hepatitis c, HCC screening LIVER: Liver measures 14.4 cm in length. The parenchyma is heterogeneous and coarsened in echotexture and nodular contour present. No definite discrete liver lesion delineated. Main portal vein patent with normal directional flow, velocity somewhat diminutive, measuring 12 cm/sec. Recanalized umbilical vein present. BILIARY TRACT: Status post cholecystectomy. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Not well seen due to overlying bowel gas but visualized portions unremarkable. KIDNEYS: The right kidney measures 12.1 cm, right upper pole renal cyst, measuring 5 x 4.2 by 4.1 cm. The left kidney measures 11.2 cm. No hydronephrosis.SPLEEN: The spleen measures 12.5 cm. in length, splenic calcifications better seen on prior imaging.

Output: 1. Cirrhotic morphology of liver with heterogeneous/coarsened parenchyma and nodular contour seen, sequela of portal hypertension seen. No definite hepatic mass.


Instruction: Generate impression based on medical findings.

Input: 61-year-old female with acute renal failure RIGHT KIDNEY: The right kidney measures 13.7 cm in length and shows normal echotexture. No mass, shadowing calculi or hydronephrosis.LEFT KIDNEY: The left kidney measures 12.8 cm in length and shows normal echotexture. No mass, shadowing calculi or hydronephrosis.URINARY BLADDER: The urinary bladder is decompressed, limiting evaluation of the bladder wall. Foley balloon noted.OTHER: There is no free or loculated fluid. Heterogeneous appearance of the liver is noted, a nonspecific finding which can be seen in diffuse hepatic disease/fatty infiltration.

Output: 1.Normal examination of the kidneys. 2.Heterogeneous appearance of the liver is noted, a nonspecific finding which can be seen in diffuse hepatic disease/fatty infiltration.


Instruction: Generate impression based on medical findings.

Input: Male 26 years old Reason: right upper quadrant pain, history of hep B. History: RUQ abd pain LIVER: Liver measures 16.4 cm in length. The parenchyma demonstrates mildly coarsened echogenicity which is nonspecific but may reflect diffuse infiltrative disease. No focal lesion is identifiedMain portal vein is patent with hepatopedal flow.BILIARY TRACT: Gallbladder unremarkable. No significant gallbladder distention, wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 11.9 cm. The left kidney measures 12.4 cm. No evidence of hydronephrosis or shadowing renal calculus.SPLEEN: The spleen measures 12.6 cm. in length. OTHER: No significant abnormality noted.

Output: 1.Mildly coarsened echogenicity of liver parenchyma is nonspecific but may reflect diffuse infiltrative disease, such as fatty liver infiltration.2.No focal hepatic lesion.


Instruction: Generate impression based on medical findings.

Input: Female 53 years old with history of multiple thyroid nodules RIGHT LOBE MEASUREMENTS: 6.7 x 2.2 x 2.0 cmLEFT LOBE MEASUREMENTS: 4.8 x 1.8 x 1.5 cmISTHMUS MEASUREMENT: 0.9 cmRIGHT LOBE: Multiple cystic and part-solid nodules are noted.-Heterogeneous superior pole nodule measures 2.0 x 1.0 x 1.6 cm. Microcalcifications and increased vascularity present.-Heterogeneous mid pole nodule measures 1.2 x 0.9 x 1.0 cm. Possible microcalcifications and increased vascularity present.-Spongiform inferior pole nodule measures 2.1 x 1.3 x 2.0 cm. Possible microcalcifications and increased vascularity present. LEFT LOBE: Multiple cystic and part-solid nodules are noted.-Superior pole cyst with mural nodular component measures 1.1 x 0.6 x 0.8 cm. No increased vascularity or microcalcifications.-Heterogeneous mid pole nodule measures 1.4 x 0.9 x 1.1 cm. Possible microcalcifications. No increased vascularity.ISTHMUS: Hypoechoic nodule measures 0.7 x 0.8 x 0.6 cm.LYMPH NODES: Prominent and benign-appearing right level 3 lymph node measures 1.0 x 1.4 x 0.5 cm.OTHER: No significant abnormality noted.

Output: Multiple bilateral thyroid nodules, some of which are hypervascular and contain microcalcifications. These would be amenable to FNA if clinically desired.


Instruction: Generate impression based on medical findings.

Input: Female 39 years old Reason: patient with renal tx, AKI History: AKI TRANSPLANTED KIDNEY: Left iliac fossa transplanted kidney biopsy. Kidney measures 12.6 cm. No hydronephrosis. Visualized parenchymal perfusion within normal limits. Rounded polar hypoechoic lesion containing smaller echogenic focus with associated twinkle artifact, suggestive of calcification, seen. Cystic structure measures 1.3 x 1.2 x 1.2 cm. No evidence of hematoma on post biopsy imaging, two passes performed.BLADDER: Visualized bladder unremarkable.

Output: Left iliac fossa transplanted kidney with calcified cystic focus and ultrasound assistance provided for biopsy of the transplanted kidney by the nephrology service as above, correlation with procedural report recommended.


Instruction: Generate impression based on medical findings.

Input: Lack of active finger range of motion. Dynamic/static evaluation of the tendons for the index finger to evaluate possible tendon injury, what level the injury is, and if injured where the tendons have retracted. The patient sustained a gunshot wound to the hand in October 2015. Recent radiographs reveal bullet fragments in the soft tissues volar to the second and third metacarpals. A scar from prior surgery is noted just proximal to the palmar crease. The patient's index finger is held in slight flexion, and she has difficulty flexing and extending the finger.Within the palm of the hand proximal to the proximal palmar crease, superficial to the adductor pollicis, the flexor digitorum superficialis and flexor digitorum profundus tendons of the index finger are identified as separate structures and appear intact. At this level, poorly defined hypoechoic scar tissue is noted superficial to the tendons. Beneath the proximal palmar crease, the two tendons become indistinct and inseparable from one another with margins that are difficult to define due to surrounding hypoechoic tissue that presumably represents scarring. As this tendon/scar tissue mass courses distally it is obscured by artifact in the overlying volar soft tissues that likely corresponds to a bullet fragment on seen on recent radiographs. Just proximal to the location of the bullet fragment, the tendons appear to split in a manner corresponding to that seen on recent MRI examinations, with a poorly defined tendon fragment deviating laterally from its normal course; I cannot clearly define its endpoint, but I suspect it lies volar to the MCP joint. The tendons remain indistinguishable at the level of the MCP joint and base of the proximal phalanx with heterogeneous hypoechogenicity compatible with tearing. The flexor tendon apparatus assumes a relatively normal appearance at the level of the mid diaphysis of the proximal phalanx, and I believe that the insertions of the flexor digitorum superficialis and flexor digitorum profundus are intact.When the transducer is placed longitudinally volar to the second MCP joint, passive movement of the DIP and PIP joints fails to elicit normal gliding motion of the flexor tendons. Restricted gliding motion is noted when the transducer is placed more proximally along the palm and the is flexed at the MCP joint.

Output: Evaluation of the flexor tendon apparatus of the index finger between the palmar crease and second MCP joint is limited as the tendons become inseparable from one another amidst what I presume to be scar tissue. Overall, the study supports the findings seen on recent MRI exam, including disruption of the flexor digitorum profundus tendon volar to the metacarpal head/neck, as well as at least partial disruption of the superficialis tendon at the same location. The tendon injury appears confined to the area between the distal margin of the adductor pollicis and the base (or perhaps mid diaphysis) of the proximal phalanx. Although the tendons split and deviate radially in this region, I see no findings to indicate frank proximal retraction.


Instruction: Generate impression based on medical findings.

Input: Female 76 years old; Reason: renal insufficiency History: renal insufficiency RIGHT KIDNEY: The right kidney measures 13 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. Poor cortical medullary differentiation. Mildly complex cystic lesion in the right kidney with septations measuring 3.1 cm.LEFT KIDNEY: The left kidney measures 12 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. Poor cortical medullary differentiation. 2.3 cm inferior left renal cyst.URINARY BLADDER: No significant abnormalityOTHER: No significant abnormalities noted.

Output: 1.Significantly echogenic kidneys compatible with nonspecific medical renal disease. Attention to mildly complex right renal cystic lesion on subsequent imaging or further characterization with cross-sectional imaging is suggested.


Instruction: Generate impression based on medical findings.

Input: 73-year-old male with elevated creatinine status post renal transplant. Reason: Evaluate kidneys. Right iliac fossa transplant kidney demonstrates moderate hydronephrosis. No shadowing calculi or mass is identified. Bladder is nondistended.

Output: Moderate hydronephrosis of the right transplant kidney.


Instruction: Generate impression based on medical findings.

Input: Female 28 years old Reason: h/o elevated alkaline phosphatase, elevated ggt LIVER: Liver measures 16.6 cm in length. Multiple hepatic masses, heterogeneous and relatively hypoechoic in appearance, minimal internal vascularity. Submitted for reference is a right sided mass measuring 6.9 x 5.9 x 4.7 cm. There is a left-sided mass measuring 3.6 x 3.3 x 2.3 cm. Main portal vein patent with normal directional flow, velocity mildly decreased, measuring 10 cm/s. Background liver increased in echogenicity.BILIARY TRACT: Gallbladder unremarkable. No significant gallbladder distention, wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Not well seen in entirety particularly tail due to overlying bowel gas.KIDNEYS: The right kidney measures 12 cm. The left kidney measures 11 cm. No hydronephrosis.SPLEEN: The spleen measures 9.8 cm. in length. OTHER: No significant abnormality noted.

Output: Multiple hepatic masses. Per patient, prior outside imaging reportedly showed "a liver mass." Follow-up with contrast-enhanced MRI using Eovist/hepatobiliary agent recommended to exclude multifocal neoplastic process.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old. Reason: Patient has CKD request renal ultrasound for size and echogenicity. History: CKD RIGHT KIDNEY: Renal parenchyma is echogenic. The right kidney is small measuring 7.5 cm in length. No shadowing calculi or hydronephrosis. There are right renal cysts. The largest in the inferior pole measures 2.5 x 2.3 x 2.7 cm.LEFT KIDNEY: The renal parenchyma is echogenic. The left kidney measures 10.7 cm in length. There are left renal cysts. The largest in the mid pole measures 4.0 x 4.4 x 3.1 cm.OTHER: The urinary bladder is unremarkable.

Output: Bilateral echogenic renal parenchyma consistent with parenchymal dysfunction/medical renal disease.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: Female 65 years old Reason: kidney stone TRANSPLANTED KIDNEY: The kidney measures 12th cm. No shadowing calculi or hydronephrosis is present. No perinephric free fluid. Renal simple cyst measuring 2.3 x 1.8 x 1.7 cm. BLADDER: Underdistended making evaluation suboptimal.OTHER: No significant abnormalities noted.

Output: Evaluation of transplant kidney demonstrates no renal stone.