Instruction: Generate impression based on medical findings.

Input: Elevated LFTs LIVER: Coarse echogenic liver echotexture again noted without mass. Liver length 12.8 cm. Limited interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow.GALLBLADDER, BILIARY TRACT: Gallbladder not well visualized. No ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10 cm in length.OTHER: Left kidney 9.97 m in length. Spleen 12.2 cm in length. No ascites.

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


Instruction: Generate impression based on medical findings.

Input: Reason: nausea and vomiting, assess for gallstones LIVER: The liver measures 14.4 cm in length. The liver demonstrates increased parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.24 m/s.BILIARY TRACT: Cholelithiasis, shadowing from which obscures the posterior aspect of the gallbladder. No gallbladder wall thickening or pericholecystic fluid is visualized. The sonographic Murphy's sign is negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 2 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 10.0 cm in length. RIGHT KIDNEY: Kidney measures 11.1 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 11.4 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No significant abnormalities noted.

Output: 1.Cholelithiasis without sonographic evidence of acute cholecystitis or biliary ductal dilatation.2.Increased hepatic echogenicity raising the possibility of parenchymal dysfunction/fatty infiltration.


Instruction: Generate impression based on medical findings.

Input: 62 years old, Female, Reason: 62 yo female with history of mucinous cervical versus ovarian cancer, s/p chemotherapy, with single liver cyst on 1/5/15 CT A/P, further characterize liver lesion History: single liver cyst on 1/5/15 CT LIVER: The liver measures 14.2 cm in length. Echogenicity of the liver is within normal limits. Hyperechoic lesion measuring 1.3 x 1.8 x 1.5 cm which correlates to the lesion seen on most recent CT scan and likely represents a hemangioma given imaging characteristics on both studies. A small hepatic cyst is identified in the right hepatic lobe. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.2 m/s.BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. Small gallbladder polyp is identified measuring up to 0.3 cm. The sonographic Murphy's sign is negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 4 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 10.2 cm in length. RIGHT KIDNEY: Kidney measures 11.0 cm in length. Lower pole the right kidney is not identified due to overlying bowel gas. Normal echotexture. No hydronephrosis or shadowing calculus.LEFT KIDNEY: Kidney measures 11.8 cm in length. Normal echotexture. No hydronephrosis or shadowing calculus.OTHER: No significant abnormalities noted.

Output: 1.Hyperechoic lesion has imaging characteristics most compatible with a hemangioma.2.Very small gallbladder polyp.


Instruction: Generate impression based on medical findings.

Input: Thyroid carcinoma status post thyroidectomy RIGHT LOBE: Status post thyroidectomy without mass. Previously noted hypoechoic focus within the right thyroid bed not identified on the current examination.LEFT LOBE: Status post thyroidectomy. Stable stable hypoechoic left thyroid bed focus measuring 0.3 x 0.2 x 0.5 cm.ISTHMUS: Status post thyroidectomy without massPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing reactive mildly prominent left level 1 lymph nodes; favor benign reactive etiologyOTHER: No significant abnormality noted.

Output: Previously noted subcentimeter right thyroid bed hypoechoic focus not appreciated on current examination. Stable subcentimeter left thyroid bed hypoechoic focus. Benign-appearing reactive mildly enlarged left level 1 lymph nodes; favor benign reactive etiology. No worrisome regional adenopathy.


Instruction: Generate impression based on medical findings.

Input: Palpable mass in the lateral right breast. Personal history of Ewings sarcoma and acute lymphocytic leukemia. On physical examination, a 2 cm soft mobile palpable mass is present in the lateral right breast. A bilateral whole breast ultrasound was performed. At the 9 o'clock position of the right breast, 3 cm from the nipple, a 2.6 x 1.6 x 2.6 cm lobulated hypoechoic parallel mass is present with minimal internal vascularity. At the 6 o'clock position of the right breast, 2 cm from the nipple, a 1.2 x 0.9 x 1.5 cm lobulated hypoechoic mass is present with mild internal vascularity. No additional masses are present in either breast.

Output: Two similarly appearing masses in the right breast, one at 9 o'clock and one at 6 o'clock. Statistically, these are most likely fibroadenomata. However, given the patient's clinical history, referral to the breast clinic for possible FNA based on palpability is recommended. Results and recommendations were discussed with the patient. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: B - Surgical Consultation.


Instruction: Generate impression based on medical findings.

Input: Ms. Parker is a 17 year old female presenting with a nontender palpable lump in the left breast x1 month. Targeted left breast ultrasound was performed for the patient's area of concern.In the left breast 4:00 location, approximately 3 cm from the nipple, there is a macrolobulated hypoechoic mass identified measuring 2.9 x 1.7 x 2.6 cm. Moderate associated vascularity is present.

Output: High probability benign morphology mass of the left breast, likely representing a fibroadenoma. However, given the size and palpability, a surgical consultation is recommended at this time. All results and recommendations were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation.


Instruction: Generate impression based on medical findings.

Input: 57 year old female post thyroidectomy for thyroid cancer. Follow-up small focus left thyroid bed. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: No massesLEFT LOBE: No masses. There is identified small hypoechoic area no longer seen.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence for mass or abnormal lymph nodes.


Instruction: Generate impression based on medical findings.

Input: 34-year-old female with history of thyroid cancer status post thyroidectomy. RIGHT LOBE MEASUREMENTS: Status post thyroidectomyLEFT LOBE MEASUREMENTS: Status post thyroidectomyISTHMUS MEASUREMENTS: Status post thyroidectomyRIGHT LOBE: Punctate hypoechoic foci in the right thyroid bed without significant interval change.LEFT LOBE: Punctate hypoechoic foci in the left thyroid bed without significant interval change.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Subcentimeter lymph nodes without significant interval change. Hypoechoic structures measuring 1.5 cm on the right and 1.3 cm on the left time stamped 14:44 and 14:47 are unchanged compared to prior studies and consistent with submandibular glands as previously labeled. Additional imaging was performed in the supraclavicular and posterior cervical regions without evidence of lymphadenopathy.OTHER: No significant abnormality noted.

Output: No acute interval change in subcentimeter hypoechoic foci in the left and right thyroid bed. No new regional lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: 60-year-old female with history of right breast lumpectomy for breast cancer in 1996 followed by recurrence (ILC), in November 2009, underwent right breast mastectomy in January 2010 and left breast reduction surgery in November, 2014 in New Orleans. Patient presents to evaluate a physician palpated lump in the left breast and denies a mammogram, due to discomfort and pain associated with the compression. A targeted left breast ultrasound was performed for the palpable area of concern at 3 to 4:00 position. On physical Examination, a 2-cm lump is palpated. Ultrasound demonstrates a oval mixed echogenic area measuring 1.3 x 0.8 x 1 cm, corresponding to the palpable abnormality, most consistent with area of fat necrosis.

Output: Palpable abnormality in the left breast corresponds to area of fat necrosis. Surgical consultation is recommended. Patient is scheduled to see her plastic surgeon from New Orleans next week. No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, bialteral diagnostic mammogram is recommended, due in October 2014. Results and recommendations were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation.


Instruction: Generate impression based on medical findings.

Input: 84-year-old female with bilateral axillary lymphadenopathy presents for bilateral axillary ultrasound A targeted bilateral axillary ultrasound was performed. Multiple prominent right axillary lymph nodes noted, largest measuring 1.9 x 1.2 x 0.8 cm. An enlarged left axillary lymph node with abnormal morphology identified measuring 1.4 x 1.2 x 1.5 cm with nonhilar blood flow. Adjacent to it is a normal morphology lymph node.

Output: Abnormal left axillary lymph node for which ultrasound-guided core biopsy is recommended.Prominent right axillary lymph nodes with normal morphology.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on medical findings.

Input: 27 year old female patient with SBP. Evaluate ascites status post aspiration. There is mild to moderate ascites, decreased in comparison to recent CT accounting for differences in modality. There is splenomegaly and an accessory splenule.

Output: Decreased mild to moderate ascites.


Instruction: Generate impression based on medical findings.

Input: 45-year-old female with history of thyroid cancer status post surgery and radioablation. RIGHT LOBE MEASUREMENTS: Surgically absentLEFT LOBE MEASUREMENTS: Surgically absentISTHMUS MEASUREMENTS: Surgically absentRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Two hypoechoic lymph nodes are identified in the left supraclavicular area which were not seen on the prior examination. A palpable superficial node measures 0.6 x 0.6 x 0.3 cm. An additional slightly deeper node measures 0.6 x 0.4 x 0.3 cm. Other scattered bilateral cervical lymph nodes with overall benign morphologic features are without significant interval change.OTHER: No significant abnormality noted.

Output: 1. Two subcentimeter lymph nodes identified in the left supraclavicular region as described above, one of which is palpable, were not seen on the prior examination and are nonspecific but raise suspicion for nodal metastasis. 2. No evidence of recurrent disease in the thyroid bed or elsewhere in the neck.


Instruction: Generate impression based on medical findings.

Input: 65 years old, Male, Reason: evalaute for obstruction History: AKI RIGHT KIDNEY: Kidney measures 13.5 cm in length. Increased echogenicity of the right kidney consistent with medical renal disease. Right upper pole renal cyst measuring 2.4 x 2.6 by 2.1 cm. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 13.8 cm in length. Increased echogenicity of the left kidneys consistent with medical renal disease. No hydronephrosis, shadowing calculus or mass.Bladder: There is a Foley within the bladder.

Output: 1.No evidence of hydronephrosis as clinically questioned.2.Increased echogenicity of the kidneys bilaterally consistent with medical renal disease.3.Right upper pole simple appearing renal cyst.


Instruction: Generate impression based on medical findings.

Input: Acute kidney injury. Right thigh swelling; evaluate for bleeding into right thigh. RIGHT KIDNEY: 12.0 cm in length. Echogenic parenchyma, without hydronephrosis. No focal renal lesions or shadowing stones noted.LEFT KIDNEY: 10.2 cm in length. Echogenic parenchyma, without hydronephrosis. No focal renal lesions or shadowing stones noted.RIGHT THIGH

Output: 1. Echogenic renal parenchyma without hydronephrosis, compatible with medial renal disease.2. 5.7 cm hematoma in the right thigh, which does not appear to directly involve the external iliac/femoral artery and vein.


Instruction: Generate impression based on medical findings.

Input: Male 35 years old with left flank pain RIGHT KIDNEY: Right kidney measures 10.3 cm. Mild increased cortical echogenicity. No hydronephrosis, shadowing calculi, or mass.LEFT KIDNEY: Left kidney measures 11.1 cm. Mildly increased cortical echogenicity. No hydronephrosis, shadowing calculi, or mass. OTHER: Bladder is visualized, mildly distended, and normal in appearance.

Output: Mildly increased echogenicity of the kidneys is nonspecific but can be seen in the setting of medical renal disease. No hydronephrosis or shadowing calculus.


Instruction: Generate impression based on medical findings.

Input: 71 year-old female with NASH cirrhosis. Evaluate for HCC. LIVER: Cirrhotic liver morphology measuring 14.0 cm in length. No focal hepatic lesions. Portal vein is patent with appropriate hepatopetal flow; peak velocity measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. No intra or extrahepatic biliary ductal dilatation.PANCREAS: Visualized portions of the pancreas are unremarkable.RIGHT KIDNEY: The right kidney is not well assessed however hyperechoic focus again seen in expected region of mid to upper pole measuring 3.3 cm x 3.1 cm x 3.3 cm, not significantly changed. No definite hydronephrosis or shadowing calculi.OTHER: Left kidney is also not well assessed however it appears to be in the expected region. No definite hydronephrosis or shadowing calculi. The spleen measures 9.5 cm in length. Multiple echogenic foci are again seen the largest of which measures 1.5-cm x 1.8 cm x 1.5 cm.

Output: 1. Cirrhotic liver morphology with no focal lesion. 2. Hyperechoic foci in the right kidney and spleen are not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Male 51 years old Reason: Significant protrusion over left lower back - please eval soft tissue. Grayscale and color Doppler ultrasound in the region of the lung show no clear mass. No cystic areas. No areas of hypervascularity.

Output: No findings to explain mass. Possibility of lipoma could be evaluated with CT if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Male 52 years old Reason: lung transplant pre evaluation, eval for liver disease LIVER: Liver echogenicity is within normal limits. No focal hepatic mass. The liver measures 13.7 cm in length.BILIARY TRACT: Gallbladder is minimally contracted. No intra or extrahepatic biliary ductal dilatation. No gallstones are identified. PANCREAS: Pancreas is obscured by overlying bowel gas.SPLEEN: Spleen is normal in appearance.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Right kidney measures 12.4 cm. Left kidney measures 12.5 cm.ABDOMINAL AORTA: Normal abdominal aortic waveforms. Distal aorta measures 1.8 cm. Right iliac measures 1.1 cm in diameter. Left iliac measures 1.2 cm in diameter.INFERIOR VENA CAVA: Not well visualized secondary to overlying bowel gas.Bladder: Bladder is normal in appearance.

Output: Normal appearing sonogram the abdomen. No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Dense breast tissue, routine whole breast ultrasound A bilateral whole breast ultrasound was performed using Sonocine. There is no solid or cystic mass identified. Normal dense glandular tissue identified.Study was double read by Dr. Kulkarni and Dr. Sheth.

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


Instruction: Generate impression based on medical findings.

Input: History of gallbladder wall thickening seen on recent chest CT. LIVER: The liver measures 15.5 cm in length. The liver parenchymal echotexture is normal. Multiple small hepatic cystic lesions likely represent biliary hamartomas. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.18 m/s.BILIARY TRACT: The anterior gallbladder wall is thickened, diffusely echogenic, generates dense shadowing, and generates twinkle artifact. The gallbladder lumen and posterior wall are obscured. This appearance is most likely related to cholesterolosis of the gallbladder wall, however, cholelithiasis cannot be excluded. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 3 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 10.0 cm in length. RIGHT KIDNEY: Kidney measures 10.2 cm in length. Normal echotexture. No hydronephrosis. Small cyst.LEFT KIDNEY: Kidney measures 11.0 cm in length. Normal echotexture. Mild hydronephrosis, not clearly evident on recent chest CT (although kidney only partially visualized on chest CT). Multiple cysts, the largest of which demonstrates minimal internal complexity.OTHER: No significant abnormalities noted.

Output: 1.Findings suggestive of gallbladder cholesterolosis. Gallbladder lumen and posterior wall obscured, and cholelithiasis not excluded.2.Mild left hydronephrosis, possibly new.Findings discussed with Dr. Schwartz at 3:50 PM on 12/2/2016.


Instruction: Generate impression based on medical findings.

Input: Asymptomatic female with dense breasts presents for whole breast ultrasound for dense breast screening. 3-D whole breast ultrasound was performed for both breasts and images were reviewed on an independent workstation. A couple of subcentimeter benign morphology cyst identified in the right upper inner quadrant. There is no suspicious solid or cystic mass identified.This exam was double read by Dr. Abe.

Output: No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: Elevated bilirubin sepsis and abdominal pain LIVER:Coarse echogenic liver echotexture without mass. Liver length 18.7 cm.GALLBLADDER, BILIARY TRACT: Mild gallbladder wall thickening with trace pericholecystic fluid. Negative Murphy's sign. No ductal dilatation. Multiple nonmobile subcentimeter gallbladder wall foci.PANCREAS: No significant abnormality noted.SPLEEN: Spleen length is 18 cmKIDNEYS: No significant abnormality noted. Right kidney 12.6 cm in length. Left kidney 12 cm in length.ABDOMINAL AORTA: No significant abnormality noted.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No ascites

Output: Hepatosplenomegaly associated with coarse echogenic liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascitesMildly thickened gallbladder wall with trace pericholecystic fluid. Although there is no Murphy's sign, some element of inflammation is suspected.Nonmobile stones or gallbladder polyps.


Instruction: Generate impression based on medical findings.

Input: Right upper quadrant abdominal pain LIVER: No significant abnormalities noted. Liver length 17 cmBILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 17.2 cm in length RIGHT KIDNEY: No significant abnormalities noted. 12.3 cm in lengthOTHER: Left kidney 14.1 cm in length. No ascites.

Output: Cholelithiasis without acute inflammation or ductal dilatation. Mild splenomegaly. No ascites.


Instruction: Generate impression based on medical findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (9/24/15), ultrasound images of both breasts (9/24/15), images from ultrasound guided biopsy of left breast with specimen radiograph and postprocedural left mammographic images, and images from ultrasound guided right breast aspiration (9/24/15) performed at Rush University Medical Center. For comparison, digital mammographic images (9/11/14, 9/11/13, 3/1/10), ultrasound images (9/11/14, 1/27/14, 9/11/13) are available. DIGITAL MAMMOGRAPHIC IMAGES (9/24/15):The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. Multiple circumscribed masses are present in both breasts. Many of those masses are stable and benign. An oval mass at lower outer quadrant in the left breast shows interval increase in size. Multiple calcifications in both breast are unchanged. There are no suspicious findings in either breast on mammogram.ULTRASOUND IMAGES OF BOTH BREASTS (9/24/15):There are multiple simple cysts in the right breast. In the left breast, there is an irregularly shaped hypoechoic mass with angular margins at 6:30 position measuring 6 x 6 mm. A complicated cyst measuring 6 mm is seen at 4:00 position. In addition, there are multiple simple cysts in the left breast. A simple cyst at left 4:30 position likely corresponds to the developing circumscribed mass on left mammogram.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF LEFT BREAST WITH SPECIMEN RADIOGRAPH AND POSTPROCEDURAL LEFT MAMMOGRAPHIC IMAGES, AND IMAGES FROM ULTRASOUND GUIDED RIGHT BREAST ASPIRATION (9/24/15):An aspiration for the complicated cyst at 4:00 position in the right breast was performed. Complete resolution of the cyst was achieved. Core needle biopsy for the hypoechoic mass at 6:30 in the left breast was performed with appropriate needle placement. Radiograph of the specimen shows several pieces of solid tissue without calcifications. Postprocedural mammographic images show a marker clip located at lower inner quadrant in the left breast.Per outside pathology report, the result of the core biopsy of left breast was DCIS grade 3.

Output: Biopsy proven DCIS in the left breast. The lesion was occult on mammogram and was detected on ultrasound. Given complicated appearance of mammogram and dense breast tissue, breast MRI would be helpful to rule out any other occult disease.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: 50-year-old male patient status post kidney transplant with high creatinine. RENAL TRANSPLANT: LOCATION: Right iliac fossa.PERITRANSPLANT TISSUES: No perirenal fluid collection is identified.KIDNEY: The transplant kidney measures 11 cm in length.COLLECTING SYSTEM/URETER: No evidence of hydronephrosis.URINARY BLADDER: The urinary bladder is decompressed.VASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vesselsThe right internal iliac artery and vein are patent.The transplant renal artery anastomosis demonstrates peak systolic velocity 1.2 m/s with RI 0.86. Intrarenal resistive indices range from 0.65-0.83. There is redemonstration of an arteriovenous fistula within the lower pole. OTHER: No significant abnormality noted

Output: 1. No hydronephrosis.2. Redemonstration of a lower pole AV fistula; consultation with interventional radiology for embolization may be considered.


Instruction: Generate impression based on medical findings.

Input: Hepatitis C LIVER: Coarse echogenic liver echotexture again noted without mass. Liver length 15.6 cm. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow.BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 9 cm in length.RIGHT KIDNEY: No significant abnormalities noted. 9.6 cm in length.OTHER: Left kidney 9 cm in length. No ascites.

Output: Coarse echogenic liver echotexture again noted consistent with chronic liver disease without mass or ductal dilatation. No ascites.


Instruction: Generate impression based on medical findings.

Input: History kidney stone RIGHT KIDNEY: 1 x 0.8 x 0.9 cm echogenic focus with posterior shadowing consistent with nonobstructing stone. No hydronephrosis. No worrisome mass. Right kidney 12 cm in lengthLEFT KIDNEY: AbsentOTHER: Bladder nondistended

Output: 1 cm nonobstructing right renal stone. No hydronephrosis. No worrisome mass.


Instruction: Generate impression based on medical findings.

Input: Low back pain RIGHT KIDNEY: Normal echogenicity without mass, stone, or hydronephrosis. 10.3 cm in lengthLEFT KIDNEY: Normal echogenicity without mass, stone, or hydronephrosis. 10.8 cm in lengthOTHER: Bladder nondistended. Incidental note made of 1 x 1.1 x 1 cm well-circumscribed hyperechoic focus within the right lobe of the liver.

Output: Normal renal parenchyma without mass, stone, or hydronephrosis. Incidental note made of well-circumscribed hyperechoic focus within the right lobe of the liver; statistically most probably represents a benign hemangioma.


Instruction: Generate impression based on medical findings.

Input: Hepatitis C. Evaluate for HCC. History of cholecystectomy in October 2015. LIVER: 14.8 cm in length. Cirrhotic liver morphology with nodular contours and coarsened parenchymal echogenicity. Moderate perihepatic ascites. No focal hepatic lesions. Patent portal vein with hepatopetal blood flow measuring 15 cm/s.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Status post cholecystectomy. A 4 cm fluid collection with debris is noted in the gallbladder fossa.PANCREAS: No sonographic abnormality evident in the visualized pancreatic head and neck. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney is 11 cm in length. The left kidney is 11 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 12.1 cm in length, without focal lesions evident.

Output: 1. Cirrhotic liver morphology with moderate ascites. No suspicious hepatic lesions.2. 4 cm fluid collection in the gallbladder fossa, likely post-surgical in etiology.


Instruction: Generate impression based on medical findings.

Input: 64-year-old female status post renal transplant presents after trauma to transplant area. RENAL TRANSPLANT: LOCATION: Right iliac fossa.PERITRANSPLANT TISSUES: Very large complex anechoic area consistent measuring approximately 16.1 x 9.9 x 13.9 cm, although these measurements are imprecise given the large complex nature of the collection. No signs of active bleeding. KIDNEY: Measures approximately 11.6 cm. There is increased echogenicity. No hydronephrosis, shadowing calculi.COLLECTING SYSTEM/URETER: No significant abnormality notedURINARY BLADDER: The bladder is nondistended.OTHER: No significant abnormality noted

Output: 1. Very large, complex fluid collection is consistent with a hematoma. No active signs of bleeding. No hydronephrosis.2. Increased echogenicity of renal transplant consistent with medical renal disease/parenchymal dysfunction. No hydronephrosis


Instruction: Generate impression based on medical findings.

Input: Female 49 years old; Reason: RUQ pain, cholecysitis vs. gallstone History: ruq pain The gallbladder wall measures 3.1 mm. An echogenic shadowing foci seen within the gallbladder fundus. This was also visualized on prior CT within the distal fundal fold. No pericholecystic fluid is seen. The common bile duct measures 3.0 mm in diameter. The portal vein is patent with hepatopetal flow. The liver is only partially visualized however no worrisome masses or intrahepatic ductal dilation are seen.

Output: Small echogenic foci within the gallbladder fundus either represents a small gallstone or milk of calcium. This was seen on prior CT. No sonographic evidence of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Right-sided abdominal pain LIVER: No significant abnormalities noted. Liver length 15.9 cm GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.7 cm in lengthOTHER: Left kidney 9.3 cm in length. Spleen 10.5 cm in length. No ascites

Output: Negative right upper quadrant ultrasound. No acute hepatobiliary abnormality.


Instruction: Generate impression based on medical findings.

Input: Hepatitis B LIVER: Coarse echogenic liver echotexture without mass. Liver length 15.3 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.8 cm in length.OTHER: Left kidney 11.6 cm in length. Spleen 9.8 cm in length. No ascites.

Output: Coarse liver echotexture consistent with chronic liver disease without mass or ductal dilatation. No ascites.


Instruction: Generate impression based on medical findings.

Input: 27 years old, Female, Reason: goiter History: goiter RIGHT LOBE MEASUREMENTS: 4.3 x 1 1.7 x 1.6 cmLEFT LOBE MEASUREMENTS: 4.4 x 1.6 x 1.7 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: The right thyroid lobe is diffusely heterogeneous without nodules.LEFT LOBE: The left thyroid lobe is diffusely heterogeneous without nodules.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Diffusely heterogeneous thyroid which can be seen in chronic thyroiditis.


Instruction: Generate impression based on medical findings.

Input: Male; 37 years old. History of a remote right inguinal hernia repair now with pain. Scanning of the bilateral inguinal area reveals no evidence of hernia at rest or with Valsalva maneuver, no hematoma/fluid collection.

Output: No evidence of hernia or fluid collection/hematoma.


Instruction: Generate impression based on medical findings.

Input: Ms. Gaevskiy is a 44-year-old female with history of palpable right breast lesions, previously worked up with mammogram and ultrasound at an outside hospital. A targeted right ultrasound was performed for the palpable area of concern. In the right breast at the 10:00 position, approximately 1 cm from the nipple, are several scattered simple cysts, the largest of which measures 6 x 3 x 6 mm, without internal vascularity. In the right breast at the 5:00 position, approximately 1 cm from the nipple, is a cluster of cysts and microcysts, with the largest individual cyst measuring 4 x 4 mm, and the entire cluster measuring approximately 13 x 6 x 9 mm; there is no associated internal vascularity within the cysts themselves.

Output: Scattered cysts and a cluster of microcysts in the right breast correlating to the patient's palpable areas of concern. Please note, diagnostic mammogram is recommended for palpable breast lesions, however her referring provider Dr. Jacobson declined that test. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram and right breast ultrasound are recommended in 6 months. Results and recommendation were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on medical findings.

Input: Elevated LFTs LIMITED ABDOMENLIVER: Mildly coarse and echogenic liver echotexture without mass. Liver length 14.9 cm.BILIARY TRACT: Gallbladder absent. No ductal dilatationPANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 13.2 cm in length RIGHT KIDNEY: No significant abnormalities noted. 10.8 cm in lengthOTHER: Left kidney 11.7 cm in length. No ascites.

Output: Mildly coarse and echogenic liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Patent hepatic vessels with normal directional flow. No ascites.


Instruction: Generate impression based on medical findings.

Input: Female 40 years old; Reason: eval thyroid nodules for interval change History: neck fullness RIGHT LOBE MEASUREMENTS: 6.5 x 1.9 x 1.7 cm.LEFT LOBE MEASUREMENTS: 5.0 x 1.6 x 1.6 cm.ISTHMUS MEASUREMENT: 0.7 cm.RIGHT LOBE: There are several nodules in the right lobe of the thyroid. Largest of these measures approximately 1.1 x 0.9 x 0.7 centimeters and appears to have changed since the prior exam and now appears mixed cystic-solid. A previously measured nodule in the inferior aspect of the right lobe appears stable since prior examination. There is a new approximately 0.3 x 0.3 round isoechoic lesion with a hypoechoic rim that was not seen on the prior examination.LEFT LOBE: Heterogeneous echotexture with multiple nodules most prominence of which is 1.1 x 0.5 x 0.7 cm is round, well-defined, hypoechoic. Appears stable since prior examination.ISTHMUS: No significant abnormality noted.LYMPH NODES: No significant adenopathy.OTHER: No significant abnormality noted.

Output: 1.Cystic degeneration of a right thyroid nodule.2.Heterogeneous multinodular thyroid.3.New thyroid nodule noted as described above; it is isoechoic with a hypoechoic rim measuring approximately 0.3 x 0.3 cm in the right mid thyroid.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for mass in epigastric, upper abdomen History: palpable firmness, possible mass in epigastric/upper abdominal area appreciated on physical exam At the site of palpable concern in the anterior superficial abdominal wall, no abnormal focal masses are identified.

Output: No focal mass identified on ultrasound.


Instruction: Generate impression based on medical findings.

Input: Ms. Afagwu is a 25-year-old female with a personal history of biopsy-proven fibroadenoma of the right breast. She presents today for a new mass in the left breast for the past 2-3 months. Upon physical exam at the patient's area of concern, no discrete mass is appreciated.A targeted left breast ultrasound was performed for the palpable area of concern. In the left breast 7:00 location, approximately 3 cm from the nipple, no suspicious cystic or solid mass is identified.

Output: No sonographic correlate identified for the patient's palpable area of concern. The patient should follow up with her primary care physician as clinically warranted, presuming these results are concordant with the physical exam findings. BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on medical findings.

Input: Cirrhosis LIVER: No change in cirrhotic morphology. Previously noted hypoechoic focus along the left liver capsule no longer visible on current examination. No worrisome mass. Liver length 14 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.9 cm in lengthOTHER: Left kidney 9.9 cm in length. Spleen 13 cm in length. Trace ascites.

Output: Stable cirrhotic morphology without worrisome mass or ductal dilatation. Trace ascites.


Instruction: Generate impression based on medical findings.

Input: 56 years Female with history of chronic thyroiditis and enlarged thyroid. RIGHT LOBE MEASUREMENTS: 3.7 x 1.2 x 1.1 cmLEFT LOBE MEASUREMENTS: 3.3 x 0.9 x 0.9 cmISTHMUS MEASUREMENTS: 0.1 cm in thickness. RIGHT LOBE: Heterogenous echotexture and increased vascularity without discrete nodules. Single hyperechoic focus with posterior shadowing in the mid lobe measures 0.5 x 0.3 x 0.4 cm and is compatible with a coarse calcification.LEFT LOBE: Heterogenous echotexture and increased vascularity without discrete nodules. ISTHMUS: Heterogenous echotexture without discrete nodules. PARATHYROID GLANDS: No significant abnormalities.LYMPH NODES: A few normal-appearing lymph nodes are noted. For example, a right level 2 lymph node measures 1.2 x 0.2 x 0.8 cm.OTHER: No significant abnormalities.

Output: Small, heterogenous thyroid compatible with history of chronic thyroiditis. Single coarse calcification in the right lobe.


Instruction: Generate impression based on medical findings.

Input: Evaluate for obstruction. History of kidney failure. RIGHT KIDNEY: The right kidney measures 8 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow. The renal cortex is echogenic.LEFT KIDNEY: The left kidney measures 11.1 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow. The renal cortex is echogenic.URINARY BLADDER: The urinary bladder is partially distended. The left ureteral jet is visualized.OTHER: No significant abnormalities noted.

Output: No hydronephrosis. Echogenic renal cortices compatible with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male patient with an elevated creatinine. Assess for hydronephrosis. RENAL TRANSPLANT: LOCATION: Right iliac fossa.PERITRANSPLANT TISSUES: No perinephric fluid collection is identified.KIDNEY: The kidney measures 10.2 cm in length. Renal cortical echogenicity is within normal limits.COLLECTING SYSTEM/URETER: No significant abnormality noted.URINARY BLADDER: The bladder is decompressed.VASCULAR DOPPLER DATA: Color Doppler were performed on inflow and outflow vessels. No significant abnormality notedOTHER: No significant abnormality noted

Output: No evidence of hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 61-year-old female with history of benign MRI guided right breast biopsy in March 2016. Now presents with palpable lump in the upper right breast. Family history of breast cancer in sister, diagnosed at age 26. Personal history of BRCA 2 mutation, enrolled in research study. Physical examination at the patient's palpable area of concern demonstrated a hard lump at the 1:00 position in the right breast, approximately 6 cm from the nipple. A targeted right breast ultrasound at the palpable area of concern demonstrated 2 mixed echogenicity avascular lesions containing debris and scattered septations. Findings are compatible with a hematoma that is comprised of two separate components separated by a thin layer of normal breast tissue. The deeper component of the hematoma contains the biopsy clip. The overall hematoma measures 3.0 x 3.4 cm. No suspicious cystic or solid lesions are identified.

Output: Right breast hematoma as described above. No sonographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral breast MRI is recommended in September 2016 followed by bilateral diagnostic mammogram in March 2017 as per the patient's research study protocol.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: Call back from screening mammogram for a new mass in the left breast. An ML view and three spot compression views of the left breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. An irregularly shaped mass is again identified at far medial left breast. The mass persists with spot compression. No calcifications are associated with this mass.Focused ultrasound was performed for left medial breast. There is an irregularly shaped hypoechoic mass at 9 o'clock position, 12 cm from nipple, in the left breast. Marked blood flow is observed within this mass. There is a tubular shaped hypoechoic lesion extending medially from the mass toward the sternum. Overall size of this lesion is 35 x 10 x 12 mm.

Output: Highly suspicious mass in the left far medial 9 o'clock position. Ultrasound guided biopsy is recommended. Results and recommendations were discussed with the patient.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on medical findings.

Input: 87-year-old female. Left breast cancer undergoing neoadjuvant hormonal therapy. Follow-up ultrasound to evaluate treatment response. A focused left breast ultrasound at the 2 o'clock location, approximately 4 to 5 cm from the nipple, showed a 1.6 x 1.1 cm hypoechoic irregular mass, previously 1.4 x 1.2 cm, not significantly changed allowing for differences in technique.

Output: No significant interval change in the known left breast cancer.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: 75 year old female with incidental thyroid nodule noted on MRI neck. RIGHT LOBE MEASUREMENTS: 1.5 cm x 1.2 cm x 2.9 cm.LEFT LOBE MEASUREMENTS: 1.2 cm x 1.6 cm x 2.8 cm.ISTHMUS MEASUREMENTS: 3 mm in thicknessRIGHT LOBE: Heterogeneous echotexture. Multiple subcentimeter nodules are noted, the largest of which is hypoechoic and measures 6 mm x 4 mm x 5 mm. LEFT LOBE: Multiple subcentimeter nodules are noted, the largest of which measures 7 mm x 7 mm x 8 mm and is cystic in appearance. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Multiple bilateral lymph nodes are noted in the neck, the majority of which appear benign with a prominent fatty hilum. However, prominent left neck level 3 lymph node measures 1.3 cm x 0.5 cm x 0.8 cm is noted with suggestion of a fatty hilum. OTHER: No significant abnormality noted.

Output: 1. Prominent left neck level 3 lymph node with suggestion of a fatty hilum. While presence of fatty hilum suggests benignity and node may merely be reactive in etiology, the node is prominent and has an abnormal rounded configuration, correlation with patient's clinical history and follow up is recommended to exclude a neoplastic process. 2. Heterogeneous thyroid gland with bilateral subcentimeter nodule, largest on the left lobe which is predominantly cystic and likely represents a benign colloid nodule.


Instruction: Generate impression based on medical findings.

Input: 65-year-old female with elevated creatinine and history of hypertension. ULTRASOUND KIDNEYSRIGHT KIDNEY: The right kidney measures 10.2 cm in length. There is normal echogenicity of the cortex. No hydronephrosis, stones, or worrisome masses are seen within the right kidney.LEFT KIDNEY: The left kidney measures 10.4 cm in length. The echogenicity is normal within the cortex. There is no hydronephrosis, stones, or worrisome masses seen in the left kidney.OTHER: The bladder is visualized but no significant abnormalities are noted. Additionally, uterine fibroids are visualized.

Output: 1. Negative ultrasound of the kidneys bilaterally. No hydronephrosis, stones, or masses are seen.2. Uterine fibroids are visualized.


Instruction: Generate impression based on medical findings.

Input: Asymptomatic female with dense breasts presents for whole breast ultrasound for dense breast screening. 3-D whole breast ultrasound was performed for both breasts and images were reviewed on an independent workstation. There is an oval hypoechoic lesion at 12:00 position in the right breast, measuring 8 mm.

Output: An oval hypoechoic lesion at 12:00 position in the right breast, measuring 8 mm. Diagnostic ultrasound study for right breast is recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on medical findings.

Input: Female 41 years old Reason: 41 yo AAF - with proteinuria and CKD - getting a biopsy History: 41 yo AAF - with proteinuria and CKD - getting a biopsy Ultrasound provided for the nephrology service for a ultrasound-guided biopsy of the right kidney.

Output: Ultrasound provided for the nephrology service for a ultrasound-guided biopsy of the right kidney.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male patient with chronic hepatitis B. LIVER: The liver measures 14.3 cm in length. Hepatic parenchymal echogenicity is increased consistent with hepatic steatosis with geographic areas of sparing. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.3 m/sec.GALLBLADDER, BILIARY TRACT: There are no gallstones, gallbladder wall thickening, or pericholecystic fluid. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 4 mm in diameter.PANCREAS: The head and body of the pancreas demonstrate normal echogenicity. The tail is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 9.7 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 10.3 cm in length. No evidence of hydronephrosis.The spleen measures 8 cm in length.No ascites.

Output: 1. Hepatic steatosis with geographic areas of fatty-sparing. No focal hepatic lesion is identified.2. No ascites.


Instruction: Generate impression based on medical findings.

Input: 55-year-old male with acute renal failure. Tubular necrosis. Ultrasound guidance was provided for biopsy of the patient's left kidney.

Output: Ultrasound guidance.


Instruction: Generate impression based on medical findings.

Input: Gross hematuria RIGHT KIDNEY: No significant abnormalities noted. 11.9 cm in lengthLEFT KIDNEY: No significant abnormalities noted. 11.4 cm in lengthOTHER: Bladder nondistended

Output: Negative renal ultrasound. Specifically, no evidence for worrisome mass, acute inflammation, stone, or obstruction.


Instruction: Generate impression based on medical findings.

Input: Reason: 51 y.o. F with thyroid nodule. Please evaluate. RIGHT LOBE MEASUREMENTS: 4.5 x 2.1 x 2.6 cm.LEFT LOBE MEASUREMENTS: 2.6 x 0.9 x 1.1 cm.ISTHMUS MEASUREMENTS: Measures up to 0.2 cm in thickness.RIGHT LOBE: Normal background parenchymal echotexture. Predominantly solid nodule within the mid pole measures 3.0 x 1.7 x 2.6 cm, is predominantly isoechoic, demonstrates internal vascularity, and lacks suspicious microcalcifications. Overall, nodule is of intermediate suspicion for neoplasm.LEFT LOBE: Normal background parenchymal echotexture. Subcentimeter solid, hypoechoic nodule within the inferior pole measuring 0.4 x 0.3 x 0.4 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There are couple mildly prominent left cervical lymph nodes which demonstrate fatty hila, favor reactive. Left level 3 lymph node measures 1.2 x x 0.6 x 0.9 cm. Left level 4 lymph node measures 1.0 x 2.2 x 1.0 cm.OTHER: No significant abnormality noted.

Output: Dominant right thyroid nodule measuring up to 3.0 cm of intermediate suspicion for neoplasm and which would be amenable to fine-needle aspiration.


Instruction: Generate impression based on medical findings.

Input: Female; 36 years old. Reason: cholecystitis? History: RUQ pain, tenderness, vomiting LIVER: Liver measures 18.7 cm in length. The liver contour is smooth, the parenchyma is normal in echogenicity. No worrisome masses identified.The main portal vein is patent and demonstrates hepatopetal flow with a peak velocity of 0.3 m/sec.BILIARY TRACT: The gallbladder is normal in appearance. There is no cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. The common duct measures 0.6 cm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The head and body of the pancreas are normal in appearance. The tail is obscured by overlying bowel gas.SPLEEN: The spleen measures 9.4 cm in length.RIGHT KIDNEY: The right kidney measures 10.7 cm in length. The renal cortex is normal in echogenicity. There is no hydronephrosis or shadowing renal stone. LEFT KIDNEY: The left kidney measures 10.7 cm in length. The renal cortex is normal in echogenicity. There is no hydronephrosis or shadowing renal stone.

Output: Mild hepatomegaly but otherwise normal ultrasound right upper quadrant. Specifically there is no cholelithiasis, biliary ductal dilatation, or evidence of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Female 88 years old Reason: Evaluate for obstruction History: worsening AKI RIGHT KIDNEY: Measures 8.5 cm in length. MIldly increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. Inferior pole right renal cyst 0.6 x 0.5 x 0.5 cm.LEFT KIDNEY: Measures 9.1 cm in length. MIldly increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. URINARY BLADDER: Incompletely distended without focal abnormality. OTHER: No significant abnormalities noted.

Output: 1. Mildly Increased renal echogenicity consistent with medical renal disease. 2. No nephrolithiasis, hydronephrosis, or suspicious mass lesion.


Instruction: Generate impression based on medical findings.

Input: 68 years old, Male, Reason: pt with elevated liver enzymes new from 2 wks ago; please eval for acute obstruction/pathology LIVER: The liver measures 17 cm in length. Increased echogenicity of the liver consistent with fatty infiltration. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.2 m/s.BILIARY TRACT: Patient is status post cholecystectomy. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 4 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 12.4 cm in length. RIGHT KIDNEY: Kidney measures 13.6 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: The patient is status post left nephrectomy.OTHER: No significant abnormalities noted.

Output: 1.Diffuse fatty infiltration of the liver. No hepatic mass2.No intrahepatic or extra hepatic biliary ductal dilatation.


Instruction: Generate impression based on medical findings.

Input: Sepsis RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 10.4 cm in length. No perinephric collectionLEFT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 11.3 cm in length. No perinephric collectionOTHER: Bladder nondistended

Output: Echogenic parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or hydronephrosis. No perinephric collection.


Instruction: Generate impression based on medical findings.

Input: 31-year-old female with right-sided abdominal pain. LIVER: Measures 13.7 in length. Increased hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: No cholelithiasis. No gallbladder wall thickening, pericholecystic fluid, or biliary ductal dilation. PANCREAS: The pancreas is incompletely imaged due to bowel gas. The imaged portions of the pancreas appear unremarkable. SPLEEN: Unremarkable in size and echogenicity. KIDNEY: 0.5 cm right lower pole renal stone without hydronephrosis.OTHER: No significant abnormalities noted.

Output: 1. Increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease. No evidence of cholelithiasis or cholecystitis. 2. Nonobstructive right nephrolithiasis.


Instruction: Generate impression based on medical findings.

Input: 63 years old, Male, Reason: right testicular mass RIGHT TESTIS: There is a dominant solid lesion in the right testis which is heterogeneous and mostly isoechoic to background testicular tissue. This lesion has vascular flow and is highly suspicious for malignancy. There is normal vascularity and Doppler flow within the visualized normal tissue of the right testicle.LEFT TESTIS: Patient status post left orchiectomy with prosthesis.RIGHT EPIDIDYMIS: Right epididymal cyst measuring 1.0 x 0.7 cm.LEFT EPIDIDYMIS: No significant abnormalities noted.

Output: Dominant solid right testicular lesion with vascularity, highly suspicious for malignancy.


Instruction: Generate impression based on medical findings.

Input: Ms. Lopez is a 39-year-old female presenting for short term ultrasound follow-up for known right chest wall lipoma. Family history of breast cancer in both maternal and paternal great aunts. Personal history of lupus. Upon physical exam at the patient's area of concern, a superficial soft mobile mass is appreciated.A targeted right breast ultrasound was performed for the patient’s area of concern. In the right breast 9:00 location, approximately 9 cm from the nipple, there is revisualization of an oval isoechoic mass measuring 2.4 x 0.5 x 1.3 cm, previously measuring 2.4 x 0.5 x 1.2 cm. Sonographic findings are compatible with a benign lipoma.In the right breast 10:00 location, approximately 5 cm from the nipple, there is a round anechoic lesion identified, measuring 0.5 x 0.3 x 0.6 cm. Sonographic findings are compatible with a simple cyst. In the right axillary region, at least four enlarged right axillary lymph nodes are again identified, appearing stable when compared to the prior ultrasound examination from July 2015.

Output: (1) Benign lymphoma of the right lateral chest.(2) Simple cyst of the right upper outer breast.(3) Enlarged but stable right axillary lymph nodes, likely related to patient's personal history of lupus.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on medical findings.

Input: History of thyroid cancer status post thyroidectomy. Possible palpable lesion on the right, just lateral and superior to the thyroid. RIGHT LOBE MEASUREMENTS: Status post thyroidectomy. No residual thyroid tissue identified.LEFT LOBE MEASUREMENTS: Status post thyroidectomy. No residual thyroid tissue identified. ISTHMUS MEASUREMENTS: Status post thyroidectomy. No residual thyroid tissue identified. RIGHT SURGICAL BED: Surgical clip identified in the lateral thyroid bed, near the region of patient's palpable interest. No significant abnormality noted.LEFT SURGICAL BED: No significant abnormality noted.ISTHMUS SURGICAL BED: No significant abnormality noted.PARATHYROID GLANDS: Not identified.LYMPH NODES: Normal morphology noncalcified lymph nodes bilaterally, measuring up to 13 mm and appearing similar to 11/14/14. OTHER: No significant abnormality noted.

Output: Surgical clips and normal morphology lymph nodes identified. No suspicious findings.


Instruction: Generate impression based on medical findings.

Input: 58-year-old female with multinodular goiter with benign cytology of larger left lobe nodules. Evaluate for change in nodules. RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 7.2 x 2.1 x 1.6 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 6.4 x 3.2 x 1.9 cm.ISTHMUS MEASUREMENTS: The thyroid isthmus measures 0.4 cm in thickness.RIGHT LOBE: Heterogenous multinodular echotexture. The predominantly isoechoic nodule of the posterior mid pole measuring 1 x 0.8 x 1.0 cm is stable in size and appearance (prior 1 x 1 x 0.9 cm). The hypoechoic nodule of the inferior right pole is stable in size and appearance measuring 1 x 0.7 x 0.9 cm (prior 1 x 0.9 x 1.1 cm).LEFT LOBE: Heterogenous multinodular echotexture. The predominantly cystic lesion of the left mid pole is stable in size and appearance measuring 2.7 x 1.5 x 2.5 cm (prior 2.7 x 1.7 x 2.7 cm). The heterogenous isoechoic nodule of the left lower pole measuring 2.4 x 1.6 x 1.7 cm is similar in size and appearance (prior 2.6 x 1.7 x 1.9 cm).ISTHMUS: Stable isthmic nodule measuring 0.4 x 0.4 x 0.5 cm (prior 0.4 x 0.5 x 0.6 cm).PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Bilateral thyroid nodules without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Right flank pain, elevated bilirubin; metastatic colon cancer LIVER: Mildly coarse echogenic liver echotexture. Bilobar hepatic metastases again noted. Liver length 16.2 cmBILIARY TRACT: Gallbladder sludge without acute inflammation. Minimal intrahepatic ductal dilatation without significant extra hepatic ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 12.9 cm in length.RIGHT KIDNEY: No significant abnormalities noted. Renal cyst again noted. 10.3 cm in lengthOTHER: Left kidney 12.9 cm in length. Left renal cyst again noted. No ascites.

Output: Bilobar hepatic metastases again noted. Mildly coarse echogenic liver echotexture suggestive for parenchymal dysfunction. Gallbladder sludge without acute inflammation. Minimal intrahepatic ductal dilatation without significant extrahepatic ductal dilatation. No ascites.


Instruction: Generate impression based on medical findings.

Input: Metastatic small cell carcinoma with liver abnormalities LIVER: Diffusely heterogeneous liver with multiple bilobar confluent hypoechoic mass lesions. Liver length 27.2 cmDoppler interrogation of hepatic vessels demonstrate a possible filling defect in the main portal vein. Main portal vein flow remains pedal with a velocity 15.8 cm/s. Hepatic artery and hepatic veins appear patent.GALLBLADDER, BILIARY TRACT: No significant abnormality noted.PANCREAS: No significant abnormality noted.SPLEEN: No significant abnormality noted. 8.1 cm in length KIDNEYS: Right kidney 12 cm in length Left kidney 11.6 cm in length ABDOMINAL AORTA: No significant abnormality noted.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: Porta hepatis adenopathy. No ascites. Right pleural effusion.

Output: Diffusely heterogeneous liver with bilobar confluent mass lesions worrisome for metastatic disease. No ductal dilatation. While the hepatic vessels appear patent with normal directional flow, there may be a nonobstructing filling defect within the main portal vein. No ascites.


Instruction: Generate impression based on medical findings.

Input: Female 20 months old Reason: Evaluate for abscess History: acute onset tender mass below nipple Round, circumscribed, hypoechoic, solid-appearing mass in the left breast at the level of the nipple measuring 1.3 cm in diameter, consistent with abscess.

Output: Hypoechoic mass in the left breast consistent with abscess.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with a history of hepatitis to follow up gallbladder polyps. LIVER:Measures 16.5 cm. Increased echogenicity of the parenchyma. No focal masses, ascites, or intrahepatic biliary dilatation. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended with an anechoic lumen. There are numerous foci within the lumen inferior to the wall that are nondependent, consistent with gallbladder polyps. The largest of these measures approximately 0.6 x 0.4 x 0.6 cm which is an interval increase in size.PANCREAS: Evaluation of the pancreas is limited due to overlying bowel gas.SPLEEN: Measures 8.8 cm without sonographic abnormalities.KIDNEYS: Right kidney measures 10.7 cm. Left kidney measures 11.5 cm. Normal echogenicity. No shadowing calculi, hydronephrosis, or focal mass. OTHER: No significant abnormality noted.

Output: 1. Multiple gallbladder polyps as described above. There is been an interval increase in the largest polyp now measuring approximately 0.6 x 0.4 x 0.6 cm.2. Increased echogenicity of the liver consistent with chronic liver disease/parenchymal dysfunction. No focal masses or ascites.


Instruction: Generate impression based on medical findings.

Input: 43-year-old male with acute renal failure. RIGHT KIDNEY: The right kidney measures approximately 9.3 cm in length. Echotexture is within normal limits. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: The left kidney measures approximately 9.1 cm in length. Echotexture is within normal limits. No hydronephrosis, shadowing calculus or mass.URINARY BLADDER: Incompletely distended without gross abnormality.OTHER: Liver appears somewhat echogenic which is nonspecific but could be due to fatty infiltration.

Output: Normal-appearing kidneys.Echogenic liver.


Instruction: Generate impression based on medical findings.

Input: male presenting with right breast mass, evaluate for cyst versus abscess Adjacent to the area of the right nipple, there is an approximately 2.2 cm subcutaneous area of hypoechogenicity likely representing edema, without definite evidence of collection or abscess formation.

Output: Subcutaneous area of hypoechogenicity adjacent to the nipple, likely representing edema without definite evidence of abscess formation. Follow-up ultrasound can be performed as clinically indicated to ensure resolution.


Instruction: Generate impression based on medical findings.

Input: Female; 27 years old. Reason: 27 yo F 25 wk pregnant with h/o Crohn's disease s/p total proctocolectomy with h/o portal vein thrombosis. Evaluate portal vein residual thrombosis History: none LIVER: The liver measures 17 cm in length. Renal parenchyma is normal in echogenicity. There is no focal hepatic lesion is identified. There is no ascites.The main portal vein is patent with hepatopetal flow and a peak velocity of 0.4 m/sec.BILIARY TRACT: Gravel-like shadowing stones and sludge are seen layering in the dependent portions of the gallbladder. There is no gallbladder wall thickening or pericholecystic fluid. The common duct measures 4 mm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The pancreatic head and body are unremarkable. The tail is obscured by overlying bowel gas.SPLEEN: The spleen measures 11 cm in length. No focal splenic lesion is identified.KIDNEYS: The right kidney measures 10.0 cm in length, the left measures 9.6 cm in length. The renal parenchyma is normal in echogenicity bilaterally. There is mild bilateral hydronephrosis. No shadowing renal stone is identified. OTHER: No significant abnormalities noted.

Output: 1.Patent portal vein with normal directional flow.2.Gallbladder gravel and sludge without evidence of acute cholecystitis.3.Mild hydronephrosis bilaterally, unchanged and likely physiologic given pregnancy.


Instruction: Generate impression based on medical findings.

Input: 42-year-old with history of excisional biopsy of papilloma in the right breast in 2010. BILATERAL DIGITAL DIAGNOSTIC MAMMOGRAPHY: Three standard views of both breasts and 2 spot compression views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Stable postsurgical changes in the right retroareolar region. There are 3 new clustered asymmetries in the left upper outer quadrant, which persist on spot compression. No suspicious microcalcifications in either breast. TARGETED LEFT BREAST ULTRASOUND: Targeted left upper outer quadrant ultrasound demonstrated a cluster of circumscribed anechoic to hypoechoic foci measuring up to 7 x 5 x 5 mm without internal vascularity; findings compatible with multiple simple cysts.

Output: Findings consistent with left upper outer quadrant multiple simple cysts. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: Hepatitis C LIVER: Mildly coarse liver echotexture without worrisome mass. Stable minimally complex benign-appearing left hepatic lobe cyst measuring 1.4 x 1.3 x 1.8 cm. Liver length 10.7 cm in lengthBILIARY TRACT: Stable cholelithiasis without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 7.8 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 11.3 cm in lengthOTHER: Left kidney 10.5 cm in length. No ascites

Output: Mildly coarse liver echotexture suggestive for chronic liver disease without worrisome mass. Stable minimally complex benign-appearing left hepatic lobe cyst. Stable cholelithiasis without acute inflammation or ductal dilatation. No ascites.


Instruction: Generate impression based on medical findings.

Input: 63-year-old female with history of multinodular thyroid presents for follow-up. RIGHT LOBE MEASUREMENTS: 4.6 x 1.4 x 1.6 cm.LEFT LOBE MEASUREMENTS: 4.8 x 1.8 x 1.8 cm.ISTHMUS MEASUREMENTS: 0.4 cm.RIGHT LOBE: The parenchyma is mildly heterogeneous and appears similar to the prior exam.LEFT LOBE: The parenchyma is mildly heterogeneous appears similar to the prior exam. There are several nodules as described below.Nodule 1: Measures approximately 1.6 x 1.2 x 1.7 cm in the superior pole. It is well defined and spongiform. Stable since prior study.Nodule 2: Measures approximately 1.6 x 1.1 x 0.9 cm in the mid pole. It is well defined, hyperechoic. Stable since prior study.Nodule 3: Measures approximately 1.2 x 0.7 x 0.9 cm in the inferior pole. It is well defined and hyperechoic. Stable since prior study.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Stable multinodular thyroid as described above.


Instruction: Generate impression based on medical findings.

Input: 64 year-old female with incidental finding of a thyroid nodule on CT of the neck. RIGHT LOBE MEASUREMENTS: 4.0 x 1.4 x 1.5 cm.LEFT LOBE MEASUREMENTS: 5.7 x 1.7 x 1.8 cm.ISTHMUS MEASUREMENTS: 0.5 cm.RIGHT LOBE: Note is made of a 3 x 4 x 2 mm anechoic collection with a punctate focus of increased echogenicity and associated comet tail artifact, without internal vascularity or microcalcification, consistent with a colloid cyst. LEFT LOBE: 9 x 8 x 9 mm spongiform nodule in the superior pole of the left lobe of the thyroid without internal vascularity or microcalcification.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Bilateral benign morphology thyroid nodules, as detailed above.


Instruction: Generate impression based on medical findings.

Input: 36-year-old male with history of renal transplant, anemia, decreased urine output. KIDNEY: Right iliac fossa transplant kidney measures 9.3 cm in length and demonstrates mildly increased echogenicity, but no hydronephrosis or perinephric fluid collections.OTHER: No significant abnormalities noted.

Output: Mildly increased renal echogenicity but no hydronephrosis or perinephric fluid collections.


Instruction: Generate impression based on medical findings.

Input: Reason: CT abdomen with innumerable hepatic hypodensities on 11/11/16 History: AML s/p chemotherapy complicated by prolonged pancytopenia. LIVER: The liver measures 14.4 cm in length. Mildly increased parenchymal echogenicity is suggestive of fatty infiltration/parenchymal dysfunction. The portal triads are perhaps mildly echogenic. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.26 m/s.BILIARY TRACT: The gallbladder appears contracted. No gallbladder wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 4 mm in diameter.PANCREAS: Not well visualized.SPLEEN: No significant abnormalities noted.The spleen measures 6.3 cm in length. RIGHT KIDNEY: Kidney measures 10.6 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 10.7 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.OTHER: Right pleural effusion. The IVC is mildly dilated.

Output: Mildly coarse liver echotexture, may represent nonspecific fatty infiltration/parenchymal dysfunction. No focal liver lesion identified. Dedicated cross-sectional imaging may be considered for further evaluation as clinically warranted.


Instruction: Generate impression based on medical findings.

Input: Acute renal insufficiency RIGHT KIDNEY: Mildly coarse echotexture without mass, stone, or hydronephrosis. Right kidney 13.5 cm in lengthLEFT KIDNEY: Mildly coarse echotexture without mass, stone, or hydronephrosis. Left kidney 11.7 cm in lengthOTHER: Bladder nondistended.

Output: Mildly coarse renal echotexture suggestive for medical renal disease/parenchymal dysfunction without mass, stone, or obstruction.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old. Recurrent UTI, r/o bladder obstruction. Recurrent suprapubic fullness RIGHT KIDNEY: The right kidney measures 9.3 cm in length, with increased cortical echogenicity. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 9.8 cm in length, with increased cortical echogenicity. No shadowing stones or hydronephrosis.OTHER: The bladder is distended, without significant wall thickening.

Output: 1.No hydronephrosis.2.Increased renal cortical echogenicity, compatible with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: 71 year old female patient with history of thyroid cancer. Evaluate for recurrence. RIGHT LOBE: Status post thyroidectomy. There is a 0.2 x 0.2 x 0.3 cm hypoechoic nodule with an echogenic center within the right thyroid bed. LEFT LOBE: Status post thyroidectomy. There is are two benign morphology lymph nodes noted within the superior and mid left thyroidectomy bed.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-morphology lymph nodes are present bilaterally.OTHER: No significant abnormality noted.

Output: Hypoechoic nodule with an echogenic hilum within the right thyroidectomy bed likely represents a lymph node; this can be followed on subsequent studies. Additional benign morphology lymph nodes are noted in the left thyroid bed.


Instruction: Generate impression based on medical findings.

Input: 54-year-old female with thyroid nodules identified on imaging, please evaluate for characteristics, small gland on exam. The patient reports dysphonia. RIGHT LOBE MEASUREMENTS: 5.2 x 1.7 x 1.8 cm.LEFT LOBE MEASUREMENTS: 5.2 x 1.5 x 1.1 cm.ISTHMUS MEASUREMENT: 0.2 cm.RIGHT LOBE: On a background of thyroid heterogeneity in the right mid thyroid is a hypoechoic nodule with a small central cystic area measuring 1.3 x 1.1 x 0.8 cm, which has increased vascularity.LEFT LOBE: Within the left lower pole on a background of thyroid heterogeneity is a hypoechoic nodule measuring 1.1 x 0.7 x 0.7 cm.ISTHMUS: Within the isthmus is a hypoechoic nodule measuring 1.2 x 1.1 x 0.8 cm.LYMPH NODES: Multiple small benign-appearing bilateral lymph nodes are visualized.OTHER: No significant abnormality noted.

Output: Findings compatible with multinodular goiter.


Instruction: Generate impression based on medical findings.

Input: HCV cirrhosis LIVER: Cirrhotic morphology again noted without mass. Liver length 19.5 cm. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow.BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 11.3 cm in lengthRIGHT KIDNEY: Right renal cyst. Right kidney 10 cm in length. OTHER: Nonobstructing subcentimeter left renal stone. Left renal cyst. Left kidney 10 cm in length. No ascites.

Output: Stable cirrhotic morphology without mass or ductal dilatation. Cholelithiasis without acute inflammation. No ascites. Nonobstructing left renal stone.


Instruction: Generate impression based on medical findings.

Input: Follow-up thyroid nodule RIGHT LOBE MEASUREMENTS: 5.3 x 1.2 x 1.5 cm.LEFT LOBE MEASUREMENTS: 4.9 x 1.2 x 1.5 cm.ISTHMUS MEASUREMENTS: 0.1 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: Stable predominantly solid lower pole left thyroid nodule measuring 1 x 0.8 x 1.3 cm. Internal echogenic foci again noted; favor benign old colloid over microcalcifications.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable solid lower pole left thyroid nodule. No regional adenopathy.


Instruction: Generate impression based on medical findings.

Input: 27-year-old female with history of hepatitis B carrier, screen for HCC. LIVER: Coarsened hepatic echotexture without discrete focal lesion. Patent main portal vein.BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.

Output: Coarsened hepatic echotexture consistent with diffuse parenchymal disease or fatty infiltration. No discrete hepatic lesion identified.


Instruction: Generate impression based on medical findings.

Input: Reason: concern for congestive hepatopathy, rule out portal vein thrombosis History: pulmonary hypertension of unclear cause LIVER: The liver measures 18.7 cm in length. The liver parenchymal echotexture is coarse. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating pulsatile hepatopetal flow with a velocity of 0.29 m/s. No filling defects are identified within the main portal vein or visualized branches. The hepatic veins appear somewhat prominent.BILIARY TRACT: No cholelithiasis. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 6 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: Not visualized.RIGHT KIDNEY: Kidney measures 14.9 cm in length. Normal echotexture. No hydronephrosis. Simple cyst.LEFT KIDNEY: Kidney measures 13.7 cm in length. Normal echotexture. No hydronephrosis.OTHER: Right pleural effusion.

Output: 1.Portal vein appears patent without evidence of thrombus.2.Pulsatile portal vein and prominent hepatic veins raise question of right-sided heart failure.


Instruction: Generate impression based on medical findings.

Input: 77 year-old female with right kidney cancer status post right partial nephrectomy. Evaluate for recurrent disease. RIGHT KIDNEY: Normal echogenicity of the right kidney measuring 9.4 cm in length. No hydronephrosis or shadowing calculi are noted.LEFT KIDNEY: Normal echogenicity of the left kidney measuring 9.2 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Distended bladder.

Output: No sonographic evidence of recurrent disease.


Instruction: Generate impression based on medical findings.

Input: Thyroid nodule RIGHT LOBE MEASUREMENTS: 2.4 x 2.1 x 4.5 cmLEFT LOBE MEASUREMENTS: 1.7 x 1.4 x 5.3 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Stable predominantly solid mid pole nodule measuring 1.8 x 1.3 x 2.4 cm.LEFT LOBE: Stable subcentimeter benign colloid cyst measuring 0.3 x 0.3 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: Stable examination. No change in bilateral thyroid nodules. No regional adenopathy.


Instruction: Generate impression based on medical findings.

Input: Male 51 years old Reason: eval transplant kidney History: transplant RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: Transplant kidney measures 11.3 cm. No evidence of hydronephrosis. Slightly echogenic kidney. Simple appearing cyst in the upper pole measuring 2 cm.COLLECTING SYSTEM/URETER: No significant abnormality notedURINARY BLADDER: No significant abnormality notedVASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels No significant abnormality noted. Peak systolic velocity at the level of the anastomosis 110 cm/s. RI values range between 0.6 and 0.7. Transplant vein is patent.OTHER: No significant abnormality noted

Output: Slightly echogenic renal transplant right iliac fossa. Normal Doppler study.


Instruction: Generate impression based on medical findings.

Input: Abdominal pain and mild lipase elevation. LIVER: The liver is mildly coarse and echogenic without a focal abnormality. No intrahepatic biliary ductal dilatation. It measures 14.5 cm in length. Normal hepatopedal portal venous blood flow at 26.7 cm/s.BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common duct measuring 4 mm. Normally distended gallbladder without gallstones wall thickening, pericholecystic fluid or focal tenderness.PANCREAS: The visualized pancreatic body and head are unremarkable. The remainder of the pancreas is obscured by overlying bowel gas shadowing.SPLEEN: The spleen measures 8.4 cm without a focal abnormality.RIGHT KIDNEY: The right kidney measures 10.7 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. OTHER: The left kidney measures 10.8 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion.

Output: Mildly coarse echogenic liver parenchyma may represent fatty infiltration and/or parenchymal dysfunction without a focal abnormality. The visualized pancreatic body and head are unremarkable. No gallstones or biliary ductal dilatation.


Instruction: Generate impression based on medical findings.

Input: 86 years old, Female, Reason: rising cr, poor UO RIGHT KIDNEY: Kidney measures 12.5 cm in length. Increased echogenicity of the kidneys consistent with medical renal disease. No evidence of hydronephrosis or shadowing calculus.LEFT KIDNEY: Left kidney only partially visualized due to obscuration by gas. Patient is unable to lay in the decubitus position. Kidney measures 9.8 cm in length. Increased echogenicity of the kidneys consistent with medical renal disease. No hydronephrosis, shadowing calculus. No mass seen in the visualized portions of the kidney.BLADDER: No significant abnormalities. OTHER: No significant abnormalities noted.

Output: 1.Bilateral increased echogenicity of the kidneys consistent with medical renal disease. No evidence of hydronephrosis or shadowing calculus.


Instruction: Generate impression based on medical findings.

Input: 24 year old female with right upper quadrant pain, nausea, emesis. Evaluate for GI pathology. LIVER: Heterogeneous echotexture of the liver measuring 16.3 cm in length. No focal hepatic lesions. Main portal vein is patent with appropriate directional flow; peak velocity measures 0.3 m/sec.GALLBLADDER, BILIARY TRACT: Normal echogenicity of the gallbladder. No gallbladder wall thickening. No pericholecystic fluid. Common bile duct measures 4 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Not well-visualized.RIGHT KIDNEY: Measures 11.8 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Left kidney measures 11.9 cm in length. No hydronephrosis or shadowing calculi are noted.Spleen measures 10.8 cm in length.

Output: 1. Heterogeneous echotexture of the liver suggestive of parenchymal dysfunction/fatty infiltration. 2. No evidence of cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Abdominal pain with elevated LFTs and lactic acidosis LIVER: Mildly heterogeneous echotexture without mass 19.8 cm in length. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow.GALLBLADDER, BILIARY TRACT: Gallbladder sludge without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Atrophic echogenic kidney without hydronephrosis. 8.9 cm in length OTHER: Spleen 13.3 cm in length no ascites.

Output: Mild hepatomegaly with mildly heterogeneous echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites. Atrophic echogenic right kidney consistent with medical renal disease/parenchymal dysfunction without hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Acute renal insufficiency; chronic renal disease RIGHT KIDNEY: Echogenic parenchyma without worrisome mass or hydronephrosis. Nonobstructing subcentimeter right renal stone. Right kidney 9.8 cm in lengthLEFT KIDNEY: Echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Left kidney 10.2 cm in length.OTHER: Bladder nondistended

Output: Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass or obstruction. Nonobstructing subcentimeter right renal stone.


Instruction: Generate impression based on medical findings.

Input: 50-year-old female with small left thyroid bed nodule after thyroidectomy. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: No massLEFT LOBE: There is again noted in the left thyroid bed a medial, hypoechoic nodular density measuring approximately 0.2 x 0.4 x 0.4 cm without significant changeISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable nodular density left thyroid bed.


Instruction: Generate impression based on medical findings.

Input: 64 year-old female with primary hyperparathyroidism, osteopenia. Evaluate for parathyroid adenoma. RIGHT LOBE MEASUREMENTS: 4.5 cm x 1.3 cm x 1.5 cmLEFT LOBE MEASUREMENTS: 4.7 cm x 1.1 cm x 1.4 cm.ISTHMUS MEASUREMENTS: 2 mm in thickness.RIGHT LOBE: Normal homogeneous echotexture. Cystic nodule at the lower pole measures 6 mm x 5 mm x 6 mm with no internal vascularity or definite microcalcifications.LEFT LOBE: Normal homogeneous echotexture.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Subcentimeter cyst in the right thyroid lobe. 2. No evidence of parathyroid adenoma.


Instruction: Generate impression based on medical findings.

Input: Ms. Tzur is a 70-year-old female with bilateral breast implants. Patient reports a nontender palpable mass in the right upper outer breast for the past 3 weeks. Upon physical exam at the patient's area of concern, a vague palpable mass is identified in the right upper outer breast.A targeted right breast ultrasound was performed for the palpable area of concern. In the right breast 10:00 location, approximately 4 cm from the nipple, there are three focal areas of increased echogenicity identified with blurring of the silicone implant contour. Sonographic findings are compatible with extracapsular rupture.

Output: Sonographic findings compatible with extracapsular rupture of right silicone implant. A breast MRI can be performed for additional confirmation if clinically warranted. All results and recommendations were discussed with the patient. Patient is to follow-up with Donna Christian later today for further evaluation.BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation


Instruction: Generate impression based on medical findings.

Input: Altered mental status with hyperbilirubinemia LIVER: Coarse echogenic liver parenchyma without mass. Liver length 15.8 cm. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.6 cm in length OTHER: Left kidney 9.3 cm in length. Spleen 7.3 cm in length. Moderate ascites.

Output: Coarse echogenic liver parenchyma consistent with fatty liver/parenchymal dysfunction without mass or ductal dilatation. Moderate ascites. Limited Doppler interrogation of the main portal vein demonstrates a patent portal vein with normal directional flow.


Instruction: Generate impression based on medical findings.

Input: Right thyroid enlargement RIGHT LOBE MEASUREMENTS: 4.9 x 1.7 x 1.7 cmLEFT LOBE MEASUREMENTS: 4.6 x 1.6 x 1.7 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Multiple predominantly cystic and spongiform nodules. The largest within the upper pole measures 0.6 x 0.4 x 0.4 cm.LEFT LOBE: Multiple spongiform nodules. The largest within the lower pole measures 1.1 x 0.5 x 0.8 cm.ISTHMUS: Spongiform nodule within the right isthmus measuring 1.9 x 1 x 1.7 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple bilateral and right isthmic cystic and spongiform nodules; a benign etiology is favored. No regional adenopathy.


Instruction: Generate impression based on medical findings.

Input: 44-year-old female patient with thrombocytosis. Assess spleen size. The liver measures 17.8 cm in length.The spleen measures 11.7 cm in length and contains multiple echogenic foci compatible with calcifications. The splenic vein and artery are patent.

Output: 1. Spleen size within normal limits.2. Splenic calcifications compatible with prior granulomatous disease.


Instruction: Generate impression based on medical findings.

Input: Acute kidney failure. Evaluate for obstruction. Lack of urine. RIGHT KIDNEY: Right kidney measures 11.0 cm. The cortex is mildly echogenic. No hydronephrosis or renal calculi are identified.LEFT KIDNEY: Left kidney measures 10.3 cm. The cortex is mildly echogenic. No hydronephrosis or renal calculi are identified.URINARY BLADDER: A Foley catheter is identified within a collapsed bladder.OTHER: No significant abnormalities noted.

Output: Echogenic kidneys, compatible with medical renal disease. No hydronephrosis or renal calculi.


Instruction: Generate impression based on medical findings.

Input: Recurrent abdominal pain status post MALS surgery LIVER: Normal parenchymal echogenicity without mass. Liver length 16.2 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.5 cm in lengthOTHER: Left kidney 10 cm in length. Spleen 12 cm in length. No ascites.

Output: Negative right upper quadrant ultrasound. No evidence for hepatobiliary abnormality.


Instruction: Generate impression based on medical findings.

Input: 65 year-old male, precardiac transplant evaluation. LIVER: Coarse architecture of the liver measuring 15.4 cm in length. No focal hepatic lesions. Main portal vein is patent with appropriate directional flow; peak velocity measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: Normal echogenicity of the gallbladder. No gallbladder wall thickening. No pericholecystic fluid. There is a cystic structure measuring 4.7 cm x 5.3 cm x 4.7 cm which appears to arise from the common bile duct near the confluence of the common bile duct with the cystic duct consistent with a choledochocele and appears stable compared to prior CT study dated 3/11/2013. No intrahepatic biliary ductal dilatation. PANCREAS: Not well visualized in its entirety due to overlying bowel gas.SPLEEN: Normal echogenicity of the spleen measuring 10.4 cm in length.KIDNEYS: Right kidney measures 11.4 cm in length. No hydronephrosis or shadowing calculi are noted.Left kidney measures 11.8 cm in length. No hydronephrosis or shadowing wire noted.ABDOMINAL AORTA: Proximal aorta measures 2.8-cm x 2.6-cm. INFERIOR VENA CAVA: The visualized IVC is patent with appropriate directional flow.OTHER: No significant abnormality noted.

Output: 1. Coarse echotexture of the liver suggestive of parenchymal dysfunction/fatty infiltration. No focal hepatic lesions. 2. Findings are consistent with a choledochocele arising from the proximal common bile duct; stable.


Instruction: Generate impression based on medical findings.

Input: Ms. Sierra Rush is a 17 years old female who presents with a palpable concern in the upper inner right breast. ULTRASOUND:On physical examination, a mobile mass is palpated in the upper inner right breast.A targeted right ultrasound was performed for the palpable area of concern. In the right breast, 1:00 position, 5 cm from the nipple, there is a homogeneously hypoechoic, well-circumscribed mass measuring 1.6 x 0.9 x 1.7 cm. There is internal flow to this mass.

Output: 1.7 cm palpable mass in the right breast most consistent with a fibroadenoma. Surgical consultation is recommended. Results and recommendation were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation.


Instruction: Generate impression based on medical findings.

Input: 51-year-old female with a history of thyroid cancer status post right thyroid lobectomy presents for follow-up. RIGHT LOBE MEASUREMENTS: The right lobe is absent.LEFT LOBE MEASUREMENTS: 5.9 x 1.8 x 1.7 cm.ISTHMUS MEASUREMENTS: 0.2 cm.RIGHT LOBE: The right lobe is absent.LEFT LOBE: Unremarkable echotexture. There are multiple nodules as below.Nodule 1: Measures approximately 1.1 x 0.6 x 1.3 cm in the mid left thyroid. Appears smaller and may have involuted since the prior study.Nodule 2: Measures approximately 1.4 x 0.8 x 1.7 cm in the mid left thyroid. Appears larger since the prior study.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multinodular thyroid. One reference nodule smaller, the other larger.


Instruction: Generate impression based on medical findings.

Input: Chronic renal disease RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 13.5 cm in lengthLEFT KIDNEY: Echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Benign appearing left renal cyst. Left kidney 12.7 cm in lengthOTHER: Bladder nondistended

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


Instruction: Generate impression based on medical findings.

Input: 29-year-old female. Evaluate kidney stones. ABDOMEN: Exam is not sensitive for solid organs or bowel to the lack of intravenous and oral contrast.LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Single 3-mm focus of nephrolithiasis midright kidney. No calcification seen along the course of the ureters. Kidney contour is normal. Perinephric fat is normal. No hydronephrosis.Left kidney is normal. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Small soft tissue focus exophytic off anterior uterus abutting the abdominal wall, may represent a small fibroid in and much less likely portion of a urachal remnant.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Single punctate calcification right kidney. Uterine finding as above.


Instruction: Generate impression based on medical findings.

Input: Male 78 years old Reason: unexplained weight loss r/o liver, kidney pathology History: unexplained weight loss r/o liver, kidney pathology LIVER: Liver measures 15.5 cm. Hepatic veins and IVC are slightly dilated likely secondary to heart failure. No focal liver lesions. Punctate calcifications within the liver.BILIARY TRACT: Gallbladder is slightly contracted. No evidence of gallstones or intra or extrahepatic biliary dilatation.PANCREAS: Not well visualized due to overlying bowel gas.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: Both kidneys are echogenic compatible with medical renal disease. Right kidney measures 14.8 cm. There are multiple cysts within the right kidney. One of the cyst is complex and measures 7.3 x 4.7 cm with layering echogenic material within the cyst. Other cysts appear simple.Left kidney measures 12.8 cm. Multiple simple appearing cysts are also noted within the left kidney. OTHER: No significant abnormalities noted.

Output: Bilateral severely echogenic kidneys with multiple renal cysts. One of the cysts in the right kidney contains layering echogenic material likely representing debris. However contrast enhanced dedicated renal protocol CT or MR is recommended for further evaluation of this lesion.


Instruction: Generate impression based on medical findings.

Input: Chronic renal disease RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 10.2 cm in length.LEFT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 10.1 cm in length.OTHER: Bladder nondistended.

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


Instruction: Generate impression based on medical findings.

Input: 45-year-old male with hypothyroidism and thyroid nodules for follow-up. RIGHT LOBE MEASUREMENTS: 5.5 x 1.8 x 1.6 cmLEFT LOBE MEASUREMENTS: 5.0 x 1.6 x 1.5 cmISTHMUS MEASUREMENTS: 0.2 cm RIGHT LOBE: vague, solid and heterogeneous nodule in the posterior midportion of the right lobe measures 0.8 x 1 x 0.8 cm without change.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable right thyroid nodule.


Instruction: Generate impression based on medical findings.

Input: History of bladder stones RIGHT KIDNEY: No significant abnormalities noted. No evidence for mass, stone, or hydronephrosis. 11.7 cm in lengthLEFT KIDNEY: No significant abnormalities noted. No evidence for mass, stone, or hydronephrosis. 12 cm in lengthOTHER: Bladder nondistended. Multiple subcentimeter bladder stones again noted. Enlarged prostate again noted.

Output: No change in multiple subcentimeter bladder stones. No evidence for renal mass, upper tract stone, or hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Female 63 years old Reason: history of thyroid cancer s/p total thyroidectomy and RAI with previous left level III lymph node measuring 4 mm History: history of thyroid cancer s/p total thyroidectomy and RAI with previous left level III lymph node measuring 4 mm MEASUREMENTS: Patient is status post thyroidectomy.RIGHT LOBE: No residual or recurrent thyroid nodulesLEFT LOBE: No residual or recurrent thyroid nodules.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Hypoechoic left level 2 nodule with internal echogenicity, possibly representing a small lymph node measures 2 x 2 x 3 mm. Unchanged left level 3 node measures 3 x 3 x 4 mm with internal echogenicity, possibly presenting calcifications remain suspicious.OTHER: No significant abnormality noted.

Output: Unchanged left level 3 lymph node with suspicious features, recommend continued interval follow-up. Newly measured left level 2 nodule, possibly representing a small lymph node.


Instruction: Generate impression based on medical findings.

Input: Weight loss nausea and abnormal LFTs and renal function LIVER: Coarse echogenic liver echotexture without mass. Liver length 15 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Echogenic parenchyma without mass, stone, hydronephrosis. 12.8 cm in length.OTHER: Echogenic left renal parenchyma without mass, stone, or hydronephrosis. Left kidney 14.1 cm in length. Spleen 15.2 cm in length. No ascites.

Output: Coarse echogenic liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Cholelithiasis without acute inflammation.Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: History of bilateral breast masses. Currently 5 months pregnant. Previous left breast surgery for a fibroadenoma. A targeted bilateral ultrasound was performed for the areas where the patient states she has known masses. Numerous bilateral typically benign morphology masses are present. In the left breast, multiple masses are seen at the 10:00, 3:00 and 1:00 positions. The largest masses are located near 3:00, with measurements of up to 2.2 cm. Within the right breast, multiple benign morphology masses are also present, at the 6:00, 7:00, 9:00 and 12:00 positions. The largest of these measures up to about 2.4 cm.

Output: Numerous bilateral benign morphology masses measuring up to several centimeters in size. These are highly likely to represent fibroadenomas. Correlation with physical examination is recommended. Biopsy or surgical intervention could be considered for the largest masses based on symptoms. If no tissue is obtained, then a 6 month ultrasound follow-up is suggested.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed.