Instruction: Generate impression based on medical findings.

Input: Female 29 years old Reason: 29 year-old female with epigastric tenderness, abdominal ultrasound requested to further evaluate History: as above LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 14.5 cm in length. The parenchyma is mildly coarse and echogenic. No suspicious hepatic lesion.BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 2 mm in thickness. Murphy's sign is negative.Common duct measures 4 mm. PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 10.6 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 10.7 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 10.5 cm in length. The spleen is unremarkable.OTHER: No significant abnormalities noted.

Output: Nonspecific diffuse mildly coarse and echogenic liver, may represent fatty infiltration or parenchymal dysfunction. No suspicious hepatic lesion. No evidence of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Female 44 years old Reason: stones RIGHT KIDNEY: The right kidney measures 9.4 cm. Increased renal cortical echogenicity. Lower pole shadowing echogenic focus, no corresponding twinkle artifact delineated but a calculus favored, measuring up to 6 mm. No hydronephrosis is present. LEFT KIDNEY: The left kidney measures 11.1 cm. Increased renal cortical echogenicity. Previously seen left intrarenal nephrolithiasis not well visualized. No hydronephrosis is present. BLADDER: Visualized portions unremarkable.

Output: Right-sided nonobstructing intrarenal nephrolithiasis.Increased renal cortical echogenicity, suggestive of underlying medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old. Reason: evaluating mass in left upper arm. DDx: lipoma, cystic lesion, malignancy. History: well circumscribed, soft mass to Left upper arm, present x 1.5 months & increasing in size. Non-tender. At time of exam, approximately 2 cm x 2 cm. Well-defined focus in the subcutaneous tissues of the left upper extremity is present which is isoechoic to surrounding tissue. This focus measures 2.8 x 1.4 x 3.0 cm with minimal internal vascularity.

Output: While this focus in the left upper extremity has an imaging appearance consistent with a lipoma, the ability of ultrasound to characterize subcutaneous lesions is limited. If there is continued clinical concern, then an MRI can be obtained.


Instruction: Generate impression based on medical findings.

Input: Left groin pain. Evaluate for renal calculus. RIGHT KIDNEY: Right kidney is normal in size and echotexture measuring 11.6 cm in length. Within the interpolar region there is an 8 mm renal calculus. No associated hydroureteronephrosis.Within the interpolar region there is a hypoechoic masslike lesion which measures 2.6 x 2.2 x 2.1 cm. There is no internal calcification, however there appears to be internal vascularity.LEFT KIDNEY: Left kidney is normal in size and echotexture measuring 12.0 cm in length. There is a punctate hyperechoic focus in the inferior cortex which may represent an additional small (2 mm) stone.URINARY BLADDER: The bladder is partially decompressed limiting evaluation, however no bladder calculi or bladder wall abnormalities are evident.OTHER: No significant abnormalities noted.

Output: 1.8 mm right renal calculus and questionable additional punctate calculus on the left. No associated hydronephrosis.2.2.6 cm masslike lesion in the right interpolar region. While this may represent a prominent column of Bertin, malignancy cannot be entirely excluded on the basis of this exam. Further evaluation with MRI or dedicated renal CT is recommended for further characterization.Findings were communicated to the ordering physician Daniel Sulmasy via text page at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Reason: 58 yo M with aml on cytarabine and daunorubicin, now with inc bilirubin, r/o gallstones va obstruction, vs hepatic etiology History: asymp LIVER: Liver measures 16.1 cm with increased echogenicity. Portal vein is patent with normal direction and velocity of 0.2 m/s. No suspicious hepatic mass is noted.BILIARY TRACT: Common bile duct measures 6 mm. Sludge-filled gallbladder measuring 10.3 cm. Gallbladder wall measures 1.5 mm. No pericholecystic fluid collection. PANCREAS: Pancreas is not well seen due to overlying bowel gas.SPLEEN: Spleen measures 10.1 cm and is normal in echogenicity and configuration.KIDNEYS: Right kidney measures 12.1 cm with mildly increased echogenicity and without hydronephrosis. Left kidney measures 12.8 cm with mildly increased echogenicity and without hydronephrosis. No renal calculi identified. OTHER: No significant abnormalities noted.

Output: 1.Increased echogenicity of the liver compatible with hepatic steatosis. 2.Distended sludge-filled gallbladder without evidence of acute inflammation or biliary ductal dilatation. 3.Mildly increased bilateral renal echogenicity compatible with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Female 61 years old Reason: fatty liver eval for lesions History: Fatty liver LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 22 cm in length. The parenchyma is moderately echogenic. No focal hepatic lesions. Main portal vein is patent.BILIARY TRACT: The gallbladder is absent. Common duct measures 6 mm. PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 11.9 cm. The cortex is thinned and echogenic. No shadowing calculi or hydronephrosis is present. The left kidney measures 11.8 cm. The cortex is thinned and echogenic. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 10.9 cm. in length. OTHER: No ascites

Output: 1.Echogenic hepatic parenchyma compatible with fatty infiltration; Hepatomegaly.2.Echogenic thinned renal cortices compatible with renal parenchymal dysfunction.


Instruction: Generate impression based on medical findings.

Input: Male 45 years old Reason: RUQ pain, rule out biliary etiology History: as above LIVER: Liver measures 15.2 cm in length. The parenchyma is coarse in echotexture, no suspicious lesion seen. Liver contour is within normal limits. Main portal vein patent with normal directional flow, velocity measures 17 to 26 cm/s. BILIARY TRACT: Gallbladder unremarkable. No shadowing mobile intraluminal echogenic foci to suggest underlying cholelithiasis. No evidence of acute cholecystitis. No significant gallbladder distention, wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Not well seen in entirety due to overlying bowel gas.KIDNEYS: The right kidney measures 12 cm. The left kidney measures 12.4 cm. No hydronephrosis or perinephric free fluid.SPLEEN: The spleen measures 11 cm. in length. OTHER: No significant abnormality noted.

Output: Gallbladder unremarkable. No evidence of cholelithiasis or acute cholecystitis. No biliary duct dilatation.Mildly coarse liver parenchymal echotexture, may reflect underlying parenchymal disease/hepatic steatosis. No suspicious liver lesion delineated.


Instruction: Generate impression based on medical findings.

Input: Male 28 years old Reason: 28 yo with hbv known hemangioma please screen for new lesion History: occ RUQ pain LIMITED ABDOMENLIVER: Normal echogenicity of the parenchyma. Hyperechoic lesion near the liver capsule of the right liver compatible with known hemangioma.BILIARY TRACT: No gallbladder wall thickening, pericholecystic fluid, or positive sonographic Murphy's sign. No biliary dilation.PANCREAS: Visualized portions are unremarkable.KIDNEYS: The right kidney measures 14 cm. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 11 cm. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 10 cm. in length. OTHER: No significant abnormalities noted.

Output: 1.No new sonographic hepatic lesions.


Instruction: Generate impression based on medical findings.

Input: Assess thyroid nodule, evaluate for suspicious features and for adenopathy; it suspicious features present, is it amenable to ultrasound-guided FNA biopsy? RIGHT LOBE: Measures 4.6 x 2.2 x 2 cm. Posteriorly located lower pole subcentimeter cystic nodule (measuring up to 4 mm) present, small size makes reliable characterization difficult but tiny colloid cyst favored.LEFT LOBE: Measures 5.1 x 2.7 x 1.5 cm. Midpole round hypoechoic lesion (measuring 6 x 6 x 5 mm) with punctate echogenic foci within and posterior acoustic shadowing visualized. Appearance suspicious for thyroid malignancy.ISTHMUS: Isthmus normal in size measuring 0.3 cm.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Left-sided midpole round hypoechoic lesion (measuring 6 x 6 x 5 mm) with punctate echogenic foci that may reflect internal microcalcifications and posterior acoustic shadowing visualized. These features particularly the latter are suspicious of thyroid malignancy, specifically papillary thyroid cancer. Lesion is small but could be FNA biopsied (recommended).No suspicious adenopathy.


Instruction: Generate impression based on medical findings.

Input: Male 57 years old; Reason: assess for obstruction 57M pancreatic ca, s/p catheter-directed lysis for saddle embolism, now with elevated Cr after contrast dye History: elevated Cr RIGHT KIDNEY: The right kidney is not well visualized, it measures 12.6 cm in length. The echogenicity of the cortex is difficult to evaluate. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney is not well visualized, it measures 14.0 cm in length. The echogenicity of the cortex is difficult to evaluate. No shadowing calculi or hydronephrosis is present. URINARY BLADDER: The bladder is non-distended. Bilateral ureteral jets are visualized.OTHER: Mild ascites.

Output: 1. No hydronephrosis.2. Mild ascites.


Instruction: Generate impression based on medical findings.

Input: Female 20 years old Reason: is there gall bladder disease History: ruq abd pain LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 18 cm in length. The parenchyma is moderately echogenic. No suspicious hepatic lesions.BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 2 mm in thickness. Common duct measures 4 mm. PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 10 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 9.5 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 9.5 cm. in length. OTHER: No ascites. Main portal vein is patent with normal directional flow.

Output: 1.No sonographic findings of cholelithiasis.


Instruction: Generate impression based on medical findings.

Input: 34-year-old female with a history of cholecystectomy presents with elevated liver enzymes. LIVER: The liver measures 16.1 cm. Increased echogenicity of the liver without discrete focal lesion. The portal vein is patent with antegrade flow.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. The common bile duct measures 6.9 mm, the upper limits of normal and likely related to the prior cholecystectomy.PANCREAS: The visualized portions of the pancreas are unremarkable.RIGHT KIDNEY: The right kidney measures 10.9 cm and is normal in echogenicity. LEFT KIDNEY: The left kidney measures 10.7 cm and is normal in echogenicity.SPLEEN: The spleen measures 9.6 cm.OTHER: No significant abnormalities noted.

Output: Increased echogenicity of the liver suggestive of fatty infiltration.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with right upper quadrant abdominal pain, rule out cholecystitis LIVER: The liver measures 16.7 cm. Increased echogenicity is suggestive of fatty infiltration.GALLBLADDER, BILIARY TRACT: There is cholelithiasis, gallbladder sludge, mild pericholecystic fluid, and mild gallbladder wall thickening. Negative sonographic Murphy's sign. No biliary dilatation. Stent is questionably seen.PANCREAS: Pancreas is not well-visualized.RIGHT KIDNEY: The right kidney measures 12. 8 cm. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present.LEFT KIDNEY: The left kidney measures 13 cm. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present.SPLEEN: The spleen measures 11.1 cm in length.

Output: 1. Cluster of findings described above, in conjunction with CT findings, can be seen in mild acute cholecystitis.2. Fatty liver.THESE RESULTS WERE DISCUSSED WITH DR. PULIMI, SANDEEP WITH READ BACK OF REPORT ON 7/31/15 AT 2:43 PM.


Instruction: Generate impression based on medical findings.

Input: Ms. Skwara is a 20 year old female presenting with a four day history of right breast tenderness/erythema/swelling. Family history of breast cancer in maternal grandmother. Upon physical exam of the right periareolar breast, there is a hard mass along with overlying skin thickening and redness. In the right breast 1:00 location, approximately 1 cm from the nipple, there is a lobulated hypoechoic mass measuring 2.9 x 2.3 x 2.3 cm. This mass is associated with floating debris, marked vascularity and overlying skin thickening (measuring up to 4 mm). Sonographic findings compatible with right breast abscess.

Output: 3 cm right breast abscess with overlying skin thickening. Surgical consultation is warranted for further evaluation and treatment. The patient is scheduled to see Dr. Chhablani immediately after this appt. BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation.


Instruction: Generate impression based on medical findings.

Input: Male 70 years old Reason: Ultrasound kidneys and bladder with post void residual. End stage renal disease on PD, recently no urine output, decreased weight, recent blood in urine. RIGHT KIDNEY: The right kidney is atrophic, measuring 6.8 cm. Echogenic renal cortex. No hydronephrosis is present. Upper pole renal cystic focus measuring 2 x 1.9 x by 1.8 cm. Nonobstructing nephrolithiasis.LEFT KIDNEY: The left kidney measures is atrophic, measuring 7.2 cm. No shadowing calculi or hydronephrosis is present. Upper pole cystic focus measuring 1.9 x 1.6 x 1.6 cm. BLADDER: Pre-void volume of 68 mL, postvoid residual volume of 46 mL.OTHER: Incompletely imaged ascites.

Output: Atrophic echogenic kidneys, compatible with medical renal disease.Nonobstructing right renal nephrolithiasis. Bilateral renal cystic foci.Incompletely imaged ascites.


Instruction: Generate impression based on medical findings.

Input: Male 29 years old Reason: pre- heart transplant w/u History: pre- heart transplant w/u LIVER: Liver measures 17.4 cm in length. The parenchyma heterogenous with coarsened echogenicity is nonspecific but may reflect fatty liver infiltration. No focal hepatic lesion is identified.Main portal vein is patent with hepatopedal flow.BILIARY TRACT: Gallbladder unremarkable. No significant gallbladder distention, wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 13.0 cm. The left kidney measures 12.5 cm. There is no hydronephrosis or shadowing renal calculus.SPLEEN: The spleen measures 9.6 cm. in length. ABDOMINAL AORTA:Proximal: Not well visualized due to overlying bowel gas.Mid: 1.7 x 1.7 x 1.7 cmDistal: 1.9 x 1.7 x 1.9 cmRight common iliac artery: Not well visualized due to overlying bowel gas.Left common iliac artery: Not well visualized due to overlying bowel gas.INFERIOR VENA CAVA: Visualized portion of the IVC is patent with normal flow.OTHER: No significant abnormality noted.

Output: Heterogeneous parenchyma, of the liver may reflect fatty liver infiltration. No evidence of cholelithiasis.


Instruction: Generate impression based on medical findings.

Input: Female 52 years old; Reason: 52 yo F with DM, HTN, cervical cancer with self catherization and worsening renal function. Eval for cyst, mass, hydronephrosis, other History: increased cr RIGHT KIDNEY: The right kidney measures 9 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. A couple subcentimeter simple appearing cysts are seen.LEFT KIDNEY: The left kidney measures 9 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. Bladder is decompressed, limiting evaluationOTHER: No significant abnormalities noted.

Output: 1.No hydronephrosis or obvious mass. 2.Bilateral echogenic kidneys can be seen in nonspecific medical renal disease.


Instruction: Generate impression based on medical findings.

Input: 71-year-old male with asymptomatic gallbladder wall thickening seen on recent CT scan. LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 15.0 cm in length. The parenchyma is mildly echogenic.BILIARY TRACT: Multiple immobile, polypoid lesions along the gallbladder wall measure 1.7 cm in length. The gallbladder wall measures about 6 mm at its thickest point. Common duct measures 4 mm.PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 8.8 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.The left kidney measures 10 point cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.SPLEEN: The spleen measures 9 point cm. in length.OTHER: No significant abnormalities noted.

Output: 1.Multiple immobile, polypoid lesions within the gallbladder wall; neoplasm cannot be excluded.2.Mildly echogenic liver is compatible with steatosis.These findings were text paged to Jennifer Paruch on 1/19/2016 at 0440 PM.


Instruction: Generate impression based on medical findings.

Input: Male 54 years old Reason: RUQ History: cholestasis LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 18.9 cm in length. The parenchyma is mildly coarse and echogenic . No focal hepatic lesions. Main portal vein is patent with normal directional flow.BILIARY TRACT: The gallbladder has echogenic calculi with posterior acoustic shadowing. Wall measures 2 mm in thickness. No pericholecystic fluid. Common duct measures 4-mm. PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 13.9 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. The left kidney measures 14.1 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 13.0 cm. in length. OTHER: Small right pleural effusion. No abdominal ascites.

Output: 1.Cholelithiasis without sonographic findings of acute cholecystitis.2.Echogenic coarsened hepatic parenchyma; correlate with liver enzymes for signs of chronic liver disease.


Instruction: Generate impression based on medical findings.

Input: 32-year-old female with history of thyroid nodules, evaluate. RIGHT LOBE MEASUREMENTS: 5.4 x 2.1 x 2.8 cm, previously 6.6 x 2.0 x 2.7 cm.LEFT LOBE MEASUREMENTS: 4.8 x 2.0 x 2.0 cm, previously 5.6 x 1.9 x 2.7 cm.ISTHMUS MEASUREMENT: 0.2 cmRIGHT LOBE: The right lobe of the thyroid demonstrates a heterogenous echotexture with multiple small nodules. A small lower pole nodule measures 1.4 x 1.0 x 1.5 cm, as compared to 2.0 x 1.4 x 1.1 cm on prior exam, demonstrating heterogenous echotexture with cystic components and no significant internal vascularity, not significant changed as compared to prior exam. The midpole nodule measures 1.0 x 0.7 x 0.9 cm, previously 1.2 x 1.0 x 0.6 cm, heterogenous in echotexture with cystic components and minimal internal vascularity, similar to prior exam.LEFT LOBE: The left thyroid lobe demonstrates a heterogenous echotexture with multiple small nodules. A lower pole nodule measures 1.1 x 0.6 x 0.6 cm, previously 0.6 x 0.5 x 0.5 cm, heterogenous in echotexture with cystic components and no significant internal vascularity. Additional new nodule in the inferior pole measures 1.0 x0.6 x 0.6 cm, with heterogenous echotexture and cystic components, is identified.ISTHMUS: No significant abnormality noted.LYMPH NODES: No cervical lymphadenopathy.OTHER: No significant abnormality noted.

Output: Diffusely heterogenous thyroid with multiple nodules, as above.


Instruction: Generate impression based on medical findings.

Input: Female 67 years old Reason: 66 year old presenting with low platelet concerning for possible congestion/liver abnormality History: as above LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 19.4 cm in length. The parenchyma is normal in echotexture. No focal hepatic lesion is identified. Prominent hepatic veins and IVC noted. The portal vein is patent and pulsatile.BILIARY TRACT: The gallbladder has echogenic calculi with posterior acoustic shadowing and sludge. Murphy's sign is negative. Wall measures 2 mm in thickness. The common bile duct measures 2 mm.PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 9.4 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. Right lower pole cyst measures 1.2 x 1.1 x 1.1 cm.The left kidney measures 8.7 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. Few simple cysts, the largest measuring 1.9 x 1.9 x 1.6 cm.SPLEEN: The spleen measures 7.7 cm in length. OTHER: Small volume ascites.

Output: 1.Cholelithiasis, without any secondary evidence of acute cholecystitis.2.Small volume ascites and prominent hepatic veins, probably secondary to right-sided heart failure.3.Echogenic kidneys, probable medical renal disease. No hydronephrosis, renal calculus or suspicious lesion.4.Mild hepatomegaly, with no focal lesion identified.


Instruction: Generate impression based on medical findings.

Input: 76-year-old male with history of HCV, please rule out hepatocellular carcinoma. LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 16.2 cm in length. The parenchyma demonstrates coarsened echotexture. No masses visualized. Portal venous flow is normal.BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 0.1 cm in thickness. Common duct measures 0.3 cm in thickness. KIDNEYS: The right kidney measures 13.7 cm. Including a superior pole cyst that measures about 5 cm, unchanged from prior. No hydronephrosis or stones are visualized.The left kidney measures 11.6 cm. No hydronephrosis or stones are visualized. SPLEEN: The spleen measures 10.1 cm. in length. No significant abnormality.OTHER: No significant abnormalities noted.

Output: Coarsened hepatic echotexture is unchanged from prior examination. No hepatic mass is appreciated.


Instruction: Generate impression based on medical findings.

Input: Male 13 months old with undescended testicles. RIGHT TESTIS: The right testicle measures 0.8 x 1.3 x 0.8 cm. It is normal in echogenicity and has normal Doppler waveforms but is located within the right groin. LEFT TESTIS: The left testicle measures 0.9 x 1.3 x 0.6 cm and is normal in echogenicity with normal arterial waveforms. It is located within the left groin which also contains a small amount of nonloculated fluid.RIGHT EPIDIDYMIS: The right epididymis measures 0.6 x 0.5 cm and is normal in sonographic appearance.LEFT EPIDIDYMIS: The left epididymis measures 0.7 x 0.3 x 0.2 cm and has a normal sonographic appearance.OTHER: No significant abnormalities noted.

Output: Both testes are in the groin.


Instruction: Generate impression based on medical findings.

Input: Female 73 years old Reason: eval biliary tree, porcelain gallbladder seen on CT chest History: eval biliary tree, porcelain gallbladder seen on CT chest LIVER: Liver measures 14.0 cm in length. The parenchyma is normal in echotexture. 2 hyperechoic well-defined lesions are seen in the right hepatic lobe. The more peripheral lesion measures 0.9 x 0.8 x 0.8 cm. The more medial lesion measures 1.1 x 1.5 x 1.1 cm. Both exhibit through transmission artifact and likely correlate to lesions seen on recent CT. While the lesions may represent hemangiomas but these are incompletely characterized.Main portal vein is patent with hepatopedal flow.BILIARY TRACT: There is a large shadowing gallstone within the lumen of the gallbladder. The gallbladder appears small and contracted around this stone, the gallbladder wall measures 0.2 cm and while not thickened appears chronically inflamed. There is no gallbladder distention or pericholecystic fluid. Negative sonographic Murphy's. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 9.8 cm. The left kidney measures 9.0 cm. No hydronephrosis or shadowing renal calculus.SPLEEN: The spleen measures 8.5 cm. in length. OTHER: No significant abnormality noted.

Output: 1.Cholelithiasis with without evidence of acute cholecystitis. Gallbladder appears contracted around a gallstone which may reflect chronic inflammation. No intrahepatic or extrahepatic biliary dilatation.2.Right hepatic lobe hyperechoic lesions may represent hemangiomas, but these are incompletely characterized.


Instruction: Generate impression based on medical findings.

Input: Female 53 years old; Reason: 53 y.o. with HPT. History: HPT The thyroid gland is diffusely hypervascular.RIGHT LOBE MEASUREMENTS: 4.4 x 1.1 x 1.7 cmLEFT LOBE MEASUREMENTS: 4.5 x 0.9 x 1.6 cmISTHMUS MEASUREMENT: 0.2 cmRIGHT LOBE: Scattered subcentimeter solid and cystic nodules within the right thyroid lobe. A reference predominantly solid nodule in the mid right thyroid gland measures 0.4 x 0.3 x 0.2 cm.LEFT LOBE: Multiple subcentimeter nodules identified in the left thyroid lobe. A reference solid hyperechoic nodule superiorly in the left lobe measures 0.4 x 0.3 x 0.5 cm.ISTHMUS: No significant abnormality noted.LYMPH NODES: Mildly prominent bilateral neck lymph nodes demonstrate benign morphology.

Output: 1.No evidence of parathyroid adenoma.2.Hypervascular thyroid gland with multiple subcentimeter thyroid nodules.


Instruction: Generate impression based on medical findings.

Input: Assess for right-sided abnormality, evaluate for possible right-sided thyromegaly RIGHT LOBE: Measures 4.6 x 2.3 x 1.8 cm. No discrete thyroid nodule.LEFT LOBE: Measures 3.6 x 2.1 x 1.4 cm. No discrete thyroid nodule.ISTHMUS: Measures 3 mm.LYMPH NODES: No suspicious lymphadenopathy. Bilateral level 2 lymph nodes seen with fatty hila.OTHER: No significant abnormality noted.

Output: Mildly asymmetrically larger right lobe, measurements above. No discrete thyroid nodule.


Instruction: Generate impression based on medical findings.

Input: Female 35 years old; Reason: Patient has bilateral renal transplant and having trouble urinating History: r/o obstructionj Renal transplant graft in the left iliac fossa. The transplant kidney measures 13.5 cm in length. There is mild pelvocaliectasis. The renal parenchyma is mildly echogenic suggesting renal dysfunction, however it is normal in thickness.URINARY BLADDER: The bladder is normal in size and wall thickness.OTHER: No significant abnormalities noted.

Output: 1.Mild pelvocaliectasis. Echogenic renal parenchyma suggestive of parenchymal dysfunction.


Instruction: Generate impression based on medical findings.

Input: Female 70 years old; Reason: AKI, pls assess for urinary obstruction History: AKI RIGHT KIDNEY: The right kidney measures 10.0 cm in length. Echogenicity of the cortex is difficult to evaluate due to poor penetration. No hydronephrosis is seen.LEFT KIDNEY: The left kidney measures 10.1 cm in length. Echogenicity cortex is difficult to evaluate due to poor penetration. No hydronephrosis is seen.URINARY BLADDER: The urinary bladder is visualized without any significant abnormalities.

Output: Sonographic examination of the kidneys is limited due to body habitus and poor penetration. No definite hydronephrosis is seen.


Instruction: Generate impression based on medical findings.

Input: History of thyroid cancer, evaluate for recurrence RIGHT LOBE: Status post thyroidectomy. No evidence of local tumor recurrence.LEFT LOBE: Status post thyroidectomy. No evidence of local tumor recurrence.ISTHMUS: Status post thyroidectomy. No evidence of local tumor recurrence.LYMPH NODES: Benign appearing neck lymph nodes. Possible right level 5 palpable subcentimeter calcified lymph node, measuring up to 4 mm.

Output: Postoperative thyroid bed unremarkable.Benign appearing neck lymph nodes.


Instruction: Generate impression based on medical findings.

Input: Post thyroidectomy and I-131 ablation with metastases to lung. Evaluate for masses. RIGHT LOBE: Post thyroidectomy. No remnant thyroid.LEFT LOBE: Post thyroidectomy. No remnant thyroid.ISTHMUS: Post thyroidectomy. No remnant thyroid.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Left level 4 hypoechoic lymph node measures 0.9 x 0.4 x 1.1 cm, mildly prominent. Left level 2 morphologically normal lymph node measures 0.8 x 0.4 x 0.9 cm. Right level 2 morphologically normal lymph node measures 0.5 x 0.2 x 0.5 cm. OTHER: No significant abnormality noted.

Output: Mildly enlarged left level 4 hypoechoic lymph node, and additional smaller lymph nodes. Attention on future imaging recommended.


Instruction: Generate impression based on medical findings.

Input: Assess for hydronephrosis RIGHT KIDNEY: Measures 14.6 cm. No hydronephrosis. Mild prominence of renal collecting system. No perinephric free fluid. No shadowing intrarenal echogenic focus seen to suggest underlying nephrolithiasis.LEFT KIDNEY: Measures 13.5 cm. Mild hydronephrosis. No perinephric free fluid. No shadowing intrarenal echogenic focus seen to suggest underlying nephrolithiasis.OTHER: Partially imaged suprapubic urinary catheter.

Output: Mild left greater than right hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Male 48 years old; Reason: evaluate for hydronephrosis History: AKI on CKD RIGHT KIDNEY: The right kidney measures 10.5 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 10.6 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present.  URINARY BLADDER: No significant abnormality notedOTHER: No significant abnormalities noted.

Output: 1.No sonographic findings of nephrolithiasis or hydronephrosis.2.Echogenic renal cortices suggestive of medical renal disease.


Instruction: Generate impression based on medical findings.

Input: 65-year-old female with family history of kidney disease and elevated creatinine. Reason: Evaluate for kidney size and hydronephrosis. RIGHT KIDNEY: The right kidney measures 10.1 cm. Echogenic renal parenchyma. No shadowing calculi or hydronephrosis is present.LEFT KIDNEY: The left kidney measures 9.8 cm. Echogenic renal parenchyma. No shadowing calculi or hydronephrosis is present.OTHER: The bladder is decompressed, limiting its evaluation.

Output: Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction.


Instruction: Generate impression based on medical findings.

Input: Female 46 years old Reason: Liver ultrasound to evaluate for fatty liver disease vs. liver lesions. History: Rising liver function tests. LIVER: Mild hepatomegaly, liver measures 17.9 cm in length. The parenchyma is echogenic. No suspicious lesion delineated. Main portal vein patent with normal directional flow, velocity measures 18.9 cm/s. BILIARY TRACT: Cholelithiasis in contracted gallbladder. Per ultrasound technologist negative sonographic Murphy's sign. No pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Not well seen in entirety due to overlying bowel gas. KIDNEYS: The right kidney measures 10.2 cm. The left kidney measures 9.2 cm. No hydronephrosis or perinephric free fluid.SPLEEN: The spleen measures 7.9 cm. in length. OTHER: No significant abnormality noted.

Output: Cholelithiasis in contracted gallbladder. No evidence of acute cholecystitis.Mild hepatomegaly and hepatic steatosis.


Instruction: Generate impression based on medical findings.

Input: Reason: 68yo F w/ likely thyroid mass, eval History: as above RIGHT LOBE MEASUREMENTS: 5.2 x 1.6 x 1.2 cmLEFT LOBE MEASUREMENTS: 4.4 x 1.5 x 1.2 cmISTHMUS MEASUREMENTS: 0.3 cm APRIGHT LOBE: In the inferior right thyroid, there is a 1.7 x 1.0 cm mixed solid and cystic nodule with apparent smaller cystic spaces and a lobulated morphology with internal vascularity.LEFT LOBE: A somewhat spongiform-appearing nodule in the inferior left thyroid measures 1.1 x 0.8 x 1.0 cm. Favor colloid nodule. Couple smaller adjacent predominantly anechoic cystic spaces are also seen.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: Large mass inferior to the right thyroid on CT is not visualized.

Output: Bilateral thyroid nodules as above. A dominant right nodule is amenable to biopsy if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Male 60 years old Reason: cirrhosis History: elev LFTs, ruq pain LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 15.6 cm in length. The parenchyma is mildly coarse. No focal hepatic lesion is identified. Patent portal vein with normal directional flow.BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 2 mm in thickness. The common bile duct measures 4 mm.PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 10.8 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.Limited visualization of the left kidney due to patient positioning. The left kidney measures 10.4 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.SPLEEN: The spleen measures 11.8 cm in length. OTHER: Small volume ascites. Possible small right pleural effusion.

Output: 1.Small volume ascites.2.Possible small right pleural effusion.3.Mildly coarse liver, may represent fatty infiltration/parenchymal dysfunction. No suspicious lesion identified.


Instruction: Generate impression based on medical findings.

Input: Male 79 years old Reason: r/o cholecystitis History: abdominal pain LIMITED ABDOMENBILIARY TRACT: The gallbladder has echogenic calculi with posterior acoustic shadowing. Wall measures 11 mm in thickness. There is wall edema, hyperemia and trace pericholecystic fluid .Common duct measures 6 mm. OTHER: No drainable fluid collections. Main portal vein is patent. Imaged portion of the hepatic parenchyma is unremarkable.

Output: 1.Sonographic findings of acute cholecystitis with gallbladder wall thickening, hyperemia in the setting of cholelithiasis.2.No ductal dilatation.3.Patent main portal vein.4.Patient was escorted to the emergency department for further evaluation and treatment.


Instruction: Generate impression based on medical findings.

Input: Female 72 years old Reason: r/o acalculous cholecystitis History: new onset RUQ pain LIMITED ABDOMENLIVER: Increased echogenicity and mild heterogeneity to the echotexture.BILIARY TRACT: No biliary dilatation. Gallbladder is mildly contracted with no significant wall thickening or pericholecystic fluid. Portal vein is patentPANCREAS: Visualized portions are unremarkable.KIDNEYS: The right kidney measures 11 cm. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. Several predominantly anechoic cystic lesions are seen throughout the right kidney, the largest measuring up to 2.2 cm, likely cysts.The left kidney measures 13 cm. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 8 cm. in length. OTHER: No significant abnormalities noted.

Output: 1.Fatty infiltration of the liver. No sonographic signs of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Constipation. Imperforate anus repair.VIEW: Abdomen AP (one view) 10/19/15 A moderate amount of feces is present in the colon. No dilated bowel loops are identified. No spinal segmentation anomalies are seen.

Output: Moderate fecal burden.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old. Reason: cholecystitis on CT scan. Cirrhosis History: abdominal pain, fevers. LIVER: Liver measures 15.9 cm in length. Coarse parenchymal echotexture with a nodular contour consistent with cirrhosis. No focal hepatic lesion or ascites. Main portal vein is patent with a normal direction of flow.BILIARY TRACT: Cholelithiasis with gallbladder wall thickening measuring 13 mm. No pericholecystic fluid. Murphy's sign was negative. No biliary ductal dilatation. Common bile duct measures 3 mm.PANCREAS: The visualized portion of the pancreas is unremarkable. The tail is obscured by overlying bowel gas.SPLEEN: Spleen is enlarged and measures 16.2 cm length with normal echotexture.RIGHT KIDNEY: Right kidney measures 11.9 cm in length. Right upper pole hypoechoic focus with internal complexity and indistinct margins measures 2.2 x 1.8 x 2.1 cm and corresponds to the focus seen on prior CT. Right inferior pole renal cyst measures 1.8 x 1.8 x 1.4 cm. No hydronephrosis or shadowing calculi.OTHER: Left kidney measures 14 cm in length. Left lower pole hypoechoic focus measures 2.9 x 2.3 x 2.3 cm and likely represents a complex cyst. No hydronephrosis or shadowing calculi.

Output: 1. Cholelithiasis and gallbladder wall thickening which is associated with a negative sonographic Murphy's sign. This is favored to be secondary to the low protein state rather than acute inflammation.2. Right upper pole hypoechoic focus with internal complexity and indistinct margins corresponds to the focus seen on prior CT. While this could represent a renal abscess, continued sonographic follow-up to resolution is recommended. 3. Cirrhotic morphology without suspicious hepatic lesion.


Instruction: Generate impression based on medical findings.

Input: Female 19 years old Reason: pyelonephritis vs. Renal abscess History: flank pain RIGHT KIDNEY: The right kidney measures 11.2 cm in length and demonstrates normal parenchymal echogenicity. There is mild right-sided hydronephrosis.LEFT KIDNEY: The left kidney measures 11.6 cm in length and demonstrates normal parenchymal echogenicity. There is mild/moderate left-sided hydronephrosis and two punctate nonobstructing renal stones in the inferior pole calices.BLADDER: No significant abnormality noted.OTHER: Note is made of an intrauterine pregnancy.

Output: Mild right and mild/moderate left hydronephrosis. Two punctate nonobstructing left-sided renal stones.


Instruction: Generate impression based on medical findings.

Input: 35 year old woman s/p removal of a thigh mass, evaluate for hematoma. Two drains are seen, one near the upper thigh and one more distally. There are extensive edematous changes to the subcutaneous soft tissues of the thigh. There is a longitudinally oriented complex fluid collection which measures an estimated 35 cm in length.

Output: There is a longitudinally oriented complex fluid collection which measures an estimated 35 cm in length. At the time of the initial formal read-out, the clinical service had already been notified of this finding by the technologist.


Instruction: Generate impression based on medical findings.

Input: Male 71 years old Reason: rule out biliary pathology History: elevated lft's, elevated T bilirubin. gram negative bacteremia LIVER: Liver measures 15.3 cm in length. The parenchyma is moderately coarse and echogenic which is compatible with parenchymal dysfunction.Main portal vein is patent with hepatopedal flow and a peak velocity of 0.2 m/s.BILIARY TRACT: Gallbladder is contracted and filled with biliary sludge and shadowing gallstones. No significant gallbladder distention, wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation. Negative sonographic Murphy's sign.PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 11.2 cm. At the mid pole of the right kidney is an anechoic lesion with posterior acoustic enhancement seen on prior ultrasound, however, there are some internal echoes which are nonspecific and may be due to artifact versus internal debris. The left kidney measures 9.8 cm. No hydronephrosis or shadowing renal calculus is seen bilaterally.SPLEEN: The spleen measures 7.3 cm. in length. OTHER: No significant abnormality noted.

Output: 1.Moderately coarse and echogenic liver parenchyma which may reflect may reflect parenchymal dysfunction. There is no intrahepatic or extrahepatic biliary ductal dilatation.2.Cholelithiasis and sludge filled gallbladder without evidence of acute cholecystitis.3.Right midpole cystic appearing lesion with nonspecific internal echoes.


Instruction: Generate impression based on medical findings.

Input: Female 79 years old with left flank mass, lipoma Circumscribed and mildly hypoechoic oblong mass measuring 2.1 x 1.5 x 2.0 cm without increased vascularity.

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


Instruction: Generate impression based on medical findings.

Input: Male 70 years old Reason: Abdominal wall hernia marked with X; rule out bowel involvement History: firm hernia A hernia sac is noted along the right mid abdominal wall measuring approximately 5.6 x 3.4 cm, which contains both mesenteric fat as well as bowel. No fluid within the hernia sac is identified.

Output: Bowel containing hernia as detailed above.


Instruction: Generate impression based on medical findings.

Input: Male 78 years old; Reason: Pt s/p subtotal thyroidectomy for papillary microca. Now with stable left side level 2 mass, follow-up exam for interval change over 1 year. RIGHT LOBE MEASUREMENTS: Surgically absent.LEFT LOBE MEASUREMENTS: Partially removed. ISTHMUS MEASUREMENT: Surgically absent.RIGHT LOBE: A mildly hypoechoic focus in the right thyroid bed measures 0.4 x 0.8 x 0.3 cm (previously 0.4 x 0.3 x 0.6 cm), not significantly changed in size or appearance since the prior exam.LEFT LOBE: Residual tissue in the thyroid bed measures 1.1 x 0.6 x 1.0 cm, it is isoechoic to muscle and unchanged in configuration and echogenicity. It may represent residual thyroid parenchyma.ISTHMUS: Stable appearance of a mildly hyperechoic 1.1 x 0.6 x 1.0 cm soft tissue focus in the left isthmus bed (previously 1.1 x 0.4 x 1.3 cm).LYMPH NODES: 1.1 x 0.9 x 0.3 cm left level 2 lymph node previously measured 0.8 x 0.8 x 0.4 cm. It has a normal sonographic appearance of the fatty hilum.OTHER: The previously seen cystic structure in the left posterior/inferior auricular region is not identified on today's exam. The patient reported that a palpable abnormality this region has resolved.

Output: 1.Status post right thyroidectomy and partial left thyroidectomy with stable soft tissue foci bilaterally.2.The previously seen cystic structure in the left posterior/inferior auricular region has resolved.


Instruction: Generate impression based on medical findings.

Input: Male 78 years old Reason: elevated T bilirubin rule out biliary pathology History: elevated T bilirubin LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 16 cm in length. The parenchyma is moderately echogenic. There is no solid hepatic lesions. No intrahepatic biliary ductal dilatation. Portal vein is patent. BILIARY TRACT: The gallbladder contains layering sludge. Wall measures 3 mm in thickness. Trace pericholecystic fluid. Common duct measures 2 mm. PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 15.7 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. The left kidney measures 11.1 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 11.1 cm. in length. OTHER: Bilateral pleural effusions.

Output: 1.No biliary obstruction.2.Gallbladder sludge.


Instruction: Generate impression based on medical findings.

Input: Male 38 years old Reason: ? biliary colic History: RUQ pain LIMITED ABDOMENLIVER: . Liver measures 15 cm in length. The parenchyma is of normal echotexture. The main portal vein demonstrates hepatopetal flow with a peak systolic velocity of 29.2 cm/s.BILIARY TRACT: The gallbladder wall is thickened measuring 4 mm and the lumen is distended. There is small amount of pericholecystic fluid. The gallbladder lumen contains gallstones. No intra or extrahepatic biliary ductal dilatation. Common bile duct measures 3 mm in diameter. Findings associated positive Murphy sign.PANCREAS: The visualized pancreas appears within normal limits.KIDNEYS: The right kidney measures 11 cm. The cortex is of normal echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 12.4 cm. The cortex is of normal echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 10 cm in length. OTHER: No significant abnormalities noted.

Output: 1.Findings compatible with acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old. Reason: Evaluate thyroid nodule found on CT. History: none RIGHT LOBE MEASUREMENTS: 4.0 x 1.4 x 1.4 cmLEFT LOBE MEASUREMENTS: 4.8 x 2.4 x 2.3 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Homogeneous echotexture. Predominantly solid lower pole nodule measures 0.7 x 0.6 x 0.6 cm without worrisome features.LEFT LOBE: Homogeneous echotexture. Predominantly solid mid pole nodule measures 3.5 x 0.8 x 2.1 cm without worrisome features.ISTHMUS: Homogeneous echotexture. Spongiform nodule measures 1.4 x 1.0 x 1.6 cm.PARATHYROID GLANDS: Extrathyroidal, hypoechoic focus measures 2.0 x 0.9 x 1.0 cm posterior and inferior to the left thyroid lobe.LYMPH NODES: Benign-appearing right level 3 neck lymph node measures 1.4 x 0.3 x 1.0 cmOTHER: No significant abnormality noted.

Output: 1. Bilateral thyroid nodules which are favored to be benign in etiology.2. Extrathyroidal focus posterior and inferior to the left thyroid lobe which may represent a parathyroid adenoma.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old. Reason: Pyelonephritis. Complicated anatomy. Please assess for abscess History: pyelo RIGHT KIDNEY: Right kidney measures 13.2 cm in length. Moderately severe right hydronephrosis similar to prior CT study. Proximal portion of the nephroureteral stent is visualized within the renal pelvis. Debris is present in the renal collecting system. No shadowing calculi or mass.LEFT KIDNEY: Left kidney measures 13.9 cm in length. Mild left hydronephrosis is slightly increased compared to prior CT study. Subcentimeter left inferior pole renal cyst is present. No shadowing calculi or mass.URINARY BLADDER: Neobladder bladder is significantly distended. Debris is present. Foley catheter and distal portion of the nephroureteral stent are visualized within the bladder.OTHER: No significant abnormalities noted.

Output: 1. Moderately severe right and mild left hydronephrosis.2. Significantly distended neobladder with Foley catheter in place suggests Foley catheter dysfunction.


Instruction: Generate impression based on medical findings.

Input: 26-year-old female with right upper quadrant pain LIVER: Echogenicity of the hepatic parenchyma is moderately increased, and echotexture is heterogeneous. No focal hepatic lesion or mass. The liver measures 14.6 cm in length. The main portal vein is patent with normal hepatopedal flow and velocity of 29 cm/s.GALLBLADDER, BILIARY TRACT: The gallbladder is normal in appearance. There is no pericholecystic fluid. No cholelithiasis. No dilatation or cystic changes are noted of the intrahepatic or extrahepatic biliary ducts. The common bile duct measures 0.3 cm in diameter. No choledocholithiasis.PANCREAS: The head and proximal body of the pancreas are normal. The tail is obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 10.0 cm in length and shows normal echotexture. No mass, stone or hydronephrosis.LEFT KIDNEY: The left kidney measures 11.4 cm in length and shows normal echotexture. No mass, stone or hydronephrosis.SPLEEN: The spleen is normal in echogenicity and measures 10.5 cm in length. OTHER: There is no free or loculated fluid.

Output: Moderately increased echogenicity and coarse echotexture of the hepatic parenchyma, consistent with fatty liver/hepatic parenchymal dysfunction. No hepatic mass or ductal dilatation.


Instruction: Generate impression based on medical findings.

Input: Female 50 years old with a history of thyroid cancer. Two year follow up study to evaluate for adenopathy, recurrence. RIGHT LOBE: Status post thyroidectomy with no residual or recurrent mass.LEFT LOBE: Status post thyroidectomy with no residual or recurrent mass.ISTHMUS: Status post thyroidectomy with no residual or recurrent mass.LYMPH NODES: There is a stable left level 3 lymph node with a fatty hilum and benign appearance.OTHER: No significant abnormality noted.

Output: Status post thyroidectomy with no evidence of recurrent or residual disease.


Instruction: Generate impression based on medical findings.

Input: Evaluate for change in nodule, history of goiter RIGHT LOBE: Measures 3.6 x 1.6 x 1.3 cm. No discrete thyroid nodule seen.LEFT LOBE: Status post lobectomy. Echogenic soft tissue focus located in left thyroid bed measures 0.8 x 0.6 x 0.4 cm, may reflect residual thyroid tissue.ISTHMUS: No significant abnormality noted.LYMPH NODES: Left level 3 lymph node measuring 1.3 x 0.7 x 0.6 cmOTHER: No significant abnormality noted.

Output: Soft tissue focus in left thyroid bed may reflect residual thyroid tissue given fairly echogenic appearance.


Instruction: Generate impression based on medical findings.

Input: Left lower extremity cellulitis Diffuse subcutaneous edema without loculated fluid collection or abscess.

Output: Diffuse subcutaneous edema without loculated fluid collection or abscess


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old. Reason: bph, rule out hydronephrosis History: incomplete bladder emptying RIGHT KIDNEY: Right kidney measures 10.8 cm in length with increased cortical echogenicity. No hydronephrosis or shadowing calculi. Subcentimeter right mid pole presumed cyst measures 0.5 x 0.4 x 0.3 cm.LEFT KIDNEY: Left kidney is atrophic and measures 7.4 cm in length with increased cortical echogenicity. No hydronephrosis, shadowing calculi, or mass.URINARY BLADDER: Urinary bladder is distended and trabeculated.OTHER: No significant abnormalities noted.

Output: 1. Echogenic renal parenchyma bilaterally suggests medical renal disease/parenchymal dysfunction. No hydronephrosis.2. Trabeculated urinary bladder which could be due to in part to chronic outlet obstruction.


Instruction: Generate impression based on medical findings.

Input: Male 52 years old; Reason: please comment on kidney condition History: FeNa 1.8 %, Acute kidney injury RIGHT KIDNEY: The right kidney measures 12.4 cm in length. The cortex is increased in echogenicity. No worrisome renal mass, shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 13.0 cm in length. The cortex is increased in echogenicity. No worrisome renal mass, shadowing calculi or hydronephrosis is present. URINARY BLADDER: The bladder is decompressed by a Foley catheter.OTHER: Limited evaluation of the liver shows coarse, echogenic parenchyma.

Output: 1.Echogenic kidneys compatible with medical renal disease. No hydronephrosis.2.Coarse, echogenic liver compatible with hepatic steatosis/parenchymal dysfunction.


Instruction: Generate impression based on medical findings.

Input: 7-year-old female with pain on ambulation. Evaluate for septic joint.EXAMINATION: Sonogram left hip 12/9/2016 9:39 Sonographic evaluation of the left hip was performed. No joint effusion or other significant abnormality noted.

Output: Normal examination.


Instruction: Generate impression based on medical findings.

Input: Female 23 years old; Reason: ? nodules History: Hashimoto's, asymmetric gland RIGHT LOBE MEASUREMENTS: 5.5 x 1.7 x 1.5 cmLEFT LOBE MEASUREMENTS: 5.0 x 1.9 x 1.2 cmISTHMUS MEASUREMENT: 0.3 cmRIGHT LOBE: Hypoechoic irregular border solid nodule at the upper pole of the left lobe with small echogenic foci measures 5 x 5 x 6 mm.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.LYMPH NODES: Hypoechoic nodule inferior to the left lobe of the gland measures 7 x 4 x 5 mm and may represent either lymph node or a parathyroid gland.Additional lymph node in the left level 2 measures 2.2 x 0.7 x 0.3 cmOTHER: No significant abnormality noted.

Output: Subcentimeter solid left upper lobe nodule with some suspicious features. Follow up of the lesion is suggested.


Instruction: Generate impression based on medical findings.

Input: Reason: history of portal vein thrombosis and ongoing issues History: portal vein thrombosis LIVER: The size of the liver is within normal limits, measuring 15.3 cm in length. Slightly increased echogenicity suggestive of fatty infiltration. No focal lesions. Multiple collateral vessels are noted at the level of porta hepatis consistent with cavernous transmission of the portal vein.GALLBLADDER, BILIARY TRACT: No evidence of cholelithiasis. The gallbladder wall is not thickened, measuring 0.1 cm. There is no intra nor extrahepatic ductal dilation. The common bile duct measures 0.3 cm in caliber.PANCREAS: Poorly visualized due to overlying bowel gas.KIDNEYS: The right kidney measures 11 cm in length. Normal echogenicity. No focal lesions. No hydronephrosis.The left kidney measures 10.4 cm in length. There is an area of indentation noted within the mid pole of the left kidney, consistent with prior partial nephrectomy. Normal echogenicity. There is a nearly anechoic lesion with posterior acoustic enhancement noted within the inferior pole of the left kidney which measures 1.1 x 1 x 1.2 cm. This likely represent benign simple cyst. No hydronephrosis.SPLEEN: The spleen is slightly enlarged, measuring 13.9 cm in length. Normal echogenicity. No focal lesions.OTHER: No significant abnormalities noted.

Output: 1. Sequela of portal vein thrombosis with cavernous transformation of the portal vein.2. Fatty infiltration of the liver.3. Status post partial left nephrectomy.4. Benign simple cyst noted within the left kidney.


Instruction: Generate impression based on medical findings.

Input: 58-year-old male with pain over kidney. Reason: Assess for infection, stone, hydronephrosis. TRANSPLANT KIDNEY: The transplant kidney in the right iliac fossa measures 13.5 cm. The cortex is of normal echogenicity. No shadowing calculi or hydronephrosis is present.The native right kidney measures 6.3 cm. Limited imaging of the native right kidney demonstrates an echogenic parenchyma without worrisome mass, stone, or hydronephrosis.LEFT KIDNEY: The left kidney measures 5.4 cm. Limited imaging of the left kidney demonstrates an echogenic parenchyma without worrisome mass, stone, or hydronephrosis.OTHER: Bladder is nondistended.

Output: 1. No sonographic evidence of renal stones or hydronephrosis involving the transplant kidney.2. Atrophic native kidneys with echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass, stone, or hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Male 60 years old; Reason: cyst seen on MRI +calcifications, r/o renal cyst vs. Stone History: back pain RIGHT KIDNEY: The right kidney measures 12.0 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. Previously noted right renal cyst is not evident by ultrasound.LEFT KIDNEY: The left kidney measures 12.1 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present.  URINARY BLADDER: No significant abnormality notedOTHER: Hepatic parenchyma is mildly echogenic.

Output: 1.Echogenic renal cortices compatible with medical renal disease. No sonographic findings of nephrolithiasis or hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Female 63 years old Reason: History of Hepatitis C. Symptoms consistent with cholelithiasis. History: History of Hepatitis C. LIMITED ABDOMENLIVER: The liver measures 14.7 cm in length. The liver has a smooth contour. The parenchyma is mildly echogenic. No suspicious mass is identified. There is no ascites. The portal vein is patent and demonstrates hepatopetal flow with a peak velocity of 0.1 m/sec.BILIARY TRACT: The gallbladder is normal in appearance. There is no cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. The common duct measures 0.3 cm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The body and head of the pancreas are unremarkable. The tail is obscured by overlying bowel gas.KIDNEYS: The right kidney measures 11.2 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 10.6 cm. The cortex is normal in echogenicity. There is a 1.0 x 1.1 x 1.0 cm lower pole cyst with a thin septation. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 10.5 cm. in length.

Output: 1.No evidence of cholelithiasis or acute cholecystitis.2.Echogenic liver parenchyma which can be seen in setting of hepatic steatosis/parenchymal dysfunction. Portal venous flow is normal in direction but velocity is mildly decreased, nonspecific.


Instruction: Generate impression based on medical findings.

Input: Male 80 years old Reason: assess hydro, CKD History: hydro RIGHT KIDNEY: The right kidney measures 10.6 cm in length and demonstrates increased parenchymal echogenicity. There are multiple complex cysts within the right kidney, which contain internal septations and calcifications. The largest cyst measuring 2.6 x 3.5 x 3.7 cm, which is located in the superior pole. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.LEFT KIDNEY: The left kidney measures 7.5 cm in length and demonstrates increased parenchymal echogenicity. Multiple complex and minimally complex cysts are also identified within the left kidney, the largest in the inferior pole measuring 2.2 x 2.3 x 2.0 cm. Left nephrostomy tube is in place. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.BLADDER: No significant abnormality noted.OTHER: No significant abnormalities noted.

Output: 1.Multiple complex bilateral renal cysts as detailed above.2.Increased renal parenchymal echogenicity consistent with medical renal disease, but no evidence of hydronephrosis.3.Left nephrostomy tube in place.


Instruction: Generate impression based on medical findings.

Input: Primary hyperparathyroidism RIGHT LOBE: Measures 4.9 x 1.9 x 1.5 cm. Mildly vascular isoechoic nodule (primarily rim vascularity) seen inferior pole, measuring approximately 2.5 x 1.3 x 1.1 cm. No associated calcifications, small internal cystic elements.LEFT LOBE: Measures 5 x 1.4 x 1.3 cm. Subcentimeter hypoechoic nodule located in lower pole, measuring up to 0.5 cm.ISTHMUS: Thickened, measuring 0.7 cm.LYMPH NODES: No definite suspicious lymphadenopathy. Right level 3 lymph node with elongated configuration and suggestion of small fatty hilum, measuring 1.2 x 0.6 x 0.2 cm.OTHER: Located posterior to lower pole of left lobe is a hypoechoic ovoid focus measuring 0.7 x 0.4 x 0.4 cm, made be a parathyroid adenoma in appropriate clinical setting.

Output: 1. Located posterior to lower pole of left lobe is a hypoechoic ovoid focus measuring 0.7 x 0.4 x 0.4 cm, made be a parathyroid adenoma in appropriate clinical setting. Please refer to concomitant nuclear medicine scintigraphic imaging from same day for additional findings/assess for corresponding persistent radionuclide uptake in this focus.2. Mildly heterogeneous isoechoic inferior pole right-sided thyroid nodule measuring 2.5 cm, indeterminant, no internal calcifications.


Instruction: Generate impression based on medical findings.

Input: 82-year-old female with thyroid nodules on CT examination. Evaluate. RIGHT LOBE MEASUREMENTS: 4.7 x 1.9 x 1.9 cmLEFT LOBE MEASUREMENTS: 3.8 x 1.7 x 2 cmISTHMUS MEASUREMENTS: 2.0 cmRIGHT LOBE: The right lobe is heterogeneous in echotexture. There is a heterogeneous spongiform nodule in the midpole measuring 2 x 1.2 x 1.7 cm. There is an additional lower pole colloid nodule measuring 1 x 1.9 x 0.8 cm.LEFT LOBE: The left thyroid lobe is heterogeneous in echotexture with lower pole spongiform nodule measuring 3.1 x 1.6 x 2.0 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple thyroid nodules are favored to be benign in etiology.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with unknown medication history. Has some history of alcohol use. Presents with GI bleed and now has upturning LFTs. Exam limitations related to the portable technique.LIVER: Nonspecific diffuse hyperechogenicity of the liver. The liver measures 21 cm in craniocaudal diameter. There is a 1.7 x 1.6 x 1.2 cm anechoic cyst of the left hepatic lobe. Other scattered smaller anechoic structures are also felt to be cystic. The portal vein demonstrates normal hepatopedal flow.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. The gallbladder likely contains biliary sludge. No significant wall thickening.PANCREAS: The pancreas is obscured due to overlying bowel gas.SPLEEN: The spleen is enlarged measuring 14.5 cm in length.RIGHT KIDNEY: The right kidney measures 10.4 cm in length. No hydronephrosis. The left kidney measures 10.6 cm in length, and there is no definite hydronephrosis. OTHER: Bilateral pleural effusions and small volume ascites.

Output: 1. Nonspecific hyperechogenicity of the liver could be related to chronic liver disease versus fatty infiltration. Scattered anechoic foci are felt to be cysts. If there is clinical concern, confirmation with MRI would be helpful.2. Suspected biliary sludge. No evidence for acute cholecystitis.3. Bilateral pleural effusions and small volume ascites noted.4. Mild splenomegaly.


Instruction: Generate impression based on medical findings.

Input: Male 47 years old; Reason: elevated BP, inc in Cr, lower extremity swelling History: see above RIGHT KIDNEY: The right kidney measures 11.3 cm in length. The cortex is moderately echogenic. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 10.7 cm in length. The cortex is moderately echogenic. No shadowing calculi or hydronephrosis is present.  URINARY BLADDER: No significant abnormality notedOTHER: No significant abnormalities noted.

Output: 1.Bilaterally echogenic renal cortices compatible with medical renal disease/renal parenchymal dysfunction. No sonographic findings of hydronephrosis or nephrolithiasis.


Instruction: Generate impression based on medical findings.

Input: 73-year-old male with history of transaminitis. LIMITED ABDOMENLIVER: The liver has a smooth contour. The parenchyma is mildly coarse and echogenic. Liver measures 16.0 cm in length. The portal vein is tortuous at the level of the hilum; portal flow is hepatopedal. No suspicious masses. Redemonstration of a septated cyst is unchanged from prior examination and measures 1.3 x 1.4 x 1.3 cm.BILIARY TRACT: The gallbladder has echogenic calculi with posterior acoustic shadowing. No gallbladder wall thickening or pericholecystic fluid. Negative Murphy's sign. No biliary ductal dilation.PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 12.5 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.The left kidney measures 13.6 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. Redemonstration of cyst within the left kidney measuring 1.7 x 2.0 cm.SPLEEN: The spleen measures 14.7 cm. in length without significant abnormality.OTHER: Bilateral pleural effusion.

Output: 1.Liver parenchyma appears mildly coarsened and echogenic consistent with chronic hepatic dysfunction.2.Bilateral pleural effusions.3.Redemonstration of unchanged septated hepatic cyst and left kidney cyst.4.Mild splenomegaly.


Instruction: Generate impression based on medical findings.

Input: Female 80 years old; Reason: Right 1.5cm Thyroid nodule seen on neck CT, please ultrasound and also biopsy today. RIGHT LOBE MEASUREMENTS: 4.9 x 1.3 x 1.7 cmLEFT LOBE MEASUREMENTS: 4.7 x 1.5 x 1.4 cmISTHMUS MEASUREMENT: 0.4 cmRIGHT LOBE: Multiple cystic nodules are seen. A dominant nodule measuring 1.2 x 0.6 x 1.0 cm in the inferior pole with a nonspecific hyperechoic focus along the posterior aspect and no solid components that would be amenable to biopsy.LEFT LOBE: The left lobe contains multiple nodules, many of which are cystic. A heterogeneous, solid nodule in the mid pole measures 0.7 x 0.6 x 0.6 cm (image timestamp 08:56:06) no definite calcification.ISTHMUS: No significant abnormality noted.LYMPH NODES: Left level 5 lymph node measures 0.8 to 0.5 x 0.9 cm without a definite fatty hilum. A right level 5 1.6 x 0.3 x 1.2 cm lymph node has a normal appearance and a fatty hilum.OTHER: No significant abnormality noted.

Output: 1.Multiple bilateral nodules the majority of which are cystic. The dominant 1.2-cm right lobe nodule is cystic and does not contain solid components amenable to biopsy. 0.7 cm heterogenous, solid nodule in the left lobe was biopsied just after this study was performed.2.Attention to follow up on subsequent studies is recommended for left level 5 lymph node.


Instruction: Generate impression based on medical findings.

Input: Female 33 years old Reason: check for progression in size of nodules RIGHT LOBE MEASUREMENTS: 5.9 x 2.2 x 1.5 cm.LEFT LOBE MEASUREMENTS: 4.9 x 2.2 x 1.6 cm.ISTHMUS MEASUREMENTS: 0.3 cm in thickness.RIGHT LOBE: The right lobe of the thyroid demonstrates heterogeneous parenchymal echogenicity. 2.0 x 1.1 x 1.2 cm heterogeneous part solid part cystic nodule in the inferior pole of the right thyroid gland, not significantly changed. Adjacent 1.0 x 0.6 x 0.9 cm spongiform nodule also unchanged. Hypoechoic thyroid nodule in the mid right lobe and measures 0.8 x 0.3 x 0.7 cm, not significantly changed.LEFT LOBE: The left lobe of the thyroid demonstrates heterogeneous parenchymal echogenicity. 2.7 x 0.3 x 0.5 cm hypoechoic lesion in the midpole left thyroid lobe is not substantially changed.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple solid and cystic nodules again identified, without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male 64 years old Reason: Evaluate echotexture, vasculature History: elevated transaminases LIMITED ABDOMENLIVER: . Liver measures 19 cm in length. The parenchyma is normal echogenicity. Patent portal vein with appropriate directional flow.BILIARY TRACT: No biliary dilatation.. Gallbladder sludge without pericholecystic fluid, gallbladder wall thickening, or positive Murphy sign. . PANCREAS: Visualized portions are normal.KIDNEYS: The right kidney measures 10 cm. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 11 cm. The cortex is normal echogenicity.. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 10 cm. in length. OTHER: Small right pleural effusion.

Output: 1.Gallbladder sludge without sonographic signs of acute cholecystitis. Right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female 65 years old; Reason: right renal cyst History: left renal tumor Benign, removed RIGHT KIDNEY: The right kidney measures 11 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney has been resected OTHER: No significant abnormalities noted.

Output: 1.Right kidney measures 11 cm. No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female with nausea and vomiting for one month LIVER: The liver measures 20.7 cm in length. Echogenic liver parenchyma without focal lesion or intrahepatic ductal dilatation. Portal vein is patent with normal hepatopetal directional flow and peak velocity of 0.2 m/s.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. No evidence of extrahepatic ductal dilatation.PANCREAS: The visualized pancreas is without significant abnormalities.RIGHT KIDNEY: The right kidney measures 11.1 cm. The cortex is of normal echogenicity. No shadowing calculi or hydronephrosis is present.LEFT KIDNEY: The left kidney measures 11.5 cm. The cortex is of normal echogenicity. No shadowing calculi or hydronephrosis is present.SPLEEN: The spleen measures 10.1 cm.OTHER: No ascites.

Output: Echogenic liver parenchyma consistent with fatty infiltration/parenchymal dysfunction without focal lesion or ductal dilatation.


Instruction: Generate impression based on medical findings.

Input: Male 66 years old; Reason: AKI with Hx of bladder cancer R/o hydronephrosis History: AKI RIGHT KIDNEY: The right kidney measures 12.6 cm in length with markedly increased cortical echogenicity. Mild hydronephrosis is present. Subcentimeter simple cyst noted. No shadowing calculi identified. Normal vascularity. LEFT KIDNEY: The left kidney measures 13.4 cm in length with markedly increased cortical echogenicity. Mild hydronephrosis is present. Minimally complex left renal cyst measuring 2.3 x 2.6 x 2.6 cm. No shadowing calculi or hydronephrosis is present. Normal vascularity.URINARY BLADDER: Partially visualized Foley catheter in place. Incompletely characterized heterogeneous bladder mass.OTHER: Ascites. Right pleural effusion.

Output: 1. Markedly increased bilateral renal cortical echogenicity consistent with medical renal disease/renal parenchymal dysfunction. 2. Mild bilateral hydronephrosis, which appears similar to CT dated 3/5/2016. No evidence of shadowing calculi.3. Incompletely characterized bladder mass, which corresponds to findings on CT dated 3/5/2016.


Instruction: Generate impression based on medical findings.

Input: Female 76 years old; Reason: h/o renal cancer, eval for disease progression History: see above RIGHT KIDNEY: Status post right nephrectomy.LEFT KIDNEY: The left kidney measures 11.0 cm in length. The cortex is mild echogenic. No shadowing calculi or hydronephrosis is present. Small hypoechoic complex cystic focus measures 1.2 x 1.1 cm. It has a small peripheral calcification. OTHER: Bladder is well distended.

Output: 1.Status post right nephrectomy without specific evidence of recurrent disease in the right renal bed.


Instruction: Generate impression based on medical findings.

Input: Male 39 years old; Reason: Patient with left flank pain s/p recent right ureteral reconstruction. Would like eval for left hydro/evidence of nephrolithiasis History: As above RIGHT KIDNEY: The right kidney is not well visualized due to patient body habitus. The right kidney measures 14.0 cm in length.LEFT KIDNEY: The left kidney is not well-visualized due to patient body habitus. The left kidney measures 12.0 cm in length.URINARY BLADDER: The bladder is obscured.OTHER: The liver appears diffusely echogenic, suggestive of steatosis.

Output: Markedly limited examination due to patient body habitus, evaluation for hydronephrosis is incomplete.


Instruction: Generate impression based on medical findings.

Input: Female 37 years old Reason: r/o gallstones History: right upper quadrant pain LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 14.9 cm in length. The parenchyma is normal in echotexture lesions. Main portal vein is patent.BILIARY TRACT: The gallbladder has echogenic calculi with posterior acoustic shadowing. Wall measures 2 mm in thickness. Small polypoid focus along the anterior wall of the gallbladder measures 4 mm. Common duct measures 2 mm . PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 11.1 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 10.9 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 10.4 cm. in length. OTHER: No significant abnormalities noted.

Output: 1.Cholelithiasis without sonographic evidence of acute cholecystitis.2.Probable 4 mm gallbladder polyp a follow-up ultrasound in 12 months is suggested.


Instruction: Generate impression based on medical findings.

Input: Male 22 years old; Reason: AKI History: AKI RIGHT KIDNEY: The right kidney measures 13.5 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 12.6 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. URINARY BLADDER: No significant abnormality notedOTHER: Within the liver adjacent to the kidney there is a focal hypoechoic lesion measuring 2.2 x 1.8 cm.There appears be malignant lymphadenopathy in the retroperitoneum adjacent to the right kidney.

Output: 1.Echogenic renal cortices compatible with medical renal disease. No sonographic findings of nephrolithiasis or hydronephrosis.2.Metastatic disease to the liver.


Instruction: Generate impression based on medical findings.

Input: Female 43 years old Reason: Why new transaminitis? History: Transaminitis Suboptimal exam secondary to patient positioning and breathing artifact.LIVER: Visualized liver parenchyma unremarkable. Liver measures approximately 17.7 cm in longitudinal dimension. Main portal vein patent with normal directional flow, velocity measures 27 cm/s. Apparent increased pulsatility most likely due to breathing artifact.BILIARY TRACT: Hydropic gallbladder. No evidence of wall thickening or cholelithiasis. No intrahepatic biliary duct dilatation. CBD prominent measuring up to 7 mm, however tapers distally.PANCREAS: Not well seen in entirety due to adjacent bowel gas but visualized portions unremarkable.KIDNEYS: The right kidney measures 12.6 cm. Left kidney not visualized. No hydronephrosis or perinephric free fluid.SPLEEN: The spleen measures 12 cm. in length. OTHER: Trace right pleural effusion.

Output: Suboptimal study secondary to patient positioning, patient was unable to by decubitus or suspend breathing for exam, hemoptysis during study as well.Hydropic gallbladder. No secondary signs of acute cholecystitis. No evidence of wall thickening or cholelithiasis.Left kidney not visualized. Trace right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Extratesticular left scrotal mass No significant change in predominately hypoechoic extratesticular superior left scrotal mass measuring 1.5 x 1 x 1.6 cm. This superior scrotal mass in addition to being extra testicular appears to be separate from the epididymis.

Output: No significant change in superior extratesticular scrotal hypoechoic mass. This lesion appears to be separate from the epididymis. While statistically this lesion represents a benign lesion such as a fibrous pseudotumor, it is best considered indeterminate.


Instruction: Generate impression based on medical findings.

Input: Please evaluate the cystic-appearing skin lesion on left lateral lower abdomen - would like to evaluate for cystic vs solid structure, and rule out fistula prior to planning for excision. Please assess for involvement of iliac periosteum to r/o osteomyelitis. History: Inflamed cystic structure on left lower lateral abdomen Sonographic evaluation of the area of interest demonstrates a hypoechoic focus in the subcutaneous soft tissues measuring 1.9 x 0.4 x 1.1 cm with direct communication to the apparent opening in the skin.

Output: Hypoechoic focus in the subcutaneous soft tissues with apparent communication to opening in the skin, suggestive of abscess.


Instruction: Generate impression based on medical findings.

Input: Male 65 years old Reason: RUQ US prior sepsis History: cholestatic LFTs LIMITED ABDOMENLIVER: Mildly echogenic and heterogenous liver echotexture without mass. Liver length is 14cm.BILIARY TRACT: No dilatation of the common hepatic duct or extra hepatic bile ducts. No gallbladder wall thickening or pericholecystic fluid. Multiple gallstones are present. Gallbladder measures up to 15.7 cm in diameter. Negative sonographic Murphy's sign. . PANCREAS: Visualized portions are unremarkable.KIDNEYS: The right kidney measures 6 centimeters and is atrophic. The cortex is heterogenous. No shadowing calculi or hydronephrosis is present. 3 cmsimple right renal cyst.The left kidney measures 6 cm. The cortex is heterogenous. No shadowing calculi or hydronephrosis is present. 2.6 x 2.9 cm complex cystic lesion in the left kidney with questionable vascularity and multiple septations. This may represent a hemorrhagic cyst, and had a similar appearance on recent CT, but solid mass lesion is not entirely excluded.Unremarkable transplant kidney. No hydronephrosis.SPLEEN: The spleen measures 11 cm. in length. OTHER: No significant abnormalities noted.

Output: 1.Distended hydropic gallbladder up to 16 cm as above. Cholelithiasis.2.Complex left renal cystic lesion. Further evaluation with renal CT or MRI is suggested.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old. Reason: acute kidney injury; sepsis; look for obstruction History: acute kidney injury; recent foley in RIGHT KIDNEY: Right kidney measures 14.1 cm in length with increased cortical echogenicity. No hydronephrosis, shadowing calculi, or mass.LEFT KIDNEY: Left kidney measures 13.1 cm in length with increased cortical kidneys. No hydronephrosis, shadowing calculi, or mass.URINARY BLADDER: Underdistended without significant abnormality noted.OTHER: Echogenic hepatic parenchyma suggests parenchymal dysfunction/fatty infiltration.

Output: 1. Echogenic renal parenchyma bilaterally compatible with medical renal disease/parenchymal dysfunction. No hydronephrosis.2. Echogenic hepatic parenchyma suggests parenchymal dysfunction/fatty infiltration.


Instruction: Generate impression based on medical findings.

Input: 31-year-old male with left thyroid nodule. Reason: Evaluate for thyroid nodule. RIGHT LOBE MEASUREMENTS: 4.9 x 1.4 x 1.7 cmLEFT LOBE MEASUREMENTS: 4.6 x 1.7 x 1.5 cmISTHMUS MEASUREMENTS: 0.4 cm in the AP dimensionRIGHT LOBE: Diffusely heterogeneous gland with numerous subcentimeter thyroid nodules.LEFT LOBE: Diffusely heterogeneous gland with numerous subcentimeter thyroid nodules. The largest nodule is slightly heterogeneous without calcifications, located in the lower pole of the left thyroid, and measures 1.1 x 0.9 x 1 cm.ISTHMUS: Diffusely heterogeneous gland with numerous subcentimeter thyroid nodules.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Diffusely heterogeneous gland with numerous subcentimeter thyroid nodules bilaterally.


Instruction: Generate impression based on medical findings.

Input: Female 59 years old; Reason: ? hydro History: urinary retention RIGHT KIDNEY: The right kidney measures 11.4 cm in length. The cortex has increased echogenicity. Small subcentimeter nonobstructing renal calculi are seen in the inferior pole. No hydronephrosis is present. No worrisome mass is seen.LEFT KIDNEY: The left kidney measures 12.7 cm in length. The cortex has increased echogenicity. No shadowing calculi or hydronephrosis is present. No worrisome mass is seen.PRE-VOID URINARY BLADDER: The bladder is visualized without any significant abnormalities noted. The bladder measures 283 cc prevoid.POST-VOID URINARY BLADDER: The bladder is not completely empty post void with a postvoid residual of 105 cc remaining.

Output: 1.Bilaterally the kidneys have increased echogenicity compatible with medical renal disease.2.Small nonobstructing subcentimeter renal stones seen on the right lower pole. No hydronephrosis.3.Significant post void bladder residual with a postvoid residual of 105 cc.


Instruction: Generate impression based on medical findings.

Input: Skin and soft tissue infection, evaluate for abscess 4.7 x 3.6 x 1.4 cm heterogeneous fluid collection containing internal echoes and septations visualized. Mildly increased vascularity seen in surrounding soft tissues.

Output: 4.7 cm heterogeneous fluid collection as above, mildly increased vascularity seen surrounding soft tissue, findings suspicious for an abscess especially given reported history. Correlation with patient's physical exam and laboratory values recommended, postprocedural hematoma another consideration.


Instruction: Generate impression based on medical findings.

Input: Female 70 years old Reason: abdominal pain, evaluate gallbladder, evaluate renal cysts History: diffuse abdominal pain LIVER: Liver measures 12 cm in length. Main portal vein patent, normal directional flow demonstrated and velocity measures 25 cm/sec.BILIARY TRACT: Gallbladder unremarkable. No mobile intraluminal echogenic foci seen to suggest underlying cholelithiasis. No significant gallbladder distention, wall thickening or pericholecystic fluid. Common bile duct at upper limits of normal for patient's age, measuring up to 7 mm, no intrahepatic biliary duct dilatation. PANCREAS: Not well seen to overlying bowel gas but visualized portions unremarkable. KIDNEYS: The right kidney measures 11.2 cm. The left kidney measures 10.4 cm. No hydronephrosis. No renal cysts delineated.SPLEEN: The spleen measures 13.4 cm. in length.

Output: Normal appearance of gallbladder.No renal cyst seen.


Instruction: Generate impression based on medical findings.

Input: Female 61 years old Reason: (+) hep c, eval for cirrhosis/HCC History: none LIMITED ABDOMENLIVER: . Liver measures 14.2 cm in length. The parenchyma is normal echogenicity without definite sonographic signs of cirrhosis.BILIARY TRACT: No biliary dilatation. No gallbladder wall thickening, pericholecystic fluid. Negative sonographic Murphy sign. . PANCREAS: Visualized portions are unremarkable.KIDNEYS: The right kidney measures 10.8 cm. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 10.2 cm. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 7 cm. in length. OTHER: No significant abnormalities noted.

Output: 1.No focal hepatic lesion.


Instruction: Generate impression based on medical findings.

Input: 22-year-old male with questionable soft tissue mass in the medial aspect distal end of the left upper extremity. No focal mass, lesion, or loculated fluid collection is identified. When compared to the right upper extremity, the left upper extremity appears symmetric and unremarkable.

Output: No focal mass, lesion, or loculated fluid collection identified in the left upper extremity to correlate with patient's palpable mass.


Instruction: Generate impression based on medical findings.

Input: Female 42 years old; Reason: Pt with h/o Graves' disease, concern for thyrotoxicosis History: hyperthermia, tachycardia, new onset heart failure RIGHT LOBE MEASUREMENTS: 6.0 x 2.1 x 3.0 cmLEFT LOBE MEASUREMENTS: 6.0 x 2.6 x 2.8 cmISTHMUS MEASUREMENT: 1.3 cmRIGHT LOBE: The thyroid gland is diffusely enlarged and heterogeneous, demonstrating increased vascularity.LEFT LOBE: The thyroid gland is diffusely enlarged and heterogeneous, demonstrating increased vascularity. A subcentimeter hypoechoic nodule in the left inferior thyroid lobe measures 0.6 x 0.5 0.4 cm and demonstrates morphology suggestive of colloid nodule.ISTHMUS: No significant abnormality noted.LYMPH NODES: No regional lymphadenopathy.OTHER: No significant abnormality noted.

Output: 1.Diffusely enlarged and heterogeneous thyroid gland demonstrating increased vascularity, suggestive of acute thyroiditis.2.Subcentimeter left inferior thyroid lobe nodule with morphology suggestive of benign etiology.


Instruction: Generate impression based on medical findings.

Input: Female 49 years old; Reason: Rule out neurogenic bladder History: Urgency and Urge incontinence RIGHT KIDNEY: The native right kidney appears mildly echogenic and atrophic without hydronephrosis.LEFT KIDNEY: The native left kidney is not well seen.The left renal transplant demonstrates normal echogenicity and mild prominence of the collecting system with no overt hydronephrosis.URINARY BLADDER: Patient voided immediately prior to the exam, limiting evaluation. The pre-second void volume was 2.6 x 3.3 x 6.3 cm, or 29 mL. The post void volume was 0.4 x 2.5 x 1.9 cm, or less than 1 mL. Apparent wall thickening was likely secondary to bladder contraction.OTHER: No significant abnormalities noted.

Output: 1.Bladder voiding volumes, given limitations described above.


Instruction: Generate impression based on medical findings.

Input: Female 39 years old; Reason: r/o recurrence History: h/o thyroid cancer Patient is status post total thyroidectomy.No residual thyroid tissue or nodules are noted in either thyroid bed. LYMPH NODES: Previously followed cervical lymph nodes may be spinous processes. Regardless, they are unchanged.OTHER: No significant abnormality noted.

Output: 1.No evidence of recurrence.


Instruction: Generate impression based on medical findings.

Input: Female 45 years old Reason: RUQ pain, assess for cholelithiasis History: as above LIVER: Liver measures 17.4 cm in length. The parenchyma is unremarkable. BILIARY TRACT: Gallbladder unremarkable. No significant gallbladder distention, wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation. Negative sonographic Murphy's sign.PANCREAS: No significant abnormalities.KIDNEYS: The right kidney measures 10.1 cm. The left kidney measures 10.5 cm. SPLEEN: The spleen measures 8.4 cm. in length. OTHER: No significant abnormality noted.

Output: No sonographic findings of cholecystitis or to explain patient's right upper quadrant pain.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female 58 years old Reason: 58F s/p open chole, oophorectomy now with elevated t. bili and increased WBC. History: Elevated t.bili and increased WBC LIMITED ABDOMENLIVER: The liver has a nodular contour. Liver measures 12 cm in length. The parenchyma is moderately coarse and echogenic. No focal hepatic lesions. Main portal vein is patent with normal directional flow with a peak velocity of 0.13 m/secBILIARY TRACT: The gallbladder is absent.Common duct measures 4 mm. PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 10.3 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. The left kidney measures 10.1 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 14.5 cm. in length. OTHER: Upper abdominal ascites.

Output: 1.Cirrhosis without focal hepatic lesion.2.Status post cholecystectomy.3.Upper abdominal ascites.4.Echogenic renal cortices compatible with medical renal disease.5.Splenomegaly indicative of elevated portal venous pressures.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o cholecystitis History: elevated bili and ast/alt LIVER: Liver measures 27.4 cm with increased echogenicity. Portal vein is patent with normal direction and velocity of 0.35 m/s. No suspicious hepatic mass is noted.BILIARY TRACT: Common bile duct measures 3 mm. Gallbladder wall measures 3 mm. Small amount of gallbladder sludge noted. No pericholecystic fluid collection. No gallstones noted.PANCREAS: Pancreas is not well seen due to overlying bowel gas and hepatomegaly.SPLEEN: Spleen measures 23.9 cm and is normal in echogenicity and configuration.KIDNEYS: Right kidney measures 14.3 cm with increased echogenicity and without hydronephrosis. Left kidney measures 15.3 cm with increased echogenicity and without hydronephrosis. Kidney size is upper limits of normal. No renal calculi identified. OTHER: No significant abnormalities noted.

Output: 1.Small amount of gallbladder sludge without evidence of acute inflammation or biliary ductal dilatation. 2.Massive hepatosplenomegaly compatible with patient's CLL.


Instruction: Generate impression based on medical findings.

Input: Female 45 years old Reason: HBV, eval for HCC History: HBV LIVER: The liver measures 13 cm in length. Mildly increased parenchymal echogenicity is suggestive of fatty infiltration/parenchymal dysfunction. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 2 m/s.BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. The sonographic Murphy's sign is negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 6 mm in diameter.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.The spleen measures 8.2 cm in length. RIGHT KIDNEY: Kidney measures 11.0 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 11.2 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.

Output: Mildly increased hepatic parenchymal echogenicity suggests fatty infiltration/parenchymal dysfunction.


Instruction: Generate impression based on medical findings.

Input: Reason: Pt with thyroid nodules, please eval for growth/lymphadenopathy History: Thyroid Nodules RIGHT LOBE MEASUREMENTS: 3.3 x 2.6 x 6.1 cm.LEFT LOBE MEASUREMENTS: 3.6 x 2.7 x 6 cm.ISTHMUS MEASUREMENTS: 1.1 cm.RIGHT LOBE: Heterogenous gland. Mixed solid and cystic nodule noted occupying the majority of the right lobe of the thyroid which measures 3.4 x 1.7 x 2.9 cm. Stable compared to prior exam.LEFT LOBE: Heterogenous gland. Multiple mixed solid and cystic nodules are noted, the largest measuring 2.9 x 2.3 x 3.4 cm within the inferior portion of the left lobe thyroid. Stable compared to prior exam.ISTHMUS: Multiple heterogeneous, primarily solid nodules are noted within the isthmus, the largest is found within the superior portion of the isthmus and measures 1.4 x 0.9 x 1 cm. Stable compared to prior exam.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No regional lymphadenopathy.OTHER: No significant abnormality noted.

Output: 1. Heterogenous, multinodular thyroid gland. Stable compared to prior exam.


Instruction: Generate impression based on medical findings.

Input: Female 80 years old; Reason: AKI, assess for obstruction History: see above RIGHT KIDNEY: The right kidney measures 11.3 cm in length. The cortex is minimally echogenic. No shadowing calculi or hydronephrosis is present. A couple simple appearing right kidney cysts are seen, the largest measuring 1.8 cm.LEFT KIDNEY: The left kidney measures 12 cm in length. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. Simple appearing left renal cysts, largest measuring 1.9 cm.OTHER: Bladder is decompressed, precluding evaluation.

Output: 1.No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Male 31 years old Reason: Evaluate for fatty liver or other pathology History: transaminitis, elevated alk phos, hyperbilirubinemia, hypertriglyceridemia LIVER: Liver measures 13.9 cm in length. The parenchyma is mildly increased in echogenicity and heterogeneous and there is a nonspecific relatively echogenic focus located medial to the gallbladder (image timestamped 3:37:56), which measures 7 x by 6 x 5 mm, no significant associated intralesional flow delineated. There is no definite posterior acoustic enhancement evident. Main portal vein patent with normal directional flow and velocity mildly decreased, 10 cm/sec.BILIARY TRACT: Gallbladder unremarkable. No intraluminal shadowing mobile echogenic foci seen to suggest underlying cholelithiasis. No significant gallbladder distention, wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Not well seen due to overlying bowel gas. KIDNEYS: Lower poles of both kidneys not well delineated due to overlying bowel gas. The right kidney measures approximately 11.3 cm, while the left kidney measures approximately 13.9 cm. No hydronephrosis.SPLEEN: The spleen measures 13.3 cm. in length.

Output: Evaluation of liver parenchyma demonstrates mildly increased echogenicity and heterogeneity, may reflect hepatic steatosis/underlying parenchymal dysfunction. In addition, subcentimeter hepatic parenchymal focus located adjacent to gallbladder fossa and this lesion is echogenic relative to background liver, may reflect benign etiology such as focal fatty infiltration or hemangioma but indeterminate and further characterization with dedicated contrast-enhanced MRI or CT imaging recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old. Reason: Further evaluate bilateral renal lesions. History: Bilateral renal lesions have increased in size and number, right upper pole lesion does not appear cystic. Exam markedly limited by body habitus.RIGHT KIDNEY: Right kidney measures 11.5 cm in length with mildly increased cortical echogenicity. No hydronephrosis. Multiple hypoechoic foci are present in the right kidney, some of which appear to be simple cysts, however, others are incompletely evaluated. The largest in the right midpole measures 4.4 x 4.5 x 4.4 cm.LEFT KIDNEY: Left kidney measures 11.1 cm in length with mildly increased cortical echogenicity. No hydronephrosis. Multiple hypoechoic foci are present in the right kidney, some of which appear to be simple cysts, however, others are completely evaluated. The largest in the left midpole measures 2.4 x 2.0 x 2.4 cm.OTHER: Urinary bladder is underdistended limiting evaluation.

Output: 1. Suboptimal exam due to body habitus. Multiple hypoechoic foci are present bilaterally, some which appear to be simple cysts, however, others are incompletely evaluated. Recommend dedicated pre and postcontrast CT study for further characterization.2. Mildly increased echogenicity bilaterally suggests medical renal disease/parenchymal dysfunction. No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 44-year-old male status post kidney transplant and low urine output. Reason: Evaluate kidneys. RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality noted.KIDNEY: No hydronephrosis or significant perinephric collection present.COLLECTING SYSTEM/URETER: No significant abnormality noted.URINARY BLADDER: Bladder is nondistended with foley in place.VASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels. No evidence for inflow or outflow compromise. Renal vessels are patent. There is mild diastolic dampening, which is expected for increased parenchymal resistive pattern.OTHER: No significant abnormality noted.

Output: 1. Patent renal vessels.2. No hydronephrosis.3. No significant perinephric collection.


Instruction: Generate impression based on medical findings.

Input: Female 50 years old Reason: r/o thyroid nodules. History: h/o thyroid nodule, s/p partial thyroidectomy as well as parathyroidectomy, now with symptoms of neck fullness. History of Hashimoto thyroiditis. RIGHT LOBE MEASUREMENTS: 0.7 x 0.9 x 3 cm (prior 0.6 x 0.9 x 2.3 cm).LEFT LOBE MEASUREMENTS: 1 x 0.9 x 2.7 cm (prior 1.5 x 1.1 x 3.4 cm).ISTHMUS MEASUREMENTS: 0.3 cm (prior 0.4 cm).RIGHT LOBE: The right thyroid lobe is small and heterogeneous in appearance without significant interval change. No discrete nodules. No hypervascularity.LEFT LOBE: The left thyroid lobe is small and heterogeneous in appearance. A lobulated hypoechoic nodular focus in the inferior left thyroid lobe measures 0.6 x 0.6 x 0.8 cm (prior 0.6 x 0.6 x 0.6 cm). No hypervascularity.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Status post partial thyroidectomy. 2. No residual hypervascularity.3. Stable appearance of lobulated hypoechoic focus in the inferior left thyroid lobe, which may represent small adjacent nodules.


Instruction: Generate impression based on medical findings.

Input: Female 32 years old; Reason: Right flank pain, concern for liver pathology History: Right flank pain LIVER: Mild increase in hepatic parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions. Hepatic length measures 15.5 cm. The main portal vein is patent with normal hepatopedal flow with a peak velocity of 22 cm/s. GALLBLADDER/BILIARY TRACT: Status post cholecystectomy. The common bile duct measures 3 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 10.3 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 10.8 cm with no hydronephrosis. Small simple appearing cyst in the mid lower right pole measures 1.6 x 1.2 x 1.2 cm. The left kidney measures 10.5 cm with no hydronephrosis. Simple appearing cyst in the left lower pole measures 1.8 x 1.4 x 1.8 cm.OTHER: No significant abnormality noted.

Output: 1.Mild increase in hepatic parenchymal echogenicity with coarsened echotexture consistent with fatty liver/hepatic parenchymal dysfunction. No hepatic mass or ductal dilatation identified.2.Bilateral simple appearing renal cysts with no evidence of hydronephrosis.