Instruction: Generate impression based on medical findings.

Input: Male 69 years old with right upper quadrant pain, evaluate for cholecystitis LIVER: Mild increase in hepatic parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions. Hepatic length measures 20.5 cm. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of 19.9 cm/s. GALLBLADDER/BILIARY TRACT: Trace pericholecystic fluid and gallbladder wall thickening without evidence of cholelithiasis. The common bile duct measures 2 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Subcentimeter anechoic cyst in the head of the pancreas. Portions of the Pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 10.5 cm and has a normal echotexture. Calcified splenic granulomas noted.KIDNEYS: The kidneys have normal corticomedullary differentiation. Possible left greater than right punctate and non-shadowing foci of nephrolithiasis. The right kidney measures 7.5 cm and has normal vascular flow. The left kidney measures 8.0 cm and has normal vascular flow. OTHER: No significant abnormality noted.

Output: 1. Nonspecific trace pericholecystic fluid and gallbladder wall thickening, likely equivocal, but cannot rule out acalculous cholecystitis.2. Hepatomegaly and mildly increased hepatic parenchymal echogenicity with coarsened echotexture consistent with fatty liver/hepatic parenchymal dysfunction. No hepatic mass or ductal dilatation identified.3. Possible left greater than right punctate and non-shadowing foci of nephrolithiasis. No evidence of hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Female 59 years old Reason: Evaluate for HCC History: Elevated liver enzymes LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 15.5 cm in length. The parenchyma is mildly echogenic diffusely. Additionally, there is a geographic area of relative hypoechogenicity without Doppler flow adjacent to the gallbladder fossa measuring approximately 1.4 x 1.2 cm.BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 2 mm in thickness. Common duct measures 5 mm. PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 11.9 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. Subcentimeter simple renal cysts noted in the interpolar region.The left kidney measures 11.8 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. Subcentimeter simple renal cysts noted in the lower pole.SPLEEN: The spleen measures 8.7 cm. in length and appears normal.OTHER: No significant abnormalities noted.

Output: Diffusely echogenic liver suggestive of fatty infiltration with areas of sparing near the gallbladder fossa. No focal lesion identified.


Instruction: Generate impression based on medical findings.

Input: Female 75 years old; Reason: r/o pyelonephritis, assess for complications 2/2 bacturia History: unable to verbalize symptoms, positive UA and reflex culture RIGHT KIDNEY: The right kidney measures 8.8 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 9.6 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.


Instruction: Generate impression based on medical findings.

Input: Male 51 years old Reason: pt w/ carotid U/S showing carotid ectasia, evaluate for aneurysm History: carotid ectasia The proximal aorta measures 2.5 x 2.6 x 2.1 cm, the mid aorta measures 2.2 x 2.0 x 2.1 cm and the distal aorta measures 2.0 x 1.9 x 1.8 cm. No aneurysmal dilatation is evident.

Output: No evidence of aortic aneurysm.


Instruction: Generate impression based on medical findings.

Input: 8-year-old male with history of hydronephrosis and hydroureter BLADDER  Wall Thickness: Normal  Contents: Distended and normal. Distal Ureter -- SFU Grade**  Right: 3  Left: 3   Ureteral Jets Right: Not observed  Left: Not observedKIDNEYS  Cortical Echogenicity: Normal   Medullary Echogenicity: Normal   Pelvicaliceal System -- SFU Grade*  Right: 3 Left: 3  Length*** Right: 9.3 cm Left: 10.4 cm   Mean for age: 8.5 cm  Range for age: 7.0 - 10.0 cmADDITIONAL OBSERVATIONS: None

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


Instruction: Generate impression based on medical findings.

Input: 69-year-old female with acute kidney injury. RIGHT KIDNEY: The right kidney measures 8.3 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present.LEFT KIDNEY: The left kidney measures 8.8 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present.OTHER: The bladder is nondistended.

Output: 1.Bilateral atrophic and echogenic kidneys consistent with medical renal disease. No evidence of hydronephrosis or nephrolithiasis.


Instruction: Generate impression based on medical findings.

Input: Female 44 years old; Reason: Secondary HPT, evaluate. RIGHT LOBE MEASUREMENTS: 4.1 x 1.3 x 1.4 cmLEFT LOBE MEASUREMENTS: 4.0 x 1.2 x 1.3 cmISTHMUS MEASUREMENT: 0.4 cmRIGHT LOBE: The right lobe of the thyroid is normal in echogenicity and echotexture with no evidence of nodules or masses.LEFT LOBE: The left lobe of thyroid is normal in echogenicity and echotexture with no evidence of nodules or masses.ISTHMUS: The isthmus is normal in echogenicity and echotexture with no evidence of nodules or masses.LYMPH NODES: Right level 2 lymph node with benign morphology and echogenic center measuring 1.4 x 0.7 x 2.1 cm. Left level 2 lymph node with benign morphology and echogenic center measuring 0.3 x 0.9 x 1.7 cm is noted.OTHER: Extrathyroidal hypoechoic vascular mass posterior to the inferior pole of the right thyroid lobe measures 0.9 x 0.5 x 0.6 cm.

Output: 1.Normal appearance of thyroid gland.2.Extrathyroidal hypoechoic mass posterior to the inferior pole of the right thyroid lobe suggestive of parathyroid adenoma, as above. Please refer to same-day parathyroid nuclear medicine scan report for additional findings.


Instruction: Generate impression based on medical findings.

Input: Evaluate for change in right-sided thyroid nodules RIGHT LOBE: Echotexture markedly heterogeneous. Lobe measures 4.9 x 2.6 x 2.2 cm. Reference largest discrete inferior pole spongiform nodule seen measuring 1.5 x 1.4 x 1.2 cm, previously measured 1.8 x 1.4 x 1.2 cm.LEFT LOBE: Left lobe absent.ISTHMUS: Measures 0.4 cm.LYMPH NODES: No significant abnormality noted.OTHER: Asymmetric intraluminal heterogeneity of left-sided internal jugular vein, nonspecific but suspicious for slow flow, appearance similar to prior exam.

Output: Reference right-sided thyroid nodule stable to slightly decreased in size.Similarly appearing left-sided internal jugular vein with intraluminal heterogeneity of left-sided internal jugular vein, nonspecific but suspicious for slow flow, appearance similar to prior exam..


Instruction: Generate impression based on medical findings.

Input: Female 65 years old Reason: cause of abdominal distention History: nausea, vomiting, abdominal pain with distention. LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 17 cm in length. The parenchyma is normal in echotexture no focal hepatic lesions. Main portal vein is patent.BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 2.0 mm in thickness. Common duct measures 5 mm. PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas. The pancreatic duct is dilated measuring up to 4 mmKIDNEYS: The right kidney measures 14 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. There are multiple cysts. The cyst at the upper pole is mildly complex with septation and measures 2.0 cm.The left kidney measures 9.0 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. Complex cystic lesion at the midpole with calcification and thick septations measures 2.3 cm.SPLEEN: The spleen measures 9.0 cm. in length. OTHER: No ascites

Output: 1.Dilatation of the pancreatic duct of unclear etiology. MRCP is suggested2.Left renal complex cystic lesion with dedicated imaging of the kidney is recommended


Instruction: Generate impression based on medical findings.

Input: Reason: Patient with large thyroid multinodular goiter, here with hyperthyroid symptoms, endo recommended thyroid US. History: SOB, LE edema, Afib w/ RVR RIGHT LOBE MEASUREMENTS: 3.5 x 2.8 x 5.7 cm.LEFT LOBE MEASUREMENTS: 2.4 x 1.9 x 4.3 cm.ISTHMUS MEASUREMENTS: 0.2 cm.RIGHT LOBE: Predominantly hypoechoic superior right thyroid nodule measuring 0.8 x 0.7 x 0.7 cm, previously 0.9 x 0.7 x 1.3 cm. Large mixed solid cystic right mid thyroid nodule measuring 3.6 x 2.6 x 3.7 cm, previously 3.9 x 2.8 x 4.0 cm. Predominantly hypoechoic right inferior nodule measuring 0.9 x 1.0 x 1.4 cm, previously 1.5 x 0.9 x 1.4 cm.LEFT LOBE: Large mixed solid cystic left mid thyroid nodule measuring 2.9 x 1.4 x 2.0 cm, previously 3.3 x 1.5 x 2.0 cm. Predominantly hypoechoic left inferior thyroid nodule measuring 0.8 x 0 5 x 1.3 cm, previously 0.8 x 0.6 x 1.3 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Right level 3 lymph node measuring 1.2 x 0 4 x 1.3 cm.OTHER: No significant abnormality noted.

Output: Bilateral complex nodules with reference measurements as above. These nodules are without significant change from prior study. No regional cervical lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Female 79 years old Reason: hep c and thrombocytopenia, eval for hcc and for spleen size/portal HTN History: same LIVER: The liver measures 14.1 cm in length and demonstrates coarsened parenchymal echogenicity. No intrahepatic or extrahepatic biliary ductal dilatation is evident and no focal mass lesions are seen. Anechoic lesion in the right hepatic lobe consistent with a hepatic cyst, measuring 1.3 x 1.4 x 1.1 cm. The main portal vein is patent and demonstrates hepatopedal flow with a velocity of 0.2 m/s. GALLBLADDER, BILIARY TRACT: No cholelithiasis or choledocholithiasis is seen. The common duct measures 0.4 cm in diameter. PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 10.7 cm in length and demonstrates normal parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen. Anechoic lesion in the inferior pole the right kidney measures 1.9 x 2.2 x 1.6 cm, consistent with simple renal cyst.LEFT KIDNEY: The left kidney measures 11.9 cm in length and demonstrates normal parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.SPLEEN: The spleen measures 10.0 cm in length.OTHER: No significant abnormalities noted.

Output: 1.Coarsened hepatic parenchymal echogenicity consistent with chronic liver disease, but no mass lesions identified to suggest HCC.2.Normal flow direction and velocity of the portal vein, no evidence of splenomegaly.


Instruction: Generate impression based on medical findings.

Input: Female 43 years old Reason: RUQ pain, eval for cholecystitis History: RUQ pain, eval for cholecystitis LIVER: The liver measures 17.2 cm in length. The liver parenchymal echotexture is normal. No focal hepatic lesions or masses are identified. No intrahepatic biliary ductal dilatation is seen. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 3 m/s.BILIARY TRACT: Numerous shadowing stones are present in the gallbladder, which is mildly distended. There is trace pericholecystic fluid, but without definite wall thickening. The common duct is dilated measuring 1.2 cm in diameter. There is an 8 mm shadowing stone within the pancreatic portion of the common duct.PANCREAS: No significant abnormalities noted.SPLEEN: The spleen measures 8.0 cm in length. RIGHT KIDNEY: Kidney measures 13.3 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass. There is a 7.9 x 5.4 x 5.6 cm anechoic lesion in the upper pole the right kidney consistent with a simple renal cyst.LEFT KIDNEY: Kidney measures 13.7 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.

Output: 1.8mm echogenic focus in the pancreatic portion of the common duct with associated dilatation of the common duct compatible with obstructing choledocholithiasis. Further evaluation with MRCP may be warranted.2.Mild distention of the gallbladder with associated trace pericholecystic fluid suspicious for early acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: 65-year-old female presents with right upper quadrant pain and elevated liver enzymes. LIVER: Diffuse increase in hepatic parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions. Hepatic length measures 14 cm. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of 55 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 3 mm. Sludge and stones in gallbladder. No secondary signs of acute cholecystitis. The common bile duct measures 5 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified. Per technologist, negative sonographic Murphy's sign. No pericholecystic fluid. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 8 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 13 cm and has normal vascular flow. The left kidney measures 12 cm and has normal vascular flow. Hypoechoic focus arising from the mid to lower pole of the left kidney measures 1.8 x 1.6 x 1.7 cm, compatible with a simple renal cyst. OTHER: No significant abnormality noted.

Output: 1. Sludge and stones in gallbladder. No secondary signs of acute cholecystitis.2. Diffuse increase in hepatic parenchymal echogenicity with coarsened echotexture consistent with fatty liver/hepatic parenchymal dysfunction. No hepatic mass or ductal dilatation identified.3. Left renal cyst.


Instruction: Generate impression based on medical findings.

Input: 62-year-old female with worsening renal function over the past 6 months. ULTRASOUND KIDNEYSRIGHT KIDNEY: No evidence of hydronephrosis or nephrolithiasis. The kidney is normal in echogenicity. The right kidney measures 11.6 cm.LEFT KIDNEY: No evidence of hydronephrosis or nephrolithiasis. The kidney is normal in echogenicity. Left kidney measures 11.1 cm. Previously described left proteinaceous cyst is visualized and appears isoechoic, measuring 2.2 x 1.7 x 2.2 cm.OTHER:The bladder is nondistended.

Output: 1. Renal vasculature is patent without evidence of inflow or outflow irregularity.2. Bilateral kidneys are normal in echogenicity without evidence of hydronephrosis or nephrolithiasis.


Instruction: Generate impression based on medical findings.

Input: Female 28 years old; Reason: eval renal parenchyma History: elevated cr RIGHT KIDNEY: The right kidney measures 9.1 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 9.9 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.Echogenic renal cortices compatible with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: 56-year-old female with history of multinodular goiter. Reason: Evaluate for change in size. RIGHT LOBE MEASUREMENTS: Status post partial thyroidectomy, measuring 3.3 x 1.3 x 1.4 cmLEFT LOBE MEASUREMENTS: 6.6 x 3 x 2 cmISTHMUS MEASUREMENTS: 0.18 cm in the AP dimensionRIGHT LOBE: There is a mildly hypoechoic nodule in the mid pole, measuring 0.8 x 0.9 x 1.1 cm.LEFT LOBE: Heterogenous gland with spongiform nodules, the largest of which measures 1.3 x 1.2 x 1.1 in the inferior pole.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Note is made of benign-appearing lymph nodes.OTHER: No significant abnormality noted.

Output: 1. Status post partial right thyroidectomy with a mildly hypoechoic nodule in the residual right thyroid lobe.2. Heterogenous left thyroid lobe with spongiform nodules.


Instruction: Generate impression based on medical findings.

Input: Reason: HBV evaluate for HCC History: HBV LIVER: Liver measures 13.5 cm with heterogeneous echotexture. Portal vein is patent with normal direction and velocity of 0.2 m/s. Right hepatic cyst noted measuring 1.0 x 0.9 x 0.9 cm. More superficial right hypoechoic lesion measures 0.6 x 0.5 x 0.7 cm, femur cyst. Left hepatic cyst measures 0.6 x 0.4 x 0.5 cm. No suspicious hepatic mass is noted.BILIARY TRACT: Common bile duct measures 5 mm. Gallbladder wall measures 3 mm. 0.4 x 0.4 x 0.5 cm a bladder polyp is again noted. No pericholecystic fluid collection.PANCREAS: Distal pancreas is obscured by overlying bowel gas. Visualized part is within normal limits.SPLEEN: Spleen measures 7.3 cm and is normal in echogenicity and configuration.KIDNEYS: Right kidney measures 9.2 cm with normal echogenicity and without hydronephrosis. Left kidney measures 9.7 cm with normal echogenicity and without hydronephrosis. No renal calculi identified. OTHER: No significant abnormalities noted.

Output: Heterogeneous hepatic echotexture again noted. New right superficial hepatic hypoechoic lesion, favor cyst, but attention on follow-up imaging.


Instruction: Generate impression based on medical findings.

Input: Female 76 years old; Reason: H/o Alport's now w/ AKI in setting of dehydration and recent NSAID use. R/o hydronephrosis. RIGHT KIDNEY: The right kidney measures 9.3 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. An interpolar simple cyst 0.7 x 0.7 x 0.6 cm noted.LEFT KIDNEY: The left kidney measures 8.9 cm in length. The cortex is echogenic. No hydronephrosis. A small midpole nonobstructing shadowing calculi measuring 0.6 x 0.4 x 0.5 cm is noted. Simple cyst measuring 0.9 x 0.8 x 0.9 cm noted.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.

Output: 1.Slight increased echogenicity of bilateral kidneys suggestive of medical renal disease, with no evidence of hydronephrosis.2.Small nonobstructing calculus in the left kidney.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o adenopathy, recurrence History: h/o thyroid cancer RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: No focal lesion noted in the right thyroid bed.LEFT LOBE: There is a 0.3 x 0.2 x 1 cm hypoechoic lesion noted within the inferior aspect of the left thyroid bed. Unchanged prior exam.ISTHMUS: No focal lesion noted in the isthmus bed.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Status post thyroidectomy.2. Stable left thyroid bed nodule. Recommend continued surveillance.


Instruction: Generate impression based on medical findings.

Input: Female 65 years old Reason: Assess for interval change in nodes History: Thyroid cancer s/p surgery I131 RIGHT LOBE MEASUREMENTS: Status post thyroidectomy. LEFT LOBE MEASUREMENTS: Status post thyroidectomy. ISTHMUS MEASUREMENT: Status post thyroidectomy. RIGHT LOBE: Homogeneous hyperechoic focus in the right thyroidectomy bed, this measures 1.1 x 0.4 x 0.5 cm, previously 0.9 x 0.4 x 0.5 cm, and is essentially unchanged in appearance compared to prior study.LEFT LOBE: Homogeneous hyperechoic focus in the right thyroidectomy bed. This measures 1.0 x 1.0 x 0.6 cm, previously 1.1 x 0.5 x 0.6 cm, and is unchanged in appearance compared to prior study.ISTHMUS: No significant abnormality noted.LYMPH NODES: Prominent bilateral lymph nodes with benign morphology.

Output: 1.Stable examination with homogeneous hyperechoic material in both the right and left thyroidectomy beds.


Instruction: Generate impression based on medical findings.

Input: Male 30 years old Reason: s/p islet cell transplant. Please eval portal vein flow History: as above LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 20 cm in length. The parenchyma is mildly echogenic. No focal hepatic lesions. Main portal vein is patent with normal directional flow and a peak velocity of 0.3 m/sec.BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 3mm in thickness. Common duct measures 5mm. PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 11.9 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 12.7 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 10.5 cm. in length. OTHER: No ascites

Output: 1.Patent main portal vein with normal directional flow.2.No perihepatic hematoma or fluid collection.


Instruction: Generate impression based on medical findings.

Input: Male 7 days old Reason: evaluate cyst, kidneys, bowels, and liver History: abdominal distention LIVER: The liver measures 5.5 cm. Normal liver echotexture without focal mass. Limited interrogation of the main portal vein demonstrates blood flow towards the liver measuring 10 cm/sec, slightly slow. BILIARY TRACT: The gallbladder is within normal limits. No cholelithiasis. Gallbladder wall measures 1 mm. The common bile but measures 1 mm.PANCREAS: No significant abnormality.KIDNEYS: The right kidney measures 3.9 cm. Grade 2 hydronephrosis of the right kidney. The left kidney measures 3.8 cm. Grade 1 hydronephrosis of the left kidney. SPLEEN: The spleen measures 3.2 cm. in length. Small amount of perisplenic ascites.OTHER: No significant abnormalities noted.ABDOMINAL AORTA: UAC catheter is visualized.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: The bladder is distended.

Output: 1.Decreased protal vein velocity measuring 10 cm/sec is of uncertain clinical significance. 2.Small amount of perisplenic ascites. 3.Grade 2 hydronephrosis on the right.


Instruction: Generate impression based on medical findings.

Input: Female 27 years old; Reason: Sickle cell patient with elevated creatinine History: Elevated creatinine RIGHT KIDNEY: The right kidney measures 7.6 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. Further, there is a nonspecific 1 cm hypoechoic nodule that statistically is likely representative of a cyst but too small to characterize.LEFT KIDNEY: The left kidney measures 6.8 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present.OTHER: No significant abnormality of the bladder is noted.

Output: 1.Bilateral small, echogenic kidneys are consistent with medical renal disease. No evidence of hydronephrosis or nephrolithiasis.


Instruction: Generate impression based on medical findings.

Input: Male 61 years old; Reason: h/o pyeloplasty History: intermittent left flank pain RIGHT KIDNEY: The right kidney measures 13.2 cm in length. The cortex has normal echogenicity. No shadowing calculi or hydronephrosis is present. No worrisome masses are seen.LEFT KIDNEY: The left kidney measures 12.2 cm in length. The cortex has normal echogenicity. No shadowing calculi or hydronephrosis is present. No worrisome masses are seen.URINARY BLADDER: The bladder is visualized without significant abnormalities. Bilateral ureteral jets are visualized.

Output: Negative bilateral renal ultrasound. No hydronephrosis, stones, or worrisome masses are seen.


Instruction: Generate impression based on medical findings.

Input: Female 76 years old Reason: elevated lfts, assess for mass, inflammation History: elevated lfts LIMITED ABDOMENLIVER: The liver has a nodular contour. Liver measures 17.1 cm in length. The parenchyma is mildly coarse and echogenic. No focal hepatic lesion is identified. Prominent hepatic veins. Pulsatile portal vein.BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 4 mm in thickness, and nonspecific in setting of ascites. The common bile duct measures 2 mm. Negative Murphy's sign. 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 echogenic. No shadowing calculi or hydronephrosis is present. The left kidney measures 9.9 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 9.9 cm in length.OTHER: Small volume ascites. Small bilateral pleural effusions.

Output: 1.Nodular liver with coarsened and echogenic parenchyma, compatible with hepatic parenchymal dysfunction.2.Pulsatile portal vein, probably secondary to right heart failure.3.Small bilateral pleural effusions and small volume ascites.4.Mild gallbladder wall thickening, which is nonspecific in the setting of ascites. No secondary signs of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Male 61 years old Reason: R/O HCC History: HCV, cirrhosis; abnormal findings on previous US LIVER: Liver measures 14.2 cm in length. The parenchyma appears heterogeneous which is nonspecific and may represent diffuse infiltrative disease. No focal hepatic lesion is identified.Portal vein is patent and demonstrates hepatopedal flow with a peak velocity of 0.3 m/s.BILIARY TRACT: Echogenic foci with posterior shadowing compatible with gallstones are unchanged from the prior study. There is no gallbladder wall thickening or pericholecystic fluid. The common bile duct measures up to 1.4 cm in diameter which is stable to slightly more prominent when compared to the prior ultrasound. There is no intrahepatic biliary ductal dilatation seen.PANCREAS: Again seen is a porta hepatis lymph node measuring 2.2 x 1.1 x 2.0 cm, and previously measured 2.0 x 2.0 x 1.2 cm. The head and the body of the pancreas are unremarkable.KIDNEYS: The right kidney measures 9.8 and demonstrates normal cortical echogenicity. The left kidney measures 9.4 cm; the cortex is increased in echogenicity which is nonspecific but may represent medical renal disease. Note is made of an inferior pole simple appearing cyst in the left kidney which measures 0.7 x 0.7 x 0.7 cm.SPLEEN: Evaluation of the spleen is limited and grossly measures 9.1 cm. in length. ABDOMINAL AORTA AND INFERIOR VENA CAVA: Not well seen due to overlying bowel gas. OTHER: No significant abnormality noted.

Output: 1.Heterogeneous appearing liver parenchyma without focal lesion identified.2.Stable to slightly more prominent extrahepatic biliary ductal dilatation would be better evaluated on ERCP/MRCP if clinically warranted as recommended on prior study.3.Unchanged bilateral prominent peripancreatic lymph node which may be benign and reactive in etiology in the setting of cirrhosis. However this would be better characterized on ERCP/MRCP as recommended on prior study.4.Cholelithiasis without evidence of cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for goiter History: neck tightness RIGHT LOBE MEASUREMENTS: 5.1 x 1.8 x 1.2 cmLEFT LOBE MEASUREMENTS: 4.3 x 1.7 x 1.4 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: In the inferior right thyroid, there is a spongiform-appearing nodule measuring 0.2 x 0.2 x 0.2 cm.LEFT LOBE: No significant abnormality noted.ISTHMUS: 0.7 x 0.6 x 0.3 cm predominantly cystic nodule without definite microcalcifications or increased vascularity.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing right-sided lymph nodes. In the left neck, level 3, there is a 1.0 x 0.5 x 2.4 cm lymph node which does not have definitive benign characteristics. This is indeterminate.OTHER: No significant abnormality noted.

Output: Benign-appearing thyroid nodules as above. Indeterminant level 3 left neck lymph node as described above can be followed up in 6 months to document stability.


Instruction: Generate impression based on medical findings.

Input: Female 72 years old; Reason: rapidly rising cr in the s/o acyclovir History: as above RIGHT KIDNEY: The right kidney measures 11.4 cm in length. The cortex is mildly echogenic. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 10.8 cm in length. The cortex is mildly echogenic. No shadowing calculi or hydronephrosis is present. It has a small cyst measuring 9 mm. URINARY BLADDER: No significant abnormality notedOTHER: The spleen appears enlarged. Hepatic parenchyma is echogenic.

Output: 1.Mildly echogenic renal cortices compatible with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Male 77 years old Reason: Ascites and AKI History: Ascites RIGHT KIDNEY: The right kidney measures 9.6 cm in length and demonstrates appropriate parenchymal echogenicity. No hydronephrosis or hydroureter is evident. No nephrolithiasis or ureterolithiasis is seen. A 0.5 x 0.5 x 0.6 cm hypoechoic lesion in the superior pole is nonspecific, but likely benign.LEFT KIDNEY: The left kidney measures 10.4 cm in length and demonstrates appropriate parenchymal echogenicity. No hydronephrosis or hydroureter is evident. No nephrolithiasis or ureterolithiasis is seen.BLADDER: No significant abnormality noted.OTHER: Moderate volume ascites, not significantly changed from the prior exam.

Output: 1.Normal renal parenchymal echogenicity, and no evidence of hydronephrosis.2.Moderate volume ascites, not significantly changed from the prior exam.


Instruction: Generate impression based on medical findings.

Input: Female 77 years old Reason: abdominal pain, h/o cholelithiasis - r/o cholecystitis History: abdominal pain BILIARY TRACT: Distended gallbladder containing numerous stones and small sludge. No gallbladder wall thickening or pericholecystic fluid seen. Per ultrasound technologist, no tenderness elicited over right upper quadrant. No intrahepatic or extrahepatic biliary duct dilatation.OTHER: Right renal cyst incidentally seen, refer to recent CT study for improved characterization.

Output: Distended gallbladder containing numerous stones and small sludge. No additional signs of acute cholecystitis.Please refer to recent CT study for additional findings.


Instruction: Generate impression based on medical findings.

Input: Male 48 years old; Reason: stone? Source for infection? History: hematuria and fever RIGHT KIDNEY: The right kidney measures 13.9 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 13.7 cm in length. The cortex is the. No shadowing calculi or hydronephrosis is present.  URINARY BLADDER: No significant abnormality notedOTHER: No significant abnormalities noted.

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


Instruction: Generate impression based on medical findings.

Input: Reason: thyroid US with doppler to eval for vascularity History: hyperthyroidism. RIGHT LOBE MEASUREMENTS: 5.9 x 2.5 x 3.2 cm.LEFT LOBE MEASUREMENTS: 3.3 x 2.5 x 7 cm.ISTHMUS MEASUREMENTS: 0.8 cm.RIGHT LOBE: The right lobe appears heterogenous. There is a 1.2 x 1.2 x 1.7 cm heterogenous, primarily solid nodule within the inferior portion of the right lobe of the thyroid. There are no magnification visualized. This was not visualized on prior exam.LEFT LOBE: The left lobe appears heterogenous. There is no discrete nodule identified.ISTHMUS: There is a 1 x 0.5 x 0.8 cm questionable nodule noted within the isthmus. Not visualized on prior exam.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Heterogenous and enlarged thyroid gland is again visualized. 2. Small discrete, questionable nodule noted within the isthmus which was not visualized on prior exam. 3. Heterogenous, mixed solid and cystic nodule within the inferior portion of the right lobe the thyroid. Benign-appearing. Not seen on the prior exam.


Instruction: Generate impression based on medical findings.

Input: Reason: eval liver, spleen and kidneys for possible abscess History: concern for insidious infection LIVER: Liver measures 10 cm with normal echogenicity. Portal vein is patent with normal direction and velocity. BILIARY TRACT: The common bile duct is normal in size. No pericholecystic fluid collection. Gallbladder sludge noted without gallstones.PANCREAS: Pancreas is not seen due to overlying bowel gas.SPLEEN: Spleen is normal in echogenicity and configuration.KIDNEYS: Right kidney is normal echogenicity and without hydronephrosis. Left kidney is normal echogenicity and without hydronephrosis. No renal calculi identified. OTHER: Small right pleural effusion and moderate left pleural effusion noted. No abdominal free fluid is noted.

Output: 1. Bilateral pleural effusions, but no abdominal free fluid or abscess.2. Gallbladder sludge.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o abbess of right inferior clavicular wound History: s/p heart transplant persist ant leukocytosis has remnant of axillary graft present had drainage 1 day back Small simple fluid collection measuring 1.4 x 1.3 cm just beneath the skin staple. No other fluid collections noted. This is likely a seroma.

Output: Likely small seroma underneath the skin staple. No definite evidence of abscess.


Instruction: Generate impression based on medical findings.

Input: Reason: HCC screening History: ETOH cirrhosis, history of TIPS LIVER: Liver measures 11 cm with increased heterogeneous echogenicity. Nodular liver capsule noted. Portal vein is patent with normal directional flow and velocity of 0.4-0.7 m/s. TIPS appears patent on this nondedicated study with velocity of 1.1-1.2 m/s. Suboptimal imaging of the liver due to patient's inability to cooperate, limiting evaluation for masses.BILIARY TRACT: Common bile duct measures No significant abnormalities noted.. Gallbladder wall measures 2mm. No pericholecystic fluid collection. Gallstone measuring 10 mm noted. Polyp measuring 3 x 4 x 4 mm.PANCREAS: Distal pancreas is obscured by overlying bowel gas. Visualized portion is within normal limits.SPLEEN: Spleen measures 14.2 cm and is normal in echogenicity and configuration.KIDNEYS: Right kidney measures 10 cm with normal echogenicity and without hydronephrosis. Left kidney measures 12.2 cm with normal echogenicity and without hydronephrosis. OTHER: No significant abnormalities noted.

Output: 1.Suboptimal evaluation of the liver due to patient's inability to cooperate with exam. For HCC screening, recommend contrast-enhanced CT or MRI.2.TIPS appears patent on this nondedicated study. 3.Mild splenomegaly.


Instruction: Generate impression based on medical findings.

Input: Female 76 years old Reason: s/p renal transplant AKI on CKD History: AKI on CKD RENAL TRANSPLANT: LOCATION: Right iliac fossa.PERITRANSPLANT TISSUES: Small volume free fluid is noted about the transplant kidney.KIDNEY: There is minimal hydronephrosis. The parenchymal echogenicity is within normal limits.COLLECTING SYSTEM/URETER: Minimal hydronephrosis.URINARY BLADDER: The urinary bladder is not well seen.OTHER: No significant abnormality noted

Output: Minimal hydronephrosis and small volume free fluid about the transplant kidney, but normal parenchymal echogenicity of the right iliac fossa transplant kidney.


Instruction: Generate impression based on medical findings.

Input: Female 45 years old Reason: 45 y/o fever unknown origin, MICU patient eval gallbladder thickness and CBD History: fevers, leukocytosis Suboptimal study secondary to patient's intubated state, receipt of dialysis during the study and limited mobility/inability to be positioned decubitus, additionally, patient was not nothing by mouth for 6 hours prior.LIVER: Liver measures 17.2 cm in length. The parenchyma is coarsened in echotexture. No focal liver lesion. Intraluminal portal venous echogenic focus measuring 2.2 x 2.1 x 0.9 cm, with mild associated aliasing, appearance suspicious for partially occlusive thrombus. Main portal vein appears mostly patent otherwise with normal directional flow, velocity measures 33 cm/s proximal to the level of intraluminal echogenic focus and measures 20 cm/s distal to this point. BILIARY TRACT: Gallbladder mildly contracted, unremarkable otherwise. 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 14.6 cm. The left kidney measures 13.1 cm. No hydronephrosis, no perinephric free fluid.SPLEEN: The spleen measures 7.9 cm in length. OTHER: No significant abnormality noted.

Output: Suboptimal study but within limitations findings suspicious for partially occlusive portal vein thrombus as described.Unremarkable gallbladder, no evidence of acute cholecystitis.Coarsened echotexture of liver, likely reflecting underlying hepatic steatosis/parenchymal dysfunction.


Instruction: Generate impression based on medical findings.

Input: Female 76 years old; Reason: enlarging thyroid cyst. RIGHT LOBE MEASUREMENTS: 6.7 x 2.7 x 2.5 cm, previously 5.7 x 2 x 2.9 cm.LEFT LOBE MEASUREMENTS: 5.6 x 2 x 2.1 cm, previously 5.5 x 1.5 x 2 cm. ISTHMUS MEASUREMENT: 0.8 cm, previously 0.5 cm.RIGHT LOBE: The thyroid gland is heterogeneous in echotexture, with the lower pole nodule demonstrating a spongiform morphology measuring 1.6 x 1.4 x 1.2 cm compared to 1.9 x 1.4 x 1.4 cm in prior exam.LEFT LOBE: The thyroid gland is heterogenous in echotexture, with predominantly solid lower pole nodule measuring 1.7 x 1.4 x 1.4 cm as compared to 1.2 x 1.1 x 1.2 cm, slightly increased in size compared to prior exam. Upper pole nodule with cystic component measures 2.1 x 1.1 x 2.1 cm compared to 1.6 x 1.1 x 1.4 cm. ISTHMUS: The predominantly cystic lesion in the isthmus measures 3.5 x 2.2 x 3.5 cm compared to 2.4 x 1 x 2.2 cm on the prior exam, with interval increase in size. There is interval increase in internal debris within the cystic lesion.LYMPH NODES: No regional lymphadenopathy.OTHER: No significant abnormality noted.

Output: 1.Slight interval increase in size of predominantly solid nodule in the left inferior thyroid pole2.Interval increase in size of cystic lesion in the isthmus, with increase in internal debris.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old. Reason: Screen for HCC History: AIH cirrhosis LIVER: Liver is enlarged and measures 18.1 cm in length with coarse echotexture. The contour is nodular suggesting cirrhosis. Focal hepatic calcification is present. Mild ascites is present. Main portal vein is patent with a normal direction of flow.BILIARY TRACT: Common bile duct measures 4 mm. No biliary ductal dilatation. Gallstones are present. There is mild gallbladder wall thickening which is nonspecific and likely due to the low protein state. PANCREAS: No significant abnormalities noted.SPLEEN: Spleen is enlarged and measures 14.5 cm in length with normal echotexture.RIGHT KIDNEY: Right kidney measures 13.4 cm in length with mildly increased cortical echogenicity. No hydronephrosis, mass, or shadowing calculi. OTHER: Left kidney measures 12.7 cm in length with mildly increased cortical echogenicity. No hydronephrosis, mass, or shadowing calculi.

Output: 1. Cirrhotic morphology without suspicious hepatic lesion.2. Cholelithiasis without sonographic evidence of acute inflammation.3. Echogenic renal parenchyma bilaterally suggest parenchymal dysfunction/medical renal disease. No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 28 year-old female status post thyroidectomy and I-131 treatment. LOBE MEASUREMENTS: Patient is status post thyroidectomy.RIGHT BED: 2 small nodules are redemonstrated. The first is well circumscribed and slightly hypoechoic, measuring 0.9 x 0.6 x 0.5 cm, previously 1.0 x 0.6 x 0.8 cm. The second is similar in appearance measuring 0.5 x 0.2 x 0.4 cm adjacent to the right carotid, previously 0.6 x 0.5 0.3 cm.LEFT BED: Multiple nodules that are well-circumscribed and slightly hypoechoic within the left thyroid bed are redemonstrated and unchanged from prior examination.ISTHMUS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Unchanged, small bilateral well-circumscribed hypoechoic nodules seen within the bilateral thyroid beds.


Instruction: Generate impression based on medical findings.

Input: Male 66 years old Reason: kidney stone History: stone RIGHT KIDNEY: The right kidney measures 11.9 cm in length and demonstrates normal parenchymal echogenicity. Two shadowing stones are noted, one in an upper pole calix and one in a lower pole calix. There is mild right-sided hydronephrosis.LEFT KIDNEY: The left kidney measures 12.0 cm in length and demonstrates normal parenchymal echogenicity. A 0.8 cm nonobstructing stone is noted in the inferior pole calix of the left kidney.BLADDER: No significant abnormality noted.OTHER: No significant abnormalities noted.

Output: 1.Mild right-sided hydronephrosis.2.Bilateral nonobstructive renal stones as detailed above.


Instruction: Generate impression based on medical findings.

Input: Male 45 years old Reason: HBV, eval for HCC History: HBV LIMITED ABDOMENLIVER: The liver has a smooth contour. The liver measures 14.4 cm in length. The liver echotexture is mildly coarse. No suspicious lesion is identified. There is a left hepatic cyst measuring 6 x 6 x 7 mm.BILIARY TRACT: The gallbladder has a 2 x 2 mm nondependent echogenic focus within the body, compatible with a polyp. The wall measures 2 mm in thickness. The common duct measures 3 mm. PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 11.3 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 10.8 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. There is a 0.9 x 0.9 x 0.9 cm simple cyst within the mid pole.SPLEEN: The spleen measures 10.4 cm in length. The spleen is unremarkable.OTHER: No significant abnormalities noted.

Output: 1.Coarse hepatic echotexture, with no focal lesion identified.2.Small gallbladder polyp.


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old. Reason: Pt w/ new HCV Ab positive, eval for changes c/w cirrhosis, HCC surveillance/baseline US History: HCV Ab positive LIVER: The liver measures 15.9 cm in length. Mildly coarse parenchymal echotexture. Main portal vein has a normal direction of flow with a velocity of 20 cm/s. No worrisome hepatic mass or ascites.BILIARY TRACT: Gallbladder sludge without gallbladder wall thickening or pericholecystic fluid. Common bile duct measures 5 mm. No intrahepatic or extrahepatic ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: Spleen measures 8.2 cm in length with a normal echotexture.RIGHT KIDNEY: Right kidney measures 11.5 cm in length with normal cortical echogenicity. No hydronephrosis, mass, or shadowing calculi. OTHER: Left kidney measures 11.3 cm in length with normal cortical echogenicity. No hydronephrosis, mass, or shadowing calculi.

Output: 1. Mildly coarse hepatic parenchyma suggests chronic liver disease. No worrisome mass.2. Gallbladder sludge without evidence of acute inflammation.


Instruction: Generate impression based on medical findings.

Input: 21-year-old Reason: 20 wks pregnant, right sided abdominal/back pain with persistent n/v, anorexia, concern for appendicitis History: n/v, abdominal pain, anorexia, right CVA tenderness LIVER:The liver measures 14.5 cm in length. Liver parenchyma is normal in echogenicity.Main portal vein is patent with hepatopetal flow.GALLBLADDER, BILIARY TRACT: Gallbladder is unremarkable. No gallbladder distention, wall thickening, or pericholecystic fluid. There is no intrahepatic or extrahepatic biliary ductal dilatation.PANCREAS: Visualized components of the pancreatic head are unremarkable. The pancreatic body and tail are obscured by overlying bowel gas.SPLEEN: The spleen measures 7.5 cm in length.KIDNEYS: The right kidney measures 11.4 cm in length. There is moderate hydronephrosis. No shadowing renal calculus is identified within the right renal collecting system. The renal parenchyma is somewhat heterogeneous. And there is a moderate amount of perinephric fluid with a complex appearing fluid collection surrounding the right kidney.The left kidney measures 10.7 cm in length. No evidence of hydronephrosis or shadowing renal calculus.ABDOMINAL AORTA: The proximal abdominal aorta measures 1.9 x 1.9 cm. The middle portion of the abdominal aorta measures 1.4 x 1.1 cm. The distal aorta measures approximately 1.5 x 1.2 cm. The iliac arteries are not visualized on this examination.INFERIOR VENA CAVA: Visualized component of the IVC is patent.OTHER: Right ovary appears normal in size and echogenicity with normal expected vascular flow. The appendix is not visualized on this examination. Incompletely imaged gravid uterus is noted.

Output: 1.Moderate right-sided hydronephrosis may be physiologic due to patient's gravid state. However given heterogenous appearing renal parenchyma and superimposed pyelonephritis cannot be entirely excluded. The left kidney is unremarkable with no shadowing renal calculus or hydronephrosis.2.Complex fluid collection surrounding the right kidney may reflect a perinephric hematoma.3.Incompletely imaged gravid uterus.


Instruction: Generate impression based on medical findings.

Input: Possible cirrhosis. Evaluate for hepatocellular carcinoma. LIVER: There is diffusely increased hepatic echogenicity compatible with hepatic steatosis. The liver is normal in size measuring 15.3 cm in length. The hepatic capsule is smooth without evidence of cirrhosis. No focal mass lesion. The portal vein has normal hepatopedal flow with a velocity of 26 cm/s.GALLBLADDER, BILIARY TRACT: No intrahepatic or extrahepatic biliary ductal dilatation. The gallbladder is normal in size and wall thickness. No cholelithiasis. The common bile measures 4 mm in diameter.PANCREAS: The pancreas is poorly visualized due to overlying bowel gas.RIGHT KIDNEY: The right kidney is normal in size measuring 11.7 cm in length. There is normal corticomedullary differentiation. No hydronephrosis or nephrolithiasis.LEFT KIDNEY: The kidney is normal in size measuring 11.0 cm in length. There is normal corticomedullary differentiation. No hydronephrosis or nephrolithiasis.SPLEEN: The spleen is normal in size and echotexture measuring 11.7 cm in length.OTHER: No ascites.

Output: Hepatic steatosis without evidence of cirrhosis, mass lesion, or sequela of portal hypertension.


Instruction: Generate impression based on medical findings.

Input: Male 65 years old Reason: r/o cholecystitis History: mild transaminitis and fever w/ RUQ abdominal pain LIMITED ABDOMENBILIARY TRACT: The gallbladder has an anechoic lumen. Wall is mildly thickened. Nodules along the gallbladder wall with associated comet tail effect are consistent with adenomyomatosis. Further, the gallbladder appears mildly distended with trace pericholecystic fluid. Common duct measures 3 mm.OTHER: No significant abnormalities noted.

Output: 1.Mildly distended gallbladder with gallbladder wall thickening and trace pericholecystic fluid could represent an early acalculus cholecystitis.2.Adenomyomatosis of the gallbladder.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old. Reason: assess for hepatomegaly History: elevated LFTs, fever LIVER: Liver measures 16.5 cm in length. Liver parenchyma is within normal limits. Main portal vein has a normal direction of flow.BILIARY TRACT: Common bile duct measures 2 mm. No cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. No intrahepatic or extrahepatic biliary ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: Spleen size is upper limit of normal and measures 14.9 cm. Echotexture is within normal limits.RIGHT KIDNEY: Right kidney measures 11.7 cm in length. Corticomedullary differentiation is preserved. No hydronephrosis, mass, or shadowing calculi. OTHER: Left kidney measures 11.9 cm in length. Corticomedullary differentiation is preserved. No hydronephrosis, mass, or shadowing calculi.

Output: No evidence of hepatomegaly or other specific finding to account for the patient's symptomatology.


Instruction: Generate impression based on medical findings.

Input: Male 74 years old, assess kidneys, difficulty urinating RIGHT KIDNEY: The right kidney measures 11.7 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. No increased vascularity. Superior pole exophytic cyst measuring 1.0 x 0.9 x 1.2 cm.LEFT KIDNEY: The left kidney measures 10.9 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. No increased vascularity. Mid pole cysts measuring 2.0 x 1.7 x 1.6 cm and 1.2 x 1.7 x 1.6 cm.URINARY BLADDER: No significant abnormality notedOTHER: Prostatomegaly measuring up to 10.1 x 4.2 x 5.6 cm.

Output: Marked prostatomegaly. No evidence of nephrolithiasis or hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old. Reason: 27 yo with HCV please screen for lesions History: none LIVER: Mildly coarse hepatic echotexture. Liver measures 12.7 cm in length. Main portal vein has a normal direction of flow with a velocity of 12 cm/s. No suspicious hepatic lesion or ascites is visualized.BILIARY TRACT: Common bile duct measures 5 mm. Gallbladder contains multiple folds, however, there is no cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. No intrahepatic or extrahepatic biliary ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: Spleen measures 8.9 cm in length and normal in echotexture.RIGHT KIDNEY: Right kidney measures 9.6 cm in length. Right kidney is abnormally rotated with the hilum directed anteriorly. No hydronephrosis, mass, or shadowing calculi. OTHER: Left kidney measures 9.8 cm in length. No hydronephrosis, mass, or shadowing calculi. Prominent, nonspecific peripancreatic lymph node measures 1.0 x 0.5 x 1.2 cm.

Output: Mildly coarse hepatic echotexture which likely represents chronic liver disease. No suspicious hepatic lesion or ascites is visualized.


Instruction: Generate impression based on medical findings.

Input: Female 62 years old Reason: eval AKI, also with urinary retention, eval hydronephrosis History: retention, AKI RIGHT KIDNEY: The right kidney measures 11.7 cm in length and demonstrates normal parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.LEFT KIDNEY: The left kidney measures 11.0 cm in length and demonstrates normal parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.BLADDER: The bladder is nondistended.OTHER: No significant abnormalities noted.

Output: Normal renal parenchymal echogenicity, and no evidence of hydronephrosis or hydroureter.


Instruction: Generate impression based on medical findings.

Input: Female 75 years old; Reason: eval for cause of new onset renal failure History: as above RIGHT KIDNEY: The right kidney measures 10.0 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 8.6 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present.  OTHER: Urinary bladder is unremarkable.

Output: 1.Echogenic renal kidneys without sonographic evidence of hydronephrosis or nephrolithiasis.


Instruction: Generate impression based on medical findings.

Input: Female 62 years old; Reason: Evaluate for recurrence. Please compare to prior ultrasound. History: thyroid cancer status post thyroidectomy RIGHT LOBE: Status post thyroidectomy. The previously seen hypoechoic ovoid nodule in the right thyroidectomy bed is not identified on today's exam.LEFT LOBE: Status post thyroidectomy. No evidence of recurrent disease.ISTHMUS: Status post thyroidectomy. No evidence of recurrent disease.LYMPH NODES: Normal appearing appearing bilateral cervical lymph nodes.OTHER: No significant abnormality noted.

Output: The previously seen nodule in the right thyroidectomy bed is not identified on today's exam. No evidence of recurrent disease.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old. Reason: Evaluate for nodule. History: Thyroid cancer s/p Sg I131 RIGHT LOBE MEASUREMENTS: Status post thyroidectomyLEFT LOBE MEASUREMENTS: Status post thyroidectomyISTHMUS MEASUREMENTS: Status post thyroidectomyRIGHT LOBE: Status post thyroidectomy without focal mass.LEFT LOBE: Status post thyroidectomy without focal mass.ISTHMUS: Status post thyroidectomy without focal mass.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing right level 3 neck lymph node measures 1.1 x 1.5 x 0.3 cm. Two benign-appearing left level 3 lymph nodes are present. Representative left level 3 neck lymph node located medially has an unremarkable morphology and measures 1.2 x 0.4 x 0.8 cmOTHER: No significant abnormality noted.

Output: Status post thyroidectomy without evidence of focal mass or regional lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Male 32 years old; Reason: acute renal injury History: evaluate for hydronephrosis This examination is extremely limited secondary to overlying bowel gas and inability for patient cooperation. Within these limitations, the following observations are made:RIGHT KIDNEY: The right kidney is not visualized.LEFT KIDNEY: The left kidney measures 13.7 cm in length. No hydronephrosis is visualized.OTHER: The bladder is collapsed with a Foley catheter.

Output: Limited examination with no hydronephrosis on the left. The right kidney is not visualized on this exam.PLEASE NOTE:  THIS REPORT HAS BEEN ADDENDED FOR CHANGE IN ORDERED EXAMINATION.  THE REPORT IS CORRECT AS DICTATED.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old. Reason: 72yoM hx adenocarcinoma in 2013 that invaded the bladder muscle layer s/p cystectomy, right hemicolectomy, and sigmoid resection in May 2013 for pathologic stage T4N0 adenocarcinoma. History: worsening renal function RIGHT KIDNEY: Right kidney measures 10 cm in length with increased cortical echogenicity. No hydronephrosis or shadowing calculi.LEFT KIDNEY: Left kidney measures 9.6 cm in length with increased cortical echogenicity. Left upper pole simple-appearing cyst measures 1.3 x 0.6 x 1.6 cm.Left lower pole simple-appearing cyst measures 1.7 x 1 x 1.7 cm. No hydronephrosis or shadowing calculi.URINARY BLADDER: Status post cystectomy. Ileal conduit is obscured by overlying gas.OTHER: No significant abnormalities noted.

Output: Echogenic renal parenchyma bilaterally suggests medical renal disease/parenchymal dysfunction. No hydronephrosis.


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 this formal read-out, the clinical service had already been notified of this finding by the technologist.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old. Reason: follow up on nodule History: as above RIGHT LOBE MEASUREMENTS: 5.6 x 1.9 x 2.4 cmLEFT LOBE MEASUREMENTS: 5.9 x 2.6 x 2.7 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Diffusely heterogeneous gland with multiple nodules. Right superior thyroid nodule with calcifications measures 1.4 x 1.3 x 0.9 cm, previously 1.1 x 1.0 x 1.5 cm. Right mid thyroid nodule with calcifications measures 0.6 x 0.6 x 1.0 cm, previously 0.8 x 0.6 x 1.0 cm. Right inferior dominant nodule with calcifications measures 2.3 x 1.6 x 1.5 cm, previously 2.5 x 1.4 x 1.5 cm.LEFT LOBE: Diffusely heterogeneous gland with a dominant nodule. Dominant nodule measures 2.0 x 3.5 x 5.0 cm, previously 2.0 x 2.7 x 4.8 cm.ISTHMUS: Superior spongiform nodule measures 0.6 x 0.4 x 0.7 cm, previously 0.6 x 0.4 x 0.8 cm. Inferior spongiform nodule measures 0.5 x 0.8 x 1.0 cm, previously 0.3 x 1.0 x 1.0 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Multiple, prominent right cervical lymph nodes with unremarkable morphologies are present. A representative right level 2 cervical lymph node measures 1.7 x 1.4 x 0.8 cm, previously 1.2 x 0.5 x 2.3 cm.OTHER: No significant abnormality noted.

Output: Diffusely heterogeneous gland with multiple nodules which are not significantly changed in size or appearance. Previously biopsied right thyroid nodules with calcifications were found to be benign.


Instruction: Generate impression based on medical findings.

Input: Female 69 years old; Reason: hx of 2 right renal masses, evaluate change in size RIGHT KIDNEY: Exophytic and slightly echogenic mid-pole lesion measuring 1.4 x 1.5 cm, which is not significantly changed from CT dated 4/9/2015. The right kidney measures 9.2 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. Normal vascularity.LEFT KIDNEY: The left kidney measures 10.8 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. Normal vascularity.URINARY BLADDER: Partially distended bladder, which is not well visualized on this exam.OTHER: No significant abnormalities noted.

Output: Right exophytic renal lesion appears unchanged in size when compared to CT dated 4/9/2015 accounting for technical differences.


Instruction: Generate impression based on medical findings.

Input: Abdominal pain exacerbated by fluid. Evaluate for gallstones. LIVER: The liver is normal in size and echotexture measuring 19.0 cm. No focal parietal lesion.GALLBLADDER, BILIARY TRACT: The gallbladder demonstrates multiple large shadowing gallstones as well as layering sludge. The gallbladder wall is thickened measuring 6 mm however there is no pericholecystic fluid and the sonographic Murphy sign is negative. Multiple foci of ringdown artifact within the gallbladder wall compatible with adenomyosis.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Right kidney is normal in size measuring 10.4 cm in length. No hydronephrosis.OTHER: Left kidney is normal in size measuring 13.1 cm in length. No hydronephrosis. The spleen is normal in length and echotexture measuring 7.7 cm.

Output: Cholelithiasis and gallbladder wall thickening. As the sonographic Murphy's sign is negative, acute cholecystitis is considered unlikely. The appearance may reflect chronic cholecystitis. This can be further evaluated with nuclear medicine HIDA scan as clinically warranted.


Instruction: Generate impression based on medical findings.

Input: Male 18 years old Reason: ? pancreatitis History: elevated lipase LIVER: Hepatomegaly, liver measures 19.6 cm in length. No focal liver lesion. Main portal vein patent with normal directional flow, velocity increased, measuring 62 cm/s. BILIARY TRACT: Small sludge in gallbladder. No significant gallbladder distention, wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Visualized portions of pancreas unremarkable. However, if there is persistent clinical concern for acute pancreatitis, this would be better assessed with dedicated contrast-enhanced CT.KIDNEYS: The right kidney measures 12.9 cm. The left kidney measures 12.6 cm. Increased renal cortical echogenicity. No hydronephrosis.SPLEEN: Splenomegaly, measures 15.8 cm.OTHER: No significant abnormality noted.

Output: Visualized pancreas unremarkable. However, if there is persistent clinical concern for acute pancreatitis, this would be better assessed with dedicated contrast-enhanced CT.Small sludge in gallbladder. No evidence of acute cholecystitis.Hepatosplenomegaly.Increased main portal vein velocity.Increased renal cortical echogenicity, suggestive of medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Female 64 years old Reason: 64 yo female with right upper abdominal pain that worsens with meals. Please evaluate for cholelithiasis or cholecystitis History: right upper abdominal pain LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 19 cm in length. The parenchyma is moderately echogenic . No focal hepatic lesions.There is moderate intrahepatic biliary ductal dilatation.BILIARY TRACT: The gallbladder contains layering sludge. Wall measures 2mm in thickness. There is mild pericholecystic fluid and pericholecystic edema in the liver. The gallbladder is distended.Common duct measures 2cm proximally. PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 9.3 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 10.5 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 8.4 cm. in length. OTHER: No ascites.

Output: 1.Severe extrahepatic and moderate intrahepatic ductal dilatation.2.Distended gallbladder with sludge. There is trace pericholecystic fluid and developing cholecystitis can have a similar appearance.3.The findings are most compatible with a common bile duct obstruction the etiology for which is not evident on the current exam. Correlation with MRCP is suggested. Findings discussed with Dr. Naylor. Patient is advised to follow up in the emergency Department for emergent care.


Instruction: Generate impression based on medical findings.

Input: 81-year-old male with history of BPH. Evaluate for hydronephrosis. RIGHT KIDNEY: The right kidney measures 9.6 cm. Increased cortical echogenicity compatible with medical renal disease. No evidence of hydronephrosis.LEFT KIDNEY: The left kidney measures 11.3 cm. Increased cortical echogenicity compatible with medical renal disease. No evidence of hydronephrosis.OTHER: The prostate measures 4.4 x 3.5 cm and protrudes into the bladder neck. The bladder is distended. There is a diverticulum arising from the left aspect of the bladder measuring 3.9 x 3.0 cm.

Output: Mild BPH with no evidence of hydronephrosis. Bilateral medical renal disease. Moderate sized left bladder diverticulum.


Instruction: Generate impression based on medical findings.

Input: 43-year-old male Reason: 43 yo M admitted with Aflutter, hyperthyroidism, eval for thyroiditis vs graves History: Aflutter, undetectable TSH RIGHT LOBE MEASUREMENTS: 6.0 x 2.4 x 2.1 cm.LEFT LOBE MEASUREMENTS: 5.1 x 2.2 x 2.1 cm.ISTHMUS MEASUREMENTS: 1.0 cm.RIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: In the isthmus is a iso to hypoechoic bulbous nodule that measures 2.8 x 2.0 x 1.6 cm with punctate echogenic foci without reverberation artifact which may represent internal calcifications and does not demonstrate any internal vascularity.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Indeterminate nodule in the isthmus with possible calcifications.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for nephrolithiasis History: colicky L flank pain with groin radiation; per patient prior hernia surgery with resolution of pain Exam is limited by overlying bowel gas.RIGHT KIDNEY: Right kidney measures 8.7 cm and is mildly increased in echogenicity. Cystic focus in the right kidney measuring 1.1 cm may correspond to cysts seen on prior study. No definite hydronephrosis. No evidence of renal calculi.LEFT KIDNEY: Left kidney measures 9.1 cm and is mildly increased in echogenicity without hydronephrosis. No evidence of renal calculi.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.

Output: Mildly increased bilateral renal echogenicity compatible with medical renal disease. No evidence of kidney stones.


Instruction: Generate impression based on medical findings.

Input: Male 61 years old Reason: RUQ pain with elevated bilirubin. s/p gallbladder removal. Please eval liver LIVER: Liver measures 14.7 cm in length. The parenchyma is echogenic and coarse. Main portal vein patent with normal directional flow, velocity measures 33 cm/s. BILIARY TRACT: Status post cholecystectomy. Mildly dilated CBD measuring 8-9 mm (likely due in part to patient's postcholecystectomy state), unable to follow duct distally. No intrahepatic biliary duct dilatation delineated.PANCREAS: Not well seen in entirety due to overlying bowel gas.KIDNEYS: The right kidney measures 12.2 cm. The left kidney measures 12.1 cm. No hydronephrosis.SPLEEN: The spleen measures 12.9 cm. in length. OTHER: No significant abnormality noted.

Output: Echogenic liver, likely reflecting underlying hepatic steatosis/parenchymal dysfunction.Mildly dilated CBD measuring 8-9 mm, unable to follow duct distally to exclude obstructing stone. No intrahepatic biliary duct dilatation delineated.


Instruction: Generate impression based on medical findings.

Input: Secondary hyperparathyroidism of renal origin, assess for thyroid nodules including size and location and any abnormal lymph nodes RIGHT LOBE: Measures 4.2 x 2.2 x 2 cm. Subcentimeter mid to lower pole colloid cyst visualized.LEFT LOBE: No significant abnormality noted.ISTHMUS: Thickened measuring 0.5 cm.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Subcentimeter right-sided colloid cyst, exam unremarkable otherwise.


Instruction: Generate impression based on medical findings.

Input: Female 49 years old Reason: RUQ US History: abdominal pain , increased lipase levels Exam limited by patient's body habitus.LIVER: Hepatomegaly, liver measures 22 cm. Heterogeneous echotexture seen, likely reflecting underlying hepatic steatosis/parenchymal dysfunction. Main portal vein patent with normal directional flow, velocity measures 42 cm/s.BILIARY TRACT: Gallbladder unremarkable. No significant gallbladder distention, wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Not well seen in entirety due to adjacent bowel gas.KIDNEYS: The right kidney measures 11.5 cm. Large heterogeneous right renal mass, better evaluated on earlier contrast-enhanced cross-sectional imaging. The left kidney measures 12.5 cm. SPLEEN: Splenomegaly, spleen measures up to 14.6 cm.OTHER: No significant abnormality noted.

Output: Patient's known right-sided renal cell carcinoma better evaluated on earlier contrast-enhanced cross-sectional imaging. Hepatosplenomegaly.


Instruction: Generate impression based on medical findings.

Input: Male 40 years old; Reason: evaluate bilateral renal cysts History: History of renal cell carcinoma, sp partial nephrectomy RIGHT KIDNEY: The right kidney measures 14 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. Again noted is cystic appearing structure in the upper pole of the right kidney, with the cystic component measuring 2.1 x 1.9 x 1.8 cm with associated calcification measuring 1.4 x 1 x 1.8 cm.LEFT KIDNEY: Patient status post partial nephrectomy. The left kidney measures 13.3 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. Left upper pole cystic structure measures 0.9 x 1.1 x 1.1 cm with associated calcification measuring 1.2 x 0.8 x 0.9 cm. The cystic portion appears stable as compared to prior CT, with the calcification component new as compared to the prior exam.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.

Output: Bilateral upper pole cystic structures, stable as compared to prior CT from 6/24/2015.


Instruction: Generate impression based on medical findings.

Input: Female 51 years old Reason: eval for etiology of hepatomegaly History: N/V, abdominal pain LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 19 cm in length. The parenchyma is echogenic. No focal hepatic lesions. Main portal vein is patent with normal flow. BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 2 mm in thickness. Common duct measures 5 mm. PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 5.6 cm. The cortex is thinned and echogenic. No shadowing calculi or hydronephrosis is present. The left kidney measures 6.2 cm. The cortex is thinned and echogenic. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 12.5 cm. in length. OTHER: No significant abnormalities noted.

Output: 1.Borderline hepatosplenomegaly.2.Renal atrophy.


Instruction: Generate impression based on medical findings.

Input: Reason: further characterization of L lower back mass History: Mass There is a hypoechoic, primarily solid lesion noted within the subcutaneous tissue which measures 0.8 x 0.7 x 0.6 cm.

Output: 1. Hypoechoic, primarily solid lesion within the subcutaneous tissue. This is a nonspecific finding but may represent a small hematoma versus subcutaneous nodule. Imaging characteristics are not suggestive of an abscess.


Instruction: Generate impression based on medical findings.

Input: Male 78 years old; Reason: hydronephrosis? History: New AKI oliguria RIGHT KIDNEY: The right kidney measures 10.8 cm in length. The cortex has increased echogenicity. No shadowing calculi or hydronephrosis is present. No worrisome mass is seen.LEFT KIDNEY: The left kidney measures 12.1 cm in length. The cortex has increased echogenicity. No shadowing calculi or hydronephrosis is present. No worrisome mass is seen.URINARY BLADDER: Unremarkable.OTHER: A small right pleural effusion is noted.

Output: 1.Increased echogenicity of the kidneys bilaterally consistent with chronic medical renal disease.2.Small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female 54 years old Reason: Thyroid nodules: eval for growth History: thyroid nodules RIGHT LOBE MEASUREMENTS: 8.4 x 3.6 x 2.9 cmLEFT LOBE MEASUREMENTS: 8.3 x 3.4 x 2.9 cm.ISTHMUS MEASUREMENTS: 1.4 cmRIGHT LOBE: The right lobe of the thyroid demonstrates heterogeneous parenchymal echogenicity. There is a conglomerate of part cystic/solid and spongiform nodules in the right lower lobe, which measures approximately 4.0 x 2.1 x 3.5 cm, overall increased in size from the prior examination. There is a calcification, which appears to be adjacent to the medial aspect the right thyroid lobe is felt to be within the tracheal cartilage.LEFT LOBE: The left lobe of the thyroid demonstrates heterogeneous parenchymal echogenicity. The multiple left lower pole spongiform nodules, which have now also slightly increased in size resulting in a conglomerate of inseparable nodules now measuring approximate 5.2 x 2.6 x 2.8 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Thyromegaly, resulting from bilateral conglomerates of thyroid nodules, which have increased in size from the prior examination, but lack definite suspicious features.


Instruction: Generate impression based on medical findings.

Input: Female 62 years old Reason: 62 yo F w/ relapsed ALL admitted with neutropenic fever, GNR bacteremia, CT scan w gallbladder thickening but no stones; please eval for evidence of acalculous cholecystitis History: see above LIMITED ABDOMENLIVER: The liver has a smooth contour. BILIARY TRACT: No shadowing calculi or significant sludge. Wall measures 5mm in thickness. Trace pericholecystic fluid. Common duct measures 6 mm. PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.OTHER: No ascites

Output: 1.Mild gallbladder wall thickening without gallbladder distention. These findings are nonspecific and may be seen in the setting of acalculous cholecystitis or hypoalbuminemia. As previously recommended a HIDA scan is suggested.


Instruction: Generate impression based on medical findings.

Input: 42-year-old female with left lower extremity swelling over anterior shin. Reason: Question lipoma. Unremarkable subcutaneous tissue of the left anterior shin without obvious mass or fluid collection.

Output: Unremarkable subcutaneous tissue of the left anterior shin without obvious mass or fluid collection. If clinically indicated, consider MRI for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old. Reason: Elevated alk phos and transaminases. History of head and neck cancer. RUQ u/s requested to further evaluate. History: as above LIVER: Liver measures 17 cm in length with coarse, echogenic hepatic parenchyma. No focal mass or ascites. Main portal vein is patent with a normal direction of flow.BILIARY TRACT: Cholelithiasis without gallbladder wall thickening or pericholecystic fluid. Sonographic Murphy's sign is negative. No biliary ductal dilatation. Common bile duct measures 4 mm.PANCREAS: The visualized portions of the pancreas are unremarkable. The pancreatic tail is obscured by overlying bowel gas.SPLEEN: Spleen measures 10.4 cm in length with normal echotexture.RIGHT KIDNEY: Right kidney measures 10.1 cm in length with normal cortical echogenicity. No hydronephrosis, shadowing calculi, or mass.OTHER: Left kidney measures 10.8 cm in length with normal cortical echogenicity. No hydronephrosis, shadowing calculi, or mass.

Output: 1. Cholelithiasis without evidence of acute inflammation.2. Coarse, echogenic hepatic parenchyma suggests parenchymal dysfunction/fatty infiltration. No focal mass or biliary ductal dilatation.


Instruction: Generate impression based on medical findings.

Input: Male 69 years old Reason: acute renal failure, eval for hydronephrosis History: arf RIGHT KIDNEY: The right kidney measures 12.3 cm. No shadowing calculi or hydronephrosis is present. No perinephric free fluid. Increased renal cortical echogenicity. LEFT KIDNEY: The left kidney measures 12.5 cm. No shadowing calculi or hydronephrosis is present. No perinephric free fluid. Increased renal cortical echogenicity. BLADDER: Visualized bladder unremarkable.OTHER: No significant abnormalities noted.

Output: No hydronephrosis.Increased renal cortical echogenicity likely reflecting medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Male 42 years old Reason: AKI, ascites, pv thrombosis History: SOB, ascites LIVER: The liver has a mildly nodular contour. Liver measures 18 cm in length. The parenchyma is moderately echogenic. The main portal vein is grossly patent by color Doppler and flow is hepatopedal at 0.3 m/s. The hepatic veins are patent by color Doppler.BILIARY TRACT: The gallbladder contains layering sludge. Wall measures 0.2 cm in thickness. Common duct measures 0.3 cm. PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 10.2 cm. The cortex is mildly echogenic. No shadowing calculi or hydronephrosis is present. The left kidney measures 10.3 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 15.1 cm. in length and is mildly enlarged. OTHER: There is a moderate amount of simple appearing ascites.ABDOMINAL AORTA: Mid: 2.9 x 2.2 cmDistal: 1.8 x 1.4 cmINFERIOR VENA CAVA: Patent without significant abnormality.OTHER: No significant abnormality noted.

Output: 1.Mildly nodular and echogenic liver suggestive of cirrhosis.2.Portal veins grossly patent on color Doppler.3.Moderate amount of simple appearing ascites.4.Mild splenomegaly.


Instruction: Generate impression based on medical findings.

Input: Female 77 years old; Reason: Evaluate for obstruction History: AKI RIGHT KIDNEY: The right kidney measures 8 cm in length. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 10 cm in length. The cortex is normal echogenicity.. No shadowing calculi or hydronephrosis is present. Simple appearing left renal cyst measuring 2 cm in the upper pole.OTHER: Foley catheter in urinary bladder, causing decompression and precluding evaluation.

Output: 1.No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old. Reason: Liver disease, cholecystitis, bile duct obstruction. History: transaminitis, abdominal pain LIVER: Liver measures 17.8 cm in length with coarse and mildly echogenic parenchyma. No focal lesion or ascites. Main portal vein is patent with a normal direction of flow.BILIARY TRACT: No cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. No intrahepatic biliary ductal dilatation. Common bile duct is mildly prominent and measures 9 mm.PANCREAS: Visualized portions of the pancreas are unremarkable. The distal body and tail are obscured by overlying gas.SPLEEN: Spleen measures 9.8 cm in length with normal echotexture.RIGHT KIDNEY: Right kidney measures 10.1 cm in length with normal cortical echogenicity. No hydronephrosis, shadowing calculi or mass.OTHER: Left kidney measures 8.3 cm in length with normal cortical echogenicity. No hydronephrosis, shadowing calculi or mass.

Output: 1. Coarse, echogenic hepatic parenchyma suggests parenchymal dysfunction/fatty infiltration. No focal mass or significant biliary ductal dilatation.2. No cholelithiasis or acute inflammation of the gallbladder.


Instruction: Generate impression based on medical findings.

Input: 76-year-old female with history of left nephrectomy and known right AML. Reason: Surveillance. RIGHT KIDNEY: The right kidney measures 11.9 cm. The cortex is of normal echogenicity. There is a large slightly lobulated, hyperechoic focus in the mid to lower pole measuring 5.7 x 4.2 x 5.6 cm, corresponding to angiomyolipoma seen on prior MR study. A smaller posterior angiomyolipoma seen on prior MR study was not evaluated in this sonographic study.LEFT KIDNEY: Status post left nephrectomy.OTHER: The bladder is nondistended.

Output: Slightly lobulated, hyperechoic focus in the mid to lower pole corresponding to the angiomyolipoma seen on prior MR study. It is difficult to compare measurements with the MR study, but the lesion appears largely unchanged. A smaller posterior angiomyolipoma was not fully evaluated in this sonographic study.


Instruction: Generate impression based on medical findings.

Input: Female 48 years old Reason: thyroid nodules, please evaluate for changes History: thyroid nodules RIGHT LOBE MEASUREMENTS: 9.1 x 2.7 x 3.5 cmLEFT LOBE MEASUREMENTS: 3.7 x 1.0 x 1.5 cm.ISTHMUS MEASUREMENTS: 0.7 cm in thickness.RIGHT LOBE: The right lobe of the thyroid demonstrates heterogenous parenchymal echogenicity. 1.4 x 1.0 x 1.6 cm anechoic cystic lesion in the mid to upper pole of the right lobe of the thyroid, although comparison is difficult due to multinodular nature of the gland. Previously measured cystic lesion in the right lobe of the thyroid, which in retrospect appears to be part of a larger cystic/solid nodule which measures approximately 5.0 x 3.0 x 2.5 cm, not substantially changed compared to the prior examination, although precise comparison is difficult given differences in acquisition technique.LEFT LOBE: The left lobe of the thyroid demonstrates normal parenchymal echogenicity. Please identified cystic lesion in the upper pole of the left lobe of thyroid not seen on today's examination.ISTHMUS: 1.7 x 0.9 x 1.7 cm partially solid partially cystic nodule in the isthmus, not significantly changed. 1.2 x 1.2 x 0.6 cm predominantly cystic nodule with a mural nodular component, slightly decreased compared to the prior study when it measured 1.8 x 0.9 x 1.7 cm. 1.4 x 1.3 x 0.6 cm cystic nodule in the left aspect of the isthmus, slightly decreased in size from the prior exam when it measured 1.6 x 1.0 x 1.6 cm.PARATHYROID GLANDS: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multinodular goiter with stable to slight decrease in size of the reference nodules.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male presents with renal insufficiency. RIGHT KIDNEY: The right kidney is slightly echogenic and measures 12 cm in length. Corticomedullary differentiation is maintained. No shadowing calculi or hydronephrosis is present.LEFT KIDNEY: The left kidney is slightly echogenic and measures 13 cm in length. Corticomedullary differentiation is maintained. No shadowing calculi or hydronephrosis is present. URINARY BLADDER: The bladder is decompressed by a Foley catheter.OTHER: No significant abnormalities noted.

Output: Slightly echogenic kidneys suggestive of medical renal disease. No evidence of hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Reason: 46 yo with acute RUQ pain, assess for gallbladder pathology LIVER: Liver measures 25.7 cm with increased echogenicity. Portal vein is patent with normal direction and velocity of 0.3 m/s. No suspicious hepatic mass is noted.BILIARY TRACT: Common bile duct measures 4-6 mm. Hyperechoic gallbladder sludge with mild shadowing suggestive of stone in the sludge. Gallbladder wall measures 2 mm. No pericholecystic fluid collection. PANCREAS: Distal pancreas is obscured by overlying bowel gas. Visualized part is within normal limits.SPLEEN: Spleen measures 12.9 cm and is normal in echogenicity and configuration.KIDNEYS: Right kidney measures 11.7 cm with normal echogenicity and without hydronephrosis. Left kidney measures 13.1 cm with normal echogenicity and without hydronephrosis. No renal calculi identified. OTHER: No significant abnormalities noted.

Output: Hepatomegaly with increased echogenicity. Gallbladder sludge with possible stone in the sludge noted without evidence of acute inflammation or biliary ductal dilatation.


Instruction: Generate impression based on medical findings.

Input: Reason: Increased abdominal girth- ?Ascites; decreased appetite- ?cirrhosis History: Increased abdominal girth- ?Ascites; decreased appetite- ?cirrhosis LIVER: The size of the liver is at the upper limits of normal, measuring 17.1 cm. Diffusely increased echogenicity, suggestive of fatty infiltration. No focal lesions. No intrahepatic ductal dilation.GALLBLADDER, BILIARY TRACT: No cholelithiasis. The gallbladder wall is not thickened, measuring 0.2 cm. The common hepatic duct is not dilated, measuring 0.3 cm.PANCREAS: The pancreas is poorly visualized due to overlying bowel gas.KIDNEYS: The right kidney measures 11.4 cm in length. Normal echogenicity. There is a minimally complex cyst noted within the superior pole of the right kidney which measures 2 x 1.8 x 2 cm. No hydronephrosis.The left kidney measures 11.3 cm in length. Normal echogenicity. No focal lesions. No hydronephrosis.OTHER: The main portal vein is patent with hepatopetal flow and a normal waveform.

Output: 1. Fatty infiltration of the liver. No focal lesions.2. No ascites.3. Minimally complex cyst noted within the superior pole of the right kidney.


Instruction: Generate impression based on medical findings.

Input: 60 year-old female history of left buttock mass. A targeted ultrasound was performed in the area of the patient's palpable mass. In this area, there is a subcutaneous, hypoechoic, heavily calcified lesion without internal vascular flow measuring 2.2 x 2.2 cm which correlates to an injection granuloma seen on prior CTs dating back to 2012.

Output: Probable injection granuloma in the left buttocks, stable since 2012.


Instruction: Generate impression based on medical findings.

Input: Preheart transplant evaluation. LIVER:The liver measures approximately 13.7 cm with increased echogenicity. The liver surface is nodular, compatible with a cirrhotic morphology. The portal and is patent with normal direction. No suspicious hepatic masses are noted.GALLBLADDER, BILIARY TRACT: The common bile duct measures 0.15 cm. The gallbladder wall measures 0.2 cm. There is a small amount of gallbladder sludge noted. No pericholecystic fluid. No gallstones.PANCREAS: The pancreas sister by overlying bowel gas. Visualized part is within normal limits.SPLEEN: No significant abnormality noted.KIDNEYS: The kidneys have increased echogenicity bilaterally without hydronephrosis. No renal calculi are identified. ABDOMINAL AORTA: Not well visualized.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: There is a Foley catheter in the bladder.

Output: 1. Cirrhotic morphology and echogenicity of the liver, unchanged from prior study.2. Bilateral increased echogenicity of the kidneys compatible with chronic medical renal disease.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male with history of bladder stones RIGHT KIDNEY: The right kidney measures 12.3 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.LEFT KIDNEY: The left kidney measures 12.5 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.URINARY BLADDER: Multiple shadowing calculi within the bladder. OTHER: Prostate is enlarged protruding into the bladder similar to prior study.

Output: 1.Bladder calculi. No nephrolithiasis or hydronephrosis. 2.Enlarged prostate.


Instruction: Generate impression based on medical findings.

Input: Male 79 years old; Reason: elevated AST and ALT, evaluate for liver injury. Please note that exam is limited by patient positioning and inability to be placed in the decubitus position.LIVER: The liver is normal in echogenicity and echotexture. No focal hepatic lesions. Hepatic length measures 15.6 cm. The main portal vein is patent with normal hepatopetal flow with a velocity of 28.1 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 2 mm. The common bile duct measures 6.7 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 is not visualized due to inability to place patient in the decubitus position.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 11.6 cm with no hydronephrosis. Left kidney is not visualized due to inability to place the patient in decubitus position.OTHER: No significant ascites.

Output: Normal echogenicity and echotexture of the liver without focal mass.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for malignancy History: Hyperthyroidism RIGHT LOBE MEASUREMENTS: 2.0 x 2.2 x 5.1 cmLEFT LOBE MEASUREMENTS: 1.9 x 2.1 x 6.2 cmISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: Diffusely heterogeneous gland. LEFT LOBE: Diffusely heterogeneous gland.ISTHMUS: No significant abnormality noted.LYMPH NODES: Left cervical lymph node measuring 0.7 x 0.4 x 1.5 cm.OTHER: Hypoechoic focus posteroinferior to the right thyroid lobe measuring 1.2 x 0.7 x 0.6 cm, which may be a lymph node or parathyroid adenoma.

Output: 1.Diffusely heterogeneous gland compatible with chronic thyroiditis.2.Hypoechoic focus posterior inferior to the right thyroid lobe, which may be a lymph node or parathyroid adenoma. Clinical correlate with PTH levels.


Instruction: Generate impression based on medical findings.

Input: Male 70 years old; Reason: Patient with elevated BUN/Creatinine History: Azotemia RIGHT KIDNEY: The right kidney measures 12.2 cm in length. The cortex is mildly increased in echogenicity. Prominent anechoic cystic lesion in the pelvis, which corresponds to peri-pelvic cyst on CT dated 4/7/2016. Minimally complex lower pole cyst with thin septation. No shadowing calculi or hydronephrosis is present. Normal vascularity.LEFT KIDNEY: The left kidney measures 13.5 cm in length. The cortex is mildly increased in echogenicity. No shadowing calculi or hydronephrosis is present. Normal vascularity.URINARY BLADDER: Partially distended without visualization of urinary jets.OTHER: No significant abnormalities noted.

Output: Mildly increased renal cortical echogenicity bilaterally consistent with medical renal disease. Prominent cystic lesion on the right favors a peripelvic cyst. No definitive evidence of hydronephrosis or shadowing calculi.


Instruction: Generate impression based on medical findings.

Input: Female 73 years old; Reason: worsening flank pain mild hydro on last exam History: back pain RIGHT KIDNEY: The right kidney measures 10 cm in length. The cortex is normal echogenicity. No shadowing calculi. Mild fullness of the right collecting system.LEFT KIDNEY: The left kidney measures 10 cm in length. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. OTHER: Visualized portions of the urinary bladder are unremarkable.

Output: 1.Minimal right hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Female 38 years old; Reason: history of papillary thyroid carcinoma with hypoechoic nodule in left thyroid bed, please evaluate for interval change History: none RIGHT LOBE MEASUREMENTS: Status post thyroidectomy LEFT LOBE MEASUREMENTS: Status post thyroidectomy ISTHMUS MEASUREMENT: Status post thyroidectomy RIGHT LOBE: Status post thyroidectomy. No suspicious lesions in the right thyroid bed.LEFT LOBE: Status post thyroidectomy. Hypoechoic nodule in the left thyroid bed measures 1.25 x 0.8 cm previously, 0.67 x 0.62 centimeters it has imaging features most suggestive of a lymph node.ISTHMUS: No significant abnormality noted.LYMPH NODES: Small perivascular lymph nodes.OTHER: No significant abnormality noted.

Output: 1.Interval growth of the nodule in the left thyroid bed with imaging features of a lymph node.


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old. Reason: ? Abnormal masses or nodes History: Thyroid cancer with nodal metastasis s/p Sg with elevated thyroglobulin RIGHT LOBE MEASUREMENTS: Status post thyroidectomyLEFT LOBE MEASUREMENTS: Status post thyroidectomyISTHMUS MEASUREMENTS: Status post thyroidectomyRIGHT LOBE: Heterogeneous, hypoechoic focus in the right surgical bed with possible microcalcifications measures 0.8 x 0.9 x 1.0 cm.LEFT LOBE: Two subcentimeter mildly hypoechoic foci are present in the left thyroid bed. The largest of which measures 0.7 x 0.3 x 0.4 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Left level 3 neck lymph node is mildly enlarged and measures 2.4 x 0.4 x 1.0 cm. Benign-appearing right level 3 neck lymph node measures 1.7 x 0.4 x 1.0 cm.OTHER: No significant abnormality noted.

Output: 1. Hypoechoic nodule with possible microcalcifications in the right surgical bed is suspicious for recurrent tumor and biopsy is recommended. 2. Mildly enlarged left level 3 neck lymph node is favored to be reactive in etiology, however, biopsy is recommended for further characterization 3. Subcentimeter hypoechoic foci in the left thyroid bed are favored to represent residual thyroid tissue or small lymph nodes. Special attention should be paid to this area on subsequent surveillance studies.


Instruction: Generate impression based on medical findings.

Input: 57 year-old female with myeloma nephropathy, rising creatinine. Evaluate for stones, pyelonephritis. RIGHT KIDNEY: The right kidney measures 11.2 cm in length. The cortex is increased in echogenicity. No shadowing calculi or hydronephrosis is present. There is a mildly complex perinephric fluid collection noted. LEFT KIDNEY: The left kidney measures 11.6 cm in length. The cortex is increased in echogenicity. No shadowing calculi or hydronephrosis is present. URINARY BLADDER: No significant abnormality noted.OTHER: Incompletely imaged left pleural effusion.

Output: 1. Mildly complex right perinephric fluid collection. Appearance suggestive of perinephric hematoma. 2. Increased echogenicity of the kidneys suggestive of parenchymal dysfunction. No hydronephrosis. 3. No sonographic evidence of pyelonephritis. Contrast enhanced CT study can be obtained if clinically warranted for further evaluation. 4. Incompletely imaged left pleural effusion. Findings were discussed with Dr. Elizabeth Rich by phone on 3/31/2015 at 9:00 AM.


Instruction: Generate impression based on medical findings.

Input: Male 75 years old; Reason: elevated Cr History: as above RIGHT KIDNEY: The right kidney measures 11 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. Simple appearing renal cysts. A cyst in the mid right kidney may have some layering debris, measuring 3.6 cm.LEFT KIDNEY: The left kidney measures 12 cm in length. The cortex is echogenic.. No shadowing calculi or hydronephrosis is present. Simple appearing renal cysts. In the inferior left kidney, there is a mildly complex 2.8 x 4.4 cm cyst with debris and thin septationsURINARY BLADDER: Foley catheter precludes evaluationOTHER: No significant abnormalities noted.

Output: 1.Echogenic kidneys can be seen in nonspecific medical renal disease. Bilateral simple and complex cysts as described above.


Instruction: Generate impression based on medical findings.

Input: Male 59 years old; Reason: r/o pyelonephritis History: severe sepsis RIGHT KIDNEY: The right kidney measures 10.1 cm in length and demonstrates normal echogenicity. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 10.3 cm in length and demonstrates normal echogenicity. No shadowing calculi or hydronephrosis is present. URINARY BLADDER: Slight thickening of the posterior gallbladder wall, with layering debris in the lumen of the bladder.OTHER: No significant abnormalities noted.

Output: Slight thickening of the posterior gallbladder wall with layering debris in the lumen of the bladder, correlate with cystitis. Otherwise no significant sonographic renal abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female 62 years old Reason: 62 year old female with ALL undergoing treatment. MRI shows gall bladder distension and ascites. please evaluate for cholecystitis, gallstones History: RUQ pain LIMITED ABDOMENLIVER: The liver has a smooth contour. The parenchyma is normal in echotexture. There is negative sonographic Murphy sign.BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 2 mm in thickness. Common duct measures 3 mm. PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.OTHER: No significant abnormalities noted.

Output: 1.No sonographic evidence of acute cholecystitis. No cholelithiasis.


Instruction: Generate impression based on medical findings.

Input: Female 17 years old; Reason: 17 y.o. F with metastatic papillary thyroid cancer. History: PTC Sonography was performed of the neck to target the PET positive lymph nodes.Right level 4 lymph node was localized using 0.2 cc of methylene blue under sonographic guidance.Right level 3 lymph node was localized using 0.2 cc of methylene blue under sonographic guidance.

Output: 1.Intraoperative localization of right neck lymph nodes that correspond to the PET-positive disease.


Instruction: Generate impression based on medical findings.

Input: Male 59 years old Reason: recurrent ascites - eval for new liver abnormality or clot History: as above LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 15.2 cm in length. The parenchyma is mildly coarse and echogenic. No focal hepatic lesion is identified. The main portal vein is patent, with normal directional flow and normal waveform.BILIARY TRACT: No intra or extra hepatic biliary ductal dilatation. The gallbladder appears contracted, with shadowing stones. The largest stone measuring 1 cm.PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 6.2 cm. The cortex is thinned and echogenic. No shadowing calculi or hydronephrosis is present. The left kidney measures 8.8 cm. The cortex is thinned and echogenic. No shadowing calculi or hydronephrosis is present.SPLEEN: The spleen measures 16.0 cm in length. OTHER: Large volume ascites containing thin septations, unchanged.

Output: 1.Large volume ascites containing thin septations, probably partially loculated, similar to prior.2.Diffuse mildly coarse and echogenic liver, may be secondary to nonspecific fatty infiltration/parenchymal dysfunction. Portal vein is patent. No suspicious lesion identified.3.Cholelithiasis, with contracted gallbladder and no ductal dilatation. No evidence of cholecystitis.