Instruction: Generate impression based on medical findings.

Input: Reason: Hx of CHF on dobutamine, alcohol use. Eval liver size. Assess abdominal aorta. History: CHF, alcohol use. LIVER:The liver is normal in size and echotexture, measuring approximately 15.9 cm in length.GALLBLADDER, BILIARY TRACT: No evidence of biliary dilatation. The common bile duct measures 3 mm. No gallstones, gallbladder wall thickening or pericholecystic fluid is identified. The gallbladder wall measures less than 3 mm in diameter.PANCREAS: The pancreatic body and tail are obscured secondary to bowel gas, but no focal abnormalities are identified.SPLEEN: Spleen measures 11.6 cm in length. No focal masses appreciated. The known superior medial infarct in the spleen is not appreciated on this study.KIDNEYS: The right kidney is normal in size and echotexture, no focal lesion, hydronephrosis, nephrolithiasis, measuring 12 cm in length.The left kidney is normal in size and echotexture, no focal lesion, hydronephrosis, nephrolithiasis, measuring 12 cm in length.ABDOMINAL AORTA: The abdominal aorta is normal in caliber without aneurysmal dilatation. The proximal aorta measures 2.1 x 2.1 cm, the mid aorta measures 2.2 x 2.0 cm, the distal aorta measures 2.0 x 1.8 cm.INFERIOR VENA CAVA: The IVC is patent.OTHER: The iliac arteries are not well visualized on this study. The main portal vein is patent, with a peak velocity of 0.2 m/s.

Output: No acute abnormality, with measurements as above.


Instruction: Generate impression based on medical findings.

Input: 46 y/o M w/ rectal CA s/p ileostomy reversal w/ anastomotic leak s/p IR drain on vancomycin now with creatinine of 3, assess for hydronephrosis RIGHT KIDNEY: The right kidney measures 11.8 cm in length and shows increased echotexture. No mass, stone or hydronephrosis.LEFT KIDNEY: The left kidney measures 12.1 cm in length and shows increased echotexture. No mass, stone or hydronephrosis.URINARY BLADDER: The urinary bladder is normal in appearance.OTHER: There is no free or loculated fluid.

Output: No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Female 58 years old; Reason: s/p renal pancreas transplant elevated Cr History: elevated Cr Sonographic guidance provided for renal biopsy.5 passes were performed of the left iliac fossa renal allograft by the nephrology service. Please refer to the patients medical chart for procedure details.

Output: 1.Sonographic guidance provided for renal biopsy.


Instruction: Generate impression based on medical findings.

Input: Abdominal pain and bilious vomiting.VIEWS: Abdomen AP supine/upright (two views) 12/18/2015 21:20 A navel ring is present.No free intraperitoneal air is seen. A small amount of bowel gas is seen within both the small bowel and colon. Several air-fluid levels are present, increased from prior.

Output: Worsening abnormal bowel gas pattern without evidence of bowel perforation.


Instruction: Generate impression based on medical findings.

Input: History of left parotid cancer status post surgery. Thyroid nodules noted on surveillance MRI scan. RIGHT LOBE MEASUREMENTS: 4.2 x 1.6 x 2.1 cmLEFT LOBE MEASUREMENTS: 4.5 x 1.9 x 1.6 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Predominantly solid nodule measuring 1 x 0.8 x 0.6 cm in the isthmus/right thyroid lobe.LEFT LOBE: Left inferior spongiform nodule measuring 1.0 x 0.4 x 0.6 cm, likely benign.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Subcentimeter predominantly solid nodule in the isthmus/right thyroid. Left spongiform subcentimeter nodule is likely benign.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female with a history of breast cancer and positive PET for left thyroid nodule. RIGHT LOBE MEASUREMENTS: 4.9 x 1.8 x 1.5 cm.LEFT LOBE MEASUREMENTS: 4.0 x 1.4 x 1.1 cm.ISTHMUS MEASUREMENTS: 0.3 cm.RIGHT LOBE: Multiple, spongiform-appearing right thyroid nodules. The largest measures 1.8 x 0.9 x 1.4 cm.LEFT LOBE: Multiple left nodules are seen. The dominant, predominantly hypoechoic nodule measuring 1.1 x 0.9 x 0.9 cm is amenable to biopsy.ISTHMUS: Spongiform-appearing right isthmus nodule measuring 1.2 x 0.4 x 1.1 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Bilateral thyroid nodules. The left dominant, predominantly hypoechoic nodule as described above is amenable to biopsy.


Instruction: Generate impression based on medical findings.

Input: Male 74 years old with elevated liver enzymes, evaluate right upper quadrant LIVER: Mild increase in hepatic parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions. Hepatic length measures 17.5 cm. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of 24 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 2 mm. The common bile duct measures 4 mm in diameter. No cholelithiasis or choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 10.8 cm and has a normal echotexture.KIDNEYS: Bilateral renal cortical thinning, likely age-related, with normal normal corticomedullary differentiation. The right kidney measures 10.1 cm and has normal vascular flow. The left kidney measures 10.1 cm and has normal vascular flow. OTHER: No significant abnormality noted.

Output: 1. Mild increase in hepatic parenchymal echogenicity with coarsened echotexture consistent with fatty liver/hepatic parenchymal dysfunction. No hepatic mass or ductal dilatation identified.2. No evidence of cholelithiasis.


Instruction: Generate impression based on medical findings.

Input: Male 2 years old Reason: Hydronephrosis follow up BLADDER  Wall Thickness: Normal  Contents: The bladder is nondistended. Distal Ureter -- SFU Grade**  Right: 0  Left: 0   Ureteral Jets Right: Not observed  Left: Not observedKIDNEYS  Cortical Echogenicity: Normal   Medullary Echogenicity: Normal   Pelvicaliceal System -- SFU Grade*  Right: 0 Left: 0  Length*** Right: 7.2 cm Left: 9.4 cm   Mean for age: 7.0 cm  Range for age: 8.0 - 6.0 cmADDITIONAL OBSERVATIONS: None

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


Instruction: Generate impression based on medical findings.

Input: Female 80 years old; Reason: acute transaminitis, r/o infarct/clot History: acute transaminitis, LIVER: The liver is normal in echotexture and echogenicity. Simple appearing cysts in the right hepatic lobe measuring 1.6 x 1.9 x 2.2 cm and appears similar to prior CT from 12/6/2015. Hepatic length measures 19.7 cm. The main portal vein is patent with normal hepatopetal flow with a velocity of 17 cm/s. GALLBLADDER/BILIARY TRACT: Sludge is noted within the gallbladder with the wall measuring 5 mm. The common bile duct measures 2 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 9.2 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 11.8 cm and demonstrates increased echogenicity with no hydronephrosis. Trace perinephric fluid is noted.The left kidney measures 12.8 cm and demonstrates increased echogenicity with no hydronephrosis. Trace perinephric fluid is noted.OTHER: Line is noted within the inferior vena cava.

Output: 1.Normal echogenicity and echotexture of the liver with no mass or biliary ductal dilatation.2.Increased echogenicity of bilateral kidneys suggestive of medical renal disease, with no evidence of hydronephrosis.3.Gallbladder wall thickening and trace perinephric fluid, possibly secondary to hypoproteinemia.4.Asymmetric renal sizes


Instruction: Generate impression based on medical findings.

Input: Male 51 years old Reason: rising bilirubin, concerns of biliary obstruction History: rising bilirubin LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 20.9 cm in length. The parenchyma is mildly echogenic no intrahepatic biliary ductal dilatation. No definite solid hepatic lesions. Main portal vein is patent with appropriate direction of flow. BILIARY TRACT: Gallbladder contains possible sludge. Wall is normal in thickness. Wall measures 2 mm in thickness. No pericholecystic fluid. Common duct is obscured. . PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 11.8 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. Echogenic interpolar region measures 9 mm.The left kidney is not imaged. SPLEEN: The spleen is not imaged OTHER: No ascites

Output: 1.Mild enlargement of the liver; echogenic hepatic parenchyma compatible with fatty infiltration/hepatic dysfunction.2.No sonographic findings of biliary obstruction.3.Echogenic right renal lesion which is indeterminate.


Instruction: Generate impression based on medical findings.

Input: Reason: R groin -- any mass beneath cyst? History: epidermal cyst Small loculated fluid collection underneath the wound measuring 1.0 x 1.5 x 0.4 cm without internal vascularity.

Output: Small loculated fluid collection underneath the wound without internal vascularity.


Instruction: Generate impression based on medical findings.

Input: Female 58 years old Reason: please evaluate for parathyroid adenomas and thyroid nodules History: please evaluate for parathyroid adenomas and thyroid nodules RIGHT LOBE MEASUREMENTS: 6.1 x 2.1 x 2.0 cm.LEFT LOBE MEASUREMENTS: 4.6 x 1.6 x 1.3 cm.ISTHMUS MEASUREMENTS: 0.5 cm in thickness.RIGHT LOBE: The right lobe of the thyroid demonstrates heterogeneous parenchymal echogenicity. There is a 4.1 x 1.9 x 1.8 cm heterogeneous hypoechoic nodule in the right lobe of thyroid.LEFT LOBE: The left lobe of the thyroid demonstrates heterogeneous parenchymal echogenicity. There is a 1.2 x 0.9 x 1.0 cm heterogeneous hypoechoic nodule arising from the superior pole of the left thyroid lobe.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Probable bilateral enlarged parathyroid glands, measuring 2.7 x 0.7 x 1.7 cm on the right and 1.5 x 0.6 x 1.0 cm on the left.LYMPH NODES: Bilateral normal-appearing subcentimeter cervical lymph nodes are evident.OTHER: No significant abnormality noted.

Output: 1.Possible bilateral parathyroid glands suggestive of parathyroid hyperplasia. This could be confirmed with a nuclear medicine sestamibi scan as clinically indicated.2.Bilateral heterogeneous hypoechoic thyroid nodules.3.Heterogeneous thyroidal parenchyma.


Instruction: Generate impression based on medical findings.

Input: Left arm AV fistula with pain Diffuse edema without loculated fluid collection, abscess, or hematoma. AV fistula appears patent although extensive mural thrombus is observed.

Output: Diffuse subcutaneous edema without loculated fluid collection, abscess, or hematoma. AV fistula appears patent although extensive mural thrombus is observed.


Instruction: Generate impression based on medical findings.

Input: Female 75 years old; Reason: CKD, ? obstruction History: CKD RIGHT KIDNEY: The right kidney measures 8.5 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. There are two cortical cysts each measuring 1.7 cm.LEFT KIDNEY: The left kidney measures 8.7 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present.  OTHER: Urinary bladder is unremarkable.

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


Instruction: Generate impression based on medical findings.

Input: 36-year-old female with right upper quadrant pain. LIMITED ABDOMENLIVER: The liver has a smooth contour and normal echogenicity. Liver measures 14.6 cm in length. Portal flow is hepatopedal. No intrahepatic biliary ductal dilation.BILIARY TRACT: The gallbladder has an anechoic lumen. No gallbladder wall thickening or pericholecystic fluid is seen. No biliary ductal dilation.PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: Patient is status post right nephrectomy.The left kidney measures 10.1 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.SPLEEN: The spleen measures 8.5 cm. in length. No significant abnormality.OTHER: No significant abnormalities noted.

Output: 1.No cholelithiasis or other specific findings to explain patient's symptomology.


Instruction: Generate impression based on medical findings.

Input: Male 69 years old; Reason: 68M with history of bilateral renal cysts, assess for interval change. RIGHT KIDNEY: The right kidney measures 10.2 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. Again noted is multiple minimally complex cysts that are unchanged, with the largest measuring 2.5 x 3.0 x 2.7 cm in the lower pole as compared to 2.8 x 2.9 x 3.1 cm a previous exam, unchanged.LEFT KIDNEY: The left kidney measures 11.3 cm in length. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. Again noted is minimally complex cyst in the upper pole measuring 1.4 x 1.4 x 1.2 cm as compared to 1.4 x 1.1 x 1.6 cm in the previous exam, essentially unchanged.URINARY BLADDER: No significant abnormality.OTHER: Enlarged prostate is noted.

Output: Stable minimally complex bilateral renal cysts.


Instruction: Generate impression based on medical findings.

Input: Multiple thyroid nodules. Evaluate for interval change. RIGHT LOBE MEASUREMENTS: 5.1 x 2.0 x 1.3 cmLEFT LOBE MEASUREMENTS: 5.1 x 1.7 x 1.2 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Spongiform nodule within the right upper pole measures 1.6 x 0.9 x 1.0 cm, with internal vascularity, but no calcification, probably unchanged given differences in technique.LEFT LOBE: A partially cystic nodule within the left mid thyroid measures 0.4 x 0.3 x 0.4 cm, with no internal vascularity or calcifications, probably benign.ISTHMUS: Solid hypoechoic nodules within the isthmus are unchanged, the largest measuring 0.6 x 0.3 x 0.8 cm. Unchanged smaller nodule within the mid isthmus measuring 0.6 x 0.4 x 0.3 cm, containing calcifications.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Morphologically normal mildly enlarged lymph nodes are identified within the neck. Representative right level 3 lymph node measures 1.0 x 0.4 x 1.3 cm. OTHER: No significant abnormality noted.

Output: Grossly unchanged multiple thyroid nodules, with one within the isthmus containing calcifications. No suspicious adenopathy.


Instruction: Generate impression based on medical findings.

Input: Female 69 years old Reason: please evaluate characteristics of left neck soft tissue mass, possible lipoma based on clinical examination History: 4 cm x 3 cm superficial mass, lateral aspect of left neck (level V?, Zone 2) Within the subcutaneous soft tissues superficial to the underlying neck musculature there is a well-defined soft tissue mass measuring 3.6 x 4.0 by 1.6 cm. The mass has well-defined margins and minimally heterogeneous echotexture approximately isoechoic to the adjacent musculature. No internal vascular flow is identified. Minimal posterior acoustic enhancement is present.

Output: Subcutaneous, well defined soft tissue mass as described.


Instruction: Generate impression based on medical findings.

Input: Female 62 years old Reason: c/o abd swelling. R/o ascites History: hx of hep cancer with transplant LIVER: Liver parenchyma is heterogeneous in echotexture. No evidence of ascites. BILIARY TRACT: No biliary duct dilatation delineated on this nondedicated study.PANCREAS: Not well seen secondary to overlying bowel gas.KIDNEYS: Not visualized.SPLEEN: No focal lesion seen.

Output: No ascites.


Instruction: Generate impression based on medical findings.

Input: Male 46 years old Reason: elevated LFTs History: as above LIMITED ABDOMENLIVER: . Liver measures 15 cm in length. The parenchyma is normal echogenicity and mildly coarsened.BILIARY TRACT: No biliary dilatation. No gallbladder wall thickening or pericholecystic fluid. No stones. . PANCREAS: Visualized portions are unremarkable.KIDNEYS: The right kidney measures 11 cm. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 12 cm. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. Simple appearing anechoic exophytic left renal cyst with thin septation.SPLEEN: The spleen measures 12 cm. in length. OTHER: No significant abnormalities noted.

Output: 1.Mildly coarsened hepatic parenchyma is nonspecific, and can be seen in diffuse parenchymal dysfunction/fatty infiltration


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old. Reason: evaluate for kidney stones or pathology in upper tract History: gross hematuria, history of prostatectomy in 2011 RIGHT KIDNEY: Right kidney measures 12.7 cm in length with normal cortical echogenicity. No hydronephrosis, shadowing calculus, or mass.LEFT KIDNEY: Left kidney measures 12.6 cm in length with normal cortical echogenicity. Prominent column of Bertin is present. No hydronephrosis, shadowing calculus, or mass.URINARY BLADDER: Urinary bladder is mildly distended without significant abnormality noted. OTHER: Status post prostatectomy.

Output: No evidence of hydronephrosis, renal mass, or shadowing calculi.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male Reason: evaluate for aneurysm, size History: Small mass felt on exam. ABDOMINAL AORTA:Proximal: 2.6 x 2.2 x 2.1 cm in maximal diameter.Mid: 2.1 x 2.2 x 1.9 cm in maximal diameter.Distal: 2.1 x 1.9 x 1.8 cm in maximal diameter.There is stable mild aneurysm of the distal abdominal aorta.Right common iliac artery: 1.3 x 1.5 x 1.7 cm in maximal diameter.Left common iliac artery: 1.3 x 1.3 x 1.4 cm in maximal diameter.Stable mild aneurysm of the common iliac arteries.OTHER: None.

Output: Stable mild aneurysm of the distal abdominal aorta and common iliac arteries.


Instruction: Generate impression based on medical findings.

Input: Reason: Abnoraml nodules nodes? History: thyroid cancer s/p sg I131 Patient is status post total thyroidectomy. No nodules are noted within either thyroid bed.LYMPH NODES: A couple benign-appearing level 2 lymph nodes are noted.OTHER: No significant abnormality noted.

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


Instruction: Generate impression based on medical findings.

Input: 41-year-old female with history of hyperparathyroidism. Reason: Evaluate for thyroid nodules and location of parathyroid adenoma. RIGHT LOBE MEASUREMENTS: 3.6 x 1.3 x 0.9 cmLEFT LOBE MEASUREMENTS: 3.9 x 1.1 x 1.4 cmISTHMUS MEASUREMENTS: 0.4 cm in the AP directionRIGHT LOBE: Mildly heterogeneous gland without dominant thyroid nodule.LEFT LOBE: Mildly heterogeneous gland without dominant thyroid nodule.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Hypoechoic, extrathyroidal focus located posteroinferior to the right thyroid gland measuring 1.3 x 1 x 0.8 cm.LYMPH NODES: Note is made of benign appearing lymph nodes.OTHER: No significant abnormality noted.

Output: Hypoechoic, extrathyroidal focus posteroinferior to the right thyroid gland, consistent with suspected parathyroid adenoma.


Instruction: Generate impression based on medical findings.

Input: 62-year-old female with acute kidney injury. Reason: Evaluate for obstruction. RIGHT KIDNEY: The right kidney measures 10.7 cm. Echogenic renal parenchyma. No shadowing calculi or hydronephrosis is present. There is a small amount of perinephric fluid.LEFT KIDNEY: The left kidney measures 10.1 cm. Echogenic renal parenchyma. No shadowing calculi or hydronephrosis is present.OTHER: The bladder is partially decompressed, limiting its evaluation.

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


Instruction: Generate impression based on medical findings.

Input: 69-year-old female with thyroid nodules and a mediastinal mass on CT. RIGHT LOBE MEASUREMENTS: 4.3 x 1.7 x 1.2 cmLEFT LOBE MEASUREMENTS: 4.1 x 2.0 x 1.8 cmISTHMUS MEASUREMENTS: 0.3 cm in AP dimension. RIGHT LOBE: Multiple hypoechoic nodules are seen in the right lobe of the thyroid. A representative lower pole nodule measures 1.0 x 0.9 x 0.8 cm.LEFT LOBE: There is a predominantly solid nodule in the lower pole of the left lobe which measures 1.5 x 1.0 x 1.3 cm.ISTHMUS: Normal in appearance.PARATHYROID GLANDS: No enlarged parathyroid gland identified.LYMPH NODES: No regional lymphadenopathy. OTHER: Again noted is an incompletely characterized slightly hyperechoic mass lesion inferior to the thyroid gland, unchanged from previous exam.

Output: 1.There are multiple hypoechoic nodules in the right lobe of the thyroid. There is a predominantly solid nodule in the lower pole of the left lobe, which is amenable to biopsy.2.Again noted is an incompletely characterized slightly hyperechoic mass lesion inferior to the thyroid gland, unchanged from previous exam.


Instruction: Generate impression based on medical findings.

Input: 63-year-old male with sepsis, please evaluate for hydronephrosis. RIGHT KIDNEY: The right kidney measures 10.1 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present.LEFT KIDNEY: The left kidney measures 10.8 cm in length. The cortex is echogenic. No shadowing calculi are present. The previously described left hydronephrosis appears slightly improved when compared to prior examination.OTHER: The bladder is poorly evaluated secondary to Foley decompression. However, the wall appears very thickened measuring 1.3 cm.

Output: 1.Bilateral echogenic kidneys are consistent with a medical renal disease. Left hydronephrosis appears slightly improved compared to prior examination.2.The bladder is poorly evaluated secondary to Foley decompression. However, the bladder wall appears thickened, which may be seen in the setting of cystitis.


Instruction: Generate impression based on medical findings.

Input: Male 75 years old Reason: Abdominal pain, assess for cholecystitis History: Abdominal pain, assess for cholecystitis LIVER: Liver measures 14.5 cm in length. Main portal vein patent with normal directional flow, velocity measures 0.4 m/sec. BILIARY TRACT: Gallbladder unremarkable. No shadowing intraluminal echogenic foci seen to suggest underlying cholelithiasis. No significant gallbladder distention, wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Not well seen in entirety, particularly tail, but visualized portions unremarkable.KIDNEYS: The right kidney measures 13.2 cm. Left kidney not well visualized due to overlying bowel gas.SPLEEN: Not well seen due to obscuration by bowel gas.

Output: 1. No evidence of acute cholecystitis.2. Nonvisualization of left kidney and spleen due to overlying bowel gas.


Instruction: Generate impression based on medical findings.

Input: 42-year-old female with right upper extremity deltoid mass, tender to touch Multiple hypoechoic, noncystic-appearing nodules are noted in the right upper extremity within the subcutaneous tissue adjacent to the deltoid. One nodule measures 6 x 5 x 6 mm. Additional heterogeneous noncystic appearing measures 5 x 4 x 5 mm. Additional smaller nodules noted. Limited interrogation with color Doppler demonstrates no vascularity.

Output: Multiple, hypoechoic, noncystic and nonvascular nodules in the right upper extremity deltoid area are incompletely characterized by ultrasound and are indeterminate by ultrasound criteria.


Instruction: Generate impression based on medical findings.

Input: Female 83 years old; evaluate for cholecystitis. History: Nausea after oral intake, right upper quadrant discomfort LIVER: The liver is normal in echogenicity and echotexture. No focal hepatic lesions. Hepatic length measures 15.5 cm. The main portal vein is patent with normal hepatopetal flow with a velocity of 31.7 cm/s. GALLBLADDER/BILIARY TRACT: Echogenic shadowing calculi are present within the gallbladder, with the wall measuring 2 mm. No pericholecystic fluid is identified. The common bile duct measures 2 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 8.6 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 9.4 cm with no hydronephrosis. The left kidney measures 8.8 cm with no hydronephrosis. OTHER: Bilateral pleural effusions are identified.

Output: 1.Cholelithiasis, without sonographic evidence of acute cholecystitis.2.Bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male 73 years old Reason: obstructive uropathy, eval for hydronephrosis History: obstruction RIGHT KIDNEY: The right kidney measures 13.2 cm. No shadowing calculi or hydronephrosis is present. The cortex is slightly echogenic, unchanged from prior exam.LEFT KIDNEY: The left kidney measures 13.4 cm. No shadowing calculi or hydronephrosis is present. The renal cortex is slightly echogenic, unchanged from prior exam.BLADDER: The urinary bladder is underdistended with Foley in place, limiting evaluation.OTHER: No significant abnormalities noted.

Output: 1.No evidence of hydronephrosis or shadowing renal calculus.2.Bilateral renal parenchyma are slightly echogenic and may reflect medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Male 49 years old; Reason: CKD of unclear etiology History: increase BUN/Creatinine RIGHT KIDNEY: The right kidney measures 12.9 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 12.9 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. Hypoechoic tubular structure in the lower pole seen previously is not identified on this study.URINARY BLADDER: No significant abnormality noted.

Output: 1.Bilateral echogenic kidneys compatible with medical renal disease.2.No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Male 40 years old; Reason: S/p stem cell transplant with rising creatinine, now 3.1. Unclear etiology. Significant DVT/clotting history History: AKI RIGHT KIDNEY: The right kidney measures 11.8 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. In the inferior pole there is a 8x8x9 mm simple cyst. In addition there is a 7mm non-obstructing inferior pole calculus.LEFT KIDNEY: The left kidney measures 12.0 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 bilateral renal parenchyma compatible with medical renal disease.2.Non-obstructing right renal calculus.


Instruction: Generate impression based on medical findings.

Input: Male 74 years old Reason: fatty liver, screen for hcc History: same LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 21 cm in length. The parenchyma is moderately echogenic right hepatic lobe cyst adjacent to the gallbladder. Main portal vein is patent.BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 2 mm in thickness. Common duct measures 3 mm.. PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 12.6 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 13.0 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 10.7 cm. in length. OTHER: No significant abnormalities noted.

Output: 1.Fatty liver. Right hepatic lobe cyst. No suspicious hepatic lesions.


Instruction: Generate impression based on medical findings.

Input: Female 40 years old; Reason: Evaluate for gallstones or liver disease History: right upper quadrant pain; father with pancreatic cancer LIVER: Liver is normal in echogenicity and echotexture. No focal hepatic lesions. Hepatic length measures 16.1 cm. The main portal vein is patent with normal hepatopetal flow with a velocity of 50.7 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 2 mm. The common bile duct measures 3 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 12.3 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 10.6 cm with no hydronephrosis. The left kidney measures 9.5 cm with no hydronephrosis. OTHER: No ascites.

Output: Normal sonographic evaluation the abdomen.


Instruction: Generate impression based on medical findings.

Input: Male 47 years old Reason: Patient with CML and splenomegaly, now has large splenic hematoma. Please measure dimensions. Use Doppler to assess for active bleeding into the spleen. History: epigastric pain LIMITED ABDOMENSPLEEN: The spleen measures 23 cm. in length. Large cystic area within the central portion of the spleen with some residual peripheral parenchyma. Splenic artery is patent.OTHER: There is small amount of pelvic ascites.

Output: 1.Enlarged spleen with cystic area the center aspect; differential considerations include large cystic lesion, liquefying subcapsular hematoma.


Instruction: Generate impression based on medical findings.

Input: Reason: suspected lipoma of the right anterior thigh - US for further evaluation History: lipoma A well-defined ovoid slightly echogenic masses seen in the anterior thigh deep to the patient's area of palpable abnormality. This is not seen on the contralateral thigh.

Output: 2.3 cm right anterior thigh lesion has sonographic features of a lipoma.


Instruction: Generate impression based on medical findings.

Input: Female 25 years old Reason: Patient with RUQ abdominal pain, eval for gallbladder pathology including gallstone, cholecystitis, etc History: see above LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 16.3 cm in length. The parenchyma is moderately coarse and echogenic. No focal hepatic lesion is identified.BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 3 mm in thickness. The common bile duct measures 3 mm.PANCREAS: The pancreatic head and body are well-visualized. The pancreatic tail is obscured by bowel gas.KIDNEYS: The right kidney measures 13.0 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present.The left kidney measures 13.4 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present.SPLEEN: The spleen measures 13.3 cm in length. OTHER: No significant abnormalities noted.

Output: 1.Diffusely echogenic and coarse liver, with no focal lesion identified, appearance probably related to fatty infiltration/parenchymal dysfunction.2.Splenomegaly.3.Echogenic kidneys, compatible with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: 66-year-old female with epigastric tenderness, elevated LFTs LIVER: The liver measures 15.5 cm in length. The parenchyma is of normal echogenicity. No focal lesion or ductal dilatation.Main portal vein is patent with normal hepatopetal directional flow and peak velocity of 35.2 cm/s. The waveform appears pulsatile.GALLBLADDER, BILIARY TRACT: No gallstones, gallbladder wall thickening, pericholecystic fluid or ductal dilatation.PANCREAS: The visualized pancreas is without significant abnormalities.RIGHT KIDNEY: The right kidney measures 11.4 cm. The cortex is of normal echogenicity. No shadowing calculi or hydronephrosis is present. There is a mildly hypoechoic focus measuring 1.6 x 1.1 x 1.1 cm with thin septation, suggestive of a cyst.LEFT KIDNEY: The left kidney measures 11 cm. The cortex is of normal echogenicity. No shadowing calculi or hydronephrosis is present.SPLEEN: The spleen measures 8.9 cm.OTHER: Right pleural effusion.

Output: Mildly hypoechoic focus in the right kidney, suggestive of a cyst. Recommend follow-up ultrasound in 6 months or renal CT if definitive characterization is warranted.


Instruction: Generate impression based on medical findings.

Input: Female 40 years old History: abnormal lfts LIVER: No focal hepatic lesion. The hepatic parenchyma has homogeneous normal echotexture. Hepatic vasculature has normal Doppler waveforms.BILIARY TRACT: No intra or extra hepatic biliary dilatation. The gallbladder is normal.SPLEEN: There is an accessory splenule present measuring 2.5 x 2.4 x 2.2 cm.RIGHT KIDNEY: There is an anechoic lesion in the superior pole of the right kidney measuring 1.8 x 1.5 x 1.5 cm within mildly irregular wall. This may be centered in the medulla. LEFT KIDNEY: No hydronephrosis, stone, or focal lesion.OTHER: No significant abnormalities noted.

Output: 1.Normal examination of the liver and biliary tract.2.There is an anechoic lesion in the superior pole the right kidney with a mildly irregular wall. This may represent an irregular cyst or a dilated calix. Recommend dedicated renal CT to further evaluate.


Instruction: Generate impression based on medical findings.

Input: 74-year-old male with history of cirrhosis. Reason: Assess for HCC. LIVER: The liver measures 24 cm in length. Coarse echogenic liver parenchyma without focal lesion or ductal dilatation.GALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation. The common duct was not visualized this sonographic study.PANCREAS: The pancreas is obscured due to overlying bowel gas.RIGHT KIDNEY: The right kidney measures 11.8 cm. Echogenic renal parenchyma. No shadowing calculi or hydronephrosis is present. There is an anechoic focus measuring 1.3 x 1.1 x 1.4 cm, compatible with a simple cyst.LEFT KIDNEY: The left kidney measures 13.5 cm. Echogenic renal parenchyma. No shadowing calculi or hydronephrosis is present. There is an anechoic focus measuring 2.3 x 2.5 x 2.4 cm, compatible with a simple cyst.SPLEEN: The spleen measures 12 cm.OTHER: No ascites.

Output: 1. Hepatomegaly and coarse echogenic liver parenchyma consistent with fatty infiltration/parenchymal dysfunction without focal lesion or ductal dilatation.2. Cholelithiasis without acute inflammation.3. Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction.


Instruction: Generate impression based on medical findings.

Input: Female 24 years old; Reason: cholelithiasis vs cholecystitis History: RUQ pain crampy worse w fatty foods constant for 3 days LIVER: The liver is normal in echogenicity and echotexture. No focal hepatic lesions. Hepatic length measures 13 cm. The main portal vein is patent with normal hepatopedal flow with a peak velocity of 32 cm/s. Intrahepatic ductal dilatation is noted.GALLBLADDER/BILIARY TRACT: The gallbladder is collapsed. The gallbladder wall is thickened, measuring 5 mm diameter. The sonographic Murphy's sign is positive. The common bile duct is dilated and measures 9 mm in diameter. Sludge is noted within the common bile duct extending all the way to the pancreatic head, with possible stones, indicating possible choledocholithiasis. Intra and extrahepatic biliary ductal dilatation is identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 8.5 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 10.3 cm with no hydronephrosis. The left kidney measures 10.2 cm with no hydronephrosis. OTHER: No significant abnormality noted.

Output: 1.Cholelithiasis, gallbladder wall thickening, and positive sonographic Murphy's sign suggestive of acute cholecystitis with intra and extrahepatic biliary ductal dilatation.2.Dilatation, sludge and possible stones within the common bile duct, suggestive of possible choledocholithiasis.


Instruction: Generate impression based on medical findings.

Input: Female 45 years old Reason: ? abnormal nodes History: thyroid cancer s/p surgery only RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: Status post thyroidectomy.LEFT LOBE: Status post thyroidectomy.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Normal appearing left level three lymph node measuring 0.6 x 0.4 x 0.8 cm.OTHER: No significant abnormality noted.

Output: Status post total thyroidectomy without evidence of recurrence in the thyroid bed. Normal appearing left-sided cervical lymph node.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male 63 years old; Reason: AKI. evidence of urinary obstruction? History: AKI RIGHT KIDNEY: The right kidney measures 11 cm in length. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 9 cm in length. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. OTHER: Visualized portions of the urinary bladder unremarkable. Both ureteral jets are seen.

Output: 1.No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Reason: multiple thyroid nodules, planning surveillance while requiring anticoagulation, please evaluate for interval change History: none RIGHT LOBE MEASUREMENTS: 6.7 x 3.1 x 3.8 cmLEFT LOBE MEASUREMENTS: 8.2 x 3.2 x 5.0 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: A representative nodule measures 3.1 x 2.4 x 4.8 cm, and is heterogenous, predominantly solid with some cystic components and no significant vascularity or definite microcalcifications.LEFT LOBE: Is somewhat difficult to measure a left lobe nodule, but approximately measures 3.2 x 5.0 cm, with similar characteristics as described above with slightly more cystic spaces.ISTHMUS: Predominantly cystic nonvascular nodule is again seen in the right isthmus measuring 0.8 x 0.7 x 1.2 cm. Stable. A hypoechoic/cystic nodule in the left isthmus measures 0.8 x 0.7 x 0.7 cm, also stable.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Grossly stable thyroid nodules within the heterogenous enlarged thyroid gland.


Instruction: Generate impression based on medical findings.

Input: Reason: hyperthyroidism in setting of admiodarone, rule out hypervascularity or nodules History: none RIGHT LOBE MEASUREMENTS: 6.3 x 1.5 x 2.4 cmLEFT LOBE MEASUREMENTS: 4.6 x 1.4 x 1.7 cmISTHMUS MEASUREMENTS: 0.7 cm APRIGHT LOBE: Mild diffuse heterogeneity. No discrete nodule.LEFT LOBE: Mild diffuse heterogeneity. There may be a left inferior hypoechoic thyroid nodule (0.9 x 0.8 x 0.6 cm) without significant internal vascularity or microcalcifications. Alternatively, this may just represent more focal heterogeneity in the left thyroid gland.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Mild diffuse heterogeneity and prominence of the thyroid gland can be seen in thyroiditis, and can be correlated with lab values. A subcentimeter nodule in the left thyroid gland may just be adjacent focal heterogenous parenchyma. If clinically indicated, this can be followed up.


Instruction: Generate impression based on medical findings.

Input: Male 61 years old Reason: abnormal LFTs History: r/o fatty infiltration; cirrhosis LIVER: The liver measures 16.6 cm in length and demonstrates increased parenchymal echogenicity. No intrahepatic or extrahepatic biliary ductal dilatation is evident and no focal mass lesions are seen. The main portal vein is patent and demonstrates hepatopedal flow with a velocity of 0.3 m/s. GALLBLADDER, BILIARY TRACT: No cholelithiasis or choledocholithiasis is seen. The common duct measures 0.5 cm in diameter. PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 11.6 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 11.3 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 12.2 cm in length.OTHER: No significant abnormalities noted.

Output: Increased hepatic parenchymal echogenicity consistent with hepatic steatosis or chronic liver disease.


Instruction: Generate impression based on medical findings.

Input: Male 72 years old Reason: R swollen LE History: swollen posterior calf There is an approximately 6.9 x 2.5 x 9.6 cm heterogeneous complex collection within the right upper calf without significant vascularity

Output: Large complex heterogeneous collection in the right upper calf; favor evolving hematoma over abscess or neoplasm


Instruction: Generate impression based on medical findings.

Input: 60-year-old male with right upper quadrant pain. Reason: Evaluate liver and stent. LIVER: The liver measures 17.2 cm in length. Coarse echogenic liver parenchyma with a nodular contour. No focal lesion or ductal dilatation. Portal vein is patent with normal hepatopetal directional flow and peak velocity of 0.1 m/s.GALLBLADDER, BILIARY TRACT: Exam of the gallbladder is slightly limited as patient had breakfast prior to exam. Given this limitation, the gallbladder is contracted without evidence of gallstones, gallbladder wall thickening, pericholecystic fluid or ductal dilatation. Negative sonographic Murphy's sign. Patient reportedly has a biliary stent, which is not visualized in this sonographic study.PANCREAS: The visualized pancreas is without significant abnormalities.RIGHT KIDNEY: The right kidney measures 9.9 cm. The cortex is of normal echogenicity. No shadowing calculi or hydronephrosis is present. There is an anechoic focus in the upper pole measuring 1 x 0.7 x 0.9 cm, compatible with a simple cyst.LEFT KIDNEY: The left kidney measures 9.8 cm. The cortex is of normal echogenicity. No shadowing calculi or hydronephrosis is present.SPLEEN: The spleen measures 9.8 cm.OTHER: No ascites.

Output: 1. Cirrhotic liver morphology without focal lesion or ductal dilatation.2. Reported biliary stent is not visualized in this sonographic study.


Instruction: Generate impression based on medical findings.

Input: 32-year-old female with abdominal pain. LIVER: Echogenicity of the hepatic parenchyma is moderately increased. No focal hepatic lesion or mass. The liver measures 19.8 cm in length. No dilatation or cystic changes are noted of the intrahepatic or extrahepatic biliary ducts.The main portal vein is patent with normal hepatopedal flow and velocity of 20.7 cm/s.GALLBLADDER, BILIARY TRACT: The gallbladder is normal in appearance. There is no pericholecystic fluid, gallbladder wall thickening or cholelithiasis. The common bile duct measures 0.4 cm in diameter. PANCREAS: The head and proximal body of the pancreas are normal. The tail is obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 10.9 cm in length and shows normal echotexture. No mass, stone or hydronephrosis.LEFT KIDNEY: The left kidney measures 11.5 cm in length and shows normal echotexture. No mass, stone or hydronephrosis.SPLEEN: The spleen is normal in echogenicity and measures 7.1 cm in length. URINARY BLADDER: The urinary bladder is normal in appearance.OTHER: There is no free or loculated fluid.

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


Instruction: Generate impression based on medical findings.

Input: Female 74 years old; Reason: ATN vs cardiorenal syndrome History: oliguric AKI RIGHT KIDNEY: The right kidney measures 8.5 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 8.9 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. Left lower pole cyst measures 1.8 cm. URINARY BLADDER: The bladder is obscuredOTHER: No significant abnormalities noted.

Output: 1.Mild echogenic renal cortices.


Instruction: Generate impression based on medical findings.

Input: Epigastric abdominal pain No evidence for hernia/fascial defect or mass.

Output: No evidence for hernia/fascial defect or mass.


Instruction: Generate impression based on medical findings.

Input: Female 50 years old Reason: RUQ History: pancreatitis LIMITED ABDOMENLIVER: The liver has a smooth contour. The parenchyma is mildly echogenic . This minimal intrahepatic biliary ductal dilatation.BILIARY TRACT: The gallbladder has echogenic calculi with posterior acoustic shadowing. Wall measures 3 mm in thickness. Common duct measures 9 mm. Multiple echogenic filling defects within the common bile duct.PANCREAS: Pancreatic parenchyma is heterogeneous with mild peripancreatic edema and fluid compatible with acute pancreatitis.OTHER: No ascites

Output: 1.Findings of choledocholithiasis and acute pancreatitis.2.Cholelithiasis without sonographic findings of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Male 66 years old Reason: eval renal mass History: routine f/u bosniak IIF RIGHT KIDNEY: The right kidney measures 8.3 cm in length and demonstrates increased parenchymal echogenicity. Multi septated cyst in the interpolar region now measuring 12.0 x 8.0 x 8.5 cm, previously 10.2 x 8.8 x 10.6 cm. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.LEFT KIDNEY: The left kidney measures 11.4 cm in length and demonstrates increased parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.BLADDER: No significant abnormality noted.OTHER: Cystic lesion in the central prostate measures approximately 1.0 x 0.9 x 1.3 cm.

Output: 1.Stable complex cyst right kidney.2.Increased renal parenchymal echogenicity consistent with medical renal disease.3.Nonspecific cystic lesion in the central prostate as detailed above.


Instruction: Generate impression based on medical findings.

Input: Male 48 years old; Reason: please assess right-sided fullness around right ear appreciated on exam History: right ear pain, odynophagia, diffuse fullness appreciated on right side near right ear on physical exam No discrete lesion is identified. There are small subcutaneous lymph nodes with benign appearing fatty hila. It measures 1.0 x 0.4 cm.

Output: 1.Small lymph node in the area of clinical concern. This can be followed clinically for size change.


Instruction: Generate impression based on medical findings.

Input: Reason: R/O HCC History: HCV, cirrhosis LIVER: Liver measures 14.6 cm with coarse echogenicity. Nodular contour of the liver noted. Portal vein is patent with normal direction and velocity of 0.2 m/s. No suspicious hepatic mass is noted.BILIARY TRACT: Common bile duct measures 4 mm. Patient is status post cholecystectomy.PANCREAS: Pancreas is not well seen due to overlying bowel gas.SPLEEN: Spleen measures 7.6 cm and is normal in echogenicity and configuration.KIDNEYS: Right kidney measures 9.8 cm with mildly increased echogenicity and without hydronephrosis. Right renal cyst measuring 2.6 x 1.5 x 2.9 cm noted, previously 1.7 x 1.3 x 1.2 cm. Left kidney measures 10.9 cm with mildly increased echogenicity and without hydronephrosis. No renal calculi identified. OTHER: No significant abnormalities noted.

Output: Cirrhotic liver morphology without focal liver lesion. Mildly hyperechoic renal cortex bilaterally consistent with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Questionable umbilical lipoma 3.9 x 3.5 x 1.7 cm fatty focus within the periumbilical subcutaneous tissues which demonstrates communication through a fascial defect with the mesenteric fat. No bowel involvement.

Output: Umbilical hernia with mesenteric fat within the hernia sac without bowel involvement.


Instruction: Generate impression based on medical findings.

Input: Male 73 years old Reason: 73 y/o man w/ acute renal failure History: AKI RIGHT KIDNEY: The right kidney measures 9.8 cm. Increased renal cortical echogenicity. No shadowing calculi or hydronephrosis is present. No perinephric free fluid. LEFT KIDNEY: The left kidney measures 10.5 cm. Increased renal cortical echogenicity. No shadowing calculi or hydronephrosis is present. No perinephric free fluid.BLADDER: Visualized portions unremarkable.

Output: Increased renal cortical echogenicity, compatible with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Male 44 years old Reason: HBV, known non-enhancing hypodensities, eval for HCC History: HBV LIMITED ABDOMENLIVER: Normal echotexture of the hepatic parenchyma. Ovoid hypoechoic lesion in the left liver with posterior acoustic enhancement most compatible with a 0.8 cm cyst. No internal vascularity. Portal vein is patent and appropriate in direction. No suspicious hepatic lesion.BILIARY TRACT: No biliary dilatation. Gallbladder polyps measuring up to 4 mm are seen, stable.PANCREAS: Visualized portions are unremarkable.KIDNEYS: The right kidney measures 12 cm. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 11 cm. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 11 cm. in length. OTHER: No significant abnormalities noted.

Output: 1.No suspicious hepatic lesion. Stable probable cyst in the left hepatic lobe.2.Stable gallbladder polyps.


Instruction: Generate impression based on medical findings.

Input: Male 65 years old Reason: eval for cholestasis History: hyperbilirubinemia, abd distension, jaundice LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 21 cm in length. The parenchyma is coarse and echogenic. No focal hepatic lesions. Main portal vein is patent with normal directional flow.BILIARY TRACT: The gallbladder is absent. Common duct measures 3mm. PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 9.1 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. The left kidney measures 12 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 12.4 cm. in length. OTHER: There is small amount of upper abdominal ascites.

Output: 1.Normal caliber of the common bile duct.2.Upper abdominal ascites.3.Coarse echogenic hepatic parenchyma.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old. Chronic kidney disease, stage II. Patient voided prior to study. RIGHT KIDNEY: Right kidney measures 10.6 cm in length with normal cortical echogenicity. No hydronephrosis, shadowing calculi, or mass.LEFT KIDNEY: Left kidney measures 11.4 cm in length with normal cortical echogenicity. No hydronephrosis, shadowing calculi, or mass.OTHER: Urinary bladder is collapsed.

Output: 1. Negative renal ultrasound. Specifically, no hydronephrosis, shadowing calculi, or mass.2. Urinary bladder is collapsed, therefore, postvoid residual could not be obtained.


Instruction: Generate impression based on medical findings.

Input: 76-year-old male with chronic right upper quadrant abdominal pain. Evaluate for abnormalities. LIMITED ABDOMENLIVER: The liver is of normal echogenicity, measuring 15 cm in length. The main portal vein has hepatopetal flow with a peak velocity of 22.4 cm/s.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. The common bile duct measures 3.8 mm in diameter. The gallbladder is nondistended and the wall measures 1.4 mm in thickness. There are no visible gallstones. PANCREAS: The pancreas is obscured by overlying gas.KIDNEYS: The right kidney measures 10 cm. The cortex is of normal echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 9.7 cm. The cortex is of normal echogenicity. No shadowing calculi or hydronephrosis is present.SPLEEN: The spleen is somewhat obscured by overlying bowel gas. No gross abnormalities.OTHER: No significant abnormalities noted.

Output: No ultrasound findings to explain the patient's right upper quadrant pain.


Instruction: Generate impression based on medical findings.

Input: Male 47 years old Reason: 47M new acute kidney injury History: AKI Suboptimal exam secondary to patient's body habitus.RIGHT KIDNEY: The right kidney measures 13.9 cm. No hydronephrosis. No shadowing echogenic stone delineated.LEFT KIDNEY: The left kidney measures 16.1 cm. No hydronephrosis. No shadowing echogenic stone delineated.BLADDER: Not well assessed due to collapsed state secondary to Foley catheter placement.OTHER: No significant abnormalities noted.

Output: 1. Suboptimal exam due to patient's body habitus.2. No hydronephrosis. Kidneys prominent in size, may be due in part to poor delineation secondary to bowel gas/body habitus.


Instruction: Generate impression based on medical findings.

Input: Female 26 years old Reason: r/o recurrence History: h/op follicular thyroid cancer (s/p surgery but no RAI) RIGHT LOBE: Status post thyroidectomy. No abnormal soft tissue is seen in the right thyroidectomy bed.LEFT LOBE: Status post thyroidectomy. Previously seen soft tissue nodule in the left thyroid bed is no longer present. No new abnormal soft tissue is seen in the left thyroidectomy bed.ISTHMUS: Status post thyroidectomy.LYMPH NODES: Multiple benign-appearing lymph nodes are seen. Right level 2 lymph node measures 0.2 x 0.5 x 1.2 cm. Right level 3 lymph node measures 0.3 x 0.7 x 0.8 cm. A left level 2 lymph node measures 0.5 x 0.9 x 2.1 cm.OTHER: No significant abnormality noted.

Output: Previously seen 6 mm soft tissue nodular focus in the left thyroid bed is no longer visualized. No evidence of local recurrence or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: History of renal cysts. Follow-up exam. Examination mildly limited by poor acoustic penetration.RIGHT KIDNEY: Right kidney is normal in size measuring 12.2 cm in length. There is normal cortical medullary differentiation. Within the interpolar region of the right kidney there are multiple small hypoechoic foci the largest of which measures 1.0 x 0.8 x 1.1 cm, previously 1.4 x 1.3 x 1.6 cm. There is no definite internal complexity, however there is also no increased through transmission due to the technical limitations of the exam.No hydronephrosis or nephrolithiasis.LEFT KIDNEY: Left kidney is normal in size measuring 11.5 cm in length. There is normal corticomedullary differentiation.Arising from the interpolar region there is an exophytic intermediate echogenicity mass which measures 1.1 x 0.9 x 1.0 cm, previously 0.9 x 0.5 x 0.7 cm. No internal vascularity is identified.No hydronephrosis or nephrolithiasis.OTHER: The bladder is nondistended and ureteral jets are visualized bilaterally. Incidental note is made of an enlarged prostate which measures 4.1 x 3.9 x 4.7 cm.

Output: Limited examination due to poor acoustic penetration.1. Interval increase in size of solid exophytic lesion arising from the left kidney. Further characterization with dedicated renal CT or MRI is recommended.2. Indeterminate cystic foci within the right kidney are likely benign, however these can also be further evaluated with dedicated imaging.


Instruction: Generate impression based on medical findings.

Input: Female 27 years old Reason: Evaluate for signs of cholecystitis History: RUQ pain LIVER: Liver measures 17.4 cm in length. The parenchyma is increased in echogenicity. Main portal vein patent with normal directional flow and velocity measures 40 cm/sec. BILIARY TRACT: Cholelithiasis. Per ultrasound technologist, tenderness over region of gallbladder elicited upon palpation with probe. No additional secondary signs of acute cholecystitis, no significant gallbladder distention, wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: KIDNEYS: The right kidney measures 12 cm, possible renocortical scarring in mid pole region; however, evaluation suboptimal due to overlying bowel gas. The left kidney measures 12.1 cm. No hydronephrosis delineated.SPLEEN: The spleen measures 8.2 cm. in length.

Output: Cholelithiasis, tenderness over gallbladder. No secondary signs of acute cholecystitis otherwise.Echogenic liver, may reflect underlying hepatic steatosis/underlying parenchymal dysfunction. No biliary duct dilatation.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old. Reason: AKI -rule out hydronephrosis. History: As above RIGHT KIDNEY: Right kidney measures 11.8 cm in length with normal cortical echogenicity. Simple-appearing mid pole renal cyst measures 2.0 x 1.6 x 1.8 cm. No hydronephrosis, shadowing calculi, or mass.LEFT KIDNEY: Left kidney measures 11.4 cm in length with normal cortical echogenicity. No hydronephrosis, shadowing calculi, or mass.URINARY BLADDER: Urinary bladder is mildly decompressed.OTHER: Small bilateral pleural effusions.

Output: 1. No evidence of hydronephrosis.2. Small bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female 77 years old Reason: R/o obstruction as etiology of AKI. History: Increasing Cr RIGHT KIDNEY: The right kidney measures 10.1 cm. Increased renal cortical echogenicity. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures cm. Increased renal cortical echogenicity. No shadowing calculi or hydronephrosis is present. BLADDER: Visualized bladder unremarkable.OTHER: Incidentally seen mildly prominent gallbladder measuring 3.4 cm containing moderate to large amount of layering sludge and stones. Gallbladder wall at upper limits of normal in thickness, and no pericholecystic fluid. No additional secondary signs of acute cholecystitis.

Output: Increased renal cortical echogenicity, consistent with medical renal disease. No hydronephrosis.Incidentally seen sludge and stone containing gallbladder without secondary signs of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Male 79 years old; Reason: h/o aki on ckd, r/o hydronephrosis History: see above RIGHT KIDNEY: The right kidney measures 9.8 cm in length. The cortex is thinned and echogenic. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 9.9 cm in length. The cortex is thinned and echogenic. No shadowing calculi or hydronephrosis is present. Small hypoechoic focus along the lateral aspect the left kidney is too small to fully characterize. Possible small stone noted in the interpolar region of the left kidney which may be parenchymal calcification. OTHER: No ascites.

Output: 1.No sonographic findings of hydronephrosis.2.Thinned echogenic renal cortices compatible with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Female 61 years old Reason: Cirrhosis, HCC screening History: HCC Screening LIVER: Liver is enlarged and measures 19.7 cm in length. The parenchyma is heterogeneous with increased echogenicity and nodular liver contour . Again seen is a right liver lobe predominantly anechoic cystic lesion with internal septations and debris which measures 7.9 x 5.8 x 5.1 cm and previously measured 5.9 x 8.2 x 6.8 cm and does not demonstrate internal vascularity; accounting for differences in technique this is unchanged from prior exam. No new suspicious hepatic lesions are identified.Main portal vein is patent with reversal of flow.BILIARY TRACT: Echogenic focus in the body of the gallbladder, near the neck, measures 0.4 x 0.3 x 0.3 cm does not demonstrate shadowing artifact or internal vascularity and may represent a subcentimeter polyp. No significant gallbladder distention, wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 12.1 cm. There is no hydronephrosis or shadowing renal calculus. The left kidney measures 12.6 cm. Again seen is a staghorn calculus in the upper pole, unchanged from the prior exam. No evidence of hydronephrosis.SPLEEN: The spleen measures 10.8 cm. in length. OTHER: No significant abnormality noted.

Output: 1.Right hepatic complex cystic lesion grossly unchanged in sonographic appearance. No new suspicious hepatic lesions. 2.Cirrhotic liver portal hypertension with reversal of main portal vein flow direction, unchanged from the prior exam.3.Staghorn left renal calculus without evidence of hydronephrosis unchanged from prior exam.


Instruction: Generate impression based on medical findings.

Input: Female 70 years old Reason: RUQ, eval for cholestasis History: cholestatic labs Suboptimal exam secondary to patient's intubated state.LIVER: Liver measures 15.3 cm in length. Main portal vein patent with normal directional flow, velocity measures 10 to 20 cm/s. BILIARY TRACT: Shadowing cholelithiasis and sludge in mildly contracted gallbladder. No significant gallbladder wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Not well seen in entirety due to adjacent bowel gas but visualized portions unremarkable. KIDNEYS: The right kidney measures 12 cm. The left kidney measures 11.8 cm. Mildly echogenic kidneys. Mild right-sided pelvocaliectasis.SPLEEN: The spleen measures 6.5 cm in length. OTHER: Right pleural effusion partially imaged.

Output: Cholelithiasis and sludge in gallbladder, no secondary signs of acute cholecystitis.Echogenic kidneys, likely reflecting underlying medical renal disease. Mild right-sided pelvocaliectasis.Right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female 70 years old Reason: Patient receiving chemotherapy for CMML. Complaints of pain to upper right quadrant of abdomen. Possible gallstones. History: Complaints of upper right quadrant abdominal pain. Pain occurs often after eating. LIVER: Liver is mildly enlarged and measures 17.6 cm in length. The parenchyma is within normal limits without a definite focal lesion. Main portal vein is patent with hepatopedal flow.BILIARY TRACT: A shadowing gallstone is seen in the body of the gallbladder without evidence of obstruction. No significant gallbladder distention, wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Partially visualized pancreas is unremarkable. Patient is limited due to overlying bowel gas.KIDNEYS: The right kidney measures 11.6 cm. The left kidney measures 11.0 cm. There is no evidence of hydronephrosis or shadowing renal calculus.SPLEEN: The spleen is mildly enlarged and measures 14.6 cm. in length. OTHER: No significant abnormality noted.

Output: 1.Cholelithiasis without evidence of cholecystitis.2.Hepatosplenomegaly.


Instruction: Generate impression based on medical findings.

Input: Female 38 years old; Reason: thyroid fullness, evaluate. RIGHT LOBE MEASUREMENTS: 1.3 x 1.3 x 4 cmLEFT LOBE MEASUREMENTS: 1.6 x 1 x 3.7 cmISTHMUS MEASUREMENT: 0.24 cmRIGHT LOBE: A predominantly cystic hypoechoic subcentimeter nodule in the mid thyroid pole measures 0.3 x 0.2 x 0.4 cm.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy.OTHER: No significant abnormality noted.

Output: Subcentimeter hypoechoic right thyroid nodule with no regional lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Female 64 years old Reason: HCV, eval for HCC History: HCV LIMITED ABDOMENLIVER: . Liver measures 16 cm in length. The parenchyma is slightly heterogenous and echogenic. BILIARY TRACT: No biliary ductal dilatation. No pericholecystic fluid or gallbladder wall thickening. . PANCREAS: Visualized portions are unremarkable.KIDNEYS: The right kidney measures 10 cm. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 11 cm. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 10 cm. in length. An isoechoic to spleen lesion well circumscribed rounded lesion near the left kidney is felt to represent a splenule.OTHER: No significant abnormalities noted.

Output: 1.No focal hepatic lesion. Hepatic parenchymal heterogeneity and echogenicity likely related to diffuse parenchymal dysfunction/fatty infiltration.


Instruction: Generate impression based on medical findings.

Input: Male 40 years old Reason: of liver, screen for HCC History: same LIMITED ABDOMENLIVER: The liver has a nodular contour. Liver measures 14.0 cm in length. The parenchyma is moderately coarse and echogenic. No focal hepatic lesion is identified. The portal vein is patent. BILIARY TRACT: Ringdown artifact is identified within the gallbladder, compatible with dental mild tendinosis. No gallstones or sludge are identified. Wall measures 2 mm in thickness. The common bile and measures 3 mm.PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 9.3 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. Echogenic lesion within the right kidney measures 0.5 x 0.5 x 0.7 cm, unchanged since 6/17/2013, probably benign.The left kidney measures 10.1 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. No suspicious lesion identified.SPLEEN: The spleen measures 10.2 cm in length.OTHER: No significant abnormalities noted.

Output: 1.Nodular contour of the liver, with coarse appearing and echogenic parenchyma, suspicious for underlying cirrhosis. No suspicious liver lesion identified.2.Adenomyomatosis of the gallbladder.


Instruction: Generate impression based on medical findings.

Input: 74-year-old female with a history of congestive heart failure presents with polycythemia, evaluate for malignancy. LIVER: Coarsened hepatic echotexture. No focal hepatic lesions. Hepatic length measures 17 cm. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of 27 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is contracted with multiple large stones. The wall measures 2 mm. The common bile duct measures 5 mm in diameter. Per technologist, negative sonographic Murphy sign. No evidence of pericholecystic fluid. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 11 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 11 cm and has normal vascular flow. AORTA: Proximal aorta measures 2.2 x 2.3 cm. The mid aorta measures 1.8 x 2.0 cm. The distal abdominal aorta measures 1.4 x 1.4 cm.OTHER: No significant abnormality noted.

Output: 1. Contracted gallbladder containing multiple large gallstones. No evidence of acute cholecystitis.2. No definite sonographic evidence of malignancy.


Instruction: Generate impression based on medical findings.

Input: Female 40 years old Reason: eval for gallstones History: RUQ pain LIVER: Liver measures 18.0 cm in length. The parenchyma is mildly increased in echogenicity which is nonspecific but may reflect diffuse infiltrative disease.BILIARY TRACT: Gallbladder unremarkable. No significant gallbladder distention, wall thickening or pericholecystic fluid. The common bile duct is dilated and measures 0.9 cm. The common hepatic duct is dilated and measures 1.2 cm. However, dilatation is unable to be evaluated distally secondary to overlying bowel gas. There is no evidence of intrahepatic dilatation.PANCREAS: Not visualized.KIDNEYS: The right kidney measures 11.1 cm. The left kidney measures 11.7 cm. SPLEEN: The spleen measures 10.5 cm in length.OTHER: No significant abnormality noted.

Output: Extrahepatic biliary dilatation with mildly enlarged common hepatic and bile duct without evidence of intrahepatic biliary dilatation. These findings are nonspecific but choledocholithiasis cannot be excluded in the presence of these findings.


Instruction: Generate impression based on medical findings.

Input: 31-year-old female with acute hepatitis. LIMITED ABDOMENLIVER: The liver has a smooth contour. The parenchyma is coarsened and mildly echogenic. Liver measures 19.4 cm in length. Portal flow is hepatopedal. No suspicious masses.BILIARY TRACT: The gallbladder is distended and has an anechoic lumen. No gallbladder wall thickening or pericholecystic fluid. No biliary ductal dilation.PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 12.5 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.The left kidney measures 11.0 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.SPLEEN: The spleen measures 10.0 cm. in length without significant abnormality.OTHER: None.

Output: 1.The liver is mildly enlarged with coarsened and echogenic parenchyma consistent with given clinical history of hepatitis. No suspicious masses are seen.


Instruction: Generate impression based on medical findings.

Input: Male 64 years old; Reason: renal mass RIGHT KIDNEY: The right kidney measures 10 cm in length. Corticomedullary differentiation is intact. No shadowing calculi or hydronephrosis is present. Septated right renal cyst measuring 2.2 x 1.5 x 1.5 cm, not significantly changed compared to the prior examination when accounting for differences in technique and positioning. The cyst does not demonstrate internal vascularity.LEFT KIDNEY: The left kidney measures 10 cm in length. Cortical medullary differentiation is intact. No shadowing calculi or hydronephrosis is present. Heterogeneous predominately solid left renal mass with vascularity measuring 2.3 x 2.5 x 2.3 cm perhaps slightly with a more solid component compared to the prior examination.URINARY BLADDER: The visualized portions of the urinary bladder are unremarkable.OTHER: Incidentally noted multifocal echogenic foci within the lumen of the gallbladder that are nonmobile and suggestive of gallbladder polyps. The largest polyp measures approximately 7 mm.

Output: 1.Heterogeneous predominantly solid left renal mass that has perhaps slightly increased in size with a slight increase in solid component.2.Incidentally noted multifocal echogenic foci within the lumen of the gallbladder that are nonmobile and suggestive of gallbladder polyps. Further imaging evaluation with sonographic evaluation of the gallbladder is recommended.3.Stable septated right renal cyst.


Instruction: Generate impression based on medical findings.

Input: 81-year-old female with history of multinodular goiter. RIGHT LOBE MEASUREMENTS: 5.0 x 1.6 x 2.0 cm.LEFT LOBE MEASUREMENTS: 6.6 x 3.9 x 3.7 cm.ISTHMUS MEASUREMENTS: 0.4 cm in AP dimension. RIGHT LOBE: The thyroid gland shows normal echogenicity. Subcentimeter benign-appearing cyst.LEFT LOBE: Normal echogenicity. A predominantly solid nodule within the left thyroid gland measures 3.9 x 2.2 x 3.9 cm.ISTHMUS: Normal echogenicity.PARATHYROID GLANDS: No enlarged parathyroid gland identified.LYMPH NODES: No regional lymphadenopathy. OTHER: Incidental finding of significant carotid calcifications.

Output: Enlarged thyroid gland with a predominantly-solid left sided nodule. Incidental finding of significant carotid calcifications consistent with atherosclerotic disease.


Instruction: Generate impression based on medical findings.

Input: Female 63 years old Reason: elevated LFTs, HCV, eval for HCC History: HCV LIVER: Liver measures 16.7 cm in length. The parenchyma is mildly coarse and echogenic. There are no focal hepatic lesions identified. No ascites.Main portal vein is patent with hepatopedal flow.BILIARY TRACT: Gallbladder unremarkable. No significant gallbladder distention, wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 11.2 cm. The left kidney measures 12.3 cm. No hydronephrosis or shadowing renal calculus.SPLEEN: The spleen measures 9.9 cm. in length. At the inferior aspect of the spleen is an anechoic lesion measuring 1.4 x 1.3 x 1.4 cm with posterior acoustic enhancement and is compatible with a splenic cyst.OTHER: No significant abnormality noted.

Output: Mildly coarsened and echogenic liver without a focal hepatic lesion. No ascites.


Instruction: Generate impression based on medical findings.

Input: Male 36 years old Reason: pre-op total pancreatectomy with autologous islet cell transplant. Please evaluate patency of portal vein, please doppler portal vein. History: see above LIVER: Liver measures 14.9 cm in length. Main portal vein patent with normal directional flow, velocity measures 22 cm/s. BILIARY TRACT: Status post cholecystectomy. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Atrophic, compatible with history of chronic pancreatitis. KIDNEYS: The right kidney measures 10.8 cm. The left kidney measures 9.9 cm. No hydronephrosis or perinephric free fluid.SPLEEN: The spleen measures 6.9 cm. in length. OTHER: No significant abnormality noted.

Output: Patent main portal vein. Atrophic pancreas, compatible with history of chronic pancreatitis.Status post cystectomy.


Instruction: Generate impression based on medical findings.

Input: Female 84 years old Reason: assess cholecystitis History: septic shock with recent cholecystitis 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 0.1 m/sec.BILIARY TRACT: The gallbladder has echogenic calculi with posterior acoustic shadowing. Wall measures 4 millimeters in thickness. No significant pericholecystic fluid.Common duct measures 6-mm. PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 11.4 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 8.0 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 9.2 cm. in length. OTHER: No significant abnormalities noted.

Output: 1.Cholelithiasis without sonographic findings of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Male 34 years old Reason: h/o obesity, HTN with mild elevation in ALT, no significant Etoh history, please evaluate for FLD/NASH History: asymptomatic, see above LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 18.9 cm in length. The parenchyma is moderately coarse and echogenic with focal areas of sparing along the gallbladder fossa. No discrete lesions are identified. The main portal vein is patent and demonstrates normal direction of flow with a peak velocity of 25 cm/sec.BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 3 mm in thickness. Common duct measures 5 mm. There is no intra-or extrahepatic biliary ductal dilatation.PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 12.5 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 11.7 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 11.0 cm in length. OTHER: No significant abnormalities noted.

Output: 1.Moderate hepatic steatosis.


Instruction: Generate impression based on medical findings.

Input: Female 58 years old; Reason: Rule out recurrence History: History thyroid cancer, with increased thyroglobulin level. RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENT: Status post thyroidectomy.RIGHT LOBE: Status post thyroidectomy, without evidence of residual thyroid tissue or recurrent disease.LEFT LOBE: Status post thyroidectomy. Previously noted hypoechoic focus in the inferior portion of the left thyroid bed is unchanged, measuring 0.3 x 0.3 x 0.6 cm compared to 0.5 x 0.3 x 0.7 cm on the prior exam.ISTHMUS: Status post thyroidectomy, without evidence of residual thyroid tissue or recurrent disease.LYMPH NODES: No regional lymphadenopathy.OTHER: No significant abnormality noted.

Output: Status post thyroidectomy, with the hypoechoic focus in the left thyroid bed not significantly changed as compared to prior exam. No new lesions or regional lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female with right thyroid nodule. RIGHT LOBE MEASUREMENTS: 2.0 x 1.8 x 6.1 cm.LEFT LOBE MEASUREMENTS: 1.4 x 1.3 x 4.6 cm.ISTHMUS MEASUREMENTS: 0.4 cm.THYROID: Diffusely nodular and heterogeneous appearing thyroid is suggestive of Hashimoto's thyroiditis.PARATHYROID GLANDS: Two nodules that appear discrete from the right thyroid gland are visualized. One superior to the right thyroid appears largely hypoechoic and measures 0.6 x 0.5 x 1.1 cm. The second, inferior to the right thyroid lobe measures 1.0 x 0.8 x 1.9 cm and appears heterogeneously isoechoic to thyroid tissue.LYMPH NODES: Left scattered, benign-appearing lymph nodes.OTHER: No significant abnormality noted.

Output: 1. Diffusely nodular and heterogeneous appearing thyroid suggestive of Hashimoto's thyroiditis.2. One superior and one inferior lesion that appear separate from the right thyroid gland are visualized, may represent hyperplastic parathyroid glands. Correlation with patient's clinical history and laboratory values recommended.


Instruction: Generate impression based on medical findings.

Input: Female 60 years old; Reason: Evaluate vascularity and nodularity of thyroid. History: Large goiter w/ Graves vs multinodular toxic goiter. RIGHT LOBE MEASUREMENTS: 7.3 x 4.2 x 4.8 cmLEFT LOBE MEASUREMENTS: 7.3 x 3.2 x 4.2 cmISTHMUS MEASUREMENT: 2.0 cmRIGHT LOBE: Heterogeneous enlarged thyroid lobe. Dominant inferior right lower pole solid nodule measures 4.6 x 4.0 cm.LEFT LOBE: Heterogeneous enlarged thyroid lobe. Dominant inferior left lower pole solid nodule measures 2.7 x 2.3 cm.ISTHMUS: Large nodule which is mostly solid with peripheral vascularity measures 3.4 x 2.3 cm.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multinodular goiter


Instruction: Generate impression based on medical findings.

Input: Female 23 years old Reason: eval for evidence of cholangitis, cholecystitis. eval GB, wall, ducts, etc History: RUQ pain, fever, jaundice LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 16 cm in length. The parenchyma is normal in echotexture. Main portal vein is patent with normal directional flow.BILIARY TRACT: The gallbladder contains layering sludge/stones. Wall measures 4mm in thickness. There is some gallbladder wall edema adjacent to the liver surface.Common duct measures 4mm. PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 9.4 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 10.4 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 12 cm. in length. OTHER: No significant abnormalities noted.

Output: 1.Cholelithiasis with possible findings of early cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Male 53 years old Reason: Outside Request: (US of liver GB and biliary tree due to elevated LFTs) ultrasound abdominal real time with image documentation; limited (single organ, quadrant f/u), abnormal transaminases LIVER: Liver measures 15.3 cm in length. The parenchyma is increased in parenchymal echogenicity. Main portal vein patent with normal directional flow, velocity measures 16.4 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 overlying bowel gas but visualized portions unremarkable. KIDNEYS: The right kidney measures 11.5 cm. The left kidney measures 12.3 cm. No hydronephrosis.SPLEEN: The spleen measures 11.8 cm. in length. OTHER: No significant abnormality noted.

Output: Echogenic liver, likely reflecting underlying hepatic steatosis/parenchymal dysfunction.


Instruction: Generate impression based on medical findings.

Input: 50-year-old female. Reason: history of multinodular goiter with 2cm nodule in inferior pole of right lobe, please evaluate for interval change and characteristics History: occasional dysphagia (may be unrelated) RIGHT LOBE MEASUREMENTS: 8.8 x 2.7 x 2.1 cm.LEFT LOBE MEASUREMENTS: 5.6 x 1.6 x 1.3 cm.ISTHMUS MEASUREMENTS: 0.14 cm.RIGHT LOBE: Right thyroid lobe appears heterogeneous. There is a lower pole right thyroid lobe nodule which is heterogeneous in appearance. This nodule measures 3.2 x 2.3 x 3.4 cm. LEFT LOBE: Multiple subcentimeter hypoechoic nodules are seen in the left thyroid lobe. A left mid thyroid pole nodule measures 1.0 x 0.6 x 0.9 cm mixed cystic/solid in appearance.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Heterogeneous appearing right thyroid lobe nodule measuring 3.4 cm in largest dimension. This nodule would be amenable to FNA.2.Multiple hypoechoic nodules are seen in the left thyroid lobe, most of which are subcentimeter. The largest measures 1.0 cm in its maximal dimension..


Instruction: Generate impression based on medical findings.

Input: Female 88 years old Reason: Please evaluate for retained CBD stone or RUQ fluid collection s/p lap chole History: RUQ pain LIMITED ABDOMENLIVER: The liver measures 14 cm in length without evidence of intrahepatic ductal dilation. The main portal vein is patent and demonstrates hepatopedal flow. Liver contour and echogenicity is within normal limits.BILIARY TRACT: Status post cholecystectomy. The distal common bile duct cannot be visualized, however the visualized biliary system demonstrates no dilation, with the common bile duct measuring 3 mm.PANCREAS: Pancreas is obscured by overlying bowel gas.KIDNEYS: The right kidney measures 9.2 cm in length. No hydronephrosis or shadowing calculi is visualized. Superior pole cyst measures 2.2 x 1.7 cm.The left kidney measures 10.0 cm without evidence of hydronephrosis or stone.SPLEEN: The spleen measures 6.6 cm. In length. OTHER: No significant abnormalities noted.

Output: 1.The distal aspect of the common bile duct cannot be visualized, however the visualized areas of the biliary system are within normal limits as described above. If concern for distal stone remains, MRCP would be of benefit for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old. Reason: assess known AAA History: known AAA Aneurysmal dilatation of the midportion of the abdominal aorta. Measurements as follows:Proximal aorta: 2.6 x 2.3 cm.Mid aorta: 4.7 x 4.9 cm.Distal aorta: 2.9 x 2.6 cm.Right and left common iliac arteries are not well visualized. Color Doppler and spectral analysis are within normal limits with normal waveforms.

Output: Aneurysmal dilatation of the mid abdominal aorta as above.


Instruction: Generate impression based on medical findings.

Input: Female 48 years old Reason: eval for cirrhosis, masses. Part of VAD work up History: CHF LIVER: The liver has a smooth contour. Liver measures 20 cm in length. The parenchyma is normal in echotexture . No focal hepatic lesions. The hepatic veins are dilated.BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 3 mm in thickness. Common duct measures 3 mm. PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 10.2 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 11.1 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 9.9 cm. in length. OTHER: No significant abnormalities noted.ABDOMINAL AORTA: Proximal: 3.4 x 2.7 cmMid: 2.1 x 1.9 cm. Distal: Obscured Right common iliac artery: Obscured Left common iliac artery: Obscured INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No focal hepatic lesion.2.Normal sonographic appearance of the gallbladder.3.No hydronephrosis.4.No abdominal aortic aneurysm.


Instruction: Generate impression based on medical findings.

Input: Male 58 years old; Reason: thyroid nodule seen on neck CT RIGHT LOBE MEASUREMENTS: 2.1 x 5.2 x 1.8 cmLEFT LOBE MEASUREMENTS: 1.9 x 5.4 x 1.7 cmISTHMUS MEASUREMENT: 0.5 cmRIGHT LOBE: Two predominantly cystic nodules in the right thyroid lobe. The largest measures 0.7 x 0.4 x 0.7 cm. LEFT LOBE: A single subcentimeter cystic nodule in the left thyroid lobe measures 0.4 x 0.3 x 0.3 cm.ISTHMUS: Single predominately solid, vascular nodule in the isthmus measures 0.6 x 0.6 x 0.4 cm. Punctate hyperechoic foci within this nodule do not demonstrate convincing comet tail artifact and the appearance is atypical for a colloid nodule.LYMPH NODES: Multiple prominent lymph nodes within the neck measuring up to 1.8 x 0.5 x 0.9 cm on the right side demonstrate benign morphology and are likely reactive.

Output: 1.Multiple subcentimeter colloid nodules within the right and left thyroid lobes. 2.A subcentimeter solid nodule within the isthmus does not have the typical appearance of a colloid nodule and follow up ultrasound is recommended.


Instruction: Generate impression based on medical findings.

Input: 31-year-old female with HBV core +. LIVER: Echogenicity of the hepatic parenchyma is normal . No focal hepatic lesion or mass. The liver measures 15.9 cm in length. No dilatation or cystic changes are noted of the intrahepatic or extrahepatic biliary ducts. A lymph node near the porta hepatis measures 0.7 cm in short axis.The main portal vein is patent with normal hepatopedal flow and velocity of 47 cm/s.GALLBLADDER, BILIARY TRACT: The gallbladder is normal in appearance. There is no pericholecystic fluid, gallbladder wall thickening or cholelithiasis. The common bile duct measures 0.2 cm in diameter. PANCREAS: The head and proximal body of the pancreas are normal. The tail is obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 10.5 cm in length and shows normal echotexture. No mass, stone or hydronephrosis.LEFT KIDNEY: The left kidney measures 11.6 cm in length and shows normal echotexture. No mass, stone or hydronephrosis.SPLEEN: The spleen is normal in echogenicity and measures 8.1 cm in length. OTHER: There is no free or loculated fluid.

Output: Normal appearance of the liver without focal mass lesion.


Instruction: Generate impression based on medical findings.

Input: Female 64 years old Reason: abnormal LFTs, elevated INR, h/o fatty liver disease; assess for hepatomegaly, cirrhosis. Also assess for splenomegaly - concern for leukemia History: see above LIVER: Liver measures 16.9 cm in length, liver borderline in echogenicity, may reflect element of mild hepatic steatosis/parenchymal dysfunction. Main portal vein patent with normal directional flow, velocity measures 33 cm/s. BILIARY TRACT: Status post cholecystectomy. Common bile duct mildly prominent, measuring 8 mm, likely reflecting the patient's postcholecystectomy state.PANCREAS: Not well seen in entirety due to overlying bowel gas but visualized portions unremarkable. KIDNEYS: The right kidney measures 12.3 cm. The left kidney measures 12.3 cm, mid pole simple cyst measuring 5.6 x 4.6 x 4.4 cm. No hydronephrosis.SPLEEN: The spleen measures 6.8 cm. in length. OTHER: Incompletely imaged right pleural effusion.

Output: No evidence of hepatosplenomegaly.Liver borderline in echogenicity, may reflect element of mild hepatic steatosis/parenchymal dysfunction. Right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 66 year old female with left lower quadrant pain and recurrent UTIs. Evaluate kidneys for stones, pelvis for etiology of pain. RIGHT KIDNEY: The right kidney measures 10.3 cm in length. The cortex is Normal in echogenicity. No shadowing calculi or hydronephrosis is present.LEFT KIDNEY: The left kidney measures 10.5 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. URINARY BLADDER: No significant abnormality noted. OTHER: No significant abnormalities noted.

Output: No evidence of nephrolithiasis or hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Male 58 years old Reason: evaluate for cause of RUQ pain in pt with nausea, vomiting, diarrhea History: nausea, vomiting, diarrhea LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 16 cm in length. The parenchyma is normal in echotexture . No focal hepatic lesions. Main portal vein is patent with normal directional flow.BILIARY TRACT: The gallbladder has no shadowing calculi. Possible sludge. Wall measures 2mm in thickness. Common duct measures 4 mm. PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 9.2 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. The left kidney measures 9.4 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 8 cm. in length. OTHER: No ascites

Output: 1.No sonographic findings of cholelithiasis.


Instruction: Generate impression based on medical findings.

Input: Female 49 years old; Reason: r/o hydronephrosis History: elevated and rising sCr despite consistent UOP RIGHT KIDNEY: The right kidney measures 13.7 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 12.4 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. URINARY BLADDER: No significant abnormality.OTHER: No significant abnormalities noted.

Output: Normal-appearing kidneys with no evidence of hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Female 67 years old; Reason: New renal failure History: elevated Cr RIGHT KIDNEY: The right kidney measures 11.5 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 11.3 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present.  URINARY BLADDER: No significant abnormality notedOTHER: Upper abdominal ascites. The liver slightly nodular.

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


Instruction: Generate impression based on medical findings.

Input: Reason: 26 y/o 13 weeks pregnant with RLQ pain, rebound/guarding History: Guarding on exam LIVER: The liver measures 10.6 cm in length. Normal echogenicity. No focal lesions.GALLBLADDER, BILIARY TRACT: No evidence of cholelithiasis. The gallbladder wall is not thickened, measuring 2 mm. There is no intrahepatic or extrahepatic biliary dilatation.PANCREAS: The visualized portions of the pancreas reveal no abnormality.KIDNEYS: No focal lesions are seen within the right kidney. No hydronephrosis.No focal lesions are seen in the left kidney. No hydronephrosis.SPLEEN: The spleen measures 9.7 cm in length. There is a small amount of perisplenic fluid, nonspecific.OTHER: The appendix is not visualized.There is a right ovarian cyst, likely physiologic.

Output: 1. The appendix is not visualized. 2. Small amount of perisplenic fluid, nonspecific.


Instruction: Generate impression based on medical findings.

Input: Female 51 years old; Reason: Evaluate for goiter. History: pills stuck when swallowing RIGHT LOBE MEASUREMENTS: 4.1 x 2.5 x 1.6 cmLEFT LOBE MEASUREMENTS: 4.7 x 2.1 x 1.5 cmISTHMUS MEASUREMENT: 2 cmRIGHT LOBE: Mixed cystic and solid nodule in the right inferior thyroid pole measures 1.2 x 1.1 x 1.2 cm.LEFT LOBE: Hyperechoic solid nodule in the left mid thyroid pole measures 1.6 x 1.4 x 1.0 cm.ISTHMUS: Large mixed cystic and solid nodule in the isthmus measuring 6.1 x 5.4 x 3.3 cm is present.LYMPH NODES: No regional lymphadenopathy.OTHER: No significant abnormality noted.

Output: Bilateral thyroid nodules most suggestive of multinodular goiter.


Instruction: Generate impression based on medical findings.

Input: 60-year-old male with right testicle/groin pain. RIGHT TESTIS: The right testicle measures 2.7 x 3.1 x 2.5 cm. Vascular inflow and outflow remain intact. No asymmetrically increased vascularity is seen. Large right hydrocele.LEFT TESTIS: The left testicle measures 3.2 x 1.4 x 2.5 cm. Vascular inflow and outflow remain intact. No asymmetrically increased vascularity is seen. Small, left hydrocele with septations.RIGHT EPIDIDYMIS: The right epididymis measures 1.2 cm. Vascular inflow and outflow remain intact without asymmetrically increased vascularity.LEFT EPIDIDYMIS: The left epididymis measures 1.2 cm. Vascular inflow and outflow remain intact without asymmetrically increased vascularity.OTHER: Small left varicocele.

Output: 1. Right greater than left hydroceles with increased complexity including septations seen on left side. 2. Small left varicocele.3. No specific evidence to indicate orchitis, epididymitis, or torsion.


Instruction: Generate impression based on medical findings.

Input: Female 48 years old Reason: Cirrhosis History: Ascites LIVER: Enlarged cirrhotic liver, nodular liver contour. Liver measures 20.5 cm. Main portal vein patent with normal directional flow, velocity measures 33 cm/s. Flow pulsatile, may reflect element of right-sided heart failure. No focal liver lesion.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 overlying bowel gas. KIDNEYS: The right kidney measures 12 cm. The left kidney measures 12.3 cm. Renal cortical echogenicity within normal limits. No hydronephrosis. No shadowing intrarenal stone.SPLEEN: Splenomegaly, measures 15.1 cm. in length. ABDOMINAL AORTA AND INFERIOR VENA CAVA: Visualized IVC patent. Nonaneurysmal abdominal aorta. Proximal abdominal aorta measures 2.5 cm in AP dimension, mid aorta measures 2.2 cm in AP dimension, distal aorta not well seen secondary to overlying bowel gas.OTHER: Moderate to large ascites. Visualized bladder unremarkable.

Output: Enlarged cirrhotic liver, no focal liver lesion. Splenomegaly and ascites.Pulsatile portal venous flow, suspicious for right-sided heart failure.


Instruction: Generate impression based on medical findings.

Input: Female 68 years old Reason: elevated direct bilirubin; evaluate for gallbladder and biliary tree pathology LIVER: Prominent liver, measuring 19.5 cm in length. The parenchyma is increased in echogenicity. Hepatic cysts, both simple appearing and containing septations, examples include anteriorly located left-sided cyst measuring 2.4 x 2.2 x 1.5 cm and a right-sided cyst measuring 1.5 x 1.5 x 1.4 cm. Main portal vein patent with normal hepatopetal flow and velocity 30 cm/sec, flow pulsatile in appearance and mild dilatation of the IVC suggested, findings may be seen in setting of underlying right-sided heart failure.BILIARY TRACT: Moderate sludge in gallbladder. No significant gallbladder distention or wall thickening. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Not well seen due to overlying bowel gas. KIDNEYS: The right kidney measures 11.8 cm. The left kidney measures 11.2 cm. Mildly increased renal cortical echogenicity.SPLEEN: The spleen measures 9.3 cm. in length. OTHER: Incompletely imaged bilateral pleural effusions and ascites.

Output: Sludge in gallbladder. No definite secondary signs of acute cholecystitis. No biliary duct dilatation.Prominent echogenic liver, may reflect underlying hepatic steatosis/parenchymal dysfunction.Findings suggestive of right-sided heart failure as above, correlate with patient's clinical history.Mildly increased renal cortical echogenicity, may reflect medical renal disease and correlation with patient's clinical history/lab values recommended.Incompletely imaged bilateral pleural effusions and ascites.