Instruction: Generate impression based on medical findings.

Input: Female 79 years old Reason: HCV, Cirrhosis eval for HCC History: HCV, Cirrhosis LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 13.4 cm in length. The parenchyma is mildly coarse in echotexture. Portal vein flow is hepatopedal. No focal hepatic lesion identified.BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 1 to 2 mm in thickness. Common duct measures 2 mm. PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 8.6 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. There is a 1.6 x 1.3 x 1.1 cm simple cyst in the superior pole.The left kidney measures 10.2 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 11.0 cm. in length. Scattered, punctate echogenic foci are noted and likely related to splenic granulomata.OTHER: No significant abnormalities noted.

Output: Coarse hepatic echotexture, likely reflecting chronic liver disease. No focal hepatic lesion.


Instruction: Generate impression based on medical findings.

Input: Reason: haplo cord stem cell transplant with AKI. History: none ULTRASOUND KIDNEYSRIGHT KIDNEY: The right kidney measures 14.3 cm in length. The parenchyma appears echogenic. There is no perinephric fluid collection. There is no hydronephrosis nor focal lesion.LEFT KIDNEY: The left kidney measures 13.7 cm in length. The parenchyma appears echogenic. There is no perinephric fluid collection. There is no hydronephrosis nor focal lesion.OTHER:The bladder is anechoic with no visualized masses.

Output: 1. Echogenic kidneys suggestive of medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Female 31 years old; Reason: AKI, proteinuria, c/f lupus nephritis, evaluate for alternative etiology of AKI History: as above RIGHT KIDNEY: The right kidney measures 10.7 cm in length and appears diffusely echogenic, consistent with medical renal disease. No hydronephrosis or stones are visualized.LEFT KIDNEY: The left kidney measures 10.3 cm in length. The left kidney also is diffusely echogenic, consistent medical renal disease. No hydronephrosis or stones are visualized. OTHER: The bladder is well-distended and without significant abnormality.

Output: Bilateral echogenic kidneys are consistent with medical renal disease. No evidence of hydronephrosis or stones.


Instruction: Generate impression based on medical findings.

Input: Male 76 years old; Reason: Bladder CA (s/p radial cystectomy w/ Ileal conduit diversion with UTI, R/o renal abscess or stone History: UTI RIGHT KIDNEY: The right kidney measures 11.8 cm in length. The cortex is thinned and echogenic. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 12.1 cm in length. The cortex is thinned and echogenic. No shadowing calculi or hydronephrosis is present.  URINARY BLADDER: Urinary bladder is absent.OTHER: No significant abnormalities noted.

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


Instruction: Generate impression based on medical findings.

Input: 50 year-old male presents with elevated liver enzymes. LIVER: Increase in hepatic parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions. Hepatic length measures 19 cm. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of 16 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 1 mm. The common bile duct measures 2 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified. No pericholecystic fluid. Nonmobile, intraluminal echogenic focus measuring 0.5 x 0.4 x 0.4 consistent with a gallbladder polyp. Per technologist, negative sonographic Murphy sign.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 10 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 12 cm and has normal vascular flow. The left kidney measures 11 cm and has normal vascular flow. No evidence of hydronephrosis.OTHER: No significant abnormality noted.

Output: 1. Increase in hepatic parenchymal echogenicity with coarsened echotexture consistent with fatty liver/hepatic parenchymal dysfunction. No hepatic mass or ductal dilatation identified.2. 5 mm gallbladder polyp, continued follow-up is recommended.


Instruction: Generate impression based on medical findings.

Input: Male 31 years old Reason: Eval for HCC, hepatitis B carrier History: Hep B carrier LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 14.9 cm in length. The parenchyma is normal in echotexture. No focal liver lesion is identified. The main portal vein is patent and demonstrates normal direction of flow with a velocity of 2.1 m/s. BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 2 mm in thickness. Common duct measures 5 mm in diameter is. There is no intrahepatic biliary ductal dilatation.PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 10.2 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 10.2cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 8.8 cm. in length. OTHER: No significant abnormalities noted.

Output: No focal liver lesions are identified. Normal exam.


Instruction: Generate impression based on medical findings.

Input: Male 68 years old Reason: evaluate right upper quadrant, aaa, abdominal pain LIVER: Hepatomegaly, measuring 20 cm in length. No focal liver lesion. Main portal vein patent with normal directional flow, velocity measures 50 cm/sec. Flow in portal vein somewhat pulsatile, may reflect right-sided heart failure.BILIARY TRACT: Distended gallbladder, measuring up to 4.8 cm. Thickened gallbladder wall, measuring up to 4 mm, particularly at level of gallbladder fundus. No intraluminal mobile echogenic foci seen to suggest underlying cholelithiasis. No intrahepatic biliary duct dilatation. Extrahepatic duct measures up to 7 mm, nonspecific and distal tapering seen.PANCREAS: Not well seen secondary to overlying bowel gas. KIDNEYS: The right kidney measures 8.2 cm. The left kidney measures 10.9 cm. Increased renal cortical echogenicity. No hydronephrosis. Right renal cyst, measuring 1.8 x 1.6 x 1.2 cm.SPLEEN: Not seen with certainty.OTHER: No significant abnormality noted.

Output: Distended gallbladder with mild wall thickening, nonspecific but correlation with patient's clinical history and physical exam recommended to exclude acute acalculous cholecystitis.Hepatomegaly.Pulsatile portal venous flow, may reflect right-sided heart failure.Increased renal cortical echogenicity, consistent with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: 54-year-old man with elevated transaminases. LIVER: Echogenicity of the hepatic parenchyma is diffusely increased. No focal hepatic lesion or mass. The liver measures 18.1 cm in length. The main portal vein is patent with normal hepatopedal flow and velocity of 29 cm/s.GALLBLADDER, BILIARY TRACT: The gallbladder is normal in appearance. There is no pericholecystic fluid. No cholelithiasis. The gallbladder wall is normal in appearance, measuring 0.2 cm in thickness. No dilatation or cystic changes are noted of the intrahepatic or extrahepatic biliary ducts. The common bile duct measures 0.4 cm in diameter. No choledocholithiasis.PANCREAS: The head and proximal body of the pancreas are normal. The tail is obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 14.4 cm in length and shows normal echotexture. No mass, stone or hydronephrosis.LEFT KIDNEY: The left kidney measures 13.8 cm in length and shows normal echotexture. No mass, stone or hydronephrosis.SPLEEN: The spleen is normal in echogenicity and measures 9.3 cm in length. OTHER: There is no free or loculated fluid.

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


Instruction: Generate impression based on medical findings.

Input: 70-year-old male with bilateral thyroid nodules on prior CT, history of tonsillar cancer status post chemotherapy and radiation RIGHT LOBE MEASUREMENTS: Right lobe measures 5.7 cm x 1.4 cm.LEFT LOBE MEASUREMENTS: The left lobe measures 2.9 cm x 2.2 cm. .ISTHMUS MEASUREMENTS: Isthmus measures 0.4 cm.RIGHT LOBE: The right lobe is heterogeneous. There are multiple vessels running through the right lobe shunt with Doppler. There is a hypoechoic nodule that measures 0.8 x 0.7 cm in the mid/inferior region, as well as a second hypoechoic nodule that measures 0.6 cm x 0.5 cm at the inferior portion.LEFT LOBE: The left lobe is heterogeneous with several very small cystic areas. At the inferior portion of the left lobe there is a spongiform nodule that measures 2.8 cm x 1.8 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.

Output: The thyroid gland is heterogeneous. There are 2 nodules noted on the right mid and inferior primarily cystic. One larger nodule is measured on the left inferior portion with mixed cystic and solid appearing components, favored to be a colloid cyst but nonspecific.


Instruction: Generate impression based on medical findings.

Input: Female 54 years old Reason: HCC screening History: PBC, cirrhosis LIVER: The liver measures 21.1 cm in length and demonstrates coarsened heterogeneous parenchymal echogenicity and a nodular surface contour. No intrahepatic or extrahepatic biliary ductal dilatation is evident and no focal mass lesions are seen. The main portal vein is patent and demonstrates hepatopedal flow with a velocity of 0.2 m/s. Nonspecific prominent porta hepatis node measures 1.2 x 2.0 cm. GALLBLADDER, BILIARY TRACT: No cholelithiasis or choledocholithiasis is seen. The common duct measures 0.4 cm in diameter. PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 11.9 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 11.7 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 13.5 cm in length.OTHER: No evidence of ascites.

Output: Cirrhotic morphology of the liver, hepatosplenomegaly, but no focal mass lesions identified within the hepatic parenchyma.


Instruction: Generate impression based on medical findings.

Input: 48-year-old female with single thyroid nodule identified incidentally on recent MRI RIGHT LOBE MEASUREMENTS: 6.9 x 2.1 x 1.8 cmLEFT LOBE MEASUREMENTS: 5.9 x 4.8 x 1.2 cmISTHMUS MEASUREMENTS: 0.3 cm in AP dimension. RIGHT LOBE: Heterogeneous gland. A few minimally complex cystic lesions are identified, with the largest in the upper pole measuring 2.8 x 1.2 x 1.9 cm.LEFT LOBE: Heterogeneous gland. A few minimally complex cystic lesions are identified, with the largest in the upper pole measuring 1.1 x 0.6 x 0.4 cm.ISTHMUS: Heterogeneous in appearance with a left sided cystic lesion measuring 0.5 x 0.4 x 0.2 cm.PARATHYROID GLANDS: No enlarged parathyroid gland identified.LYMPH NODES: No regional lymphadenopathy. OTHER: No significant abnormality noted.

Output: Heterogeneous and enlarged gland with multiple minimally complex cystic lesions, favor benign etiology.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old. Reason: Right thyroid enlargement. History: thyroid enlargement. RIGHT LOBE MEASUREMENTS: 6.8 x 4.3 x 0.7 cmLEFT LOBE MEASUREMENTS: 6.0 x 1.6 x 1.6 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Dominant nodule with mixed cystic and solid components and moderate vascularity measures 4.9 x 4.6 x 4.3 cm. No microcalcifications are present.LEFT LOBE: Homogeneous echotexture. Predominantly solid left midpole nodule with cystic areas measures 0.9 x 0.7 x 0.7 cm. No internal vascularity or calcifications.ISTHMUS: Homogeneous echotexture. Predominantly solid left isthmus nodule with peripheral cystic area measures 1.0 x 0.8 x 0.4 cm. No significant internal vascularity or microcalcifications.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing right level 3 neck lymph node node measures 1.2 x 0.7 x 0.3 cm.OTHER: No significant abnormality noted.

Output: Enlarged thyroid with multiple nodules. Given its size, the dominant left thyroid nodule is amenable to biopsy.


Instruction: Generate impression based on medical findings.

Input: 73 year-old female, surgical patient with increased creatinine. RIGHT KIDNEY: The right kidney measures 11.1 cm in length. The cortex is increased in echogenicity. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 11.2 cm in length. The cortex is increased in echogenicity. No shadowing calculi or hydronephrosis is present. Prominence of the upper pole calix is seen and appear similar to outside hospital CT dated 9/29/2014.URINARY BLADDER: Foley catheter in a decompressed bladder limits evaluation.OTHER: Increased echogenicity of the visualized liver.Small amount of abdominal ascites.

Output: 1.Increased echogenicity of the kidneys suggestive of parenchymal dysfunction. No hydronephrosis.2.Increased echogenicity of the partially visualized liver suggestive of fatty infiltration.3.Small amount of ascites.


Instruction: Generate impression based on medical findings.

Input: Female 51 years old Reason: worsening distension, eval of ascites as cause of distension, please also eval gallbladder and liver, worsening hyperbilirubinemia History: as above Suboptimal study secondary to patient positioning and overlying material.LIVER: Liver measures 17.6 cm in length. The parenchyma is echogenic. Nodular liver contour. Echogenic focus in periphery of right liver with posterior acoustic shadowing suggestive of a dystrophic calcification related to prior granulomatous disease or infection/inflammation. Reversal flow in main portal vein, velocity measures 10.5 to 12.8 cm/s. BILIARY TRACT: 6 x 4 x 3 mm soft tissue focus suggested in the dependent aspect of gallbladder, no posterior acoustic shadowing seen, may reflect a noncalcified gallstone or small gallbladder polyp (patient unable to change position in order to assess for mobility of focus) versus a gallbladder fold. Gallbladder wall thickening, nonspecific in setting of ascites. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Not well seen. KIDNEYS: The right kidney measures 9.9 cm, no hydronephrosis. The left kidney measures approximately 10.9, evaluation limited SPLEEN: The spleen measures 10.2 cm. in length. OTHER: Small to moderate ascites, possible septations.

Output: 1. Suboptimal study secondary to patient positioning and overlying material.2. Small to moderate ascites, containing possible septations.3. Reversal of flow in main portal vein.4. Echogenic liver, compatible with underlying hepatic steatosis/parenchymal dysfunction. Nodular contour suggested, correlate clinically for underlying cirrhosis.5. Subcentimeter soft tissue focus suggested in the dependent aspect of gallbladder, no posterior acoustic shadowing seen, may reflect a noncalcified gallstone or small gallbladder polyp (patient unable to change position in order to assess for mobility of focus) versus a gallbladder fold. Gallbladder wall thickening, nonspecific in setting of ascites.6. Pancreas and left kidney not well assessed.7. Pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: Why is patient's abdomen getting bigger, rule out cholecystitis. History: Abdominal distention LIVER: The liver is not enlarged, measuring 15.4 cm. Normal echogenicity. There is an echogenic focus in the right lobe of the liver which measures 1.8 x 1.8 x 2.1 cm, consistent with known hemangioma seen on prior imaging. There are no new lesions seen. No intrahepatic ductal dilation.GALLBLADDER, BILIARY TRACT: There is sludge and stones within the gallbladder. Gallbladder wall measures 0.4 cm. No pericholecystic fluid. The patient is intubated and sonographic Murphy's sign is not able to be assessed. The common bile duct is not dilated, measuring 0.3 cm.PANCREAS: Poorly visualized. Unable to be assessed.KIDNEYS: The right kidney measures 12.8 cm. Normal echogenicity. No focal lesions. No hydronephrosis.The left kidney measures 11.8 cm. Normal echogenicity. No focal lesions. No hydronephrosis.SPLEEN: Not visualized.OTHER: The main portal vein is patent with a normal waveform and a hepatopetal flow. The velocity is within normal limits, measuring 0.2 m/s.

Output: 1. Hemangioma within the right lobe the liver. Unchanged from prior exam.2. Biliary sludge and stones in the gallbladder. No evidence of acute cholecystitis.3. No ascites.


Instruction: Generate impression based on medical findings.

Input: Male 69 years old; Reason: eval for hydronephrosis History: AKI, BPH RIGHT KIDNEY: The right kidney measures 12 cm in length. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 10 cm in length. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. OTHER: Anechoic region adjacent to the bladder may represent an adjacent bowel loops versus bladder diverticulum, although a diverticulum was not seen on most recent CT from 1/21/2015.

Output: 1.No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Right-sided abdominal pain LIVER: No significant abnormalities noted.BILIARY TRACT: Diffuse gallbladder wall thickening with pericholecystic fluid associated with cholelithiasis. Positive Murphy's sign. No ductal dilatation

Output: Diffuse gallbladder wall thickening associated with pericholecystic fluid and cholelithiasis. Positive Murphy's sign. Findings consistent with acute cholecystitis. No ductal dilatation.


Instruction: Generate impression based on medical findings.

Input: Male 65 years old Reason: NASH cirrhosis evaluate for HCC History: NASH cirrhosis LIMITED ABDOMENLIVER: The liver measures 22.0 cm in length. The liver has a smooth contour. The parenchyma is mildly coarse and echogenic. No focal hepatic masses identified. There is no ascites.The portal vein is patent and demonstrates normal directional flow with a peak velocity of 0.2 m/sec.BILIARY TRACT: The gallbladder has an anechoic lumen. There is no gallbladder wall thickening or pericholecystic fluid. Common duct measures 0.4 cm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 13.6 cm with lobular contour. The cortex is echogenic. Again seen is a 2.8 x 2.4 x 2.2 cm simple appearing cyst in the inferior pole. No shadowing calculi or hydronephrosis is present. The left kidney measures 13.7 cm with a lobular contour. The cortex is thinned and echogenic. Again seen is a 3.5 x 3.2 x 3.1 cm simple appearing cyst. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 17.0 cm. in length. OTHER: No significant abnormalities noted.

Output: 1.Coarse and echogenic liver consistent with hepatic steatosis/parenchymal dysfunction. No worrisome mass is identified.2.Hepatosplenomegaly.3.Redemonstrated bilateral simple appearing renal cysts.


Instruction: Generate impression based on medical findings.

Input: Female 19 years old Reason: please evaluate patient's appendix if possible and gallbladder History: right sided abdominal pain, vomiting, 15 weeks pregnant LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 15 cm in length. The parenchyma is normal in echotexture . No focal hepatic lesions. Main portal vein is patent with normal directional flow.BILIARY TRACT: Gallbladder contains a few calculi that layer at the fundus.. Wall measures 2 mm in thickness. No pericholecystic fluid, right upper quadrant tenderness or gallbladder distention Common duct measures 2 mm. PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 9.5 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 11.6 cm. in length. OTHER: No ascites. Scan of the right lower quadrant fails to find the appendix.

Output: 1.Cholelithiasis without findings of acute cholecystitis.2.The appendix could not be visualized.


Instruction: Generate impression based on medical findings.

Input: 58-year-old female with bloating and noncirrhotic portal hypertension. Reason: Evaluate for ascites and portal vein thrombosis. LIVER: The liver measures 20.7 cm in length. Coarse echogenic liver parenchyma without focal lesion or ductal dilatation.Portal vein is patent. Normal hepatopetal directional flow with a pulsatile portal waveform. Peak velocity is 0.18 m/s.GALLBLADDER, BILIARY TRACT: Cholelithiasis and gallbladder sludge again noted without acute inflammation or ductal dilatation.PANCREAS: The visualized pancreas is without significant abnormalities.RIGHT KIDNEY: The right kidney measures 10.5 cm. No shadowing calculi or hydronephrosis is present.LEFT KIDNEY: The left kidney measures 10.6 cm. No shadowing calculi or hydronephrosis is present.SPLEEN: The spleen measures 6.8 cm.OTHER: No ascites.

Output: 1. Coarse echogenic liver parenchyma consistent with fatty infiltration/parenchymal dysfunction without focal lesion or ductal dilatation. No ascites.2. Patent portal vein with hepatopetal flow and a pulsatile portal waveform.3. Cholelithiasis without acute inflammation or ductal dilatation.


Instruction: Generate impression based on medical findings.

Input: 6 year-old female status post renal transplant 11 years ago with recent rising creatinine. Prevoid bladder evaluation was performed showing that the urinary bladder measures 6.0 x 4.6 x 5.3 cm with an approximate volume of 76.3 mL. Postvoid, the bladder measures 5.8 x 4.0 x 3.3 cm with an approximate volume of 40.0 mL.No significant abnormality was identified within the bladder.

Output: 1. Prevoid ultrasonographic examination reveals a volume of 76.3 mL. After voiding, the bladder measures approximately 40.0 mL.2. Please see same day grayscale and Doppler ultrasonographic evaluation of the transplant kidney for further details.


Instruction: Generate impression based on medical findings.

Input: Male 64 years old Reason: acute pancreatitis, hx of cholethiasis, please eval for signs of gallstone obstruction in biliary tree History: as above LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 15 cm in length. The parenchyma is severely echogenic . No definite hepatic lesions.Main portal vein is patent.BILIARY TRACT: The gallbladder has echogenic calculi. Wall measures 2 mm in thickness. No pericholecystic fluid. Common duct measures 4 mm. PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney is obscured.The left kidney is obscured.SPLEEN: The spleen measures 8 cm. in length. OTHER: Right pleural effusion

Output: 1.Severely echogenic hepatic parenchyma compatible with fatty infiltration.2.Cholelithiasis without definite sonographic findings of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Male 60 years old; Reason: kidney stone History: stone RIGHT KIDNEY: The right kidney measures 10.3 cm in length. The cortex is mildly thin though has normal echogenicity. No shadowing calculi or hydronephrosis is present. No worrisome mass is seen.LEFT KIDNEY: The left kidney measures 12.0 cm in length. The cortex is mildly thin though has normal echogenicity. No worrisome mass is seen. No shadowing calculi or hydronephrosis is present..URINARY BLADDER: No significant abnormality noted.OTHER: No significant abnormalities noted.

Output: 1.Mild cortical thinning of the kidneys bilaterally; no stones or hydronephrosis present.


Instruction: Generate impression based on medical findings.

Input: 45 year old female call back from screening for multiple right breast masses. Family history of maternal aunt with breast cancer. One standard view and five spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Circumscribed masses are again seen in the right upper outer quadrant (two) and in the 6 o'clock position (one), which persist on spot compression. SONOGRAPHIC

Output: Benign morphology masses in the right breast that likely represent two complex cysts and a fibroadenolipoma. Short term follow up in 6 months is recommended to document stability. BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on medical findings.

Input: Female 35 years old Reason: 35 year old female with new dx AML, radiographic evidence of pancreatitis, please eval for gallstones History: epigastric pain LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 14.9 cm in length. The parenchyma is normal in echotexture. Minimal intrahepatic biliary prominence. Portal flow is hepatopedal.BILIARY TRACT: The gallbladder has an anechoic lumen. A 0.4 x 0.4 x 0.4 cm mural lesion is visualized on a nondependent portion of the gallbladder without vascularity or twinkle artifact, likely representing polyp. Wall measures 1 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 11.7 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. The left kidney measures 12.2 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 10.3 cm. in length. There is redemonstration of an anechoic, septated splenic lesion measuring 1.6 x 1.5 cm, likely representing benign cyst.OTHER: No significant abnormalities noted.

Output: 1.Gallbladder polyp as above. Minimal intrahepatic biliary prominence.2.Bilateral echogenic kidneys are consistent with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Male 28 years old; Reason: patient with MRSA bacteremia and osteomyelitis, evaluate for renal emboli. History: above RIGHT KIDNEY: The right kidney measures 11 cm in length. The cortex is normal echogenicity. Moderate right hydronephrosis with suggestion of debris in the collecting system. The visualized portions of the right ureter are also dilated and followed to the urinary bladderLEFT KIDNEY: The left kidney is not well visualized secondary to overlying bowel. No obvious hydronephrosis.OTHER: Significant distention of the urinary bladder with a small amount of debris.

Output: 1.Moderate right hydronephrosis with debris in the collecting system, which is nonspecific but could be hemorrhagic or infectious. Significantly distended urinary bladder with a small amount of debris.


Instruction: Generate impression based on medical findings.

Input: Female 27 years old Reason: RUQ ultrasound History: RUQ pain LIVER: Liver measures 15.4 cm in length. The parenchyma is mildly coarsened, no focal liver lesion. Main portal vein patent with normal directional flow, velocity measures 20 cm/s. BILIARY TRACT: Status post cholecystectomy. No intrahepatic or extrahepatic biliary duct dilatation, CBD normal in size, measuring up to 6 mm.PANCREAS: Not well seen in entirety due to overlying bowel gas but visualized portions unremarkable. KIDNEYS: The right kidney measures 10.1 cm. The left kidney measures 10.5 cm. No hydronephrosis.SPLEEN: The spleen measures 11.2 cm. in length. OTHER: No significant abnormality noted.

Output: Status post cholecystectomy. No biliary duct dilatation.


Instruction: Generate impression based on medical findings.

Input: 65-year-old female with a history of metastatic breast cancer with recurrent ascites, evaluate for ascites. Moderate amount of ascites is identified.

Output: Limited examination demonstrating a moderate amount of ascites.


Instruction: Generate impression based on medical findings.

Input: Female 53 years old; Reason: Evaluate for obstruction/hydronephrosis History: oliguric renal failure of unknown cause Limited examination due to patient's inability to lay flat due to ventilator.RIGHT KIDNEY: The right kidney measures 11 cm in length and demonstrates normal echogenicity. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney is not visualized.URINARY BLADDER: Not visualized.OTHER: Small amount of ascites is noted.

Output: 1.Limited examination, with nonvisualization of the left kidney and urinary bladder and no hydronephrosis of the right kidney. 2.Small amount of ascites.


Instruction: Generate impression based on medical findings.

Input: 29-year-old male Reason: post kidney transplant History: post kidney transplant RENAL TRANSPLANT: LOCATION: Left pelvis.PERITRANSPLANT TISSUES: No significant abnormality noted. No perinephric collection.KIDNEY: Transplant kidney measures 12.0 cm in length. Renal cortical echogenicity is within normal limits. COLLECTING SYSTEM/URETER: No evidence of hydronephrosis. No shadowing renal calculus.URINARY BLADDER: Underdistended with Foley catheter in place.VASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels. Anastomosis is patent and has a peak velocity of 1.5 m/s with appropriate waveform. Left internal iliac artery is patent and has a peak velocity of 1.0 m/s.OTHER: No significant abnormality noted

Output: No perinephric collection or hydronephrosis of the transplant kidney. Patent transplant artery and vein.


Instruction: Generate impression based on medical findings.

Input: Female 48 years old Reason: epigastric and left upper quadrant pain History: epigastric and left upper quadrant pain LIMITED ABDOMENLIVER: Echogenic with poor penetration of the beam to the diaphragm suggestive of fatty infiltration.BILIARY TRACT: No biliary dilatation. Gallbladder appears unremarkable. . PANCREAS: Visualized portions are unremarkable.KIDNEYS: The right kidney measures 11 cm. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 11 cm. The cortex is normal echogenicity. No shadowing calculi. Mild prominence of the left upper collecting system. SPLEEN: The spleen measures 7 cm. in length. OTHER: No significant abnormalities noted.

Output: 1.Mild prominence of the left upper kidney collecting system.2.Fatty liver.


Instruction: Generate impression based on medical findings.

Input: Female 62 years old Reason: screening for HCC with h/o cirrhosis, HCV treated History: h/o cirrhosis LIMITED ABDOMENLIVER: Mildly coarsened parenchyma. Patent portal vein.BILIARY TRACT: No cholelithiasis. No pericholecystic fluid or gallbladder wall thickening. No ductal dilatation. 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. OTHER: Visualized portions of the bladder unremarkable.

Output: 1.Mildly coarsened hepatic parenchyma is nonspecific, can be secondary to diffuse hepatic parenchymal dysfunction.


Instruction: Generate impression based on medical findings.

Input: Female 38 years old Reason: RUQ U/S - Evaluate for Abdominal Pathology. LIMITED ABDOMENLIVER: The liver measures 16.0 cm in length. The liver has a smooth contour. The parenchyma is heterogeneous in echogenicity and coarsened in echotexture. No worrisome mass is identified. There is no ascites. The portal vein is patent and demonstrates hepatopetal flow with a peak velocity of 0.2 m/sec. BILIARY TRACT: Numerous shadowing stones fill the gallbladder. There is no gallbladder wall thickening or pericholecystic fluid. The common duct measures 0.4 cm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The head and body of the pancreas are unremarkable. The tail is obscured by overlying bowel gas.KIDNEYS: The right kidney measures 8.3 cm. The cortex is increased in echogenicity. No worrisome renal mass, shadowing calculi or hydronephrosis is identified. The left kidney measures 8.2 cm. The cortex is increased in echogenicity. No worrisome renal mass, shadowing calculi or hydronephrosis is identified. SPLEEN: The spleen measures 11.2 cm in length.

Output: 1.Cholelithiasis without evidence of acute cholecystitis2.Heterogeneous and coarse liver parenchyma compatible with hepatic steatosis/parenchymal dysfunction.3.Echogenic kidneys compatible with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: 61-year-old female Reason: prior thyroid surgery History: none RIGHT LOBE MEASUREMENTS: 4.9 x 1.9 x 1.3 cm.LEFT LOBE MEASUREMENTS: 4.1 x 0.9 x 0.9 cm.ISTHMUS MEASUREMENTS: 0.2 cm.RIGHT LOBE: A predominantly cystic appearing nodule in the mid pole of the right thyroid lobe measures 0.6 x 0.5 x 0.7 cm does not demonstrate any internal vascularity.LEFT LOBE: A solid appearing nodule in the midpole of the left lobe measures 0.4 x 0.4 x 0.6 cm and demonstrates increased vascularity.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Left neck level 3 lymph node measures 1.5 x 0.7 x 0.4 cm a left neck level 4 lymph node measures 0.9 x 0.9 x 0.3 cm. And a left neck level 5 lymph node measures 1.2 x 0.8 0.3 cm. These have benign-appearing features.OTHER: No significant abnormality noted.

Output: 1.Solid appearing subcentimeter left lobe nodule demonstrates increased vascularity. Attention to this is recommended on subsequent exam.2.Cystic-appearing right thyroid lobe nodule as described above.


Instruction: Generate impression based on medical findings.

Input: Female 42 years old; Reason: U/S needed to get more information in regards to large left renal cyst History: pain RIGHT KIDNEY: The right kidney measures 11.1 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.LEFT KIDNEY: The left kidney measures 17.1 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. There is a large upper pole cyst measuring 7.3 x 6.5 cm. There are septations within the cyst but no clear vascularity or calcifications.URINARY BLADDER: The bladder is normal.OTHER: No significant abnormalities noted.

Output: Large septated cyst of the superior pole of the left kidney, nodular component cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Female 77 years old; Reason: question of renal disease, possible hydonephrosis History: rising Cr, decreased urine output RIGHT KIDNEY: The right kidney measures 10 cm in length. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 12 cm in length. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. Simple appearing 5 cm left renal cyst.OTHER: Visualized portions of the bladder unremarkable.

Output: 1.No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Female 50 years old; Reason: rule out hydroureteronephrosis History: h/o renal calculi- has flank 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 10.7 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.  URINARY BLADDER: No significant abnormality notedOTHER: Hepatic parenchyma is mildly echogenic.

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


Instruction: Generate impression based on medical findings.

Input: Female 73 years old Reason: 73 yo F w/ elevated LFTs, evaluate RUQ for biliary or liver disease History: elevated LFTs LIVER: Liver measures 14.1 cm in length. The parenchyma is coarse in echotexture, no suspicious lesion, appearance may reflect underlying hepatic steatosis/parenchymal dysfunction. Main portal vein patent with normal directional flow, velocity measures 26 cm/s.BILIARY TRACT: Status post cholecystectomy. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Not visualized secondary to obscuration by bowel gas.KIDNEYS: Not well visualized, unable to make reliable measurement of longitudinal dimension, no gross hydronephrosis. The left kidney measures 10.4 cm. Small midpole cyst containing thin septation, lesion measures 1.6 x 1.2 x 1 cm.SPLEEN: The spleen measures 7.3 cm. in length. OTHER: Bilateral pleural effusions.

Output: Liver coarse in echotexture, no suspicious lesion. Appearance may reflect underlying hepatic steatosis/parenchymal dysfunction.Status post cholecystectomy.1.6 cm left renal cyst containing thin septation.Bilateral pleural effusions. Right kidney and pancreas not well visualized due to overlying bowel gas.


Instruction: Generate impression based on medical findings.

Input: Male 53 years old Reason: AKI, r/o hydronephrosis History: AKI RIGHT KIDNEY: The right kidney measures 9.3 cm. Increased renal cortical echogenicity. No shadowing calculi or hydronephrosis is present. No perinephric free fluid.LEFT KIDNEY: The left kidney measures 9.3 cm. Increased renal cortical echogenicity. No shadowing calculi or hydronephrosis is present. No perinephric free fluid.BLADDER: Visualized portions unremarkable.OTHER: No significant abnormalities noted.

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


Instruction: Generate impression based on medical findings.

Input: 46 year-old female with transaminitis and elevated bilirubin. LIMITED ABDOMENLIVER: The liver has a smooth contour and echogenic parenchyma. The liver is mildly enlarged, measuring 19.0 cm. Portal flow is hepatopedal. No suspicious masses are seen.BILIARY TRACT: The gallbladder contains layering sludge. 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 10.5 cm. No shadowing calculi or hydronephrosis is present.The left kidney measures 9.9 and cm. No shadowing calculi or hydronephrosis is present.SPLEEN: The spleen measures 8.7 cm. in length.OTHER: No significant abnormalities noted.

Output: 1.Layering sludge is visualized within the gallbladder.2.No suspicious hepatic mass or biliary ductal dilation is seen.


Instruction: Generate impression based on medical findings.

Input: Male 68 years old Reason: Month 18 for clinical trial LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 16.4 cm in length. The parenchyma is mildly coarse and echogenic. No focal hepatic lesion is identified.BILIARY TRACT: Gallbladder surgically absent. Common bile duct measures 7 mm, at the upper limits of normal. PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 11.9 cm. The cortex is thinned and echogenic. No shadowing calculi or hydronephrosis is present. The left kidney measures 12.5 cm. The cortex is thinned and echogenic. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 8.5 cm in length.OTHER: No significant abnormalities noted.

Output: 1.Post liver transplant, with the parenchyma appearing mildly coarse and echogenic, may represent nonspecific fatty infiltration/hepatic dysfunction.2.Echogenic kidneys, compatible with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female with hepatitis C and renal failure. Reason: Assess liver for cirrhosis. LIVER: The liver measures 20.6 cm in length. Coarse echogenic liver echotexture. There is a hyperechoic lesion in the left lobe measuring 0.9 x 1.1 x 1.1 cm, most compatible with a hemangioma. Portal vein is patent.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted. Negative sonographic Murphy's sign. PANCREAS: The visualized portion of the pancreas is without significant abnormalities.RIGHT KIDNEY: The right kidney measures 9.6 cm. Severely echogenic parenchyma without mass, stone, or hydronephrosis.LEFT KIDNEY: The left kidney measures 8.7 cm. Severely echogenic parenchyma without mass, stone, or hydronephrosis.SPLEEN: The spleen measures 12 cm.OTHER: Note is made of ascites.

Output: 1. Coarse echogenic liver echotexture consistent with fatty infiltration/parenchymal dysfunction without worrisome mass or ductal dilatation.2. Severely echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction.3. Mild ascites.


Instruction: Generate impression based on medical findings.

Input: Female 74 years old; Reason: chronic kidney disease - rule out obstruction History: elevated creatinine RIGHT KIDNEY: The right kidney measures 10.0 cm in length. Corticomedullary differentiation is maintained. No shadowing calculi or hydronephrosis is present.LEFT KIDNEY: The left kidney measures 10.2 cm in length. Cortical medullary differentiation is maintained No shadowing calculi or hydronephrosis is present.URINARY BLADDER: The visualized portions of the bladder are unremarkable.OTHER: No significant abnormalities noted.

Output: No sonographic evidence of renal dysfunction, renal calculi, or hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Male 64 years old; Reason: s/p kidney txp last night History: above Left iliac fossa allograft is obscured by bowel gas

Output: 1.Unable to evaluate the left iliac fossa allograft due to bowel gas


Instruction: Generate impression based on medical findings.

Input: 66-year-old female with a history of hypothyroidism status post thyroidectomy. RIGHT LOBE: Status post thyroidectomy. No echogenic foci are identified.LEFT LOBE: Status post thyroidectomy. No echogenic foci are identified.ISTHMUS: Status post thyroidectomy. No echogenic foci are identified.LYMPH NODES: Multiple left cervical lymph nodes. Left lateral level one lymph node measures 0.9 x 0.4 x 1.5 cm with a fatty hilum and ovoid shape is likely benign. Left level two lymph node measures 0.9 x 1.0 x 1.3 cm and has a rounded contour with heterogeneity. There is loss of the fatty hilum and the lymph node demonstrates vascularity. Left level three lymph node measures 1.9 x 1.4 x 2.3 cm and appears as two conjoined lymph nodes with a heterogeneous appearance. The lymph node demonstrates vascularity. Left level four lymph node measures 0.9 x 0.7 x 1.3 cm with a rounded shape.OTHER: No significant abnormality noted.

Output: Suspicious appearing left cervical lymph nodes consistent with patient's known history of recurrent disease.


Instruction: Generate impression based on medical findings.

Input: Male 68 years old; Reason: AKI, please evaluate for medical renal disease. RIGHT KIDNEY: The right kidney measures 13.2 cm in length and demonstrates mild increase in echogenicity. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 12.6 cm in length and demonstrates mild increase in echogenicity. No shadowing calculi or hydronephrosis is present. URINARY BLADDER: Bladder not well visualized.OTHER: No significant abnormalities noted.

Output: Mild increase in echogenicity of bilateral kidneys, suggestive of medical renal disease, with no evidence of hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Female 56 years old Reason: Pt is a 56 yo female; potential allo sct donor for possible splenomegaly History: evaluate LIVER: Liver measures 15.4 cm in length. The parenchyma is normal in echogenicity and texture. No focal hepatic lesions are identified.Main portal vein is patent with hepatopedal flow.BILIARY TRACT: Gallbladder unremarkable. No significant gallbladder distention, wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Pancreas is not well visualized due to overlying bowel gas.KIDNEYS: The right kidney measures 9.2 cm. There is mild prominence of the collecting system. No shadowing renal calculus is identified.The left kidney measures 10.4 cm. There is mild prominence of the collecting system, greater than the right. No shadowing renal calculus is identified.SPLEEN: The spleen measures 8.3 cm. in length. Note is made of an accessory splenule.OTHER: No significant abnormality noted.

Output: Mild prominence of the bilateral renal collecting systems, left greater than right. No shadowing renal calculus is identified.


Instruction: Generate impression based on medical findings.

Input: Male 82 years old Reason: eval for obstruction History: elevated alk phos and ggt LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 14 cm in length. The parenchyma is moderately echogenic . No suspicious hepatic lesions.BILIARY TRACT: The gallbladder contains layering sludge. Wall measures 3 mm in thickness. Gallbladder is mildly distended Common duct measures 4 mm. PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 11.5 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. The left kidney measures 11.1 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. Focal hyperechoic lesion in the left kidney measures 1 cm.SPLEEN: The spleen measures 11 cm. in length. OTHER: No significant abnormalities noted.

Output: 1.Distended gallbladder with sludge.2.1 cm left renal lesion is nonspecific with differential considerations include a small AML or small renal cell carcinoma. This can be followed on subsequent CT.


Instruction: Generate impression based on medical findings.

Input: Status post thyroidectomy for thyroid malignancy, evaluate for recurrence RIGHT LOBE: Status post thyroidectomy.LEFT LOBE: Status post thyroidectomy.ISTHMUS: Status post thyroidectomy.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable exam, no evidence of local tumor recurrence or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female 76 years old; Reason: rule out progression in thyroid nodules RIGHT LOBE MEASUREMENTS: 4.6 x 1.4 x 1.9 cmLEFT LOBE MEASUREMENTS: 4.5 x 1.7 x 2.3 cmISTHMUS MEASUREMENT: 0.5 cmRIGHT LOBE: Multiple cystic and spongiform nodules are seen throughout.-Inferior anechoic lesion with a part solid component measures 1.5 x 1.2 x 1.5 cm and appears similar to prior exam. No associated microcalcifications or increased vascularity.-Spongiform lesion in the mid portion of the gland measures 1.3 x 0.7 x 1.4 cm and appears similar to prior exam. No associated microcalcifications or increased vascularity.LEFT LOBE: Multiple cystic and spongiform nodules are seen throughout.-Spongiform and mildly vascular lesion in the midportion of the gland measures 1.7 x 0.8 x 1.0 cm and appears similar to prior exam. No associated microcalcifications.-Inferior anechoic lesion measures 0.9 x 0.6 x 0.9 cm and appears similar to prior exam. No associated microcalcifications or increased vascularity.ISTHMUS: New part solid and cystic lesion in the left isthmus measures 0.8 x 0.5 x 0.7 cm and demonstrates some vascularity. No associated microcalcifications.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multinodular thyroid as described above. New thyroid nodule within the left isthmus, otherwise, stable combination of cystic and solid nodules.


Instruction: Generate impression based on medical findings.

Input: Female 30 years old Reason: ? Change in nodule History: Thyroid cancer RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: 0.4 x 0.3 x 0.3 cm hypoechoic lesion in the mid right thyroid bed is not significantly changed from the prior exam. 0.4 x 0.2 x 0.2 cm hypoechoic lesion in the right inferior thyroid bed not definitely seen on the prior examination.LEFT LOBE: Status post thyroidectomy.ISTHMUS: Status post thyroidectomy.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant cervical lymphadenopathy evident.OTHER: No significant abnormality noted.

Output: Status post thyroidectomy. Unchanged hypoechoic lesion in the mid right thyroid bed. Additional subcentimeter hypoechoic lesion inferior right thyroid bed that was not definitely seen on the prior examination. Special attention at follow-up is recommended.


Instruction: Generate impression based on medical findings.

Input: Male 87 years old; Reason: recurrent hydronephrosis History: recurrent AKI, hydronephrosis RIGHT KIDNEY: The right kidney measures 10 cm in length. The cortex is normal echogenicity. No shadowing calculi. Redemonstrated mild hydronephrosis of the lower pole. A partially visualized stent is noted within the collecting system.LEFT KIDNEY: The left kidney measures 13 cm in length. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. Bladder is decompressed limiting evaluation.OTHER: Enlarged heterogenous prostate.

Output: 1.No significant change in mild right hydronephrosis as above.


Instruction: Generate impression based on medical findings.

Input: Thyromegaly RIGHT LOBE: Enlarged markedly heterogeneous gland. Right lobe measures 5.9 x 2.6 x 2.6 cm. No discrete nodule.LEFT LOBE: Enlarged markedly heterogeneous gland. Left lobe measures 4.8 x 2.2 x 1.8 cm. No discrete nodule.ISTHMUS: Enlarged, measuring 12 mm. No discrete nodule.LYMPH NODES: Bilateral lymph nodes with fatty hila, likely reactive in etiology. On right side, representative lymph node measures 1.6 x 0.9 x 0.4 cm. On left side, representative lymph node measures 2.7 x 1 x 0.4 cm. OTHER: No significant abnormality noted.

Output: Enlarged markedly heterogeneous thyroid gland, no discrete nodule. Appearance may reflect underlying thyroiditis/diffuse parenchymal disease such as Hashimoto's thyroiditis or subacute thyroiditis and correlation with patient's clinical history and laboratory values recommended.


Instruction: Generate impression based on medical findings.

Input: Male 52 years old Reason: r/o nephro, r/o pyelo History: back pain, hesitancy RIGHT KIDNEY: The right kidney measures 13.3 cm in length and demonstrates slightly increased parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.LEFT KIDNEY: The left kidney measures 12.3 cm in length and demonstrates slightly increased parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.BLADDER: The bladder is nondistended.OTHER: No significant abnormalities noted.

Output: Slightly increased bilateral renal parenchymal echogenicity suggestive of medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Female 88 years old Reason: Bedside US in ED showed signs of Cholecystitis History: 1039 LIMITED ABDOMENLIVER: Numerous anechoic cystic lesions throughout the liver with no obvious complexity, suggestive of hepatic cysts. The largest measures approximately 8 cm in the posterior right hepatic lobe. Patent portal vein. Increased echogenicity of the liver.BILIARY TRACT: Diffuse gallbladder wall thickening measuring up to 6 mm with trace pericholecystic fluid.PANCREAS: Visualized portions are unremarkable.KIDNEYS: The right kidney measures 9 cm. The cortex is echogenic.. No shadowing calculi or hydronephrosis is present. The left kidney measures 12 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. Mid right anechoic cystic lesion, likely cyst.SPLEEN: The spleen is not well visualized.OTHER: Ascites.

Output: 1.Diffuse gallbladder wall thickening with trace pericholecystic fluid. These findings could be related to known ascites. However, if clinical suspicion for acalculus cholecystitis, consider HIDA scan.2.Echogenic liver can be seen in nonspecific diffuse hepatic dysfunction/fatty infiltration.3.Bilateral nonspecific medical renal disease.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female with elevated LFTs, evaluate for fatty liver. LIVER: Increase in hepatic parenchymal echogenicity with coarsened echotexture. No focal hepatic mass. Anechoic focus in the left lobe of the liver measuring 0.7 x 1.1 x 0.9 cm compatible with a hepatic cyst. Hepatic length measures 13.3 cm. The main portal vein is patent with normal hepatopetal flow with a velocity of 16.8 cm/s. GALLBLADDER/BILIARY TRACT: Multiple shadowing calculi and sludge is present within the gallbladder, with the wall measuring 3 mm. Sonographic Murphy's sign was negative. 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 6 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 9.3 cm and demonstrates increased echogenicity with no hydronephrosis. The left kidney measures 8.6 cm and demonstrates increased echogenicity with no hydronephrosis. OTHER: No ascites.

Output: 1.Increase in hepatic parenchymal echogenicity with coarsened echotexture consistent with fatty liver/nonspecific hepatic parenchymal dysfunction. No hepatic mass or ductal dilatation identified.2.Increased cortical echogenicity of bilateral kidneys, compatible with medical renal disease, without evidence of hydronephrosis or shadowing calculi.3.Cholelithiasis without evidence of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Female 46 years old Reason: please evaluate for malignancy, progression of cirrhosis, portal HTN History: 46 yo F with hep C cirrhosis LIMITED ABDOMENLIVER: Liver does not have an overt cirrhotic morphology. Liver measures 15 cm in length. The parenchyma is mildly echogenic . No focal hepatic lesions. Main portal vein is patent with normal directional flow.BILIARY TRACT: Status post cholecystectomy. Common duct measures 2 mm. PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 10.8 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 11.9 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 10.0 cm. in length. OTHER: No ascites.

Output: 1.Echogenic hepatic parenchyma without focal hepatic lesion.


Instruction: Generate impression based on medical findings.

Input: 83-year-old female with history of end-stage renal disease, HBV. LIVER: Cirrhotic morphology of the liver. No focal hepatic lesion or mass. Again seen is a punctate hyperechoic focus with posterior shadowing, which likely represents the calcified nodule identified on recent CT scan. The liver measures 14.0 cm in length. The main portal vein is patent with normal hepatopedal flow and velocity of 39 cm/s.GALLBLADDER, BILIARY TRACT: The gallbladder is normal in appearance. There is no pericholecystic fluid. No cholelithiasis. The gallbladder wall is normal in appearance, measuring 0.2 cm in thickness. No dilatation or cystic changes are noted of the intrahepatic or extrahepatic biliary ducts. The common bile duct measures 0.3 cm in diameter. No choledocholithiasis.PANCREAS: The head and proximal body of the pancreas are normal. The tail is obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 7.2 cm in length and shows normal echotexture. No mass, stone or hydronephrosis.LEFT KIDNEY: The left kidney measures 7.3 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: Small volume ascites.

Output: 1.Cirrhotic morphology of the liver without worrisome mass lesion. No ductal dilatation. Small ascites. Punctate hyperechoic focus likely represents calcified nodule described on recent CT scan. 2.Atrophic appearance of the kidneys, compatible with the patient's stated history of end-stage renal disease.


Instruction: Generate impression based on medical findings.

Input: Female 33 years old Reason: eval for cholelithiasis and cholecystitis History: ruq pain LIVER: Hepatomegaly with liver measuring approximately 20 cm in length. The parenchyma is increased in echogenicity. No discrete liver lesion seen. Main portal vein patent with normal directional flow, velocity measures 25 cm/s. BILIARY TRACT: Numerous gallstones. No secondary signs of acute cholecystitis. No significant gallbladder distention, wall thickening or pericholecystic fluid. Per ultrasound technologist negative sonographic Murphy's sign. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Not well visualized in entirety due to adjacent bowel gas but visualized portions unremarkable. KIDNEYS: The right kidney measures 11.3 cm. The left kidney measures 11.5 cm. No hydronephrosis or perinephric free fluid.SPLEEN: The spleen measures 9.2 cm. in length. OTHER: No significant abnormality noted.

Output: Cholelithiasis. No secondary signs of acute cholecystitis.No biliary duct dilatation.


Instruction: Generate impression based on medical findings.

Input: 56-year-old male presents with elevated liver enzymes and low albumin, evaluate for cirrhosis. LIVER: Mild increase in hepatic parenchymal echogenicity with coarsened 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 19 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 2 mm. The common bile duct measures 6 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified. Echogenic intraluminal mobile material compatible with gallbladder sludge. No evidence of cholecystitis.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 12 cm and has normal vascular flow. The left kidney measures 11 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. Gallbladder sludge without evidence of cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Male 47 years old; Reason: AKI, r/o obstruction History: AKI RIGHT KIDNEY: The right kidney measures 11.4 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 11.9 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.  URINARY BLADDER: No significant abnormality notedOTHER: No significant abnormalities noted.

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


Instruction: Generate impression based on medical findings.

Input: Reason: Assess clot burden in the bladder History: Gross hematuria RIGHT KIDNEY: Right kidney measures 10.9 cm and is slightly increased in echogenicity without hydronephrosis. No evidence of renal calculi. There is simple cyst in the right upper pole measuring 1.6 x 1.4 x 1.7 cm.LEFT KIDNEY: Left kidney is surgically removed per patient.URINARY BLADDER: Urinary bladder catheter is in place. Evaluation of the bladder is limited due to inadequate distention.OTHER: No significant abnormalities noted.

Output: Slightly increased echotexture of the right kidney compatible with medical renal disease. Left kidney is surgically removed. Collapsed urinary bladder with catheter.


Instruction: Generate impression based on medical findings.

Input: Female 62 years old with known colloid nodules on both thyroid lobes, the largest on the right is 4 cm RIGHT LOBE MEASUREMENTS: 4.1 x 3.8 x 5.8 cmLEFT LOBE MEASUREMENTS: 2.9 x 2.7 x 6.0 cmISTHMUS MEASUREMENT: 0.3 cmRIGHT LOBE: Heterogeneous parenchymal echotexture. Large echogenic and predominantly solid nodule replacing most of the right thyroid gland measuring 3.7 x 3.7 x 4.3 cm, slightly increased from prior 3.4 x 2.8 x 3.7 cm. The nodule demonstrates internal vascularity. No microcalcifications are present.LEFT LOBE: Heterogeneous parenchymal echotexture. Mid-pole echogenic and heterogeneous nodule measuring 1.6 x 1.6 x 1.8 cm, not significantly changed from prior exam. The nodule contains punctate non-shadowing echogenic foci, which may represent microcalcifications. No increased vascularity is present. Heterogeneous lower pole nodule with microcalcifications measuring 2.4 x 2.2 x 3.2 cm, not significantly changed from prior exam. The nodule demonstrates internal vascularity.ISTHMUS: Heterogeneous parenchymal echotexture. No increased vascularity.LYMPH NODES: No regional lymphadenopathy.OTHER: No significant abnormality noted.

Output: Multinodular goiter with dominant right thyroid nodule slightly increased in size from prior exam. No regional lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Female 45 years old Reason: eval for cholecystitis History: fever, n/v/d, abd pain LIMITED ABDOMENEvaluation is technically limited due to patient body habitus.LIVER: The liver has a smooth contour. Liver measures 21.8 cm in length. The parenchyma is mildly coarse with increased echogenicity. No focal hepatic lesion is identified.BILIARY TRACT: The gallbladder has echogenic calculi with posterior acoustic shadowing. Wall measures 3 mm in thickness. The common bile duct measures 4 mm. PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 12.1 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. A right upper pole cyst measures 2.9 x 2.0 x 2.1 cm. No suspicious lesion identified.The left kidney measures 10.7 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. No suspicious lesion identified.SPLEEN: Unable to evaluate the spleen due to poor penetration/bowel gas.OTHER: No significant abnormalities noted.

Output: Evaluation technically limited due to patient body habitus.1.Cholelithiasis, without evidence of cholecystitis.2.Mildly coarse and echogenic liver, probably fatty infiltration/parenchymal dysfunction.3.Simple right renal cyst. No other abnormality identified.


Instruction: Generate impression based on medical findings.

Input: Female 60 years old Reason: thyroid enlargement History: hypothyroidism RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 3.4 cm in transverse, 2.7 cm in AP, and 6.2 cm in length. LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 2.3 cm in transverse, 2.5 cm in AP, and a 5.5 cm in length.ISTHMUS MEASUREMENTS: The isthmus measures 0.2 cm in thickness.RIGHT LOBE: The enlarged right thyroid lobe demonstrates a diffuse heterogenous micronodular appearance. There is hypervascularity with color Doppler application. No discrete measurable nodules are identified.LEFT LOBE: The enlarged left thyroid lobe demonstrates a diffuse heterogenous micronodular appearance. There is hypervascularity with color Doppler application. No discrete measurable nodules are identified.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Small bilateral normal-appearing lymph nodes.OTHER: No significant abnormality noted.

Output: Enlarged thyroid gland with sonographic appearance of chronic thyroiditis. No worrisome discrete masses. No regional adenopathy.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male with a history of bladder cancer presenting with right groin pain. RIGHT TESTIS: No significant abnormalities noted. No intratesticular mass is visualized. The right testicle measures 5.4 x 2.1 x 3.0 cm.LEFT TESTIS: No significant abnormalities noted. No intratesticular mass is visualized. The left testicle measures 5.2 x 2.2 x 2.7 cm.RIGHT EPIDIDYMIS: No significant abnormalities noted. The right epididymis measures 4.5 0.8 x 0.8 cm.LEFT EPIDIDYMIS: No significant abnormalities noted. The left epididymis measures 4.6 x 1.0 x 1.0 cm.OTHER: Small, benign hydrocele. The imaged areas of the right groin do not demonstrate significant abnormality, including hernia.DOPPLER

Output: 1. Small, benign hydrocele. No other significant abnormalities are visualized.


Instruction: Generate impression based on medical findings.

Input: History of recent diagnosis of breast cancer postpartum, palpable lesion in the isthmus. RIGHT LOBE MEASUREMENTS: 5.0 x 1.2 x 1.6 cmLEFT LOBE MEASUREMENTS: 4.8 x 1.3 x 1.5ISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Subcentimeter hypoechoic nodule measuring 0.6 x 0.6 x 0.3 cm in the inferior pole. Otherwise the lobe appears normal.LEFT LOBE: Normal appearing thyroid lobe.ISTHMUS: Solid heterogeneous lesion measuring 1.2 x 1.0 x 1.8 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.8 cm solid heterogeneous lesion of the isthmus, which is amenable to ultrasound-guided biopsy.


Instruction: Generate impression based on medical findings.

Input: Male 81 years old; Reason: obstruction? hematuria History: decreased urine output RIGHT KIDNEY: The right kidney measures 12 cm in length. The cortex is normal echogenicity. Mild fullness of the collecting system without definitive hydronephrosis or shadowing calculi.LEFT KIDNEY: Mildly limited evaluation of the left kidney shows that it measures 9 cm in length. The cortex is normal in echogenicity. Mild fullness of the collecting system without definitive hydronephrosis or shadowing calculi.OTHER: Foley catheter within the urinary bladder. Otherwise, the bladder is unremarkable except for mild distention.

Output: 1.Mild fullness of the collecting system without definite hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Male 19 years old Reason: nausea and vomiting History: as above LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 15 cm in length. The parenchyma is normal in echotexture . No suspicious hepatic lesions. Main portal vein is patent.BILIARY TRACT: The gallbladder contains layering sludge. Wall measures 2 mm in thickness. Common duct measures 2 mm. PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 10 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 10 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 8.5 cm. in length. OTHER: No ascites.

Output: 1.Gallbladder sludge


Instruction: Generate impression based on medical findings.

Input: Male 62 years old Reason: Evaluate for hydronephrosis History: Pt in acute renal failure secondary to urinary obstruction. Foley has been placed. pt being admitted to hospital RIGHT KIDNEY: The right kidney measures 11.7 cm. No shadowing calculi. Mild hydronephrosis present. No perinephric free fluid. Increased renal cortical echogenicity.LEFT KIDNEY: The left kidney measures 11.7 cm. No shadowing calculi. Mild hydronephrosis present. No perinephric free fluid. Increased renal cortical echogenicity.BLADDER: Not well assessed secondary to collapsed state of bladder containing Foley catheter.OTHER: No significant abnormalities noted.

Output: Mild bilateral hydronephrosis. Kidneys echogenic, compatible with underlying medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Female 44 years old; Reason: Acute kidney injury. The exam is extremely limited due to patient body habitus.RIGHT KIDNEY: The right kidney measures 11.9 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. No masses.LEFT KIDNEY: The left kidney measures 12.9 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. No masses.URINARY BLADDER: The bladder is not visualized.OTHER: No significant abnormalities noted.

Output: No evidence of hydronephrosis or shadowing calculi within the technical limitations of the exam.


Instruction: Generate impression based on medical findings.

Input: Male 23 years old Reason: Evidence of hepatic disease History: Hx of ETOH, drug use, transaminitis LIVER: Liver prominent, measuring 18.4 cm in length. Main portal vein patent with normal directional flow, velocity measures 36 cm/sec.BILIARY TRACT: Sludge-containing gallbladder. No evidence of acute cholecystitis. No significant gallbladder distention, wall thickening or pericholecystic fluid. Mildly prominent CBD, measuring up to 7 mm, unable to follow duct distally secondary to overlying bowel gas. No intrahepatic biliary duct dilatation.PANCREAS: Not well visualized secondary to overlying bowel gas. KIDNEYS: The right kidney measures 11.5 cm. The left kidney is not as well seen, measures approximately 11.9 cm. SPLEEN: The spleen measures 12.4 cm. in length. OTHER: No significant abnormality noted.

Output: Mild hepatomegaly.Sludge-containing gallbladder, no evidence of acute cholecystitis.Mild extrahepatic biliary duct prominence, measuring up to 7 mm. No intrahepatic biliary duct dilatation.


Instruction: Generate impression based on medical findings.

Input: Female 81 years old Reason: ELevated LFTs, predominant transaminitis, AST>.ALT History: diarrhea, chronic LIVER: The liver measures 11.8 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: Fluid and echogenic material in the right upper quadrant may represent collapsed gallbladder or adjacent bowel, as the gallbladder is not definitely identified. The common duct measures 0.3 cm in diameter. PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 10.6 cm in length and demonstrates increased parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.LEFT KIDNEY: The left kidney measures 9.5 cm in length and demonstrates increased parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.SPLEEN: The spleen measures 6.0 cm in length.OTHER: Moderate volume ascites. Multiple loops of dilated bowel are evident suggestive of obstruction or ileus.

Output: 1.Increased hepatic parenchymal echogenicity may reflect hepatic steatosis/chronic liver disease.2.Moderate volume ascites.3.Multiple markedly dilated loops of bowel suggestive of obstruction or ileus.4.Increased renal parenchymal echogenicity consistent with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Status post thyroidectomy for thyroid cancer in 2006 RIGHT LOBE: Status post thyroidectomy. Heterogeneous soft tissue focus measuring 1 x 0.7 x 0.7 cm, previously measured 1 x 0.6 x 0.5 cm (likely unchanged accounting for differences in technique), central increased echogenicity seen and lesion may be a lymph node.LEFT LOBE: Status post thyroidectomy.ISTHMUS: Status post thyroidectomy. Near junction of right lobe/isthmus bed is a stable ovoid soft tissue focus measuring 0.5 x 0.4 x 0.3 cm, previously measured 0.5 x 0.5 x 0.3 cm.LYMPH NODES: No suspicious lymphadenopathy. Fatty hila containing prominent lymph nodes, likely reactive in etiology.OTHER: Incidentally seen mild to moderate atherosclerotic carotid plaque.

Output: Stable study with right-sided soft tissue foci in postoperative bed as above.


Instruction: Generate impression based on medical findings.

Input: Hyperbilirubinemia, hx of sludging s/p sphincterotomy; AML arising from the MDS admitted for stem cell transplant, date 6 LIVER: Liver measures 15.6 cm with mildly coarse echotexture. Portal vein is patent with normal direction and velocity of 0.3 m/s. Hyperechoic left lobe lesion measuring 1.1 x 0.7 x 1.1 cm. BILIARY TRACT: Common bile duct measures 5 mm. Gallbladder wall measures 4 mm. Small amount of gallbladder sludge is noted without distention. No pericholecystic fluid collection. Small amount of gas in the gallbladder, compatible with history of sphincterotomy.PANCREAS: Distal pancreas is obscured by overlying bowel gas. Visualized part is within normal limits.SPLEEN: Spleen measures 12.8 cm and is normal in echogenicity and configuration.KIDNEYS: Right kidney measures 12.1 cm with normal echogenicity and without hydronephrosis. Left kidney measures 12.3 cm with normal echogenicity and without hydronephrosis. No renal calculi identified. OTHER: No significant abnormalities noted.

Output: 1.Mildly coarse echotexture of the liver. 2.Hyperechoic left liver lobe lesion, which may be a hemangioma but indeterminate and can be fully evaluated with contrast enhanced cross-sectional imaging. 3.Gallbladder with small amount of sludge and gas compatible with history of sphincterotomy. No sonographic evidence of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Female 20 years old; Reason: r/o growth of node, other suspicious lesions. If growth, is it amenable to FNA? History: h/o thyroid cancer. New small left node (too small to biopsy). 4 month follow up study RIGHT LOBE MEASUREMENTS: Status post thyroidectomy LEFT LOBE MEASUREMENTS: Status post thyroidectomy ISTHMUS MEASUREMENT: Status post thyroidectomy RIGHT LOBE: No suspicious lesions in the right thyroid bed.LEFT LOBE: No suspicious lesions in the left thyroid bed.ISTHMUS: Status post thyroidectomyLYMPH NODES: Left level 3 lymph node measures 0.7 x 0.5 x 0.3 cm previously, to 0.7 x 0.6 x 0.4 cm.The left level 4 lymph node measures 0.6 x 0.4 x 1.1 cmRight perivascular level 3 lymph node measures 7.6 x 0.1 x 2.1 cmOTHER: No significant abnormality noted.

Output: 1.Near stable size measurements of the left level 3 lymph node.2.Indeterminate left level 4 lymph node.


Instruction: Generate impression based on medical findings.

Input: Female 69 years old; Reason: 69F with large mediastinal mass, eval for goiter History: SOB, tracheal compression, elevated TSH, Hx of "thyroid problems" RIGHT LOBE MEASUREMENTS: 10.7 x 9.6 x 7.6 cmLEFT LOBE MEASUREMENTS: 3.3 x 1.4 x 1.1 cmISTHMUS MEASUREMENT: 0.3 cmRIGHT LOBE: Enlarged and diffusely heterogeneous. No discrete measurable nodule.LEFT LOBE: Mildly enlarged with central subcentimeter focus of calcification. No discrete measurable nodule.ISTHMUS: No significant abnormality noted.LYMPH NODES: Mildly enlarged level 4 lymph nodes.OTHER: No significant abnormality noted.

Output: 1.Large multinodular goiter.


Instruction: Generate impression based on medical findings.

Input: Abdominal tenderness, evaluate for umbilical/abdominal fluid collection or abscess, status post C-section In umbilical region complex fluid collection measuring 2.9 x 1.4 x 1.3 cm seen containing internal debris and septations. Mildly increased vascularity seen in surrounding soft tissues.

Output: Periumbilical complex fluid collection (per ultrasound technologist collection located superior to incision line and staples) with mildly increased surrounding vascularity, findings may reflect postoperative abscess in the appropriate clinical setting. Postsurgical hematoma or seroma also among differential constrictions. Correlation with patient's clinical history/physical exam and laboratory values recommended.


Instruction: Generate impression based on medical findings.

Input: Female 54 years old; Reason: ruq tender to palpation, transaminitis. LIVER: Increase in hepatic parenchymal echogenicity with coarsened 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 20 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 4 mm. The common bile duct is dilated and measures up to 13 mm in diameter, with multiple foci within the distal common bile duct worrisome for stones. Mild intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Pancreas is obscured by overlying bowel gas and is not well-visualized..SPLEEN: The spleen measures 7.2 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 9.7 cm with no hydronephrosis. The left kidney measures 10.1 cm with no hydronephrosis. OTHER: No ascites.

Output: 1.Dilatation of the common bile duct with multiple echogenic foci in the common bile duct worrisome for choledocholithiasis. There is mild associated intrahepatic and extrahepatic biliary ductal dilatation. The distal common bile duct and pancreatic head are obscured by overlying bowel gas, and an obstructing mass at the pancreatic head/distal bile duct cannot be ruled out and MRCP is recommended for further evaluation.2.Increase in hepatic parenchymal echogenicity with coarsened echotexture consistent with fatty liver/hepatic parenchymal dysfunction. No hepatic mass identified.These findings were discussed with Dr. Elyssa Berg at 1:35 PM on 6/29/2016.


Instruction: Generate impression based on medical findings.

Input: Male 58 years old Reason: R/O HCC History: HCV, cirrhosis LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 13.3 cm in length. The parenchyma is mildly echogenic no suspicious hepatic lesions. Main portal vein is patent.BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 3 mm in thickness. Common duct measures 2 mm. PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 12.3 cm. The cortex is mild echogenic.. No shadowing calculi or hydronephrosis is present. The left kidney is atrophic with a cyst.SPLEEN: The spleen measures 10.6 cm. in length. OTHER: No significant abnormalities noted.

Output: 1.Atrophic left kidney.2.No suspicious hepatic lesions.


Instruction: Generate impression based on medical findings.

Input: 56-year-old male with a history of hepatitis B, evaluate for HCC. LIMITED ABDOMENLIVER: The liver has a nodular contour and is mildly coarsened and echogenic, consistent with chronic liver disease. Liver measures 16.2 cm in length. Portal venous flow is hepatopedal. No intrahepatic biliary ductal dilation is seen.Two echogenic foci within the left liver are redemonstrated. The first measures 7 x 8 x 8 mm, previously 9 x 6 x 9 mm. The second, more superior lesion measures about 4 mm, previously about 5 mm. These appear largely unchanged from prior examination. The previously described right hyperechoic liver lesion on 12/23/2014 is again not demonstrated on this examination.BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 2 mm in thickness. Common duct measures 6 mm.PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 10.9 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 11.6 cm. in length. No significant abnormality.OTHER: Scattered, prominent regional lymph nodes likely normal in the setting of chronic liver disease. No ascites is seen.

Output: 1.Redemonstration of 2 hyperechoic left liver lesions, unchanged from prior. The previously described right liver lesion is again not demonstrated on this study.2.Coarsened and echogenic liver consistent with chronic liver disease.3.Redemonstration of scattered prominent regional lymph nodes, unchanged from prior.


Instruction: Generate impression based on medical findings.

Input: Female 42 years old; Reason: Evaluate for abscess in right lower extremity History: Right lower extremity cellulitis, rising wbc count No focal mass is evident. No discrete fluid collections. Mild skin thickening.

Output: 1.Nonspecific skin thickening without a discrete fluid collection.2.Suboptimal exam due to poor acoustic penetration


Instruction: Generate impression based on medical findings.

Input: Female 73 years old Reason: screen for HCC History: possible advanced liver disease LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 2.7 cm in length. The parenchyma is mildly coarse and echogenic. There is a 0.6 x 0.5 x 0.5 cm hyperechoic right hepatic lesion, may represent hemangioma versus focal fat.BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 2 mm in thickness. Common duct measures 2 mm.PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 9.9 cm cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.The left kidney measures 9.9 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.SPLEEN: The spleen measures 8.9 cm in length. The spleen is unremarkable.OTHER: No significant abnormalities noted.

Output: Mildly coarse and echogenic liver, probable fatty infiltration/parenchymal dysfunction. No suspicious hepatic lesion.


Instruction: Generate impression based on medical findings.

Input: Male 34 years old; Reason: r/o flank pain, stones History: r/o flank pain, stones RIGHT KIDNEY: The right kidney measures 11.5 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 13.2 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.  URINARY BLADDER: No significant abnormality notedOTHER: Hepatic parenchyma is echogenic suggesting fatty infiltration.

Output: 1.No sonographic findings of nephrolithiasis or hydronephrosis.2.Echogenic hepatic parenchyma.


Instruction: Generate impression based on medical findings.

Input: Female 62 years old s/p LVAD, evaluate for LVAD driveline site fluid collection Mildly heterogeneous and hypoechoic collection surrounding the LVAD driveline. The collection extends along the anterior abdominal wall subcutaneous tissues from the skin to peritoneal insertion sites. The collection demonstrates mildly increased doppler flow in the surrounding tissues.

Output: Small fluid collection surrounding the LVAD driveline along the abdominal wall subcutaneous tissues. Increased surrounding soft tissue vascularity raises the possibility of acute inflammatory process.


Instruction: Generate impression based on medical findings.

Input: Male 67 years old with angiopathy with AST and alk phos elevation LIVER: Coarsened hepatic echotexture. Multiple septated left hepatic cysts measuring up to 1.4 x 1.4 x 1.0 cm. Hepatic length measures 21.1 cm. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of 35 cm/s. GALLBLADDER/BILIARY TRACT: Dependent cholelithiasis. No significant pericholecystic fluid. The gallbladder wall measures 3 mm. The common bile duct measures 5 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 20.4 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 13.5 cm and has normal vascular flow. The left kidney measures 13.4 cm and has normal vascular flow. OTHER: Bilateral pleural effusions noted.

Output: 1. Cholelithiasis without evidence cholecystitis.2. Coarsened echotexture consistent with fatty liver/hepatic parenchymal dysfunction. Multiple septated hepatic cysts. No ductal dilatation identified.


Instruction: Generate impression based on medical findings.

Input: Reason: eval GB, liver, pancreas History: vomiting, diarrhea LIVER: The size of the liver is within normal limits, measuring 13.9 cm in length. There is increased echogenicity surrounding the portal triads, consistent with periportal edema. No focal lesions. No intrahepatic ductal dilation.BILIARY TRACT: The gallbladder wall is markedly thickened, measuring 0.7 cm. There is a small amount of pericholecystic fluid. No evidence of cholelithiasis nor sludge within the gallbladder. The gallbladder itself is not distended. The common bile duct is not dilated, measuring 0.3 cm.PANCREAS: The visualized portions of the pancreas reveal no significant abnormality.SPLEEN: The size of the spleen is within normal limits, measuring 8.3 cm. There are 2 round, well-circumscribed, exophytic isoechoic lesions noted near the medial portion of the superior aspect of the spleen consistent with benign splenules. The largest measures 1.2 x 1.1 x 1.2 cm.KIDNEYS: The size of the right kidney is within normal limits, measuring 10.4 cm. Normal echogenicity. No focal lesions. No hydronephrosis.The size of the left kidney is within normal limits, measuring 10.1 cm. Normal echogenicity. No focal lesions. No hydronephrosis. OTHER: The main portal vein is patent with hepatopetal flow. The velocity is within normal limits, measuring 0.2 m/s.No ascites.

Output: 1. Nonspecific gallbladder wall edema with surrounding pericholecystic fluid. Wide differential includes but is not limited to heart failure, hypoalbuminemia, infection, portal hypertension, lymphatic obstruction. There is no evidence of cholelithiasis.2. Benign splenules.


Instruction: Generate impression based on medical findings.

Input: Female 63 years old Reason: History of HCC History: HCV, cirrhosis LIMITED ABDOMENLIVER: The liver has a nodular contour, it measures 16.2 cm in length. The parenchyma is coarse and echogenic. There is a simple cyst centrally within the right hepatic lobe which measures 1.2 x 1.1 x 1.1 cm (previously 0.8 x 0.9 x 0.9 cm). No additional focal lesion is identified. The main portal vein is patent and demonstrates hepatopetal flow with a velocity of 1.9 m/s. BILIARY TRACT: The gallbladder has an anechoic lumen and normal wall thickness. The common duct measures up to 0.9 cm. No mass or stone is seen along the course of the common duct. There is no intrahepatic biliary ductal dilatation.PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 10.3 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 13.7 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 12.4 cm. in length. OTHER: No ascites.

Output: 1.Mild extrahepatic biliary ductal dilatation is unchanged and may be within normal limits for the patient given stable appearance of associated findings.2.Cirrhotic liver morphology without new or suspicious focal lesion identified.


Instruction: Generate impression based on medical findings.

Input: Female 69 years old Reason: Thyroid lesion, history of alveolar ridge cancer History: None RIGHT LOBE MEASUREMENTS: 5.7 x 1.5 x 1.2 cm.LEFT LOBE MEASUREMENTS: 4.6 x 1.2 x 1.0 cm.ISTHMUS MEASUREMENTS: 0.2 cm thick.RIGHT LOBE: The right lobe of the thyroid demonstrates normal parenchymal echogenicity. Heterogeneous solid nodule in the mid pole measures 1.1 x 0.7 x 1.2 cm and contains a single punctate calcification. Mixed cystic and solid nodule in the inferior pole measures 1.2 x 1.1 x 0.7 cm.LEFT LOBE: The left lobe of the thyroid demonstrates normal parenchymal echogenicity. There is a subcentimeter spongiform nodule in the midpole of the left lobe.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Heterogeneous solid nodule in the midpole the right lobe of the thyroid containing internal calcification, which would be amenable to biopsy.


Instruction: Generate impression based on medical findings.

Input: Reason: assess kidney size History: ckd RIGHT KIDNEY: Right kidney measures 8.5 cm and is increased in echogenicity and atrophic. No evidence of renal calculi.LEFT KIDNEY: Left kidney measures 8.2 cm and is increased in echogenicity and atrophic. Mid left kidney hypodense cyst measuring 0.6 x 0.5 x 0.6 cm. No evidence of renal calculi.URINARY BLADDER: Limited evaluation of the bladder due to decompression. No significant abnormality noted.OTHER: No significant abnormalities noted.

Output: Atrophic kidneys with increased echogenicity compatible with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: 44-year-old female with right upper quadrant pain. Reason: Evaluate gallbladder. LIVER: The liver measures 12.3 cm in length. Mildly coarse echogenic liver echotexture without mass or biliary dilatation. Portal vein is patent.GALLBLADDER, BILIARY TRACT: No gallstones, pericholecystic fluid, gallbladder wall thickening or biliary dilatation. Note is made of a gallbladder polyp measuring 0.4 x 0.5 x 0.4 cm.PANCREAS: The visualized portion of the pancreas is without significant abnormalities.RIGHT KIDNEY: The right kidney measures 9.2 cm. The cortex is of normal echogenicity. No shadowing calculi or hydronephrosis is present.LEFT KIDNEY: The left kidney measures 10.9 cm. The cortex is of normal echogenicity. No shadowing calculi or hydronephrosis is present.SPLEEN: The spleen measures 7.3 cm.OTHER: No significant abnormalities noted.

Output: 1. Subcentimeter gallbladder polyp. Recommend follow-up ultrasound in 6 months.2. No sonographic evidence of cholelithiasis or cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Male 62 years old; Reason: 62M hx cystectomy/ileal conduit with increasing abdominal/flank pain. Evaluate for progressive hydronephrosis History: as above RIGHT KIDNEY: The right kidney measures 8.6 cm in length. The cortex is normal in echogenicity. No shadowing calculi present. There is mild, stable hydronephrosis.LEFT KIDNEY: The left kidney measures 11.3 cm in length. The cortex is normal in echogenicity. No shadowing calculi present. There is mild, stable hydronephrosis.URINARY BLADDER: Patient status post cystectomy.OTHER: No significant abnormalities noted.

Output: Mild, stable bilateral hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Papillary thyroid carcinoma status post thyroidectomy Real time ultrasound scanning revealed a soft tissue nodular focus measuring up to approximately 1.1 cm in the right thyroid bed, corresponding to nodule of interest in right aspect of tracheoesophageal groove on prior CT imaging. A total of approximately 0.2 cc of methylene blue was instilled at level of aforementioned focus. These findings were reviewed with attending surgeon Dr. Portugal at the time of the examination.

Output: Intraoperative localization of right-sided nodular focus, suspicious for residual or recurrent tumor.


Instruction: Generate impression based on medical findings.

Input: Multinodular goiter. Evaluate for change in nodules. RIGHT LOBE MEASUREMENTS: 6.0 x 1.7 x 1.9 cmLEFT LOBE MEASUREMENTS: 8.7 x 3.7 x 3.7 cm.ISTHMUS MEASUREMENTS: 1.6 cm.RIGHT LOBE: Heterogeneous thyroid parenchyma with multiple underlying nodules. Small heterogeneous hypoechoic nodule in the superior lobe of the right thyroid measures 6 x 3 x 6 mm and is similar to prior. Additional nodule in the inferior right lobe is not significantly changed measuring 8 x 8 x 5 mm, previously 8 x 8 x 5 mm.LEFT LOBE: Large inferior left lobe solid heterogeneous nodule without calcification is not significantly changed measuring 3.7 x 3.7 x 2.9 cm, previously 3.7 x 4.0 x 4.2 cm. There is minimal internal vascular flow.ISTHMUS: Large solid heterogeneous nodule in the isthmus. This is not significantly changed from prior measuring 2.8 x 4.9 x 1.6 cm, previously 3.4 x 4.7 x 1.7 cm. No internal calcifications, however there is internal vascular flow.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign appearing right level 3 lymph node measures 1.1 x 0.6 x 0.4 cm.OTHER: No significant abnormality noted.

Output: Multinodular goiter with multiple indeterminate nodules as described above which are not significantly changed from prior.


Instruction: Generate impression based on medical findings.

Input: Female 66 years old; Reason: Eval CKD History: Pancytopenia, Elevated Cr, Reported baseline CKD RIGHT KIDNEY: The right kidney measures 8 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 10 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. There is a cyst at the lower pole. URINARY BLADDER: No significant abnormality notedOTHER: No significant abnormalities noted.

Output: 1.Echogenic mildly atrophic kidneys compatible with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Kidney disease and hepatic steatosis. Limited exam due to extensive body wall edema and inability to position the patient.LIVER:The liver is normal in size measuring 12.9 cm in length. The parenchyma echotexture is coarsened compatible with the history of hepatic steatosis. The portal vein is patent with normal hepatopedal flow and a velocity of 20 cm/s.GALLBLADDER, BILIARY TRACT: The gallbladder wall is normal in thickness. No gallstones are identified, however this is likely technical in etiology. Common bile duct is normal in size measuring 5 mm in diameter.PANCREAS: Poorly visualized due to overlying bowel gas.SPLEEN: Spleen is borderline enlarged measuring 12.4 cm in length.KIDNEYS: Right kidney is normal in size measuring 11.6 cm. No hydronephrosis. Normal parenchymal echotexture. Inferior pole simple cyst measuring 1.9 x 1.4 x 1.9 cm. The left kidney is normal in size and echotexture measuring 12.1 cm in length. ABDOMINAL AORTA: Poorly visualized due to overlying bowel gas.INFERIOR VENA CAVA: The visualized overlying bowel gas, however there is preserved multiphasic flow.OTHER: No significant abnormality noted.

Output: Limited exam due to patient body wall edema and inability to reposition the patient. Hepatic steatosis. Previously noted gallstones are not visualized although this is likely technical. No biliary ductal dilatation. No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old. Reason: Pt with ruq pain please eval gb and kidneys. History: RUQ pain LIVER: Liver measures 14.5 cm in length with normal parenchymal echogenicity. No focal mass or ascites. Main portal vein is patent with a normal direction of flow and a velocity of 21 cm/s.BILIARY TRACT: No intrahepatic or extrahepatic ductal dilatation. Common bile duct measures 1 mm. No cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. Negative Murphy's sign.PANCREAS: No significant abnormalities noted.SPLEEN: Spleen measures 7.8 cm in length. There is a hyperechoic focus measuring 0.5 x 0.3 x 0.7 cm which may represent a granuloma. RIGHT KIDNEY: Right kidney measures 9.7 cm in length with normal cortical echogenicity. No hydronephrosis, shadowing calculi, or mass. OTHER: Left kidney measures 9.2 cm in length with normal cortical echogenicity. No hydronephrosis, shadowing calculi, or mass.

Output: Negative right upper quadrant ultrasound. Specifically, no evidence of hydronephrosis or acute inflammation of the gallbladder.


Instruction: Generate impression based on medical findings.

Input: Male 26 years old Reason: Pt with L nephrectomy. Evaluate R kidney for anatomical abnormalities History: hematuria and LUTS in setting of nephrectomy RIGHT KIDNEY: The right kidney measures 12.8 cm in length and demonstrates increased parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.LEFT KIDNEY: The patient is status post left nephrectomy.BLADDER: The bladder is decompressed.OTHER: No significant abnormalities noted.

Output: 1.Status post left nephrectomy.2.Increased echogenicity of the right kidney suggesting medical renal disease, but no evidence of hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Male 58 years old; Reason: 58 y/o man w/ a hx of cirrhosis and AKI History: 58 y/o man w/ a hx of cirrhosis and AKI RIGHT KIDNEY: The right kidney measures 12 cm in length. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 12 cm in length. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. Visualized portions of the bladder are unremarkable. OTHER: Cirrhosis with large varices.

Output: 1.No hydronephrosis.2.Cirrhosis with large varices..


Instruction: Generate impression based on medical findings.

Input: Female 66 years old; Reason: assess for hydronephrosis, obstruction History: AKI, urinary urgency RIGHT KIDNEY: The right kidney measures 11 cm in length. The cortex is normally echogenic. No shadowing calculi or hydronephrosis is present. No worrisome masses are seen.LEFT KIDNEY: The left kidney measures 10.3 cm in length. The cortex is normally echogenic. No shadowing calculi or hydronephrosis is present. No worrisome masses are seen.URINARY BLADDER: The urinary bladder is only partially visualized as it is currently decompressed.

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