Instruction: Generate impression based on medical findings.

Input: Elevated LFTs and fatigue LIVER: Mildly coarse liver echotexture without mass. Liver length 14.4 cm. Limited Doppler interrogation the main portal vein demonstrates a patent main portal vein with normal directional flow.BILIARY TRACT: Cholelithiasis and gallbladder sludge without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 12.4 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 9.9 cm in lengthOTHER: Left kidney 10 cm in length. No ascites

Output: Mildly coarse liver echotexture raises the possibility of fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Cholelithiasis and gallbladder sludge without acute inflammation. No ascites.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for hydronephrosis/obstruction History: AKI RIGHT KIDNEY: The right kidney measures 9.3 cm in length. Anechoic lesion in the right upper pole represents a small cyst or scarring. No hydronephrosis or shadowing stones.LEFT KIDNEY: The left kidney measures 9.47 m in length. No hydronephrosis or shadowing stones.OTHER: Subtle nodular contour of the liver and moderate to large volume ascites is consistent with cirrhosis. The renal jets are not visualized.

Output: 1. No acute renal abnormality. No hydronephrosis.2. Moderate to large ascites and nodular liver contour, consistent with cirrhosis.


Instruction: Generate impression based on medical findings.

Input: Male; 55 years old. Reason: stones Supernumerary kidneys fused at the midline.RIGHT KIDNEY: The right superior kidney measures 10.8 cm in length. Renal cortex is normal in echogenicity. At least two nonobstructing, shadowing stones with twinkle artifact are seen in the right kidney. The largest measures 0.6 cm. There are two collecting systems on the right, the inferior collecting system is prominent similar to CT. In the inferior aspect of the right duplicated inferior kidney is a 2.4 x 1.7 x 1.8 cm hypoechoic lesion with some internal echoes, a septation, and no internal flow on color Doppler. This corresponds to the lesion seen on recent CT.LEFT KIDNEY: The left superior kidney measures 14.6 cm. The renal cortex is normal in echogenicity. There are two collecting systems. There is no hydronephrosis or shadowing renal stone on the left.BLADDER: The bladder is nondistended.

Output: 1.Supernumerary kidneys fused at the midline.2.At least 2 nonobstructing stones on the right. Prominent inferior right collecting system, similar to prior CT exam, no significant hydronephrosis otherwise.3.2.4 cm hypoechoic lesion in the inferior right duplicated kidney corresponds to the lesion seen on recent CT. This is indeterminant on ultrasound and may be further evaluated with MRI if clinically warranted.


Instruction: Generate impression based on medical findings.

Input: Right renal mass RIGHT KIDNEY: Interval decrease in size of mid pole mass now measuring 1.3 x 1.4 cm; this is in comparison to 2.5 x 2.4 cm on 1/28/2013. Benign subcentimeter renal cysts. No stone or hydronephrosis. Right kidney 11.2 cm in lengthLEFT KIDNEY: Subcentimeter cysts. No worrisome mass, stone, or hydronephrosis. 10.7 cm in length.OTHER: Bladder nondistended. Large prostate gland again noted. Right pleural effusion.

Output: Interval decrease in size of right mid pole renal mass.


Instruction: Generate impression based on medical findings.

Input: Cardiac patient; evaluate hepatic vasculature LIMITED ABDOMENLIVER: Mildly coarse and echogenic liver echotexture without mass. Liver length 19.8 cm.BILIARY TRACT: Gallbladder contracted. No ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 10.4 cm in length. RIGHT KIDNEY: Echogenic renal parenchyma without mass or stone. Mild hydronephrosis. Right kidney 11 cm in lengthOTHER: Left kidney demonstrates echogenic renal parenchyma without mass or stone. Mild left hydronephrosis. Left kidney 11.5 cm in length. Mild ascites.

Output: Mild hepatomegaly associated with coarse echogenic liver parenchyma consistent with chronic liver disease without mass or ductal dilatation. Gallbladder collapsed. Mild ascites.Patent hepatic vessels with normal directional flow.Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction with mild bilateral hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 32-year-old female with premature hypertension. RIGHT KIDNEY: Right kidney measures 12.3 cm in length. There is no hydronephrosis, shadowing calculus or mass. Echotexture is normal.LEFT KIDNEY: The left kidney measures 12.4 cm in length. There is no hydronephrosis, shadowing calculus or mass. Echotexture is normal.OTHER: Bladder appears unremarkable.

Output: Normal-appearing kidneys with symmetric size.


Instruction: Generate impression based on medical findings.

Input: 75-year-old female with pancreatic adenocarcinoma with known liver metastases, now with abdominal swelling, evaluate for ascites. There is large four quadrant abdominal ascites. Incompletely visualized bilateral pleural effusions.Coarse echotexture and nodular contour of the visualized liver consistent with cirrhotic liver morphology.

Output: 1. Large four quadrant abdominal ascites and bilateral pleural effusions. 2. Cirrhotic liver morphology.


Instruction: Generate impression based on medical findings.

Input: Female 63 years old Reason: r/o obstruction / hydronephrosis History: AKI RIGHT KIDNEY: Increased echogenicity of the right kidney suggestive of medical renal disease. No hydronephrosis or shadowing calculus.LEFT KIDNEY: Increased cortical echogenicity of the left kidney suggestive of medical renal disease. Mild left pelvicaliceal fullness without frank hydronephrosis.URINARY BLADDER: Bladder is not well-visualizedOTHER: Again seen are numerous very large loculated cystic lesions throughout the abdomen consistent with known metastatic disease.

Output: 1.Numerous very large complex loculated cystic lesions throughout the abdomen compatible with known metastatic disease.2.Increased cortical echogenicity bilaterally suggestive of medical renal disease. Mild left pelvicaliceal fullness without hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 49 year-old female with pancreatitis. Evaluate for gallbladder stones. LIVER: Increased echogenicity of the liver measuring 14.3 cm in length. No focal hepatic lesions. Portal vein is patent with appropriate directional flow; peak velocity measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: Normal echogenicity of the gallbladder. No evidence of cholelithiasis. No gallbladder wall thickening. No pericholecystic fluid. Common bile that measures 3 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Visualized portions of the pancreas are unremarkable.RIGHT KIDNEY: Atrophic echogenic native right kidney.OTHER: Right lower quadrant transplant kidney is normal in echogenicity measuring 11.9 cm in length. No hydronephrosis or shadowing calculi are noted.

Output: Increased echogenicity of the liver compatible with fatty infiltration. No evidence of cholelithiasis.


Instruction: Generate impression based on medical findings.

Input: Ms. Mukhopadhyay is a 24 year old female presenting with a palpable abnormality in the left breast for the past 6 months. She denies any tenderness or history of trauma. Upon physical exam at the patient's area of concern, no discrete mass is appreciated.A targeted left breast ultrasound was performed for the palpable area of concern. Dense fibroglandular tissue is identified at the area of concern along with a 6 mm cyst. No suspicious cystic or solid masses are identified.

Output: Dense fibroglandular tissue without sonographic evidence for malignancy. Patient should follow-up with her primary care physician as clinically warranted. All results and recommendations were relayed to the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Distended abdomen with sepsis LIVER: Hepatomegaly without mass. Liver length 21.5 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Echogenic renal parenchyma again noted. Right renal cyst. Right kidney 10.7 cm in length.OTHER: Spleen 11.2 cm in length. Complex loculated perisplenic and perihepatic ascites again noted

Output: Cholelithiasis without acute inflammation or ductal dilatation. No change in complex loculated perisplenic and perihepatic ascites; infection cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Female 75 years old Reason: r/o hydronephrosis History: CT w/nephrolithiasis, UTI RIGHT KIDNEY: Right kidney measures 10.6 cm. The cortex is echogenic suggesting medical renal disease. There are multiple shadowing stones. A simple appearing anechoic cyst is present within the midpole of the right kidney measuring 2.2 x 1.8 x 1.7 cm. No hydronephrosis.LEFT KIDNEY: Left kidney measures 8.9 cm. The left kidney has mildly increased cortical echogenicity suggesting medical renal disease. No hydronephrosis.URINARY BLADDER: The bladder is collapsed.OTHER: No significant abnormalities noted.

Output: Echogenic kidneys bilaterally suggesting medical renal disease. Multiple shadowing stones without hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Single thyroid nodule. Palpable. History of Hashimoto's thyroiditis, per patient. RIGHT LOBE MEASUREMENTS: 4.0 x 1.4 x 1.5 cm. Normal in size with normal background echotexture and vascularity.LEFT LOBE MEASUREMENTS: 3.9 and 1.1 x 1.2 cm. Normal in size with normal background echotexture and vascularity.ISTHMUS MEASUREMENTS: 1 mm in AP dimension.RIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: 6 mm solid isoechoic nodule in the right aspect of the isthmus.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Benign-appearing cervical lymph nodes identified.OTHER: No significant abnormality noted.

Output: 6 mm solid nodule in the right aspect of the isthmus. This may be amenable to percutaneous biopsy.


Instruction: Generate impression based on medical findings.

Input: Ms. ELAINE MCKENNEY is a 62 years old female with a personal history of right lumpectomy in June 2014 for IDC. She also has history of benign biopsy in March 2014 at outside hospital. She presents today with intermediate palpable concern in the left breast, same area as found one month ago. In the left breast upper inner quadrant, approximately 10:00 location, there is ink marker to indicate the palpable concern by the surgical clinic staff. Patient's palpable area of concern is slightly inferior to the ink marker at approximately 9:00 position.A targeted left ultrasound was performed at areas of palpable concern. Normal breast tissues are noted in both 10:00 and 9:00 location, 2 cm from the nipple. There is no solid or cystic mass to correspond to the palpable concerns.

Output: No sonographic findings to account for patient's palpable concern. Routine annual diagnostic mammograms are recommended, due in March 2016. Results and recommendations were discussed with the patient. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: AML with elevated LFTs LIVER: Coarse echogenic liver parenchyma again noted without mass. Liver length 17.3 cm. Limited Doppler interrogation of the main portal vein demonstrates a patent portal vein with normal directional flow.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy; no ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 12.6 cm in lengthOTHER: Left kidney 13.1 cm in length. Spleen 11.9 cm in length. No ascites.

Output: Coarse echogenic liver parenchyma again noted consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: 62-year-old female with HCV, cirrhosis. Evaluate for HCC. LIVER: Nodular hepatic contour and mildly coarsened hepatic echogenicity without discrete focal lesion.BILIARY TRACT: No significant abnormalities noted.PANCREAS: Portions of the pancreas not clearly visualized due to bowel gas. The visualized portions of the pancreas appear unremarkable.SPLEEN: Splenic granulomata. KIDNEY: No significant abnormalities noted. OTHER: 1.8 cm peripancreatic lymph node with benign morphologic features.

Output: Nodular hepatic contour and increased echogenicity consistent with chronic liver disease, without discrete lesion identified.


Instruction: Generate impression based on medical findings.

Input: Asymptomatic female with dense breasts presents for whole breast ultrasound for dense breast screening. 3-D whole breast ultrasound was performed for both breasts and images were reviewed on an independent workstation. There is no solid or cystic mass identified. Images were double read by Dr. Kulkarni and Dr. Schacht.

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


Instruction: Generate impression based on medical findings.

Input: 65-year-old female with history of thyroid cancer post thyroidectomy. Evaluate for recurrent disease. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: ThyroidectomyRIGHT LOBE: No massesLEFT LOBE: No massesISTHMUS: No massesPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence for local recurrence or nodal disease.


Instruction: Generate impression based on medical findings.

Input: Ms. Smith is a 16 year old female presenting with a physician detected mass in the right breast. The patient herself does not palpate any abnormality. Upon physical exam at the palpable area of concern, a soft, mobile nontender mass is appreciated in the right lower, inner breast.A targeted right breast ultrasound was performed for the palpable area of concern. In the right breast 5 o'clock location, approximately 2 cm from the nipple, there is a 3.0 x 1.1 x 2.0 cm lobulated hypoechoic solid mass. There is moderate amount of associated vascularity.

Output: Sonographic findings compatible with a fibroadenoma. Due to the size and palpability of this lesion, a surgical consultation is recommended at this time. All results and recommendations were relayed to the patient and her mother at time of dictation.BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation.


Instruction: Generate impression based on medical findings.

Input: Status post mastectomy of the right breast and implant placement. Small palpable area of concern noted by patient and physician. A targeted right ultrasound was performed for the patient’s area of concern. There is no solid or cystic mass identified. There is a slight contour irregularity along the implant in this region. However, there is no suspicious cystic or solid mass or evidence of a lymph node at the site marked by the clinical service.

Output: No sonographic evidence for malignancy. Clinical follow-up is recommended for this finding.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: 81-year-old male with leukocytosis, conjugated hyperbilirubinemia LIVER: Increased hepatic echogenicity without discrete focal lesionGALLBLADDER, BILIARY TRACT: Redemonstration of cholelithiasis and biliary sludge, now with mild gallbladder distension. Mild gallbladder wall thickening, but no pericholecystic fluid or sonographic Murphy sign. No biliary ductal dilation.PANCREAS: No significant abnormalities noted.KIDNEY: Not included on this examination. OTHER: No significant abnormalities noted.

Output: The abnormal appearance of the gallbladder as described above remains nonspecific, but given the persistence of symptoms and sonographic findings, both acute and chronic cholecystitis are differential considerations. If further imaging evaluation is warranted, a nuclear medicine hepatobiliary scan may be considered.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for liver lesions History: Hx of HCV with advanced liver fibrosis LIVER: The liver measures 17.4 cm in length. The liver parenchymal echotexture is normal. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.25 m/s.BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 6 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 7.8 cm in length. RIGHT KIDNEY: Kidney measures 10.9 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 10.9 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: Porta hepatis lymph node measuring 1.4 x 1.1 x 0.7 cm, similar to prior.

Output: No suspicious focal hepatic lesions identified.


Instruction: Generate impression based on medical findings.

Input: Thyroid cancer status post thyroidectomy. RIGHT LOBE MEASUREMENTS: Status post thyroidectomy LEFT LOBE MEASUREMENTS: Status post thyroidectomy ISTHMUS MEASUREMENTS: Status post thyroidectomy RIGHT LOBE: The previously described hyperechoic tissue in the right thyroid bed is again seen, with linear hyperechoic focus likely representing a surgical clip.LEFT LOBE: The anechoic focus in the left thyroid bed is unchanged at 7 x 4 x 4 mm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Benign-appearing cervical lymph nodes identified.OTHER: No significant abnormality noted.

Output: Stable examination, without evidence of recurrent disease.


Instruction: Generate impression based on medical findings.

Input: 63-year-old female patient with HCV, cirrhosis. Evaluate for HCC. LIVER: The liver measures 16.9 cm in length, demonstrates coarsened echogenicity, and is nodular contour. There is a 1.2 x 1.0 x 1.0 cm hypoechoic lesion within the right hepatic lobe dome. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: There are gallstones without gallbladder wall thickening or pericholecystic fluid. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 3 mm in diameter.PANCREAS: The head and body of the pancreas demonstrate normal echogenicity. The tail is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 10.7 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 10.8 cm in length. No evidence of hydronephrosis. There is a 1.1 cm left midpole renal cyst.The spleen measures 8.5 cm in length.

Output: 1. Cirrhotic morphology of the liver with a right hepatic dome hypodense lesion; dedicated contrast enhanced liver CT/MRI is recommended for further evaluation.2. Cholelithiasis without sonographic evidence of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: 80-year-old female with chronic kidney disease. Evaluate bladder emptying. Prevoid bladder is almost completely empty measuring 4.3 x 4.6 x 2 cm with a volume of 20 cc. Post void film was there is almost complete emptying with a volume of 2.8 cc.

Output: Almost complete emptying of nondistended bladder.


Instruction: Generate impression based on medical findings.

Input: 63-year-old female with a known history of left breast IDC. Presents for evaluation of known left breast masses. A targeted left breast ultrasound was performed for the patient's known left breast masses. Again seen are 2 reference masses in the left breast at the 4:00 position approximately 5 cm from the nipple. The medial mass measures 1.8 x 1.1 x 1.5 cm (TR x AP x CC), previously 1.3 x 1.1 (TR x CC), increased in size. This mass appears more confluent with the second reference left breast mass which is situated immediately lateral to the dominant mass and now measures approximately 1.3 x 1.0 x 1.2 cm (TR x AP x CC), previously 1.0 x 1.1 cm (TR x CC), increased in size. There is associated increased vascularity within both masses on Doppler interrogation.

Output: Interval increase in size of the patient's reference left breast masses consistent with the patient's known history of IDC with reference measurements provided above. Consultation in the breast surgery clinic is recommended. These findings and recommendation were discussed directly with the patient. The patient reports she has already been seen in the breast surgery clinic and is opting for alternative therapy.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Acute kidney failure, on chronic kidney disease stage IV. Worsening creatinine. RIGHT KIDNEY: The right kidney measures 11 cm. The renal parenchyma is echogenic and atrophic. There are multiple subcentimeter hypodense lesions, probable simple cysts. No suspicious lesion is identified. There is no hydronephrosis or renal calculus.LEFT KIDNEY: The left kidney measures 11.1 cm. The renal parenchyma is echogenic and atrophic. There are multiple simple cysts. There is no hydronephrosis or renal calculi.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.

Output: Echogenic, atrophic renal parenchyma, compatible with medical renal disease/parenchymal dysfunction. No worrisome mass, hydronephrosis or renal calculus.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male with multiple myeloma, renal disease, rising creatinine. RIGHT KIDNEY: Measures 11.7 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. LEFT KIDNEY: Measures 13.6 cm in length. Left renal cysts measuring up to 2.3 cm without discrete septation or solid component. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. URINARY BLADDER: Incompletely distended without focal abnormality. OTHER: No significant abnormalities noted.

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


Instruction: Generate impression based on medical findings.

Input: Female 28 years old Reason: please evaluate right flank for hematoma formation History: anemia, firm mass under incision on right flank/abdomen Soft tissue edema along the right flank. Heterogeneous well-circumscribed collection in the deep subcutaneous tissues along the site of the incision concerning for hematoma. Estimated measurements 12 x 10 x 4 cm.

Output: Probable hematoma as measured.


Instruction: Generate impression based on medical findings.

Input: 51 year old female with elevated PTH and calcium. RIGHT LOBE MEASUREMENTS: 1.5 x 2.5 x 5.9 cmLEFT LOBE MEASUREMENTS: 1.2 x 2.5 x 5.4 cmISTHMUS MEASUREMENTS: 3 mmRIGHT LOBE: The right thyroid lobe is normal in morphology, echogenicity and size without a discrete dominant nodule.LEFT LOBE: The left thyroid lobe background parenchyma is normal in echogenicity. There is a 1.4 x 0.9 x 0.6 cm superior pole solid hypoechoic nodule with well defined margins. No hypervascularity or associated calcifications. Additional, 8 x 5 x 7 mm inferior pole hypoechoic nodule with minimal vascularity and well-defined margins. No associated calcifications. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Immediately dorsal to the inferior pole of the left thyroid lobe is a 1.1 x 0.7 x 1.4 cm hypoechoic lesion without significant vascularity which may represent a parathyroid adenoma. LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. 1.4 cm lesion immediately dorsal to the inferior pole of the left thyroid lobe may represent a parathyroid adenoma; correlate with nuclear medicine study.2. 1.4 cm left thyroid lobe solid indeterminate nodule.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male patient with advanced heart failure secondary to ICM, thrombocytopenia. Also with history of ulcerative colitis. Evaluation for heart transplant and exploration of thrombocytopenia. LIVER:The liver measures 17.6 cm in length. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.2 m/s.GALLBLADDER, BILIARY TRACT: No gallstones, gallbladder wall thickening, or pericholecystic fluid is identified. The common duct measures 4 mm in diameter.PANCREAS: The pancreas is poorly visualized examination.SPLEEN: The spleen measures 12.3 cm in length.KIDNEYS: The right kidney measures 9.9 cm and the left kidney measures 10.7 cm in length. No evidence of hydronephrosis. ABDOMINAL AORTA: The proximal abdominal aorta measures 1.8 x 1.7 cm and the distal aorta measures 1.7 x 1.5 cm. The midportion of the abdominal aorta is obscured by overlying bowel gas.INFERIOR VENA CAVA: The IVC is patent.OTHER: No significant abnormality noted.

Output: 1. No acute sonographic abnormality within the abdomen.2. Poor visualization of the mid-abdominal aorta.


Instruction: Generate impression based on medical findings.

Input: Right upper quadrant pain status post cholecystectomy LIVER: No significant abnormalities noted. 13.7 cm in lengthGALLBLADDER, BILIARY TRACT: Status post cholecystectomy. No ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 8.1 cm in lengthOTHER: Left kidney 9.3 cm in length. Spleen 9.1 cm in length. No ascites

Output: Status post cholecystectomy. No evidence for hepatobiliary abnormality.


Instruction: Generate impression based on medical findings.

Input: UTI with sepsis RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. No perinephric collection. 10.1 cm in lengthLEFT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. No perinephric collection. 10.4 cm in length.OTHER: Bladder nondistended. Ascites noted. Right pleural effusion.

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


Instruction: Generate impression based on medical findings.

Input: 60-year-old female with marginal zone lymphoma, scleroderma, vasculitis who presents with persistent microscopic hematuria. Evaluate for renal disease. RIGHT KIDNEY: The right kidney measures 12.6 cm in length. No hydronephrosis. Normal echogenicity.LEFT KIDNEY: The left kidney measures 11.6 cm in length. No hydronephrosis. Left mid pole renal cyst measuring 2.7 x 2.6 x 3 cm. Otherwise, normal echogenicity.URINARY BLADDER: The urinary bladder is partially distended without acute abnormality.OTHER: Interval enlargement of left pleural effusion.

Output: 1. Left-sided simple renal cyst. Otherwise normal parenchymal echogenicity. No hydronephrosis.2. Interval enlargement of left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: HPT. Assess for parathyroid adenoma. History of thyroid nodule that was biopsied in the past. RIGHT LOBE MEASUREMENTS: 4.0 x 1.4 x 0.7 cmLEFT LOBE MEASUREMENTS: 3.9 x 1.2 x 1.3 cm.ISTHMUS MEASUREMENTS: 0.3 cm.RIGHT LOBE: Diffusely heterogeneous thyroid gland. No discrete nodules or masses.LEFT LOBE: Diffusely heterogeneous thyroid gland. Exophytic lesion in the inferior aspect of the left thyroid lobe measures 0.8 x 0.7 x 0.9 cm likely represents a benign colloid nodule.ISTHMUS: Diffusely heterogeneous thyroid gland. No discrete nodules or masses.PARATHYROID GLANDS: Well-defined hypoechoic extrathyroidal lesion projecting inferiorly to the right thyroid lobe measures 0.5 x 0.5 x 0.3 cm and is favored to represent suspected parathyroid adenoma.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Extrathyroidal lesion projecting inferior to the right thyroid lobe is consistent with a parathyroid adenoma candidate.Heterogeneous thyroid gland suggestive of chronic thyroiditis.


Instruction: Generate impression based on medical findings.

Input: 63 year old female who was recalled from screening mammogram for incompletely characterized mass in the left superior breast. Mammogram: An ML view and two spot compression views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty(BiRads Density Category A), unchanged in pattern and distribution. 5 mm round circumscribed mass with lucency in the center most likely represents a benign intramammary lymph node.Ultrasound: Targeted left upper-outer quadrant ultrasound was performed. Benign morphology 5 x 4 mm hypoechoic mass is identified in the left breast 1:00 position without definite peripheral blood flow which could represent a complex cyst or a benign intramammary lymph node with central fatty hilum. No suspicious cystic or solid mass noted.

Output: Benign morphology subcentimeter mass in the left breast most likely represents a complex cyst or a benign intramammary lymph node. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: Male 38 years old Reason: 38M with left groin pain History: rule out inguinal hernia No significant abnormality is seen in the area of discomfort. No hernia is seen and there is no inguinal lymphadenopathy.

Output: No significant abnormality is seen in the area of discomfort.


Instruction: Generate impression based on medical findings.

Input: 63 year old with history of right mastectomy for breast cancer. Patient has declined routine mammogram and left breast ultrasound is requested. On physical exam, there is no palpable abnormality of the left breast.A whole left breast ultrasound was performed. In the left breast 7:00 position 3 cm from nipple, there is a small cluster of cysts measuring approximately 3 x 3 x 4 mm. There is no suspicious solid mass identified.

Output: No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Female; 67 years old. Reason: cirrhosis eval for HCC History: cirrhosis LIVER: The liver measures 5.5 cm in length. The liver parenchyma nodular and echogenic with a coarse echotexture. No suspicious lesion is identified. There is a small amount of ascites. The portal vein is patent and demonstrates a normal direction of flow with a peak velocity of 30 cm/sec.BILIARY TRACT: The gallbladder is not distended. There is no cholelithiasis, gallbladder wall thickening or pericholecystic fluid. The common bile duct measures 4 mm. There is no intrahepatic biliary ductal dilatation.PANCREAS: The pancreas is obscured by overlying bowel gas.SPLEEN: The spleen measures 20.2 cm in length.RIGHT KIDNEY: The right kidney measures 9.5 cm in length. The renal cortex demonstrates normal echogenicity. There is no hydronephrosis. OTHER: Left kidney measures 12.5 cm in length. There is no hydronephrosis.

Output: 1.Cirrhotic liver morphology without focal hepatic lesion. Small amount of ascites.2.Splenomegaly.


Instruction: Generate impression based on medical findings.

Input: 52-year-old male with history of Kennedy's disease with right flank superficial discomfort and swelling. In the subcutaneous tissues in the region of the patient's discomfort and visible swelling there is an ovoid region which is isoechoic to surrounding fat measuring 0.8 x 3.8 x 3.5 cm. There is no defect in the adjacent abdominal wall nor is or significant change with Valsalva. Findings are most suggestive of lipoma.

Output: Findings most consistent with lipoma involving the subcutaneous fat of the right flank.


Instruction: Generate impression based on medical findings.

Input: Male; 48 years old. Reason: 48M PMHx lymphoma as a child w/ radiation S/P AVR/MVR for AS/MS, with transaminitis and elevated bilirubin. Eval for biliary etiologies, possible fatty liver or hepatic congestion? History: none LIVER: The liver measures 16.8 cm in length. The liver surface is smooth and the parenchyma is normal in echotexture. There is no worrisome mass and no ascites. The main portal vein is patent and demonstrates a normal direction of flow with a paucity of 20 cm/sec.GALLBLADDER, BILIARY TRACT: The gallbladder is normal in appearance without wall thickening or cholelithiasis. The common duct measures 2 mm. There is no intrahepatic biliary ductal dilatation.PANCREAS: The head and body of the pancreas are normal in appearance. The tail of the pancreas is obscured by overlying bowel gas.SPLEEN: The spleen measures 10 cm in length.RIGHT KIDNEY: The right kidney measures 12.0 cm in length. The renal cortex is normal in echogenicity. There is no renal stone, hydronephrosis or worrisome renal mass.LEFT KIDNEY: The left kidney measures 11.3 cm in length. The renal cortex is normal in echogenicity. There is no renal stone, hydronephrosis or worrisome renal massOTHER: No significant abnormalities noted.

Output: Normal ultrasound of the right upper quadrant. No cholelithiasis or evidence of hepatic steatosis.


Instruction: Generate impression based on medical findings.

Input: 80-year-old male with elevated creatinine. Rule out hydronephrosis. RIGHT KIDNEY: Measures 9.7 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. Right renal cysts measuring up to 1.4 cm without septation or solid component.LEFT KIDNEY: Measures 9.4 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. Left renal cysts measuring up to 1.2 cm without septation or nodular component.URINARY BLADDER: Incompletely distended without focal abnormality. OTHER: Enlarged prostate measures 4.9 x 4.4 x 4.1 cm.

Output: 1. Increased renal echogenicity consistent with medical renal disease. 2. No nephrolithiasis, hydronephrosis, or suspicious mass.3. Enlarged prostate.


Instruction: Generate impression based on medical findings.

Input: Male 76 years old; Reason: evaluate for hepatic dysfunction History: as above LIVER: The liver measures 16.6 cm in length. There is coarse increased echogenicity of the liver parenchyma. There is a nodular appearance to the liver and moderate ascites is seen. No focal hepatic lesions. No intrahepatic ductal dilation is seen. The main portal vein is patent with normal hepatopetal flow measured at 19.8 cm/s. Pleural effusion is seen on the right.GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 1.2 mm. Several small shadowing stones are seen along with minimal layering sludge. No pericholecystic fluid. Negative sonographic Murphy sign. The common bile duct measures 2.9 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 12.0 cm and no significant abnormalities are noted.Pleural effusion is seen on the left.RIGHT KIDNEY: The right kidney measures 10.8 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 10.8 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.

Output: 1. The liver has a coarse nodular appearance which is compatible with cirrhotic morphology. Moderate ascites is present. There are no worrisome masses seen within the liver.2. Cholelithiasis without evidence of acute cholecystitis.3. Bilateral pleural effusions are seen.


Instruction: Generate impression based on medical findings.

Input: Asymptomatic female with dense breasts presents for whole breast ultrasound for dense breast screening. Strong family history of breast cancer in sister, maternal aunt, maternal cousin, paternal aunt, and two paternal cousins. 3-D whole breast ultrasound was performed for both breasts and images were reviewed on an independent workstation. There is no solid or cystic mass identified.

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


Instruction: Generate impression based on medical findings.

Input: Epigastric pain and nausea LIVER: Unremarkable parenchymal echogenicity without mass. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow. Liver length 15.6 cm.BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 7.2 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 9.9 cm in lengthOTHER: Left kidney 10.6 cm in length. No ascites.

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


Instruction: Generate impression based on medical findings.

Input: 51-year-old male with history of cystic lesion seen on cervical spine MRI. RIGHT LOBE MEASUREMENTS: 5.0 x 2.7 x 1.2 cmLEFT LOBE MEASUREMENTS: 5.4 x 2.1 x 1.2 cmISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: A 1.6 x 1.1 x 0.7 cm cystic lesion is noted posteriorly and inferiorly to the right thyroid lobe. There is a clear fat plane separating this structure from the thyroid. The lesion is completely cystic without internal solid components or significant internal vascularity.

Output: Cystic lesion posterior and inferior to the right thyroid lobe without internal solid component or internal vascularity. Differential considerations include simple cyst vs cystic parathyroid adenoma.


Instruction: Generate impression based on medical findings.

Input: History renal stones RIGHT KIDNEY: Normal parenchymal echogenicity without mass, stones, or hydronephrosis. Right kidney 10.4 cm in lengthLEFT KIDNEY: Normal parenchymal echogenicity without mass, stone, or hydronephrosis. Left kidney 11.2 cm in length.OTHER: Bladder nondistended

Output: Negative renal ultrasound. No evidence for mass, stone, or obstruction.


Instruction: Generate impression based on medical findings.

Input: 63-year-old with biopsy proven left breast cancer, left breast ultrasound requested to evaluate interval change in size of the known cancer. A targeted left ultrasound was performed. 10 o'clock position of the left breast. There is a iso-to hypoechoic, irregular mass with internal calcifications that appears unchanged from prior study, measures 3.4 x 1.5 by 3.1 cm, mostly unchanged from prior study, when it measured 3.4 x 1.5 x 3.2 cm.

Output: No interval change in size of known left breast cancer on ultrasound.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: 62-year-old female with refractory hypoglycemia without history of diabetes. Morbid obesity. Evaluate for evidence of hepatic cirrhosis. LIVER: Mild hepatomegaly without gross, focal abnormality. No definite morphology to suggest cirrhosis. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: Gallbladder appears normal without cholelithiasis, wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: Not visualized due to bowel gas.SPLEEN: Mildly enlarged.RIGHT KIDNEY: Poorly visualized due to body habitus. There is suggestion of atrophy and parenchymal thinning.OTHER: No ascites. Small, bilateral pleural effusions. Left kidney cannot be visualized.

Output: No obvious evidence for cirrhosis.Question atrophy right kidney.Minimal pleural effusions.No ascites.


Instruction: Generate impression based on medical findings.

Input: Renal dialysis with ascites LIVER: Coarse echogenic liver echotexture without mass. Liver length 14.7 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Atrophic echogenic kidney. Right kidney 4.7 cm in lengthOTHER: Spleen 9.6 cm in length. Trace ascites.

Output: Coarse echogenic liver echotexture consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Trace ascites. Atrophic echogenic kidneys.


Instruction: Generate impression based on medical findings.

Input: Post heart transplant 2 weeks ago. Now with acute kidney injury. Evaluation limited by patient body habitus.RIGHT KIDNEY: Right kidney measures 9.5 cm. No hydronephrosis or renal calculus identified.LEFT KIDNEY: Left kidney measures 10.0 cm. No hydronephrosis or renal calculus identified.URINARY BLADDER: No significant abnormalities noted. Right ureteral jet is observed.OTHER: No significant abnormalities noted.

Output: Limited evaluation, with no evidence of acute renal abnormality. No renal calculus or hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 41-year-old female with right renal biopsy earlier in the day, now with dizziness and hematuria. RIGHT KIDNEY: The right kidney measures 8.1 cm in length. Cortex is echogenic. No hydronephrosis, shadowing calculus or mass. There is a trace of perinephric fluid. No significant hematoma identified.LEFT KIDNEY: The left kidney measures 10.4 cm in length and the cortex is mildly echogenic. No hydronephrosis, shadowing calculus or mass.OTHER: Urinary bladder appears unremarkable without significant internal debris. No free fluid.

Output: Trace perirenal fluid on the right. No significant hematoma identified.Mildly echogenic kidneys with asymmetric size.


Instruction: Generate impression based on medical findings.

Input: Ms. ZELLA HARRIS is a 46 years old female who presents for further evaluation for masses seen in both breasts on screening mammogram. DIAGNOSTIC MAMMOGRAM FOR BILATERAL BREAST:ML and spot compression views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is mostly fatty replaced, unchanged in pattern and distribution. There is well defined 28 mm mass with a few calcification in the upper outer right breast. There is a 16 mm mass in the posterior left upper outer breast. In addition, another 1.2 cm lobulated mass is noted anterior to 16 mm mass in the left upper outer breast. TARGETED ULTRASOUND OF BOTH BREASTS:Targeted ultrasound of both breasts were performed at the sites of mammographic concerns. In the right breast, 11:00, 12 cm from the nipple, there is a 16 x 16 x 21 mm well-circumscribed hypoechoic mass with internal flow and a few echogenic calcifications. This likely represents a fibroadenoma.In the left breast, 11:00 location, 12 cm from the nipple, there is a 10 x 6 x 10 mm slightly hypoechoic mass parallel to the skin, which correlates with the mammographic finding in the posterior left upper outer breast. The anterior mass in the left upper outer breast found on the mammogram is not seen on the ultrasound.

Output: Probably benign findings in both breasts as described above. As long as the patient's physical examination remains unremarkable, bilateral diagnostic mammogram is recommended in 6 months. Results and recommendations were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on medical findings.

Input: 54-year-old female with history of left breast asymmetries on recent mammogram. Occasional breast pain. Three standard views of the left breast with spot compression were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density(BiRads Density Category B), unchanged in pattern and distribution. Subcentimeter masses in the left inner breast persist with spot compression. ULTRASOUND

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


Instruction: Generate impression based on medical findings.

Input: The patient submitted outside mammogram dated 10/12/2007, from presence St. Joseph Hospital. Submitted outside study was compared to the current mammogram dated 12/15/2015. There is no significant change between these two studies in the left breast. Focal asymmetry in the left upper-outer quadrant with calcifications and cluster of calcifications in central left breast are mostly unchanged.Segmental distribution calcifications in the right upper-outer quadrant spanning approximately 6 cm with associated focal asymmetry has increased from prior exams and needs further evaluation with spot magnification views and ultrasound.

Output: Segmental distribution calcifications in the right upper-outer quadrant spanning approximately 6 cm with associated focal asymmetry has increased from prior exams and needs further evaluation with spot magnification views and ultrasound.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on medical findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (4/5/16, 4/28/16), post procedural bilateral digital mammographic images (5/3/16) performed at St. James Olympia Fields. For comparison, ultrasound images (4/28/16, 5/3/16) are available (dictated separately). DIGITAL MAMMOGRAPHIC IMAGES (4/5/16, 4/28/16):The breast parenchyma is composed of scattered fibroglandular elements (BiRADS Density Category B). There are 2 spiculated masses in the right breast at upper inner quadrant; anteriorly located mass measures 11 mm, and posteriorly located mass measures 19 mm. In the left breast, there is a spiculated mass at upper outer quadrant measuring 15 mm.Multiple benign appearing calcifications are seen in both breasts. 3 linear scar markers overlie left breast.POST PROCEDURAL BILATERAL DIGITAL MAMMOGRAPHIC IMAGES (5/3/16):Images are obtained after ultrasound-guided biopsy of the right breast (2 sites) and left breast (one site).A marker clip is placed approximately 1 cm lateral to the spiculated mass at anterior upper inner quadrant in the right breast. A marker clip is placed within the spiculated mass at posterior upper inner quadrant in the right breast and a spiculated mass at upper outer quadrant in the left breast. Per outside pathology report, all 3 lesions are malignant.

Output: Known right and left breast cancer (2 sites in right breast, and one site in the left breast). Given multiple synchronous breast cancers, recommend bilateral breast MRI.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: 55-year-old male, advanced heart failure workup. LIVER: Liver measures 19.1 cm in length with slight nodular contour of the liver likely related to passive hepatic congestion. There is mild pulsatility of the main portal vein. There is perihepatic ascites. GALLBLADDER, BILIARY TRACT: Gallbladder is normal with pericholecystic fluid. Gallbladder wall measures 3 mm in thickness. Sonographic Murphy's sign is negative. Common bile duct measures 3 mm in caliber. No intra or extrahepatic biliary ductal dilatation.PANCREAS: Tail of pancreas is obscured by overlying bowel gas however the remaining pancreatic parenchyma is normal in echogenicity with no evidence of pancreatic ductal dilatation.RIGHT KIDNEY: Measures 11.4 cm in length with no hydronephrosis.OTHER: Left kidney is normal measuring 11.5 cm in length. Spleen is normal measuring 11.9 cm in length.

Output: Perihepatic ascites with slight nodular contour of the liver likely related to passive hepatic congestion. Thickened gallbladder wall likely related to ascites.


Instruction: Generate impression based on medical findings.

Input: Mass seen at base of penis. RIGHT TESTIS: 3.7 x 3 x 2.5 cm. No intratesticular mass. Bilaterally symmetric Doppler flow characteristics.LEFT TESTIS: 3.2 x 2.4 x 2.8 cm. No intratesticular mass. Bilaterally symmetric Doppler flow characteristics.RIGHT EPIDIDYMIS: Benign-appearing subcentimeter epididymal cystLEFT EPIDIDYMIS: Benign-appearing subcentimeter epididymal cyst.OTHER: Abnormal soft tissue mass measuring 2.8 x 4.8 x 3 cm at the base of the penis adjacent to the urethra; this lesion demonstrates internal vascularity.

Output: Abnormal soft tissue mass adjacent to the urethra within the base the uterus with internal vascularity; a neoplastic etiology cannot be excluded. No intratesticular mass.


Instruction: Generate impression based on medical findings.

Input: Reason: follow-up of multinodular goiter History: neck swelling RIGHT LOBE MEASUREMENTS: 5.1 x 1.8 x 1.7 cmLEFT LOBE MEASUREMENTS: 5.5 x 2.7 x 2.0 cmISTHMUS MEASUREMENTS: 0.36 cmRIGHT LOBE: Reference nodules as noted below:Nodule #1:1.5 x 1.0 x 1.0 cm, predominantly hypoechoic spongiform nodule without significant vascularity or definite microcalcifications.Nodule #3:1.1 x 0.6 x 0.8 cm, part solid hypoechoic nodule without significant vascularity or definite microcalcifications.LEFT LOBE: Reference nodules as noted below:Nodule #1: 1.1 x 0.7 x 0.9 cm, predominantly solid nodule with hypoechoic rim and minimal vascularity without definite microcalcifications.Nodule #3: 0.8 x 0.7 x 0.8 cm, mixed solid and cystic nodule without significant vascularity or definite microcalcifications.ISTHMUS: Reference nodules as noted below:Nodule #1:1.0 x 0.8 x 0.8 cm, predominantly solid nodule with hypoechoic rim without significant vascularity or definite microcalcifications.Nodule #2: 0.9 x 0.6 x 0.7 cm, predominantly solid nodule with hypoechoic rim without significant vascularity or definite microcalcifications.PARATHYROID GLANDS: Not visualized.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multinodular goiter as described above.


Instruction: Generate impression based on medical findings.

Input: History lymphoma with fever of unknown origin history of ampullary Arceneaux, status post Whipple LIVER: Mildly coarse echogenic liver echotexture without worrisome mass. Stable hepatic cyst. Liver length 16.3 cmBILIARY TRACT: Pneumobilia again noted. No ductal dilatation. Gallbladder absent.PANCREAS: Obscured by overlying gasSPLEEN: No significant abnormalities noted. 12.5 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 12.9 cm in lengthOTHER: Left kidney 12.9 cm in length. No ascites.

Output: Mildly coarse echogenic liver echotexture raises the possibility of fatty infiltration/parenchymal dysfunction without worrisome mass or ductal dilatation. Stable expected pneumobilia. No ascites


Instruction: Generate impression based on medical findings.

Input: 45-year-old with history of left mastectomy. Routine right mammogram was normal earlier today. A palpable area of concern was felt in the right outer breast at posterior depth. Targeted ultrasound was performed for the palpable area which was marked by the clinical service. No suspicious solid or cystic mass is apparent. A few prominent fat lobules were noted.

Output: No sonographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Clinical correlation is recommended for the palpable area of concern as further workup may be warranted if the area is highly suspicious on physical exam. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: 33-year-old female with generalized abdominal pain, right upper quadrant pain and elevated white count. Sickle cell. LIVER: Liver is again noted to be enlarged, measuring 21 cm in length. There is no focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal veinGALLBLADDER, BILIARY TRACT: Patient has had a cholecystectomy. Visualized portions of the intra and extra hepatic biliary tract are normal in caliber.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: Very small spleen.

Output: Hepatomegaly as previously noted. No abnormalities to explain patient's pain.


Instruction: Generate impression based on medical findings.

Input: Islet cell transplant LIVER: Pneumobilia noted. Liver length 14.1 cm. Limited interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow. Main portal vein velocity 32 cm/sGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.2 cm in lengthOTHER: Left kidney 10.3 cm in length. Spleen 8.2 cm in length. No ascites.

Output: Pneumobilia noted. No liver mass. Main portal vein patent with normal directional flow. No ascites.


Instruction: Generate impression based on medical findings.

Input: Dermatomyositis. Evaluate hepatic architecture. LIVER: Coarsened hepatic echogenicity with minimally nodular contours. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Status post cholecystectomy.PANCREAS: Obscured by bowel gas.KIDNEYS: The right kidney is 10.1 cm in length. The left kidney is 10.1 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 11.3 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites identified.

Output: Coarsened hepatic echogenicity with minimally nodular contours compatible with chronic liver disease.


Instruction: Generate impression based on medical findings.

Input: Male 66 years old; Reason: eval for etiology of RUQ pain and nausea, r/o gall bladder disease History: RUQ pain, nausea LIVER: The liver measures 15.7 cm in length. There is normal echogenicity of the liver parenchyma. A round well-circumscribed hyperechoic lesion is seen within the right lobe measuring 1.5 cm x 1.8 cm x 1.8 cm. This does not have internal vascular flow. No intrahepatic ductal dilation is seen. The main portal vein is patent with normal hepatopetal flow measured at 19.7 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 1.5 mm. No stones are seen. No pericholecystic fluid. The common bile duct measures 2.5 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 12.1 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 10.9 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen. A renal cyst is seen in the superior pole measuring 3.1 cm x 2.7 cm x 2.9 cm.LEFT KIDNEY: The left kidney measures 10.5 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen. A renal cyst is visualized measuring 3.3 cm x 2.9 cm x 3.1 cm.

Output: 1. No evidence of cholelithiasis or acute cholecystitis.2. A well-circumscribed hyperechoic lesion is seen within the right lobe of the liver favored to be a benign hemangioma.


Instruction: Generate impression based on medical findings.

Input: HCV LIVER: Normal hepatic morphology. Mildly heterogeneous echotexture without mass. Liver length 16.1 cm.BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 8.9 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 10.8 cm in lengthOTHER: Left kidney 11.1 cm in length. No ascites.

Output: Normal noncirrhotic morphology with mildly heterogeneous echotexture without mass or ductal dilatation. No ascites.


Instruction: Generate impression based on medical findings.

Input: 81-year-old male with new onset renal failure. Evaluate perfusion to kidneys. RIGHT KIDNEY: Status post partial nephrectomy compared to the previous ultrasound examination. Normal cortical echogenicity and corticomedullary differentiation. The longest dimension measures 12.2 cm. No calculus, hydronephrosis, or other evidence of obstruction.Right lower pole hypoechoic lesion measuring 0.9 x 0.7 x 1.0 cm and demonstrates a possible blood vessel coursing at the periphery; this lesion corresponds to a hyperdense cyst measuring 55 Hounsfield units on the CT 6/10/2015 (series 4, image 56).LEFT KIDNEY: Normal cortical echogenicity and corticomedullary differentiation. The longest dimension measures 15.6 cm. There are multiple hypoechoic lesions in the left kidney with the largest measuring 4.1 x 3.1 x 2.8 cm, likely benign cyst.OTHER: No significant abnormalities noted.

Output: 1.No evidence of abnormal perfusion or obstruction as clinically questioned.2.Subcentimeter right lower pole hypoechoic lesion as detailed above is present on the recent CT examination and may represent a proteinaceous cyst; however, close interval follow-up is recommended.


Instruction: Generate impression based on medical findings.

Input: 72-year-old male with history of renal transplant, CHF, osteomyelitis, altered mental status. Evaluate for urosepsis. RIGHT KIDNEY: Echogenic atrophic native right kidney secondary to endstage renal disease.LEFT KIDNEY: Echogenic atrophic multicystic native left kidney secondary to end-stage renal disease. The largest cyst measures 2.9 cm without evidence of septation or solid component.TRANSPLANT KIDNEY: Transplant kidney in the right iliac fossa measures 7.9 cm in length. No hydronephrosis. Linear echogenic focus in the proximal collecting system may represent a renal transplant stent, however this is incompletely visualized. There is no perinephric collection.URINARY BLADDER: Collapsed with a Foley catheter in place and possible wall thickening, though accentuated by bladder collapse.OTHER: No significant abnormalities noted.

Output: 1. No hydronephrosis or perinephric collection. Linear echogenic focus in the proximal transplant collecting system could possibly represent a stent catheter, however this is incompletely imaged. This may be further imaged with abdominal radiographs as warranted clinically.2. Collapsed bladder with questionable wall thickening raises a possibility of cystitis. 3. Echogenic multicystic native kidneys consistent with end stage renal disease.


Instruction: Generate impression based on medical findings.

Input: 78-year-old male with tender left testicular mass, leukocytosis, fever, pyuria and hematuria. Evaluate left testicular mass. RIGHT TESTIS: Measures 3.6 cm x 2.1 cm x 2.0 cm and is normal in echogenicity. Right testicular cyst measures 3 mm x 3 mm x 3 mm. Arterial and venous flow is visualized on Doppler exam. LEFT TESTIS: Measures 3.5 cm x 2.4 cm x 2.8 cm and is normal in echogenicity. Arterial and venous flow was visualized on Doppler exam.RIGHT EPIDIDYMIS: Measures 1.9 cm x 1.4 cm x 2.3 cm and contains several cysts, the largest of which is in the epididymal head measuring 1.8 cm x 0.9 cm x 1.5 cm. Appropriate flow is visualized on Doppler exam. LEFT EPIDIDYMIS: Enlarged measuring 1.9 cm x 1.8 cm x 3.5 cm and is heterogeneous in echotexture and hyperemic. Extending from the left epididymis is a the complex cystic structure measuring 5.7 cm x 2.5 cm x 2.8 cm with peripheral vascularity.OTHER: Moderate left hydrocele.

Output: 1. Findings compatible with acute left epididymitis with associated abscess. Moderate left hydrocele. 2. Right testicular and epididymal cysts.


Instruction: Generate impression based on medical findings.

Input: 33-year-old female with generalized abdominal pain. LIVER: Measures 21.0 in length. Hyperechoic focus in the liver thought to represent calcified malignant. Otherwise unremarkable hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: No cholelithiasis. No gallbladder wall thickening, pericholecystic fluid, or biliary ductal dilation. PANCREAS: The pancreas is incompletely imaged due to bowel gas. The imaged portions of the pancreas appear unremarkable. SPLEEN: Unremarkable in size and echogenicity. KIDNEY: Increased renal echogenicity. No hydronephrosis, nephrolithiasis, or solid mass. OTHER: No significant abnormalities noted.

Output: 1. Mildly enlarged liver without evidence of focal lesion or biliary obstruction.2. Mild gallbladder sludge versus small stones without evidence of cholecystitis.3. Increased renal echogenicity suggestive of medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Left neck mass RIGHT LOBE MEASUREMENTS: 4 x 1.8 x 1.4 cmLEFT LOBE MEASUREMENTS: 4.5 x 1.4 x 1 cmISTHMUS MEASUREMENTS: 0.25 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: 0.8 x 0.5 x 0.7 cm well-circumscribed hypoechoic nodule upper pole ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Subcentimeter well-circumscribed hypoechoic upper pole left thyroid nodule. This lesion is amenable to ultrasound-guided percutaneous biopsy. No regional adenopathy.


Instruction: Generate impression based on medical findings.

Input: Rising creatinine RIGHT KIDNEY: Echogenic renal parenchyma without mass, stone, or hydronephrosis. 8.2 cm in length.LEFT KIDNEY: Echogenic renal parenchyma again noted without worrisome mass, stone, or hydronephrosis. Benign renal cyst. Left kidney 9.7 cm in lengthOTHER: Bladder collapsed

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


Instruction: Generate impression based on medical findings.

Input: 42 year old female with epigastric pain, history of gallbladder polyp. LIVER: Normal echogenicity of the liver measuring 13.6 cm in length. No focal hepatic lesions. Main portal vein is patent with appropriate directional flow; peak velocity measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: Two subcentimeter polyps are noted along the nondependent portion of the gallbladder wall, one of which measures 3 mm x 2 mm x 3 mm and the second measures 5 mm x 4 mm x 5 mm. No gallbladder wall thickening. No cholecystic fluid. Common duct measures 4 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Tail of the pancreas is obscured by overlying bowel gas. The remaining visualized portions are unremarkable.RIGHT KIDNEY: Measures 10.2 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Left kidney measures 9.7 cm in length. No hydronephrosis or shadowing calculi are noted.Spleen measures 8.4 cm in length and is normal in echogenicity.

Output: Two subcentimeter gallbladder polyps.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval for signs of cirrhosis or portal hypertension History: Chronic HCV LIVER: The liver measures 13.8 cm in length. The liver is smooth in contour and is normal in echotexture. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.21 m/s.BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. The sonographic Murphy's sign is negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 2 mm in diameterPANCREAS: No significant abnormalities noted.SPLEEN: The spleen measures 14 cm in length and is top normal in size. RIGHT KIDNEY: Kidney measures 12.1 cm in length. Normal echotexture No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 10.6 cm in length. Normal echotexture No hydronephrosis, shadowing calculus or mass.OTHER: No ascites

Output: No focal liver lesions. No ascites.


Instruction: Generate impression based on medical findings.

Input: Prerenal transplant evaluation RIGHT KIDNEY: Atrophic echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Stable right renal cysts Right kidney 9.1 cm in length. LEFT KIDNEY: Atrophic echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Left kidney 7.4 cm in length Complex fluid collection within the inferior left perinephric space measuring 5.2 x 4.1 x 7.7 cm consistent with evolution of previously noted hematoma.OTHER: Bladder nondistended. Moderate ascites with dialysis catheter noted.

Output: Atrophic echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass, stone, or hydronephrosis. Interval decrease in size of loculated complex inferior left perinephric space cystic/fluid collection consistent with resolution of previously noted hematoma.


Instruction: Generate impression based on medical findings.

Input: 55-year-old male with a history of heart failure and lower extremity edema. Evaluate for cirrhosis. LIVER: The liver is mildly coarse and increased in echogenicity. It is normal in size, measuring 16.4 cm. The liver morphology is normal. No focal hepatic lesion or intrahepatic biliary ductal dilatation. Normal hepatopetal portal venous blood flow at 30 cm/sec.GALLBLADDER, BILIARY TRACT: Normally distended gallbladder without gallstones, wall thickening, focal tenderness or pericholecystic fluid. No extrahepatic biliary ductal dilatation with the common duct measuring 6 mm.PANCREAS: The pancreas is obscured by overlying bowel gas shadowing.RIGHT KIDNEY: The right kidney is normal in size, measuring 10 cm without hydronephrosis, shadowing nephrolithiasis or discrete lesion evident. Increased cortical echogenicity.OTHER: The left kidney is normal in size, measuring 12.9 cm without hydronephrosis, shadowing nephrolithiasis or discrete lesion evident. Increased cortical echogenicity.The spleen is normal in size, measuring 11.2 cm.

Output: Coarsened and increased hepatic echogenicity likely related to diffuse fatty infiltration. No focal hepatic lesion or specific findings of cirrhosis.Medical renal disease.


Instruction: Generate impression based on medical findings.

Input: 22-year-old female with fever, elevated AST/ALT, alkaline phosphatase. Evaluate causes of abnormal LFT. LIVER: The liver is enlarged measuring 20.1 cm in length and is normal in echogenicity with no focal hepatic lesions. No intrahepatic biliary ductal dilatation.GALLBLADDER, BILIARY TRACT: Focal echogenic focus along the gallbladder wall with comet tail artifact compatible with focal adenomyoma. No sludge or gallstones. No pericholecystic fluid. Sonographic Murphy's sign is negative. No extrahepatic biliary ductal dilatation. The common duct measures 2 mm in caliber.PANCREAS: The distal body and tail of pancreas are obscured by overlying bowel gas. The remaining visualized pancreas is normal in echogenicity. No pancreatic ductal dilatation.RIGHT KIDNEY: The right kidney measures 11.5 cm in length with no hydronephrosis or nephrolithiasis. OTHER: The left kidney measures 11.9 cm in length with no hydronephrosis or nephrolithiasis. The spleen measures 12.4 cm in length, upper limits of normal.

Output: 1. Hepatomegaly and borderline splenomegaly.2. Focal adenomyoma along the gallbladder wall.


Instruction: Generate impression based on medical findings.

Input: 52-year-old female with right breast palpable lump for 1-2 months. The patient also has a history of congestive heart failure and sarcoidosis. Three standard views of both breasts with 3 spot compression views of right breast and 2 spot compression views of left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses (BiRads Density Category C), unchanged in pattern and distribution. An 18 mm focal asymmetry with irregular margins is present at the 2:00 position of the right breast which persists with spot compression. This corresponds to the palpable tiangular marker. A mole marker is placed over the sebaceous cyst in the left axilla. Spot compression of an oval enlarged right axillary lymph node was performed. Additional spot compression of an asymmetry in the left central breast mid depth disperses into benign-appearing glandular tissue. ULTRASOUND

Output: Palpable right breast mass as described above is suspicious for neoplasm. Additionally an 8 mm lymph right axillary lymph node demonstrates cortical thickening which could represent malignancy or possibly sarcoidosis given the patient's clinical history. Ultrasound-guided biopsies of both the right breast mass and right axillary lymph node are recommended. This was discussed with the patient who agreed to participate in the Allan Penn research trial. Sharon Harris will contact the patient with further instructions. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on medical findings.

Input: Right breast ultrasound performed, patient scheduled first stereotactic biopsy of right breast calcifications in the upper inner quadrant. A targeted right ultrasound was performed for the mammographic area of concern, in the central and upper inner breast. Multiple simple and clustered cyst identified in the right breast 12:00 position, clustered cyst measuring 1.2 x 0.5 cm and a small complex cyst measuring 4 x 3 mm.No suspicious solid mass or a correlate to the cluster of calcifications in the upper inner quadrant identified.

Output: No definite ultrasound correlate identified to the cluster of calcifications in the right breast. Simple and clustered cyst identified in the right breast 12:00 position. BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: 51 year-old female with large left forearm IV infiltration. Assess size of infiltrate, rule out hematoma. In the left upper extremity there is infiltrating edema in the subcutaneous soft tissues diffusely from the level of the biceps to the wrist.Mild infiltrating edema in the subcutaneous tissues in the right elbow.No loculated fluid collection is noted.

Output: Infiltration edema in the bilateral upper extremity soft tissues, left greater than right as described above. Correlation with clinical history is suggested to exclude cellulitis. No loculated fluid collection or a collection that would be amenable to drainage is noted.


Instruction: Generate impression based on medical findings.

Input: Male 35 years old; Reason: to determine NASH staging History: none LIVER: The liver measures 21.9 cm in length. There is significantly increased echogenicity of the liver parenchyma which appears heterogeneous. There is also slight nodular appearance. No focal hepatic lesions. No intrahepatic ductal dilation is seen. The main portal vein is patent with normal hepatopetal flow measured at 22.9 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 2.0 mm. A single shadowing and movable stone is seen within the gallbladder. This measures 0.5 cm x 0.3 cm. No pericholecystic fluid. The common bile duct measures 3.5 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 13.1 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 11.9 cm in length. The cortex hasnormal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 12.5 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.

Output: The liver has significantly increased echogenicity compatible with fatty infiltration. There is also some slight nodularity which may represent early cirrhotic morphology. No worrisome masses are seen within the liver however detection of masses is limited due to significantly echogenic liver.


Instruction: Generate impression based on medical findings.

Input: Nausea vomiting right upper quadrant pain LIVER: 2.9 x 2.7 x 3 cm mixed echogenicity within segment 7 of the right lobe of the liver; this lesion is unchanged. Background liver again demonstrates heterogeneous echotexture. Liver length 15.5 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.7 cm in length OTHER: Left kidney 10.5 cm in length. Spleen 8.8 cm in length. No ascites.

Output: Cholelithiasis without acute inflammation or ductal dilatation. Stable right hepatic lobe mass lesion consistent with FNH. Background liver parenchyma consistent with chronic liver disease. No ascites.


Instruction: Generate impression based on medical findings.

Input: 21-year-old female with history of thyroid cysts, enlarged thyroid on exam RIGHT LOBE MEASUREMENTS: 4.4-cm x 2.0 x 1.1 cmLEFT LOBE MEASUREMENTS: 5.1 cm x 1.6 cm x 0.6 cmISTHMUS MEASUREMENTS: 3 mm in thicknessRIGHT LOBE: Hypoechoic nodule in the upper pole measures 3 mm x 2 mm x 2 mm containing echogenic foci likely inspissated colloid.LEFT LOBE: Hypoechoic cystic appearing nodule at the inferior pole measures 3 mm x 3 mm x 4 mm containing internal echogenic foci likely inspissated colloid.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Right neck level 3 benign-appearing lymph node measures 6 mm x 2 mm x 9 mm.OTHER: No significant abnormality noted.

Output: Findings suggestive of bilateral colloid nodules.


Instruction: Generate impression based on medical findings.

Input: 57-year-old woman presents with self palpated left axillary lymph node. No family history of cancer. DIAGNOSTIC MAMMOGRAM

Output: No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: Male 23 years old Reason: s/p renal transplant History: elevated cr Ultrasound guidance and technical assistance was provided for a renal allograft in the left iliac fossa. 3 passes were made. The procedure was successfully completed.

Output: Successful ultrasound guided biopsy of the renal allograft in the left iliac fossa


Instruction: Generate impression based on medical findings.

Input: 68-year-old female with history of bilateral thyroid nodules. Nodules suspicious for malignancy. Preoperative lymph node mapping. RIGHT LOBE MEASUREMENTS: 1.7 x 1.7 x 5.1 cmLEFT LOBE MEASUREMENTS: 4.4 x 2.0 x 1.9 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: There is right thyroid gland nodule with irregular borders, increased vascularity, and calcifications measures 1.1 x 1.3 x 1.4 cm.LEFT LOBE: There is a bunch of form left thyroid lobe nodule which measures 1.8 x 1.3 x 1.1 cm most likely a colloid nodule.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Right level 1 lymph node measures 1.2 x 0.9 x 0.4 cm.Right level 2 lymph node measures 1.6 x 0.5 x 0.3 cm.Left level 1 lymph node measures 1.3 x 1.7 x 0.6 cm.Left level 2 lymph node measures 1.3 x 0.5 x 0.3 cm.Left level 3 lymph node measures 0.9 x 0.4 x 0.4 cm.Left level 5 lymph node measures 0.8 x 0.5 x 0.2 cm.OTHER: No significant abnormality noted.

Output: 1.Suspicious right thyroid lobe nodule.2.Benign-appearing left thyroid lobe nodule.3.Bilateral enlarged lymph nodes.


Instruction: Generate impression based on medical findings.

Input: Male; 63 years old. Reason: ascites History: distention Cirrhotic liver morphology. Mild ascites, redistributed but overall stable to slightly decreased from prior.

Output: Mild ascites, stable to slightly decreased from prior.


Instruction: Generate impression based on medical findings.

Input: Hepatitis C LIVER: Coarse echotexture again noted. No mass. Liver length 16 cmGALLBLADDER, BILIARY TRACT: Stable gallbladder subcentimeter polyps. The largest measures 0.3 x 0.4 x 0.2 cm.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Echogenic renal parenchyma again noted with multiple cysts. No hydronephrosis. Right kidney 9.1 cm in length.OTHER: Echogenic left renal parenchyma again noted with multiple cysts. Left kidney 11.9 cm in length. Spleen 11.2 cm in length. No ascites.

Output: Stable coarse liver echotexture consistent with chronic liver disease without mass or ductal dilatation. No ascites. Stable gallbladder subcentimeter polyps. No change in echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without obstruction.


Instruction: Generate impression based on medical findings.

Input: 34-year-old female with right upper quadrant pain. Nausea, vomiting and pancreatitis. LIVER: Irregularly echogenic which may be due to fatty infiltration. No gross focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: The gallbladder contains dependent stones and sludge without significant wall thickening. No definite pericholecystic fluid on this exam. The biliary tract is normal in caliber.PANCREAS: Diffusely enlarged. No loculated peripancreatic fluid collections.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.

Output: Gallstones without obvious complication.Enlarged pancreas.


Instruction: Generate impression based on medical findings.

Input: 56-year-old female patient with history of breast cancer. Evaluate thyroid nodules. RIGHT LOBE MEASUREMENTS: 4.2 x 1.6 x 2.0 cm.LEFT LOBE MEASUREMENTS: 3.6 x 1.6 x 1.7 cm.ISTHMUS MEASUREMENTS: 2 mm in thickness.RIGHT LOBE: The right thyroid lobe contains a 0.5 x 0.4 x 0.5 cm spongiform nodule within the right lower pole, unchanged in size.LEFT LOBE: The left thyroid lobe is without focal thyroid lesion.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There are scattered nonspecific lymph nodes within the left level four lymph node station, with the largest measuring 0.6 x 0.3 x 1.8 cm. A right level 1B lymph node with a fatty hilum measures 1.8 x 0.7 x 2.9 cm.OTHER: No significant abnormality noted.

Output: 1. Unchanged subcentimeter right thyroid nodule.2. Nondescript scattered left cervical lymph nodes.


Instruction: Generate impression based on medical findings.

Input: 69-year-old female with enlarged thyroid. Evaluate RIGHT LOBE MEASUREMENTS: 7.8 x 3.9 x 3.4 cmLEFT LOBE MEASUREMENTS: 8.1x 3.2 x 3.4 cmISTHMUS MEASUREMENTS: 0.8 cmRIGHT LOBE: Both thyroid lobes are diffusely enlarged with coarse echotexture consistent with patient's known thyroiditis. Vascularity is also increased.LEFT LOBE: Both thyroid lobes are diffusely enlarged with coarse echotexture consistent with patient's known thyroiditis. Vascularity is also increased.ISTHMUS: Coarse echotexture. On the left side of the isthmus there is a predominantly solid nodule measuring 2.8 x 2.6 x 1.6 cm; although this nodule is more solid compared of the previous examination, there has been no significant interval change in the size of this nodule.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable enlarged thyroid with diffuse coarse echotexture and stable left isthmic solid nodule.


Instruction: Generate impression based on medical findings.

Input: 70 year-old male with cirrhosis. Evaluate liver for for cirrhosis, evidence of HCC. LIVER: Nodular contour and heterogeneous echotexture of the liver measuring 16.3 cm in length. No focal hepatic lesions. Main portal vein is patent with appropriate directional flow; peak velocity measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. Common duct measures 6 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Not well-visualized due to overlying bowel gas.RIGHT KIDNEY: Measures 10.6 cm in length. No hydronephrosis or shadowing calculi are noted. Cyst at the midpole measures 2.3 cm x 2.5 cm x 3.3 cm unchangedOTHER: Spleen measures 15.5 cm in length and is normal in echogenicity.Left kidney measures 10.4 cm in length. No hydronephrosis or shadowing calculi are noted.Incompletely visualized bilateral pleural effusions.

Output: 1. Cirrhotic liver morphology with no focal hepatic lesions.2. Incompletely visualized bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Heart transplant status, rule out infection to bilateral groins In the right groin area there is a small linear hypoechoic band arising anteriorly from the femoral vessels which could represent a post procedural tract/fluid collection. No suspicious abnormality noted in the left groin area.

Output: As aboveCLINICAL INFORMATION:Retained prior partial impella graft right subclavian, leukocytosisCOMPARISON: NoneTECHNIQUE: Grayscale and Doppler ultrasound of bilateral chest wall performedFINDINGS:Small fluid collection identified in the left upper chest wall measures 2.5 x 1.8 x 0.5 cm. No evidence of any fluid collection or abscess along the right upper chest wall.


Instruction: Generate impression based on medical findings.

Input: Acute kidney injury. RIGHT KIDNEY: The right kidney measures 10.3 cm. The cortex is mildly echogenic. There is a right upper pole exophytic lesion measuring 1.0 x 1.0 x 0.8 cm, probable cysts. There is no hydronephrosis, renal calculus, or suspicious mass.LEFT KIDNEY: Left kidney measures 10.7 cm. The cortex is mildly echogenic. There is no renal calculus, hydronephrosis, or suspicious mass.URINARY BLADDER: No significant abnormalities noted.OTHER: Small volume of ascites.

Output: 1.Echogenic kidneys, compatible with medical renal disease. No hydronephrosis, renal calculus or suspicious mass.2.Small volume ascites.


Instruction: Generate impression based on medical findings.

Input: Female; 18 years old. Reason: eval transplant kidney and native kidney, r/o pyelo (fat stranding, etc) History: fever, s/p renal transplant RENAL TRANSPLANT LOCATION: Right iliac fossa.PERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: The transplanted kidney measures 17.8 cm in length. There is no shadowing renal stone or worrisome renal mass.COLLECTING SYSTEM/URETER: There is minimal hydronephrosis.URINARY BLADDER: The bladder is not distended.VASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels The renal transplant inflow and outflow vessels are patent.OTHER: The native kidneys are atrophic and echogenic. The right native kidney measures 6.4 cm in length. The left native kidney measures 9.0 cm in length. No fluid collections surrounding the native kidneys.

Output: 1.Atrophic, echogenic native kidneys.2.Minimal hydronephrosis of the transplanted kidney. Patent renal transplant vasculature. 3.No evidence of pyelonephritis.


Instruction: Generate impression based on medical findings.

Input: Ms. Lacocque is a 62-year-old female recalled from screening mammogram of 08/31/16 for a posterior depth circumscribed mass in the right breast. A targeted right breast ultrasound was performed for the mammographic area of concern. Two benign lymph nodes are seen in the right breast at the 9:00 position, approximately 9 cm from the nipple. No solid or cystic mass is identified.

Output: Benign intramammary lymph nodes of the right breast. No mammographic or sonographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually, due next in August 2017. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: 25-year-old male with a history of hepatitis B. Evaluate for evidence of cirrhosis. LIVER: The liver is normal in morphology, echogenicity and size, measuring 18 cm in craniocaudal dimension. No intrahepatic biliary ductal dilatation or focal hepatic lesion is identified. The liver capsule is smooth. Normal hepatopetal portal venous blood flow is present at 17 cm/sec.BILIARY TRACT: Normal common duct caliber at the hilum, measuring 2 mm. Normally distended gallbladder without wall thickening, pericholecystic fluid, focal tenderness or gallstones.PANCREAS: The visualized portions of the pancreatic body and head are unremarkable. The common bile duct at the pancreatic head is normal in caliber, measuring 3 mm.SPLEEN: The spleen is mildly enlarged, measuring 12.7 cm in length.RIGHT KIDNEY: The right kidney measures 11 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident. Color Doppler demonstrates hilar blood flow. OTHER: The left kidney measures 11.7 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident. Color Doppler demonstrates hilar blood flow.

Output: The spleen is top-normal in size which is non-specific. Otherwise, no sonographic evidence of advanced liver disease, as clinically questioned. No focal hepatic lesion.


Instruction: Generate impression based on medical findings.

Input: 73 year-old female with abdominal pain and pancreatitis. Are there gallstones? LIVER: Increased echogenicity of the liver is nonspecific, but can be seen in hepatic steatosis. Moderate hepatomegaly. The liver measures 21.2 cm in diameter. Portal vein flow is hepatopetal. Small amount of ascites.GALLBLADDER, BILIARY TRACT: Note is made of numerous punctate dependent gallstones within the gallbladder, including the body and gallbladder neck. There is mild nonspecific gallbladder wall thickening, measuring 3 mm in diameter. Sonographic Murphy sign is negative. The common duct measures 3 mm in diameter. No common duct stones are seen. PANCREAS: The pancreas appears slightly enlarged with decreased echogenicity consistent with the stated history of pancreatitis. The pancreas is partially obscured by overlying bowel gas.RIGHT KIDNEY: No significant abnormalities noted.OTHER: Foley catheter in place.

Output: 1. Findings consistent with the stated history of acute pancreatitis.2. Hepatomegaly with a small amount of ascites.3. Increased echogenicity of the liver is nonspecific, but can be seen in hepatic steatosis.4. Gallstones without evidence of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Female; 67 years old. Reason: elevated LFT's; liver ultrasound History: Lymphoma and elevated LFT's LIVER: The liver measures 18.7 cm in length. The liver contour is smooth. The parenchyma is diffusely increased in echogenicity and demonstrates a coarsened echotexture. The right lobe of liver, adjacent to the gallbladder fossa is a geographic area of increased echogenicity likely represents focal fatty infiltration or fibrosis. There is no ascites.The main portal vein is patent with hepatopetal flow and a peak velocity of 0.16 m/sec.BILIARY TRACT: The gallbladder is normal in appearance. The common duct measures 3 mm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The pancreas is normal in appearance. The body and tail are obscured by overlying bowel gas.SPLEEN: The spleen measures 12.6 cm in length.RIGHT KIDNEY: The right kidney measures 10.5 cm in length. The cortex is normal in echogenicity. There is minimal hydronephrosis. No shadowing stone or worrisome renal mass is identified. LEFT KIDNEY: The left kidney measures 10.9 cm in length. The cortex is normal in echogenicity. There is mild hydronephrosis. A ureteral stent is seen within the collecting system. No shadowing renal stone or worrisome mass is identified.OTHER: A ureteral stent is seen within the nondistended bladder.

Output: 1.Mild hepatomegaly.2.Increased echogenicity and coarse echotexture compatible with hepatic dysfunction/fatty infiltration.3.Bilateral hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 63-year-old male with history of hepatitis B, s/p liver transplant. Evaluate for trauma. LIMITED ABDOMENLIVER: 16.8 cm length. Again noted is heterogeneous echotexture, and a small stable cyst. No focal masses.BILIARY TRACT: Gallbladder is surgically absent. No intrahepatic or extrahepatic biliary dilatation.PANCREAS: Obscured by bowel gas.SPLEEN: 11.6 cm length. RIGHT KIDNEY: 9.3 cm in length. No hydronephrosis or hydroureter.OTHER: Left kidney 10.4 cm in length. Left lower pole cyst, measuring 2.5 x 3.8 x 2.7 cm. No hydronephrosis.

Output: Patent vasculature, with no focal liver masses or other significant abnormality. Unchanged exam.


Instruction: Generate impression based on medical findings.

Input: Status post thyroidectomy for follicular carcinoma with increased uptake on PET/CT within left thyroid bed, right supraclavicular space, and left cervical chain RIGHT LOBE: Status post thyroidectomy without mass.LEFT LOBE: Status post thyroidectomy. 0.7 x 0.7 x 1 cm hypoechoic nodular focus within the left thyroid bed.ISTHMUS: Status post thyroidectomy without massPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Status post thyroidectomy. Hypoechoic nodular focus within the left thyroid bed. This focus will be biopsied today. No regional adenopathy. Specifically, no abnormality appreciated within the right supraclavicular region or left cervical nodes.


Instruction: Generate impression based on medical findings.

Input: Neutropenia with Dr. urea RIGHT KIDNEY: Markedly echogenic renal parenchyma without mass, stone, or hydronephrosis. Right kidney 10.5 cm in lengthLEFT KIDNEY: Markedly echogenic renal parenchyma without mass, stone, or hydronephrosis. Left kidney 8.7 cm in length.OTHER: Bladder nondistended. Moderate ascites. Bilateral pleural effusions.

Output: Markedly echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or hydronephrosis. No evidence for abscess or acute inflammatory process. Moderate ascites. Bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Asymptomatic female with dense breasts presents for whole breast ultrasound for dense breast screening. 3-D whole breast ultrasound was performed for both breasts and images were reviewed on an independent workstation. There is no solid mass identified. A few simple cysts are seen in both breasts.

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


Instruction: Generate impression based on medical findings.

Input: 77 year old female who was recalled from screening mammogram for right lower inner quadrant cluster of increasing calcifications and partially circumscribed subcentimeter mass in the right central outer breast. Family history of breast carcinoma in her mother at age 70. An ML view and two spot compression and two spot magnification 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. The previously seen lower inner quadrant calcifications are vascular in etiology on spot magnification compression images. The previously seen partially circumscribed subcentimeter mass in the right central outer breast persists on spot compression images.ULTRASOUND

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


Instruction: Generate impression based on medical findings.

Input: Nausea vomiting LIVER: Mildly enlarged liver with mildly heterogeneous echotexture without mass. Liver length 19.2 cm.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. Minimal extrahepatic ductal prominence without distal obstructing lesion; favor benign chronic etiology.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.6 cm in lengthOTHER: Left kidney 9.6 cm in length. Spleen 8.6 cm in length. No ascites.

Output: Mild hepatomegaly with mildly heterogeneous echotexture suggestive for parenchymal dysfunction without mass or significant ductal dilatation status post cholecystectomy. No ascites.


Instruction: Generate impression based on medical findings.

Input: 70-year-old female with right sided abdominal pain. LIVER: Liver is normal in echotexture and upper normal in size. No focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: The biliary tract is normal in caliber. The gallbladder is well-visualized and appears unremarkable.PANCREAS: There is mild dilatation of the pancreatic duct without obstructing mass or calculus identified.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: Echogenic with significant parenchymal thinning and cysts as previously identified. No hydronephrosisOTHER: Left kidney is echogenic with parenchymal thinning and cysts as previously identified.. No hydronephrosis.

Output: 1. Normal gallbladder.2. Mild dilatation pancreatic duct of uncertain significance.3. Echogenic kidneys with parenchymal thinning and cysts.


Instruction: Generate impression based on medical findings.

Input: Thyroid carcinoma status post resection RIGHT LOBE: Status post thyroidectomy without worrisome mass. Stable postoperative echogenic focus within the right thyroidectomy bed measuring 1.3 x 0.4 x 0.4 cm.LEFT LOBE: Status post thyroidectomy without worrisome massISTHMUS: Status post thyroidectomy without worrisome massPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable examination post thyroidectomy without worrisome mass or regional adenopathy.


Instruction: Generate impression based on medical findings.

Input: Multinodular goiter RIGHT LOBE MEASUREMENTS: 1.7 x 1.5 x 4.5 cmLEFT LOBE MEASUREMENTS: 2.4 x 1.4 x 5.7 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant change in left thyroid nodules. Dominant mixed cystic and solid nodule measures 1.9 x 1 x 1.9 cm.ISTHMUS: No change in spongiform isthmic nodule measuring 1.4 x 0.7 x 1.6 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable left and isthmic thyroid nodules. No regional adenopathy.


Instruction: Generate impression based on medical findings.

Input: 73-year-old female with acute renal failure. RIGHT KIDNEY: Measures 9.9 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. LEFT KIDNEY: Measures 12.0 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. URINARY BLADDER: Collapsed with a Foley catheter in placeOTHER: No significant abnormalities noted.

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


Instruction: Generate impression based on medical findings.

Input: Antiphospholipid syndrome. Recurrent GI bleed. Evaluate for mesenteric thrombosis. Evaluation of portal vein only requested. LIVER: Non-cirrhotic liver morphology. Normal parenchymal echogenicity. No focal hepatic lesions. Patent portal vein with normal flow velocity and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Normal appearance of the gallbladderPANCREAS: No sonographic abnormality evident in the visualized pancreatic head and neck. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney is 7.6 cm in length. The left kidney is 8.2 cm in length. The renal parenchyma is echogenic bilaterally. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 10.6 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites.

Output: 1. Patent portal vein.2. Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: 60-year-old male with cirrhosis. Screen for HCC. Limited evaluation, particularly of the liver at the dome, due to technical factors including poor patient breath holding and bowel gas. Within this limitation, the following observations are made.LIVER: Cirrhotic liver morphology. No definite focal hepatic lesion. Liver measures 13 cm in length. Main portal vein is patent with normal directional flow. Patent TIPS visualized. No intrahepatic biliary ductal dilation.GALLBLADDER, BILIARY TRACT: Normal appearance of the gallbladder. Common bile duct measures 2 mm.PANCREAS: Poorly visualized due to overlying bowel gas.RIGHT KIDNEY: Right kidney is 9.9 cm in length. No hydronephrosis.OTHER: Left kidney is 11.7 cm in length. No hydronephrosis.Spleen is 15.3 cm in length. No focal splenic lesions.No ascites.

Output: Limited examination without evidence of focal liver lesion.


Instruction: Generate impression based on medical findings.

Input: Female; 84 years old. Reason: concern for abscess History: indurated wound Diffuse subcutaneous edema of the lower back in the area of induration. No fluid collection is identified.

Output: Diffuse subcutaneous edema without drainable abscess.