Instruction: Generate impression based on medical findings.

Input: 52-year-old female who is pre-op for right sided parathyroid adenoma. Evaluate for thyroid nodules. RIGHT LOBE MEASUREMENTS: 1.4 x 2.2 x 4.2 cmLEFT LOBE MEASUREMENTS: 2.0 x 2.4 x 4.5 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: In the right lobe of the thyroid there is an ovoid, hypoechoic nodule measuring 0.6 x 1.2 x 1.3 cm which is nondescript in appearance although there is a suggestion of comet tail artifact as seen with colloid. Review of the prior study demonstrates that this was more cystic in 2013 but unchanged in size measuring 0.8 x 1.2 x 1.3 cm. There is at least one other small simple-appearing cyst as well as.LEFT LOBE: Occupying a significant portion of the left lobe is a large predominantly solid nodule with cystic components measuring 1.9 x 2.5 x 2.7 cm. This has comet tail artifact consistent with colloid. There is difficult to measure on the prior study but this mass was present. Adjacent to this is a smaller 0.8 x 0.9 x 1.1 cm complex cystic nodule with clear comet tail artifact consistent with colloid. This was also present on the prior exam and is not significantly changed in size or appearance.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: There is a large, hypoechoic mass posterior to the right lobe of the thyroid measuring 1 x 1.2 x 2.7 cm consistent with parathyroid adenoma.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Bilateral thyroid nodules. These appear likely to represent colloid nodules.2. Right extrathyroidal mass.US GUIDED FNA, US THYROID; 3/25/2016 10:32 AMCLINICAL INFORMATION AND PRE-OPERATIVE DIAGNOSIS: Right parathyroid adenoma. Bilateral thyroid nodules.POST-OPERATIVE DIAGNOSIS : Same OPERATORS: Doctors Paushter; I, the attending physician, Dr. Paushter, performed the entire procedure.TECHNIQUE: Following a discussion of the procedure with the patient, including its risks, benefits, alternatives and steps to prevent infection, an informed written consent was obtained and documented in the patient's chart. The time-out form was completed to confirm patient identity and side/type of procedure.Localizing US demonstrated previously described bilateral nodules.. The skin over the target area was cleansed with chlorhexidine. Transducer was sterilely sheathed. Local anesthesia was obtained using 1% lidocaine, superficially and at depth. RIGHT side: Using aseptic technique, and continuous ultrasound guidance, the lesion was sampled using 25 gauge needles. 3 fine needle aspirations were performed. Due to capsular deflection of the needle and motion of the nodule, this biopsy was extremely difficult.LEFT side: Using aseptic technique, and continuous ultrasound guidance, the lesion was sampled using 25 gauge needles. 2 fine needle aspirations were performed.Cytology was present to confirm specimen adequacy. Specimen was handed to cytology. The patient tolerated the procedure well without immediate complications. Routine post procedure instructions were communicated to the patient.COMPLICATIONS: NoneESTIMATED BLOOD LOSS: Less than 5 cc. An adhesive bandage was placed on the patient’s skin.


Instruction: Generate impression based on medical findings.

Input: 66-year-old female presents for evaluation of her liver after recent CT examination. LIVER:Measures 18.3 cm. There is markedly increased echogenicity, limiting the penetration of the sound beam through the liver and limiting the sensitivity of the examination. No ascites or intrahepatic biliary dilation. No definite masses. Portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: Gallbladder is poorly visualized given limited penetration of the sound beam through the liver. Appears to be nondistended with an anechoic lumen. No definite stones or sludge. No pericholecystic fluid.PANCREAS: Evaluation the pancreas limited due to overlying bowel gas.SPLEEN: Measures 7.3 cm without sonographic abnormalities.KIDNEYS: Right kidney measures 10.9 cm. Left kidney measures 10.4 cm. Normal echogenicity. No shadowing calculi, hydronephrosis, or focal mass. OTHER: No significant abnormality noted.

Output: 1. Markedly increased echogenicity of the liver consistent with fatty infiltration and chronic liver disease/parenchymal dysfunction. Increased echogenicity limits sensitivity for detection of masses. If a mass is clinically suspected, then dedicated cross sectional imaging is recommended.


Instruction: Generate impression based on medical findings.

Input: History of left renal cancer, suprapubic tube placement. Limited images of the bladder for intraoperative guidance for suprapubic tube placement demonstrate echogenic debris throughout the bladder. Additional nonspecific solid appearing material layers dependently within the bladder. Catheter balloon seen in the bladder on postprocedural images.

Output: Ultrasound images for intraoperative guidance for suprapubic tube placement. Solid, dependent material within the bladder which is nonspecific and could reflect blood products, though neoplasm is not excluded and continued follow-up is recommended.


Instruction: Generate impression based on medical findings.

Input: Chronic kidney disease status post right nephrectomy RIGHT KIDNEY: AbsentLEFT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 9.5 cm in length.OTHER: Bladder nondistended

Output: Echogenic left renal parenchyma suggestive for medical renal disease/parenchymal dysfunction without mass, stone, or obstruction.


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 suspicious 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: 45-year-old female patient with elevated LFTs. Question of cholelithiasis or hepatic congestion. LIVER: The liver measures 19.9 cm in length. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: There is a single gallstone, but no gallbladder wall thickening or pericholecystic fluid. Sonographic Murphy's sign is negative. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 2 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 12.6 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 13.1 cm in length. No evidence of hydronephrosis.The spleen measures 17 cm in length. A splenic calcification is present.

Output: 1. Mild hepatosplenomegaly.2. Cholelithiasis without sonographic evidence of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Patient is a 34-year-old female with known right breast cancer, on neoadjuvant therapy, who presents for ultrasound examination of treatment response. A right ultrasound was performed at the area of the known breast cancer. At 10:00 location, posterior right breast, 12 cm from the nipple, there is a 11 x 12 x 12 mm hypoechoic irregular mass with spiculated margin, compatible with known cancer, which previously measured 19 x 17 x 14 mm.

Output: Interval reduction in size of the known right breast cancer. Results and recommendations were discussed with the patient.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


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 suspicious solid mass identified. Numerous bilateral simple and complicated cysts are present.Screening ultrasound exams are optimally performed when prior breast imaging studies are available to compare. If the patient's prior studies can be submitted, then an addendum to this report will be made.

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


Instruction: Generate impression based on medical findings.

Input: 82-year-old male with history of right upper back soft tissue swelling/mass which he first noticed approximately 3 weeks ago. No pain, no limited range of motion, no fevers, no redness or any other complaints. Physical exam reveals a fluctuant, nontender soft and relatively mobile approximately 6 to 8-cm wide area of masslike swelling in the right upper back just deep to the skin surface. No overlying redness or crepitus.Ultrasound shows a large, approximately 5-10 cm structure within the subcutaneous soft tissues between the skin and the chest wall. It appears separate from the underlying ribs and chest wall, and has a clearly defined interface with the adjacent soft tissues. The structure contains relatively homogeneously isoechoic material that causes dirty shadowing and partially obscures its posterior extent. Although the relatively high acoustic impedance of this structures internal contents limits evaluation, we favor a benign etiology such as epidermoid inclusion cyst.

Output: Findings suggestive of benign etiology, such as a large epidermoid inclusion cyst.


Instruction: Generate impression based on medical findings.

Input: Ms Li is a 20-year-old female presenting with a non-tender left breast lump. On the physical exam, there is nodularity in the upper periareolar left breast in patient's area of palpable concern.Targeted ultrasound of the left breast 12:00 position 1 cm from the nipple reveals no suspicious solid or cystic mass.

Output: No sonographic evidence for malignancy. The patient should follow up with her primary care physician as clinically warranted, presuming these results are concordant with the physical exam findings. All results and recommendations were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on medical findings.

Input: Thyroid nodule RIGHT LOBE MEASUREMENTS: 4.1 x 1.4 x 1.4 cmLEFT LOBE MEASUREMENTS: 7.7 x 4.1 x 5.3 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: Large predominately solid nodule occupying much of the left thyroid gland measuring 7.3 x 4.0 x 5.5 cm. Coarse internal calcification noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Large predominantly solid nodule occupying much of the left thyroid gland. This lesion is amenable to ultrasound-guided biopsy. No regional adenopathy.


Instruction: Generate impression based on medical findings.

Input: 88-year-old female patient with right chest wall fullness and right arm swelling. History of left breast mastectomy in 2007 for IDC and right axillary lymph node dissection in 2009. Family history of breast cancer in maternal aunt at 58 years of age. A right ultrasound was performed for the patient’s area of concern in the right axilla and right breast. There is no solid or cystic mass identified.

Output: No sonographic evidence for malignancy.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: Male 64 years old; Reason: Follow up previously noted thyroid mass and right cervical lymph node. RIGHT LOBE MEASUREMENTS: 4.6 x 1.9 x 1.6 cm.LEFT LOBE MEASUREMENTS: 4.3 x 2.5 x 2.0 cm.ISTHMUS MEASUREMENT: 0.5 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: Again noted is a round solid nodule measuring approximately 1.4 x 1.2 cm which is stable in appearance when compared to the prior examination. Of note, these measurements are considered stable the prior measurements are corrected.ISTHMUS: No significant abnormality noted.LYMPH NODES: Again noted is a right level III lymph node measuring approximately 1.1 x 0.5 cm which appears stable in appearance to the prior study.OTHER: No significant abnormality noted.

Output: 1.Stable round solid nodule of the left lobe of the thyroid 2.Stable right level 3 mildly enlarged lymph nodes; favor benign etiology.


Instruction: Generate impression based on medical findings.

Input: 60-year-old male with renal cysts, evaluate stability, size, mass or suspicious lesion. History of weight loss, fatigue. RIGHT KIDNEY: Measures 10.8 cm in length. Increased renal echogenicity. 2.2 x 2.1 x 1.9 cm renal cyst with a prominent solid component is indeterminate and warrants further investigation. An adjacent cyst measuring 1.7 x 1.9 x 1.8 cm demonstrates no septation or solid component. No hydronephrosis.LEFT KIDNEY: Measures 11.4 cm in length. Multiple left renal cysts measuring up to 2.3 cm without septation or solid component. Increased echogenicity without hydronephrosis.URINARY BLADDER: Incompletely distended without focal abnormality. OTHER: No significant abnormalities noted.

Output: 1. Right renal inferior pole cyst with a prominent solid component is indeterminate and warrants further investigation with a dedicated renal protocol contrast enhanced MRI or CT. Additional renal cysts are without suspicious features. 2. Increased renal echogenicity consistent with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: History melanoma with radiation exposure as a child. RIGHT LOBE MEASUREMENTS: 5.4 x 2.4 x 1.7 cmLEFT LOBE MEASUREMENTS: 7.2 x 4.2 x 3.2 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: 2.4 x 1.8 x 1.3 cm predominantly solid nodule with rim and possible internal calcifications and somewhat irregular borders.LEFT LOBE: 4.5 x 3.5 x 3.2 cm predominantly solid nodule occupying much of the left thyroid gland.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Bilateral dominant indeterminate thyroid nodules; both nodules are amenable to ultrasound-guided FNA biopsy. No regional adenopathy.


Instruction: Generate impression based on medical findings.

Input: Reason: worsening renal function RIGHT KIDNEY: The right kidney measures 12.8 cm in length. No evidence of hydronephrosis or stones.LEFT KIDNEY: Non-visualized.OTHER: Poorly distended urinary bladder. Small volume of ascites.

Output: Normal appearing right kidney without hydronephrosis. Left kidney not visualized.


Instruction: Generate impression based on medical findings.

Input: Hyperkalemia RIGHT KIDNEY: 9.8 cm in length. The renal parenchyma is echogenic. No hydronephrosis. Subcentimeter renal cysts noted. No suspicious lesions are noted.LEFT KIDNEY: 12.1 cm in length. The renal parenchyma is echogenic. No hydronephrosis. No suspicious lesions are noted.BLADDER: Distended, without significant abnormality noted.OTHER: Small amount of ascites identified. Right pleural effusion partially visualized.

Output: 1. Echogenic renal parenchyma, without hydronephrosis, compatible with medical renal disease.2. Small amount of ascites and right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female 38 years old Reason: gallstones History: epigastric pain LIVER: Liver measures 16.6 cm. Liver has coarse echogenicity which can be seen in diffuse hepatic dysfunction or fatty infiltration. No focal mass. Main portal vein is patent with normal directional flow and peak velocity of 20 cm/s.BILIARY TRACT: No intra or extra hepatic biliary ductal dilatation. Gallbladder is normal in appearance. No gallstones are identified. No gallbladder wall thickening or evidence of cholecystitis. Common bile duct is normal measuring 3 mm. Negative Murphy's sign.PANCREAS: Head of the pancreas is normal in appearance without pancreatic ductal dilatation. Body and tail of the pancreas are obscured by overlying bowel gas.SPLEEN: Spleen is normal in appearance measuring 11.4 cm.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Right kidney measures 10.2 cm. Left kidney measures 9.6 cm.OTHER: No significant abnormalities noted.

Output: 1. No evidence of acute cholecystitis. No gallstones are visualized.2.Liver has coarsened echogenicity which can be seen in diffuse hepatic dysfunction or fatty infiltration.


Instruction: Generate impression based on medical findings.

Input: 77-year-old female with weight loss, Nash LIVER: Measures 18.3 in length. Increased hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: Cholelithiasis without 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: No hydronephrosis, nephrolithiasis, or solid mass. OTHER: No significant abnormalities noted.

Output: 1. Increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease, without discrete focal lesion. 2. Cholelithiasis.


Instruction: Generate impression based on medical findings.

Input: 64-year-old female with right upper quadrant pain. LIVER:Measures 15.2 cm. Increased, coarse echogenicity of the parenchyma. No ascites or intrahepatic biliary dilation. There is an approximately 2.6 x 2.3 x 2.8 cm well-defined hyperechoic lesion in the posterior right lobe.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended with an anechoic lumen. The wall measures 1.9 mm. No pericholecystic fluid, sludge, or stones. Common duct measures 4.1 mm.PANCREAS: Evaluation the pancreas is limited due to overlying bowel gas.SPLEEN: Measures 10.7 cm without sonographic abnormalities.KIDNEYS: Right kidney measures 12.8 cm. Left kidney measures 13.1 cm. Unremarkable echogenicity. No shadowing calculi, hydronephrosis, or focal mass.OTHER: No significant abnormality noted.

Output: 1. Increased, coarse echogenicity of liver parenchyma consistent with chronic liver disease and fatty infiltration/parenchyma dysfunction. No ascites.2. Hyperechoic lesion as described above statistically most likely represents a benign etiology such as a hemangioma. If a malignancy is clinically suspected, then dedicated cross-sectional imaging may be indicated.3. No evidence of cholelithiasis or cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Ms. Warren is a 64-year-old woman with known biopsy proven left breast cancer on hormonal therapy presents for follow-up. On physical exam, there is a palpable hard mass in the left breast centered at the 12:00 position, compatible with known cancer.A targeted left breast ultrasound was performed for the palpable area of concern. In the 12:00 position, 1 cm from nipple, there is a 4.3 x 1.6 x 3.6 cm hypoechoic to isoechoic mass consistent with the known malignancy, previously measuring 3.4 x 1.5 x 3.1 cm. There does not seem to be any significant change in size of this mass, accounting for differences in image acquisition (panoramic views) and technique.

Output: No significant change in size of biopsy-proven cancer in the left breast. Continued surgical management is recommended. The results and recommendations were discussed with the patient.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: 46 year old female with history of left breast benign core biopsy (fibroadenoma) with increasing size of right-sided breast mass and focal asymmetry in the left upper outer breast. Patient is currently asymptomatic. No personal or family history of breast cancer. DIAGNOSTIC MAMMOGRAM

Output: Circumscribed mass in the right breast 10 o'clock position is compatible with a benign cyst. Normal breast parenchyma in the left upper outer breast. No evidence for 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: Female 40 years old; Reason: r/o cholecystitis History: RUQ pain worse w food intake LIVER: The liver measures 18.3 cm in length. There is normal echogenicity of the liver parenchyma. No focal hepatic lesions. No intrahepatic ductal dilation is seen. The main portal vein is patent with normal hepatopetal flow measured at 15.1 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 1.2 mm. No stones are seen. No pericholecystic fluid. Negative sonographic Murphy sign. The common bile duct measures 1.9 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 8.0 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 11.1 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 10.0 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.

Output: 1. No evidence of cholelithiasis or acute cholecystitis.2. Mild hepatomegaly, no worrisome masses or intrahepatic ductal dilation are seen.


Instruction: Generate impression based on medical findings.

Input: 40-year-old male presents with prominent aortic pulse. There is clinical concern for an AAA. ABDOMINAL AORTA: The aorta is patent with normal dimensions.The proximal aorta measures 2.6 x 2.4 cm.The mid aorta measures 1.9 x 1.9 cm.The distal aorta measures 1.8 x 1.9 cm.After the bifurcation the right iliac artery measures 1.2 x 1.3 cm and the left iliac artery measures 1.3 cm.There is no evidence of aneurysm.Doppler flow of the abdominal aorta is within normal limits.OTHER: No significant abnormality noted.

Output: Normal ultrasound of the abdominal aorta.


Instruction: Generate impression based on medical findings.

Input: 29 year-old female with recent elevated liver enzymes and epigastric abdominal pain. LIVER: Normal echogenicity of the liver measuring 13.8 cm in length. No focal hepatic lesions. Main portal vein is patent with appropriate directional flow; peak velocity measures 0.1 m/sec.GALLBLADDER, BILIARY TRACT: Normal echogenicity of the gallbladder. No gallbladder wall thickening. Pericholecystic fluid. Common duct measures 2 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Measures 10.5 cm in length and is normal in echogenicity. No hydronephrosis or shadowing calculi are noted.OTHER: Normal echogenicity of the spleen measuring 8.9 cm in length. Cyst measures 7 mm x 7 mm x 7 mm.Left kidney measures 10.8 cm in length and is normal in echogenicity. No hydronephrosis or shadowing calculi are noted.

Output: Splenic cyst. Otherwise unremarkable examination.


Instruction: Generate impression based on medical findings.

Input: Male 73 years old; Reason: 73M recent scrotal abscess s/p I\T\D with rising LFTs, eval for liver pathology History: as above LIVER: The liver measures 7.0 cm in length. There is increased echogenicity of the liver parenchyma. No focal hepatic lesions. No intrahepatic ductal dilation is seen. The main portal vein is patent with normal hepatopetal flow. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 2.5 mm. There is echogenic material in the gallbladder that could represent sludge or stones.. No pericholecystic fluid. The common bile duct measures 4.7 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: Evaluation spleen is limited on this study.RIGHT KIDNEY: The right kidney measures 10.1 cm in length. The cortex has increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 9.6 cm in length. The cortex has increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: There are trace bilateral pleural effusions study.

Output: 1. Increased echotexture of liver consistent with diffuse parenchymal dysfunction/fatty infiltration. No masses.2. Increased echogenicity of kidneys consistent with medical renal disease/parenchymal dysfunction.3. Sludge or stones in the gallbladder without signs of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Acute and chronic kidney disease RIGHT KIDNEY: Mild echogenic parenchyma. No significant change in mild right hydronephrosis. No worrisome mass or stone. Right kidney 9.4 cm in length.LEFT KIDNEY: Mildly echogenic parenchyma without mass, stone, or hydronephrosis. 13.6 in meters in length.OTHER: Bladder nondistended

Output: Mild echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass or stone. No change in mild right hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 51-year-old male with history of thyroid cancer. Evaluate for recurrence. RIGHT LOBE MEASUREMENTS: Status post thyroidectomyLEFT LOBE MEASUREMENTS: Status post thyroidectomyISTHMUS MEASUREMENTS: Status post thyroidectomyRIGHT LOBE: No significant abnormality noted.LEFT LOBE: Hyperechoic nodular focus in the left thyroid bed unchanged measuring 0.6 x 0.5 x 0.9 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Right level 3-4 lymph node measuring 1.1 x 1.0 x 0.4 cm without significant interval change. Left level 3 lymph node with benign morphologic features also unchanged.OTHER: No significant abnormality noted.

Output: No significant interval change since the prior study.


Instruction: Generate impression based on medical findings.

Input: 24 years old, Male, Reason: evaluate for cholelithiasis History: post prandial abdominal pain, nausea LIVER: The liver measures 16.4 cm in length. The liver parenchyma 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 0.2 m/s. Small subcentimeter calcification within the left lobe of the liver is indeterminate and may represent a granuloma.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 4 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 11.5 cm in length. RIGHT KIDNEY: Kidney measures 11.1 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 12.5 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.

Output: 1.Normal gallbladder and biliary tract with no evidence of cholelithiasis or cholecystitis.2.Subcentimeter calcification in the left hepatic lobe is indeterminate and may represent a granuloma.


Instruction: Generate impression based on medical findings.

Input: Left renal mass RIGHT KIDNEY: Multiple benign cysts again noted. No worrisome mass, stone, or hydronephrosis. Right kidney 11.7 cm in lengthLEFT KIDNEY: 1.9 x 1.6 x 2.1 cm mildly echogenic solid lesion corresponding to the enhancing focus seen on the MR within the midportion of the left kidney. Stable benign left renal cysts. No stone or hydronephrosis. Left kidney 11.9 cm in length.OTHER: Bladder nondistended

Output: Previous seen MR enhancing lesion within the left renal interpolar region can be identified on ultrasound as an mildly echogenic solid lesion on ultrasound which does not fulfill the criteria for a simple cyst; a malignant etiology such as papillary renal cell carcinoma is suspected.


Instruction: Generate impression based on medical findings.

Input: Neck pain and snapping when turning head. The parotid and submandibular glands are clear. Patient is edentulous. Dystrophic calcifications are identified in the tonsils. The carotid arteries are tortuous but there is no focal stenotic lesion identified. Small shotty lymph nodes are present, none are enlarged by size criterion. Small lucencies are present in the thyroid gland, this may be further evaluated with ultrasound if warranted clinically.There are mild degenerative findings present in the cervical spine with decreased disk height and spurs, this is most marked at C6-7 and this results in mild central and foraminal stenosis. Note is also made of a small sclerotic focus in the T2 or vertebral body on the left side. This has a benign appearance suspicious for a bone island, if there is history of neoplasm follow up bone scan is suggested. There are nonspecific patchy opacities probably scarring at the lung apices.

Output: Unremarkable CT study of the soft tissues of the neck. There are mild degenerative findings present in the cervical spine which could be better described as a dedicated study. There is sclerotic focus in the T4 vertebral body on the left side and although the appearance is benign a follow up bone scan may be helpful if warranted clinically.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old. Acute renal failure. Rule out obstruction. RIGHT KIDNEY: The right kidney measures 13.6 cm in length with mildly increased cortical echogenicity. No focal lesion or hydronephrosis.LEFT KIDNEY: The left kidney measures 13.1 cm in length with mildly increased cortical echogenicity. No focal lesion or hydronephrosis.OTHER: The bladder is decompressed.

Output: Increased renal cortical echogenicity compatible with medical renal disease. No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Lower abdominal pain; heart transplant workup LIVER:Mildly coarse echogenic liver echotexture without mass. Liver length 18.1 cm. Prominent hepatic veins. Limited Doppler interrogation the main portal vein demonstrates a patent main portal vein with normal directional flow.GALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatation.PANCREAS: No significant abnormality noted.SPLEEN: No significant abnormality noted. 12.3 cm in length.KIDNEYS: No significant abnormality noted. Right kidney 9.8 cm in length. Left kidney 8.9 cm in length.ABDOMINAL AORTA: No significant abnormality noted.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No significant abnormality noted. No ascites

Output: Mild hepatomegaly associated with coarse liver echotexture suggestive for chronic liver disease. No mass. Cholelithiasis without acute inflammation or ductal dilatation. No ascites.


Instruction: Generate impression based on medical findings.

Input: 70-year-old female with cirrhosis, HCC screening LIVER: Coarse echogenicity of the liver measuring 13.0 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: Shadowing stones within the gallbladder which is not well distended limiting evaluation for wall thickening. No pericholecystic fluid. Sonographic Murphy's sign is negative. Common duct measures 5 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Distal body and tail are obscured by overlying bowel gas. Remaining portions of the visualized pancreas unremarkable.RIGHT KIDNEY: Measures 9.8 cm in length. No hydronephrosis or shadowing calculi noted.OTHER: Normal echogenicity of the spleen measuring 11.8 cm in length.Left kidney measures 10.3 cm in length. No hydronephrosis or shadowing calculi noted.

Output: 1. Coarse echogenicity of the liver suggestive of parenchymal dysfunction/fatty infiltration. No focal hepatic lesions. 2. Cholelithiasis with no definite evidence of cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old. Hx of hydronephrosis, evaluate for stricture. RIGHT KIDNEY: The right kidney measures 11.4 cm in length, with normal echotexture. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.5 cm in length, with normal echotexture. No shadowing stones or hydronephrosis.OTHER: The urinary bladder is not seen, likely decompressed.

Output: No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Reason: Upper abdomen/epigastric pain, recent transplant day +5. History: Upper abdominal pain, epigastric pain, some nausea LIVER: The liver measures 15.9 cm in length. Mildly increased parenchymal echogenicity is suggestive of fatty infiltration/parenchymal dysfunction. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.3 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 biliary ductal dilatation is present. The common bile duct measures 8-9 mm in diameter and tapers distally. No choledocholithiasis is visualized.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 9.0 cm in length. RIGHT KIDNEY: Kidney measures 12.7 cm in length. Normal cortical echotexture. No hydronephrosis, shadowing calculus, or mass.LEFT KIDNEY: Kidney measures 12.1 cm in length. Normal cortical echotexture. No hydronephrosis, shadowing calculus, or mass.OTHER: Trace abdominal ascites.

Output: 1.Mild prominence of the common bile duct which may simply reflect age-related ectasia but may be correlated with liver function tests. No evidence of intrahepatic biliary duct dilatation.2.Echogenic liver suggestive of parenchymal dysfunction/fatty infiltration.3.Trace abdominal ascites.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate evidence of liver fibrosis. History: Hep C LIVER: The liver measures 15.8 cm in length. Coarse, echogenic hepatic parenchymal echotexture. Normal morphology with a smooth contour. The portal vein is patent with normal directional hepatopedal flow, peak velocity of 31.2 cm/s. No focal mass.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted. No intraluminal stones or sludge. The common bile duct measures 0.2 cm. The gallbladder wall measures 0.2 cm. No biliary ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 10.4 cm in length. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 11.2 centers in length. No shadowing stones or hydronephrosis.OTHER: The spleen measures 8.7 cm in length. No ascites.

Output: Coarse, echogenic hepatic parenchyma, consistent with parenchymal dysfunction or chronic liver disease. No evidence of cirrhosis or ascites.


Instruction: Generate impression based on medical findings.

Input: Evaluation of subcutaneous seroma for possible drainage. There is an approximately 37.4 x 11.7 x 1.2 cm long, lenticular loculated fluid collection without increased vascularity along the length of the patient's prior donor site.

Output: 1. Long, lenticular, loculated fluid collection within the subcutaneous tissues along the length of the patient's scar as described above.


Instruction: Generate impression based on medical findings.

Input: Precardiac transplant evaluation. LIVER:The liver parenchyma is coarse and increased in echogenicity compatible with stated history of cirrhosis. It measures 14.4 cm in craniocaudal dimension. There is a multilobulated hypoechoic focus measuring approximately 3 cm in the right liver lobe. Additional hypoechoic round focus near the gallbladder fossa measuring 10 x 6 x 9 mm.Normal hepatopedal portal venous blood flow at 0.3 m/s.No intrahepatic biliary ductal dilatation.GALLBLADDER, BILIARY TRACT: Normally distended gallbladder without wall thickening, pericholecystic fluid or focal tenderness. No extrahepatic biliary ductal dilatation with the common duct measuring 5 mm in short axis.PANCREAS: The visualized portions of the pancreatic head are unremarkable.SPLEEN: The spleen is enlarged measuring 17 cm in length.KIDNEYS: The right kidney measures 11.7 cm in length without hydronephrosis or shadowing nephrolithiasis. The left kidney measures 12 cm in length without hydronephrosis or shadowing calculus.ABDOMINAL AORTA: The proximal abdominal aorta is obscured by overlying bowel gas. The mid abdominal aorta measures 3.1 cm in AP dimension. The distal abdominal aorta measures 1.9 cm in AP dimension. The right and left iliac arteries measure 1.3 and 1.4 cm in AP dimension respectively.INFERIOR VENA CAVA: The visualized IVC is patent.OTHER: Partially contracted urinary bladder with free pelvic fluid. Small volume perihepatic ascites.

Output: 1. Coarse echogenic liver parenchyma compatible with stated history of chronic liver disease/cirrhosis. Splenomegaly.2. Incompletely characterized liver lesions. Dedicated liver CT or MRI with and without contrast contrast is recommended for further characterization.3. Small volume ascites.


Instruction: Generate impression based on medical findings.

Input: No retroperitoneal neuroendocrine tumor with chronic renal disease RIGHT KIDNEY: Mildly echogenic parenchyma without mass, stone, or hydronephrosis. 10.2 cm in lengthLEFT KIDNEY: Mildly echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Stable left renal cyst. Left kidney 8.7 cm in lengthOTHER: Bladder nondistended. Retroperitoneal mixed cystic and solid mass again noted

Output: Mildly echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass, stone, or hydronephrosis. Retroperitoneal mixed cystic and solid mass again noted.


Instruction: Generate impression based on medical findings.

Input: 26-year-old male with history of HBV, evaluate for HCC structural disease. LIVER: Normal echogenicity of the liver measuring 15.9 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: Gallbladder is contracted limiting evaluation for wall thickening. No pericholecystic fluid. Common duct measures 2 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Not well visualized due to overlying bowel gas.RIGHT KIDNEY: Normal echogenicity of the right kidney measuring 10.1 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Normal echogenicity of the spleen measuring 9.3 cm in length.Normal echogenicity of the left kidney measuring 9.2 cm in length. No hydronephrosis or shadowing calculi are noted.

Output: Unremarkable examination.


Instruction: Generate impression based on medical findings.

Input: Reason: 42 year old male with hepatitis C cirrhosis History: variceal bleed LIVER: Coarse, heterogeneous hepatic echotexture along with nodular peripheral contour, consistent with cirrhosis. The liver measures 18.8 cm in length, indicating mild hepatomegaly. The portal vein is patent with normal hepatopedal portal venous blood flow, maximum flow rate 23.6 cm/s.GALLBLADDER, BILIARY TRACT: Echogenic debris in the gallbladder without evidence of inflammation or cholecystitis. The gallbladder wall measures 0.3 cm. The proximal common bile duct measures 0.4 cm. No biliary ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 12.6 cm in length. No hydronephrosis, mass, or stones.LEFT KIDNEY: The left kidney measures 13.2 cm in length. No hydronephrosis, mass, or stones.OTHER: Trace ascites. Splenomegaly, with spleen length measuring 22.3 cm.

Output: 1. Cirrhotic liver, mild hepatosplenomegaly, and trace ascites without focal mass or biliary ductal dilatation.2. Small debris in the gallbladder without evidence of inflammation or cholecystitis.


Instruction: Generate impression based on medical findings.

Input: 77-year-old female with enlarged left thyroid seen on CT, possible cause of dysphagia. RIGHT LOBE MEASUREMENTS: 5.3 x 2.2 x 2.0 cmLEFT LOBE MEASUREMENTS: 7.9 x 5.1 x 4.0 cmISTHMUS MEASUREMENTS: 0.3 cm.RIGHT LOBE: 0.7 x 0.6 x 0.5 cm mixed cystic and solid nodule in the right upper pole and 0.9 x 0.9 x 0.6 cm nodule in the right lower pole, favor benign.LEFT LOBE: Dominant large primarily solid nodule in the left thyroid with coarse calcifications and small cystic spaces measures 5.5 x 3.5 x 3.4 cm. A superior adjacent hypoechoic nodule with somewhat ill-defined margins as well as both micro and macro calcifications measures 1.7 x 1.4 x 1.6 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multinodular thyroid as described above. The smaller more superior hypoechoic nodule on the left in particular is amenable to biopsy as warranted clinically.


Instruction: Generate impression based on medical findings.

Input: 52-year-old male with right upper quadrant pain, hyperbilirubinemia LIVER: Measures 16 cm in length. Mildly increased 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: No hydronephrosis, nephrolithiasis, or solid mass. OTHER: No significant abnormalities noted.

Output: 1.No evidence of cholelithiasis, cholecystitis, or biliary obstruction.2.Increased hepatic echogenicity suggestive of hepatic steatosis or parenchymal disease.


Instruction: Generate impression based on medical findings.

Input: 55-year-old male with concern for abdominal aortic aneurysm ABDOMINAL AORTA: Abdominal artery is patent with appropriate directional flow.Proximal: 2.7 cm in AP dimensionMid: 2.0 cm in AP dimensionDistal: 2.0 cm AP dimensionRIGHT ILIAC ARTERY: Measures 1.3 cm AP dimension.LEFT ILIAC ARTERY: Measures 1.2 cm AP dimension.

Output: Mild abdominal aortic ectasia. No aneurysmal dilatation of the abdominal aorta or right and left iliac arteries are seen.


Instruction: Generate impression based on medical findings.

Input: 24-year-old female with thyromegaly on exam. RIGHT LOBE MEASUREMENTS: 5.4 x 1.9 x 2.5 cm with homogeneous echogenicity and normal parenchymal vascularity.LEFT LOBE MEASUREMENTS: 6.1 x 2.4 x 2.1 cm with homogeneous echogenicity and normal parenchymal vascularity.ISTHMUS MEASUREMENTS: 0.6 cm in AP dimension.RIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not visualizedLYMPH NODES: Mildly prominent lymph nodes bilaterally, which are nonspecific.

Output: Mildly prominent thyroid gland, without suspicious features or nodules.


Instruction: Generate impression based on medical findings.

Input: Female 65 years old Reason: 65 yo with cirrhosis please screen for HCC LIVER: Nodular contour of the liver compatible with known cirrhosis. No focal hepatic mass. Liver measures 13.9 cm. Main portal vein is patent with normal directional flow and a peak velocity of 32 cm/s.BILIARY TRACT: No intra or extra hepatic biliary ductal dilatation. The common bile duct measures 3 mm. No significant gallbladder wall thickening. There is a shadowing gallstone present within the gallbladder. No evidence of acute inflammation of the gallbladder.PANCREAS: Pancreas is normal in appearance. The distal tail the pancreas is secured by overlying bowel gas.SPLEEN: Spleen is normal in appearance measuring 8.5 cm.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Right kidney measures 10.1 cm. Left kidney measures 10.5 cm. OTHER: No significant abnormalities noted.

Output: 1.Nodular contour of the liver compatible with cirrhosis without evidence of a focal mass.2.Cholelithiasis without evidence of cholecystitis.


Instruction: Generate impression based on medical findings.

Input: 59-year-old female with abdominal distention, ascites. Evaluate for portal vein thrombosis. History of metastatic breast cancer. LIVER: Measures 21.7 cm in length. Diffusely abnormal echotexture with several subtle lesions is consistent with diffuse hepatic metastases seen on prior studies.The portal vein is well visualized at the porta hepatis, and is patent in this location with antegrade flow measuring 0.1 m/s. The right and left portal vein branches are also patent. BILIARY TRACT: Collapsed gallbladder with secondary wall thickening. PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.KIDNEY: No significant abnormalities noted. OTHER: Mild ascites.

Output: 1. Limited examination of the portal vein as detailed above demonstrates patency at the porta hepatis. Slow portal venous flow in this region may be secondary to widespread hepatic metastatic disease. 2. Hepatomegaly with diffusely abnormal hepatic echotexture consistent with hepatic metastases seen on prior studies. 3. Mild ascites.


Instruction: Generate impression based on medical findings.

Input: 65 years old, Male, Reason: evaluate for cirrhotic morphology History: HCV, prior HBV LIVER: The liver measures 14.1 cm in length. Echogenicity of the liver is within normal limits. No surface nodularity of the liver to suggest cirrhosis. No focal hepatic lesion identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.2 m/s.BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. The sonographic Murphy's sign is negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 4 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 8 cm in length. RIGHT KIDNEY: Kidney measures 8.6 cm in length. Normal echotexture. No hydronephrosis or shadowing calculus.LEFT KIDNEY: Kidney measures 9.0 cm in length. Normal echotexture. No hydronephrosis shadowing calculus. Small cortical renal cyst measuring 0.7 x 0.5 x 0.5 cm.

Output: No sonographic evidence of cirrhosis or focal hepatic lesion.


Instruction: Generate impression based on medical findings.

Input: Ms. Goodman is a 20-year-old female presenting with bilateral palpable breast masses for the past 6 years. According to the electronic medical record, patient has had multiple prior ultrasounds, a biopsy revealing fibroadenoma in 2013 and recommendations to see a breast surgeon. This history was gathered after the exam was done, as at the time of examination today the patient did not provide any of this history. Upon physical exam of the right breast, at least 3 palpable masses are identified, the largest of which is in the right lower inner breast.Targeted right breast ultrasound is performed for the patient's areas of concerns.- 5 o'clock location: 3.1 x 1.6 x 2.2 cm, compared to 3.3 x 1.8 x 2.6 cm.- 9 o'clock location: 1.6 x 1 .0 x 1.7 cm, compared to 1.8 x 1.1 x 1.8 cm- 10 o'clock location: 1.0 by 0.4 x 1.2 cmUpon physical exam of left breast, at least for palpable masses are identified, the largest of which is in the left lower inner breast.Targeted left breast ultrasound is performed for the patient's area of concerns.- 7 o'clock location: 3.2 x 1.2 x 3.6 cm, compared to 3.7 x 2.0 x 3.5 cm.- 3 o'clock location: 1.1 x 0.7 x 1.2 cm- 12 o'clock location: 0.9 x 0.8 cm, compared to 0.9 x 1.2 cm.- 12 o'clock location: 1.1 x 0.6 cm

Output: Multiple bilateral hypoechoic masses, likely representing fibroadenomata. Surgical consultation is recommended for this patient. All results and recommendations were thoroughly discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation.


Instruction: Generate impression based on medical findings.

Input: 44-year-old female recalled from screening mammogram for bilateral breast masses. No family history of breast cancer. Bilateral ML views and 3 right spot compression views and 2 left spot compression views of bilateral breast masses 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. Within the right upper outer breast there is a well-circumscribed 8 mm mass within the right upper outer quadrant. There is a focal asymmetry within the right breast 6:00, which persists on spot compression images.Within the left breast 12:00, posterior depth, the previously identified focal asymmetry does not persist on spot compression views.A targeted ultrasound was performed of the right breast at 10:00 and 6:00. Within the right breast at 10:00, 5 cm from the nipple, there is a cluster of cysts measuring 0.9 x 0.6 x 0.7 cm. Within the right breast at 7:00, 5cm from the nipple, there is an additional cluster of cysts measuring 0.7 x 0.4 x 0.9 cm. A targeted ultrasound of the left breast at 12:00 identified few simple cysts, the largest measuring 0.6 x 0.4 x 0.4 cm. No suspicious mass is identified.

Output: There are clustered cysts within the right breast at 10:00 and 6:00, for which unilateral ultrasound is recommended in 6 months. No mammographic or sonographic evidence of malignancy within the left breast. Results and recommendation were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months). 3


Instruction: Generate impression based on medical findings.

Input: Hematuria; chronic renal disease RIGHT KIDNEY: Mildly echogenic parenchyma. 1.6 x 1.5 x 1.6 cm echogenic focus arising from the superior pole right kidney. Right kidney 11.6 cm in length. No hydronephrosis or stones.LEFT KIDNEY: Mildly echogenic parenchyma. Multiple renal cysts. No hydronephrosis or stones. Left kidney 10.8 cm in length.OTHER: Bladder nondistended.

Output: Mildly echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without stones or obstruction. Echogenic focus arising from the superior pole of the right kidney; favor benign etiology such as AML.


Instruction: Generate impression based on medical findings.

Input: Cirrhosis. Evaluate for hepatocellular carcinoma. LIVER: Non-cirrhotic liver morphology. Mildly coarsened parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow 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 9.8 cm in length. The left kidney is 9.4 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 9.8 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites identified.

Output: Mildly coarsened hepatic echogenicity compatible with parenchymal dysfunction, without suspicious hepatic lesion identified.


Instruction: Generate impression based on medical findings.

Input: 50 year old asymptomatic female recalled from screening mammogram 03/29/16 for segmentally distributed calcifications in the left lateral breast. An ML view and four spot magnification views of the 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. Again seen are segmentally distributed calcifications in the left breast, spanning approximately 16 cm in AP dimension. There are additional focal asymmetries within this region of calcification in the left upper outer breast. Again seen are an enlarged intramammary lymph node in the left upper outer breast as well as slight prominence of lymph nodes in the left axilla.ULTRASOUND

Output: Redemonstration of segmentally distributed calcifications in the left upper outer breast corresponding to multiple hypoechoic lesions on ultrasound with indistinct margins and increased vascularity, highly suspicious for malignancy. Enlarged intramammary lymph node with markedly increased vascularity at the 2:00 position. Borderline enlarged left axillary lymph nodes. Further workup with bilateral breast MRI and ultrasound guided biopsies of the suspicious left breast lesions and abnormal intramammary lymph node is recommended. Findings and recommendations were discussed with the patient.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on medical findings.

Input: Renal cell carcinoma status post partial nephrectomy RIGHT KIDNEY: No significant abnormalities noted. 9.6 cm in length LEFT KIDNEY: Status post partial nephrectomy. No worrisome mass, stone, or hydronephrosis. Left kidney 11.2 cm in lengthOTHER: Bladder nondistended

Output: Negative renal ultrasound. Status post partial left nephrectomy without evidence for worrisome mass, stone, or hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 20-year-old male with abnormal liver function. LIVER: The liver is normal in size but is moderately echogenic, progressive when compared to prior exams. Presumably this is related to fatty infiltration although other causes of parenchymal dysfunction cannot be excluded. No focal hepatic abnormality. Portal vein is patent with appropriate flow direction.BILIARY TRACT: No significant abnormalities noted.PANCREAS: Limited due to bowel gas. No gross abnormality.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.

Output: Progressively echogenic liver.


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. In the right breast at 8 - 9 o'clock near the nipple, there is an indeterminate hypoechoic lesion, measuring 8 mm. There is no solid or suspicious lesion identified in the left breast.

Output: Indeterminate hypoechoic lesion at 8 - 9 o'clock near the nipple in the right breast. Diagnostic ultrasound study is recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on medical findings.

Input: Evaluate for nephrolithiasis RIGHT KIDNEY: Unremarkable echogenicity without mass, stone, or hydronephrosis. Right kidney 11.4 cm in lengthLEFT KIDNEY: Unremarkable echogenicity without mass, stone, or hydronephrosis. The left kidney 11 cm in lengthOTHER: Bladder nondistended

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


Instruction: Generate impression based on medical findings.

Input: 54 years old, Female, Reason: eval for liver dz History: RUQ pain, elevated ALT, ALP. Pt has no gallbladder. LIVER: The liver measures 20 cm in length. There is diffusely increased echogenicity of the liver suggestive of diffuse hepatic steatosis. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of .3 m/s. No evidence of ascites.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 7.8 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 9.1 cm in length. RIGHT KIDNEY: Kidney measures 12 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 12.6 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.

Output: Hepatic steatosis without evidence of biliary ductal dilatation or focal hepatic mass lesion. No evidence of ascites.


Instruction: Generate impression based on medical findings.

Input: Elevated bilirubin LIVER: Mildly coarse and echogenic liver echotexture without mass. Liver length 17.8 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 13.1 cm in lengthOTHER: Left kidney 11.8 cm in length. Spleen 11.2 cm in length. No ascites.

Output: Mildly coarse and echogenic liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites.


Instruction: Generate impression based on medical findings.

Input: Ms. Gayton is a 91-year-old female presenting with a palpable right breast mass, identified one month previous. History of benign left breast cyst. Three standard views of both breasts and two additional spot compression views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. A trying a marker is placed at the site of palpable abnormality in the right upper inner breast. Underlying this marker, is a dense, spiculated, poorly circumscribed mass. Multiple additional benign calcifications, including arterial calcifications, are present bilaterally. ULTRASOUND

Output: (1) 2.5 cm suspicious mass in the right upper inner breast, corresponding to the patient's palpable area of concern. An ultrasound-guided biopsy with placement is recommended for further evaluation. (2) Abnormal right axillary lymph node. An ultrasound-guided biopsy with clip placement is recommended for further evaluation.The patient does take Xarelto and has been asked to hold this medication for 5 days prior to the biopsy. All results and recommendations were discussed with the patient and her caretaker at time of dictation. BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.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: 47-year-old female with history of thyroid cancer status post thyroidectomy. Evaluate for masses and lymphadenopathy RIGHT LOBE MEASUREMENTS: Status post thyroidectomy LEFT LOBE MEASUREMENTS: Status post thyroidectomyISTHMUS MEASUREMENTS: Status post thyroidectomyRIGHT LOBE: No discrete nodules or masses in the thyroidectomy bed.LEFT LOBE: No discrete nodules or masses in the thyroidectomy bed.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Several small benign appearing lymph nodes in the neck. No pathologic lymphadenopathy.OTHER: No significant abnormality noted.

Output: No evidence of disease recurrence or pathologic lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: 39-year-old male with elevated alkaline phosphatase, pre-heart transplant evaluation. LIVER: Slight coarse echogenicity of the liver measuring 20.1 cm in length. No focal hepatic lesions. Main portal vein is patent with appropriate directional flow; peak velocity measures 0.3 m/sec.GALLBLADDER, BILIARY TRACT: Normal echogenicity of the gallbladder. No gallbladder wall thickening. No pericholecystic fluid. Common duct measures 3 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Not well visualized.SPLEEN: Normal echogenicity measuring 11.6 cm in length.KIDNEYS: Right kidney measures 10.4 centers in length. No hydronephrosis or shadowing calculi are noted. Limited evaluation of the left kidney measuring 10.2 cm in length. No definite hydronephrosis or shadowing calculi are noted.ABDOMINAL AORTA: The proximal visualized aorta is patent measuring 2.0 cm x 1.8 cm x 0.8 cm. The remaining abdominal aorta is obscured by overlying bowel gas.INFERIOR VENA CAVA: The visualized IVC is patent with appropriate directional flow.OTHER: Bladder is well distended with no significant abnormalities noted. The prostate is visualized and is unremarkable.

Output: Slight coarse echogenicity of the liver suggestive of parenchymal dysfunction/fat infiltration. No focal hepatic lesions.


Instruction: Generate impression based on medical findings.

Input: Ventriculomegaly, seizure. There is moderate prominence of the lateral ventricles bilaterally. Cortical sulci are also prominent and there is relative lucency in the periventricular white matter. There is no gross hemorrhage or mass. Subtle scalp swelling is incidentally noted in the frontal region.

Output: Immature appearance with prominent ventricles and sulci especially in the frontal region and decreased attenuation white matter with no hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Ms. Calle is a 60 year old female with a personal history of right breast mastectomy for ILC in 2009 followed by radiation and tamoxifen therapy. She presents today for a physician palpated superficial lump in her right axilla. On physical examination, a superficial mass is palpated in the right axilla.A targeted right axillary ultrasound was performed for the palpable area of concern. There is a superficially located, round anechoic lesion with layering echogenic material measuring 6 x 4 x 8 mm. There is no internal vascular flow. Sonographic findings are consistent with a benign oil cyst with calcifications.

Output: Benign oil cyst of the right axilla corresponding to the palpable area of concern. No sonographic evidence for malignancy in the right axilla. As long as the patient's physical examination remains normal, left breast unilateral diagnostic mammogram is recommended annually, due next in June 2017. Results and recommendations were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: Male 47 years old Reason: any ischemia/necrosis observed, renal perfusion History: s/p cardiac arrest, renal failure, anuria RIGHT KIDNEY: 10.9 cm in length. Mild increased echogenicity. No hydronephrosis or hydroureter.LEFT KIDNEY: 11.2 cm length. Mild increased echogenicity. No hydronephrosis or hydroureter.OTHER: Limited color Doppler shows blood flow to both kidneys.Urinary bladder is collapsed with Foley catheter in place.Well-demarcated echogenic lesion in the right lobe of the liver is identified measuring 1.8 x 1.6 cm consistent with hemangioma.

Output: Mildly echogenic kidneys suggesting medical renal disease. No hydronephrosis. Incidental small echogenic lesion in the liver likely hemangioma.


Instruction: Generate impression based on medical findings.

Input: 49 year old male with polycystic kidney disease, evaluate left renal lesion, superior pole RIGHT KIDNEY: Renal parenchyma is completely replaced by innumerable cysts compatible with history of polycystic kidney disease. There is a mixture of simple and complex cysts. The ability of ultrasound to detect smaller, solid masses and polycystic kidneys is limited. Kidney grossly enlarged. No obvious hydronephrosis.LEFT KIDNEY: Renal parenchyma is completely replaced by innumerable cysts compatible with history of polycystic kidney disease. There is a mixture of simple and complex cysts. The ability of ultrasound to detect smaller, solid masses and polycystic kidneys is limited. Kidney grossly enlarged. No obvious hydronephrosis.Left upper pole hyper density noted on prior CT study is difficult to visualize given the innumerable cysts present. OTHER: No significant abnormalities noted. Bladder poorly distended.

Output: Findings are compatible with patient's history of polycystic kidney disease. Left upper pole hyper density noted on prior CT study is difficult to visualize given the innumerable complex cysts present.


Instruction: Generate impression based on medical findings.

Input: Thyroid nodule RIGHT LOBE MEASUREMENTS: 3.7 x 1.4 x 1.9 cmLEFT LOBE MEASUREMENTS: 3.7 x 1 x 1.3 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Multiple benign-appearing spongiform nodules. The largest within the lower pole measures 1.4 x 1.2 x 1.2 cm.LEFT LOBE: Benign-appearing spongiform nodule lower pole measuring 0.9 x 0.4 x 0.6 cmISTHMUS: Spongiform nodule measuring 1.1 x 0.8 x 0.4 cmPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Benign-appearing spongiform thyroid nodules bilaterally. No regional adenopathy.


Instruction: Generate impression based on medical findings.

Input: Reason: 62M refractory ALL with septic shock, rule out acalculous cholecystitis History: as above LIVER: The liver measures 17.1 centimeters in length, indicating mild hepatomegaly. Course hepatic parenchymal echotexture, consistent with hepatic steatosis, parenchymal dysfunction, or cirrhosis. The portal vein is patent with normal directional hepatopedal portal venous blood flow, peak velocity 16.2 cm/s. No focal masses.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. No biliary ductal dilatation. The proximal common bile duct measures 0.3 cm.PANCREAS: Obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 11.4 cm in length. No evidence of hydronephrosis, masses, or shadowing calculi.LEFT KIDNEY: The left kidney measures 12.5 cm in length. No evidence of hydronephrosis, masses, or shadowing calculi.SPLEEN: The spleen measures 13.7 cm in length.OTHER: No significant abnormalities noted.

Output: 1. Mild hepatomegaly and coarse hepatic parenchymal echotexture, consistent with hepatic steatosis, parenchymal dysfunction, or cirrhosis.2. Status post cholecystectomy without biliary ductal dilatation.


Instruction: Generate impression based on medical findings.

Input: 50 year-old female with goiter. RIGHT LOBE MEASUREMENTS: 8.3 x 7.2 x 5.4 cm.LEFT LOBE MEASUREMENTS: 5.5 x 3.4 x 2.7 cm.ISTHMUS MEASUREMENTS: 7 mm.RIGHT LOBE: The right lobe is enlarged and nearly entirely replaced by a dominant predominantly solid nodule with cystic components. LEFT LOBE: The left lobe of the thyroid is enlarged and nearly entirely replaced by a dominant predominantly solid isoechoic nodule with cystic components, measuring 4.6 x 2.5 x 3.2 cm. There is associated internal vascularity as well as a peripheral hypoechoic halo. These findings are consistent with an indeterminate nodule.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. 4.6-cm indeterminate nodule in the left lobe of the thyroid gland. Further evaluation with FNA is recommended.2. Diffusely enlarged, heterogeneous thyroid gland, consistent with the stated history of goiter.


Instruction: Generate impression based on medical findings.

Input: 19-year-old woman complaining of left breast tenderness No family history of breast cancer. A targeted left ultrasound was performed for the patient’s area of concern. The area of concern in the 9:00 position and retroareolar region corresponded with normal-appearing breast tissue. A 5 x 4 mm cyst is noted within this tissue. No large cyst or other mass lesion is noted.

Output: The area of concern corresponds with normal breast tissue. No sonographic evidence for malignancy. Results and recommendations were discussed with the patient.Breast pain should be managed clinically.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on medical findings.

Input: Right upper quadrant pain LIVER: Non-cirrhotic liver morphology. Normal parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. 15 mm gallstone noted in the gallbladder neck, with mild gallbladder distention, wall thickening, and pericholecystic fluid. Positive sonographic Murphy's sign.PANCREAS: 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 14.7 cm in length. The left kidney is not well visualized. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 11.2 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No significant abdominal free fluid identified.

Output: Acute calculous cholecystitis.


Instruction: Generate impression based on medical findings.

Input: 45 year-old male with persistently mildly elevated LFTs. LIVER: The liver is coarse, echogenic with decreased through transmission, limiting evaluation for a focal lesion. Given this limitation, there is no focal lesion or intrahepatic biliary ductal dilatation. Liver measures 21.4 cm in craniocaudal dimension. Normal hepatopetal portal venous blood flow at 20 cm/sec.BILIARY TRACT: Normally distended gallbladder without gallstones, wall thickening, pericholecystic fluid, or focal tenderness. No extrahepatic biliary ductal dilatation with the common bile duct measuring 2 mm.PANCREAS: The suboptimally visualized pancreatic body and head are grossly unremarkable.SPLEEN: The spleen is mildly enlarged, measuring 14.1 cm in length.RIGHT KIDNEY: The right kidney measures 13.7 cm in length without hydronephrosis. OTHER: The left kidney measures 13.3 cm in length without hydronephrosis.

Output: 1. Hepatomegaly and findings compatible with severe diffuse fatty infiltration of the liver. 2. Mild splenomegaly.


Instruction: Generate impression based on medical findings.

Input: Male 64 years old Reason: 64 yo with HTn adn new CKD (?AKI) perofrm renal us for eval of size shape and echogenicitiy as well as blood flow History: 64 yo with HTn adn new CKD (?AKI) perofrm renal us for eval of size shape and echogenicitiy as well as blood flow ULTRASOUND KIDNEYSRIGHT KIDNEY: Right kidney measures 11.2 cm. Echogenic kidney. Multiple subcentimeter cysts. No evidence of hydronephrosis.LEFT KIDNEY: Left kidney measures 10.9 cm. Echogenic kidneys. Multiple cysts largest measuring 2 cm diameter. No hydronephrosis.OTHER:No significant abnormalities noted.

Output: Normal Doppler study. Bilateral echogenic kidneys and simple cysts


Instruction: Generate impression based on medical findings.

Input: Elevated liver enzymes. LIVER: The liver is mildly coarse in echotexture. It is normal in size and morphology measuring 13 cm in craniocaudal dimension. No intrahepatic biliary ductal dilatation or focal lesion. Normal hepatopedal portal venous blood flow at 0.2 m/s.BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common duct measuring up to 7 mm at the pancreatic head. The patient is status post cholecystectomy.PANCREAS: Limited evaluation of the visualized pancreatic head and neck demonstrates no significant abnormality.SPLEEN: The spleen is normal in size measuring 8.6 cm without a discrete lesion.RIGHT KIDNEY: The right kidney is diminutive measuring 9.4 cm without hydronephrosis. Mildly echogenic renal cortices. OTHER: The left kidney is diminutive 9.3 cm in length without hydronephrosis. Mildly echogenic renal cortices.

Output: 1. Mildly coarse liver echotexture may be seen in the setting of parenchymal dysfunction, differential including but not limited to steatosis. 2. Status post cholecystectomy without significant biliary ductal dilatation. 3. Diminutive kidneys which appear mildly echogenic, suggesting medical renal disease, correlate with renal function.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female with history of right breast DCIS status post lumpectomy in 2007 followed by radiation therapy and tamoxifen, status post right breast stereotactic biopsy with benign results on 11/5/14 for a bilateral diagnostic mammogram and right breast ultrasound which demonstrated a likely benign lesion. Patient presents for follow-up of the right breast lesion. A targeted right breast ultrasound was performed for the patient’s area of concern. Again identified is a mixed echogenicity area with hyperechoic components at 1:00 o'clock position which measures 1.0 x 0.8 cm, previously measuring 3.2 x 1.8 x 1.8 cm; this lesion is compatible with a resolving hematoma. There is an echogenic area within this lesion which corresponds to the marking clip.

Output: 1.Right breast resolving hematoma.2.No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: 62-year-old female patient with bloating with occasional constipation. Decreased appetite. History of scleroderma. Evaluate for intra-abdominal pathology. LIVER: The liver measures 15.5 cm in length and demonstrates increased parenchymal echogenicity with small focal areas of hypoechogenicity near the portal venous structures. There is a 0.7 x 0.6 x 0.6 cm left hepatic lobe cyst. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: There are no gallstones, gallbladder wall thickening, or pericholecystic fluid. Sonographic Murphy's sign is negative. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 2 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 10.8 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 11.1 cm in length. No evidence of hydronephrosis.The spleen measures 7.1 cm in length.No ascites.

Output: 1. Increased hepatic echogenicity consistent with hepatic steatosis with focal areas of sparring. 2. Left hepatic cyst.


Instruction: Generate impression based on medical findings.

Input: Male 62 years old; Reason: HCC surveillance History: HCV cirrhosis LIVER: The liver measures 14.1 cm in length. There is coarse and increased echogenicity of the liver parenchyma. The liver appears nodular. No focal hepatic lesions are seen. On prior CT multiple subcentimeter hypodensities were present throughout the liver, however these were not seen on this ultrasound. No intrahepatic ductal dilation is seen. The main portal vein is patent with normal hepatopetal flow measured at 14.8 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is surgically absent. 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 10.3 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 9.1 cm in length. The cortex hasnormal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 10.0 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.

Output: The liver is nodular with coarse increased echogenicity compatible with cirrhotic morphology. No ascites is seen. No new worrisome masses. Subcentimeter hypodensities within the liver seen on prior CT were not visualized on this study.


Instruction: Generate impression based on medical findings.

Input: UTI; overactive bladder RIGHT KIDNEY: Normal echogenicity without mass, stone, or hydronephrosis. 9.7 cm in lengthLEFT KIDNEY: Normal echogenicity without mass, stone, or hydronephrosis. 9.3 cm in lengthOTHER: Bladder nondistended

Output: Negative renal ultrasound.


Instruction: Generate impression based on medical findings.

Input: 66-year-old female with known CLL in remission with concern for a left anterior cervical node. Two cervical lymph nodes were palpable by the patient's physician, and this study is limited to identifying those 2 lymph nodes. The cervical lymph node on the right was identified sonographically measuring 0.5 cm x 0.3 cm x 0.5 cm and has a fatty hilum. The other cervical lymph node is identified on the left measuring 0.5 cm x 0.3 cm x 0.7 cm. This also demonstrates a fatty hilum. No suspicious adenopathy is identified.

Output: Right and left cervical lymph nodes, corresponding to the patient's palpable lymph nodes were visualized, and demonstrate benign morphology. No suspicious adenopathy is identified.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female patient with history of hyperparathyroidism. Evaluate thyroid nodule size, location, and any abnormal lymph nodes. RIGHT LOBE MEASUREMENTS: 7.2 x 3.1 x 2.2 cm.LEFT LOBE MEASUREMENTS: 4.7 x 1.6 x 1.4 cm.ISTHMUS MEASUREMENTS: 6 mm in thickness.RIGHT LOBE: The right thyroid lobe contains multiple nodules with the largest complex cystic nodule measuring 2.4 x 1.1 x 2.0 cm in the lower pole. Either within or extrathyroidal and posterior to the lower pole there is a 2.2 x 1.7 x 2.5 cm hypoechoic, solid nodule that demonstrates internal vascularity.LEFT LOBE: The left thyroid lobe contains scattered cystic nodules and a dominant 1.8 x 1.1 x 1.4 cm solid nodule with a central cyst.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Either within or extrathyroidal and posterior to the right lower pole there is a 2.2 x 1.7 x 2.5 cm hypoechoic, solid nodule that demonstrates internal vascularity. There is a solid, hypoechoic nodule measuring 0.9 x 1.0 x 1.7 cm medial to the inferior pole of the left thyroid lobe may represent a parathyroid adenoma.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Solid, hypoechoic nodule which is either extrathyroidal and posterior to the right lower pole or within in. If this is extrathyroidal, a parathyroid adenoma is favored; correlate with nuclear medicine scan. If this does not correlate to a parathyroid adenoma on nuclear medicine scan and/or is intrathyroidal in location, then biopsy is recommended for further evaluation.2. Extrathyroid hypoechoic nodule medial to the left lower pole may represent a parathyroid adenoma.3. Bilateral thyroid nodules as described above.


Instruction: Generate impression based on medical findings.

Input: 46-year-old female with 2 sites of fat necrosis/coil cyst in the left reconstructed breast presents for follow-up study. Focused ultrasound is performed for the palpable lumps at left 9:00 position and left axillary tail.At left 9:00 position, again seen is a hypoechoic lesion measuring 5 x 3 x 5 mm with an internal hyperechoic clip, consistent with fat necrosis. There is no significant change in size or shape of this lesion.At left axillary tail, there is a similar hypoechoic lesion measuring 5 x 3 x 7 mm with an internal hyperechoic clip, consistent with fat necrosis. Size of this lesion is somewhat smaller than the prior study.

Output: Benign fat necrosis at 9:00 position and axillary tail in the left breast.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: Female 60 years old Reason: multinodular goiter - pls eval \T\ compare past studies History: as above RIGHT LOBE MEASUREMENTS: 6 x 3.1 x 2.7 cmLEFT LOBE MEASUREMENTS: 9.4 x 4.8 x 3.7 cmISTHMUS MEASUREMENTS: 4 mmRIGHT LOBE: Again noted numerous nodules, not significantly changed compared to previous study. Largest nodule measures 2.7 x 2.4 x 2.2 cm. This is a solid nodule with cystic component in the inferior lobe of the thyroid.LEFT LOBE: Again noted multiple nodules in the left lobe of the thyroid. Largest nodule measures 6.1 x 4.1 x 4.9 cm, not significantly changed compared to previous study.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multinodular goiter. No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: 64-year-old female with abnormal liver function. Evaluate for NASH. LIVER: Liver is normal in size but is highly echogenic. Presumably this is due to severe fatty liver, but other causes of hepatic dysfunction cannot be excluded. No obvious hepatic mass although penetration to the depth of the liver is limited.BILIARY TRACT: Gallbladder is normal without cholelithiasis, wall thickening or pericholecystic fluid. The biliary tract is normal in caliberPANCREAS: The head and body are normal. The tail is obscured by bowel gas.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.

Output: Highly echogenic liver, presumably fatty liver.


Instruction: Generate impression based on medical findings.

Input: Female, 36 years old. Nephrotic proteinuria. Anasarca Three passes were performed. A small hematoma is noted after the third pass.

Output: Right kidney biopsy.


Instruction: Generate impression based on medical findings.

Input: Reason: 44 yo F w/ lower abdominal pain, N/V, CT shows thickened gallbladder. Evaluate for cholecystitis. BILIARY TRACT: Cholelithiasis with shadowing stones throughout the gallbladder. Equivocal gallbladder wall thickening measuring up to 3.4 mm. No definite pericholecystic fluid. The sonographic Murphy's sign is negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 3 mm in diameter.

Output: Cholelithiasis and equivocal gallbladder wall thickening raising the possibility of acute cholecystitis. Nuclear medicine HIDA scan could be considered for additional evaluation as clinically warranted.


Instruction: Generate impression based on medical findings.

Input: Asymptomatic female with dense breasts presents for whole breast ultrasound for dense breast screening. She has a personal history of benign left axillary lymph node biopsy in 2013. 3-D whole breast ultrasound was performed for both breasts and images were reviewed on an independent workstation. Scattered simple cysts are identified in both breasts. 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: Acute renal insufficiency RIGHT KIDNEY: Unremarkable echogenicity without mass, stone, or hydronephrosis. 14.1 cm in length.LEFT KIDNEY: Unremarkable echogenicity without mass, stone, or hydronephrosis. 14.7 cm in lengthOTHER: Fatty infiltration of the liver. Trace ascites. Bladder nondistended.

Output: Unremarkable echogenicity without mass, stone, or obstruction. Fatty infiltration of the liver. Trace ascites.


Instruction: Generate impression based on medical findings.

Input: Male; 59 years old. Reason: nephrology rec History: AKI RIGHT KIDNEY: The right kidney measures 11.6 cm in length. The cortex demonstrates normal echogenicity. There is no hydronephrosis, shadowing renal stone, or concerning mass identified.LEFT KIDNEY: The left kidney measures 12.8 cm in length. The cortex demonstrates normal echogenicity. There is no hydronephrosis, shadowing renal stone, containing mass identified.URINARY BLADDER: The bladder is decompressed by Foley catheter.OTHER: No significant abnormalities noted.

Output: 1.No hydronephrosis. Normal ultrasound of the kidneys.


Instruction: Generate impression based on medical findings.

Input: Neoplasm of uncertain behavior of skin. 17-year-old woman with 1 cm nodule in the occipital area which is intermittently tender. Lipoma versus cyst versus bony abnormality. The palpable area in the occiput appears to originate from the bone and cannot be further evaluated using ultrasound. There is no evidence of a lipoma or cyst in the subcutaneous tissues which were able to be evaluated.

Output: Palpable abnormality is within bone and could be better evaluated using CT or MRI. Ultrasound revealed no abnormality in the overlying soft tissues.


Instruction: Generate impression based on medical findings.

Input: 73 years Female with history of thyroid nodule. RIGHT LOBE MEASUREMENTS: 4.4 x 1.3 x 1.5 cmLEFT LOBE MEASUREMENTS: 5.4 x 2.2 x 1.6 cmISTHMUS MEASUREMENTS: 0.2 cm in thickness. RIGHT LOBE: Normal echotexture. There is an oval-shaped, hypoechoic nodule with well-defined borders in the inferior aspect of the right lobe which measures 0.5 x 0.3 x 0.3 cm.LEFT LOBE: Normal echotexture. There is a dominant nodule within the mid pole of the left lobe which measures 1.8 x 1.5 x 1.7 cm. The nodule is mixed solid and cystic, is round/oval in shape, has smooth borders, and demonstrates internal vascularity.ISTHMUS: Normal echotexture without discrete nodules. PARATHYROID GLANDS: No significant abnormalities.LYMPH NODES: No significant abnormalities. OTHER: No significant abnormalities.

Output: Dominant left midpole mixed solid/cystic nodule measuring up to 1.8 cm which would be amenable to biopsy.


Instruction: Generate impression based on medical findings.

Input: 69-year-old female patient with elevated LFTs. Question of nonalcoholic fatty liver disease. LIVER: The liver measures 19.2 cm in length and demonstrates increased hepatic parenchymal echogenicity. A 1.4 x 1.0 x 1.5 cm anechoic lesion within the left hepatic lobe with posterior acoustic enhancement is compatible with a cyst. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: There are gallstones but no gallbladder wall thickening or pericholecystic fluid. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 2 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 12.8 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 13.4 cm in length. No evidence of hydronephrosis.The spleen measures 10.9 cm in length.

Output: 1. Increased hepatic parenchymal echogenicity consistent with hepatic steatosis.2. Left hepatic cyst.3. Cholelithiasis without sonographic evidence of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Ms. Jackson submitted outside mammograms dated 7/25/2011 and 7/2/2013 and outside ultrasounds dated 5/31/2012 and 7/2/2013 from Little Company of Mary Hospital. Submitted outside studies were compared to the current mammogram dated 9/8/2016. The breast parenchyma is heterogeneously dense, which may obscure small masses (BiRads Density Category C), unchanged in pattern and distribution. Previously identified partially obscured masses in bilateral breasts are either stable to slightly decreased in size when compared to prior mammograms, compatible with benign involuting cysts.The mammographic findings correspond to the prior ultrasound examinations demonstrating multiple benign simple cysts.

Output: Bilateral benign involuting cysts. No mammographic evidence of malignancy. Physical examination is of increased importance for a patient with dense breast. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually, due in September 2017. BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: Malignant neoplasm of the thyroid RIGHT LOBE MEASUREMENTS: Post thyroidectomy LEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post 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 recurrent or metastatic disease in the neck.


Instruction: Generate impression based on medical findings.

Input: Congestive heart failure ascites LIVER: Mildly heterogeneous liver echotexture without mass. Liver length 18.5 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.5 cm in lengthOTHER: Left kidney 9.8 cm in length. Spleen 7.4 cm in length. No ascites

Output: Mildly heterogeneous liver echotexture suggestive for chronic liver disease without mass or ductal dilatation. No ascites.


Instruction: Generate impression based on medical findings.

Input: 63-year-old male with palpable soft tissue mass involving the lateral, anterior abdominal wall. Region of pelvic abnormality, there is some deep soft tissue asymmetry adjacent to or involving the deep musculature. This is not changed appreciably with Valsalva maneuver. Differential considerations would include hernia, hematoma or less likely soft tissue mass. MR may provide superior soft tissue differentiation.

Output: Soft tissue asymmetry in the deep subcutaneous tissues of the right abdomen as noted above. MR may provide better characterization.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate right neck and right upper chest wall for retained line/object History: palpable object right neck. Corresponding to the superficial linear palpable structure in the right lateral neck, there is a corresponding tubular predominantly hypoechoic structure within the superficial subcutaneous soft tissues which measures approximately 2 mm in diameter and may reflect a retained catheter fragment.

Output: Suspected retained catheter fragment within the superficial segment tissues of the right lateral neck. Soft tissue neck radiography recommended for confirmation (pager #1032 contacted, awaiting response; recommendation also entered into the follow-up tool).


Instruction: Generate impression based on medical findings.

Input: 50 year-old female with hematuria. Ultrasound guidance was provided for biopsy of left kidney

Output: Ultrasound guidance


Instruction: Generate impression based on medical findings.

Input: Ms. Siwak is a 26 year old female presenting with a palpable tender lump in the right axilla for one month. A targeted right breast ultrasound is performed for the patient's area of concern.In the right breast 10:00 location, approximately 6 cm from the nipple, no suspicious cystic or solid mass is identified.Seen just slightly superolateral to this is a normal right axillary lymph node measuring approximately 1.8 x 1.1 cm with normal hilar flow.

Output: Patient's palpable tender lump may correspond to a low-lying normal right axillary lymph node. No sonographic evidence of malignancy. The patient should follow up with her primary care physician as clinically warranted, presuming these results are concordant with the physical exam findings. All results and recommendations were discussed with the patient. BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on medical findings.

Input: 16-year-old female at 28 weeks gestation with palpable left breast lump. On physical examination, there is a pea-sized mobile mass along the medial inframammary fold. A targeted left ultrasound was performed for the palpable area of concern. A 0.4 x 0.3 x 0.3 cm cyst is present subjacent to the area of palpable concern at the 8:00 position, 10 cm from the nipple. This cyst has a tail extending to the cutaneous surface, compatible with a sebaceous cyst.

Output: Sebaceous cyst corresponding to the area of palpable concern in the left breast. No sonographic evidence for malignancy. The patient was instructed to return to her referring physician for clinical management.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on medical findings.

Input: 48 year old female with abnormal liver function tests. LIVER: The liver measures 14.9 cm in length. Mildly increased parenchymal echogenicity is suggestive of fatty infiltration/parenchymal dysfunction. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.2 m/s.BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. The sonographic Murphy's sign is negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 3 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 9.6 cm in length. RIGHT KIDNEY: Kidney measures 9.5 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass. Superior pole simple cyst measuring 1.8 x 1.5 x 1.9 cm. LEFT KIDNEY: Kidney measures 13.1 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.

Output: 1.Normal gallbladder and biliary tract with no evidence of cholelithiasis or cholecystitis.2.Mildly increased parenchymal echogenicity is suggestive of fatty infiltration/parenchymal dysfunction.


Instruction: Generate impression based on medical findings.

Input: 71-year-old male with acute renal failure. Evaluate for obstruction. RIGHT KIDNEY: The right kidney measures 7.9 cm in length. The kidney is echogenic consistent with parenchymal disease and there is parenchymal loss. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: The left kidney measures 10.2 cm in length. The kidney is echogenic consistent with parenchymal disease and there is parenchymal loss. There is a 1.5 cm cyst arising from the left kidney which appears simple on today's study. Second cyst is not identified. There is also a small amount of perinephric fluid on the left.URINARY BLADDER: No significant abnormalities noted.OTHER: Varices noted in the splenic hilum.

Output: Echogenic kidneys bilaterally with parenchymal loss and no hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for portal HTN and cirrhosis History: Lower GI bleed LIVER: The liver measures 11.1 cm in length and smooth in contour. The liver demonstrates increased parenchymal echogenicity with coarsened echotexture. Multiple cysts appearing similar to recent CT without suspicious hepatic lesions identified. The portal vein is patent demonstrating normal hepatopetal flow with velocity of 33 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 4 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 9.1 cm in length. RIGHT KIDNEY: Kidney measures 12.2 cm in length. Increased cortical echogenicity. No hydronephrosis. Multiple cysts, the largest of which measures 3.7 x 3.3 x 2.9 cm appearing similar to prior.LEFT KIDNEY: Kidney measures 11.9 cm in length. Increased cortical echogenicity. No hydronephrosis.OTHER: No significant abnormalities noted.

Output: 1.Increased hepatic echogenicity suggestive of parenchymal dysfunction/fatty infiltration. No ascites. Patent portal vein.2.Increased renal echogenicity suggestive of medical renal disease.


Instruction: Generate impression based on medical findings.

Input: 42 years old, Female, Reason: Abnormal nodes? History: THyrodi cancer s/p surgery MEASUREMENTS: Patient is status post thyroidectomy.RIGHT LOBE AREA: No significant abnormality noted. No evidence of local recurrence.LEFT LOBE AREA: Asymmetry in the area of the left thyroidectomy bed. No focal mass.ISTHMUS AREA: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign appearing left level 2 lymph node with a fatty hilum measuring 0.6 x 0.2 x 0.8 cm.OTHER: No significant abnormality noted.

Output: Asymmetry in the area of the left thyroidectomy bed without focal mass. No definite evidence of recurrence or lymphadenopathy. However follow up imaging of the thyroid is recommended to ensure stability.


Instruction: Generate impression based on medical findings.

Input: 76-year-old male who is status post cholecystectomy presents with right upper quadrant pain. LIVER:Measures 13.9 cm. Normal echotexture. No focal mass or ascites. There is dirty shadowing arising from the intrahepatic biliary tract, consistent with pneumobilia. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder is absent. The common hepatic duct measures 0.3 cm.PANCREAS: Evaluation of the pancreas limited due to overlying bowel gas.SPLEEN: Measures 12.5 cm.KIDNEYS: Right kidney measures 6.7 cm. Left kidney measures 13.1 cm. Normal echogenicity. Approximately 1.6 x 1.5 x 2.0 cm well-defined anechoic area is consistent with a simple renal cyst in the midpole of the left kidney. No shadowing calculi, hydronephrosis, or worrisome mass. OTHER: No significant abnormality noted.

Output: 1. Pneumobilia; benign. This was also present on a CT abdomen dated April 12, 2016. Otherwise, negative exam.


Instruction: Generate impression based on medical findings.

Input: 62-year-old female with metastatic medullary thyroid carcinoma RIGHT LOBE MEASUREMENTS: 5.4 x 2.0 x 1.8 cmLEFT LOBE MEASUREMENTS: 6.0 x 2.8 x 2.6 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: Heterogeneous hypoechoic mass with calcifications and ill-defined margins in the left thyroid lobe measures approximately 4.1 x 3.3 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Unilateral left cervical lymphadenopathy in stations II-IV. The largest lymph node in the level III station measures 2.5 x 2.8 x 1.8 cm and contains calcifications.OTHER: No significant abnormality noted.

Output: Left thyroid mass and bulky left lymphadenopathy as described above is consistent with the patient's known malignancy.