Instruction: Generate impression based on medical findings.

Input: Female 58 years old; Reason: 58-year-old with HBV please screen for HCC. LIVER: Marked increase in hepatic parenchymal echogenicity with coarsened echotexture. There is significantly decreased penetration due to increased echogenicity, limiting evaluation for deep lesions. Within these limitations, no definite focal hepatic lesions are identified. Hepatic length measures 18.5 cm. The main portal vein is patent with normal hepatopetal flow with a velocity of 29 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 3 mm. The common bile duct measures 9 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 9.8 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 11.8 cm with no hydronephrosis. The left kidney measures 12.3 cm with no hydronephrosis. OTHER: No significant ascites.

Output: Hepatomegaly with marked increase in hepatic parenchymal echogenicity with coarsened echotexture consistent with fatty liver/hepatic parenchymal dysfunction. No hepatic mass or ductal dilatation identified.


Instruction: Generate impression based on medical findings.

Input: Male 68 years old; Reason: 68 y/o male h/o AML s/p chemo and neupogen, tender mass on left upper back x 2-3 days History: tender mass on left upper back Hypoechoic mass superficial to the rib cage measuring at least 2.5 cm in thickness and 5.6 cm in width. No internal vascularity.

Output: 1.Noncystic hypoechoic mass. Differential considerations include hematoma or soft tissue mass. Consider MRI


Instruction: Generate impression based on medical findings.

Input: 18-year-old male with excision of retroperitoneal lipoma in December 2013 presenting with right flank pain. Please rule out mass or recurrent lipoma. BLADDER  Wall Thickness: Normal  Contents: Distended and normal. Distal Ureter -- SFU Grade**  Right: 0  Left: 0   Ureteral Jets Right: Not observed  Left: Not observedKIDNEYS  Cortical Echogenicity: Normal   Medullary Echogenicity: Normal   Pelvicaliceal System -- SFU Grade*  Right: 0 Left: 0  Length*** Right: 10.3 cm Left: 10.2 cm   Mean for age: 9.8 cm  Range for age: 9.5 - 12 cmADDITIONAL OBSERVATIONS: No free fluid is seen. No mass is identified.

Output: Normal examination without evidence of recurrent mass or lipoma.*SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning. **SFU grading system retrovesical ureter: Grade 0: No ureteral dilatation. Grade 1: Ureter less than 7 mm. Grade 2: Ureter is 7-10 mm. Grade 3: Ureter is over 10 mm. Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469


Instruction: Generate impression based on medical findings.

Input: Reason: please assess post voidal residuals History: recurrent UTI The prevoid bladder has a volume of 61.4 mm. The postvoid bladder has a volume of 2.9 mm.Right iliac fossa transplant kidney measures 11 cm in length, with mild pelviectasis appearing similar to prior ultrasound on 11/2/2015.

Output: Near complete emptying of bladder on voiding, as above.


Instruction: Generate impression based on medical findings.

Input: 41-year-old female with history of pelvic mass and decreased renal function. Reason: Evaluate for hydronephrosis. RIGHT KIDNEY: The right kidney measures 10.5 cm. Severely echogenic parenchyma without mass, stone, or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.2 cm. Severely echogenic parenchyma without mass, stone, or hydronephrosis.OTHER: Bladder is nondistended with Foley in place. Moderate ascites. Again demonstrated is a large mixed cystic-solid mass in the pelvis and lower abdomen, as seen on prior CT.

Output: Severely echogenic renal parenchyma compatible with medical renal disease/parenchymal dysfunction without mass, stone, or hydronephrosis. Again demonstrated is a large mixed cystic-solid mass in the pelvis and lower abdomen, as seen on prior CT.


Instruction: Generate impression based on medical findings.

Input: 47-year-old male with right upper quadrant pain. Reason: Evaluate for cholecystitis. LIVER: The liver measures 26.1 cm in length. Echogenic liver parenchyma without focal lesion or ductal dilatation. Portal vein is patent.GALLBLADDER, BILIARY TRACT: Cholelithiasis with mildly edematous gallbladder wall. Positive sonographic Murphy's sign. No pericholecystic fluid or ductal dilatation is present.PANCREAS: The visualized pancreas is without significant abnormalities.RIGHT KIDNEY: The right kidney measures 14.6 cm. The cortex is of normal echogenicity. No shadowing calculi or hydronephrosis is present.LEFT KIDNEY: The left kidney measures 14.4 cm. The cortex is of normal echogenicity. No shadowing calculi or hydronephrosis is present.SPLEEN: The spleen measures 14.2 cm.OTHER: No significant abnormalities noted.

Output: 1. Cholelithiasis with positive sonographic Murphy's sign, findings are suspicious for acute cholecystitis.2. Hepatomegaly with echogenic coarse liver parenchyma, consistent with fatty infiltration/parenchymal dysfunction, without focal lesion or ductal dilatation.These findings were relayed to and acknowledged by Dr. STAHLBAUM, DANIELLE by phone at the time of this dictation.


Instruction: Generate impression based on medical findings.

Input: Severe calf pain suddenly playing basketball. Likely gastrocnemius tear. Anechoic fluid separates the medial gastrocnemius muscle distally from the underlying soleus over longitudinal distance of at least 6 cm, indicating a tear. Fluid/hemorrhage is also noted superficial to the retracted distal fibers of the muscle. The remainder of the muscle is enlarged and relatively hypoechoic, indicating edema. There is also edema in the overlying subcutaneous fat.

Output: Myoaponeurotic tear of the medial gastrocnemius muscle distally with thin but elongated hematoma between the muscle and the underlying soleus.


Instruction: Generate impression based on medical findings.

Input: Female 57 years old; Reason: Sharp increase in serum creatinine of unclear etiology; r/o postrenal etiology History: Rising serum creatinine RIGHT KIDNEY: The right kidney measures 13 cm in length. The cortex is normal echogenicity. No shadowing calculi. Mild hydronephrosis.LEFT KIDNEY: The left kidney measures 13 cm in length. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. MIld fullness of the left collecting system.OTHER: Visualized portions of the urinary bladder are unremarkable

Output: 1.Mild right hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: History of ulnar nerve release, transposition, and neurolysis, with persistent left upper extremity pain. There is heterogeneity of the flexor tendon origin at the medial epicondyle likely reflecting scarring from prior surgery, but I see no fluid-filled gap to confirm a tear. The underlying ulnar collateral ligament appears intact. There is also mild heterogeneity of the proximal flexor forearm musculature likely reflecting scarring, but I see no mass or tear.As stated in the clinical history, the patient has undergone ulnar nerve release and a submuscular transposition. Within the soft tissues of the elbow, the ulnar nerve shows prominent fascicles suggesting neuritis and compatible with the MRI appearance, normalizing more distally within the proximal forearm. At and just above the level of the medial epicondyle, a crescentic focus of hypoechogenicity is noted adjacent to the ulnar nerve that I suspect reflects adjacent scarring or perhaps a small collection of fluid. Distal to the medial epicondyle, the nerve becomes slightly compressed between the medial margin of the distal humerus and the overlying pronator teres, but the significance of this is uncertain. I see no obvious differences in the nerve between flexion and extension of the elbow and upon flexion and extension of the wrist. The ulnar nerve appears normal within the mid and distal forearm.

Output: Surgical changes of ulnar nerve transposition. Prominence of the fascicles of the ulnar nerve could reflect a neuritis. There is slight flattening of the nerve between the pronator teres and the medial margin of the distal humerus that is of uncertain clinical significance.


Instruction: Generate impression based on medical findings.

Input: Male 32 years old Reason: HCC screening/ evaluate liver parenchyma in chronic AIH r/o History: AIH with likely cirrhosis (could not be staged via biopsy 2/2 necrosis) LIVER: Liver measures 13.3 cm in length. The parenchyma is unremarkable. There are no focal lesions. BILIARY TRACT: Gallbladder unremarkable. No significant gallbladder distention, wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation. Common bile duct measures 0.2 cm.PANCREAS: The pancreas appears unremarkable. A peripancreatic/porta hepatis lymph node measures 2.3 x 2.4 x 0.6 cm and was not definitively seen on the prior scan, but is nonspecific and may reflect hepatic disease.KIDNEYS: The right kidney measures 11.6 cm. The left kidney measures 10.6 cm. Bilateral renal cortices demonstrate normal echogenicity.SPLEEN: The spleen measures 8.1 cm. in length. OTHER: No significant abnormality noted.

Output: 1. Normal appearing liver parenchyma without focal lesion.2. A peripancreatic/porta hepatis lymph node measures 2.4 cm and was not definitively seen on the prior scan, but is nonspecific and may be related to suspected hepatic disease.


Instruction: Generate impression based on medical findings.

Input: Male 64 years old; Reason: h/o CKD, AKI History: elevated cr RIGHT KIDNEY: The right kidney measures 9 cm in length. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 10 cm in length. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present.  URINARY BLADDER: No significant abnormality.OTHER: No significant abnormalities noted.

Output: 1.No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Female 61 years old Reason: assess gallbladder History: RUQ pain, N/V, prior diagnosis of cholelithiasis LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 17.5 cm in length. The parenchyma is mildly echogenic . Probable hepatic cyst near the gallbladder fossa measuring 1.2 cm.. Main portal vein is patent.BILIARY TRACT: The gallbladder has echogenic calculi with posterior acoustic shadowing. Wall measures 5 mm in thickness. There is questionable trace pericholecystic fluid. Common duct measures 6 mm. PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 10.9 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 11.5 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 10.0 cm. in length. OTHER: No ascites.

Output: 1.Gallbladder wall thickening with stones. With questionable trace pericholecystic fluid. Findings are compatible with cholelithiasis but early acute cholecystitis is not entirely excluded.2.Mildly prominent CBD, given the patient's elevated bilirubin choledocholithiasis should be excluded. Since the common bile duct is not imaged in its entirety MRI/MRCP can be obtained.


Instruction: Generate impression based on medical findings.

Input: Female 51 years old; Reason: eval cause of AKI History: 0.5-->3.4 Cr RIGHT KIDNEY: The right kidney measures 9.6 cm in length. The cortex is normal in echotexture. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 9.2 cm in length. The cortex is normal in echotexture. No shadowing calculi or hydronephrosis is present.  URINARY BLADDER: The bladder is decompressed by a Foley catheter.OTHER: Echogenic hepatic parenchyma compatible with fatty infiltration.

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


Instruction: Generate impression based on medical findings.

Input: 84-year-old female, evaluate for ascites. Sonographic evaluation the abdomen (four quadrants) was performed in limited fashion to assess for ascites. No sonographic evidence of ascites.

Output: No sonographic evidence of ascites.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old. Reason: Concern for hydronephrosis. RIGHT KIDNEY: Right kidney measures 12 cm in length with normal cortical echogenicity. No hydronephrosis, shadowing calculi, or mass.LEFT KIDNEY: Left kidney measures 13.7 cm in length with normal cortical echogenicity. No hydronephrosis, shadowing calculi, or mass.OTHER: Urinary bladder is underdistended without significant abnormality noted.

Output: Negative renal ultrasound. Specifically, no hydronephrosis, shadowing calculi, or mass.


Instruction: Generate impression based on medical findings.

Input: Reason: recurrent UTI History: UTI RIGHT KIDNEY: Right kidney measures 9.5 cm and is increased in echogenicity without hydronephrosis. Multiple cystic-appearing lesions. Compared to prior study these lesions are better seen and appears to be lobulated simple cysts. No evidence of renal calculi.LEFT KIDNEY: Left kidney measures 11.5 cm and is increased in echogenicity without hydronephrosis. Multiple renal cysts noted. Left upper pole cyst with septation measures 5.6 x 4.2 x 4.8 cm. Left inferior pole septated cyst measures 1.9 x 2.4 x 2.0 cm. Nonobstructing left renal stone measures 1.0 x 0.9 x 1.3 cm.URINARY BLADDER: Nonmobile hypodense bladder wall lesion with small internal vascularity suggested. This is new from prior study and may represent clot or debris, but cannot exclude malignancy.OTHER: No significant abnormalities noted.

Output: 1.Numerous bilateral simple and minimally complex renal cyst as above, these may be better characterized with contrast enhanced CT or MRI if clinically warranted.2.Bilateral increased echogenicity of the kidneys compatible with medical renal disease.3.Nonmobile hypodense bladder wall lesion, small internal vascularity suggested. This is new from prior study and may represent clot or debris, but cannot exclude malignancy.


Instruction: Generate impression based on medical findings.

Input: Female 22 years old Reason: eval for liver abscess, cholecystitis History: RUQ pain LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 16 cm in length. The parenchyma is normal in echotexture Main portal vein is patent with normal directional flow.BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 3 mm in thickness. Common duct measures 3 mm. PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 8.9 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. The left kidney measures 12 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 13 cm. in length. OTHER: No ascites

Output: 1.No sonographic findings of cholelithiasis or acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Male 57 years old; Reason: 56 yo with elevated creatinine and decreased GFR, pease evaluate size, shape and function RIGHT KIDNEY: The right kidney measures 8.9 cm in length. The kidney has a mildly bulbous contour. The echogenicity of the cortex is borderline increased. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 9.2 cm in length. The kidney has a bulbous contour, underlying dromedary hump suspected, a normal anatomic variant. The echogenicity of the cortex is borderline increased. No shadowing calculi or hydronephrosis is present. URINARY BLADDER: The bladder is nondistended.

Output: Borderline increased echogenicity of the kidneys nonspecific but may be seen in setting of medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Female 55 years old Reason: 55 y/o with AKI History: aki Evaluation severely limited by patient body habitus.RIGHT KIDNEY: Poorly visualized right kidney kidney measures 12.2 cm in length. No definite hydronephrosis evident, but not entirely excluded given poor visualization.LEFT KIDNEY: The left kidney measures 10.8 cm in length and demonstrates normal parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.BLADDER: Not identified.OTHER: No significant abnormalities noted.

Output: Limited examination due to patient body habitus. Right kidney poorly visualized, but no definite hydronephrosis. No hydronephrosis of the left kidney.


Instruction: Generate impression based on medical findings.

Input: Female 63 years old Reason: eval liver for cholecystitis, RUQ ultrasound History: worsening hyperbilli LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 15 cm in length. The parenchyma is mildly echogenic probable cyst in the right lobe of the liver measures 1.5 cm.Main portal vein is patent.BILIARY TRACT: Gallbladder contains sludge and stones and is mildly distended.. Wall measures 2 mm in thickness. No pericholecystic fluid Common duct measures 4 mm. PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 10.8 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 8.2 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 8 cm cm. in length. OTHER: No significant abnormalities noted.

Output: 1.Gall bladder sludge and stones without pericholecystic fluid.


Instruction: Generate impression based on medical findings.

Input: Female 77 years old Reason: AKI s/p cholangitis, eval for obstruction History: AKI RIGHT KIDNEY: The right kidney measures 10.3 cm. No shadowing calculi or hydronephrosis is present. Increased renal cortical echogenicity. No perinephric free fluid. LEFT KIDNEY: The left kidney measures 9.8 cm. No shadowing calculi or hydronephrosis is present. Increased renal cortical echogenicity. No perinephric free fluid. Left lower pole renal cyst measuring 1.8 x 1.8 x 1.8 cm. BLADDER: Underdistended making assessment suboptimal, Foley catheter in place.OTHER: No significant abnormalities noted.

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


Instruction: Generate impression based on medical findings.

Input: Male 49 years old; Reason: r/o postrenal AKI History: AKI, elevated Cr RIGHT KIDNEY: The right kidney measures 12.8 cm in length. The cortex has increased echogenicity. No shadowing calculi or hydronephrosis is present. No worrisome masses are seen.LEFT KIDNEY: Exam of the left kidney is limited due to a chest tube on the left. The left kidney measures 12.4 cm in length. The cortex has increased echogenicity. No shadowing calculi or hydronephrosis is present. No worrisome masses are seen. URINARY BLADDER: Evaluation of the bladder is limited as it is decompressed with a Foley catheter in place.

Output: Bilaterally the kidneys have increased echogenicity which is compatible with medical renal disease. No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: History of hepatitis C cirrhosis. Subcentimeter cystic lesions noted on prior MRI. Surveillance examination. Evaluate for interval change and hepatocellular carcinoma. LIVER: The liver has a cirrhotic morphology with a nodular surface contour. It remains normal in size measuring 13.7 cm in length. The hepatic parenchyma has diffusely increased echogenicity which may be seen in hepatic steatosis and chronic liver disease. The 2 cystic lesions identified on prior MR are not identified on today's exam possibly related to the increased parenchymal echogenicity. No focal mass lesion is identified.The portal vein is patent with hepatopedal flow and a velocity of 17 cm/s.GALLBLADDER, BILIARY TRACT: No intrahepatic or extrahepatic biliary ductal dilatation. The common bile duct measures 3 mm in diameter. The gallbladder is unremarkable.PANCREAS: No significant abnormality noted. The tail is obscured by overlying bowel gas.RIGHT KIDNEY: Right kidney is normal in size measuring 10.6 cm in length. Parenchymal echotexture within normal limits. No hydronephrosis or nephrolithiasis.LEFT KIDNEY: Left kidney is normal in size measuring 12.4 cm in length. Parenchymal echotexture within normal limits. No hydronephrosis or nephrolithiasis.SPLEEN: The spleen is borderline enlarged measuring 12.8 cm in length.OTHER: No ascites.

Output: 1. Cirrhotic morphology of liver. No mass lesion is identified. The subcentimeter cysts noted on prior MRI, are not visualized likely related to the poor acoustic penetration through the cirrhotic liver as well as inherently small size of lesions.2. Borderline splenomegaly. Otherwise no sonographic findings of portal hypertension.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: 56-year-old male with induration of left inner thigh, evaluate. Sonographic evaluation of bilateral medial thighs demonstrate mild bilateral soft tissue edema without evidence of abscess formation. The superficial venous vasculature appear patent.

Output: Mild soft tissue edema of bilateral medial thigh without evidence of abscess formation or superficial thrombophlebitis.


Instruction: Generate impression based on medical findings.

Input: 55-year-old male with history of amyloidosis presents with incidentally noted liver lesions seen on an outside CT. LIVER: Minimal increase in hepatic parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions. Hepatic length measures 21 cm. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of 17 cm/s. Scattered anechoic foci with posterior acoustic enhancement compatible with hepatic cyst. For reference, the largest hepatic cyst measures 1.2 x 1.4 x 1.6 cm.GALLBLADDER/BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 2 mm. The common bile duct measures 2 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 12 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 12 cm and has normal vascular flow. The left kidney measures 13 cm and has normal vascular flow. OTHER: No significant abnormality noted.

Output: Hepatomegaly likely due to patient's underlying amyloidosis with scattered anechoic foci suggestive of simple hepatic cysts.


Instruction: Generate impression based on medical findings.

Input: Female 61 years old Reason: please evaluate liver including vasculature History: transaminase and ammonia elevation Per ultrasound technologist, limited exam secondary to patient's body habitus, positioning and obscuration by bowel gas.LIVER: Hepatomegaly, liver measures 19.2 cm in length. The parenchyma is echogenic. No suspicious liver lesion delineated. Main portal vein patent with normal directional flow, velocity measures 28 cm/s. BILIARY TRACT: Status post cholecystectomy. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Not well seen secondary to overlying bowel gas. KIDNEYS: The right kidney measures 11.8 cm. The left kidney is not as well seen particularly the upper pole secondary to adjacent bowel gas and overlying artifact, measures approximately 10.9 cm. No hydronephrosis.SPLEEN: The spleen measures 9.7 cm. in length but not well assessed secondary to adjacent bowel gas. OTHER: No significant abnormality noted.

Output: Enlarged echogenic liver, likely reflecting hepatic steatosis/parenchymal dysfunction.Status post cholecystectomy.


Instruction: Generate impression based on medical findings.

Input: Female 63 years old; Reason: r/o recurrence History: h/o thyroid cancer RIGHT LOBE: Status post thyroidectomy. Hypoechoic nodule in the right thyroid bed has intervally decreased in size measuring 0.6 x 0.5 x 0.5 cm, previously 0.7 x 1.3 x 0.3 cm.LEFT LOBE: Status post thyroidectomy. No masses to suggest recurrence.ISTHMUS: Status post thyroidectomy. No masses to suggest recurrence.LYMPH NODES: Benign appearing right level II and level IV lymph nodes measuring 0.4 x 1.0 x 1.3 and 0.3 x 0.5 x 0.6 cm, respectively. Additional benign appearing left level three lymph nodes measuring 0.3 x 0.4 x 0.6 cm and 1.4 x 0.3 x 0.6 cm.OTHER: No significant abnormality noted.

Output: Hypoechoic nodule in the right thyroid bed has intervally decreased in size and prominence, favoring benignity.


Instruction: Generate impression based on medical findings.

Input: 71-year-old male presents with hyperkalemia, evaluate for urinary obstruction. RIGHT KIDNEY: The right kidney measures 10 cm in length. Corticomedullary differentiation is maintained. No shadowing calculi or hydronephrosis is present.LEFT KIDNEY: The left kidney measures 10 cm in length. Corticomedullary differentiation is maintained. No shadowing calculi or hydronephrosis is present. URINARY BLADDER: The visualized portions of the urinary bladder are unremarkable.OTHER: Mild prostatomegaly.

Output: 1. Unremarkable sonographic evaluation of the kidneys. Specifically, no evidence of hydronephrosis.2. Mild prostatomegaly.


Instruction: Generate impression based on medical findings.

Input: 58-year-old male with chest pain, evaluate cause of intrahepatic and extrahepatic biliary ductal dilatation. LIVER: Mild increase in hepatic parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions. Hepatic length measures 16.3 cm. The main portal vein is patent with normal hepatopetal flow with a velocity of 27 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 2 mm. Multiple shadowing calculi are noted within the gallbladder. The common bile duct is dilated at the pancreatic head and measures 14 mm in diameter. No definite choledocholithiasis. There is significant intrahepatic and extrahepatic biliary ductal dilatation.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 8.8 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 9.3 cm with no hydronephrosis. The left kidney measures 9.3 cm with no hydronephrosis. OTHER: No significant ascites.

Output: 1.Significant intrahepatic and extrahepatic biliary ductal dilatation, with no definite mass or choledocholithiasis. However given the degree of dilatation, particularly of the common bile duct at the level of the pancreatic head, further evaluation with MRI/MRCP suggested.2. Mild increase in hepatic parenchymal echogenicity with coarsened echotexture consistent with fatty liver/hepatic parenchymal dysfunction. No focal hepatic mass.3.Cholelithiasis without evidence of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o recurrence History: h/o medullary thyroid cancer Status post total thyroidectomyRIGHT BED: No significant abnormality noted.LEFT BED: No significant abnormality noted.ISTHMUS BED: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing level 2 and level 3 lymph nodes are seen, a couple of which were seen on prior exam. For reference, a left level 2 lymph node previously measured 1.0 x 0.4 x 0.3, now measuring the same. On the right, a morphologically appearing level 3 similar node now measures 1.2 x 0.3 x 0.3 cm is, previously 0.9 x 0.4 x 0.3 cm.OTHER: No significant abnormality noted.

Output: Status post thyroidectomy without specific evidence of recurrence.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate for renal abnormalities History: Nephrotic syndrome KIDNEYS  Cortical Echogenicity: Normal   Medullary Echogenicity: Normal   Pelvicaliceal System -- SFU Grade*  Right: 0 Left: 0  Length*** Right: 7.2 cm Left: 7.3 cm   Mean for age: 6.2 cm  Range for age: 5.0 - 7.8 cmADDITIONAL OBSERVATIONS: Significant gallbladder wall thickening, measuring up to 8 mm. No evidence of evidence of cholelithiasis. Sonographic Murphy sign was negative.

Output: Normal appearance of the kidneys. Gallbladder wall thickening, which may be related to patient's hypoproteinemic state.*SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning.Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469


Instruction: Generate impression based on medical findings.

Input: 58-year-old male with a history of hepatitis B virus, hepatocellular carcinoma screening. LIVER: Normal hepatic parenchymal echogenicity. No focal hepatic lesions. Hepatic length measures 15 cm. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of 29 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 2 mm. The common bile duct measures 3 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 9 cm has a normal echotexture.KIDNEYS: The kidneys are echogenic but have normal corticomedullary differentiation. The right kidney measures 8 cm and has normal vascular flow with prominence of the collecting system. The left kidney measures 9 cm and has normal vascular flow. Anechoic focus arising from the midpole the left kidney measuring 2.6 x 2.0 x 2.3 cm compatible with a renal cyst. OTHER: No significant abnormality noted.

Output: 1. No hepatic mass or ductal dilatation identified.2. Echogenic kidneys suggestive of medical renal disease. Left renal cyst.


Instruction: Generate impression based on medical findings.

Input: 63-year-old female with a history of hepatitis C, evaluate for cirrhosis/liver disease. LIVER: Increase in hepatic parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions. Hepatic length measures 15 cm. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of 30 cm/s. Nearly anechoic focus in the right hepatic lobe with posterior acoustic enhancement compatible with a hepatic cyst. The focus measures 2.7 x 2.3 x 2.9 cm.GALLBLADDER/BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 3 mm. The common bile duct measures 7 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 6 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 12 cm and has normal vascular flow. The left kidney measures 13 cm and has normal vascular flow. OTHER: No significant abnormality noted.

Output: 1. Increase in hepatic parenchymal echogenicity with coarsened echotexture consistent with fatty liver/hepatic parenchymal dysfunction. 2. Hepatic cyst.


Instruction: Generate impression based on medical findings.

Input: Male 55 years old Reason: assess renal parenchyma and for hydronephrosis History: oliguria, elevated Cr RIGHT KIDNEY: The right kidney measures 12.6 cm. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 11.4 cm. Mild UPJ prominence. No shadowing calculi or hydronephrosis is present otherwise. BLADDER: Mildly distended. Nonvisualization of ureteral jets, nonspecific.OTHER: Partially imaged ascites and pleural effusions.

Output: Mild left-sided UPJ prominence. No evidence of hydronephrosis otherwise.Partially measured ascites and bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 34-year-old male with increased calcium and parathyroid hormone. RIGHT LOBE MEASUREMENTS: 1.7 x 1.7 x 4.4 cm.LEFT LOBE MEASUREMENTS: 1.6 x 1.3 x 4.1 cm.ISTHMUS MEASUREMENTS: 0.3 cm.RIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted. There is a homogenous, isoechoic to thyroid 1.4 x 0.5 x 0.8 nodule that appears just inferior to the left lobe of the thyroid, likely representing exophytic thyroid tissue.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: A mildly heterogeneous and mildly echogenic focus with peripheral and central vascularity measuring 1.9 x 0.8 x 1.2 cm is visualized inferior to the right thyroid at lymph node level #4 that appears consistent with a parathyroid adenoma.LYMPH NODES: Large, heterogeneous lymph node with fatty hilum visualized at the caudal margin of the left thyroid bed on the left at nodal level 4 measuring 1.3 x 0.6 x 1.2 cm.OTHER: No significant abnormality noted.

Output: 1. Findings consistent with a right parathyroid adenoma inferior to the thyroid gland located at right lymph node level #4.


Instruction: Generate impression based on medical findings.

Input: Male 67 years old Reason: assess for liver lesions History: Hx of HCV; cirrhosis LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 14.3 cm in length. The parenchyma is mildly coarse and echogenic. No focal hepatic lesion is identified.BILIARY TRACT: The gallbladder has echogenic calculi with posterior acoustic shadowing filling the lumen. Wall measures 3 mm in thickness. The common bile duct measures 6 mm. Murphy's sign is negative.PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 10.6 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. No suspicious lesion identified.The left kidney measures 11.0 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. No suspicious lesion identified.SPLEEN: The spleen measures 12.6 cm in length. The spleen is normal in echogenicity.OTHER: No significant abnormalities noted.

Output: 1.Cholelithiasis, without evidence of acute cholecystitis.2.Mildly coarse and echogenic liver, may represent nonspecific fatty infiltration/parenchymal dysfunction. No suspicious lesion is identified.


Instruction: Generate impression based on medical findings.

Input: Female 56 years old with abdominal pain LIMITED ABDOMENLIVER: Liver measures 19.4 cm in length. The parenchyma is moderately coarse and echogenic. No Focal Liver Lesions Are Evident. Limited interrogation of the main portal vein demonstrates blood flow to the liver measuring 11.9 cm/s.BILIARY TRACT: The gallbladder is within normal limits.. Wall measures 3 mm in thickness. No pericholecystic fluid. The patient was tender while scanning the upper abdomen.The common bile duct is dilated measuring 8 mm. No choledocholithiasis is visualized.PANCREAS: The head of the pancreas is unremarkable. The body and tail are obscured by overlying gas.KIDNEYS: The right kidney measures 11.6 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 10.9 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 9.1 cm. In length. OTHER: No significant abnormalities noted.

Output: 1.Moderately coarse and echogenic liver parenchyma compatible with fatty liver infiltration/parenchymal dysfunction without focal liver lesion.2.Mildly dilated common bile duct measuring 8 mm. No evidence of choledocholithiasis. The patient was tender while scanning the upper abdomen. If there is clinical suspicion for choledocholithiasis, an ERCP or MRCP is recommended.


Instruction: Generate impression based on medical findings.

Input: Female 46 years old; Reason: underlying CKD History: nephrotic range proteinuria RIGHT KIDNEY: The right kidney measures 12 cm in length. The cortex is slightly echogenic. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 12 cm in length. The cortex is slightly echogenic. No shadowing calculi or hydronephrosis is present. OTHER: Visualized portions of the bladder are unremarkable.

Output: 1.Echogenic cortices can be seen in nonspecific medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Female 54 years old; Reason: Left thyroid lobe enlarged RIGHT LOBE MEASUREMENTS: 5.2 x 2.3 x 1.4 cmLEFT LOBE MEASUREMENTS: 4.3 x 2.0 x 1.5 cmISTHMUS MEASUREMENT: 0.41 cmRIGHT LOBE: The right lobe is normal in echogenicity, no nodules are identified.LEFT LOBE: The left lobe is normal in echogenicity, no nodules are identified.ISTHMUS: No significant abnormality noted.LYMPH NODES: No lymphadenopathy is visualized.OTHER: No significant abnormality noted.

Output: Normal thyroid ultrasound.


Instruction: Generate impression based on medical findings.

Input: Male 68 years old; Reason: Renal cyst follow up History: None RIGHT KIDNEY: The right kidney measures 10 cm in length. The cortex is increased in echogenicity. No shadowing calculi or hydronephrosis is present. Multiple bilateral renal cysts without significant change from prior study.LEFT KIDNEY: The left kidney measures 10 cm in length. The cortex is increased in echogenicity. No shadowing calculi or hydronephrosis is present. Multiple bilateral renal cysts without significant change from prior study.OTHER: Bladder is unremarkable.

Output: 1.Stable renal cystic lesions from 6/16/2015. Stable mildly increased bilateral renal echogenicity likely related to medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Female 70 years old; Reason: eval both kidneys for degree of hydronephrosis History: none RIGHT KIDNEY: Stable moderate to severe hydronephrosis. A partially visualized urinary stent is in place.LEFT KIDNEY: The left kidney measures 10 cm in length. The cortex is normal echogenicity. Stable mild left hydronephrosis.OTHER: The bladder is decompressed from a Foley catheter, precluding evaluation.

Output: 1.Stable right and left hydronephrosis as above. Interval placement of a partially visualized stent catheter on the right.


Instruction: Generate impression based on medical findings.

Input: Female 88 years old Reason: eval for mets History: hx of cholangiocarcinoma LIMITED ABDOMENLIVER: Central portion of the liver hilum has a heterogeneous echotexture with peripherally dilated bile ducts.. Liver measures 19 cm in length. The parenchyma is moderately echogenic .BILIARY TRACT: The gallbladder contains layering sludge. Wall measures 4 mm in thickness. There is perihepatic and pericholecystic ascites. Common duct measures 9 mm. There is internal soft tissue and debris.PANCREAS: Pancreatic duct is dilated measuring 2 mm at the head.KIDNEYS: The right kidney measures 11 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. The left kidney measures 10 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 10.5 cm. in length. OTHER: Small amount upper abdominal ascites.

Output: 1.Central hilar mass causing biliary ductal obstruction most suspicious for a hilar cholangiocarcinoma. The exact extent of disease cannot be determined by ultrasound. Further evaluation with an MRI/MRCP is suggested.2.Mildly dilated common bile duct.3.Mildly thickened gallbladder wall.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old. Reason: Soft tissue mass anteromedial to right shoulder, suspected lipoma History: None Well-circumscribed, oval hyperechoic mass in the subcutaneous tissues near the right shoulder measures 4.1 x 2.5 x 1.4 cm. The lesion is nonvascular.

Output: While this well-circumscribed, nonvascular mass in the subcutaneous tissues near the right shoulder may represent a lipoma, sonography has limited specificity in characterizing these lesions in patients of this age. If there is clinical suspicion for malignancy, MRI can be performed.


Instruction: Generate impression based on medical findings.

Input: Female 36 years old Reason: RUQ (gallstone) - pancreatitis if able to visualise History: epigastric pain LIVER: The liver is enlarged and measures 20 cm in length. The parenchyma is unremarkable. There is a small amount of perihepatic fluid.BILIARY TRACT: Gallbladder unremarkable. No significant gallbladder distention, wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Limited assessment of the pancreas demonstrates a mildly hypoechoic pancreatic head. However the body and the tail are not well evaluated on this examination.KIDNEYS: The right kidney is atrophic and measures 7.7 cm. The right renal parenchyma demonstrates increased echogenicity. A right inferior pole renal cyst is noted. The left kidney is not visualized on this examination.SPLEEN: The spleen measures 11.0 cm. in length. Note is made of an accessory splenule and measures 1.4 x 1.3 x 0.7 cm.OTHER: Partially visualized left-sided pleural effusion.

Output: 1.No evidence of cholelithiasis.2.Hepatomegaly and trace perihepatic fluid3.Partially visualized pancreas appears mildly hypoechoic which may reflect pancreatitis. Clinical correlation is recommended.4.Partially visualized left-sided pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 59-year-old female with a history of resection of left inferior parathyroid adenoma and removal of a 4 mm papillary thyroid microadenoma from the isthmus. RIGHT LOBE MEASUREMENTS: 5.3 x 1.2 x 1.5 cmLEFT LOBE MEASUREMENTS: 4.4 x 1.6 x 1.3 cmISTHMUS MEASUREMENT: 0.3 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.LYMPH NODES: Left level 3 lymph node measures 7 x 4 x 2 mm and has normal morphology with a fatty hilum.OTHER: No significant abnormality noted.

Output: 1.Status post resection of left parathyroid adenoma.2.Normal thyroid ultrasound.


Instruction: Generate impression based on medical findings.

Input: Reason: is there bleeding from right subclavian artery? History: recently placed stent for subclavian aneurysm and noted blood loss and eval for hematoma Heterogeneous fluid collection measuring 8.8 x 6.9 x 4.3 cm corresponding to known area of hematoma.

Output: Hematoma in the right supraclavicular area as above.


Instruction: Generate impression based on medical findings.

Input: Reason: Primary HPT History: Primary HPT RIGHT LOBE MEASUREMENTS: 4 cm sagittal dimensionLEFT LOBE MEASUREMENTS: 3.6 cm sagittal dimensionISTHMUS MEASUREMENTS: 0.3 cm APRIGHT LOBE: No significant abnormality noted.LEFT LOBE: A predominantly solid nodule measuring 1.9 x 1.4 x 1.7 cm is seen in the left thyroid with internal vascularity and no definite microcalcifications. A couple punctate high density foci are within cystic spaces, and may represent colloid.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Inferior to the right thyroid gland there is an isoechoic lesion which is somewhat difficult to differentiate from normal thyroid parenchyma, but measures 1.6 x 1.2 x 0.6 cm, suspicious for parathyroid adenoma. Similar sonographic characteristics are seen on the left, although the lesion is slightly more hyperechoic, measuring 1.1 x 0.5 x 1.2 cm. LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 2 lesions inferior to the thyroid gland as above are suspicious for parathyroid adenomas. Additionally a dominant left thyroid lobe nodule is amenable to percutaneous biopsy if indicated. Correlation with same-day parathyroid scan is suggested.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for cholecystitis, pancreatitis History: acute abdominal pain LIVER: The liver is not enlarged, measuring 15 cm in length. Normal echogenicity. No focal lesions. No intrahepatic ductal dilation.BILIARY TRACT: No evidence of cholelithiasis. The gallbladder wall is not thickened, measuring 0.2 cm. There is no pericholecystic fluid. The common hepatic duct is not dilated, measuring 0.3 cm in caliber.PANCREAS: The pancreas is obscured by bowel gas, unable to adequately assess.SPLEEN: The size of the spleen is within normal limits, measuring 8 cm in length. Normal echogenicity. No focal lesions.KIDNEYS: The size of the right kidney is within normal limits, measuring 9.2 cm in length. Normal echogenicity. No focal lesions. No hydronephrosis.The size of the left kidney is within normal limits, measuring 9.2 cm in length. Normal echogenicity. No focal lesions. No hydronephrosis. OTHER: The main portal vein is patent with hepatopetal flow and a normal waveform.

Output: 1. No evidence of cholelithiasis nor acute cholecystitis.2. The pancreas is obscured by bowel gas and unable to be adequately assessed sonographically.


Instruction: Generate impression based on medical findings.

Input: 53-year-old male with acute kidney injury RIGHT KIDNEY: The right kidney measures 11 cm. The cortex is of normal echogenicity. No shadowing calculi or hydronephrosis is present.LEFT KIDNEY: The left kidney measures 11.7 cm. The cortex is of normal echogenicity. No shadowing calculi or hydronephrosis is present.OTHER: The visualized bladder is without significant abnormalities. Incidentally noted heterogenous liver parenchyma.

Output: Incidentally noted heterogenous liver parenchyma consistent with fatty infiltration/parenchymal dysfunction. Otherwise, unremarkable renal sonography.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old. Reason: r/o recurrence. Please compare to prior ultrasound and CT scans History: h/o medullary thyroid cancer, with persistent increased calcitonin level RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE SURGICAL BED: Stable hypoechoic focus in the right surgical bed measures 0.6 x 0.5 x 0.5 cm, previously 0.7 x 0.5 x 0.7 cm. LEFT LOBE SURGICAL BED: No significant abnormality noted.ISTHMUS SURGICAL BED: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No regional lymphadenopathy.OTHER: No significant abnormality noted.

Output: Stable subcentimeter hypoechoic focus in the right thyroid surgical bed. No regional lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Reason: concern for rejection in transplanted kidney given elevated Cr, N/V, fevers History: Elevated Cr, N/V, fevers RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: No significant abnormality notedCOLLECTING SYSTEM/URETER: Persistent mild-to-moderate hydronephrosis, even after voiding.URINARY BLADDER: No significant abnormality noted. VASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels. No significant abnormality noted. Resistive indices were under 0.8. All the vasculature was patent.OTHER: No significant abnormality noted

Output: Mild to moderate hydronephrosis, even after voiding.


Instruction: Generate impression based on medical findings.

Input: Evaluate "bilateral ear masses" Appearing to correspond to reported ear masses are the symmetric parotid glands. Remainder of study also unremarkable.

Output: Unremarkable study.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old. Reason: History of gallstones and RUQ pain. History: RUQ pain LIVER: The liver measures 16 cm in length with coarse, echogenic hepatic parenchyma. No focal hepatic mass or ascites. Main portal vein is patent with a normal direction of flow.BILIARY TRACT: Multiple echogenic, shadowing foci are present in the gallbladder lumen consistent with gallstones. No gallbladder wall thickening or pericholecystic fluid. No ductal dilatation. Common bile duct measures 4 mm.PANCREAS: The visualized portions of the pancreas are unremarkable. The pancreatic tail is obscured by overlying bowel gas.SPLEEN: Spleen measures 10.9 cm in length with normal echotexture.RIGHT KIDNEY: Surgically absent. OTHER: Left kidney measures 11 cm in length with normal cortical echogenicity. No hydronephrosis, shadowing calculi or mass.

Output: 1. Coarse, echogenic hepatic parenchyma suggests chronic liver disease/fatty infiltration. No biliary ductal dilatation.2. Cholelithiasis without acute inflammation.


Instruction: Generate impression based on medical findings.

Input: 26-year-old man status post left ureteral reimplantation RIGHT KIDNEY: The right kidney measures 10.1 cm in length and shows normal echotexture. No mass, shadowing calculi or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.4 cm in length and shows normal echotexture. Mild to moderate left hydronephrosis. No mass. No shadowing renal calculi.URINARY BLADDER: The urinary bladder is normal in appearance.OTHER: There is no free or loculated fluid.

Output: Mild to moderate left hydronephrosis. No right hydronephrosis. No shadowing renal calculi are seen.


Instruction: Generate impression based on medical findings.

Input: Male 70 years old Reason: 70M CAD, CKD, AKI History: AKI RIGHT KIDNEY: The right kidney measures 9.3 cm. Increased renal cortical echogenicity. No shadowing calculi or hydronephrosis is present. Renal cysts measuring up to 1.4 cm on right side. LEFT KIDNEY: The left kidney measures 8.6 cm. Increased renal cortical echogenicity. No shadowing calculi or hydronephrosis is present. Renal cysts measuring up to 0.6 cm on left side.BLADDER: Mild thickening of wall.OTHER: Small left-sided pleural effusion.

Output: Echogenic kidneys, consistent with medical renal disease. No hydronephrosis.Partially imaged left-sided pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o adenopathy, recurrence. Are lesions amenable to biopsy? History: h/o recurrent thyroid cancer. hs stable but increaesd thyroglobulinb level, as well as small thyroid bed lesions. This is a 9 month follow up study RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: Within the right thyroid bed, there is a stable hypoechoic 0.5 x 0.4 x 0.5 nodule in the superior bed. Another superior medial nodule measures 0.4 x 0.2 x 0.7 cm without internal vascularity or microcalcifications. Stable. In the mid right thyroid bed there is a 0.6 x 0.4 x 0.8 cm nodule with internal vascularity and no definite microcalcifications, stable. A similar-appearing inferior right thyroid nodule measures 0.6 x 0.4 x 0.8 cm, stable.LEFT LOBE: A 0.4 x 0.3 x 0.2 cm similar appearing nodule as above is stable in the mid bed. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A benign-appearing lymph node in the right lateral neck level 4 measures 0.6 x 0.4 x 0.8 cm. A similar benign-appearing lymph node in the left level 3 region measures 1.0 x 0.3 x 0.9 cmOTHER: No significant abnormality noted.

Output: Status post thyroidectomy with stable bilateral thyroid bed nodules as above.


Instruction: Generate impression based on medical findings.

Input: Female 67 years old; Reason: r/o adenopathy, recurrence. History: h/o thyroid cancer. US in 12/15 showed some new adenopathy, though she also had URI symptoms. This is a 6 month follow up study. RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENT: Status post thyroidectomy.RIGHT LOBE: No residual thyroid tissue noted.LEFT LOBE: No residual thyroid tissue noted.ISTHMUS: No residual thyroid tissue noted.LYMPH NODES: Interval decrease in previously noted lymphadenopathy. Previously noted right level 1B lymph node measures 1.3 x 1.1 x 0.6 cm compared to 2.2 x 1 x 2 cm. Multiple other subcentimeter lymph nodes are noted on the right. Left level 3 lymph node measures 1.1 x 0.7 x 0.3 cm compared to 2 x 0.6 x 1.1 cm on the prior exam.OTHER: No significant abnormality noted.

Output: 1.No evidence of recurrent or residual thyroid tissue.2.Interval decrease in previously noted lymphadenopathy, favoring a reactive etiology.


Instruction: Generate impression based on medical findings.

Input: Female 60 years old Reason: assess liver morphology, has hepatitis C History: hepatitis C with positive viral load LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 18.1 cm in length. The parenchyma is moderately coarse and echogenic. There is limited penetration of the liver, markedly limiting evaluation. No mass.BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 3 mm in thickness. Common duct measures 6 mm. No gallstone is identified.PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 11.9 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present.The left kidney measures 12.7 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present.SPLEEN: The spleen measures 10.4 cm. in length. The spleen is unremarkable.OTHER: No significant abnormalities noted.

Output: 1.Coarse and echogenic liver, compatible with fatty infiltration/parenchymal disease. No mass.2.Increased echogenicity of the kidneys, probably medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Wound dehiscence, right index finger laceration. Evaluate flexor tendons of right index finger following laceration. The patient's bandage was removed. There was a laceration along the volar aspect of the index finger at the DIP joint oozing a small amount of blood. Therefore, a sterile probe cover and sterile gel were used for the examination. Hypoechoic tissue/material extended from the patient's wound to the volar aspect of the base of the distal phalanx; this was nonspecific but presumably represented a combination of blood, inflammation, and granulation tissue. I saw no focal fluid collection to indicate an abscess. The cortex along the volar aspect of the base of the distal phalanx of the index finger, however, was slightly irregular compared to that of the middle finger, I cannot exclude the possibility of osteolysis due to adjacent infection.The distal end of flexor digitorum profundus tendon of the index finger was abnormally hypoechoic, and while I could trace a few linear echogenic structures from the tendon to the bone, the majority of the tendon appeared to be disrupted at its insertion with minimal retraction. There was also slight displacement of the tendon from the surface of the head and neck of the middle phalanx, which may reflect underlying inflammation or pulley injury. There was minimal if any motion of the FDP tendon volar to the PIP joint as the DIP joint was passively flexed and extended.Following the procedure, the patient's finger was re-bandaged. The patient and his mother were told to follow-up with Dr. Angeles.

Output: 1.Near-full-thickness or full-thickness tear of the flexor digitorum profundus tendon of the index finger at/near its insertion with adjacent/overlying soft tissue inflammation.2.Slight irregularity of the cortex along the volar aspect of the base of the distal phalanx is of uncertain significance; however, radiographs may be considered to assess for the possibility of osteolysis due to osteomyelitis.


Instruction: Generate impression based on medical findings.

Input: Reason: Please further define the possible fluid collection/abscess in the right paraspinal musculature as seen on MRI from June 11. Ultrasound of paraspinal region has extremely limited sensitivity. Given overlying bone and muscle, no loculated fluid collection is visualized.

Output: Limited sonographic evaluation with no evidence of loculated fluid collection.


Instruction: Generate impression based on medical findings.

Input: Reason: follow-up ultrasound on lymphadenopathy History: as above There is a benign-appearing 1.3 x 0.5 cm lymph node noted at level 2 of the right neck.There is a benign-appearing 2.7 x 0.4 cm lymph node noted at level 2 of the left neck. Unchanged from prior exam.There is a benign-appearing 1.1 x 0.4 cm lymph node noted in the left scapular/base of neck area. Unchanged from prior exam.There is a benign-appearing 0.7 x 0.2 cm node in the right occiput area. Unchanged from prior exam.Prior lymph node at the right base of the neck/scapular area is no longer visualized.

Output: 1. Stable exam. Benign-appearing lymph nodes.2. Prior lymph node noted at the right base of the neck/skull area is no longer visualized.


Instruction: Generate impression based on medical findings.

Input: Male 77 years old Reason: Assess for obstruction as cause for acute renal failure History: Cr increase RIGHT KIDNEY: The right kidney measures approximately 10.2 cm. No shadowing calculi or hydronephrosis is present. Mildly increased renal echogenicity. Renal cysts, for example, largest measures 3.7 x 3.6 x 3.5 cm on the right.LEFT KIDNEY: The left kidney measures 12.2 cm. No shadowing calculi or hydronephrosis is present. Mildly increased renal echogenicity. Renal cysts, for example, left renal cyst measuring up to 1.1 x 0.9 x 0.8 cm.BLADDER: Underdistended bladder, making assessment suboptimal.OTHER: No significant abnormalities noted.

Output: No hydronephrosis. Mildly increased renal echogenicity, consistent with underlying medical renal disease. Renal cysts.


Instruction: Generate impression based on medical findings.

Input: 33-year-old female Reason: postpartum with newly diagnosed right sided thyroid nodule, measuring 1 cm History: same as above RIGHT LOBE MEASUREMENTS: 6.1 x 2.2 x 2.6 cm.LEFT LOBE MEASUREMENTS: 5.2 x 1.1 x 1.4 cm.ISTHMUS MEASUREMENTS: 0.2 cm.RIGHT LOBE: The right thyroid lobe appears somewhat heterogenous. At the mid pole of the right thyroid lobe is a predominantly solid appearing nodule that measures 2.4 x 1.9 x 1.0 cm and demonstrates some increased surrounding vascularity. No definite microcalcifications are identified.LEFT LOBE: The superior aspect of the left lobe is a hypoechoic predominantly cystic appearing subcentimeter nodule that measures 0.4 x 0.2 x 0.4 cm. No definite microcalcifications are identified.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Predominantly solid right lobe nodule as described above. This would be amenable to biopsy if clinically warranted.2.Hypoechoic subcentimeter left thyroid lobe nodule.


Instruction: Generate impression based on medical findings.

Input: Female 61 years old Reason: evaluate for biliary obstruction, cholecystitis History: elevated LFT's, fevers, HepC LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 17.3 cm in length. The parenchyma is mildly coarse and echogenic. No focal lesion identified. Limited evaluation of the left side due to patient positioning.BILIARY TRACT: The gallbladder is incompletely distended. Wall measures 2 mm in thickness. The mild focal dilatation of the common bile duct, measuring 8 mm. PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas. There is a small peripancreatic lymph node measuring 1.5 x 1.0 x 1.2 cm.KIDNEYS: The right kidney measures 13.6 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. No suspicious lesion identified.The left kidney measures 9.3 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. No suspicious lesion identified.SPLEEN: Spleen not identified due to bowel gas.OTHER: No significant abnormalities noted.

Output: 1.Focal dilatation of the common bile duct, with no stone identified. Distal obstruction not excluded. MRCP recommended for further evaluation.2.Diffuse mildly coarse and echogenic liver, may represent nonspecific fatty infiltration/parenchymal disease.


Instruction: Generate impression based on medical findings.

Input: Female 67 years old; Reason: assess for causes of acute kidney injury History: septic RIGHT KIDNEY: The right kidney measures 16.9 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. Multiple right renal cysts.LEFT KIDNEY: The left kidney measures 11.5 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. It has a lower pole cyst.URINARY BLADDER: No significant abnormality notedOTHER: No significant abnormalities noted.

Output: 1.No sonographic findings of hydronephrosis or renal stones.2.Bilateral renal cysts.3.Echogenic renal cortices suggestive of medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Thyroid nodules; patient is on Synthroid RIGHT LOBE MEASUREMENTS: 3.7 x 1.4 x 1.6 cm.LEFT LOBE MEASUREMENTS: 3.5 x 1.4 x 1.3 cm.ISTHMUS MEASUREMENTS: 0.3 cm.RIGHT LOBE: Heterogeneous hypoechoic gland. Right mid mixed solid cystic nodule measures 0.9 x 0.7 x 0.5 cm, previously 0.8 x 0.6 x 0.3 cm. Right inferior thyroid nodule is not visible on this study. LEFT LOBE: Heterogeneous hypoechoic gland. Left inferior hyperechoic nodule measuring 1.0 x 0.9 x 0.7 cm, previously 1.2 x 0.8 x 0.7 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Left level 4 lymph node measuring 0.8 x 0.4 x 0.6 cm with normal fatty hilum.OTHER: No significant abnormality noted.

Output: Heterogeneous gland. Thyroid nodules as above without significant change from prior study.


Instruction: Generate impression based on medical findings.

Input: 71-year-old female with a reported history of a parathyroid adenoma. RIGHT LOBE: The right thyroid gland measures 4.9 x 1.4 x 1.2 cm. Scattered subcentimeter hypoechoic foci, some of which are spongiform in appearance, likely representing simple colloid cysts.LEFT LOBE: The left thyroid gland measures 5.0 x 1.5 x 1.4 cm. Subcentimeter hypoechoic thyroid nodules. Behind the inferior pole of the left thyroid lobe is an again noted ovoid hypoechoic focus measuring 0.7 x 0.3 x 0.4 cm, not substantially changed since the prior examination when accounting for differences in technique and positioning. Minimal internal vascularity is noted.ISTHMUS: Normal in size, measuring 2 mm.LYMPH NODES: No significant abnormality noted. Benign-appearing lymph nodes.OTHER: No significant abnormality noted.

Output: Extrathyroidal 0.7 cm hypoechoic focus located behind the left inferior pole of the thyroid gland remains suspicious for a small parathyroid adenoma.


Instruction: Generate impression based on medical findings.

Input: Female 57 years old with history of papillary cancer s/p thyroidectomy, last US 2012, evaluate for evidence of recurrent disease RIGHT LOBE: Status-post thyroidectomy without evidence of new or recurrent disease.LEFT LOBE: Status-post thyroidectomy without evidence of new or recurrent disease.ISTHMUS: Status-post thyroidectomy without evidence of new or recurrent disease.LYMPH NODES: Mildly prominent right level three lymph node measuring 1.2 x 0.8 x 0.3 cm, not significantly changed from prior.Mildly prominent left level three lymph nodes measuring 1.1 x 0.4 x 0.3 cm and 1.7 x 0.8 x 0.4 cm, not significantly changed from prior.OTHER: No significant abnormality noted.

Output: Mildly prominent bilateral level 3 lymph nodes appear stable from prior exam. No evidence of new or recurrent disease.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male with possible hyperparathyroidism. RIGHT LOBE MEASUREMENTS: 4.1 x 2.1 x 1.8 cm.LEFT LOBE MEASUREMENTS: 3.5 x 1.3 x 1.3 centers.ISTHMUS MEASUREMENTS: 0.3 cm.RIGHT LOBE: A predominantly hypoechoic lesion with posterior acoustic enhancement is visualized within the right midpole measuring 0.6 x 0.4 x 0.5 cm.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. No ultrasonographic evidence of parathyroid adenoma.2. Right colloid cyst as described above.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: Living related renal transplant RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: No significant abnormality noted. 10 cm in lengthCOLLECTING SYSTEM/URETER: No significant abnormality notedURINARY BLADDER: No significant abnormality notedVASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels No evidence for inflow or outflow compromise. Renal vessels patent.OTHER: No significant abnormality noted

Output: Patent renal vessels. No hydronephrosis. No significant perinephric collection.


Instruction: Generate impression based on medical findings.

Input: Male 69 years old; Reason: change in left lobe nodules? History: multinodular goiter RIGHT LOBE MEASUREMENTS: 7.0 x 2.4 x 2.6 cmLEFT LOBE MEASUREMENTS: 6.3 x 2.7 x 3.0 cmISTHMUS MEASUREMENT: 0.5 cmRIGHT LOBE: Multiple nodules are again seen in the right lobe. The nodule in the mid thyroid gland measures 0.9 x 0.8 x 0.7 cm (previously 0.9 x 0.8 x 0.7 cm). It is hypoechoic and heterogeneous without calcification or increased vascularity.LEFT LOBE: Multiple nodules are again seen in the left lobe. The inferior pole nodule measures 1.4 x 1.6 x 1.8 cm (previously 1.4 x 1.8 x 2.2 cm) and is spongiform in appearance. The superior pole nodule measures 1.6 x 1.6 x 0.8 cm (previously 1.5 x 1.8 to 0.9 cm). It is predominantly cystic with a peripheral solid component. There is no calcification or increased vascularity.ISTHMUS: No significant abnormality noted.LYMPH NODES: Right level 2 and left 3 lymph nodes with normal, benign ultrasound appearance are identified.

Output: Multinodular goiter. Continued surveillance with attention to the left superior pole nodule is recommended.


Instruction: Generate impression based on medical findings.

Input: Male 28 years old Reason: r/o liver abnormality History: transaminitis post lung transplant. pt also has cystic fibrosis LIVER: Liver measures 15.3 cm in length. The parenchyma is within normal limits without evidence of nodularity.Main portal vein is patent with hepatopedal flow. BILIARY TRACT: Multiple echogenic foci within the lumen of the gallbladder with posterior shadowing compatible with gallstones. No significant gallbladder distention, wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Pancreas is not well visualized due to overlying bowel gas.KIDNEYS: The right kidney measures 9.7 cm. The left kidney measures 8.8 cm. Bilateral renal cortical echogenicity is are normal in appearance.SPLEEN: The spleen measures 13.4 cm. in length. OTHER: No significant abnormality noted.

Output: 1.Cholelithiasis without evidence of cholecystitis.2.Patent portal vein.


Instruction: Generate impression based on medical findings.

Input: Male 62 years old Reason: Hepatitis C, eval for hepatic lesions History: HCV LIMITED ABDOMENEvaluation limited due to patient body habitus.LIVER: Liver measures 13.9 cm in length. The parenchyma is mildly coarse and echogenic. No focal hepatic lesion is identified. The portal vein is patent.BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 1 mm in thickness. The common bile duct measures 4 mm.PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 10.4 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. No suspicious lesion is identified.The left kidney measures 10.9 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. No suspicious lesion is identified.SPLEEN: The spleen measures 10.3 cm in length. OTHER: No significant abnormalities noted.

Output: Mildly coarse and echogenic liver, may represent nonspecific fatty infiltration/parenchymal dysfunction. No suspicious lesion identified.


Instruction: Generate impression based on medical findings.

Input: Sprain of left rotator cuff capsule, subsequent encounter. Check for healing of the left rotator cuff. Evaluation of the shoulder is limited due to inability to optimally position the patient for the examination as a result of pain and discomfort.Evaluation of the bicipital groove revealed absence of the biceps tendon proximally, compatible with biceps tenodesis, which was confirmed by the patient. At the expected site of the biceps reattachment, there is extensive amorphous hypoechogenicity, along with shadowing, that I presume represents scar tissue and other postoperative changes. Within/adjacent to this hypoechogenicity is a linear collection of echogenic foci that may represent suture material. I cannot comment on the integrity of the attachment itself; however, distal to the expected site of attachment I see no frankly retracted tendon. The patient complained of pain at this location.The subscapularis tendon is slightly heterogeneous indicating tendinosis, but I do not see a discrete tear. There is heterogeneous hypoechogenicity of the overlying deltoid muscle that presumably represents postoperative scarring.Evaluation of the supraspinatus tendon is limited due to inability to optimally position the patient in a Crass or modified Crass position due to pain and discomfort. The anterior fibers of the supraspinatus tendon appear intact. As the transducer progresses posteriorly, the cuff becomes hypoechoic in a manner that I suspect reflects severe tendinosis rather than anisotropy, with enthesopathic changes in the underlying greater tuberosity. The posterior fibers of the supraspinatus tendon/anterior fibers of the infraspinatus tendon appear detached from the greater tuberosity, suggesting a full-thickness insertional tear. Multiple poorly defined hypoechoic foci in the overlying deltoid presumably represent scarring from prior surgery.

Output: 1. Limited study due to inability to optimally position the patient for the examination on account of pain and discomfort.2. Given this limitation, the rotator cuff appears abnormal at the junction of the posterior supraspinatus/anterior infraspinatus fibers in a manner suggesting both severe tendinosis and a full-thickness insertional tear.3. Postoperative changes of biceps tenodesis with limited visualization of the biceps reattachment site. I cannot comment on integrity of the attachment site itself; however, distal to the expected site of attachment I see no frankly retracted tendon.4. Given the limited nature of this study, MRI could be considered for additional evaluation.


Instruction: Generate impression based on medical findings.

Input: Reason: RUQ abd pain LIVER: Liver measures 16.3 cm with normal echogenicity. Portal vein is patent with normal direction and velocity of 0.3 m/s. No suspicious hepatic mass is noted.BILIARY TRACT: Common bile duct measures 4 mm. Gallbladder wall measures 4 mm. No pericholecystic fluid collection. No gallstones noted.PANCREAS: Distal pancreas is obscured by overlying bowel gas. Visualized part is within normal limits.SPLEEN: Spleen measures 11.8 cm and is normal in echogenicity and configuration.KIDNEYS: Right kidney measures 12.2 cm with normal echogenicity and without hydronephrosis. Left kidney measures 12.5 cm with normal echogenicity and without hydronephrosis. No renal calculi identified. OTHER: No significant abnormalities noted.

Output: No acute abnormality identified. No evidence of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Stage V chronic kidney disease with progressive renal decline, RAS, hypertension, CHF, please evaluate prior to possible renal biopsy RIGHT KIDNEY: Measures 8.9 cm. Renal cortical thinning and increased echogenicity, no hydronephrosis.LEFT KIDNEY: Measures 8 cm. Renal cortical thinning and increased echogenicity, no hydronephrosis.OTHER: Visualized portions of bladder unremarkable.

Output: 1. No hydronephrosis. Findings compatible with medical renal disease with renal cortical thinning and increased echogenicity seen.


Instruction: Generate impression based on medical findings.

Input: Female 55 years old Reason: Cholecystitis History: history of cholecystitis s/p drain removal, abdominal pain , nausea/vomiting LIMITED ABDOMENLIVER: No intrahepatic biliary dilatation.BILIARY TRACT: Mild persistent gallbladder wall thickening, likely related to known cholecystitis. Positive sonographic Murphy sign.OTHER: No obvious fluid collections are seen sonographically.

Output: 1.Persistent gallbladder wall thickening likely related to known cholecystitis. No obvious fluid collection seen sonographically.


Instruction: Generate impression based on medical findings.

Input: Female 35 years old; Reason: Eval for left leg stump abscess History: sepsis, PVD There is subcutaneous edema and skin thickening over the left leg stump superior to the staple line. No drainable fluid collections. The underlying fascial planes and musculature are unremarkable.There is subcutaneous edema and skin thickening over the right leg stump superior to the staples. No drainable fluid collections. The underlying fascial planes of musculature unremarkable.

Output: 1.Subcutaneous edema and skin thickening without drainable fluid collection


Instruction: Generate impression based on medical findings.

Input: 31-year-old female with history of acute myelocytic leukemia status post stem cell transplant x2 presents with elevated liver enzymes. LIVER: Mild increase in hepatic parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions. Hepatic length measures 16 cm. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of 20 cm/s. GALLBLADDER/BILIARY TRACT: Status post cholecystectomy. Stable echogenic focus in the gallbladder fossa measuring 2.7 x 2.9 x 2.7 cm. The common bile duct measures 4 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 13 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 8 cm and has normal vascular flow. The left kidney measures 8 cm and has normal vascular flow. OTHER: No significant abnormality noted.

Output: 1. Slight increase in hepatic parenchymal echogenicity with coarsened echotexture consistent with fatty liver/hepatic parenchymal dysfunction. No hepatic mass or ductal dilatation identified. 2. Mild splenomegaly.3. Stable echogenic focus in the gallbladder fossa.


Instruction: Generate impression based on medical findings.

Input: Female 55 years old; Reason: CKD worsenign History: CKD RIGHT KIDNEY: The right kidney measures 10.5 cm in length. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 9 cm in length. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. URINARY BLADDER: No significant abnormality.OTHER: No significant abnormalities noted.

Output: 1.No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Male 73 years old; Reason: 73-year-old male with autoimmune hepatitis complicated by cirrhosis admitted with rapidly reaccumulating ascites, evaluate for portal vein thrombus History: rapid re-accumulation of ascites in cirrhotic patient. LIVER: Increase in hepatic parenchymal echogenicity with coarsened echotexture and cirrhotic morphology appear similar to prior exam. No focal hepatic lesions. Hepatic length measures 19 cm. The main portal vein is patent with normal hepatopetal flow with a velocity of 18.8 cm/s. GALLBLADDER/BILIARY TRACT: Status post cholecystectomy. The common bile duct measures 6 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 20.8 cm and has a normal echotexture but increased in size.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 13 cm with no hydronephrosis. The left kidney is not well visualized but approximately measures 12.4 cm with no hydronephrosis. OTHER: Small volume ascites is present in the right lower quadrant.

Output: 1.Stable cirrhotic morphology of the liver with patent main portal vein and no evidence of focal mass or biliary ductal dilatation.2.Small volume intra-abdominal ascites.3.Splenomegaly.


Instruction: Generate impression based on medical findings.

Input: Male 87 years old Reason: ? liver/gallbladder abnormality History: elevated LFTs LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 13.7 cm in length. The parenchyma is moderately echogenic. No focal hepatic lesions. Main portal vein is patent with normal directional flow.BILIARY TRACT: The gallbladder contains layering sludge. Wall measures 2 mm in thickness. Common duct measures 4 mm. PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 11.1 cm. The cortex is mildly echogenic. No shadowing calculi or hydronephrosis is present. A 1.6 cm cyst is located at the lower pole.The left kidney measures 10.3 cm. The cortex is mildly echogenic. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 6.9 cm. in length. OTHER: No ascites

Output: 1.Echogenic hepatic parenchyma possibly from mild fatty infiltration.2.Gallbladder sludge.


Instruction: Generate impression based on medical findings.

Input: Female 86 years old; Reason: eval for obstruction, hydronephrosis History: urinary retention RIGHT KIDNEY: Right kidney is not visualized.LEFT KIDNEY: The left kidney measures 11.4 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. A 1.9 cm simple left renal cyst is seen. A 6 mm shadowing stone is seen in the mid left kidney. There is also a 3 mm shadowing stone more superiorly.OTHER: Urinary bladder is unremarkable.

Output: 1.Echogenic left kidney is seen in nonspecific medical renal disease. Nephrolithiasis as above.


Instruction: Generate impression based on medical findings.

Input: Male 26 years old; Reason: abnormal masses History: thyroid cancer s/p I131 RIGHT LOBE: Status post thyroidectomy, no residual thyroid tissue. There is no residual thyroid tissue and no nodules are identified in the thyroid bed.LEFT LOBE: Status post thyroidectomy, no residual thyroid tissue. There is no residual thyroid tissue and no nodules are identified in the thyroid bed.ISTHMUS: Status post thyroidectomy, no residual thyroid tissue. There is no residual thyroid tissue and no nodules are identified in the thyroid bed.LYMPH NODES: Status post lymph node dissection, no lymph nodes were identified.OTHER: No significant abnormality noted.

Output: No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male 34 years old Reason: history of hcv, assess for cirrhosis/lesions History: as above LIVER: Liver measures 14.4 cm in length. The parenchyma is mildly coarse in echotexture. Micronodular contour suggested when liver capsule interrogated with linear transducer. Main portal vein patent with normal directional flow, velocity measures 16 cm/s. BILIARY TRACT: Gallbladder unremarkable. No significant gallbladder distention, wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Not well seen in entirety but visualized portions unremarkable.KIDNEYS: The right kidney measures 12.3 cm. The left kidney measures 11.3 cm. No hydronephrosis or perinephric free fluid.SPLEEN: The spleen measures 13.2 cm. in length. OTHER: No significant abnormality noted.

Output: Mildly coarse liver echotexture, no suspicious lesion. Micronodular contour suggested when liver capsule interrogated with linear transducer, suggesting cirrhosis.


Instruction: Generate impression based on medical findings.

Input: 52-year-old male with abdominal pain, nausea, emesis with history of stem cell transplant. LIVER: The liver measures 14.8 cm in length. Echogenic liver parenchyma without focal lesion or intrahepatic ductal dilatation.GALLBLADDER, BILIARY TRACT: No gallstones, pericholecystic fluid or gallbladder wall thickening. Common bile duct is mildly dilated at 8.5 mm. Negative sonographic Murphy's sign.PANCREAS: The visualized pancreas is slightly echogenic without definite ductal dilatation. RIGHT KIDNEY: The right kidney measures 12 cm. The cortex is of normal echogenicity. No shadowing calculi or hydronephrosis is noted. LEFT KIDNEY: The left kidney measures 12.2 cm. The cortex is of normal echogenicity. No shadowing calculi or hydronephrosis is noted.SPLEEN: The spleen is mildly enlarged and measures 15.6 cm. OTHER: No significant abnormalities noted.

Output: 1. Dilated common bile duct at 8.5 mm without definite lesions or stones seen. If clinically warranted, MRCP is recommended.2. Echogenic liver parenchyma suggestive of parenchymal dysfunction/fatty infiltration without focal lesion or intrahepatic ductal dilatation.3. Mild splenomegaly.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female with epigastric pain. LIMITED ABDOMENLIVER: The liver has a smooth contour and parenchyma is normal in appearance. Liver measures 14.0 cm in length. Portal flow is hepatopedal.BILIARY TRACT: The gallbladder has an anechoic lumen. No gallbladder wall thickening or pericholecystic fluid is seen. No biliary ductal dilation.PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 9.6 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. A 1.0 x 1.0 x 1.1 cm cyst is seen in the right kidney.The left kidney measures 9.5 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.SPLEEN: The spleen measures 8.8 cm. in length.OTHER: No significant abnormalities noted.

Output: 1.No significant abnormality is seen.


Instruction: Generate impression based on medical findings.

Input: Male 43 years old; Reason: kidney stone History: stone RIGHT KIDNEY: The right kidney measures 12 cm in length. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney is absent URINARY BLADDER: Decompressed limiting evaluationOTHER: Increased echogenicity of the liver most compatible with fatty infiltration..

Output: 1.No hydronephrosis of right kidney. Fatty liver.


Instruction: Generate impression based on medical findings.

Input: Status post drain placement on 1/6/2016 in the right lower quadrant for perinephric fluid collection. No longer draining. Assess for interval change. Transplant kidney measures 12.4 cm without hydronephrosis. The previously described complex fluid collection is markedly decreased in size and currently measures 6.8 x 5.9 x 2.8 cm. A stent is noted within the bladder and the drain is identified within the complex collection.

Output: Interval decrease in fluid collection status post percutaneous drainage. Dr. Chon will be notified by telephone.


Instruction: Generate impression based on medical findings.

Input: Male 53 years old with new anemia and hematuria, assess kidneys for structural abnormalities RIGHT KIDNEY: The right kidney measures 9.5 cm in length. The cortex is mildly echogenic. No shadowing calculi or hydronephrosis is present.LEFT KIDNEY: The left kidney measures 10.3 cm in length. The cortex is mildly echogenic. No shadowing calculi or hydronephrosis is present. URINARY BLADDER: Debris-filled bladder with wall thickening measuring up to 0.6 cm. OTHER: No significant abnormalities noted.

Output: 1. Mildly echogenic kidneys consistent with medical renal disease. No evidence of hydronephrosis or calculi.2. Debris-filled and thick-walled bladder, which may be post-procedural or secondary to cystitis, correlation with patient's clinical history and laboratory values recommended.


Instruction: Generate impression based on medical findings.

Input: Male 63 years old; Reason: assess for hydronephrosis History: pain with urination, history of stone RIGHT KIDNEY: The right kidney measures 11.9 cm in length. The cortex is mild echogenic. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 12.5 cm in length. The cortex is mild echogenic. No shadowing calculi or hydronephrosis is present.  URINARY BLADDER: No significant abnormality notedOTHER: No significant abnormalities noted.

Output: 1.Mild echogenic renal cortices. No hydronephrosis or nephrolithiasis.


Instruction: Generate impression based on medical findings.

Input: Erythema and swelling of left lower extremity, history of diabetes, assess for abscess Moderate degree of left lower extremity subcutaneous edema with largest area of focal fluid measuring up to 2.7 x 1.9 x 0.6 cm, however does not have the appearance of an abscess. When compared to contralateral side, degree of subcutaneous edema is similar.

Output: Bilateral lower extremity subcutaneous edema/cellulitis.No evidence of abscess.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o growth of nodules, worrisome characteristics History: multinodular goiter RIGHT LOBE MEASUREMENTS: 1.7 x 1.1 x 4.2 cmLEFT LOBE MEASUREMENTS: 1.4 x 0.9 x 3.8 cmISTHMUS MEASUREMENTS: 0.1 cmRIGHT LOBE: There is a 0.5 x 0.4 x 0.6 cm nodule of mixed echogenicity noted in the inferior lobe of the right thyroid, unchanged from prior exam. A second nodule is noted in the midportion of the right thyroid which measures 0.3 x 0.3 x 0.5 cm, unchanged from prior exam.LEFT LOBE: There is a 0.2 x 0.2 x 0.3 cm nodule noted in the midportion of the left lobe of the thyroid. This was not visualized on prior exam.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There is a 0.6 x 0.5 x 2 cm lymph node noted in the level 2-3 area of the left neck.OTHER: No significant abnormality noted.

Output: Stable exam. Recommend continued surveillance.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old. Reason: none incidental small nodules on CT History: none RIGHT LOBE MEASUREMENTS: 8.0 x 2.6 x 1.6 cmLEFT LOBE MEASUREMENTS: 6.9 x 2.4 x 1.5 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: Mildly enlarged thyroid lobe with heterogeneous echotexture. There are multiple hypoechoic, benign-appearing colloid nodules. Right lower pole nodule measures 0.6 x 0.5 x 0.6 cm. No increased internal vascularity.LEFT LOBE: Mildly enlarged thyroid lobe with heterogeneous echotexture. There are multiple hypoechoic, benign-appearing colloid nodules.Left upper pole hypoechoic nodule measures 1.1 x 0.5 x 0.9 cm. No increased internal vascularity.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: The benign-appearing left level 3 neck lymph node measures 1.4 x 0.9 x 0.3 cm.OTHER: No significant abnormality noted.

Output: Mildly enlarged thyroid gland with multiple benign-appearing colloid nodules. No regional lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Female 63 years old Reason: Evaluate for renal abscess History: hx of MDRO and UTI, elevated WBC and hx of E.coli UTI RIGHT KIDNEY: The right kidney measures 8.2 cm. Mildly increased renal cortical echogenicity. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 9 cm. Mildly increased renal cortical echogenicity. Presumed prominent dromedary hump seen. No shadowing calculi or hydronephrosis present. BLADDER: Underdistended, making evaluation for wall thickening suboptimal.

Output: Mildly echogenic kidneys, likely reflecting underlying medical renal disease. Bulbous appearance of left midpole may be a prominent dromedary hump. If there is continued clinical concern for renal abscess, further evaluation with dedicated contrast enhanced CT or MRI recommended.


Instruction: Generate impression based on medical findings.

Input: Male 83 years old; Reason: noted mass seen on CT History: none RIGHT KIDNEY: The right kidney measures 10.3 cm in length. The cortex is mild echogenic. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 10.8 cm in length. The cortex is mild echogenic. No shadowing calculi or hydronephrosis is present. In the interpolar region of the kidney is a hypoechoic area that is isoechoic to renal cortex and likely represents a renal column of Bertin. No discrete renal mass is identified.OTHER: No significant abnormalities noted.

Output: 1.No hydronephrosis or nephrolithiasis at the kidney.2.No evident mass in either kidney.


Instruction: Generate impression based on medical findings.

Input: Female 67 years old Reason: Chronic HCV, evaluate parenchyma rule out lesions History: Chronic HCV, evaluate parenchyma rule out lesions. LIMITED ABDOMENLIVER: . Liver measures 15.2 cm in length. The parenchyma demonstrates coarse echotexture. No mass lesions are detected. The flow in the main portal vein is hepatopetal with a peak systolic velocity of 0.2 m/s.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. The gallbladder wall measures 4 mm in thickness. The gallbladder is nondistended. Gallstones are noted within the lumen of the gallbladder.PANCREAS: No significant abnormalities are noted of the visualized pancreas.KIDNEYS: The right kidney measures 11.3 cm. The cortex is of normal echotexture. No shadowing calculi or hydronephrosis is present. The left kidney measures 10.6 cm. The cortex is of normal echotexture. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 6.8 cm in length. OTHER: No significant abnormalities noted.

Output: 1.Coarse echotexture of the liver without evidence of a focal lesion.2.Cholelithiasis.


Instruction: Generate impression based on medical findings.

Input: 32-year-old female with a history of thyroid cancer status post thyroidectomy. RIGHT LOBE MEASUREMENTS: The patient is status post thyroidectomy.LEFT LOBE MEASUREMENTS: The patient is status post thyroidectomy.ISTHMUS MEASUREMENTS: The patient is status post thyroidectomy.RIGHT LOBE: No significant abnormality noted. No evidence of recurrent disease.LEFT LOBE: No significant abnormality noted. No evidence of recurrent disease.ISTHMUS: No significant abnormality noted. No evidence of recurrent disease.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No residual lymph nodes on the right. Left, benign appearing level III lymph nodes appear unchanged from prior examination.OTHER: No significant abnormality noted.

Output: No evidence of recurrent disease.


Instruction: Generate impression based on medical findings.

Input: Male 39 years old Reason: 39 M new T cell ALL, tumor lysis, AKI, eval kidneys History: AKI RIGHT KIDNEY: The right kidney measures 14.4 cm. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 13.6 cm. No shadowing calculi or hydronephrosis is present. BLADDER: No significant abnormalities.OTHER: No significant abnormalities noted.

Output: No evidence of hydronephrosis or shadowing renal calculus bilaterally.


Instruction: Generate impression based on medical findings.

Input: Reason: 70 worth cirrhosis please screen for HCC History: none LIVER: The size of the liver is at the lower limit of normal, measuring 12.8 cm. There is coarsened echotexture and a nodular contour, consistent with cirrhotic morphology. There are no masses. There is no intrahepatic ductal dilation.BILIARY TRACT: There is a small amount of biliary sludge layering within the dependent portion of the gallbladder. There is no cholelithiasis. The gallbladder wall is not thickened, measuring 0.2 cm. The common hepatic duct is not dilated, measuring 0.4 cm.PANCREAS: Poorly visualized. Unable to be adequately assessed.SPLEEN: The size of the spleen is within normal limits, measuring 11 cm in length. Normal echogenicity. No focal lesionsKIDNEYS: The right kidney measures 8.8 cm in length. Normal echogenicity. No focal lesions. No hydronephrosis.The left kidney measures 8.6 cm in length. Normal echogenicity. No focal lesions. No hydronephrosis. OTHER: The main portal vein is patent with hepatopetal flow and normal waveform. The velocity 0.2 m/s.No ascites.

Output: 1. Stable cirrhotic liver. No mass is visualized.


Instruction: Generate impression based on medical findings.

Input: Incomplete bladder emptying Prevoid bladder volume measures 864 mL.Postvoid bladder volume measures 4 mL.Visualized bladder unremarkable.

Output: No significant postvoid residual.


Instruction: Generate impression based on medical findings.

Input: Female 57 years old Reason: 57F with worsening renal function and pelvic mass, assess for obstruction. History: AKI, pelvic mass RIGHT KIDNEY: The right kidney measures 10.2 cm. There is increased echogenicity of the renal cortex. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 11.1 cm. There is increased echogenicity of the renal cortex. No shadowing calculi or hydronephrosis is present. Hypoechoic focus just anterior to the renal pelvis is compatible with an extrarenal pelvis.BLADDER: No significant abnormalities noted.OTHER: In left adnexal area is a heterogenous mass with no significant internal vascularity and scan lines compatible with a fibroid as seen on recent CT. Note is made of bilateral pleural effusions.

Output: 1.Increased echogenicity of the bilateral renal cortices is compatible with medical renal disease. No hydronephrosis or shadowing renal calculus is seen bilaterally.2.Left adnexal fibroid.3.Bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female 26 years old; Reason: left sided flank pain at 20 weeks gestation History: left sided flank pain at 20 weeks gestation RIGHT KIDNEY: The right kidney measures 10.3 cm in length. The kidney appears echogenic. No hydronephrosis is present. No calculi are visualized.LEFT KIDNEY: The left kidney measures 12.1 cm in length. The kidney appears echogenic and mild hydronephrosis is present. No calculi are visualized.URINARY BLADDER: The bladder is empty and not well visualized.OTHER: No significant abnormalities noted.

Output: 1.Echogenic kidneys with mild left hydronephrosis consistent with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Female 46 years old Reason: s/p right distal ureterectomy with reimplant - psoas hitch History: s/p right distal ureterectomy with reimplant - psoas hitch RIGHT KIDNEY: The right kidney measures 9.3 cm in length and demonstrates normal parenchymal echogenicity. Mild hydronephrosis appears similar to the prior examination.LEFT KIDNEY: The left kidney measures 9.7 cm in length and demonstrates normal parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.BLADDER: No significant abnormality noted.OTHER: Unchanged anechoic lesion in the left hepatic lobe measures 1.4 x 1.6 x 1.2 cm consistent with a simple hepatic cyst.

Output: Mild hydronephrosis on the right similar to prior.


Instruction: Generate impression based on medical findings.

Input: Male 50 years old with cardiomyopathy now with pancreatitis of unclear etiology, please eval for gallstones LIVER: Mild increase in hepatic parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions. The main portal vein is patent with normal hepatopedal flow directed towards the liver. GALLBLADDER/BILIARY TRACT: The gallbladder is contracted, which limits evaluation. Multiple dependent shadowing echogenic foci are noted within the gallbladder. No pericholecystic fluid. The gallbladder wall measures 4 mm. The common bile duct measures 3 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Pancreas is not well-visualized.KIDNEYS: The right kidney is mildly echogenic and measures 9.8 cm with normal vascular flow. Mild to moderate hydronephrosis is present on the right.BLADDER: No acute abnormalities.OTHER: Right pleural effusion is noted.

Output: 1. Cholelithiasis without evidence of cholecystitis.2. Mild increase in hepatic parenchymal echogenicity with coarsened echotexture consistent with fatty liver/hepatic parenchymal dysfunction. No hepatic mass or ductal dilatation identified.3. Mild to moderate right-sided hydronephrosis and increased renal echogenicity consistent with medical renal disease.4. Right pleural effusion noted.