Instruction: Generate impression based on medical findings.

Input: 56-year-old male, evaluate for medical kidney disease. RIGHT KIDNEY: The right kidney measures 10.6 cm in length. The cortex is increased in echogenicity. No shadowing calculi or hydronephrosis is present.LEFT KIDNEY: The left kidney measures 10.9 cm in length. The cortex is increased in echogenicity. No shadowing calculi or hydronephrosis is present.URINARY BLADDER: Foley catheter within a slightly distended bladder is noted. OTHER: No significant abnormalities noted.

Output: 1.Increased echogenicity of the kidneys suggestive of parenchymal dysfunction. No obstruction. 2.Foley catheter within a slightly distended bladder. Evaluation for patency of Foley catheter is recommended.


Instruction: Generate impression based on medical findings.

Input: Reason: 56F s/p SLK now with elevated wbc with Rlq abdominal pain increase in creatnine Please eval blood flow to kidney and r/o abscess in rlq History: Rlq abdominal pain and wbc elevated RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: Minimal amount of peritransplant fluid.KIDNEY: No significant abnormality notedCOLLECTING SYSTEM/URETER: No significant abnormality notedURINARY BLADDER: Catheter is seen within the urinary bladder, which is otherwise unremarkable.VASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels. No significant abnormality notedOTHER: 2.5 x 1.7 cm somewhat superficial lesion with arterial waveforms medial to the transplant and adjacent to the bladder is suspicious for an aneurysm. This correlates with a patient's palpable painful abnormality.

Output: 2.5 x 1.7 cm somewhat superficial lesion with arterial waveforms medial to the transplant and adjacent to the bladder is suspicious for an psuedoaneurysm/aneurysm. This correlates with a patient's palpable painful abnormality. Further evaluation with vascular Doppler or cross-sectional imaging with contrast enhancement if possible, is suggested.Findings d/w Dr. Burress at 4:02pm on 8/24/2015.


Instruction: Generate impression based on medical findings.

Input: Thyroid enlargement RIGHT LOBE MEASUREMENTS: 6.0 x 1.2 x 2.2 cm.LEFT LOBE MEASUREMENTS: 5.5 x 1.4 x 2.5 cm.ISTHMUS MEASUREMENTS: 4.5 mm.RIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Right level 1 lymph node measuring 1.6 x 0.5 x 2.1 cm. Left level 1 lymph node measuring 2.0 x 0.8 x 3.0 cm. Left level 2 lymph nodes measuring 1.0 x 0.4 x 1.2 cm.OTHER: No significant abnormality noted.

Output: 1.Normal appearing thyroid gland without evidence of thyroid nodules. 2.Bilateral benign reactive level I lymph nodes.


Instruction: Generate impression based on medical findings.

Input: 46-year-old female with history of thyroid nodule. RIGHT LOBE MEASUREMENTS: 5.6 x 1.5 x 1.7 cmLEFT LOBE MEASUREMENTS: 5.4 x 1.4 x 1.6 cmISTHMUS MEASUREMENT: 0.4 cmRIGHT LOBE: Mildly heterogeneous appearing right thyroid gland. No discrete nodules are identified.LEFT LOBE: Mildly heterogeneous appearing left thyroid gland. Subcentimeter hypoechoic nodule measuring 0.8 x 0.3 x 0.7 cm without significant vascularity.ISTHMUS: No significant abnormality noted.LYMPH NODES: Scattered benign-appearing lymph nodes.OTHER: No significant abnormality noted.

Output: Mildly heterogeneous thyroid gland with a subcentimeter hypoechoic left thyroid nodule, favored to be benign.


Instruction: Generate impression based on medical findings.

Input: Male 44 years old Reason: right upper quadrant ultrasound-previously cholecystostomy tube History: worsening right upper quadrant pain X 1 week, LIVER: Liver measures 14.4 cm in length. The parenchyma is normal in echotexture .Main portal vein is patent with hepatopedal flow..BILIARY TRACT: The gallbladder is contracted. There is wall thickening and edema measuring up to 0.7 cm. There is no loculated fluid collection. There is no intrahepatic or extrahepatic biliary duct dilatation. Negative sonographic Murphy's sign.PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 9.1 cm. The left kidney measures 9.4 cm. There is no hydronephrosis or shadowing renal calculus.SPLEEN: The spleen measures 7.7 cm. in length. OTHER: Partially imaged small pericardial effusion is noted.

Output: 1.Contracted gallbladder with wall thickening. However, no loculated fluid collection is identified.2.Small pericardial effusion.


Instruction: Generate impression based on medical findings.

Input: Male 67 years old Reason: R/O HCC History: Hx of HCV and cirrhosis LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 14.0 cm in length. The parenchyma is mildly coarse and echogenic. No focal hepatic lesion is identified. The portal vein is patent with normal directional flow.BILIARY TRACT: The gallbladder has echogenic calculi with posterior acoustic shadowing. Wall measures 2 mm in thickness. The common bile duct measures 5 mm, normal in caliber. 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 11.5 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. The left kidney measures 11.2 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present.SPLEEN: The spleen measures 13.1 cm in length. OTHER: No significant abnormalities noted.

Output: 1.Mildly coarse and echogenic liver. No focal lesion identified.2.Echogenic kidneys compatible with medical renal disease. No hydronephrosis or renal calculi.3.Cholelithiasis, without secondary signs of inflammation to suggest acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Female 61 years old; evaluate for gallbladder/liver pathology appear history: Right upper quadrant pain, recent ERCP LIVER: Liver is normal in echogenicity and echotexture. No focal hepatic lesions. Hepatic length measures 17.8 cm. The main portal vein is patent with normal hepatopetal flow with a velocity of 21.8 cm/s. GALLBLADDER/BILIARY TRACT: Echogenic foci within the gallbladder neck are most suggestive of residual cholelithiasis, although without significant shadowing. The gallbladder wall is within normal limits, measuring 3 mm. The common bile duct measures 5 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen approximately measures 10 cm and is not well-visualized.KIDNEYS: The right kidney measures 11.9 cm with no hydronephrosis. The cortex is echogenic and somewhat atrophic. Multiple small renal cysts are unchanged. No solid mass.The left kidney measures 10.4 cm with no hydronephrosis. The cortex is echogenic and somewhat atrophic. Multiple small renal cysts are unchanged. Additional areas of hypoechogenicity in the cortex are not fully characterized.OTHER: No significant ascites.

Output: 1.Cholelithiasis, without evidence of acute cholecystitis.2.Normal echogenicity and echotexture of the liver without evidence of focal hepatic mass or intrahepatic or extra hepatic biliary ductal dilatation.3.Mild-to-moderate increased cortical echogenicity and parenchymal volume loss of bilateral kidneys, compatible with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Primary hyperparathyroidism RIGHT LOBE: Measures 4.1 x 1.4 x 1.2 cm. Posterior to mid to lower right lobe is a hypoechoic focus measuring 0.6 x 0.6 x 0.5 cm, minimal corresponding vascular flow.LEFT LOBE: Measures 3.5 x 0.8 x 0.7 cm. Subcentimeter midpole benign cystic nodule.ISTHMUS: Normal in size.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Hypoechoic focus posterior to mid to lower pole of right lobe suspicious for a parathyroid adenoma.Please refer to same day medicine scintigraphic imaging for additional findings.


Instruction: Generate impression based on medical findings.

Input: 82-year-old male. Reason: AKI, please assess for hydronephrosis History: as above RIGHT KIDNEY: The right kidney measures 9.8 cm in length. No definite hydronephrosis is identified. There is cortical thinning with cystic appearing structure at the mid pole that do not demonstrate internal vascularity. The appearance favors a parapelvic cyst, less likely hydronephrosis. LEFT KIDNEY: The left kidney measures 12.0 cm in length. There is a midpole renal cyst which does not demonstrate internal vascularity and is likely benign.OTHER: No significant abnormalities noted.

Output: Right sided cystic lesion favor parapelvic renal cyst, with no definite hydronephrosis. Left sided simple renal cyst.


Instruction: Generate impression based on medical findings.

Input: 42-year-old woman with history of lanced subcutaneous fluid collection yesterday, evaluate for abscess. On examination, two ~1cm incisions are seen without purulent drainage. The incisions are seen sonographically in the subcutaneous soft tissues without discrete underlying fluid collection.

Output: Cutaneous incisions without residual underlying fluid collections.


Instruction: Generate impression based on medical findings.

Input: Female 49 years old; Reason: s/p total thyroidectomy (thyroiditis), also h/o breast cancer. PET avid lesion in left neck eval for correlate History: none RIGHT LOBE MEASUREMENTS: Status post thyroidectomy. LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENT: Status post thyroidectomy.LYMPH NODES: No significant abnormality noted.OTHER: In the left thyroid bed there is a subcentimeter hypoechoic nodule measuring 0.6 x 0.5 x 0.4 cm. Targeted FNA biopsy of this lesion was performed.

Output: 1.Hypoechoic nodule in the left thyroidectomy bed. Targeted biopsy of lesion was performed.


Instruction: Generate impression based on medical findings.

Input: Female 56 years old Reason: Assess fro HCC History: Cirrhosis. Liver transplant evaluation LIMITED ABDOMENLIVER: The liver has a nodular contour. Liver measures 13.5 cm in length. The parenchyma is coarse and echogenic. No focal lesion identified. The portal vein is patent with normal directional flow.BILIARY TRACT: Few non-shadowing echogenic foci along the nondependent and dependent gallbladder wall, probably polyps, measuring up to 4 mm, unchanged. Wall measures 2 mm in thickness. The common bile duct measures 3 mm.PANCREAS: The pancreatic head and body are normal in appearance. Pancreatic tail is obscured by bowel gas.KIDNEYS: The right kidney measures 9.3 cm. The cortex is thinned and echogenic. No shadowing calculi or hydronephrosis is present. Within the right lower pole there is a 1.1 x 1.1 x 0.9 cm hypoechoic lesion, probable cyst.The left kidney measures 10.0 cm. The cortex is thinned and echogenic. No shadowing calculi or hydronephrosis is present. No suspicious lesion identified.SPLEEN: The spleen measures 9.3 cm in length.OTHER: Probable small volume ascites.

Output: 1.Nodular echogenic liver, compatible with history of cirrhosis. No focal lesion identified.2.Atrophic echogenic kidneys, compatible with chronic medical renal disease. No hydronephrosis or renal calculi.3.Gallbladder polyps, measuring up to 4 mm.4.Small volume ascites.


Instruction: Generate impression based on medical findings.

Input: Female 66 years old; Reason: r/o obstruction, stones. Assess kidney size History: Chronic kidney disease, gout, hypertension RIGHT KIDNEY: The right kidney measures 10.3 cm in length. The relative echogenicity of the kidney cannot be fully assessed due to increased background echogenicity of the liver. No shadowing calculi or hydronephrosis is present. Right inferior pole simple cyst measures 1.4 x 1.5 x 1.4 cm, similar to prior exam.LEFT KIDNEY: The left kidney measures 10.7 cm in length. The relative echogenicity of the kidney cannot be fully assessed due to increased background echogenicity of the liver. No shadowing calculi or hydronephrosis is present. Left subcentimeter interpolar simple renal cyst measuring 0.6 x 0.5 x 0.6 cm is unchanged.URINARY BLADDER: No significant abnormalities notedOTHER: Diffusely increased echogenicity of the liver is noted.

Output: 1.Stable bilateral simple renal cysts with no evidence of mass, stone, or hydronephrosis.2.Diffusely increased echogenicity of the liver, which is nonspecific and but may be due to fatty infiltration.


Instruction: Generate impression based on medical findings.

Input: 64-year-old female with high fevers and shock, evaluate for cholangitis. LIVER: Liver is normal in echogenicity and echotexture. No focal hepatic lesions. Hepatic length measures 18.7 cm and is slightly increased in size. The main portal vein is patent with normal hepatopetal flow with a velocity of 34.3 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 3.7 mm. Multiple small polyps in the gallbladder with the largest measuring 0.6 x 0.5 x 0.5 cm. Sonographic Murphy's sign is negative. The common bile duct measures 3 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 12.2 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 11.1 cm with no hydronephrosis. The left kidney measures 11.2 cm with no hydronephrosis. OTHER: No ascites.

Output: 1.No evidence of cholelithiasis or acute cholecystitis.2.No intrahepatic or extrahepatic biliary ductal dilatation or wall thickening to suggest cholangitis.3.Mild hepatomegaly.4.Subcentimeter gallbladder polyps.


Instruction: Generate impression based on medical findings.

Input: Female 51 years old Reason: UTI, renal stents. Pyelo? Infected stents. History: Sepsis, UTI RIGHT KIDNEY: The right kidney measures 10.6 cm in length and demonstrates increased parenchymal echogenicity. A nephroureteral stent is in place. There is a significant amount of soft tissue about the proximal ureter, likely representing lymphadenopathy. Additionally, there appears to be soft tissue thickening of the proximal ureter; however, this is difficult to differentiate from the surrounding nodal tissue. There is mild right hydronephrosis.LEFT KIDNEY: The left kidney measures 12.2 cm in length and demonstrates increased parenchymal echogenicity. There is a nephroureteral stent in place. Multiple nonobstructing renal stones are present within both the superior and inferior calices. There is mild left-sided hydronephrosis.BLADDER: The bladder is nondistended.OTHER: No significant abnormalities noted.

Output: 1.Soft tissue about the proximal right ureter likely representing lymphadenopathy.2.Increased renal parenchymal echogenicity suggestive of medical renal disease.3.Apparent soft tissue thickening of the proximal ureter may be infectious or inflammatory in etiology.4.Bilateral nephroureteral stents in place with mild associated bilateral hydronephrosis.5.Nonobstructing left renal stones.


Instruction: Generate impression based on medical findings.

Input: Female 31 years old; Reason: assess for thyroid abnormality, comment on lymph nodes History: left neck swelling, enlarged anterior cervical lymph node RIGHT LOBE MEASUREMENTS: 5.3 x 1.7 x 1.4 cmLEFT LOBE MEASUREMENTS: 5.1 x 1.5 x 1.3 cmISTHMUS MEASUREMENT: 0.4 cmRIGHT LOBE: The thyroid gland is normal in echogenicity and echotexture without discrete nodules.LEFT LOBE: The thyroid gland is normal in echogenicity and echotexture without discrete nodules.ISTHMUS: The thyroid gland is normal in echogenicity and echotexture without discrete nodules.LYMPH NODES: Cervical lymph nodes are normal in morphology and size.OTHER: No significant abnormality noted.

Output: Normal sonographic evaluation of the thyroid gland.


Instruction: Generate impression based on medical findings.

Input: Reason: pt with intermittent left groin pain \T\ fullness, evaluating for inguinal hernia History: pt with intermittent low level left groin pain, palpable fullness that is reducible on exam, ttp in left groin A couple benign-appearing lymph nodes are seen within the left groin. No definitive hernia is noted.

Output: No definitive hernia is seen. If clinically indicated, can obtain CT for further evaluation.


Instruction: Generate impression based on medical findings.

Input: 36-year-old male with right axillary furuncle. Reason: Characterize abscess. Edema and pockets of fluid in the soft tissues underlying the area of interest, measuring approximately 2.9 x 1.6 x 1.8 cm. This is associated with increased vascularity, but without a discrete fluid collection.

Output: Pockets of fluid associated with increased vascularity, but without a discrete drainable fluid collection.


Instruction: Generate impression based on medical findings.

Input: Male 61 years old Reason: 61 yo M with abdominal pain, evaluate for liver or biliary pathology please image renal txp for cause of pain History: right upper quadrant ultrasound, rlq pain LIVER: The liver measures 16.0 cm in length and demonstrates normal parenchymal echogenicity. No intrahepatic or extrahepatic biliary ductal dilatation is evident and no focal mass lesions are seen. The main portal vein is patent and demonstrates hepatopedal flow with a velocity of 0.2 m/s. GALLBLADDER, BILIARY TRACT: No cholelithiasis or choledocholithiasis is seen. The common duct measures 0.3 cm in diameter. Mild nonspecific bladder wall thickening may reflect hypoproteinemia or fluid status.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 8.7 cm in length and demonstrates marked cortical thinning and multiple cysts. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.LEFT KIDNEY: The left kidney measures 10.8 cm in length and demonstrates marked cortical thinning, the parenchyma of which is nearly completely replaced with cysts. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.SPLEEN: The spleen measures 11.5 cm in length.OTHER: Right iliac fossa transplant kidney is without hydronephrosis or associated fluid collection.

Output: 1.Thinning of the bilateral renal cortex, with multiple cysts consistent with end-stage renal disease.2.Mild nonspecific gallbladder wall thickening may reflect hypoproteinemia or fluid status.


Instruction: Generate impression based on medical findings.

Input: 75-year-old female with history of gallstones, please evaluate. LIVER: The hepatic parenchymal echogenicity is within normal limits. There is no intrahepatic biliary ductal dilatation or focal mass lesion within the hepatic parenchyma. The main portal vein is patent and demonstrates hepatopedal flow.BILIARY TRACT: The common bile duct is prominent, measuring approximately 7.5 mm in diameter. There is no gallbladder wall thickening, pericholecystic fluid or cholelithiasis. The gallbladder is mildly atrophic.PANCREAS: The visualized portions of the pancreatic head and proximal body are normal in appearance.SPLEEN: The spleen is normal in size.RIGHT KIDNEY: The right kidney measures 9.4 cm in length and demonstrates normal parenchymal echogenicity. There is mild right hydronephrosis and proximal right hydroureter. LEFT KIDNEY: The left kidney measures 9.2 cm in length and demonstrates normal parenchymal echogenicity. There is a lobulated septated cystic lesion in lower pole hilum of the left kidney measuring approximately 2.4 x 3.7 x 2.3 cm, which may represent renal sinus cysts, or possibly focal hydronephrosis.OTHER: No significant abnormalities noted.

Output: 1.Mild right-sided hydronephrosis and proximal hydroureter.2.Lobulated septated cystic lesion in the lower pole hilum of the left kidney, which may represent renal sinus cysts or less likely focal hydronephrosis. Comparison to prior abdominal CT imaging is recommended.3.Prominent common bile duct, but without evidence of proximal choledocholithiasis.


Instruction: Generate impression based on medical findings.

Input: Male 78 years old Reason: cirrhosis, evaluate for hcc LIMITED ABDOMENLIVER: The liver measures 15.7 cm in length. The liver has a nodular contour. The parenchyma is heterogeneous with coarsened echotexture. No worrisome mass is identified. There is no ascites. The portal vein is patent and demonstrates hepatopetal flow with a peak velocity of 0.3 m/sec. BILIARY TRACT: Gallbladder is contracted and contains multiple shadowing. There is no gallbladder wall thickening or pericholecystic fluid. Common duct measures 0.3 cm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The pancreas is obscured by overlying bowel gas.KIDNEYS: The right kidney measures 10.6 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 9.6 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 12.3 cm in length.

Output: 1.Cirrhotic liver, no worrisome masses identified. There is no ascites.2.Cholelithiasis without evidence of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: 26-year-old male with soft tissue induration of the right upper extremity. Edematous changes of the subcutaneous soft tissues. No drainable collection is seen.

Output: Soft tissue edema without a drainable collection.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with history of kidney stones and right lower pole caliectasis. RIGHT KIDNEY: The right kidney measures 9.3 cm in length. The cortex is normal in echogenicity. No shadowing hydronephrosis is present. Some residual small, nonobstructing stones are visualized, the largest of which measures approximately 0.4 x 0.4 x 0.3 cm. Unchanged caliectasis of the right lower pole. The upper pole is normal in appearance.LEFT KIDNEY: The left kidney measures 9.7 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.OTHER: The bladder is nondistended. Bilateral ureteral jets are visualized.

Output: 1.Nonobstructing right renal stones, the most prominent of which measures 0.4 x 0.4 x 0.3 cm.2.Unchanged caliectasis of the right lower pole.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o recurrence. Is this more c/w thyroid remnant or adenopathy? History: h/o thyroid cancer but not RAI. Prior US showed focus in thyroid bed, somewhat biggerin size. This is a 6 month follow up Status post total thyroidectomy. RIGHT BED: In the inferior right thyroid bed, there is a redemonstrated 9 x 4 x 11 mm nodule, previously measuring 10 x 5 x 12 mm. This nodule has not significant changed and is slightly echogenic and heterogenous with no significant vascularity and no demonstrable microcalcifications.Just superior to this, best seen on longitudinal images, there is a homogenous echogenic area measuring 10 x 7 x 10 mm with no microcalcifications and minimal vascularity.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Right level 2 lymph node without suspicious features.OTHER: No significant abnormality noted.

Output: Stable nodule in the inferior right thyroid bed as described above. Newly seen, and adjacent to this nodule, there is an area of echogenicity as described above which is nonspecific, but could be residual thyroid tissue or postsurgical scarring.


Instruction: Generate impression based on medical findings.

Input: Male 62 years old; Reason: renal failure. R/o obstruction History: AKI. Low output RENAL TRANSPLANT: Renal allograft cortex is mildly echogenic. The cortex is mildly thinned. It measures 12.7 cm in length.LOCATION: Right iliac fossa.PERITRANSPLANT TISSUES: No peri-nephric fluid collections.COLLECTING SYSTEM/URETER: No hydronephrosis or nephrolithiasis.URINARY BLADDER: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1.No sonographic findings of nephrolithiasis or hydronephrosis of the renal transplant.2.No perinephric fluid collections.3.Mildly echogenic renal cortex.


Instruction: Generate impression based on medical findings.

Input: Female 67 years old Reason: R/O HCC History: HCV, cirrhosis LIVER: Liver measures 12.6 cm in length. The parenchyma is moderately coarse and echogenic with a nodular liver contour suggestive of cirrhosis. No obvious focal hepatic lesion. No ascites.Main portal vein is patent with hepatopetal flowBILIARY TRACT: Gallbladder unremarkable. No significant gallbladder distention, wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 9.2 cm. Again seen is splaying of the renal pelvis suggestive of mild hydronephrosis, unchanged from the prior exam. No shadowing renal calculus. The left kidney measures 9.4 cm. No evidence of hydronephrosis or shadowing renal calculus.SPLEEN: The spleen measures 8.0 cm. in length. OTHER: No significant abnormality noted.

Output: 1.Cirrhotic appearing liver without obvious focal hepatic mass or ascites.2.Stable mild right-sided hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 65-year-old female with history of kidney stones RIGHT KIDNEY: The right kidney measures 10 cm. The cortex is of normal echogenicity. Redemonstrated is a nonobstructing renal stone in the lower pole measuring 0.9 x 0.5 x 1 cm and another nonobstructing renal stone in the lower pole. Also redemonstrated is an anechoic focus in the mid right kidney measuring 0.8 x 0.8 x 0.8 cm, compatible with a simple cyst. There is no hydronephrosis.LEFT KIDNEY: The left kidney measures 10.3 cm. The cortex is of normal echogenicity. Redemonstrated is a nonobstructing renal stone in the inferior pole measuring 0.6 x 0.5 x 0.4 cm. Also redemonstrated is an anechoic focus in the mid left kidney measuring 0.9 x 0.8 x 0.7 cm, compatible with a simple cyst. There is no hydronephrosis.OTHER: Bladder is nondistended.

Output: Bilateral nonobstructing renal stones, largely unchanged when compared to the prior study.


Instruction: Generate impression based on medical findings.

Input: Female 60 years old Reason: thyroid cancer History: thyroid nodule RIGHT LOBE MEASUREMENTS: 6.3 x 2.7 x 2.7 cmLEFT LOBE MEASUREMENTS: 5.8 x 1.6 x 1.6 cm.ISTHMUS MEASUREMENTS: 0.4 cm in thickness.RIGHT LOBE: The right lobe of the thyroid demonstrates normal parenchymal echogenicity. There is a 4.9 x 2.5 x 4.0 cm heterogeneous part solid part cystic nodule in the right lobe of the thyroid, previously measuring 4.6 x 2.4 x 2.6 cm.LEFT LOBE: The left lobe of the thyroid demonstrates normal parenchymal echogenicity. Conglomerate heterogeneous left lobe nodule measures 1.0 x 0.7 x 0.6 cm, previously 1.0 x 0.6 x 0.6 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multinodular goiter, not significantly changed from the prior examination.


Instruction: Generate impression based on medical findings.

Input: 59 year old female Reason: Ultrasound of the thyroid with attention to parathyroid as well. History: Ultrasound of the thyroid with attention to parathyroid as well. RIGHT LOBE MEASUREMENTS: 5.6 x 2.3 x 2.3 cm.LEFT LOBE MEASUREMENTS: 6.0 x 2.1 x 2.3 cm.ISTHMUS MEASUREMENTS: 0.4 cm.RIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: Within the left aspect of the isthmus is a rounded well-defined hypoechoic homogenous focus measuring 0.5 x 0.4 x 0.5 cm without evidence of definite calcifications.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A right neck level 3 lymph node measures 2.5 x 0.8 x 1.0 cm. A second more superior right level 3 lymph node measures 2.7 x 0.7 x 1.0 cm. Both these lymph nodes have benign appearing features and are likely reactive.OTHER: No significant abnormality noted.

Output: 1.Left sided hypoechoic well-defined focus without evidence of definite calcifications. Continued surveillance with imaging is recommended.2.Enlarged right neck lymph nodes with benign features are likely reactive.


Instruction: Generate impression based on medical findings.

Input: 48-year-old female with elevated creatinine. Reason: Evaluate for hydronephrosis, obstruction. RIGHT KIDNEY: The right kidney measures 10.4 cm. Echogenic parenchyma without mass, stone, or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.4 cm. Echogenic parenchyma without mass, stone, or hydronephrosis.OTHER: Bladder is nondistended. Incidentally noted is an echogenic liver parenchyma, compatible with fatty infiltration/parenchymal dysfunction.

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


Instruction: Generate impression based on medical findings.

Input: Female 49 years old with right upper quadrant abdominal pain on Victoza, evaluate for gallstones, pancreatitis LIVER: Normal hepatic parenchymal echogenicity with mildly coarsened echotexture. No focal hepatic lesions. Hepatic length measures 14.8 cm. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of 22.4 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is normal in appearance with the wall measuring 2 mm. The common bile duct measures 3 mm in diameter. No cholelithiasis or choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen is not well visualized on this exam.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 10.3 cm and has normal vascular flow. The left kidney measures 10.2 cm and has normal vascular flow. OTHER: No significant abnormality noted.

Output: Mildly coarsened hepatic echotexture suggestive of hepatic parenchymal dysfunction. No hepatic mass or ductal dilatation identified. No evidence of cholelithiasis or cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Female 61 years old Reason: eval parathyroid nodule History: hypercalcemia RIGHT LOBE MEASUREMENTS: 4.8 x 2.0 x 1.7 cm.LEFT LOBE MEASUREMENTS: 4.8 x 1.7 x 1.7 cmISTHMUS MEASUREMENTS: 0.4 cm in thickness.RIGHT LOBE: Mildly heterogeneous gland parenchyma without discrete nodule.LEFT LOBE: Mildly heterogeneous gland parenchyma without discrete nodule.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No parathyroid glands are identified.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Mildly heterogeneous gland parenchyma which can be seen in a setting of thyroiditis. No extrathyroidal mass to indicate a parathyroid adenoma is identified.


Instruction: Generate impression based on medical findings.

Input: Localized swelling, mass in forearm persisting for one month. Within the subcutaneous tissues there is focal area of edema extending 2.0 x 1.3 x 0.3 cm, with increased vascularity in the surrounding soft tissues. No other abnormality is identified.

Output: Focal edema within the left forearm, with no drainable collection identified.


Instruction: Generate impression based on medical findings.

Input: Female 70 years old Reason: define abscess in abdominal wall near PD exit site is it related to the tunnel? History: abdominal wall abscess There is a subcutaneous drainage catheter in the soft tissues of the anterior abdominal wall. There is a heterogeneous fluid collection along the course of the catheter, which is nonspecific, but associated hyperemia is suggestive of infection.

Output: Heterogeneous collection along the anterior abdominal wall drainage catheter, with associated hyperemia is suggestive of infection.


Instruction: Generate impression based on medical findings.

Input: 70 year-old male status post bilateral ureteral stents for hydronephrosis now with worsening AKI. Evaluate for obstruction and assess for perfusion to kidneys. Limited study as patient could not lie in decubitus position. RIGHT KIDNEY: The right kidney measures 14.0 cm in length. The cortex is increased in echogenicity. Mild hydronephrosis not significantly changed. Please note that what were previously described as cysts in the upper and lower pole appear to represent hydronephrosis on today's exam. No shadowing calculi. Right renal stent is again seen. LEFT KIDNEY: Not well assessed as patient could not lie in decubitus position. However it measures 11.6 cm in length and appears increased in echogenicity. Mild hydronephrosis not significantly changed. No shadowing calculi. Left renal stent is again seen. URINARY BLADDER: Foley catheter within a decompressed bladder limits evaluation.OTHER: Perfusion is seen to the bilateral kidneys.Moderate ascites.

Output: 1. Increased echogenicity of the kidneys suggestive of parenchymal dysfunction. 2. Bilateral mild hydronephrosis, right greater than left, not significantly changed. 3. Moderate ascites. Findings were discussed with Dr. Darren King by phone on 3/18/2015 at 2:30 PM.


Instruction: Generate impression based on medical findings.

Input: Female 27 years old Reason: eval reason for hyperbili. eval biliary tree, panc, liver History: Duodenal switch in 2012 status post bowel obstruction repair last week. Now with jaundice status post cholecystectomy. LIVER: Liver measures 19.4 cm in length. The parenchyma demonstrates mildly increased echogenicity, unchanged from the prior exam. No focal hepatic lesion is identified. Main portal vein is patent with hepatopedal flow.BILIARY TRACT: Patient is status post cholecystectomy. There is interval development of intrahepatic biliary ductal dilatation. The common bile duct is enlarged and measures 1.3 cm in diameter. Limited visualization of the extrahepatic biliary ducts distally, however no definite stone is identified.PANCREAS: Partially visualized pancreas is unremarkable.KIDNEYS: The right kidney measures 11.2 cm. The left kidney measures 11.6 cm. Bilateral renal cortices are within normal limits.SPLEEN: The spleen measures 9.3 cm. in length. OTHER: No significant abnormality noted.

Output: Interval development of intrahepatic and extrahepatic biliary ductal dilatation. Choledocholithiasis cannot entirely be excluded. Further evaluation with MRCP is recommended.


Instruction: Generate impression based on medical findings.

Input: 56-year-old male with hematuria. Evaluate transplant kidney. RIGHT KIDNEY: Status post right nephrectomy.LEFT KIDNEY: The left kidney is markedly atrophic and contains a simple cyst.RIGHT ILIAC FOSSA TRANSPLANT KIDNEY: There is expected minimal prominence of the pelvicalyceal system in this transplant kidney. No mass, cyst or shadowing calculi.URINARY BLADDER: The urinary bladder is normal in appearance.OTHER: No perinephric fluid collection.

Output: Normal appearance of the right iliac fossa transplant kidney without significant hydronephrosis, worrisome mass or shadowing calculi. No perinephric fluid collection.


Instruction: Generate impression based on medical findings.

Input: 73-year-old female with acute kidney injury. RIGHT KIDNEY: The right kidney appears atrophic, and measures 10.4 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present.LEFT KIDNEY: The left kidney appears atrophic, and measures 9.3 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present.OTHER: The bladder is nondistended.

Output: 1.Bilateral atrophic kidneys. 2.Bilateral increased echogenicity of the kidneys is consistent with medical renal disease without evidence of calculi or hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Reason: Acute on chronic kidney disease History: none RIGHT KIDNEY: Right kidney measures 13.4 cm and is increased in echogenicity without hydronephrosis. No evidence of renal calculi.LEFT KIDNEY: Left kidney measures 13.5 cm and is mildly increased in echogenicity without hydronephrosis. No evidence of renal calculi.URINARY BLADDER: Limited evaluation of the decompressed bladder.OTHER: No significant abnormalities noted.

Output: Bilateral echogenic kidneys compatible with medical renal disease. No evidence of hydronephrosis or renal calculi.


Instruction: Generate impression based on medical findings.

Input: History of hepatitis C and altered mental status. Assess for structural lesion. LIVER: The liver is normal in size measuring 12.4 cm in length. There is diffusely increased hepatic parenchymal echotexture which is most commonly seen in hepatic steatosis. No focal focal mass lesion is evident. The portal vein is patent with hepatopedal flow and a velocity of 13 cm/s.GALLBLADDER, BILIARY TRACT: The gallbladder is not distended. There is no wall thickening or pericholecystic fluid. There are 2 shadowing foci within the gallbladder neck compatible with gallstones. No intrahepatic or extrahepatic biliary duct dilatation. The common bile duct measures 3 mm in diameter.PANCREAS: Evaluation limited by overlying bowel gas.KIDNEYS: Evaluation limited by patient motion and ability to breath-hold. The right kidney measures 9.2 cm in length and has stable mildly echogenic parenchyma. The left kidney is poorly visualized.OTHER: Spleen is normal in size measuring 10.1 cm in length.

Output: 1. Diffusely increased hepatic parenchymal echogenicity most commonly seen in hepatic steatosis. No focal masslesion.2. Cholelithiasis without evidence of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with a history of thyroid cancer status post thyroidectomy, surveillance examination. RIGHT LOBE: Status post thyroidectomy. Redemonstration of three hypoechoic foci in the right thyroid bed that have not significantly changed in size or appearance. For reference, the largest of which measures 0.3 x 0.5 x 0.6 cm, previously 0.4 x 0.5 x 0.6 cm.LEFT LOBE: Status post thyroidectomy.ISTHMUS: Status post thyroidectomy.LYMPH NODES: Scattered bilateral benign appearing lymph nodes, grossly stable. OTHER: No significant abnormality noted.

Output: Stable appearing hypoechoic foci in the right thyroid bed.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male with a history of renal transplant presents with anasarca and elevated BUN/creatinine. RENAL TRANSPLANT:LOCATION: Right iliac fossa.TRANSPLANT KIDNEY: The transplant kidney measures 12 cm. Corticomedullary differentiation is maintained. 0.5 x 0.4 x 0.8 cm echogenic focus in the upper pole of the transplant kidney with twinkling artifact suggestive of a renal calculus. Stable simple cyst.PERITRANSPLANT TISSUES: No significant abnormality notedCOLLECTING SYSTEM/URETER: Mild hydronephrosis, appearing similar to the prior examination. URINARY BLADDER: The visualized portions of the urinary bladder unremarkable.OTHER: No significant abnormality noted

Output: Stable mild hydronephrosis of the right iliac fossa transplant kidney with a upper pole echogenic focus suggestive of a renal calculus.


Instruction: Generate impression based on medical findings.

Input: History of renal cyst. Further evaluation. RIGHT KIDNEY: The right kidney measures 15.5 cm. The cortex is mildly echogenic. There is no hydronephrosis or renal calculus. A right upper pole simple cyst measures 2.2 x 2.7 x 3.2 cm.LEFT KIDNEY: The left kidney measures 13.3 cm. The cortex is mildly echogenic. There is no hydronephrosis, renal calculus or suspicious mass.OTHER: The bladder is unremarkable.

Output: Simple appearing right upper pole renal cyst.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old. Reason: History of HPT. RIGHT LOBE MEASUREMENTS: 3.9 x 1.6 x 1.9 cmLEFT LOBE MEASUREMENTS: 3.6 x 1.3 x 1.7 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Homogeneous echotexture without focal nodule.LEFT LOBE: Homogeneous echotexture without focal nodule.ISTHMUS: Homogeneous echotexture without focal nodule.PARATHYROID GLANDS: Extrathyroidal ovoid, hypoechoic focus with central echogenicity is present posterior to the mid left thyroid gland and measures 1.5 x 0.5 x 0.6 cm. This focus has a configuration typical of a lymph node, however, an atypical parathyroid adenoma cannot be excluded.LYMPH NODES: No regional lymphadenopathy.OTHER: No significant abnormality noted.

Output: 1. Extrathyroidal ovoid, hypoechoic focus posterior to the mid left thyroid gland has a configuration typical of a lymph node, however, an atypical parathyroid adenoma cannot be excluded.2. No suspicious thyroid nodule or regional lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Female 60 years old Reason: any sign of obstruction History: rising creatinine RIGHT KIDNEY: The right kidney measures 7.8 cm. Increased renal cortical echogenicity. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 9.8 cm. Increased renal cortical echogenicity. No shadowing calculi or hydronephrosis is present. BLADDER: Distended, containing moderate amount of debris.OTHER: Partially imaged nodular liver contour. Ascites seen.

Output: No hydronephrosis. Increased renal cortical echogenicity, reflecting underlying medical renal disease.Distended debris-containing bladder.Partially imaged nodular liver.Ascites.


Instruction: Generate impression based on medical findings.

Input: Male 60 years old Reason: 60 yo with HBV please assess for lesions LIVER: Liver measures 15.9 cm in length. The parenchyma is coarsened in echotexture, appearance consistent with history of chronic liver disease. No suspicious liver lesion. Main portal vein patent with normal directional flow, velocity measures 17 cm/s. BILIARY TRACT: Gallbladder unremarkable. No significant gallbladder distention, wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Not well seen in entirety due to adjacent bowel gas.KIDNEYS: The right kidney measures 10.3 cm. Fullness of right renal collecting system. The left kidney measures 11 cm. Simple left renal cyst measuring 1.6 x 1.6 x 1.6 cm, possible very thin internal septation versus reverberation artifact. No perinephric free fluid.SPLEEN: The spleen measures 9.4 cm. in length. OTHER: No significant abnormality noted.

Output: No suspicious liver lesion.Fullness of right renal collecting system, nonspecific.


Instruction: Generate impression based on medical findings.

Input: Evaluate for growth of thyroid nodule or adenopathy, one year follow-up RIGHT LOBE: Measures 5.1 x 2.3 x 2.2 cm, previously measured 4.8 x 2.6 x 2.2 cm. There is a stable inferiorly located heterogeneous nodule measuring 2.8 x 2.4 x 2.1 cm, previously measured 2.8 x 2.1 x 2 cm. Nodule is stable in appearance with small internal vascularity and scattered punctate internal echogenic foci.LEFT LOBE: Measures 4.8 x 1.6 x 1.2 cm, previously measured 4 x 1.5 x 1.1 cm.ISTHMUS: Measure 0.2 cm.LYMPH NODES: Mildly prominent left neck lymph nodes, for example, level 3 lymph node with fatty hilum, may be reactive in etiology. No suspicious adenopathy seen.

Output: Stable right thyroid nodule. Mild interval increase in size of thyroid gland itself.


Instruction: Generate impression based on medical findings.

Input: Female 49 years old; Reason: Outside Request: left lose nodules and cervical lymph nodes History: RIGHT LOBE MEASUREMENTS: 1.7 x 1.6 x 5.5 cmLEFT LOBE MEASUREMENTS: 1.7 x 1.5 x 4.9 cmISTHMUS MEASUREMENT: 0.4 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: There are 2 left thyroid lobe nodules.#1 upper pole nodule which is hypoechoic and solid measures 0.8 x 0.7 x 1.1 cm previously 0.8 x 0.9 x 0.6 cm#2 slightly hypoechoic solid lower pole nodule could posteriorly measures 1.0 x 0.8 x 1.0 cm previously 1.0 x 0.6 x 1.2 cmISTHMUS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Left thyroid nodules as detailed above


Instruction: Generate impression based on medical findings.

Input: Reason: History of Gross Hematuria - Rule Out cysts, Tumors, Calculi, Etc. History: History of Gross Hematuria - Rule Out cysts, Tumors, Calculi, Etc. RIGHT KIDNEY: Right kidney measures 12 cm. No hydronephrosis. No focal masses or calculi.LEFT KIDNEY: The left kidney measures 12 cm. No hydronephrosis. No focal masses or calculi.OTHER: Bladder is unremarkable.

Output: Normal sonogram of the kidneys and bladder.


Instruction: Generate impression based on medical findings.

Input: Pain surrounding G-tube No evidence for loculated fluid collection, abscess, or hematoma within subcutaneous tissues surrounding gastrostomy tube

Output: No evidence for loculated fluid collection, abscess, or hematoma within subcutaneous tissues surrounding gastrostomy tube


Instruction: Generate impression based on medical findings.

Input: Female 59 years old; Reason: evaluate for renal abscess - 59 yo w septic shock likely from pyelonephritis History: septic shock, bacteruria 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 not visualized.OTHER: No significant abnormalities noted.

Output: 1.No right-sided hydronephrosis. Limited study as above.


Instruction: Generate impression based on medical findings.

Input: 63-year-old female presents with elevated liver enzymes. LIVER: Diffuse increase in hepatic parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions. Hepatic length measures 13 cm. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of 25 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is contracted limiting evaluation. The gallbladder wall measures 2 mm. The common bile duct measures 7 mm in diameter, appearing similar to the prior examination. No sonographic evidence of cholecystitis. No pericholecystic fluid. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 9 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 10 cm and has normal vascular flow. The left kidney measures 11 cm and has normal vascular flow. No evidence of hydronephrosis.OTHER: No significant abnormality noted.

Output: Diffuse 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: 25-year-old female with colon area, elevated creatinine. Evaluate for obstruction. RIGHT KIDNEY: The right kidney measures 9.8 cm in length and shows normal echotexture. Minimal hydronephrosis. No mass or shadowing calculi.LEFT KIDNEY: The left kidney measures 9.6 cm in length and shows normal echotexture. No mass, shadowing calculi or hydronephrosis.URINARY BLADDER: Not evaluated due to patient's bandages.OTHER: Bilateral pleural effusions.

Output: 1.Minimal right hydronephrosis.2.Bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Evaluate for lymphocele/abscess/hematoma in the right groin following femoral line placement. There is marked subcutaneous edema. There is no focal collection or abscess identified.

Output: Subcutaneous edema, with no evidence of loculated collection or hematoma.


Instruction: Generate impression based on medical findings.

Input: Female 63 years old Reason: Please assess RUQ for gallbladder distention or fluid collection History: septic shock, abdominal pain LIMITED ABDOMENLIVER: Echogenic and coarse hepatic parenchyma. No obvious focal hepatic lesion.BILIARY TRACT: Mild biliary ductal dilatation stable from recent MRI on 9/3/2015. No definite gallbladder sludge. PANCREAS: Visualized portions of the pancreas are unremarkable.KIDNEYS: The right kidney measures 9 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. The left kidney measures 9 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 6 cm. in length. OTHER: Bilateral pleural effusions.

Output: 1.No definite gallbladder sludge. No signs of cholecystitis.2.Stable mild biliary ductal dilatation.3.Bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old. Reason: Rule out renal disease. History: proteinuria RIGHT KIDNEY: Right kidney measures 12.1 cm in length with mildly echogenic parenchyma. Minimally complex right lower pole cyst measures 3.1 x 3.4 x 2.5 cm. No hydronephrosis or shadowing calculi. LEFT KIDNEY: Left kidney is surgically absent.URINARY BLADDER: Mildly distended urinary bladder without significant abnormality noted. Right ureteral jet is visualized.OTHER: No significant abnormalities noted.

Output: 1. Right kidney demonstrates mildly echogenic renal parenchyma suggesting parenchymal dysfunction. No hydronephrosis. 2. Left kidney is surgically absent.


Instruction: Generate impression based on medical findings.

Input: 53-year-old female status post LVAD. Evaluate for a LVAD drive line site fluid collection. There is skin thickening and generalized edema but no evidence of a loculated fluid collection in the anterior abdominal wall adjacent to the LVAD device.

Output: Skin thickening and edematous anterior abdominal wall adjacent to the LVAD device without evidence of a fluid collection.


Instruction: Generate impression based on medical findings.

Input: Male 98 years old; Reason: eval for signs that would explain transaminitis up to 500 History: as above LIVER: Mild increase in hepatic parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions. Hepatic length measures 13 cm. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of 50 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 3 mm. The common bile duct measures 5 mm in diameter. Echogenic, mobile, intraluminal material suggestive of gallbladder sludge without sonographic evidence of cholecystitis. 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 10 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 9 cm and has normal vascular flow. The left kidney is not well-visualized secondary to bowel gas.OTHER: No significant abnormality noted.

Output: 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 60 years old; Reason: eval for HCC History: chronic HCV cirrhosis LIVER: Cirrhotic liver morphology with coarsened parenchyma and nodular contour. No suspicious focal hepatic lesions. Hepatic length measures 15.4 cm. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of xx cm/s. GALLBLADDER/BILIARY TRACT: Status-post cholecystectomy. 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 11.1 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 9.8 cm and has normal vascular flow. The left kidney measures 10.2 cm and has normal vascular flow. OTHER: No significant abnormality noted.

Output: Cirrhotic liver morphology without dominant hepatic mass or ductal dilatation identified.


Instruction: Generate impression based on medical findings.

Input: 88-year-old female with left upper extremity bruising. Reason: Characterize bruising better. Diffuse edematous changes involving the subcutaneous tissues of the imaged left upper extremity without focal fluid collection.

Output: Diffuse edematous changes involving the subcutaneous tissues of the imaged left upper extremity without focal fluid collection.


Instruction: Generate impression based on medical findings.

Input: Female 40 years old Reason: assess nodule. r/o worrisome characteristics. If concerning is it amenable to FNA? History: 40 year old women with nodule on outside thyroid ultrasound, by report. RIGHT LOBE MEASUREMENTS: 1.3 x 4.6 x 2.2 cm.LEFT LOBE MEASUREMENTS: 4.2 x 1.6 x 1.3 cm.ISTHMUS MEASUREMENTS: 0.4 cm thick.RIGHT LOBE: The right lobe of the thyroid demonstrates normal parenchymal echogenicity.LEFT LOBE: The left lobe of the thyroid demonstrates normal parenchymal echogenicity. There is a 0.6 x 0.5 x 0.4 cm anechoic nodule in the midpole of the left lobe of the thyroid, which demonstrates posterior acoustic enhancement and comet tail artifact, consistent with a colloid nodule.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Probable colloid nodule in the left lobe of the thyroid.


Instruction: Generate impression based on medical findings.

Input: 58-year-old male with cirrhosis. Reason: HCC screening. LIVER: The liver measures 15.4 cm in length. The liver parenchyma is coarse and echogenic, consistent with patient's history of cirrhosis. Stable appearance of an anechoic cyst in the right hepatic lobe which measures 0.9 x 0.9 x 0.9 cm. Portal vein is patent.GALLBLADDER, BILIARY TRACT: Adenomyosis of the gallbladder is again noted. No gallstones, gallbladder wall thickening, pericholecystic fluid or ductal dilatation.PANCREAS: The pancreas is not well-visualized due to overlying bowel gas.RIGHT KIDNEY: The right kidney measures 7.9 cm. The cortex is of normal echogenicity without mass, stone, or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.9 cm. The cortex is of normal echogenicity without mass, stone, or hydronephrosis.SPLEEN: The spleen measures 9.9 cm.OTHER: No significant abnormalities noted.

Output: Cirrhotic liver morphology with a stable anechoic cyst in the right hepatic lobe.


Instruction: Generate impression based on medical findings.

Input: Elevated creatinine, assess for hydronephrosis RIGHT KIDNEY: Measures 10.6 cm. Markedly increased renal cortical echogenicity. No hydronephrosis. No definite shadowing intrarenal echogenic focus seen to suggest underlying nephrolithiasis.LEFT KIDNEY: Measures 9.9 cm, simple appearing renal cysts measuring 2.2 x 2 x 1.8 cm and 2.2 x 1.8 x 1.3 cm, respectively. Markedly increased renal cortical echogenicity. No hydronephrosis. No definite shadowing intrarenal echogenic focus seen to suggest underlying nephrolithiasis.OTHER: Visualized bladder unremarkable, bilateral ureteral jets seen.

Output: 1. No hydronephrosis. 2. Markedly increased renal cortical echogenicity, compatible with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Male 58 years old Reason: hx of left partial nephrectomy, please evaluate for disease History: see above Study is somewhat limited due to patient's body habitus.RIGHT KIDNEY: The right kidney measures 9.0 cm. The renal cortex is thin and echogenic. No obvious mass, shadowing calculi, or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 8.4 cm. There is increased echogenicity of the renal cortex. No obvious mass, shadowing calculi, or hydronephrosis is present. BLADDER: Bladder is underdistended limiting evaluation however no obvious abnormality is identified.OTHER: No significant abnormalities noted.

Output: Echogenic renal cortices compatible with medical renal disease; no gross renal masses are identified as clinically questioned. However, given patient's body habitus and underlying medical renal disease subtle abnormalities are difficult to identify on ultrasound. If clinically warranted, CT imaging is recommended for appropriate evaluation.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female presents with right upper quadrant pain. LIVER: Increase in hepatic parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions. Hepatic length measures 17 cm. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of 22 cm/s. 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. No pericholecystic fluid.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 10 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 13 cm and has normal vascular flow. The left kidney measures 14 cm and has normal vascular flow. No evidence of hydronephrosis.OTHER: No significant abnormality noted.

Output: 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: Pain and swelling along the ulnar/dorsal aspect of the wrist. Evaluate for infection versus cyst. There is extensive subcutaneous edema which is nonspecific but can be seen in the setting of cellulitis. There is no underlying drainable fluid collection or cyst. There is an ovoid hypoechoic focus in the subcutaneous tissues, does not appear to be a fluid collection, has morphology and internal appearance suggestive of a lymph node. Correlation with patient's clinical history and physical exam recommended.

Output: Findings compatible with nonspecific edema or cellulitis affecting the subcutaneous tissues, please see details above. Ovoid hypoechoic focus in the subcutaneous tissues, does not appear to be a fluid collection, has morphology and internal appearance suggestive of a reactive lymph node. Correlation with patient's clinical history and physical exam recommended.


Instruction: Generate impression based on medical findings.

Input: Female 59 years old; Reason: obstructive uropathy History: AKI RIGHT KIDNEY: The right kidney measures 10.4 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 12 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. OTHER: Decompressed with Foley catheter, limiting evaluation.

Output: 1.No hydronephrosis. Echogenic renal parenchyma can be seen in nonspecific medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old. Reason: eval for ascites, cirrhosis History: distension of abdomen, major EtOH history, "told I had liver disease" LIVER: Liver measures 17.8 cm in length. Hepatic parenchyma is echogenic. Liver capsule is smooth. Main portal vein has a normal direction of flow. No ascites.BILIARY TRACT: Common bile duct measures 4.7 mm. No cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. No intrahepatic or extra hepatic ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: Spleen measures 9.6 cm in length with normal echogenicity.RIGHT KIDNEY: Right kidney measures 11 cm in length. Renal cortical parenchymal echogenicity is normal. No focal renal mass, hydronephrosis, or shadowing calculi.OTHER: Left kidney measures 11.3 cm in length. Renal cortical parenchymal echogenicity is normal. No focal renal mass, hydronephrosis, or shadowing calculi.

Output: Echogenic hepatic parenchyma likely represents parenchymal dysfunction/hepatic steatosis. No evidence of focal hepatic lesion or ascites.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old. Reason: Thyroid nodule evaluation. History: Large thyromegaly. RIGHT LOBE MEASUREMENTS: 4 x 2.3 x 1.5 cmLEFT LOBE MEASUREMENTS: 9.4 x 4.8 x 5.2 cmISTHMUS MEASUREMENTS: RIGHT LOBE: Heterogeneous echotexture. Predominantly solid nodule in the midpole measures 1.6 x 0.7 x 1.0 cm.LEFT LOBE: Left thyroid lobe is enlarged and almost entirely replaced by a large, heterogeneous solid nodule. Within the left thyroid nodule, there are multiple echogenic foci with shadowing which likely represent microcalcifications.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing left level 5 lymph node measures 1.2 x 0.3 x 0.7 cm.OTHER: No significant abnormality noted.

Output: Large, heterogeneous thyroid nodule with multiple microcalcifications which replaces nearly the entire left thyroid lobe. Biopsy is recommended for further characterization.


Instruction: Generate impression based on medical findings.

Input: 55-year-old male with metastatic cholangiocarcinoma Previously seen hepatic lesions on outside study CT abdomen and pelvis dated July 14, 2015 are not visualized on this sonographic study.

Output: Previously seen hepatic lesions on outside study CT abdomen and pelvis dated July 14, 2015 are not visualized on the sonographic study. Patient to proceed with CT-guided biopsy of hepatic lesion.


Instruction: Generate impression based on medical findings.

Input: Female 43 years old; Reason: Evaluate for left superior thyroid nodule as well as other smaller nodule History: Hashimoto thyroiditis RIGHT LOBE MEASUREMENTS: 7.8 x 3.1 x 2.8 cm, previously 7.2 x 3.5 x 2.7 cm.LEFT LOBE MEASUREMENTS: 6.9 x 3 x 2.7 cm, previously 6.2 x 2.7 x 2.7 cm.ISTHMUS MEASUREMENT: 1.3 cm, previously 0.9 cm.RIGHT LOBE: Again noted is a heterogenous right lobe with multiple small echogenic nodules. A subcentimeter echogenic nodule in the interpolar region measures 0.4 x 0.5 x 0.6 cm, as compared to 0.4 x 0.4 x 0.5 cm on the prior study, essentially unchanged.LEFT LOBE: Again noted is heterogenous left lobe with multiple small nodules. Lower pole dominant heterogeneous, mildly hypoechoic and solid nodule measures 1.6 x 1.4 x 1.9 cm as compared to 1.6 x 1.7 x 1.6 cm, unchanged in size and morphology.ISTHMUS: Isthmus is thickened. Echogenic nodule measures 0.4 x 0.5 x 0.3 cm, as compared to 0.8 x 0.9 x 0.4 cm on the prior study, unchanged to slightly smaller as compared to prior exam.LYMPH NODES: Multiple bilateral mildly enlarged cervical lymph nodes, with the largest measuring 1.8 x 1.0 x 1.0 cm on the left level 4, as compared to 1.8 x 1.4 x 0.6 cm on the prior, unchanged and demonstrating a benign morphology.OTHER: No significant abnormality noted.

Output: Enlarged hypervascular gland compatible with thyroiditis, with no significant change in size or morphology of the dominant left lower pole nodule or smaller echogenic nodules.


Instruction: Generate impression based on medical findings.

Input: Renal heart transplant with sepsis and bilateral femoral DVTs RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: No significant abnormality noted. 9.8 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 Patent right iliac fossa renal transplant vasculature without evidence for inflow or outflow compromise.Due to extensive bowel gas, only the proximal IVC could be visualized. No thrombus involving the proximal IVC observed.OTHER: No significant abnormality noted

Output: Unremarkable right iliac fossa renal transplant without evidence for perinephric collection or hydronephrosis. Patent vasculature without evidence for inflow or outflow compromise.Due to extensive bowel gas, only the proximal IVC could be visualized; no thrombus involving the proximal IVC observed.


Instruction: Generate impression based on medical findings.

Input: 77-year-old female with stage III chronic kidney disease RIGHT KIDNEY: The right kidney measures 10.9 cm in length and shows normal echotexture. No mass, shadowing calculi or hydronephrosis.LEFT KIDNEY: Status post left nephrectomyURINARY BLADDER: The urinary bladder is normal in appearance.OTHER: There is no free or loculated fluid. A right adrenal adenoma is again identified and appears stable.

Output: Status post left nephrectomy. Stable appearance of a right adrenal adenoma. Otherwise, normal examination of the right kidney.


Instruction: Generate impression based on medical findings.

Input: Female 55 years old Reason: HCC screening History: Cirrhosis LIVER: Liver measures 16.6 cm in length. The parenchyma is heterogeneous in echotexture, no suspicious liver lesion. Main portal vein patent with normal directional flow, velocity measures 29 cm/s. BILIARY TRACT: Gallbladder polyp seen along nondependent wall measuring 3 mm. No significant gallbladder distention, wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Not well seen in entirety due to overlying bowel gas. KIDNEYS: The right kidney measures 8.9 cm. The left kidney measures 9.4 cm. Increased renal cortical echogenicity. No hydronephrosis.SPLEEN: The spleen measures 9.1 cm. in length. OTHER: No significant abnormality noted.

Output: Coarse heterogeneous liver echotexture, no suspicious lesion.3 mm gallbladder polyp.Echogenic kidneys, consistent with underlying medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Male 67 years old Reason: evaluate causes of RUQ pain History: ruq abdomominal pain LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 17.8 cm in length. The parenchyma is normal in echotexture. No focal hepatic lesions. Main portal vein is patent.BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 2 mm in thickness. Common duct measures 2 mm. PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 12 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 12.3 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 9.8 cm. in length. OTHER: No ascites.

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


Instruction: Generate impression based on medical findings.

Input: Female 30 years old Reason: questioning abd pain History: ABD pain LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 14.5 cm in length. The parenchyma is normal in echotexture. No focal lesion is identified.BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 2 mm in thickness. The common bile duct measures 3 mm.PANCREAS: The pancreatic head and body are normal in appearance. The pancreatic tail is obscured by bowel gas.KIDNEYS: The right kidney measures 10.3 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 10.9 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.SPLEEN: The spleen measures 10.1 cm in length.OTHER: No significant abnormalities noted.

Output: No sonographic evidence of abdominal abnormality.


Instruction: Generate impression based on medical findings.

Input: 65-year-old male with abdominal pain and history of gallstones and acute kidney injury, evaluate for cholelithiasis, cholecystitis, hydronephrosis, renal vascular insufficiency. LIVER: Mild increase in hepatic parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions. Hepatic length measures 18.2 cm. The main portal vein is patent with normal hepatopetal flow with a velocity of 31 cm/s. GALLBLADDER/BILIARY TRACT: Large shadowing calculus is present within the gallbladder, with the wall measuring 3 mm. No pericholecystic fluid. No surrounding inflammatory changes are identified. Sonographic Murphy's sign was negative. The common bile duct measures 5 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 10.2 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 10.1 cm with no hydronephrosis. The left kidney measures 12.5 cm with no hydronephrosis. ABDOMINAL AORTA: The abdominal aorta is normal in size and demonstrates normal waveform and velocity.INFERIOR VENA CAVA: Inferior vena cava is patent.OTHER: No significant abnormality noted.

Output: 1.Increase in hepatic parenchymal echogenicity with coarsened echotexture consistent with fatty liver/hepatic parenchymal dysfunction. No hepatic mass or ductal dilatation identified.2.Cholelithiasis without evidence of acute cholecystitis.3.No evidence of hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Female 24 years old with dizziness, dysphagia RIGHT LOBE MEASUREMENTS: 5.7 x 2.0 x 1.6 cmLEFT LOBE MEASUREMENTS: 5.8 x 1.8 x 1.6 cmISTHMUS MEASUREMENT: 0.5 cmRIGHT LOBE: Normal parenchymal echotexture without evidence of mass. No increased vascularity.LEFT LOBE: Normal parenchymal echotexture. Well-defined and slightly hypoechoic nodule measuring 1.2 x 0.8 x 1.1 cm in the lower pole with small cystic components. No increased vascularity or microcalcifications are present.ISTHMUS: Normal parenchymal echotexture without evidence of mass. No increased vascularity.LYMPH NODES: Mildly prominent and benign-appearing level 2 lymph nodes bilaterally.OTHER: No significant abnormality noted.

Output: Nonspecific left lower pole nodule without increased vascularity or microcalcifications.


Instruction: Generate impression based on medical findings.

Input: 62-year-old man with elevated LFTs LIVER: Echogenicity of the hepatic parenchyma is diffusely increased. No focal hepatic lesion or mass. The liver measures 16.7 cm in length. The main portal vein is patent with normal hepatopedal flow and velocity of 37 cm/s.GALLBLADDER, BILIARY TRACT: The gallbladder is contracted with a stone noted in the gallbladder fundus. There is no pericholecystic fluid. The gallbladder wall is normal in appearance, measuring 0.3 cm in thickness. No dilatation or cystic changes are noted of the intrahepatic or extrahepatic biliary ducts. The common bile duct measures 0.5 cm in diameter. No choledocholithiasis.PANCREAS: The head and proximal body of the pancreas are normal. The tail is obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 10.5 cm in length and shows normal echotexture. No mass, stone or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.4 cm in length and shows normal echotexture. No mass, stone or hydronephrosis.SPLEEN: The spleen is normal in echogenicity and measures 7.7 cm in length. OTHER: There is no free or loculated fluid.

Output: Diffusely increased echogenicity and coarse echotexture of the hepatic parenchyma, consistent with fatty liver/hepatic parenchymal dysfunction. No hepatic mass. Contracted appearance of the gallbladder. A stone is noted in the fundus. No biliary ductal dilatation.


Instruction: Generate impression based on medical findings.

Input: Testicular mass. Evaluate further. RIGHT TESTIS: The right testicle measures 4.1 x 2.1 x 2.7 cm. No focal lesion is identified.LEFT TESTIS: The left testicle measures 3.0 x 1.9 x 3.47 m. No focal lesion is identified.RIGHT TESTIS VASCULATURE: Symmetric testicular parenchymal flow.LEFT TESTIS VASCULATURE: Symmetric testicular parenchymal flow.RIGHT EPIDIDYMIS: The right epididymis measures 3.3 x 0.5 x 0.8 cm. Incidentally seen epididymal appendage.LEFT EPIDIDYMIS: The left epididymis measures 3.6 x 0.4 x 0.8 cm.OTHER: Small right hydrocele. Small volume of extratesticular fluid on the left. Previously reported solid extratesticular mass not visualized on current study, additional imaging lateral to the right testis and midline performed; in retrospect, area visualized on earlier exam may have in actuality been portions of penile base/shaft.

Output: 1.No focal lesion or testicular mass identified. 2.Small right hydrocele and small volume of left extratesticular fluid.


Instruction: Generate impression based on medical findings.

Input: Female 50 years old Reason: eval liver morphology History: transaminitis Suboptimal study secondary to patient's limited mobility and body habitus. LIVER: Liver measures 15.8 cm in length. The parenchyma is mildly coarsened. No focal liver lesion. Main portal vein patent with normal directional flow, velocity measures 40 cm/s. BILIARY TRACT: Gallbladder unremarkable. No significant gallbladder distention, wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Not well seen in entirety due to overlying bowel gas.KIDNEYS: The right kidney measures 11.3 cm. Right parapelvic renal cyst, measuring 1.4 x 1.2 x 0.6 cm. The left kidney measures 12.8 cm. No hydronephrosis.SPLEEN: Spleen not seen.OTHER: No significant abnormality noted.

Output: Suboptimal study secondary to patient's limited mobility and body habitus. Mildly coarse hepatic parenchymal echotexture suggested, no focal liver lesion.


Instruction: Generate impression based on medical findings.

Input: 45-year-old female with history of thyroid nodule. RIGHT LOBE MEASUREMENTS: 7.6 x 2.6 x 2.3 cm.LEFT LOBE MEASUREMENTS: 6.7 x 3.1 x 1.9 cm.ISTHMUS MEASUREMENTS: 0.34 cm.RIGHT LOBE: There are multiple cystic and spongiform nodules in the right thyroid lobe. The largest of these nodules measures 1.8 x 0.7 x 0.9 cm, is smoothly marginated, well-circumscribed, without internal calcifications or colloid, and is avascular.LEFT LOBE: Similar to the right side there are numerous spongiform and cystic nodules, no more suspicious than the other within the left lobe of the thyroid. However there is a solid nodule in the inferior pole, measuring 2.2 x 1.5 x 1.6 cm which is smoothly marginated, and is slightly hypoechoic, well-circumscribed and without internal calcifications, colloid or vascularity. This nodule is indeterminate.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multinodular goiter, with most of the nodules demonstrating a benign morphology; however, there is a solid nodule in the inferior pole of the left lobe of thyroid, which would be amenable to biopsy or short-term follow-up.


Instruction: Generate impression based on medical findings.

Input: 46-year-old man with history of HCC. Evaluate for portal vein thrombosis. LIVER: The liver is enlarged, measuring 26.3 cm in length, and is largely replaced by confluent, bilobar lobar mass lesions.GALLBLADDER, BILIARY TRACT: The gallbladder is normal in appearance. There is no pericholecystic fluid, gallbladder wall thickening or cholelithiasis. The common bile duct measures 0.4 cm in diameter. PANCREAS: The head and proximal body of the pancreas are normal. The tail is obscured by bowel gas.SPLEEN: The spleen is normal in echogenicity.RIGHT KIDNEY: The right kidney measures 11.4 cm in length and shows normal echotexture. No mass, stone or hydronephrosis.LEFT KIDNEY: The left kidney measures 11.6 cm in length and shows normal echotexture. No mass, stone or hydronephrosis.OTHER: Moderate ascites.DOPPLER

Output: 1.Complete occlusion of main portal vein with early cavernous transformation. Reconstituted intrahepatic portal veins demonstrate hepatofugal flow.2.Multiple confluent, bilobar hepatic mass lesions, consistent with malignancy.3.Moderate ascites.


Instruction: Generate impression based on medical findings.

Input: Male 34 years old Reason: eval for aki History: None RIGHT KIDNEY: The right kidney measures 8.2 cm in length and demonstrates increased parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.LEFT KIDNEY: The left kidney measures 9.2 cm in length and demonstrates increased parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.BLADDER: No significant abnormality noted.OTHER: No significant abnormalities noted.

Output: Increased renal parenchymal echogenicity consistent with medical renal disease, but no evidence of hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Male 57 years old Reason: new aki and oliguria History: aki, oliguria LIVER: Visualized portions of the liver demonstrate increased echogenicity without discrete lesion identified.RIGHT KIDNEY: The right kidney measures 10.6 cm and is normal in echogenicity. No evidence of hydronephrosis.LEFT KIDNEY: The left kidney measures 12.0 cm and demonstrates increased echogenicity. No evidence of hydronephrosis. Small left renal cyst measuring 1.0 x 1.2 x 1.7 cm.OTHER: No significant abnormalities noted.

Output: 1. Increased echogenicity of the left kidney which may be seen in the setting of medical renal disease. Small left renal cyst.2. Increased echogenicity of the liver suggestive of fatty infiltration.


Instruction: Generate impression based on medical findings.

Input: Female 37 years old Reason: cause of pancreatitis. History: epigastric abdominal pain LIMITED ABDOMENLIVER: The liver has a smooth contour, it measures 15.1 cm in length. The parenchyma is mildly echogenic. No focal liver lesion is identified. The main portal vein is patent and demonstrates normal direction of flow with a velocity of 4.7 m/s. There is no ascites.BILIARY TRACT: There are a few echogenic foci in the fundus which remain dependent with changes in position. Wall measures 2 mm in thickness. Common duct measures 4 mm in diameter. There is no intrahepatic biliary duct dilatation.PANCREAS: The head and body of the pancreas appear normal. The tail is obscured by overlying bowel gas. There is no evidence of peripancreatic fluid or pancreatic ductal dilatation.KIDNEYS: The right kidney measures 12.0 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 11.7 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 8.5 cm. in length. OTHER: No significant abnormalities noted.

Output: 1.No pancreatic ductal dilatation or peripancreatic fluid.2.A few subcentimeter noncalcified gallstones. No cholecystitis.3.Mildly echogenic liver parenchyma compatible with hepatic steatosis/parenchymal dysfunction.


Instruction: Generate impression based on medical findings.

Input: Status post bilateral inguinal hernia repair with mesh now with pain and weakness out of proportion to normal postoperative course, please assess for bilateral hematomas in inguinal areas On right, 5.6 x 4.6 x 1 cm anechoic collection visualized.On left, larger more complex fluid collection containing septations and fluid-fluid level (appearance compatible with blood products) seen, collection measures 6.8 x 5.6 x 2.2 cm.

Output: Left larger than right inguinal hematomas as above.


Instruction: Generate impression based on medical findings.

Input: Reason: right hypoechoic testicular lesion- please evaluate for stability History: right hypoechoic testicular lesion- please evaluate for stability RIGHT TESTIS: The right testicle measures 4.5 x 2 x 2.3 cm. Heterogenous in appearance. There is a focal hypoechoic lesion within the right upper pole, relatively unchanged from prior exam. There is parenchymal heterogeneity with irregular borders noted within the inferior pole of the right testes without calcification. This appears to have mildly increased in size as compared to prior exam. Normal vascularity. No hydrocele. No varicocele.LEFT TESTIS: The left testicle measures 4.7 x 3.5 x 2.2 cm. Normal echogenicity. There is dilated rete testes. No hydrocele. No varicocele.RIGHT EPIDIDYMIS: The right epididymis measures 1 x 0.7 x 1.6 cm. No focal lesions.LEFT EPIDIDYMIS: The left epididymis measures 1.1 x 0.1 to 1 cm. No focal lesions.OTHER: No significant abnormalities noted.

Output: 1. Nonspecific findings noted within the right testes, somewhat increased from prior exam. Favor chronic inflammation, but cannot exclude neoplastic process.


Instruction: Generate impression based on medical findings.

Input: Reason: 70 y/o with ALL s/p SCT with elevated LFTs; eval for liver and hepatic vessels for gvhd LIVER: Liver measures 14.7 cm with increased echogenicity. No suspicious hepatic mass is noted.BILIARY TRACT: Common bile duct measures 4 mm. Gallbladder wall measures 2 mm. No pericholecystic fluid collection. No gallstones noted.PANCREAS: Hypodense solid pancreatic head lesion measuring 1.2 x 1.1 x 1.0 cm noted. Distal pancreas is obscured by overlying bowel gas. SPLEEN: Spleen measures 9.3 cm and is normal in echogenicity and configuration.KIDNEYS: Right kidney measures 9.2 cm with normal echogenicity and without hydronephrosis. Left kidney measures 8.4 cm with normal echogenicity and without hydronephrosis. No renal calculi identified. OTHER: No ascites is noted.

Output: 1.Previously seen vascular lesion is not identified on this study.2.Indeterminant hypodense pancreatic head lesion is noted. Further evaluation with MRCP is recommended.3.Increased hepatic echogenicity compatible with steatosis.


Instruction: Generate impression based on medical findings.

Input: Female 93 years old Reason: Hypervolemic hyponatremia with newly elevated bilirubin and alk phos. Please evaluate for hepatobiliary pathology. History: As above LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 17 1 cm in length. The parenchyma is moderately coarse and echogenic Main portal vein is patent. There is mild scattered intrahepatic biliary ductal dilatation.BILIARY TRACT: The gallbladder is absent. Common duct measures 6 mm. PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 11.2 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney is obscuredSPLEEN: The spleen measures 9.2 cm. in length. OTHER: Pleural effusions.

Output: 1.Mild scattered intrahepatic biliary ductal dilatation. Further evaluation with triphasic CT of the liver can be performed if clinically indicated .


Instruction: Generate impression based on medical findings.

Input: Reason: history of papillary thyroid carcinoma, please evaluate for recurrence RIGHT LOBE MEASUREMENTS: Patient is status post thyroidectomy.LEFT LOBE MEASUREMENTS: Patient is status post thyroidectomy.ISTHMUS MEASUREMENTS: Patient is status post thyroidectomy.RIGHT LOBE: No evidence of residual disease.LEFT LOBE: No evidence of residual disease.ISTHMUS: No evidence of residual disease.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Grossly stable appearing left cervical lymph nodes with mild measurement differences likely due to differences in technique. All of these lymph nodes are seen with normal echogenic hilum, but continued surveillance is recommended.OTHER: No significant abnormality noted.

Output: Stable examination.


Instruction: Generate impression based on medical findings.

Input: Male 69 years old; Reason: repeat to measure left kidney per nephrology History: repeat to measure left kidney per nephrology RIGHT KIDNEY: The right kidney measures 10.6 cm in length. The cortex has increased echogenicity. No shadowing calculi or hydronephrosis is present. There is an anechoic renal cyst and measures 2.7 x 2.7 x 2.0 cm. No worrisome masses seen.LEFT KIDNEY: The left kidney measures 10.6 cm in length. The cortex has increased echogenicity. No shadowing calculi or hydronephrosis is present. No worrisome masses seen.URINARY BLADDER: The bladder is decompressed and poorly visualized.

Output: 1. Bilaterally, kidneys have increased echogenicity compatible with medical renal disease. No stones or hydronephrosis.2. The left kidney measures 10.6 cm in length.


Instruction: Generate impression based on medical findings.

Input: Reason: Hyperparathyroidism, please search for adenomas and evaluate thyroid for nodules, please perform FNA for any thyroid nodules > 1cm History: Hyperparathyroidism, please search for adenomas and evaluate thyroid for nodules, please perform FNA for any thyroid nodules > 1cm RIGHT LOBE MEASUREMENTS: 1.4 x 6.1 x 3.1 cmLEFT LOBE MEASUREMENTS: 4.3 x 2.2 x 1.7 cmISTHMUS MEASUREMENTS: Mild heterogeneity related to underlying vasculature.RIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Inferior to the left thyroid gland is a 1.3 x 1.0 x 0.9 cm rounded hypoechoic solid appearing lesion.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.3 cm hypoechoic lesion inferior to the left thyroid gland could represent a parathyroid adenoma.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o recurrence in neck History: h/o thyroid cancer with laryngeal mass RIGHT LOBE MEASUREMENTS: Patient is status post thyroidectomy. LEFT LOBE MEASUREMENTS: Patient is status post thyroidectomy. ISTHMUS MEASUREMENTS: Patient is status post thyroidectomy. RIGHT LOBE: Heterogeneous hypervascular right thyroid bed soft tissue mass measuring 2.3 x 3.1 x 2.0 cm.LEFT LOBE: Heterogeneous hypervascular left thyroid bed soft tissue mass measuring 0.9 x 1.0 x 1.5 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: At least 3 left level 3 lymph nodes noted measuring 1.2 x 1.1 x 1.9 cm, 1.9 x 1.1 x 1.5 cm, and 1.1 x 0.8 x 1.2 cm. Is also left level 4 lymph node measuring 0.8 x 0.9 x 0.9 cm. No enlarged right cervical lymph node identified.OTHER: No significant abnormality noted.

Output: Heterogeneous hypervascular thyroid bed soft tissue masses bilaterally compatible with disease recurrence. Multiple left level 3 and level 4 enlarged lymph nodes as above. No enlarged right cervical lymph node identified.


Instruction: Generate impression based on medical findings.

Input: Male 76 years old Reason: Cholecystitis, Cholelithiasis History: RUQ pain and RLQ pain Evaluation limited by patient body habitus.LIVER: The liver measures 17.1 cm in length and demonstrates increased parenchymal echogenicity. No intrahepatic or extrahepatic biliary ductal dilatation is evident and no focal mass lesions are seen. The main portal vein is patent and demonstrates hepatopedal flow with a velocity of 0.1 m/s. GALLBLADDER, BILIARY TRACT: No cholelithiasis or choledocholithiasis is seen. The common duct measures 0.2 cm in diameter. PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 11.3 cm in length and demonstrates increased parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.LEFT KIDNEY: The left kidney measures 11.7 cm in length and demonstrates increased parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.SPLEEN: The spleen measures 9.5 cm in length.OTHER: No significant abnormalities noted.

Output: 1.No evidence of cholelithiasis or cholecystitis.2.Increased renal parenchymal echogenicity consistent with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Female 51 years old; Reason: worsening creatinine History: worsening creatinine RIGHT KIDNEY: The right kidney measures 11.2 cm in length and demonstrates increased echogenicity. No shadowing calculi or hydronephrosis is present. Small cystic lesion in the midpole measuring 1.2 x 1.2 x 0.9 cm too small to characterize.LEFT KIDNEY: The left kidney measures 10.7 cm in length and demonstrates increased echogenicity. No shadowing calculi or hydronephrosis is no significant abnormality. Present. The small cystic structure in the midpole measuring 1.2 x 1.1 x 1.1 cm and is too small to characterize.URINARY BLADDER: No significant abnormalities noted.OTHER: Focal fatty infiltration of liver is noted.

Output: Increased echogenicity of bilateral kidneys which can be seen with medical renal disease. No hydronephrosis or shadowing calculi.


Instruction: Generate impression based on medical findings.

Input: Female 43 years old; Reason: eval renal graft, eval also for pyelonephritis History: signs of pyelonephritis RENAL TRANSPLANT: The cortex is of normal echogenicity. No increase in vascularity within the transplant kidney. No worrisome masses are seen.LOCATION: Left iliac fossaPERITRANSPLANT TISSUES: No perinephric fluid collection.COLLECTING SYSTEM/URETER: There is mild fullness of the collecting system of the transplant kidney. No stones are seen.URINARY BLADDER: The urinary bladder is visualized without any significant abnormalities noted.

Output: There is mild fullness of the collecting system within the transplant kidney. No perinephric fluid collection is seen.


Instruction: Generate impression based on medical findings.

Input: Reason: 64F w/ back pain, UTI, r/o hydronephrosis History: back pain ULTRASOUND KIDNEYSRIGHT KIDNEY: The right kidney measures 10.6 cm in length. Normal echogenicity. No focal lesions. No hydronephrosis.LEFT KIDNEY: The left kidney is 10.3 cm in length. Normal echogenicity. No hydronephrosis. There is a minimally complex, septated cyst within the inferior pole of the left kidney which measures 1.1 x 1 x 1.1 cm.OTHER:The bladder is visualized and appears nondistended.

Output: 1. No hydronephrosis.2. Minimally complex, septated cyst within the inferior pole of the left kidney. Likely benign.


Instruction: Generate impression based on medical findings.

Input: Reason: HBV, eval for HCC History: HBV LIVER: Liver measures 16 cm with slightly coarsened echotexture. Portal vein is patent with normal direction and velocity of 0.2 m/s. No suspicious hepatic mass is noted.BILIARY TRACT: Common bile duct measures 4 mm. Gallbladder wall measures 1 mm. Gallbladder polyp is again seen measuring 0.4 x 0.4 x 0.3 cm. 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 10.5 cm and is normal in echogenicity and configuration.KIDNEYS: Right kidney measures 10.3 cm with normal echogenicity and without hydronephrosis. Left kidney measures 11.1 cm with normal echogenicity and without hydronephrosis. No renal calculi identified. OTHER: No significant abnormalities noted.

Output: No suspicious hepatic mass is identified. Small gallbladder polyp again noted.


Instruction: Generate impression based on medical findings.

Input: Female 59 years old; Reason: recent bladder resection and ileal conduit creation with increasing creatinine History: increasing creatinine RIGHT KIDNEY: The right kidney measures 10.9 cm in length. The cortex is echogenic. No shadowing calculi is present. There is minimal hydronephrosis. A possible right renal stent is visualized in the collecting system.LEFT KIDNEY: The left kidney measures 9.4 cm in length. The cortex is echogenic. No shadowing calculi is present. There is mild hydronephrosis.URINARY BLADDER: Status post bladder resection.

Output: 1.Mild hydronephrosis, left greater than right.2.Echogenic kidneys compatible with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Female 48 years old; Reason: H/O gallstones History: abdominal pain LIVER: Normal hepatic parenchymal echogenicity. No focal hepatic lesions. Hepatic length measures 15.4 cm. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of 18.4 cm/s. GALLBLADDER/BILIARY TRACT: Status post cholecystectomy. The common bile duct is upper limits of normal and 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 8.4 cm and has a normal echotexture.KIDNEYS: The right kidney is slightly echogenic and measures 11.8 cm and has normal vascular flow. The left kidney measures 10.6 cm and has normal vascular flow. OTHER: No significant abnormality noted.

Output: 1. Slightly echogenic right kidney suggestive of medical renal disease2. No specific sonographic findings to account for the patient's abdominal pain.


Instruction: Generate impression based on medical findings.

Input: Reason: AKI, h/o BPH, eval for hydronephrosis RIGHT KIDNEY: No hydronephrosis. Normal cortical echogenicity.LEFT KIDNEY: No hydronephrosis. Normal cortical echogenicity. Mid left renal hypoechoic pseudo-lesion is felt to represent a prominent column, and seen on CTs as far back as 2008.OTHER: Incidentally seen fatty liver.

Output: No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 30 year-old female, evaluate for thyroid enlargement. RIGHT LOBE MEASUREMENTS: 5.2 x 1.5 x 1.4 cm, previously 4.5 x 1.9 x 1.3 cm.LEFT LOBE MEASUREMENTS: 4.5 x 1.5 x 1.2 cm, previously 4.1 x 1.7 x 1.1 cmISTHMUS MEASUREMENT: 0.3 cm, previously 0.3 cm.RIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.LYMPH NODES: Benign appearing right level three lymph node measuring 1.3 x 0.6 x 0.5 cm. OTHER: No significant abnormality noted.

Output: Unremarkable sonographic evaluation of the thyroid gland.


Instruction: Generate impression based on medical findings.

Input: Female 39 years old; Reason: AKI History: Swelling RIGHT KIDNEY: The right kidney measures 13 cm in length. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 13 cm in length. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. OTHER: No significant abnormalities noted.

Output: 1.No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Male 57 years old; Reason: kidney stone History: stone RIGHT KIDNEY: The right kidney measures 12.8 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The previously noted stone in the right ureter is not evident.LEFT KIDNEY: The left kidney measures 13.9 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. URINARY BLADDER: No significant abnormality notedOTHER: No significant abnormalities noted.

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


Instruction: Generate impression based on medical findings.

Input: Female 27 years old; Reason: maternal hydronephrosis, obstruction, renal cyst, 36 weeks pregnant History: maternal hydronephrosis, obstruction, renal cyst RIGHT KIDNEY: The right kidney measures 18.2 cm in length. Marked hydronephrosis without thinning of the cortex to suggest chronicity. No shadowing calculi to suggest nephrolithiasis. No worrisome mass is seen.LEFT KIDNEY: The left kidney measures 15.6 cm in length. Moderate hydronephrosis without thinning of the cortex to suggest chronicity. No shadowing calculi to suggest nephrolithiasis. No worrisome mass is seen.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.

Output: 1.Bilateral hydronephrosis, right greater than left.


Instruction: Generate impression based on medical findings.

Input: Male 50 years old Reason: month 3 for clinical trial History: none LIVER: Liver measures 13.0 cm in length. The parenchyma is severely coarse and echogenic with a nodular liver contour compatible with cirrhosis. There is no ascites. There is a questionable iso to hypoechoic area in the peripheral aspect of the right liver lobe which measures 1.6 x 1.4 x 1.9 cm without definite internal vascularity. This may represent a discrete lesion or be related to the heterogenous liver parenchyma. Again seen in the right hepatic lobe is a simple appearing cyst that measures 1.2 x 1.6 x 1.3 cm, and is unchanged from the prior exam.Main portal vein is patent with hepatopedal flow and a peak maximum velocity of 0.15 m/s.BILIARY TRACT: Patient is status post cholecystectomy. Again seen in the gallbladder fossa is a cystic-appearing structure that measures 1.1 x 1.1 x 0.8 cm, previously measured 1.1 x 1.1 x 1.0 cm, overall unchanged from the prior exam and may represent small fluid or a postoperative biloma or seroma. No intrahepatic or extrahepatic biliary ductal dilatation is present.PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 9.9 cm. The left kidney measures 12.9 cm. There is no hydronephrosis or shadowing renal calculus. Again seen at the superior aspect of the right renal pelvis a simple renal cyst measuring 1.2 x 1.0 x 0.8 cm, unchanged from the prior exam.SPLEEN: The spleen measures 16.7 cm. in length. OTHER: No significant abnormality noted.

Output: 1.Cirrhotic liver with questionable iso to hypoechoic focus in the peripheral aspect of the right liver lobe, but limited evaluation on ultrasound. Dedicated cross-sectional imaging with CT or MRI is recommended.2.Stable gallbladder fossa cystic structure may represent small fluid/postoperative sequela.3.Splenomegaly.