Instruction: Generate impression based on medical findings.

Input: 75-year-old male with history of nodules and recurrent syncope. RIGHT LOBE MEASUREMENTS: 2.9 x 2.1 x 4.5 cm.LEFT LOBE MEASUREMENTS: 1.2 x 1.1 x 3.2 cm.ISTHMUS MEASUREMENTS: 0.2 cm.RIGHT LOBE: A predominantly solid, partly cystic nodule measuring 2.2 x 2.6 x 3.5 cm replaces the majority of the right thyroid lobe. This nodule appears increased in size when compared to prior exam on 4/26/2012.LEFT LOBE: No significant abnormality.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval increase in size of predominantly solid right thyroid nodule. The nodule is amenable to biopsy.


Instruction: Generate impression based on medical findings.

Input: Male 59 years old; Reason: History of bilateral renal cysts, evaluate for change in size or characteristics. RIGHT KIDNEY: The right kidney measures 9.9 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. Again noted are multiple cysts, some of which are minimally complex, with the largest measuring 3.6 x 3.1 x 3.2 cm, grossly similar to prior CT. No evidence of mass.LEFT KIDNEY: The left kidney measures 11.4 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. Again noted are multiple cysts, some of which are minimally complex, grossly similar to prior CT.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.

Output: 1.Mild increase in echogenicity of bilateral kidneys, suggestive of medical renal disease.2.Bilateral numerous renal cysts, some of which are minimally complex, appearing grossly similar to prior CT from 4/18/2016. No shadowing calculi, hydronephrosis, or mass identified.


Instruction: Generate impression based on medical findings.

Input: 3 days old with rising creatinine, renal US with complex abdominal mass, h/o imperforate anus, evaluate bowel gas pattern.VIEW: Abdomen AP (one view) 07/17/2016, 2025 Enteric tube terminates in the stomach. There has been surgery, with fine staple lines in the left lower quadrant. Left lower quadrant ostomy and mucous fistula are noted. An additional round opacity over the right iliac bone is nonspecific but appears external to the patient.Dilated bowel loops are seen in the upper and right abdomen with relative paucity of bowel loops over the pelvis. Soft tissue fullness in the pelvis may be related to the cystic lesion seen on sonography. No pneumatosis, portal venous gas, or free air.Again noted are right-sided cardiac apex and partial sacral agenesis.

Output: Surgical changes and dilated bowel loops. Soft tissue fullness in the pelvis may be related to the cystic lesion seen on recent sonography.


Instruction: Generate impression based on medical findings.

Input: 31-year-old male with mass in the right upper extremity near axilla, since new AVG placed about 2 months ago. Immediately adjacent to the graft, there is a 5.3 x 3.5 x 3 cm oval mildly echogenic mass with no significant internal vascularity. Smaller, adjacent mass or masses are present as well. Although these may represent a highly complex hematomas, essentially cannot exclude adenopathy or other mass. There is increased echogenicity within the graft lumen, with Doppler evaluation of the graft demonstrating no significant flow beyond this site, compatible with thrombosis.

Output: 1.Echogenic mass immediately adjacent to the graft, hematoma versus adenopathy.2.Echogenic material within the right upper extremity graft lumen, with lack of flow on Doppler beyond this site, compatible with thrombosis.


Instruction: Generate impression based on medical findings.

Input: 50-year-old male with left kidney mass, questionable cyst RIGHT KIDNEY: The right kidney measures 9.9 cm. No shadowing calculi or hydronephrosis is present.LEFT KIDNEY: The left kidney measures 10 cm. There is an exophytic anechoic focus in the upper pole corresponding to prior CT, measuring 1.9 x 2.3 x 1.7 cm, compatible with a simple cyst. There is a hyperechoic nonshadowing focus in the lower pole measuring 0.6 x 0.5 x 0.4 cm. No hydronephrosis is present.OTHER: The bladder is nondistended.Limited color Doppler shows grossly normal arterial and venous blood flow to the kidneys.

Output: 1. Exophytic anechoic focus in the upper pole of the left kidney, corresponding to prior CT, is compatible with a simple renal cyst.2. Hyperechoic nonshadowing focus in the lower pole of the left kidney. Renal calculi cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Reason: assess abdominal wall at LLQ site (where purulent drainage is located) for possible underlying abscess that may be amenable to drainage by surgery History: as above A 1.6 x 1.8 cm predominantly hypoechoic probable fluid collection is seen deep to the bandaged area with clear communication with the skin surface. The tract measures approximately 1 cm in width to the skin surface. There is surrounding soft tissue edema.

Output: 1.8 cm fluid collection deep to the bandages with clear tract to the skin surface as described above.


Instruction: Generate impression based on medical findings.

Input: 78-year-old female with transaminitis. LIMITED ABDOMENLIVER: The liver has a smooth contour and parenchyma is within normal limits. Liver is slightly enlarged, measuring 18.1 cm in length. Portal flow is hepatopedal. Within the left liver, a 3.9 x 3.0 x 3.4 cm hypoechoic lesion is visualized, likely a cyst.BILIARY TRACT: The gallbladder has echogenic calculi with posterior acoustic shadowing. No gallbladder wall thickening or pericholecystic fluid is seen. No biliary ductal dilation.PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 11.8 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. A 5.2 x 4.1 x 3.7 cm hypoechoic lesion is visualized within the right kidney, likely a cyst.The left kidney measures 8 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.SPLEEN: The spleen is not well visualized on this examination.OTHER: No significant abnormalities noted.

Output: 1.Cholelithiasis without specific evidence of cholecystitis. No evidence of biliary ductal dilation.2.Mild hepatomegaly.


Instruction: Generate impression based on medical findings.

Input: 29-year-old female with right upper quadrant pain and nausea. LIMITED ABDOMENLIVER: The liver has a smooth contour. The parenchyma is normal in echotexture. Liver measures 13 cm in length. Portal flow is hepatopedal. No suspicious masses.BILIARY TRACT: The gallbladder has an anechoic lumen. No gallbladder wall thickening or pericholecystic fluid. No biliary ductal dilation.PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 12 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.The left kidney measures 10.1 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.SPLEEN: The spleen measures 8.7 cm. in length without significant abnormality.OTHER: None.

Output: Unremarkable ultrasound examination of the right upper quadrant. No specific evidence of cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Male 44 years old; Reason: obstruction? 44M metastatic thymic ca History: decreased urine output; Cr 0.9->1.4 RIGHT KIDNEY: The right kidney measures 12.2 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 4.5 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. Hypodense solid mass at the upper pole of the left kidney measures 2.4 x 3.1 cm. URINARY BLADDER: The bladder is emptyOTHER: Pelvic ascites.

Output: 1.No sonographic findings of nephrolithiasis or hydronephrosis.2.Left upper pole renal mass. It is not present on the study from 12/24/2005 given the extensive metastatic disease, metastatic disease to the kidney should be considered.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old. Reason: hx of parotid mass, assess parotid glands bilaterally, see CT from 9/2/16 History: as above The remnant of the right parotid gland is present without focal lesion. Left parotid gland contains 2 nonspecific, subcentimeter cystic foci superiorly. The more anterior focus measures 0.8 x 0.3 x 0.4 cm. Additional posterior cystic focus measures 0.7 x 0.5 x 0.7 cm. Benign-appearing right level 1 neck lymph node at the site of the patient's palpable abnormality measures 1.0 x 0.4 x 1.6 cm.

Output: Prominent, benign-appearing right level 1 neck lymph node at the site of the patient's palpable abnormality. Additional findings as above.


Instruction: Generate impression based on medical findings.

Input: Female 84 years old Reason: eval for aortic aneurysm History: abdominal bruit Abdominal aorta:Atherosclerotic aorta, no evidence of aneurysm.Aorta measures 2 cm in AP dimension proximally.Aorta measures 1.5 cm in AP dimension at midportion.Aorta measures 1.5 cm in AP dimension distally.Left common iliac artery measures up to 1.1 cm, while right common iliac artery measures up to 0.9 cm.

Output: Nonaneurysmal atherosclerotic aorta.


Instruction: Generate impression based on medical findings.

Input: Reason: Pancreatitis; rule out gallstone etiology History: see above LIVER: Liver measures 13.6 cm with normal echogenicity. 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 2-3 mm. 0.8 cm gallstone noted. Gallbladder wall measures 2 mm. No pericholecystic fluid collection. PANCREAS: Distal pancreas is obscured by overlying bowel gas. Visualized portion is within normal limits.SPLEEN: Spleen measures 8.1 cm and is normal in echogenicity and configuration.KIDNEYS: Right kidney measures 9.8 cm with normal echogenicity and without hydronephrosis. Right renal cyst measuring 1.6 x 1.7 x 1.8 cm noted. Left kidney measures 8.8 cm with normal echogenicity and without hydronephrosis. No renal calculi identified. OTHER: No significant abnormalities noted.

Output: Gallstone noted without evidence of acute inflammation or biliary ductal dilatation.


Instruction: Generate impression based on medical findings.

Input: Right forearm fullness palpated No evidence for mass, acute inflammatory process, or loculated fluid collection

Output: No evidence for mass, acute inflammatory process, or loculated fluid collection within subcutaneous tissues proximal right forearm


Instruction: Generate impression based on medical findings.

Input: 24-year-old female presents with left upper quadrant discomfort, evaluate for pancreatic lesions/splenomegaly. LIVER: Minimal increase in hepatic parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions. Hepatic length measures 15 cm. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of 51 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. Per technologist, negative sonographic Murphy's sign.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 10 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 11 cm and has normal vascular flow. Limited evaluation of the left kidney measuring 9 cm with normal vascular flow. OTHER: No significant abnormality noted.

Output: No sonographic evidence of pancreatic lesions or splenomegaly. If there is continued clinical concern a contrast enhanced CT may be considered.


Instruction: Generate impression based on medical findings.

Input: 53-year-old male with a history of thyroid cancer status post thyroidectomy. RIGHT LOBE: Status post thyroidectomy. No echogenic foci to suggest locoregional recurrence.LEFT LOBE: Status post thyroidectomy. No echogenic foci to suggest locoregional recurrence.ISTHMUS: Status post thyroidectomy. No echogenic foci to suggest locoregional recurrence.LYMPH NODES: Benign-appearing left level four and five lymph nodes measuring 1.4 x 0.4 x 0.8 cm and 0.8 x 0.3 x 0.9 cm, respectively. The left level four lymph node has not significantly changed since the prior examination.OTHER: No significant abnormality noted.

Output: No sonographic evidence of locoregional recurrence.


Instruction: Generate impression based on medical findings.

Input: Reason: elevated LFTs, rule out portal vein thrombosis, please doppler portal vein History: elevated LFTs, rule out portal vein thrombosis, please doppler portal vein. LIVER: The liver measures 13.5 cm in length. The liver appears diffusely echogenic and mildly coarsened in echotexture, consistent with fatty infiltration. There are no masses visualized. There is no ductal dilation.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. The common bile duct is not dilated, measuring 0.5 cm.PANCREAS: The pancreas is unable to be visualized, obscured by bowel gas.SPLEEN: Spleen measures 12.6 cm in length. Normal echogenicity. No focal lesions.KIDNEYS: Status post right nephrectomy.The left kidney measures 11.1 cm in length. Mildly increased echogenicity. No focal lesions. No hydronephrosis.OTHER: The portal vein is patent with hepatopetal flow and normal waveform. Velocity is 0.2 m/s. No evidence of thrombosis.No ascites.

Output: 1. Fatty infiltration of the liver with no focal lesion.2. Patent portal vein. No evidence of thrombosis.3. Mildly increased echogenicity of the left renal cortex, consistent with medical renal disease/parenchymal function.


Instruction: Generate impression based on medical findings.

Input: 58-year-old male with right upper quadrant pain and transaminitis. LIVER: The liver measures 15.8 cm in length. Coarse echogenic liver echotexture without mass or ductal dilatation. Portal vein is patent. GALLBLADDER, BILIARY TRACT: No signs of acute inflammation or ductal dilatation.PANCREAS: The pancreas is not well-visualized due to overlying bowel gas. ARIGHT KIDNEY: The right kidney measures 10 cm. The cortex is of normal echogenicity. No mass, stone or hydronephrosis.LEFT KIDNEY: The left kidney measures 10 cm. The cortex is of normal echogenicity. No mass, stone or hydronephrosis.SPLEEN: The spleen measures 7.4 cm.OTHER: No significant abnormalities noted.

Output: Coarse echogenic liver echotexture suggestive of fatty infiltration/parenchymal dysfunction without mass or ductal dilatation.


Instruction: Generate impression based on medical findings.

Input: Female 65 years old Reason: evaluate for splenomegaly. Pt with new LUQ pain that extends posteriorly, s/p Day #4 apheresis collection for stem cell harvest History: new LUQ pain, no h/o of splenomegaly SPLEEN: The spleen measures 11.4 cm. in length. No significant abnormality. OTHER: No significant abnormality noted.

Output: No evidence of splenomegaly.


Instruction: Generate impression based on medical findings.

Input: Male 72 years old Reason: Rising bilirubin \T\ fever, concern for cholecystitis History: Fever, increased Tbili LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 18.8 cm in length. The parenchyma is mildly echogenic. Portal vein flow is hepatopetal.BILIARY TRACT: The gallbladder has an anechoic lumen. The wall measures up to 5 mm in thickness and appears edematous. There is a small amount of pericholecystic fluid and ascites. Sonographic Murphy's sign is positive. Common duct measures 4 mm. No stone is seen in the common duct.PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 12.9 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 11.3 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 13 cm. in length. OTHER: Small right pleural effusion noted.

Output: 1.Acute acalculus cholecystitis. Finding discussed with Keri Kordas, NP by phone at 16:33 on 9/26/2016.2.Small amount of ascites and small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 25-year-old male with elevated ALT. LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver is upper limits of normal, measuring 19.2 cm in length. The parenchyma is mildly echogenic. Portal venous flow is hepatopedal. No masses are visualized.BILIARY TRACT: The gallbladder demonstrates an anechoic lumen. No gallbladder wall thickening or pericholecystic fluid is noted. A 0.4 cm, nonvascular polyp is noted in the gallbladder. No biliary ductal dilation.PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 10.8 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.The left kidney measures 11.9 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.SPLEEN: The spleen measures 10.1 cm. in length and is without significant abnormality.OTHER: No significant abnormalities noted.

Output: 1.Liver measures upper limits of normal with a mildly echogenic parenchyma that may be secondary to fatty liver.


Instruction: Generate impression based on medical findings.

Input: Female 85 years old Reason: Failure to thrive, elevated liver enzymes, known history of CLL History: Failure to thrive, elevated liver enzymes LIVER: Liver measures 17 cm in length. Mildly heterogeneous echotexture, no focal liver lesion. Main portal vein patent with normal directional flow, velocity measures 29 to 32 cm/s. BILIARY TRACT: Cholelithiasis, no secondary signs of acute cholecystitis. 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 8.4 cm. The left kidney measures 8.3 cm. No hydronephrosis. Left upper pole renal cyst measuring 2.3 x 2.2 x 2 cm.SPLEEN: The spleen measures 11.7 cm. in length. OTHER: No significant abnormality noted.

Output: Mildly heterogeneous hepatic echotexture, no focal lesion seen.Cholelithiasis.Left-sided renal cyst.


Instruction: Generate impression based on medical findings.

Input: Male 74 years old Reason: evaluate for cause of liver enzyme elevation. Look for biliary obstruction, liver mets, etc History: LFT elevation in pt with esophageal cancer LIMITED ABDOMENLIVER: Coarse echotexture. Elevated main portal vein velocity of up to 110 cm/s with appropriate directional flow.BILIARY TRACT: No biliary dilatation. Shadowing gallstone without pericholecystic fluid, gallbladder wall thickening. Small amount of fluid surrounding the gallbladder is felt to be ascites.PANCREAS: Visualized portions are unremarkable.KIDNEYS: The right kidney measures 14 cm. The cortex is echogenic. No shadowing calculi. Moderate hydronephrosis. The left kidney is not well visualized, but measures 11 cm. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 12 cm. in length. OTHER: Visualized portions of the bladder are unremarkable.

Output: 1.Coarse echotexture of the liver can be seen in diffuse parenchymal disease/fatty infiltration. Small amount of ascites.2.Elevated main portal vein velocity as described above.3.Cholelithiasis without sonographic signs of acute cholecystitis.4.Moderate right hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Cyst found on MRI of neck, 1.4 cm, evaluate for abnormality RIGHT LOBE: Measures 4.8 x 1.8 x 1.1 cm. Lower pole mildly heterogeneous hypoechoic nodule seen measuring 1.4 x 1.3 x 1 cm, although nodule appears spongiform internally (suggesting colloid composition), rim vascularity seen.LEFT LOBE: Measures 4.1 x 1.6 x 1.2 cm. No discrete nodule.ISTHMUS: Measures 0.2 cm.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Lower pole mildly heterogeneous hypoechoic nodule seen measuring 1.4 x 1.3 x 1 cm, although nodule appears spongiform internally (suggesting colloid composition), rim vascularity seen. If clinically desired, colloid composition of nodule may be achieved with FNA biopsy.


Instruction: Generate impression based on medical findings.

Input: Female 44 years old; Reason: AKI History: AKI RIGHT KIDNEY: The right kidney measures 6.7 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 7.3 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. Minimally complex cyst in the interpolar region measures 1.7 cm. URINARY BLADDER: No significant abnormality notedOTHER: No significant abnormalities noted.

Output: 1.Echogenic atrophic renal cortices compatible with medical renal disease.2.Minimally complex left renal cyst.


Instruction: Generate impression based on medical findings.

Input: 34-year-old male with nausea and vomiting. Reason: Evaluate for gallstones. LIVER: The liver measures 21 cm in length. Mildly echogenic liver parenchyma without focal lesion or ductal dilatation. Patent portal vein with normal hepatopetal directional flow and peak velocity of 0.4 m/s.GALLBLADDER, BILIARY TRACT: No evidence of gallstones, gallbladder wall thickening, pericholecystic fluid or ductal dilatation. Negative sonographic Murphy's sign.PANCREAS: The visualized pancreas is without significant abnormalities.RIGHT KIDNEY: The right kidney measures 9 cm. Echogenic renal parenchyma. No shadowing calculi or hydronephrosis is present.LEFT KIDNEY: The left kidney measures 10.2 cm. Echogenic renal parenchyma. No shadowing calculi or hydronephrosis is present. There is a cystic focus measuring 1 x 0.9 x 0.9 cm.SPLEEN: The spleen measures 10.9 cm.OTHER: No other significant abnormalities.

Output: 1. No sonographic evidence of cholelithiasis or cholecystitis.2. Mildly echogenic liver parenchyma consistent with fatty infiltration/parenchymal dysfunction without focal lesion or ductal dilatation.3. Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction.


Instruction: Generate impression based on medical findings.

Input: Female 56 years old s/p sigmoidectomy, appendectomy, bilateral ureteral stent now with increased creatinine 5.4 RIGHT KIDNEY: The right kidney measures 11.0 cm in length. The cortex is increased in echogenicity. Moderate hydronephrosis is present. Non-vascular debris noted in the proximal collecting system. Normal vascular flow. No shadowing calculi.LEFT KIDNEY: The left kidney measures 11.7 cm in length. The cortex is increased in echogenicity. Moderate hydronephrosis is present. Normal vascular flow. No shadowing calculi.URINARY BLADDER: No ureteral jets identified. No significant abnormality noted..OTHER: No significant abnormalities noted.

Output: Moderate bilateral hydronephrosis and increased renal parenchymal echogenicity suggestive of medical renal disease. Debris noted in the proximal right collecting system, which may represent clot or debris. No shadowing calculi present.


Instruction: Generate impression based on medical findings.

Input: 54-year-old male with elevated amylase/nausea/vomiting. Please rule out cholecystitis. LIMITED ABDOMENLIVER: The liver has a smooth contour. The parenchyma is normal in echotexture. Liver measures 17.3 cm in length. Portal flow is hepatopedal. No suspicious masses.BILIARY TRACT: The gallbladder has an anechoic lumen. No gallbladder wall thickening or pericholecystic fluid. No biliary ductal dilation.PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 10.4 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.The left kidney measures 10.7 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.SPLEEN: The spleen measures 9.0 cm. in length without significant abnormality.OTHER: None.

Output: 1.No cholelithiasis. No biliary ductal dilation or suspicious mass seen in the liver.2.No other significant abnormality to explain patient's symptomology.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old. Reason: Evaluate for new ascites. Hx of heart failure reduced EF. Please assess for total ascites volume. Left inguinal mass, likely ascitic fluid but please rule out hernia. Moderate ascites is present throughout the abdomen, some of which have low-level echoes. Mild gallbladder wall thickening which is nonspecific in the setting of ascites. Coarse, echogenic hepatic parenchyma suggests chronic liver disease/parenchymal dysfunction. While there are several loops of bowel in the left lower quadrant, there is no evidence of an left inguinal hernia.

Output: Moderate ascites. No evidence of left inguinal hernia as clinically questioned.


Instruction: Generate impression based on medical findings.

Input: 48-year-old male with history of thyroid cancer, 1.5 year follow-up study. Evaluate for recurrence. RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.LYMPH NODES: No suspicious lymphadenopathy. Bilateral benign morphology lymph nodes are present.OTHER: No significant abnormality noted.

Output: Status post thyroidectomy with no evidence of disease recurrence.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female with nausea, vomiting, abdominal pain, acute renal failure. Reason: Evaluate for biliary dilatation or other pathology. LIVER: The liver measures 14.9 cm in length. Coarse echogenic liver parenchyma without focal lesion or ductal dilatation. Portal vein is patent with normal hepatopedal directional flow with velocity of 0.30 m/s.GALLBLADDER, BILIARY TRACT: Possible gallbladder sludge without acute inflammation or ductal dilatation.PANCREAS: The visualized pancreas is without significant abnormalities.RIGHT KIDNEY: The right kidney measures 10.9 cm. Echogenic parenchyma without mass, stone or hydronephrosis.LEFT KIDNEY: The left kidney measures 11 cm. Echogenic parenchyma without mass, stone or hydronephrosis.SPLEEN: The spleen measures 7.5 cm.ABDOMINAL AORTA: The proximal aorta measures 2.3 x 2.4 cm. The mid aorta measures 1.9 x 1.9 cm. The distal aorta measures 1.8 x 2 cm.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No significant abnormalities noted.

Output: 1. Possible gallbladder sludge without acute inflammation or ductal dilatation.2. Coarse echogenic liver parenchyma suggestive of fatty infiltration/parenchymal dysfunction without focal lesion or ductal dilatation.3. Echogenic renal parenchyma suggestive of medical renal disease/parenchymal dysfunction without mass, stone or hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Male 49 years old; Reason: evaluate for gallstones and CBD History: RUQ pain LIVER: The liver is normal in echogenicity and echotexture. No focal hepatic lesions. Hepatic length measures 20.4 cm. The main portal vein is patent with normal hepatopedal flow with a peak velocity of 27.4 cm/s. GALLBLADDER/BILIARY TRACT: Multiple gallstones are noted within the gallbladder. Trace amount of pericholecystic fluid is noted. The gallbladder wall is thickened and measures 5 mm in diameter. Sonographic Murphy's sign was positive during the examination. No intra or extrahepatic biliary ductal dilatation identified. The common bile duct measures 5 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 12.8 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. Thr right kidney measures 13 cm and has normal vascular flow. No hydronephrosis. The left kidney measures 11.9 cm and has normal vascular flow. No hydronephrosis.OTHER: No significant abnormality noted.

Output: 1.Cholelithiasis, gallbladder wall thickening, pericholecystic fluid, and positive sonographic Murphy's sign consistent with acute cholecystitis.2.Hepatomegaly.


Instruction: Generate impression based on medical findings.

Input: Female 71 years old; Reason: renal insufficiency. RIGHT KIDNEY: The right kidney measures 9 cm in length and demonstrates increased echogenicity. No shadowing calculi or hydronephrosis is present. Simple cyst in the upper pole measures 1.8 x 1.9 x 1.6 cm. Additional minimally complex cyst in the lower pole measures 1.3 x 1.6 x 1.3 cm.LEFT KIDNEY: The left kidney measures 9.2 cm in length and demonstrates increased echogenicity. No shadowing calculi or hydronephrosis is present. Simple cyst in the upper pole measures 1.6 x 1.2 x 1.3 cm.URINARY BLADDER: The bladder is collapsed.OTHER: No significant abnormalities noted.

Output: 1.Increased echogenicity of bilateral kidneys, suggestive of medical renal disease without evidence of hydronephrosis or shadowing calculi.2.Bilateral renal cysts, as above


Instruction: Generate impression based on medical findings.

Input: Papillary thyroid carcinoma status post thyroidectomy, abnormal appearing lymph nodes seen on prior sonography Real time scanning revealed enlarged right-sided level 2 and 3 lymph nodes. A total of approximately 0.2 cc of methylene blue was instilled at the sites of the largest lymph nodes at each of these levels (2 nodes total, 0.1 cc at each site). These findings were reviewed with the attending surgeon Dr. Angelos at the time of the examination.

Output: Intraoperative localization of enlarged right-sided cervical lymph nodes as above.


Instruction: Generate impression based on medical findings.

Input: Female 42 years old; Reason: Primary HPT. Sestamibi scan shows Left inferior posterior adenoma. History: Primary HPT. Sestamibi scan shows Left inferior posterior adenoma. RIGHT LOBE MEASUREMENTS: 4.4 x 1.1 x 1.8 cmLEFT LOBE MEASUREMENTS: 4.3 x 1.0 x 1.4 cmISTHMUS MEASUREMENT: 0.2 cmRIGHT LOBE: No focal cystic or solid nodule.LEFT LOBE: No focal cystic or solid nodule.ISTHMUS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: Hypoechoic nodule adjacent to the lower pole of the left thyroid lobe measuring 1.1 x 0.7 cm with slight posterior acoustic enhancement. There is a polar feeding vessel and imaging features are characteristic of parathyroid adenoma.

Output: 1.Para thyroid adenoma candidate adjacent to the lower pole of the left thyroid lobe.2.No focal thyroid nodule.


Instruction: Generate impression based on medical findings.

Input: Male 55 years old Reason: clinical research exam History: none LIMITED ABDOMENLIVER: The liver parenchyma is severely coarse and echogenic, the liver surface has a nodular contour with hypertrophy of the caudate lobe. Liver measures 14.8 cm in length. No worrisome liver lesion is identified. The main portal vein is patent and demonstrates hepatofugal (reversed) flow with a velocity of 0.2 m/s. There is a small amount of perihepatic ascites.BILIARY TRACT: Status post cholecystectomy. No intrahepatic ductal dilatation. Common duct measures 4 mm in diameter. PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 11.1 cm. The cortex is normal in echogenicity. No worrisome renal mass, shadowing calculi or hydronephrosis is present. The left kidney measures 11.5 cm. The cortex is normal in echogenicity. There is a 1.0 x 0.9 x 1.2 cm simple cyst in the superior pole. No worrisome renal mass, shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 14.5 cm in length. OTHER: No significant abnormalities noted.

Output: 1.Cirrhotic liver morphology with a small amount of ascites. No worrisome liver mass.2.Patent main portal vein with reversed direction of flow indicating portal venous hypertension.3.Splenomegaly.


Instruction: Generate impression based on medical findings.

Input: Reason: Patient with a neck mass oblong about 1 inch in length mildly raised needs ultrasound to rule out thyroid mass versus thyroglossal cyst versus lipoma versus other History: Patient with a neck mass oblong about 1 inch in length mildly raised needs ultrasound to rule out thyroid mass versus thyroglossal cyst versus lipoma versus other RIGHT LOBE MEASUREMENTS: 1.4 x 1.4 x 4.7 cmLEFT LOBE MEASUREMENTS: 1.3 x 1.2 x 4.7 cmISTHMUS MEASUREMENTS: 0.2 cm APRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A benign-appearing lymph node is seen in level 1B measuring 0.8 cm, corresponding to patient's area of palpable abnormality.OTHER: No significant abnormality noted.

Output: Benign-appearing lymph node is seen corresponding to patient's area of palpable abnormality. If continued clinical concern, follow-up suggested.


Instruction: Generate impression based on medical findings.

Input: Male 55 years old; Reason: r/o recurrence History: h/o thyroid cancer, s/p lobectomy RIGHT LOBE MEASUREMENTS: 5.2 x 1.7 x 1.8 cmLEFT LOBE MEASUREMENTS: Status post left lobectomy ISTHMUS MEASUREMENT: The isthmus is absent RIGHT LOBE: No significant abnormality noted.LEFT LOBE: No suspicious lesions in the left thyroid bedISTHMUS: No significant abnormality noted.LYMPH NODES: Small left and right perivascular lymph nodes.A left submandibular gland lymph node measures 1.8 x 0.7 cmOTHER: No significant abnormality noted.

Output: 1.No specific evidence of recurrent thyroid disease.2.Bilateral neck lymph nodes.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old. Reason: elevated liver enzyme, concern for cholecystitis History: alk phos >1000 LIVER: Liver measures 15.6 cm in length. No focal hepatic mass or ascites. Portal vein is patent with a normal direction of flow.BILIARY TRACT: Gallbladder sludge and stones without gallbladder wall thickening or pericholecystic fluid. Per the technologist, the Murphy's sign was negative. No intrahepatic or extrahepatic biliary ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: Spleen measures 9.7 cm in length.RIGHT KIDNEY: Native right kidney is atrophic measuring 6.1 cm in length with increased cortical echogenicity. No hydronephrosis, mass, or shadowing calculi. OTHER: Native left kidney is not visualized. Left iliac fossa transplant kidney measures 11.1 cm in length. No hydronephrosis, mass, or shadowing calculi. Bilateral pleural effusions.

Output: 1. Gallbladder sludge and stones without evidence of acute inflammation.2. Bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female 66 years old; Reason: eval for nodules, abnormality History: abnormal thyroid on CT scan RIGHT LOBE MEASUREMENTS: 6.3 x 3.7 x 3.4 cmLEFT LOBE MEASUREMENTS: 5.1 x 1.5 x 2.2 cmISTHMUS MEASUREMENT: 0.9 cmRIGHT LOBE: Mild hyperechoic solid nodule in the interpolar right thyroid lobe measures 4.4 x 2.4 x 1.5 cm. There are multiple other subcentimeter right thyroid nodules.LEFT LOBE: Hyperechoic nodule in the lower pole of the left thyroid lobe measures 1.9 x 1.5 x 0.4 cmThere are multiple left thyroid lobe nodules. It has coarse calcifications.ISTHMUS: Isthmus nodule measures 2.6 x 2.5 x 2.2 cm.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multinodular goiter with multiple thyroid nodules


Instruction: Generate impression based on medical findings.

Input: Female 61 years old with history of Hurthle cell tumor with intermediate malignant potential (2 cm) RIGHT LOBE: Status-post thyroidectomy. The previously demonstrated subcentimeter hypoechoic focus in the anterior thyroid bed is no longer visualized. A second subcentimeter hypoechoic focus more inferiorly in the thyroid bed is noted and measures 0.4 x 0.2 x 0.3 cm, not significantly changed from exam dated 5/23/2014, even though not visualized on the more recent study.LEFT LOBE: Status-post thyroidectomy. No evidence of new or recurrent disease.ISTHMUS: Status-post thyroidectomy. No evidence of new or recurrent disease.LYMPH NODES: No regional adenopathy.OTHER: No significant abnormality noted.

Output: Stable exam without evidence of new or recurrent disease.


Instruction: Generate impression based on medical findings.

Input: Female 38 years old Reason: Patency of bilateral ureters, confirm nonobstructive outflow History: post-op without cystoscopy Per ultrasound technologist suboptimal exam secondary to patient's overlying bandaging.RIGHT KIDNEY: The right kidney measures 11.8 cm. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 12.3 cm. No shadowing calculi or hydronephrosis is present. 1.3 x 1.2 x 0.9 cm echogenic cortically based lesion without reliable posterior acoustic shadowing, no associated twinkle artifact seen.BLADDER: Not well visualized, presumably due to underdistended state.OTHER: No significant abnormalities noted.

Output: No hydronephrosis.1.3 cm left renal echogenic lesion, may be an angiomyolipoma but nonspecific, should be confirmed with dedicated CT or MRI.


Instruction: Generate impression based on medical findings.

Input: Female 60 years old with microscopic hematuria, CKD stage 3 RIGHT KIDNEY: The right kidney measures 10.1 cm in length with normal corticomedullary differentiation and Doppler flow. Multiple small echogenic and non-shadowing foci are noted. Right renal cyst is present and measures up to 1.0 cm. No hydronephrosis is present. LEFT KIDNEY: The left kidney measures 8.4 cm in length with normal corticomedullary differentiation and Doppler flow. Left renal cyst is present and measures up to 1.9 cm. Multiple small echogenic and non-shadowing foci are noted. No hydronephrosis is present.URINARY BLADDER: Normal in appearance with ureteral stent partially visualized.OTHER: No significant abnormalities noted.

Output: Bilateral renal cysts without definitive evidence of calculi or hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Male 21 years old; Reason: patient has superficial peri-ostomy abscess, on antibiotics, please evaluate History: abdominal pain There is a right lower quadrant ostomy. Slightly superior to the ostomy there is a collection with small foci of gas that measures 2.8 x 1.7 x 4.2 cm. There is hyperemia of the bowel extending through the fascial plane. There are small foci of gas that appear to track from the ostomy into the subcutaneous collection (shown on cine images). The collection is at the level of the abdominal fascia without definite intra-abdominal extension. The collection is a conglomeration of inflammatory soft tissue, small amount of fluid and gas.

Output: 1.Right lower quadrant fluid collection adjacent to the ostomy with findings suspicious for a small fistulous connection.


Instruction: Generate impression based on medical findings.

Input: Male 67 years old; Reason: Etiology of AKI History: AKI and hypertensive emergency RIGHT KIDNEY: The right kidney measures 11.3 cm in length. The cortex is slightly echogenic. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 11.9 cm in length. The cortex is slightly echogenic. No shadowing calculi or hydronephrosis is present. Bladder is not well visualized secondary to Foley catheterization.OTHER: No significant abnormalities noted.

Output: 1.No hydronephrosis. Slight echogenicity of the renal cortices can be seen in nonspecific medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Male 55 years old Reason: 2 year follow up s/p islet cell transplant, please evaluate patency and doppler portal vein History: see above LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 14 cm in length. The parenchyma is moderately echogenic and heterogeneous . No focal hepatic lesions. Main portal vein is patent with normal flow. Small echogenic focus likely represents area of cortical placement.BILIARY TRACT: The gallbladder is absent. Common duct measures 3 mm. PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 12.4 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 10.6 cm. in length. OTHER: No ascites.

Output: 1.Patent portal vein.2.Hepatic parenchyma has progressively becoming more echogenic and heterogeneous. Correlation with liver enzymes and if needed, cross-sectional imaging such as MRI to evaluate for fatty infiltration is suggested.


Instruction: Generate impression based on medical findings.

Input: 83-year-old female with acute kidney injury. Reason: Evaluate for obstruction. RIGHT KIDNEY: The right kidney measures 7.2 cm. Mildly echogenic parenchyma without mass, stones, or hydronephrosis.LEFT KIDNEY: The left kidney measures 8.5 cm. Mildly echogenic parenchyma without masses, stones, or hydronephrosis.OTHER: Bladder is nondistended.

Output: Small bilateral kidneys with echogenic renal parenchyma, consistent with medical renal disease/parenchymal dysfunction, without masses, stones, or hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Female 79 years old; Reason: history of thyroid nodule/cyst, follow up US History: history of thyroid nodule/cyst, follow up US RIGHT LOBE MEASUREMENTS: 3.8 x 1.5 x 2.1 cmLEFT LOBE MEASUREMENTS: 6.8 x 2.9 x 2.9 cmISTHMUS MEASUREMENT: 0.5 cmRIGHT LOBE: Heterogeneous thyroid gland with multiple nodules. A reference predominantly solid mixed hyper/iso-echoic nodule in the right mid lobe measures 1.6 x 0.9 x 1.2 cm. The largely cystic nodule identified on prior FNA images is not identified.LEFT LOBE: Heterogeneous thyroid gland with multiple modules. A reference mixed solid and cystic nodule with foci of coarse calcification measures 2.7 x 2.6 x 2.4 cm inferiorly in the left thyroid lobe.ISTHMUS: No significant abnormality noted.LYMPH NODES: Multiple indeterminate lymph nodes identified in the neck as noted on recent CT neck. The largest on the right side measures 2.0 x 1.4 x 0.8 cm.OTHER: No significant abnormality noted.

Output: 1.Multiple nodules identified within the thyroid gland as detailed above.2.Multiple indeterminate lymph nodes as identified on recent CT neck.


Instruction: Generate impression based on medical findings.

Input: 63-year-old female with increased conjugated bilirubin and pancreatitis. Reason: Evaluate for biliary dilation or gallstone. LIVER: Liver parenchyma is of normal echogenicity. Portal vein is patent.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. No intrahepatic or extrahepatic biliary ductal dilatation. The common bile duct measures 0.4 cm.PANCREAS: Pancreas is not well visualized, as it is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 12.2 cm. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present.LEFT KIDNEY: The left kidney measures 11.5 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.SPLEEN: The spleen measures 9 cm.OTHER: Trace perihepatic ascites.

Output: Status post cholecystectomy without biliary ductal dilatation.


Instruction: Generate impression based on medical findings.

Input: Female 45 years old Reason: assess causes of elevated LFTs, primarily cholestatic pattern History: fevers LIVER: Liver is enlarged and measures 20.1 cm in length. The parenchyma is mildly echogenic which is nonspecific but may reflect diffuse infiltrative disease.Main portal vein is patent with hepatopedal flow and a peak velocity of 0.2 m/s.BILIARY TRACT: Patient is status post cholecystectomy. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 6.1 cm. The left kidney measures 5.8 cm. There is increased echogenicity of the cortices of the bilateral kidneys which are small and atrophic.SPLEEN: The spleen measures 12.0 cm. in length. OTHER: No significant abnormality noted.

Output: 1.Hepatomegaly with mildly echogenicity liver parenchyma which is nonspecific but may reflect hepatic steatosis/parenchymal dysfunction.2.Atrophic kidneys with increased cortical echogenicity compatible with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Male 84 years old; Reason: abdominal distension, r/o ascites and evaluate liver History: abdominal distension, r/o ascites and evaluate liver Please note exam is limited by body habitus.LIVER: Normal hepatic parenchymal echogenicity with normal echotexture. No focal hepatic lesions. Hepatic length measures 18.3 cm. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of 26.6 cm/s. GALLBLADDER/BILIARY TRACT: Status post cholecystectomy. The common bile duct measures 6 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 11.8 cm and has a normal echotexture.KIDNEYS: Interval improvement in bilateral hydronephrosis. The right kidney measures 13.8 cm and has normal vascular flow. The left kidney measures 10.9 cm and has normal vascular flow. Note is made of bilateral nephrostomy tubes. Hypoechogenic foci within the left kidney compatible with renal cysts.OTHER: Small amount of ascites.

Output: 1. Small amount of ascites without sonographic evidence of underlying hepatic dysfunction.2. Interval improvement in bilateral hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 61-year-old female with acute kidney injury. RIGHT KIDNEY: The right kidney measures 11.2 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. A 0.2 x 1.9 x 1.9 cm hypoechoic nodule visualized in the inferior right kidney, likely cyst.LEFT KIDNEY: The left kidney measures 10.5 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. Extending from the renal pelvis and isoechoic to renal cortex is a lesion that measures approximately 2.5 x 3.1 cm.OTHER: The bladder is nondistended.

Output: 1.Benign right kidney cyst.2.A lesion that extends from the renal pelvis and is isoechoic to the surrounding renal cortex is seen within the left kidney and likely represents a hypertrophied column of Bertin.


Instruction: Generate impression based on medical findings.

Input: Male 66 years old Reason: AKI rule out obstruction History: worsening creatinine RIGHT KIDNEY: The right kidney measures 10.1 cm in length and demonstrates increased parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen. There is a 0.9 x 2.0 x 1.7 cm anechoic lesion arising from the superior pole of the right kidney consistent with a simple renal cyst.LEFT KIDNEY: The left kidney measures 11.0 cm in length and demonstrates increased parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.BLADDER: The bladder is decompressed.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, 62 years old. Reason: Please eval for 2 questions: 1) kidneys of obstructive or chronic disease, 2) for any abdominal wall hernias in the Inguinal/ suprapubic area History: s/p Lung Transplant, now with anasarca of unknown cause, abdominal pain, weight loss for 5 months. He insists there is a hernia in the inguinal/ suprapubic area. Adm for AKI; Hydroureter was seen on prior Renal US. s/p paracentesis. LIVER: Partially imaged liver demonstrates a cirrhotic morphology with moderate ascites.KIDNEYS: Right kidney measures 7.5 cm in length with mildly increased cortical echogenicity. Left kidney measures 10.4 cm in length with mildly increased cortical echogenicity. No hydronephrosis, shadowing calculi, or mass. OTHER: The urinary bladder is distended without significant abnormality noted. In the right groin, at the patient's area of concern, there is ascites without evidence of a hernia.

Output: 1. Mildly echogenic renal parenchyma bilaterally suggests medical renal disease/parenchymal dysfunction. No hydronephrosis.2. No evidence of a hernia in the right groin.


Instruction: Generate impression based on medical findings.

Input: Female 63 years old Reason: assess for liver lesions History: as above LIMITED ABDOMENLIVER: Cirrhotic parenchyma with no obvious focal hepatic lesion.BILIARY TRACT: Mild extrahepatic dilatation to 8 mm. Cholelithiasis and sludge within the gallbladder. No pericholecystic fluid, gallbladder wall thickening.PANCREAS: Visualized portions are unremarkableKIDNEYS: The right kidney measures 10 cm. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 11 cm. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 15 cm. in length. OTHER: Small amount of septated ascites.

Output: 1.Cirrhosis with portal hypertension. No obvious focal hepatic lesion.2.Small amount of complicated ascites - nonspecific, could be secondary to infection, hemorrhage. Correlate clinically3.Cholelithiasis without sonographic signs of cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Female 34 years old Reason: cirrhosis History: cirrhosis LIVER: The liver measures 18.5 cm in length and demonstrates markedly coarsened parenchymal echogenicity and a nodular surface contour. No intrahepatic or extrahepatic biliary ductal dilatation is evident and no focal mass lesions are seen. The main portal vein is patent and demonstrates hepatofugal flow with a velocity of 0.2 m/s. Small/moderate volume of perihepatic ascites is present. GALLBLADDER, BILIARY TRACT: Nonspecific gallbladder wall thickening may reflect chronic cholecystitis. No cholelithiasis or choledocholithiasis is seen. The common duct measures 0.3 cm in diameter. PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 11.8 cm in length and demonstrates normal parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.LEFT KIDNEY: The left kidney measures 12.7 cm in length and demonstrates normal parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.SPLEEN: The spleen measures 13.8 cm in length.OTHER: No significant abnormalities noted.

Output: 1.Markedly coarsened parenchymal echogenicity and cirrhotic morphology of the liver, with reversed flow of the portal vein and splenomegaly consistent with portal hypertension.2.Small/moderate volume perihepatic ascites.3.Nonspecific bladder wall thickening may reflect chronic cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Male 59 years old Reason: HCV evaluate for cirrhosis History: HCV LIVER: Liver measures 14.2 cm in length. The parenchyma is echogenic. No suspicious liver lesion seen. Main portal vein patent with normal directional flow, velocity measures 17 cm/s. BILIARY TRACT: Multiple shadowing gallstones (measuring up to 14 mm). No secondary signs of acute cholecystitis. No significant gallbladder distention, wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Near level of pancreatic head/neck is 12 x 11 x 7 mm ovoid focus, relatively hypoechoic compared to pancreatic parenchyma and reportedly mobile, favored to be a peripancreatic lymph node (see last submitted cine clip), may be reactive in setting of HCV. KIDNEYS: The right kidney measures 10.7 cm. The left kidney measures 9.8 cm. No hydronephrosis. No perinephric free fluid.SPLEEN: The spleen measures 9.1 cm. in length. OTHER: No significant abnormality noted.

Output: Echogenic liver, likely reflecting underlying parenchymal dysfunction/hepatic steatosis.Near level of pancreatic head/neck is 12 mm ovoid focus, favored to be a peripancreatic lymph node (as opposed to an intrapancreatic lesion), please refer to discussion above.Cholelithiasis. No secondary signs of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: 35-year-old female with history of hypothyroidism. RIGHT LOBE MEASUREMENTS: 5.5 x 1.5 x 2.0 cmLEFT LOBE MEASUREMENTS: 4.7 x 1.4 x 1.8 cmISTHMUS MEASUREMENT: 0.5 cmRIGHT LOBE: Slightly heterogeneous appearing gland without discrete nodule identified.LEFT LOBE: Slightly heterogeneous appearing gland without discrete nodule identified.ISTHMUS: Slightly heterogeneous appearing gland without discrete nodule identified.LYMPH NODES: Scattered benign-appearing right and left cervical lymph nodes.OTHER: No significant abnormality noted.

Output: Slight heterogeneity of the thyroid gland without discrete nodule identified.


Instruction: Generate impression based on medical findings.

Input: Female 32 years old Reason: Assess for evidence of cholelithiasis and/or cholecystitis History: Nausea, vomiting and elevated bilirubin in patient with history of PNH and Budd-Chiari LIMITED ABDOMENLIVER: The liver demonstrates heterogeneous echogenicity with both hypo and hyperechoic areas, but no discrete mass. Liver measures 16.8 cm in length. Portal vein flow is hepatopedal and measures 0.2 m/s.BILIARY TRACT: Wall measures 2 mm in thickness. There are no shadowing gallstones or findings of acute cholecystitis. Common duct measures 2 mm.PANCREAS: The visualized pancreas is unremarkable.KIDNEYS: The right kidney measures 10.9 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.The left kidney measures 10.8 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 12.5 cm. in length. There is coarse echotexture of the spleen.OTHER: No significant abnormalities noted. No ascites or pleural effusions seen.

Output: 1.No cholelithiasis or cholecystitis.2.Markedly heterogeneous echotexture of the liver with increased echotexture of the spleen, possibly related to infiltrative process.


Instruction: Generate impression based on medical findings.

Input: Female 34 years old Reason: HCC screening History: hep B LIVER: The liver measures 11.5 cm in length and demonstrates increased coarsened parenchymal echogenicity. No intrahepatic or extrahepatic biliary ductal dilatation is evident. 3 mm echogenic focus again identified within the right hepatic lobe, not potentially changed from the prior examination. 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 0.2 cm in diameter. PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 10.5 cm in length and demonstrates normal parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.LEFT KIDNEY: The left kidney measures 10.5 cm in length and demonstrates normal parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.SPLEEN: The spleen measures 8.5 cm in length.OTHER: No significant abnormalities noted.

Output: 1.Unchanged 3 mm echogenic focus in the right hepatic lobe, which again is felt to be benign; however, continued special attention on follow-up is recommended.2.Unchanged increased coarsened hepatic parenchymal echogenicity, suggestive of hepatic steatosis/moderate chronic liver disease.


Instruction: Generate impression based on medical findings.

Input: Female 60 years old Reason: to rule out hcc per protocol History: none LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 16.1 cm in length. The parenchyma is mildly echogenic. BILIARY TRACT: Gallbladder contains multiple polyps the largest of which measures 0.9 x 0.6 x 0.6 cm. Wall measures 2 mm in thickness. The portal vein is patent with normal hepatopetal flow and a velocity of 20 cm/sec.Common duct measures 4 millimeters. PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 9.8 cm. The cortex is normal in echogenicity and. No shadowing calculi or hydronephrosis is present. The left kidney measures 11.1 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. There is a peripelvic simple cyst measuring 1.6 x 1.9 x 1.8 cm.SPLEEN: The spleen measures 8.1 cm. in length. There is a small accessory splenule.OTHER: No significant abnormalities noted.

Output: 1.Echogenic hepatic parenchyma without focal lesion.2.Stable gallbladder polyps largest which measures 9 mm in maximum dimension.


Instruction: Generate impression based on medical findings.

Input: Female 69 years old Reason: s/p ureteral reimplant and stent removal. Check for hydronephrosis RIGHT KIDNEY: Large upper pole renal mass, heterogeneous solid mass with internal vascularity measuring 7.8 x 7.5 x 7.3 cm. The right kidney measures 13.6 cm (including upper pole mass). No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures approximately 11.5 cm. Moderate hydronephrosis. No shadowing stones seen. BLADDER: Collapsed and unable to assess, patient voided just prior to study.OTHER: Pelvic ascites.

Output: New from earlier CT exam is left-sided hydronephrosis.Patient's known right upper pole renal solid mass again seen.Pelvic ascites.


Instruction: Generate impression based on medical findings.

Input: 32-year-old female with a history of thyroid cancer status post thyroidectomy, surveillance examination. RIGHT LOBE: Status post thyroidectomy.LEFT LOBE: Status post thyroidectomy. Redemonstration of well demarcated echogenic focus within the left thyroid bed containing some vascularity. The focus measures 0.8 x 0.5 x 0.4 cm, not significantly changed accounting for differences in technique and positioning.ISTHMUS: No significant abnormality noted.LYMPH NODES: Right level II lymph node has a lobulated appearance which may represent two adjacent lymph nodes or an interval increase in size of a previously identified lymph node. The lymph node measures 2.3 x 0.7 x 1.6 cm. It contains a small amount of vascular flow. The nodal metastases cannot entirely be excluded. Additional right level III benign-appearing lymph node measures 2.0 x 0.3 x 0.9 cm. Left level III benign-appearing lymph node measures 0.3 x 0.8 x 1.1 cm, not significantly changed.OTHER: No significant abnormality noted.

Output: 1.Stable well-demarcated echogenic focus within the left thyroid bed.2.Lobulated appearing right level II lymph node which has a small amount of vascular flow. Appearance may reflect two adjacent lymph nodes, however, nodal metastases cannot entirely be excluded and continued follow-up is recommended.


Instruction: Generate impression based on medical findings.

Input: 25-year-old man with history of splenomegaly on 2013 CT, now presents with abnormal LFTs. LIVER: Echogenicity of the hepatic parenchyma is diffusely increased. No focal hepatic lesion or mass. The liver measures 17.4 cm in length. The main portal vein is patent with normal hepatopedal flow and velocity of 29 cm/s.GALLBLADDER, BILIARY TRACT: The gallbladder is collapsed, limiting evaluation of the wall. There is no pericholecystic fluid. No cholelithiasis. The gallbladder wall is normal in appearance, measuring 0.2 cm in thickness. No dilatation or cystic changes are noted of the intrahepatic or extrahepatic biliary ducts. The common bile duct measures 0.2 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 11.5 cm in length and shows normal echotexture. No mass, stone or hydronephrosis.LEFT KIDNEY: The left kidney measures 12.5 cm in length and shows normal echotexture. No mass, stone or hydronephrosis.SPLEEN: The spleen is normal in echogenicity and measures 13.0 cm in length. A 1.2 x 1.4 x 1.3 splenule is noted.OTHER: There is no free or loculated fluid.

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


Instruction: Generate impression based on medical findings.

Input: 9-week-old male, former 27 weeks with history of hydronephrosis. Evaluate for hydronephrosis. BLADDER  Wall Thickness: Mildly thickened measuring 2 mm.  Contents: Distended and containing debris.  Distal Ureter -- SFU Grade**  Right: 0  Left: 0   Ureteral Jets Right: Not observed  Left: Not observedKIDNEYS  Cortical Echogenicity: Normal   Medullary Echogenicity: Normal   Pelvicaliceal System -- SFU Grade*  Right: 1 Left: 1  Length*** Right: 4.8 cm Left: 4.7 cm   Mean for age: 5 cm  Range for age: 4 - 6 cmADDITIONAL OBSERVATIONS: None

Output: Debris within the bladder with mildly thickened bladder wall. Otherwise normal examination.*SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning. **SFU grading system retrovesical ureter: Grade 0: No ureteral dilatation. Grade 1: Ureter less than 7 mm. Grade 2: Ureter is 7-10 mm. Grade 3: Ureter is over 10 mm. Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469


Instruction: Generate impression based on medical findings.

Input: Female 65 years old with increased hepatic parenchyma echogenicity seen on the ultrasound 8/28/2015. LIVER: The liver measures 17.1 cm in length and demonstrates increased coarsened 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. PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 10.3 cm in length and demonstrates normal parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.LEFT KIDNEY: The left kidney measures 11.3 cm in length and demonstrates normal parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.SPLEEN: The spleen measures 14.6 cm in length.OTHER: No significant abnormalities noted.

Output: Increased coarsened parenchymal echogenicity of the liver, which may reflect hepatic steatosis/chronic liver disease.


Instruction: Generate impression based on medical findings.

Input: Reason: 79, h/o nhl had hydronephrosis now with slight creatinine bump want to eval for worsening History: creatinine bump ULTRASOUND KIDNEYSRIGHT KIDNEY: The size of the right kidney is within normal limits, measuring 10.7 cm in length. Borderline increased echogenicity. No focal lesions. Mild hydronephrosis, this appears stable if not mildly decreased as compared to prior CT. A portion of the ureteral stent is visualized in the renal pelvis.LEFT KIDNEY: The size of the left kidney is within normal limits, measuring 10.5 cm in length. Borderline increased echogenicity. No focal lesions. No hydronephrosis.OTHER: The bladder is visualized and appears nondistended. A portion of the ureteral stent is noted within the bladder.

Output: 1. Mild right-sided hydronephrosis, stable or mildly decreased when compared to prior CT, accounting for differences in technique and modality.


Instruction: Generate impression based on medical findings.

Input: End stage renal disease on dialysis; evaluate transplanted kidney for infection Marked cortical thinning associated with moderately severe hydronephrosis with internal debris within the dilated collecting system. Diffuse thickening of the urothelial surfaces of the right collecting system also noted. Transplant kidney 12.7 cm in length. Mild ascites.

Output: No change in marked cortical thinning of right iliac fossa renal transplant associated with moderately severe hydronephrosis with internal debris within the dilated collecting system. Diffuse thickening of the urothelial surface of the right collecting system suggestive for extensive inflammation also noted. Secondary infection should be considered.


Instruction: Generate impression based on medical findings.

Input: Female 81 years old; Reason: assess kidney size r/o obstruction History: ckd, dm htn RIGHT KIDNEY: The right kidney measures 8.9 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. Small cyst near the lower pole measures 1.0 cm.LEFT KIDNEY: The left kidney measures 9.0 cm in length. The cortex is mild echogenic.. No shadowing calculi or hydronephrosis is present. Small cortical cyst near the upper pole measures 8 mm. URINARY BLADDER: No significant abnormality notedOTHER: No significant abnormalities noted.

Output: 1.Mild echogenic left renal cortex.2.No sonographic findings of nephrolithiasis or hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old. Reason: hx of thyroid nodules History: asymptomatic RIGHT LOBE MEASUREMENTS: 5.2 x 1.4 x 1.5 cmLEFT LOBE MEASUREMENTS: 6.4 x 1.1 x 0.9 cmISTHMUS MEASUREMENTS: 0.4RIGHT LOBE: Complex hypoechoic inferior pole nodule measures 1.2 x 0.8 x 0.8 cm, previously 0.9 x 0.8 x 0.8 cm.LEFT LOBE: Inferiorly located dominant nodule with a complex appearance measures 2.7 x 2.3 x 1.3 cm, previously 2.6 x 2.6 x 1.1. Additional predominantly hypoechoic nodule measures 1.0 x 0.8 x 0.9 cm, previously 0.9 cm in greatest dimension.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No regional lymphadenopathy.OTHER: No significant abnormality noted.

Output: Stable examination with no regional lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Female 47 years old Reason: HCC History: hep C positive LIMITED ABDOMENLIVER: The liver has a nodular contour with widened fissures. Liver measures 17.6 cm in length. The parenchyma is moderately coarse and echogenic. No focal lesion is identified. BILIARY TRACT: The gallbladder contains layering and adherent sludge. Wall measures 2 mm in thickness. The common bile duct measures 5 mm. Murphy's sign is negative. PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 10.9 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. No suspicious lesion is identified.The left kidney measures 11.4 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. No suspicious lesion is identified.SPLEEN: The spleen measures 10.7 cm in length. OTHER: Bilateral pleural effusions. Small volume ascites.

Output: 1.Cirrhotic morphology of the liver. No focal lesion identified.2.Echogenic kidneys, compatible with medical renal disease.3.Bilateral pleural effusions and small volume ascites.4.Sludge within the gallbladder, without evidence of acute inflammation.


Instruction: Generate impression based on medical findings.

Input: Female 73 years old; Reason: evaluate left renal mass History: hx of 1 cm left renal mass RIGHT KIDNEY: The right kidney measures 13 cm in length. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. Emanating from the right upper pole, there is a 1.0 x 1.2 x 1.0 cm hypoechoic and exophytic cystic focus likely corresponding to recent CT finding.LEFT KIDNEY: The left kidney measures 12 cm in length. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. URINARY BLADDER: Not well visualized likely secondary to decompression.OTHER: No significant abnormalities noted.

Output: 1.1 cm exophytic right renal cyst likely corresponding to recent hyperdense cyst on CT. Please note that the indication asks for evaluation of a left renal mass, which the CT or today's ultrasound has no evidence of. Presumably, the request was a left/right error, and actually wanting evaluation for the right renal lesion, not the left.


Instruction: Generate impression based on medical findings.

Input: Female 51 years old Reason: assess for cholestasis, known RCC met to liver, elevated total bili on exam History: as above LIVER: The liver measures 17.4 cm in length and demonstrates heterogeneous parenchymal echogenicity, with innumerable hypoechoic lesions compatible with metastases. No intrahepatic or extrahepatic biliary ductal dilatation is evident 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 0.4 cm in diameter. PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Status post right nephrectomy.LEFT KIDNEY: The left kidney measures 13.1 cm in length and demonstrates normal parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.SPLEEN: The spleen measures 12.0 cm in length.OTHER: No significant abnormalities noted.

Output: 1.Innumerable hypoechoic lesions in the liver compatible with metastases.2.Splenomegaly.3.No evidence of biliary ductal dilatation.


Instruction: Generate impression based on medical findings.

Input: 71-year-old male with a history of urethral strictures and now with elevated creatinine. RIGHT KIDNEY: The right kidney measures 10.2 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.LEFT KIDNEY: The left kidney measures 10.4 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.OTHER: The bladder is distended without significant abnormality. The previously seen prostate is not visualized on this examination.

Output: 1.No nephrolithiasis or hydronephrosis seen.


Instruction: Generate impression based on medical findings.

Input: Male 27 years old Reason: AKI, obstructive? History: AKI, urine retention RIGHT KIDNEY: The right kidney measures 13.4 cm. Mildly increased renal cortical echogenicity. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 11.7 cm. Mildly increased renal cortical echogenicity. Bulbous appearance of mid pole of left kidney centrally may reflect prominent column of Bertin. No shadowing calculi or hydronephrosis is present. BLADDER: Thick-walled underdistended bladder containing Foley catheter.OTHER: No significant abnormalities noted.

Output: Mildly echogenic kidneys, likely reflecting medical renal disease. No hydronephrosis.Bulbous appearance of mid pole of left kidney centrally may reflect prominent column of Bertin.Apparent bladder wall thickening may be secondary to underdistended state but correlation with patient's clinical history and urinalysis recommended to exclude underlying cystitis.


Instruction: Generate impression based on medical findings.

Input: 56-year-old female with leukocytosis GALLBLADDER, BILIARY TRACT: The gallbladder contains sludge and debris. There is a moderate amount of pericholecystic fluid. The gallbladder wall is thickened, measuring up to 0.5 cm in thickness. No cholelithiasis. Negative sonographic Murphy's sign. The common bile duct is dilated, measuring up to 1.1 cm in diameter. No choledocholithiasis.

Output: Gallbladder sludge and debris, moderate pericholecystic fluid and thickening of the gallbladder wall. While these findings may be explained by low albumin and ascites, an inflammatory component cannot be excluded. If further imaging evaluation is clinically warranted, HIDA scan could be considered.


Instruction: Generate impression based on medical findings.

Input: Male 55 years old Reason: soft mass in groin/inguinal canal on left side, patient with neutropenic fever History: as above There is mild soft tissue edema and trace fluid intercalating between the fascial planes within the right groin, but no drainable fluid collection is evident. No hernia is evident.

Output: Edema of the left groin, but no drainable fluid collection evident.


Instruction: Generate impression based on medical findings.

Input: Male 65 years old Reason: Hep C positive. Assessing for cirrhosis History: Hep C positive. asymptomatic LIVER: Liver measures 13.9 cm in length. Liver parenchyma within normal limits, no focal liver lesion. Main portal vein patent with normal directional flow, velocity measures 20 cm/s. BILIARY TRACT: Cholelithiasis (stone seen near gallbladder neck measuring up to 18 mm), no secondary signs of acute cholecystitis. No significant gallbladder wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Not well seen secondary to overlying bowel gas. KIDNEYS: The right kidney measures 10.2 cm. The left kidney measures 10.8 cm. No hydronephrosis.SPLEEN: Not seen, evaluation suboptimal secondary to bowel gas.OTHER: No significant abnormality noted.

Output: No suspicious liver lesion.Cholelithiasis, no secondary signs of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Male 49 years old; Reason: 49 yo with cirrhosis please screen for HCC. LIVER: Significant increase in hepatic parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions. Hepatic length measures 14.2 cm. Liver has a cirrhotic morphology. The main portal vein is patent with normal hepatopetal flow with a velocity of 24 cm/s. GALLBLADDER/BILIARY TRACT: A 1.3 x 1.3 cm Gallstone is noted within the gallbladder associated with the dependent sludge, with the wall measuring 3 mm. Sonographic Murphy's sign is negative. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified. The common bile duct measures 6 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen is enlarged and measures 19.6 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 11.8 cm with no hydronephrosis. The left kidney measures 13.1 cm with no hydronephrosis. OTHER: No ascites.

Output: 1.Coarse echotexture of the liver and splenomegaly with no focal hepatic lesions.2.Cholelithiasis without evidence of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Female 44 years old; Reason: r/o recurrence, regrowth of left sided cystic structure History: small left sided cystic structure concerning for recurrence on FNA, but then no longer localized. This is a follow -up US to check fro regrowth RIGHT LOBE MEASUREMENTS: Surgically absent.LEFT LOBE MEASUREMENTS: Surgically absent.ISTHMUS MEASUREMENT: Surgically absent.RIGHT THYROID BED: No significant abnormality noted.LEFT THYROID BED: No significant abnormality noted.ISTHMUS that: No significant abnormality noted.LYMPH NODES: Right level 2 lymph node measures 1.3 x 0.5 x 0.3 cm and has a normal appearance with a fatty hilum.OTHER: The previously seen hypoechoic focus in the right thyroid bed is a blood vessel.

Output: No evidence of disease recurrence or lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Hypothyroidism, dysphagia RIGHT LOBE: Measures 4.3 x 1.4 x 1.3 cm. No suspicious thyroid nodule.LEFT LOBE: Measures 4.1 x 1.8 x 1.4 cm. Deep posteriorly located subcentimeter calcified nodule.ISTHMUS: Normal in size measuring 0.2 cm.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Subcentimeter thyroid nodules.


Instruction: Generate impression based on medical findings.

Input: 58-year-old male with abdominal distention, please exclude ascites. LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 24.0 cm in length. The parenchyma is echogenic. Portal flow is hepatopedal.QUADRANT SEARCH FOR ASCITES: No abdominal ascites is visualized.

Output: 1.No ultrasonographic evidence of ascites.2.Hepatomegaly and echogenic liver consistent with steatosis.


Instruction: Generate impression based on medical findings.

Input: Male 69 years old Reason: aki, has neurogenic bladder s/p suprapubic catheter History: low uop, leukocytosis Suboptimal exam secondary to patient's body habitus and overlying bowel gas.RIGHT KIDNEY: The right kidney measures 13.3 cm. No shadowing calculi or hydronephrosis is present. No perinephric fluid. LEFT KIDNEY: The left kidney measures 13.3 cm. No shadowing calculi or hydronephrosis is present. No perinephric fluid. BLADDER: Bulb of urinary catheter seen in relatively collapsed bladder, making assessment suboptimal. Curvilinear echogenic line extending from bulb may be related to catheter itself versus septation formation.OTHER: No significant abnormalities noted.

Output: Suboptimal exam secondary to patient's body habitus and overlying bowel gas.No hydronephrosis or perinephric fluid seen. Bulb of urinary catheter seen in relatively collapsed bladder, making assessment suboptimal. Curvilinear echogenic line extending from bulb may be related to catheter itself versus septation formation.


Instruction: Generate impression based on medical findings.

Input: Male 38 years old Reason: assess for ascites History: abd distention LIMITED ABDOMENAscites is seen in all 4 quadrants, and appears more pronounced compared to prior scan.

Output: 1.Moderate ascites, worsened compared to prior sonogram. Of note, this is a limited exam simply to evaluate for ascites.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old. Reason: r/o hydronephrosis or stone. History: hx of pyelonephritis. Questionable stone seen on CT done outside RIGHT KIDNEY: Right kidney measures 10.7 cm in length with normal cortical echogenicity. No evidence of hydronephrosis, mass, or shadowing calculi.LEFT KIDNEY: Left kidney measures 11.4 cm in length with normal cortical echogenicity. No evidence of hydronephrosis, mass, or shadowing calculi.OTHER: Bladder is decompressed.

Output: No evidence of hydronephrosis or shadowing calculi.


Instruction: Generate impression based on medical findings.

Input: Male 24 years old Reason: Abnormal LFTs LIVER: Liver measures 16.2 cm in length. The parenchyma is unremarkable, no focal liver lesion. Main portal vein patent with normal directional flow, velocity measures 40 cm/sec.BILIARY TRACT: Mobile echogenic intraluminal foci seen, consistent with cholelithiasis. No evidence of acute cholecystitis. No significant gallbladder distention, wall thickening or pericholecystic fluid. Per ultrasound technologist, negative sonographic Murphy's sign. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Not well seen in entirety particularly tail due to overlying bowel gas.KIDNEYS: The right kidney measures 11.3 cm. The left kidney measures 11.4 cm, mid pole simple cyst measuring 2.9 x 1.9 x 1.7 cm. No hydronephrosis.SPLEEN: Status post splenectomy.

Output: Cholelithiasis. No secondary signs of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Male 60 years old; Reason: r/o hydronephrosis History: AKI on CKD RIGHT KIDNEY: The right kidney measures 13 cm in length. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. Simple 1.2 cm mid right renal cyst.LEFT KIDNEY: Limited evaluation of the left kidney due to body habitus and mobility. The left kidney measures 12 cm in length. The cortex is difficult to accurately visualize. No shadowing calculi or hydronephrosis is present.  OTHER: Ascites. Bladder not well visualized.

Output: 1.Limited evaluation of the left kidney as described above. No right hydronephrosis. Ascites.


Instruction: Generate impression based on medical findings.

Input: History of thyroid cancer and lymphoma status post right thyroid lobectomy. RIGHT LOBE: Status post lobectomy. LEFT LOBE MEASUREMENTS: 1.8 x 1.4 x 4.2 cmISTHMUS MEASUREMENTS: No significant abnormality noted.RIGHT LOBE: The previously identified nodular hypoechoic focus within the thyroidectomy bed is not significantly changed from prior measuring 3 x 2 x 3 mm, previously 3 x 3 x 6 mm. No specific evidence of local recurrence.LEFT LOBE: Minimally complex predominantly cystic nodule in the superior pole of the left thyroid lobe is not significant change from prior measuring 5 x 3 x 6 mm (previously 3 x 4 x 5 mm). Additional predominantly cystic nodule in the interpolar region measuring 7 x 5 x 8 mm this is not significantly changed from prior when it measured 5 x 3 x 6 mm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Posterior to the inferior left lobe is a mildly hypoechoic 1.5 x 1.1 x 1.5 cm mass which may represent a parathyroid adenoma. This previously measured 1.4 x 1.1 x 1.4 cm.LYMPH NODES: Right level 3 lymph node measuring 1.1 x 0.6 x 1.3 cm has a uniform cortex and preserved echogenic hilum. Level 3 lymph node measuring 1.4 x 0.5 x 1.7 cm has benign reniform morphology.OTHER: No significant abnormality noted.

Output: 1.Stable examination status post right thyroidectomy. No specific evidence of recurrent disease.2.1.5 cm hypoechoic mass posterior to the inferior left lobe of the thyroid suspicious for a parathyroid adenoma.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old. Reason: hx of possible diabetic nephropathy History: lower extremity swelling RIGHT KIDNEY: Right kidney measures 11 cm in length with normal cortical echogenicity. Right upper pole renal cyst measures 1.4 x 0.9 x 1.3 cm. No hydronephrosis, shadowing calculi, or mass.LEFT KIDNEY: Left kidney measures 10 cm in length with normal cortical echogenicity. No hydronephrosis, shadowing calculi, or mass.OTHER: Urinary bladder is mildly distended with mild wall thickening. Echogenic hepatic parenchyma suggests fatty infiltration/parenchymal dysfunction.

Output: 1. Renal cortical echogenicity is unremarkable. No evidence of hydronephrosis.2. Mild wall thickening of the urinary bladder. Correlate for cystitis. 3. Echogenic hepatic parenchyma suggests fatty infiltration/parenchymal dysfunction.


Instruction: Generate impression based on medical findings.

Input: Female 28 years old Reason: patient with RUQ and back pain - please evaluate RUQ for hepatobiliary pathology History: RUQ pain LIMITED ABDOMENLIVER: Liver measures 15.6 cm in length. The parenchyma is normal in echotexture. Portal vein flow is hepatopedal and measures 0.2 m/s.BILIARY TRACT: The gallbladder wall measures 2 mm in thickness. No gallstones are identified. The common duct measures 3 mm in diameter.PANCREAS: The partially visualized pancreas is unremarkable.KIDNEYS: The right kidney measures 11 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.The left kidney measures 12 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.SPLEEN: The spleen measures 10.3 cm. in length.OTHER: No significant abnormalities noted. No ascites or pleural effusion seen.

Output: Normal right upper quadrant ultrasound.


Instruction: Generate impression based on medical findings.

Input: Pain reported in back of knee, suspecting Baker's cyst No evidence of fluid in interrogated region, no popliteal cyst.

Output: No Baker's cyst visualized.


Instruction: Generate impression based on medical findings.

Input: Dysphagia, food getting stuck in throat RIGHT LOBE: Measures 4.1 x 1.2 x 1.1 cm. No discrete nodule.LEFT LOBE: Measures 3.8 x 1.1 x 1.1 cm. No discrete nodule.ISTHMUS: Normal in size measuring 0.2 cm.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Unremarkable study.


Instruction: Generate impression based on medical findings.

Input: Female 65 years old Reason: Screen for HCC History: + cirrhosis LIMITED ABDOMENLIVER: The liver has a nodular contour with widened fissures. Liver measures 11.4 cm in length. The parenchyma is moderately coarse and echogenic. No focal hepatic lesions. Main portal vein is patent with normal flow.BILIARY TRACT: The gallbladder has echogenic calculi with posterior acoustic shadowing. Wall measures 3 mm in thickness. Common duct measures 3 mm. PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 8.9 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. The left kidney measures 9.6 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 11.9 cm. in length. OTHER: Trace perihepatic ascites.

Output: 1.Cirrhotic liver without suspicious hepatic lesion.


Instruction: Generate impression based on medical findings.

Input: 58-year-old female with hypertension. RIGHT KIDNEY: The right kidney measures 7.1 cm in length and shows increased echotexture. No mass, shadowing calculi or hydronephrosis.LEFT KIDNEY: The left kidney measures 8.5 cm in length and shows increased echotexture. No mass, shadowing calculi or hydronephrosis.URINARY BLADDER: Collapsed and not visualized.OTHER: There is no free or loculated fluid.

Output: Increased echogenicity of the renal parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass, stone or hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Goiter RIGHT LOBE: Measures 4.6 x 1.3 x 1.1 cm. Heterogeneous mixed cystic/solid nodule in mid pole measuring 1.2 x 0.9 x 0.8 cm, no internal flow seen, most likely a benign nodule containing debris and hemorrhagic or proteinaceous material. Additional subcentimeter colloid nodule noted.LEFT LOBE: Measures 4.5 x 2.1 x 1.9 cm. Replacing majority of left lobe is mixed cystic/solid appearing nodule measuring 3 x 1.9 x 1.6 cm, no internal flow seen. Again most likely a benign cystic nodule containing debris.ISTHMUS: At junction of left lobe and isthmus is ovoid solid-appearing nodule (with small cystic component) nodule measuring 2.2 x 1.5 x 0.6 cm.LYMPH NODES: Normal in size measuring 0.2 cm.OTHER: No significant abnormality noted.

Output: Findings compatible with multinodular goiter. As requested, left-sided 3 cm and 2.2 cm nodules underwent same day FNA biopsy, please refer to separate procedural report and pathology results.


Instruction: Generate impression based on medical findings.

Input: 73-year-old male Reason: Abnormal nodes, masses? History: Prior history small thyroid cancer and large suspicious nodule removed surgically . 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: Patient is status post thyroidectomy.LEFT LOBE: Patient is status post thyroidectomy.ISTHMUS: Patient is status post thyroidectomy.LYMPH NODES: A right neck level 3 lymph node measures 1.5 x 0.4 0.9 cm and is indeterminate in appearance. A lymph node in the left sided thyroid surgical bed measures 1.2 x 0.3 x 0.4 cm and is indeterminate in appearance.OTHER: No significant abnormality noted.

Output: Right level 3 lymph node and left thyroid surgical bed lymph node indeterminate in appearance. Continued follow-up is recommended.


Instruction: Generate impression based on medical findings.

Input: Female 52 years old; Reason: PAIN History: ABDOMINAL BRUIT Aortic measurements are as follows:Proximal aorta: 2.1 x 2.0 cmMid aorta: 1.2 x 1.4 cmDistal aorta: 1.2 x 1.4 cmRight common iliac artery: 0.7 x 0.6 cmLeft common iliac artery: 0.6 x 0.6 cmNo calcific arteriosclerotic disease is identified.

Output: 1.Normal caliber of the aorta that tapers appropriately.


Instruction: Generate impression based on medical findings.

Input: Female 66 years old Reason: for heart transplant workup; s/p LVAD insertion History: routine for OHT workup LIVER: The liver has a smooth contour. Liver measures 17.6 cm in length. The parenchyma is moderately coarse and echogenic . No focal hepatic lesions. Main portal vein is patent.BILIARY TRACT: The gallbladder contains layering sludge. Wall measures 3 mm in thickness. Common duct measures 5 mm. PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 10.8 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. The left kidney measures 11.0 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 9.5 cm. in length. OTHER: Rectus sheath hematoma measures 11.1 x 4.4 cmABDOMINAL AORTA: Abdominal aorta is obscured due to bowel gasINFERIOR VENA CAVA: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Gallbladder sludge.2.Coarse echogenic liver.3.Patent main portal vein4.Rectus sheath hematoma


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old. Reason: elevated LFT's, please evaluate liver for mass, cirrhosis, no etoh hx and no mess currently. History: occ liver region pain LIVER: Liver measures 15 cm in length. Hepatic echotexture is coarse. Main portal vein has a normal direction of flow with a velocity of 25 cm/s. No worrisome mass or ascites.BILIARY TRACT: Common bile duct measures 6 mm. No cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. No intrahepatic or extrahepatic biliary ductal dilatation.PANCREAS: No significant abnormalities noted in the visualized portion of the pancreas. The body and tail of pancreas are obscured by overlying bowel gas.SPLEEN: Spleen measures 8.4 cm in length with a normal echotexture.RIGHT KIDNEY: Right kidney measures 9.6 cm in length with normal cortical echogenicity. No hydronephrosis, mass, or shadowing calculi. OTHER: Left kidney measures 9.1 cm in length with normal cortical echogenicity. No hydronephrosis, mass, or shadowing calculi.

Output: Coarse hepatic echotexture suggests chronic liver disease. No worrisome hepatic mass.


Instruction: Generate impression based on medical findings.

Input: Male 53 years old Reason: evaluate causes of elevated cr History: elevated cr RIGHT KIDNEY: The right kidney measures 12.1 cm. Increased renal cortical echogenicity. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 10.7 cm. Increased renal cortical echogenicity. No shadowing calculi or hydronephrosis is present. BLADDER: Visualized portions unremarkable.OTHER: Partially imaged moderate volume ascites and nodular liver, consistent with cirrhosis.

Output: Echogenic kidneys, consistent with medical renal disease. No hydronephrosis.Partially imaged ascites and cirrhotic liver.


Instruction: Generate impression based on medical findings.

Input: Female 59 years old; Reason: tertiary hyperpara History: high calcium RIGHT LOBE MEASUREMENTS: 5.1 x 1.5 x 1.9 cmLEFT LOBE MEASUREMENTS: 5.0 x 1.9 x 1.7 cmISTHMUS MEASUREMENT: 0.9 cmRIGHT LOBE: Hypoechoic nodule in the mid right thyroid lobe measures 5 x 4 x 3 mm it has a small echogenic central focus and suggestive of a early degenerative colloid nodule.LEFT LOBE: Scattered subcentimeter left thyroid lobe nodules.ISTHMUS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: Posterior to the the inferior pole of the left thyroid lobe there is a focal hypoechoic lesion measuring 0.8 cm and has a polar feeding vessel.

Output: 1.Hypoechoic nodule in the lower pole of the left thyroid lobe corresponding to the abnormality seen on parathyroid scintigraphy compatible with a small parathyroid adenoma candidate.


Instruction: Generate impression based on medical findings.

Input: History of traumatic laceration and middle phalanx fracture from knife injury. Assess tendons. Evaluation of the flexor tendon apparatus is limited due to inability to optimally position and manipulate the small finger. Volar to the base of the proximal phalanx are two fibular structures that I presume represent the flexor digitorum superficialis and flexor digitorum profundus. The structures become indistinct and inseparable from one another volar to the mid diaphysis of the proximal phalanx, and there appears to be an abrupt termination of one of these tendons at this point immediately volar to the surface of the bone; however, I cannot determine if this represents retracted superficialis or profundus tendon. A second fibular structure continues distally from this site toward the proximal fracture fragment of the middle phalanx; while this could represent a slip of the flexor digitorum superficialis that remains attached to the middle phalanx, it may also represent the flexor digitorum profundus tendon that has pierced to the superficialis, and lies transected at the site of laceration adjacent to the middle phalanx. I'm not able to clearly identify tendon fibers distal to the site of the fracture. Mild heterogeneity of the flexor tendons volar to the fifth metacarpal is noted, but I suspect that this represents slight redundancy due to retraction more distally rather than additional traumatic abnormality.

Output: Limited study showing what I believe to be transection of both the flexor digitorum superficialis and flexor digitorum profundus tendons with retraction to the level of the mid diaphysis of the proximal phalanx, although there may possibly be a small slip of superficialis tendon that remains attached to the proximal fracture fragment of the middle phalanx.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male with AKI, evaluate for obstruction. RIGHT KIDNEY: The right kidney measures 12.3 cm in length and shows increased echogenicity. A round hypoechoic structure at the lower pole of the right kidney measures 1.5 x 1.4 x 1.7 cm and contains no internal calcifications, septations or debris. No mass, shadowing calculi or hydronephrosis.LEFT KIDNEY: The left kidney measures 11.9 cm in length and shows increased echogenicity. No mass, shadowing calculi or hydronephrosis.URINARY BLADDER: The urinary bladder is normal in appearance. Left ureteral jet is seen.OTHER: Abdominal ascites.

Output: 1.Increased echogenicity of the renal parenchyma consistent with medical renal disease/parenchymal dysfunction without shadowing calculi or hydronephrosis.2.Ascites.


Instruction: Generate impression based on medical findings.

Input: Male 71 years old Reason: ascites? History: abdominal distension Partially visualized liver demonstrates increased echogenicity of the parenchyma. There is no perihepatic fluid visualized.Undersurface in the gallbladder with debris in the dependent portion. Trace amount of pelvic fluid is seen.Partially visualized right pleural effusion.

Output: Trace amount of pelvic fluid. No sonographic evidence of large volume ascites.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval right post-auricular mass History: Right post-auricular mass stable for approximately 10 years according to patient Ill-defined subcutaneous soft tissue nodule measuring 1.7 x 1.7 x 0.9 cm without internal vascularity noted.

Output: Nonspecific subcutaneous soft tissue nodule as above.


Instruction: Generate impression based on medical findings.

Input: Male 67 years old; Reason: Evaluate for liver disease, cirrhosis, liver lesions. History: Hep C LIVER: The liver is normal in echogenicity and echotexture. No focal hepatic lesions. Hepatic length measures 14.8 cm. The main portal vein is patent with normal hepatopetal flow with a velocity of 19 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 1 mm. The common bile duct is minimally dilated measures 8 mm in diameter. There is minimal intra and extrahepatic biliary ductal dilatation, appearing similar to prior exam. No choledocholithiasis. 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 9.1 cm and demonstrates increased echogenicity with no hydronephrosis. Right simple renal cyst measures 2.2 x 1.5 x 2 cm, similar to prior exam. The left kidney measures 9.8 cm and demonstrates increased echogenicity with no hydronephrosis. Left simple renal cyst measures 2.7 x 2 x 2.2 cm, similar to prior exam.OTHER: No ascites.

Output: 1.Normal echogenicity and echotexture of the liver with no focal mass. Mild intra and extrahepatic biliary ductal dilatation appears similar to the prior exam.2.Increased echogenicity of bilateral kidneys, suggestive of medical renal disease with no evidence of hydronephrosis or shadowing calculi.


Instruction: Generate impression based on medical findings.

Input: Female 23 years old Reason: evaluate for splenomegaly History: LUQ pain, recent mono infection Spleen: The spleen is normal in echogenicity and measures 9.8 cm in length. Liver: The liver is normal in echotexture and measures 15.9 cm in length.

Output: Normal appearance of the spleen without evidence of hepatomegaly.