Instruction: Generate impression based on medical findings.

Input: Female, 19 years old. Pain over graft site, UTI RIGHT KIDNEY: The right kidney measures 6.7 cm in length, with markedly increased cortical echogenicity. No hydronephrosis.LEFT KIDNEY: The left kidney is not well visualized.TRANSPLANT KIDNEY: The right iliac fossa transplant kidney measures 13.77 m in length, with increased cortical echogenicity. Hydronephrosis is progressed from prior, particularly in the upper pole calyx/collecting system appears more dilated. No perinephric fluid collection is identified.OTHER: The bladder is incompletely distended.

Output: 1.Increased hydronephrosis predominantly involving the upper portion of the transplant kidney collecting system.2.Increased parenchymal echogenicity of the transplant kidney, similar to prior.3.Atrophic native kidneys.


Instruction: Generate impression based on medical findings.

Input: Ms. Rudolph is a 52-year-old female with history of biopsy-proven right breast cancer status post neoadjuvant chemotherapy. Three standard views of the right breast and an additional right CC view were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Again seen is a speculated mass in the right breast at the 12:00 position. There has been interval decrease in size and conspicuity of the calcifications within the mass. The biopsy clip is well seated within the center of the mass.ULTRASOUND

Output: Interval decrease in size of known right breast cancer status post neoadjuvant chemotherapy. Continued surgical management is recommended. Patient is scheduled to have an MRI later on this date (09/23/16).BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Reason: 55 y/o F with prior RUQ pain. RUQ ultrasound requested to rule out gallstones or other etiology LIVER: Mildly increased hepatic parenchymal echogenicity and mild hepatomegaly. No intrahepatic or extrahepatic biliary ductal dilatation. The liver measures 16.7 cm in length. Normal portal venous hepatopedal blood flow, 39.1 cm/s.GALLBLADDER, BILIARY TRACT: No stones or sludge. No pericholecystic fluid. The gallbladder wall measures 0.3 centimeters in thickness. The common hepatic duct measures 0.4 cm.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 11.5 cm in length. The left kidney measures 12.9 cm in length. No hydronephrosis.OTHER: No significant abnormalities noted.

Output: Mild hepatomegaly and echogenic liver, which may reflect parenchymal dysfunction or hepatic steatosis.


Instruction: Generate impression based on medical findings.

Input: 67 year old female with history of acute renal failure. Evaluate right upper quadrant due to elevated bilirubin, and for renal obstruction. LIVER: The liver has a subtly nodular contour, and measures 15.5 cm in length. Heterogeneous echogenicity, suggestive of cirrhosis. Moderate amount of abdominal and pleural fluid.GALLBLADDER, BILIARY TRACT: No biliary dilatation, or other significant abnormality. History of cholecystectomy.PANCREAS: No significant abnormality noted.SPLEEN: No significant abnormality noted. The spleen measures 13.5 cm.KIDNEYS: No hydronephrosis or hydroureter, and no additional significant abnormality noted. The right kidney measures 13 cm, the left kidney measures 12.5 cm.ABDOMINAL AORTA: The abdominal aorta measures 2.4 cm in widest dimension.INFERIOR VENA CAVA: The IVC is not well visualized.OTHER: No significant abnormality noted.

Output: Abdominal ascites and pleural effusions as above, without findings of biliary dilatation, or renal obstruction. Imaging findings suggestive of cirrhosis.


Instruction: Generate impression based on medical findings.

Input: HIV with abdominal pain LIVER: No significant abnormalities noted. Liver length 18 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.7 cm in length.OTHER: Left kidney 11.7 cm in length. Spleen 11 cm in length. No ascites.

Output: Negative for acute, inflammatory, or neoplastic process. No hepatobiliary abnormality noted.


Instruction: Generate impression based on medical findings.

Input: Ms. McGhee is a 27-year-old female presenting with palpable lump in the right breast, and complaining of transient bilateral breast pain over the last few months. Family history is positive for breast cancer in paternal cousin diagnosed at 40 years of age. Mobile smooth lump is present within the right upper outer quadrant on the physical exam.A targeted ultrasound was performed for the patient’s area of concern in the right breast at the 11:00 position, approximately 5 cm from the nipple, which revealed no focal sonographic correlate. No suspicious cystic or solid mass is identified.Targeted ultrasound was also performed of bilateral breasts in the 3:00, 6:00, 9:00, 12:00 and retroareolar positions. There is no solid or cystic mass identified.

Output: Normal sonographic evaluation of bilateral breasts. Palpable area of concern is associated with dense fibroglandular tissue within the right axillary tail. The patient should follow up with her primary care physician as clinically warranted, presuming these results are concordant with the physical exam findings. All results and recommendations were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on medical findings.

Input: 61 year-old female with left breast mass on prior ultrasound examination from 2014 with increasing calcifications on recent mammogram. Left breast ultrasound:Targeted left breast ultrasound examination was performed for the patient's mammographic area of concern and area of previously seen left breast mass. Note is made of a normal morphology intramammary lymph node at the 3:00 position of the left breast approximately 2 cm from the nipple. Note is made of a heterogeneous but predominantly hypoechoic irregular mass at the 3:00 position of the left breast approximately 3 cm from the nipple, measuring approximately 1.4 x 0.4 x 1.0 cm with internal vascularity on Doppler interrogation, previously 1.1 x 0.6 x 1.0 cm, increased in size. Targeted left breast ultrasound examination was performed for the area of increasing calcification seen on recent mammogram. Note is made of an irregular heterogeneous but predominantly hypoechoic mass measuring 1.8 x 0.8 x 1.3 cm at the 12:00 position of the left breast approximately 1 cm from the nipple. There is extensive peripheral and internal vascularity on Doppler interrogation.

Output: Multiple left breast masses with the largest measuring 1.8 cm at the 12 o'clock position of the left breast. Further evaluation with ultrasound-guided core needle biopsy is recommended. These findings and recommendation were discussed directly with the patient.BIRADS: 5 - Highly suggestive of malignancy. RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on medical findings.

Input: Elevated lipase. Pancreatic cyst. Please note that this examination is limited by poor acoustic penetration.LIVER: Non-cirrhotic liver morphology. Normal parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Cholelithiasis. No gallbladder wall thickening or sonographic Murphy sign.PANCREAS: No sonographic abnormality evident in the visualized pancreatic head and neck. No cystic lesion is evident in this region. The body and tail are obscured by bowel gas. KIDNEYS: The right kidney is 9.3 cm in length. The renal parenchyma is echogenic. No suspicious renal lesions are evident. No hydronephrosis is present. The left kidney is not well visualized due to increased echogenicity and poor acoustic penetration.SPLEEN: Not well visualized.OTHER: No significant abnormalities noted. No ascites.

Output: 1. Limited visualization of the pancreatic head and neck, without cystic lesion evident.2. Cholelithiasis without evidence of cholecystitis.3. Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Female 67 years old; Reason: Nodule size and characterisitics? History: Multindoular goiter, previous benign FNA large left lobe nodule RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 4.9 x 2.5 x 2.4 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 5.0 x 2.7 x 2.6 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.3 cm.RIGHT LOBE: The right lobe is heterogeneous. There is a dominant nodule in the upper portion of the right lobe with peripheral calcification and a hypoechoic center measuring 0.8 cm x 0.8 cm x 0.7 cm.LEFT LOBE: The left lobe is heterogeneous. There is a dominant nodule in the superior portion that is heterogeneous and isoechoic to hyperechoic compared to the thyroid. This nodule measures 1.8 cm x 1.2 cm x 1.7 cm.ISTHMUS: There is a hyperechoic dominant nodule in the isthmus measuring 0.6 cm x 0.5 cm x 0.5 cm. LYMPH NODES: No suspicious adenopathy noted.

Output: Multinodular goiter, as above. No suspicious adenopathy.


Instruction: Generate impression based on medical findings.

Input: Pericholecystic fluid noted on recent CT LIVER: No significant abnormalities noted.BILIARY TRACT: Diffuse gallbladder wall thickening with pericholecystic fluid associated with cholelithiasis. Negative Murphy's sign. No ductal dilatation.OTHER: No significant abnormalities noted.

Output: Diffuse gallbladder wall thickening with pericholecystic fluid associated with cholelithiasis. Although there was a negative Murphy's sign, the patient was sleeping; acute and/or chronic inflammation is suspected. No ductal dilatation.


Instruction: Generate impression based on medical findings.

Input: Elevated lipase and LFTs with gallbladder wall thickening seen on recent CT LIVER: Mild hepatomegaly. Liver length 19.2 cm.BILIARY TRACT: Gallbladder wall thickening with pericholecystic fluid associated with numerous gallstones. A Murphy's sign could not be elicited. Prominent extra hepatic duct without obvious distal obstructing lesion or intrahepatic ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 8.4 cm in lengthRIGHT KIDNEY: Right renal cyst. Right kidney 9.2 cm in length. OTHER: Left kidney 10.4 cm in length.

Output: Gallbladder wall thickening with pericholecystic fluid associated with cholelithiasis. Although a Murphy's sign could not be elicited, the ultrasonographic findings are suggestive for acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Male 15 years old; Reason: Evaluate asymmetry of the testicles. History: Possible history of testicular torsion. RIGHT TESTIS: No significant abnormalities noted and measured 4.1 x 1.7 x 2.2 cm.LEFT TESTIS: No significant abnormalities noted and measured 2.8 x 1.3 x 1.6 cm.RIGHT EPIDIDYMIS: No significant abnormalities noted and measures 0.9 x 0.9 x 0.9 cmLEFT EPIDIDYMIS: Left epididymal cyst and measures 1.7 x 1.2 x 1.1 cm.OTHER: No significant abnormalities noted.

Output: Left epididymal cyst.


Instruction: Generate impression based on medical findings.

Input: EtOH use LIVER: Heterogeneous coarse liver echotexture without mass. Liver length 14.4 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.3 cm in lengthOTHER: Left kidney 11.4 cm in length. Spleen 8.3 cm in length. No ascites.

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


Instruction: Generate impression based on medical findings.

Input: Right upper quadrant pain LIVER: Normal echogenicity without worrisome mass. Multiple liver cysts. The largest within the right lobe measuring 3.5 x 3.7 x 2.6 cm. Liver length 13 cmGALLBLADDER, BILIARY TRACT: Nonmobile subcentimeter soft tissue focus within the gallbladder measuring 0.3 x 0.4 x 0.3 cm. No acute inflammation. No ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.9 cm in lengthOTHER: Left kidney 11.3 cm in length. Spleen 8.9 cm in length. No ascites.

Output: Multiple liver cysts. No worrisome hepatic mass or ductal dilatation. No acute inflammatory process. Probable subcentimeter gallbladder polyp. No ascites.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old. BPH. Evaluate for hydronephrosis. RIGHT KIDNEY: The right kidney measures 6.6 cm in length, with significantly increased cortical echogenicity. No hydronephrosis or perinephric fluid.LEFT KIDNEY: The left kidney measures 11.3 cm in length with mild increased cortical echogenicity. No hydronephrosis or perinephric fluid.OTHER: The bladder is distended. The prostate measures 6.1 x 5.8 x 4.3 cm. Post void residual volume is approximately 446 mL.

Output: 1.Atrophic right kidney and increased renal cortical echogenicity, compatible with medical renal disease. No hydronephrosis.2.Enlarged prostate and significant post-void residual volume.


Instruction: Generate impression based on medical findings.

Input: Flank pain, hematuria, evaluate renal stones RIGHT KIDNEY: Measures 12.5 cm. No hydronephrosis or nephrolithiasis.LEFT KIDNEY: Measures 12.1 cm. No hydronephrosis. Nonobstructive renal pelvis stone measures up to 0.9 cm. Multiple simple renal cysts measuring up to 2.3 cm.OTHER: No significant abnormalities noted.

Output: Nonobstructive left renal pelvis stone. No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Abdominal pain with nausea. LIVER: 13.1 cm in length. Non-cirrhotic liver morphology. Normal parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Normal appearance of the gallbladderPANCREAS: No sonographic abnormality evident in the visualized pancreatic head and neck. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney is 10.1 cm in length, with a 2.2 cm benign-appearing cyst at the inferior pole.. The left kidney is 11.4 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 9.7 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No abdominal free fluid identified.

Output: No acute intra-abdominal abnormality identified.


Instruction: Generate impression based on medical findings.

Input: 25-year-old female with a palpable left breast mass for 2 weeks presents for ultrasound. No family history of breast cancer Targeted ultrasound of the left breast performed at the palpable area of concern. A pea sized mobile palpable mass noted in the left breast 12:00 position 5 cm from the nipple. This on demonstrates a parallel oriented hypoechoic mass, with smooth margins measuring 1.9 x 1.1 x 1.7 cm. Located 6 mm lateral to it is a smaller similar morphology mass that measures 1.2 x 0.4 x 1 cm. Mild to moderate peripheral blood flow noted in both these lesions.No suspicious mass noted.

Output: Palpable abnormality in the left breast 12:00 position corresponds most likely to a benign fibroadenoma based on imaging. A smaller similar morphology mass is located 6 mm lateral to it.Surgical consultation is recommended.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female patient with history of multinodular goiter. RIGHT LOBE MEASUREMENTS: 6.6 x 1.5 x 2.3 cm.LEFT LOBE MEASUREMENTS: 7.2 x 3.0 x 2.3 cm.ISTHMUS MEASUREMENTS: 5 mm in thickness.RIGHT LOBE: No discrete thyroid nodule is identified.LEFT LOBE: A predominantly solid nodule replacing the mid to lower pole of the left thyroid gland measures 3.5 x 2.8 x 3.9 cm, previously 3.4 x 2.4 x 3.8 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable predominately solid dominant left thyroid nodule.


Instruction: Generate impression based on medical findings.

Input: 81-year-old female patient with abdominal pain. LIVER: The liver measures 15.9 cm in length. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: There are no gallstones, gallbladder wall thickening, or pericholecystic fluid. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 5 mm in diameter.PANCREAS: The head and body of the pancreas demonstrate normal echogenicity. Visualized portions of the pancreatic duct measures up to 3 mm in diameter, similar to a prior CT. The tail is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 10.7 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 10.3 cm in length. No evidence of hydronephrosis. There is a 2.1 x 2.2 x 2.4 cm well-defined echogenic lesion within the left lower pole. This is grossly stable in size when compared to prior MR lumbar spines dating back to 11/28/2003, given differences in modality/technique.The spleen measures 6.8 cm in length.

Output: 1. No acute sonographic findings to account for the patient's symptoms.2. 2.4 cm echogenic left lower pole renal lesion appears stable in size when compared to MRI lumbar spines dating back to 11/28/2003, given non-dedicated imaging and differences in modality/technique. The length of stability of the lesion favors a benign etiology, possibly an angiomyolipoma.


Instruction: Generate impression based on medical findings.

Input: Extensive skin burns. Evaluate for perinephric abscess or stones; sepsis RIGHT KIDNEY: Normal echogenicity without mass, stone, or hydronephrosis. No perinephric collection. 10.7 cm in lengthLEFT KIDNEY: Normal echogenicity without mass, stone, or hydronephrosis. No perinephric collection. 9.3 cm in length.OTHER: Bladder nondistended. Trace ascites

Output: Negative renal ultrasound. Normal parenchymal echogenicity without mass, stone, or hydronephrosis. No perinephric collection. Trace ascites.


Instruction: Generate impression based on medical findings.

Input: 54 years old, Male, Reason: neutropenic stem cell transplant patient w/ complaints of dysuria and elevated Cr. History: dysuria, Cr trending up over last couple days. Cr today 2.9 RIGHT KIDNEY: Kidney measures 11.8 cm in length. Mildly increased echogenicity consistent with medical renal disease. No evidence of hydronephrosis.LEFT KIDNEY: Kidney measures 11.4 cm in length. Mildly increased echogenicity consistent with medical renal disease. No evidence of hydronephrosis or shadowing calculus.Bladder: The bladder is at least moderately distended and concentrically thick walled which is nonspecific but may be secondary to cystitis. Other: Partially visualized liver parenchyma is increased in echogenicity consistent with fatty infiltration.

Output: 1.Mildly increased echogenicity bilaterally consistent with medical renal disease. No evidence of hydronephrosis.2.The bladder wall is concentrically thickened, nonspecific but may be seen in setting of cystitis, correlation with patient's clinical history and urinalysis recommended.3.Partially visualized liver parenchyma is increased in echogenicity consistent with fatty infiltration.


Instruction: Generate impression based on medical findings.

Input: Reason: please assess liver for cirrhosis, please assess for hydronephrosis; decreased UOP Examination limited due to constraints positioning patient. LIVER: The liver measures 13.7 cm in length and is nodular in contour. The liver parenchymal echotexture is coarse. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating hepatopetal flow with a velocity of 0.31 m/s.BILIARY TRACT: Cholelithiasis without significant gallbladder wall thickening. Gallbladder is relatively collapsed. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 3 mm in diameter.PANCREAS: Not well visualized.SPLEEN: No significant abnormalities noted. The spleen measures 11.6 cm in length. RIGHT KIDNEY: Kidney measures 9.7 cm in length. Increased parenchymal echogenicity. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Not well visualized.ABDOMINAL AORTA: Proximal aorta measures 2.4 cm in AP dimension. Middle and distal aorta not well visualized.INFERIOR VENA CAVA: Not well visualized.OTHER: Moderate ascites. Foley catheter.

Output: 1.Limited exam.2.Cirrhotic liver morphology. No focal hepatic lesions identified.3.Cholelithiasis.4.Echogenic right kidney suggestive of medical renal disease. No right hydronephrosis. Left kidney not visualized.5.Moderate ascites.


Instruction: Generate impression based on medical findings.

Input: Reason: 70-year-old man with hyperthyroidism. On anti-thyroid meds. Check thyroid anatomy. History: hyperthyroidism RIGHT LOBE MEASUREMENTS: 7.0 x 3.0 x 3.4 cm.LEFT LOBE MEASUREMENTS: 6.6 x 3.4 x 3.0 cm.ISTHMUS MEASUREMENTS: Up to 1.5 cm in thickness.RIGHT LOBE: Enlarged, heterogeneous gland containing multiple hyperechoic nodules. LEFT LOBE: Enlarged, heterogeneous gland containing multiple hyperechoic nodules. ISTHMUS: Enlarged, heterogeneous gland containing multiple hyperechoic nodules. PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No regional lymphadenopathy.OTHER: No significant abnormality noted.

Output: Enlarged, heterogeneous thyroid gland with multiple hyperechoic nodules compatible with thyroiditis. No suspicious nodules identified.


Instruction: Generate impression based on medical findings.

Input: Acute kidney injury. Ultrasound guidance was provided to the clinical service for performance of a renal biopsy. 3 passes with an 18-gauge core biopsy device were made of the left iliac fossa transplant graft. Postbiopsy images show no evidence of hematoma or other complication.

Output: Ultrasound guidance was provided to the clinical service for performance of a renal biopsy.


Instruction: Generate impression based on medical findings.

Input: 63-year-old female with stage IV chronic kidney disease. Ultrasound guidance was provided for biopsy the patient's right kidney.

Output: Ultrasound guidance


Instruction: Generate impression based on medical findings.

Input: 59 year old female presents for hepatocellular carcinoma screening. Participant in a clinical trial. LIVER: Subtle heterogeneous echogenicity of the liver, with contour nodularity consistent with early cirrhosis. No identifiable masses. The liver measures 20.7 cm.BILIARY TRACT: No biliary dilatation. Small amount of gallbladder sludge/debris. No pericholecystic fluid or gallbladder wall thickening.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. The spleen measures 10.7 cm.RIGHT KIDNEY: No significant abnormalities noted. The right kidney measures 12.3 cm.OTHER: No significant abnormalities noted. The left kidney measures 10.2 cm, and has a small superior pole exophytic simple cyst measuring 2.5 x 2.1 x 2.6 cm.

Output: Findings of early hepatic cirrhosis, with no identifiable liver masses.


Instruction: Generate impression based on medical findings.

Input: Female; 67 years old. Reason: usg of liver, hcc screen for cirrhosis History: same LIVER: The liver measures 13.0 cm in length. The liver surface is nodular, the parenchyma is diffusely echogenic and coarsened in echotexture. No focal hepatic lesion is evident. There is no ascites.The main portal vein is patent and demonstrates a hepatopetal flow with a peak velocity of 0.2 m/sec. Portal vein diameter is 1.6 cm in diameter on the current study, previously 2.3 cm.BILIARY TRACT: Status post cholecystectomy. The common duct measures 9 mm in diameter, unchanged. There is no intrahepatic biliary duct dilatation.PANCREAS: The pancreas is not well visualized due to overlying bowel gas.SPLEEN: The spleen measures 14.4 cm in length.KIDNEYS: The right kidney measures 11.0 cm in length, the left measures 11.5 cm in length. The renal parenchyma is normal in echogenicity bilaterally. There is no hydronephrosis or shadowing renal stone. OTHER: No significant abnormalities noted.

Output: 1.Cirrhotic liver morphology. No focal hepatic lesion.2.Splenomegaly.


Instruction: Generate impression based on medical findings.

Input: 54 years old, Male, Reason: ?AKI vs CKD, eval for obstruction History: see above RIGHT KIDNEY: Kidney measures 13.2 cm in length. The right kidney is diffusely echogenic indicating medical renal disease. Simple appearing right renal cyst is present measuring 1.2 x 1.2 x 1.3 cm.LEFT KIDNEY: Kidney measures 12.2 cm in length. Increased echogenicity of the left kidney is consistent with medical renal disease. No hydronephrosis, shadowing calculus or mass.BLADDER: No significant abnormalities. OTHER: No significant abnormalities noted.

Output: 1.No evidence of hydronephrosis or shadowing calculus.2.Diffusely increased echogenicity of the kidneys bilaterally is consistent with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: 41 year-old male with hepatitis B. HCC screening. LIVER: Diffuse increased echogenicity of the liver measuring 16.0 cm in length. No focal hepatic lesion. Portal vein is patent with appropriate directional flow.GALLBLADDER, BILIARY TRACT: Linear echogenic strands within the gallbladder are again seen and appear similar to prior study. No pericholecystic fluid. No gallbladder wall thickening. Common bile duct measures 4 mm in caliber. No intra or extrahepatic biliary ductal dilatation.PANCREAS: The visualized portions of the pancreas are normal in echogenicity. No pancreatic ductal dilatation.RIGHT KIDNEY: The right kidney measures 12.3 cm in length. No hydronephrosis.OTHER: Left kidney measures 11.9 cm in length. No hydronephrosis. Normal echogenicity of the spleen measuring 12.5 cm in length.

Output: 1. Increased echogenicity of the liver suggestive of parenchymal dysfunction/fatty infiltration. No focal hepatic lesion. 2. Linear echogenic strands within the gallbladder may represent septations or adherent sludge, however given stability compared to prior exam, findings favor internal gallbladder septations.


Instruction: Generate impression based on medical findings.

Input: 73 year old female who was recalled from outside screening mammogram for left breast asymmetry. MAMMOGRAM: An ML view and two spot compression views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Within the left breast, 12 o'clock position, the previously visualized asymmetry partially disperses on spot compression imaging, suggesting superimposition of fibroglandular tissues.Within the right breast, upper outer quadrant, there is a new 0.8-cm mass which persists on spot compression imaging.ULTRASOUND: A targeted left ultrasound was performed for the mammographic area of concern. A dense band of fibroglandular tissue is noted. There is no solid or cystic mass identified.A targeted right ultrasound was subsequently performed for the mammographic area of concern. At the 10 o'clock position of the right breast, 5 cm from the nipple, there is a well-circumscribed anechoic cyst mild posterior acoustic enhancement measuring 0.5 x 0.4 x 0.5 cm, likely corresponding to the finding on mammogram.

Output: Dense fibroglandular tissue in the upper central left breast corresponding to the asymmetry on mammogram. Right simple breast cyst. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: Female 64 years old; Reason: RUQ US to evaluate for gallbladder pathology in setting of pancreatitis. History: As above LIVER: The liver measures 15.8 cm in length. The liver parenchyma has normal echogenicity. No worrisome masses are seen within the liver. There is no intrahepatic ductal dilation seen. The main portal vein is patent with hepatopetal flow measuring 49.7 cm/s.GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 3.4 mm. Several small shadowing stones are seen within the gallbladder. Negative sonographic Murphy sign. No pericholecystic fluid. The common bile duct measures 4.2 mm in diameter. RIGHT KIDNEY: The right kidney measures 11.4 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.

Output: Cholelithiasis without sonographic evidence of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Hypothyroidism RIGHT LOBE MEASUREMENTS: 5.5 x 1.8 x 1.7 cmLEFT LOBE MEASUREMENTS: 10.8 x 6.7 x 5.4 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: Diffusely heterogeneous gland. 1.9 x 1.2 x 1.5 cm predominant solid mid pole nodule.LEFT LOBE: Heterogeneous enlarged left thyroid gland with dominant mixed cystic solid nodule measuring 7.1 x 3.0 x 6.6 cmISTHMUS: Spongiform left isthmic nodule measuring 2.0 x 1.4 x 1.2 cmPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Heterogeneous enlarged thyroid gland with dominant mixed cystic and solid nodule. Predominantly solid mid pole right thyroid nodule. Both of these nodules are amenable to ultrasound-guided biopsy. Spongiform left isthmic nodule; favor benign etiology. No regional adenopathy.


Instruction: Generate impression based on medical findings.

Input: 74 year old male with history of HCV, evaluate for HCC. LIVER: The liver measures 17 cm in length. Cirrhotic morphology without focal solid lesions. Two small lesions, likely cysts, one in the right lobe measuring 1.5 x 1.4 x 1.1 cm (previously 1.5 x 1.5 x 1.3 cm) and one in the left lobe measuring 0.6 x 0.5 x 0.6 cm (previously 0.5 x 0.7 x 0.5 cm). The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.2 m/s.BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common hepatic duct measures 3 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 11.6 cm in length. RIGHT KIDNEY: Kidney measures 10.5 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 10.1 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.OTHER: No evidence of ascites.

Output: 1. Cirrhotic morphology with two small lesions, likely cysts, not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Reason: cholecystitis? History: RUQ pain, elevated white blood cell count LIVER: The liver measures 17.4 cm in length. Mildly coarse echotexture and. No intrahepatic or extrahepatic biliary ductal dilatation. Normal hepatopedal portal venous blood flow. Portal venous flow = 34.1 cm/second.GALLBLADDER, BILIARY TRACT: The gallbladder is mildly distended. Cholelithiasis, one of which is within the gallbladder neck (measures 24 mm), with possible small volume layering sludge. The gallbladder wall measures 1 mm. The common bile duct measures 7 mm, borderline dilated. No intrahepatic biliary duct dilatation appreciated. No pericholecystic fluid or gallbladder wall thickening. Negative sonographic Murphy's sign.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 12.6 cm in length. No hydronephrosis.LEFT KIDNEY: The left kidney measures 11.3 cm in length. No hydronephrosis.SPLEEN: The spleen measures 8.6 cm in length.OTHER: No significant abnormalities noted.

Output: 1. Mildly distended gallbladder with cholelithiasis, one located in the gallbladder neck measures 24 mm, no evidence of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Female 71 years old; Reason: Evaluate left thyroid nodules seen on CT scan. RIGHT LOBE MEASUREMENTS: 4.8 x 1.4 x 1.5 cmLEFT LOBE MEASUREMENTS: 3.7 x 1.7 x 1.1 cmISTHMUS MEASUREMENT: No significant abnormality noted. 0.4 cm AP.RIGHT LOBE: The background thyroid gland has a mildly coarse echotexture. Multiple, subcentimeter solid, hypoechoic nodules are seen throughout the right lobe of the thyroid. A dominant nodule in the inferior aspect of the right thyroid lobe measures 5 x 4 x 4 mm.LEFT LOBE: The background thyroid gland has a mildly coarse echotexture. There are multiple subcentimeter solid, hypoechoic nodules. The dominant nodule is predominantly hypoechoic with some isoechoic components and measures 4 x 5 x 3 mm.ISTHMUS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.

Output: Bilateral subcentimeter thyroid nodules.


Instruction: Generate impression based on medical findings.

Input: Reason: 69 yo female with history of right upper quadrant pain and gallstones; please evaluate for any abnormalities. LIVER: The liver measures 15.6 cm in length. The liver demonstrates increased parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.21 m/s.BILIARY TRACT: Cholelithiasis including nonmobile shadowing stones without associated gallbladder wall thickening or pericholecystic fluid. The sonographic Murphy's sign is negative (confirmed with technologist). No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 5 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 8.2 cm in length. RIGHT KIDNEY: Kidney measures 11.0 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 11.4 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No significant abnormalities noted.

Output: 1.Cholelithiasis without sonographic evidence of acute cholecystitis or biliary ductal dilatation.2.Increased hepatic echogenicity raising the possibility of parenchymal dysfunction/fatty infiltration. No ascites.


Instruction: Generate impression based on medical findings.

Input: 48-year-old female for evaluation of liver status on clinical trial. LIVER: Liver is normal in size. Liver is mildly and heterogeneously echogenic without change likely due to irregular fatty infiltration. There is no focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: Post cholecystectomy. The biliary tract is normal in caliber.PANCREAS: Head and body are normal. The tail was not well seen.SPLEEN: Upper normal in size. Accessory splenic tissue noted. RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.

Output: No significant change. Likely mild fatty liver. Kidneys do not appear echogenic on today's exam.


Instruction: Generate impression based on medical findings.

Input: 57 years old, Female, Reason: 57 yo F with intermittent RLQ abdominal pain x weeks with CT showing concerns for cholecystitis. Pls aid in eval of acute vs. chronic cholecystitis. History: intermittent RLQ pain LIVER: The liver measures 14.1 cm in length. Mildly increased hepatic parenchymal echogenicity is consistent with fatty infiltration. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.2 m/s.BILIARY TRACT: Multiple gallstones are present within the gallbladder. Gallbladder wall is hypovascular is mildly thickened measuring 5 mm. The sonographic Murphy's sign is negative. No intrahepatic biliary ductal dilatation is present. The common bile duct measures 8 mm in diameter. No evidence of pericholecystic fluid.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 9.7 cm in length. RIGHT KIDNEY: Kidney measures 10.3 cm in length. Normal echotexture of the right kidney. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 9.7 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.

Output: Cholelithiasis without definite evidence of acute cholecystitis. However findings may represent chronic cholecystitis.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male with chronic hepatitis C. LIVER: Measures 14.5 in length. Increased hepatic echogenicity without discrete focal lesion. Two hepatic cysts in the right hepatic lobe measure 1.2 and 1.0 cm. Patent portal vein with antegrade flow. BILIARY TRACT: Cholelithiasis without gallbladder wall thickening, pericholecystic fluid, or biliary ductal dilation. PANCREAS: The pancreas is incompletely imaged due to bowel gas. The imaged portions of the pancreas appear unremarkable. SPLEEN: Unremarkable in size and echogenicity. KIDNEY: No hydronephrosis, nephrolithiasis, or solid mass. 1.6 x 1.5 cm right and 0.8 x 0.8 cm left renal cysts without septation or solid component.OTHER: No significant abnormalities noted.

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


Instruction: Generate impression based on medical findings.

Input: Right upper quadrant abdominal pain since oct 2016 LIVER: The liver measures 15.3 cm in length. The liver demonstrates increased parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.2 m/s.BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 4 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 5.9 cm in length. RIGHT KIDNEY: Kidney measures 11.8 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 11.9 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No significant abnormalities noted.

Output: 1.No evidence of acute cholecystitis or biliary ductal dilatation.2.Increased hepatic echogenicity raising the possibility of parenchymal dysfunction/fatty infiltration.


Instruction: Generate impression based on medical findings.

Input: Female 58 years old Reason: evaluate medial side of elbow for possible infection History: pain and swelling s/p surgery There is a small, ill-defined fluid collection measuring 1.3 x 0.5 x 1.4 cm abutting the left epicondyle.No other fluid collections are seen

Output: Small ill-defined fluid collection.Dr. Meagan Meislin informed.


Instruction: Generate impression based on medical findings.

Input: 31-year-old female with right upper quadrant pain, nausea/vomiting. LIVER: Measures 13.7 in length. Increased hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: No cholelithiasis. No gallbladder wall thickening, pericholecystic fluid, or biliary ductal dilation. 0.3 cm gallbladder polyp.PANCREAS: The pancreas is incompletely imaged due to bowel gas. The imaged portions of the pancreas appear unremarkable. SPLEEN: Unremarkable in size and echogenicity. KIDNEY: No hydronephrosis, nephrolithiasis, or solid mass. OTHER: No significant abnormalities noted.

Output: 1.Increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease.2.No evidence of cholelithiasis or acute cholecystitis.


Instruction: Generate impression based on medical findings.

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

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


Instruction: Generate impression based on medical findings.

Input: Acute onset abdominal pain LIVER: Non-cirrhotic liver morphology. 16.5 cm in length. Normal parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Moderate to large amount of biliary sludge with a 1-2 cm gallstone noted. No gallbladder wall thickening to suggest cholecystitis.PANCREAS: No sonographic abnormality evident in the visualized pancreatic head and neck. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney is 10.1 cm in length. The left kidney is 11.8 cm in length, with a 3.2 cm simple appearing cyst in the midpole. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 8 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No abdominal free fluid identified.

Output: Gallbladder sludge and cholelithiasis, without evidence of cholecystitis.


Instruction: Generate impression based on medical findings.

Input: History of urothelial cancer, acute kidney injury, rule out hydronephrosis or obstruction RIGHT KIDNEY: Measures 7.5 cm. Echogenic renal parenchyma. Small renal cyst measuring 1.3 cm. No hydronephrosis or mass.LEFT KIDNEY: Measures 12.2 cm. Echogenic renal parenchyma. Multiple cysts measuring up to 1.4 cm. No hydronephrosis or mass.OTHER: Foley catheter in decompressed bladder.

Output: Medical renal disease without hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Scrotal pain. RIGHT TESTIS: 3.8 x 2.5 x 3.1 cm. Few nonspecific coarse calcifications noted. Otherwise, normal parenchymal echotexture and vascularity. LEFT TESTIS: 3.4 x 2.0 x 3.3 cm. Normal parenchymal echotexture and vascularity.RIGHT EPIDIDYMIS: No significant abnormalities noted.LEFT EPIDIDYMIS: 5 mm epididymal cyst noted. No significant abnormalities identified.OTHER: No significant abnormalities noted. No evidence of hydrocele or varicocele.DOPPLER

Output: No specific findings to account for the patient's pain.


Instruction: Generate impression based on medical findings.

Input: 70-year-old female with breast cancer, elevated liver function tests. LIVER: Measures 13.5 cm in length. Unremarkable contour and echogenicity without discrete focal lesion. Patent portal vein with antegrade flow measuring 0.3 m/s.BILIARY TRACT: No cholelithiasis, gallbladder wall thickening, or biliary ductal dilation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.KIDNEY: Anechoic 1.7 x 1.2 cm right renal lesion in the superior pole with increased through transmission is consistent with a cyst. No hydronephrosis. OTHER: In the right adrenal region is a 2.0 x 2.0 cm round hypoechoic mass which is nonspecific and incompletely characterized.

Output: 1. 2.0 cm hypoechoic right adrenal lesion is nonspecific, and given the history of breast cancer metastasis cannot be excluded. Dedicated adrenal protocol MRI or CT is recommended for further evaluation. 2. No findings to account for the patient's elevated liver function tests.


Instruction: Generate impression based on medical findings.

Input: Abdominal pain with history of chronic viral hepatitis and hepatocellular carcinoma LIVER: Coarse echogenic liver echotexture again noted. Known hepatic mass lesion not well demonstrated on ultrasound. Porta hepatis infiltrative tumor and adenopathy again noted. Thrombosed undivided left portal vein again noted. Liver length 18.8 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.4 cm in lengthOTHER: Left kidney 11.6 cm in length. Spleen 14 cm in length. No ascites

Output: Coarse echogenic liver parenchyma again noted consistent with chronic liver disease. Known hepatic mass lesion is not well appreciated on today's ultrasound. Porta hepatis infiltrative tumor and adenopathy unchanged. Thrombosed undivided left portal vein again noted. No ascites.


Instruction: Generate impression based on medical findings.

Input: 15-year-old male complains of swelling in the left pectoral region. Left nipple areolar complex is asymmetric in comparison to the right. No abnormal fluid collections. No mass.

Output: Left nipple areolar complex asymmetry without mass or abnormal fluid collection.


Instruction: Generate impression based on medical findings.

Input: Male 63 years old; Reason: Cirrhosis, eval for HCC History: Cirrhosis LIVER: The liver measures 15.3 cm in length. There is coarse increased echogenicity of the liver parenchyma. No focal hepatic lesions. No intrahepatic ductal dilation is seen. The main portal vein is patent with normal hepatopetal flow measured at 20.8 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 2.5 mm. No stones are seen. Redemonstrated gallbladder polyp is visualized measuring 0.6 cm x 0.3 cm x 0.6 cm. No pericholecystic fluid. The common bile duct measures 4.7 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 7.8 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 10.8 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 10.5 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.

Output: 1. Coarse echogenic liver compatible with history of cirrhosis. No new worrisome masses seen.2. Redemonstration of small gallbladder polyp, stable stable in appearance but slightly larger than prior exam.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with transaminitis. History of cystectomy. LIVER: Normal in size but moderately echogenic which may be due to fatty infiltration although not specific. There is a 1.4 cm mildly complex cyst in the region of the caudate with smaller cyst as well as.GALLBLADDER, BILIARY TRACT: Gallbladder is not visualized on this exam. Visualized portions of the intra and extrahepatic biliary tract are normal in caliber.PANCREAS: Pancreas is not visualized. Patient has a dense, midline scar with obscuration of underlying structures.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.

Output: Echogenic liver, presumably related to fatty infiltration.Hepatic cysts.


Instruction: Generate impression based on medical findings.

Input: Abnormal LFTs, patient overweight LIVER: Hepatomegaly, liver measures 24 cm in longitudinal dimension. Markedly increased liver parenchymal echogenicity. Main portal vein patent with normal directional flow, velocity measures 20 cm/sec.GALLBLADDER, BILIARY TRACT: Gallbladder unremarkable. No mobile intraluminal echogenic foci seen to suggest underlying cholelithiasis. No secondary signs of acute cholecystitis.PANCREAS: Not well assessed secondary to obscuration by bowel gas.SPLEEN: Splenomegaly, spleen measures 17.6 cm.KIDNEYS: Right kidney measures 10.4 cm, while left kidney measures 12.9 cm. No hydronephrosis. Renal cortical echogenicity within normal limits.OTHER: No significant abnormality noted.

Output: Markedly increased hepatic parenchymal echogenicity, likely reflecting underlying hepatic steatosis/parenchymal dysfunction.Hepatosplenomegaly.


Instruction: Generate impression based on medical findings.

Input: Male 67 years old; Reason: assess for cholecystitis History: sepsis LIVER: The liver is incompletely visualized however numerous ill-defined lesion seen within the liver on prior CT are not visualized on this study.GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 1.9 mm but is difficult to define in this study. Several small shadowing echogenic foci are seen within the gallbladder. Negative sonographic Murphy sign. There is a trace amount of pericholecystic fluid which is likely compatible with patient's current ascites, seen better on prior CT. The common bile duct was unable to be visualized due to difficulty with technique and overlying bowel gas.

Output: 1. Cholelithiasis without overt sonographic evidence of acute cholecystitis. There is a trace amount of pericholecystic fluid which is likely compatible with patient's ascites. This study is limited however and acute cholecystitis, although unlikely, cannot be entirely ruled out.2.The common bile duct was not able to be visualized due to difficulty in technique and overlying bowel gas.3. Multiple ill-defined lesions within the liver seen on CT are not well visualized on this ultrasound.


Instruction: Generate impression based on medical findings.

Input: 43 year-old male with obesity and transaminitis. LIVER: The liver is mildly coarsened and increased in echogenicity. It is normal in size, measuring 15 cm in the craniocaudal attention with no intrahepatic biliary ductal dilatation or focal hepatic lesion evident. The liver capsule is smooth. Normal hepatopetal portal venous blood flow at 24 cm/sec.BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common bile duct measuring 6 mm at the level of the pancreatic head. Normally distended gallbladder without gallstones, wall thickening, pericholecystic fluid, or focal tenderness.PANCREAS: The poorly visualized pancreatic head is grossly unremarkable. SPLEEN: The spleen measures 11.2 cm in length without a discrete abnormality.RIGHT KIDNEY: The right kidney measures 10.8 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident. OTHER: The left kidney measures 10.6 cm without hydronephrosis, shadowing calculus or discrete lesion evident.

Output: Coarse echogenic liver parenchyma most commonly seen in diffuse fatty infiltration without a discrete lesion or biliary ductal dilatation.


Instruction: Generate impression based on medical findings.

Input: Elevated creatinine RIGHT KIDNEY: Echogenic renal parenchyma without stone or hydronephrosis. Multiple cystic foci some demonstrating internal increased echogenicity and complexity. Right kidney 10.2 cm in length.LEFT KIDNEY: Echogenic renal parenchyma without stone, worrisome mass, or hydronephrosis. Left kidney 7.9 cm in length.OTHER: Bladder nondistended

Output: Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without stone or obstruction. Multiple cystic foci involving the right kidney some with increased internal echogenicity and complexity. Would pay special attention to these lesions on future surveillance scans as clinically relevant.


Instruction: Generate impression based on medical findings.

Input: Ms. Norfolk is a 65 year old female with known right breast IDC and metastatic right axillary lymph node. She presents for imaging evaluation to assess for response to hormonal therapy. Targeted grayscale and color ultrasound of the right breast and axilla.In the right breast 9:00 position, approximately 6 cm from the nipple, there is revisualization of an irregular hypoechoic mass with centrally located biopsy marker clip now measuring approximately 1.1 x 0.9 x 0.8 cm, previously 1.0 x 0.8 x 0.5 cm on outside examination. In the right axilla, previously biopsied axillary lymph node with centrally located clip now measures approximately 1.5 x 0.9 cm, previously 1.9 x 1.4 cm.

Output: Known index malignancy in the right breast and metastatic right axillary lymph node are stable to slightly decreased when compared to prior imaging. Continued surgical consultation is recommended at this time. All results and recommendations were discussed with the patient.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: 51-year-old female with goiter. Follow-up study. Evaluate for nodule. RIGHT LOBE MEASUREMENTS: 5.7 x 2.8 x 2.2 cmLEFT LOBE MEASUREMENTS: 4.7 x 1.7 x 1.5 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: Diffusely heterogeneous with a pattern consistent with thyroiditis. No dominant nodule.LEFT LOBE: Diffusely heterogeneous with a pattern consistent with thyroiditis. No dominant nodule.ISTHMUS: There is again noted adjacent to the right isthmus and ovoid nodular area measuring 0.4 x 0.8 x 0.9 cm. This has the appearance of lymph node on today's study.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Adjacent to the inferior left lobe of the thyroid there again noted to ovoid hypoechoic nodular densities measuring 0.3 x 0.4 x 0.5 cm and 0.4 x 0.5 x 0.8 cm. These likely represent lymph nodes.OTHER: No significant abnormality noted.

Output: Stable examination with thyroiditis pattern. Benign-appearing lymph nodes as noted.


Instruction: Generate impression based on medical findings.

Input: Reason: Progressive CKD, assess kidney size, echogenecity History: Progressive CKD RIGHT KIDNEY: The right kidney measures 12.6 cm in length. Echogenic renal parenchyma is again noted. Hyperechoic focus in the midpole of the right kidney with twinkling artifact may represent a nonobstructive stone. Numerous anechoic simple cysts are seen throughout the lower, mid, and upper pole. Reference upper pole cyst measures 2.3 x 2.1 x 2.9 cm and is minimally complex with a thin septation. No hydronephrosis.LEFT KIDNEY: The left kidney measures 9.6 cm in length. Echogenic renal parenchyma is again noted. Numerous anechoic simple cysts are seen throughout the lower, mid, and upper pole. Reference complex cystic lesion in the midpole with multiple thin septations and peripheral calcification appears similar to prior exam, measuring 2.7 x 2.6 x 2.8 cm. No definite shadowing calculi or hydronephrosis.OTHER: Unremarkable bladder.

Output: 1. Echogenic renal parenchyma, consistent with medical renal disease.2. Stable bilateral simple to complex renal cystic lesions as described above.3. Questionable nonobstructive right renal stone. No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Question of possible parathyroid adenoma versus thyroid nodule seen at outside institution. RIGHT LOBE MEASUREMENTS: 1.9 x 1.8 x 4.5 cm.LEFT LOBE MEASUREMENTS: 1.6 x 1.8 x 3.9 cm.ISTHMUS MEASUREMENTS: 2 mm in AP dimension.RIGHT LOBE: No significant abnormality noted.LEFT LOBE: 5 mm benign-appearing nodule in the inferior pole, similar to prior. The previously described nodular region in the posterior inferior left thyroid gland matches normal thyroid echogenicity on the current examination, with minimal nonsuspicious heterogeneity. No discrete nodule is present.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not identified.LYMPH NODES: No significant abnormality noted.

Output: No suspicious nodules identified. The previously described lesion on the outside institution study in the posterior left thyroid gland appears to be nonsuspicious minimally heterogeneous thyroid tissue.


Instruction: Generate impression based on medical findings.

Input: Primary hyperparathyroidism. Assess for renal stones. RIGHT KIDNEY: 11.0 cm in length. Increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: 11.8 cm in length. Increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.BLADDER: No significant abnormality noted.OTHER: Trace ascites identified.

Output: No nephrolithiasis identified. Echogenic renal parenchyma without hydronephrosis, suggestive of medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Evaluate for acute cholecystitis. Evaluate right iliac fossa renal allograft. LIVER: The liver is normal in morphology, echogenicity and size measuring 15.3 cm in craniocaudal dimension. No focal lesion or intrahepatic biliary ductal dilatation. Normal hepatopedal portal venous blood flow at 36 cm/s. Normally distended gallbladder without significant wall thickening pericholecystic fluid or focal tenderness (although non-specific in the setting of pain medication administration)2 4 mm non-dependent adherent non-shadowing gallstones and/or polyps.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation with the common duct measuring 2 mm.PANCREAS: The visualized portions of the pancreatic head are unremarkable. The body and tail is obscured by overlying bowel gas.SPLEEN: The spleen measures 10.9 cm in length.RIGHT ILIAC FOSSA TRANSPLANT: The right iliac fossa transplanted kidney measures 13.7 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. It demonstrates normal corticomedullary differentiation. No peritransplant fluid collection. Color Doppler demonstrates hilar blood flow.OTHER: No significant abnormalities noted.

Output: 1. Two 4 mm adherent non-shadowing gallstones versus gallbladder polyps. No evidence of acute cholecystitis.2. Unremarkable right iliac fossa renal allograft. Please note that detailed evaluation of the vasculature was not performed.


Instruction: Generate impression based on medical findings.

Input: Thyroid nodule seen incidentally on recent MR RIGHT LOBE MEASUREMENTS: 4.6 x 1.7 x 2.1 cmLEFT LOBE MEASUREMENTS: 5.4 x 2 x 2.3 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Heterogeneous gland with multiple benign-appearing mixed cystic and solid as well as spongiform nodules. A representative inferior mixed cystic and solid nodule measures 1.1 x 0.5 x 0.8 cm.LEFT LOBE: Heterogeneous gland with dominant predominantly solid mid pole nodule measuring 1.7 x 1.3 x 2 cm.ISTHMUS: Heterogeneous gland.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Bilateral thyroid nodules. Dominant predominantly solid mid pole left thyroid nodule amenable to ultrasound-guided biopsy. No regional adenopathy.Heterogeneous somewhat small thyroid gland without increased vascularity. Finding raises the possibility of chronic thyroiditis. Correlation with thyroid function tests suggested.


Instruction: Generate impression based on medical findings.

Input: Parathyroid adenoma RIGHT LOBE MEASUREMENTS: 5.3 x 2.0 x 1.8 cm. Normal in size with normal background echotexture and vascularity.LEFT LOBE MEASUREMENTS: 4.4 x 1.2 x 1.2 cm. Normal in size with normal background echotexture and vascularity.ISTHMUS MEASUREMENTS: 10 mm in AP dimensionRIGHT LOBE: There is a slightly hypoechoic 1.7 cm solid nodule in the superior pole. LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: A 1.3 x 0.8 x 1.3 cm hypoechoic nodule is noted posterior to the right inferior thyroid pole. A 4.2 x 2.6 x 1.7 cm hypoechoic nodule is noted posterior to the left inferior thyroid pole. These are similar to the prior ultrasound and correspond to areas of increased uptake on the prior nuclear medicine parathyroid study.LYMPH NODES: Benign-appearing cervical lymph nodes identified.OTHER: No significant abnormality noted.

Output: 1. Bilateral parathyroid adenomas, left larger than right. 2. 1.7 cm right intrathyroid nodule. This nodule is amenable to percutaneous biopsy.


Instruction: Generate impression based on medical findings.

Input: Male 58 years old Reason: OHT evaluation History: OHT evaluation LIVER:Liver parenchyma is within normal limits. No focal hepatic mass. Main portal vein is patent with normal directional flow.GALLBLADDER, BILIARY TRACT: No intra or extra hepatic biliary ductal dilatation. Gallbladder is normal. No gallstones.PANCREAS: The visualized portions of the pancreas are normal in appearance.SPLEEN: No significant abnormality noted. Spleen measures 11.6 cm.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Right kidney measures 11.6 cm. Left kidney measures 11.5 cm. ABDOMINAL AORTA: No significant abnormality within the aorta. No aneurysms identified. Normal vascular flow in the aorta.INFERIOR VENA CAVA: No significant abnormality noted.BLADDER: No significant abnormality noted.

Output: Normal sonographic evaluation of the abdominal viscera.


Instruction: Generate impression based on medical findings.

Input: 59 year-old male with right upper quadrant pain and nausea. LIVER: Coarsened liver architecture. Smooth liver contour. No focal mass lesions are identified. The portal vein flow is hepatopetal.GALLBLADDER, BILIARY TRACT: The gallbladder is incompletely distended. No gallstones are identified. No findings to suggest acute cholecystitis. No common duct stones are seen.PANCREAS: No significant abnormalities noted although partially of by overlying bowel gas.SPLEEN: Mild splenomegaly.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.

Output: 1. Coarsened liver echotexture may be seen in chronic liver disease.2. Mild splenomegaly.


Instruction: Generate impression based on medical findings.

Input: Status post renal transplant. Guidance for Biopsy Ultrasound guidance was provided for a transplant renal biopsy. Transplant is located in the right iliac fossa

Output: Ultrasound guidance for transplant renal biopsy


Instruction: Generate impression based on medical findings.

Input: Multinodular goiter RIGHT LOBE MEASUREMENTS: 3.5 x 1.9 x 1.6 cm.LEFT LOBE MEASUREMENTS: 5.1 x 2.6 x 1.6 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Dominant solid nodule within the right thyroid gland/isthmus measuring 3.9 x 3.8 x 2.9 cmLEFT LOBE: Dominant solid nodule within the left lobe measuring 2.6 x 1.6 x 1.4 cmISTHMUS: Dominant solid nodule within the right thyroid gland/Isthmus measuring 3.9 x 3.8 x 2.9 cmPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Bilateral solid dominant thryoid nodules as described. Both nodules are amenable to ultrasound-guided percutaneous biopsy.


Instruction: Generate impression based on medical findings.

Input: Ms. Lara is a 33-year-old woman with a 0.5 cm palpable nodule within the outer left breast who presents for additional evaluation. Physical examination demonstrates a subcentimeter palpable nodule within the upper outer left breast.A targeted left ultrasound was performed for the palpable area of concern. Within the left breast at the 2:00 position approximately 6 cm from the nipple, no solid or cystic masses are identified.

Output: No sonographic evidence for malignancy. Palpable concern should be managed clinically. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually beginning at the age of 40.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate for abscess/soft tissue source of infection in left leg History: Left leg pain, erythema, swelling. There is extensive subcutaneous edema and inflammation in the subcutaneous tissues of the left anteromedial lower extremity without focal fluid collection or abscess.

Output: Extensive subcutaneous edema and inflammation, which can be seen in cellulitis. No focal fluid collection or abscess.


Instruction: Generate impression based on medical findings.

Input: Asymptomatic female presents for routine screening mammography. History of right breast benign biopsy. Family history of breast cancer in mother diagnosed in her 60's and maternal grandmother diagnosed in her 50's. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD. The breast parenchyma is heterogeneously dense, which may obscure small masses (BiRads Density Category C), unchanged in pattern and distribution. New asymmetry is present in the superior posterior right breast best seen on MLO view. Stable scattered bilateral benign calcifications. Previously described ill-defined mass previously confirmed to be a cyst on ultrasound in the left lower outer breast is not visualized on the current exam compatible with a waxing and waning cyst. No suspicious masses, microcalcifications are present.

Output: New asymmetry in the superior posterior right breast best seen on MLO view which further evaluation with spot compression views and possibly ultrasound is recommended. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EC - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on medical findings.

Input: Female 54 years old Reason: assess for steatosis, any e/o cirrhosis History: high output cardiac failure with unknown etiology, h/o hepatic steatosis in the past LIVER: Markedly coarse and echogenic liver consistent with fatty infiltration. No focal masses. Liver capsule appears smooth. Main portal vein is patent with peak velocity of 30.8 cm/s.BILIARY TRACT: Patient status post cholecystectomy. No intra or extrahepatic biliary ductal dilatation. Common bile duct measures 5.4 mm.PANCREAS: Pancreas is not well-visualized.SPLEEN: Spleen is normal echogenicity measuring 13.8 cm.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Left kidney measures 11.7 cm. Right kidney measures 11.8 cm.OTHER: No significant abnormalities noted.

Output: Marked hepatic steatosis without sonographic evidence of cirrhosis. No focal mass is identified, however with this degree of hepatic steatosis, ultrasound ability to detect small masses is diminished. If there is high clinical suspicion for hepatic mass, CT is recommended.


Instruction: Generate impression based on medical findings.

Input: Abnormal LFTs LIVER: Coarse echogenic liver echotexture without mass. Liver length 13 cmBILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 11 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 11.4 cm in lengthOTHER: Left kidney 12.8 cm in length. No ascites.

Output: Coarse echogenic liver echotexture consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Cholelithiasis without acute inflammation. No ascites.


Instruction: Generate impression based on medical findings.

Input: Mesothelioma with abdominal distention Moderate free-flowing ascites throughout the abdomen and pelvis

Output: Moderate free-flowing ascites throughout the abdomen and pelvis.


Instruction: Generate impression based on medical findings.

Input: 55-year-old male with history of thyroid cancer status post thyroidectomy. Evaluate for recurrence and adenopathy. RIGHT LOBE, LEFT LOBE, ISTHMUS MEASUREMENTS: The thyroid is absent.RIGHT LOBE: The thyroid is absent.LEFT LOBE: The thyroid is absent.ISTHMUS: The thyroid is absent.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Surgical changes of a thyroidectomy without evidence of recurrence.


Instruction: Generate impression based on medical findings.

Input: Acute renal failure RIGHT KIDNEY: Mildly echogenic renal parenchyma without mass, stone, or hydronephrosis. 9.9 cm in lengthLEFT KIDNEY: Mildly echogenic renal parenchyma without mass, stone, or hydronephrosis. 9.5 cm in lengthOTHER: Bladder nondistended

Output: Mildly echogenic renal parenchyma raises the possibility of medical renal disease/parenchymal dysfunction without mass, stone, or hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Reason: enlarged thyroid History: Crohn's disease, fatigue RIGHT LOBE MEASUREMENTS: 5.0 x 1.7 x 1.4 cm. LEFT LOBE MEASUREMENTS: 4.7 x 1.4 x 0.7 cm. ISTHMUS MEASUREMENTS: 0.2 cm. RIGHT LOBE: No significant abnormality noted. Normal parenchyma without nodules or masses.LEFT LOBE: No significant abnormality noted. Normal parenchyma without nodules or masses.ISTHMUS: No significant abnormality noted. Normal parenchyma without nodules or masses.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Prominent benign-appearing right level 3 cervical lymph node measures 2.2 x 1.1 x 0.5 cm. Prominent benign-appearing level 3 cervical lymph node measures 2.4 x 0.9 x 0.3 cm.OTHER: No significant abnormality noted.

Output: No discrete thyroid nodule.


Instruction: Generate impression based on medical findings.

Input: Reason: distended abdomen; r/o hepatomegaly, ascites LIVER: The liver measures 17.8 cm in length. The liver demonstrates increased parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.27 m/s.BILIARY TRACT: Gallbladder not visualized and may be surgically absent. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 4 mm in diameter.PANCREAS: Not well visualized.SPLEEN: No significant abnormalities noted. The spleen measures 8.5 cm in length. RIGHT KIDNEY: Kidney measures 10.2 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 10.7 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No ascites.

Output: Increased hepatic echogenicity suggestive of parenchymal dysfunction/fatty infiltration. No ascites.


Instruction: Generate impression based on medical findings.

Input: 55-year-old with history of left lumpectomy in 1995. Today, Dr. Chhablani palpates an area of concern in the high left axilla. A targeted left ultrasound was performed for the palpable area of concern. A subcentimeter normal morphology lymph node is found at the site marked by the clinical service. There is no suspicious lymph node, or solid or cystic mass identified.

Output: No sonographic evidence for malignancy. Normal morphology left axillary lymph node. The patient's next bilateral diagnostic mammogram will be due in December 2015.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: 58-year-old male with chronic kidney disease and worsening renal function. RIGHT KIDNEY: Right kidney measures 11.5 cm in length. Echotexture is difficult to judge due to overlying ascites, cortex is at least moderately echogenic. There is a small cyst in the upper pole of the kidney. No hydronephrosis, shadowing calculus or solid mass.LEFT KIDNEY: The left kidney measures 12.7 cm in length. Cortex is moderately echogenic. No hydronephrosis, shadowing calculus or mass.URINARY BLADDER: No significant abnormalities noted.OTHER: Moderate ascites.

Output: Echogenic kidneys with small right cyst. Overall, the appearance of the kidneys is little changed from prior exams.Moderate ascites.


Instruction: Generate impression based on medical findings.

Input: Thyroid nodules RIGHT LOBE MEASUREMENTS: 5.3 x 2.5 x 2.1 cm. Unchanged in size with normal vascularity.LEFT LOBE MEASUREMENTS: 6.0 x 2.2 x 1.9 cm. Unchanged in size with normal vascularity.ISTHMUS MEASUREMENTS: 7 mm in AP dimension, unchanged.RIGHT LOBE: Multiple mixed solid and cystic nodules, some of which demonstrate slightly decreased cystic components. Otherwise no significant change is evident, accounting for differences in technique. The reference upper pole nodule measures 2.6 x 1.8 x 1.5 cm. The reference lower pole nodule measures 3.0 x 2.3 x 2.2 cm.LEFT LOBE: Multiple mixed solid and cystic nodules, without significant interval change. The reference midpole nodule is difficult to measure separately from an adjacent cystic nodule, measuring 3.7 x 1.9 x 2.1 cm in total.ISTHMUS: The reference nodule measures 2.1 x 1.9 x 1.0 cm, unchanged.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Benign-appearing cervical lymph nodes identified.OTHER: No significant abnormality noted.

Output: Bilateral thyroid nodules, which are stable to slightly decreased in size. No suspicious interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: thyroid nodule on left side History: thyroid nodule RIGHT LOBE MEASUREMENTS: Measures 4.9 x 1.6 x 1.6 cm.LEFT LOBE MEASUREMENTS: Measures 4.6 x 1.7 x 1.9 cm.ISTHMUS MEASUREMENTS: Measures up to 0.4 cm in thickness.RIGHT LOBE: Mildly heterogeneous background parenchymal echotexture without discrete nodules. LEFT LOBE: Mildly heterogeneous background parenchymal echotexture. Left lower pole spongiform nodule measuring 0.7 x 0.5 x 0.6 cm, very low suspicion for neoplasm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Mildly heterogeneous thyroid. Dominant subcentimeter spongiform nodule, low suspicion for neoplasm.


Instruction: Generate impression based on medical findings.

Input: Male 31 years old Reason: R posterior cervical lymph node enlargement, ultrasound to quantify size and shape History: see above There are a few benign-appearing cervical lymph nodes. Largest measures 1.6 x 0.4 cm.

Output: Benign-appearing cervical lymph nodes at the site where the patient feels the lump.


Instruction: Generate impression based on medical findings.

Input: Male 66 years old Reason: eval for thyroid nodules, lymphadenopathy History: hyperthyroidism, L sided nodule on thyroid bed on exam RIGHT LOBE MEASUREMENTS: 8.1 x 3 x 4.8 cmLEFT LOBE MEASUREMENTS: 2 x 2.7 x 2.4 cmISTHMUS MEASUREMENTS: 3 mmRIGHT LOBE: There are multiple subcentimeter nodules in the right lobe of the thyroid. Most of them looks sponges. Some of them have nonspecific ultrasound appearance. An index nodule in the upper lobe measures 9 x 6 x 10 mm. LEFT LOBE: There are multiple subcentimeter nodules in the right lobe of the thyroid. Most of them looks sponges. Some of them have nonspecific ultrasound appearance. An index nodule in the upper lobe measures 15 x 6 x 11 mmISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multinodular goiter. Most of the nodules are small and appear benign.


Instruction: Generate impression based on medical findings.

Input: Elevated LFTs LIVER: No significant abnormalities noted. 16.6 cm in lengthGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.2 cm in lengthOTHER: Left kidney 10.9 cm in length. Benign left renal cyst. Spleen 7.6 cm in length. No ascites.

Output: Negative right upper quadrant limited ultrasound. Specifically, no evidence for hepatobiliary abnormality. No ascites.


Instruction: Generate impression based on medical findings.

Input: 12-year-old male patient with cyclic vomiting. Evaluate for hydronephrosis. KIDNEYS  Cortical Echogenicity: Normal   Medullary Echogenicity: Normal   Pelvicaliceal System -- SFU Grade*  Right: 0 Left: 0  Length*** Right: 9.0 cm Left: 8.5 cm   Mean for age: 10.4 cm  Range for age: 8.66 - 12.1 cmADDITIONAL OBSERVATIONS: None.

Output: 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.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 76 years old; Reason: follow up US history of thyroid nodule History: follow up US history of thyroid nodule RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 4.6 x 2.0 x 1.7 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 4.7 x 2.6 x 1.8 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.13 cm.RIGHT LOBE: Multiple benign-appearing spongiform nodules all stable in size with the exception of one. There has been an interval increase in size of a mixed solid and cystic, predominantly cystic, lesion. It previously measured 5 cm x 5 cm and now measures 9 cm x 9 cm. There is peripheral vascularity but no definite microcalcifications.LEFT LOBE: Multiple benign-appearing nodules all stable in size in comparison to the prior study.ISTHMUS: No significant abnormality noted.LYMPH NODES: No suspicious adenopathy noted. OTHER: No significant abnormality noted.

Output: 1.Multiple lesions throughout the thyroid all stable in size except slight increase of one right sided nodule as above.2.Overall increase of vascularity suggestive of possible underlying thyroiditis. Please correlate with laboratory values.


Instruction: Generate impression based on medical findings.

Input: 74 years old, Female, Reason: 74 y/o F with therapy realated MPS now R lateral thigh cellulitis with induration. Please evaluate for drainable fluid collection/abscess History: pain, R thigh cellulitis Skin thickening with increased echogenicity and edema within the soft tissues consistent with cellulitis. No focal fluid collections to suggest abscess.

Output: Cellulitis without evidence of abscess.


Instruction: Generate impression based on medical findings.

Input: Ms. Ciochina is a 58 year old female presenting from outside hospital with a questionable sonographic lesion in the right periareolar region. She presents today for repeat ultrasound evaluation of this area. On physical examination, no discrete mass is palpated at the right breast periareolar region.A targeted right breast ultrasound was performed for the periareolar area of concern. There is no suspicious solid or cystic mass identified. Heterogenous shadowing from the nipple is seen, corresponding to the images obtained at the outside hospital.A targeted left breast periareolar ultrasound was performed solely for comparison. Very similar heterogenous shadowing from the nipple is again seen.

Output: No sonographic evidence for malignancy. No additional workup is necessary for the right periareolar region. Of note, patient does have two clusters of calcifications in the right breast, for which stereotactic biopsy continues to be recommended for. All results and recommendations were discussed with the patient and Dr. Henry in the breast surgical clinic. The patient will follow up with Dr. Jaskowiak later today. BIRADS: 1 - Negative.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Papillary thyroid carcinoma status post resection RIGHT LOBE: Status post thyroidectomy without massLEFT LOBE: Status post thyroidectomy without massISTHMUS: Status post thyroidectomy without massPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Multiple round hypoechoic mildly hypervascular lymph nodes left level 3 and 4 again noted. The largest again measures approximately 0.8 x 0.9 x 0.6 cm. In addition, multiple round hypoechoic subcentimeter nodules within the submental region level 1 are noted.OTHER: No significant abnormality noted.

Output: Abnormal appearing left level 3 and 4 as well as submental level 1 lymph nodes noted. Would recommend correlation with ultrasound guided percutaneous FNA biopsy.


Instruction: Generate impression based on medical findings.

Input: 26-year-old male patient with cirrhosis. Evaluate for HCC. LIVER: The liver measures 18 cm in length and demonstrates coarsened, increased parenchymal echogenicity and is nodular in contour. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: There are no gallstones, gallbladder wall thickening, or pericholecystic fluid. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 3 mm in diameter.PANCREAS: The pancreas is poorly visualized on this examination.RIGHT KIDNEY: The right kidney measures 11 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 9 cm in length. No evidence of hydronephrosis.The spleen measures 12.5 cm in length.No ascites.

Output: Nodular liver contour consistent with cirrhosis. No focal hepatic lesion is identified.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with abnormal liver function. Elevated bilirubin. LIVER: There is normal in size and appears mildly echogenic consistent with parenchymal disease. No focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: Gallbladder contains a single shadowing gallstone in the region of the neck. Mobility could not be well assessed. No gallbladder wall thickening. Moderate ascites.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Significantly echogenic without hydronephrosis on limited view.OTHER: Left kidney significantly echogenic without hydronephrosis on limited view. Splenic size normal.Moderate ascites.Bilateral pleural effusions.

Output: No focal hepatic abnormality. Gallstone but no other gross biliary tract abnormality.Ascites.Echogenic kidneys.


Instruction: Generate impression based on medical findings.

Input: 15-year-old female with tender palpable lump in the upper inner quadrant of the left breast for 5 months. Patient reports that the pain has been constant and the lump has been present all time. A targeted left ultrasound was performed for the palpable area of concern. On physical examination, vague focal thickening can be appreciated at the 10:00 position of the left breast at the site indicated by the patient. Placement of the transducer at this site elicited focal tenderness, which the patient indicated was her typical symptoms. The transducer was passed over this area multiple times in multiple different orientations. No solid masses or cysts are identified. Sonographically unremarkable appearing fibroglandular tissue is seen.

Output: No sonographic evidence for malignancy. No sonographic abnormality to explain the patient's area of palpable concern and focal tenderness. Continued clinical management is recommended. Further evaluation of a clinically suspicious abnormality should not be delayed by negative imaging. Rather, negative imaging may serve to reinforce a negative or benign clinical impression. The results and recommendations were discussed with the patient and with her father at the completion of the examination.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on medical findings.

Input: 33 year old female with history of thyroid cancer status post thyroidectomy. Evaluate for adenopathy, recurrence. RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: No discrete nodules or masses are noted in the thyroidectomy bed.LEFT LOBE: Hypoechoic nodular focus within or adjacent to the thyroidectomy bed measures 6 mm x 2 mm x 4 mm and is unchanged. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Right neck level 2 benign-appearing lymph node measures 1.6 cm x 0.5 cm. No pathologic lymphadenopathy. OTHER: No significant abnormality noted.

Output: Unchanged hypoechoic nodular focus within or adjacent to the left thyroidectomy bed.


Instruction: Generate impression based on medical findings.

Input: 54-year-old male with metastatic esophageal carcinoma with severe abdominal pain and abnormal liver function. LIVER: Liver is heterogeneous in echotexture and normal in size. Discrete mass is not seen with certainty. There is now thrombosis of the portal venous system, progressive from the prior CT.GALLBLADDER, BILIARY TRACT: There appears to represent gallbladder is filled with echogenic material. The wall is not easily separated from internal material but is likely mildly thickened which is not specific in the face of ascites. No shadowing gallstones. There is now significant and diffuse biliary tract dilatation with the common duct measuring 1.7 cm in greatest diameter extending to the patient's known mass which infiltrates the porta hepatis.PANCREAS: Not discretely visualized. Large midline mass.RIGHT KIDNEY: No significant abnormalities noted.OTHER: Significant ascites. Pleural effusions.

Output: Biliary tract dilatation likely due to obstruction in the porta by metastatic disease. Portal venous thrombosis.Gallbladder sludge without shadowing stones.Diffuse, moderate ascites. Pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male 80 years old; Reason: evaluate liver parencyhma for cirrhossi History: low albumin, transaminits, persistent lactate, rv failure LIVER: The liver measures 15.1 cm in length. There is coarse increased echogenicity of the liver parenchyma. There is a very subtle nodular morphology along the liver capsule. No focal hepatic lesions. No intrahepatic ductal dilation is seen. The main portal vein is patent with normal hepatopetal flow measured at 36.6 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 1.8 mm. No stones or sludge are seen. No pericholecystic fluid. The common bile duct measures 1.5 mm in diameter. PANCREAS: The pancreas is not well-visualized due to bowel gas.SPLEEN: The spleen was not visualized due to difficulty with patient positioning.RIGHT KIDNEY: The right kidney measures 10.2 cm in length. The cortex has increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 10.5 cm in length. The cortex has increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.

Output: 1. There is a very subtle nodular appearance to the liver with increased echogenicity which is concerning for possible early cirrhosis. No worrisome masses are seen.2. Bilaterally the kidneys have increased echogenicity which is compatible with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Reason: 79 yo male with CHF and new hyperbilirubinemia Examination somewhat limited by postsurgical changes in anterior abdominal wall.LIVER: The liver measures 14.2 cm in length. The liver parenchymal echotexture is coarse. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating biphasic hepatopetal flow with a velocity of 0.21 m/s. The hepatic veins appear prominent.BILIARY TRACT: The gallbladder is not visualized, and surgical clips in the right upper quadrant on prior chest radiograph suggests that the gallbladder is surgically absent. No intrahepatic biliary ductal dilatation is present. The common bile duct is mildly prominent measuring 8.9 mm in diameter which would not be unexpected status post cholecystectomy.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 9.7 cm in length. RIGHT KIDNEY: Kidney measures 9.8 cm in length. Increased parenchymal echogenicity and cortical thinning. No hydronephrosis.LEFT KIDNEY: Kidney measures 9.7 cm in length. Increased parenchymal echogenicity and cortical thinning. No hydronephrosis.OTHER: Large ascites.

Output: 1.Findings suggestive of elevated right heart pressures.2.Increased hepatic echogenicity suggestive of parenchymal dysfunction which may be due to congestive hepatopathy.3.Large ascites.4.Increased renal echogenicity compatible with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Reason: pre-op bariatric surgery LIVER:The liver measures 16 cm in length. Coarse, echogenic hepatic parenchyma. The portal vein is patent with normal hepatopedal directional flow, peak velocity 31 cm/s. No focal mass.GALLBLADDER, BILIARY TRACT: No significant abnormality noted. No shadowing stones are sludge. The gallbladder wall measures 0.4 cm. The common bile duct measures 0.3 cm. No biliary ductal dilatation.PANCREAS: Obscured by bowel gas.SPLEEN: The spleen measures 8.2 cm in length.KIDNEYS: The right kidney measures 10.9 cm in length. The left kidney measures 10.5 cm in length. Unremarkable renal parenchymal echogenicity and echotexture. No shadowing stones or hydronephrosis. ABDOMINAL AORTA: The proximal aorta measures 2.3 x 2.1 cm, mid aorta 1.9 x 1.7 cm, distal aorta 2.1 x 1.6 cm. The iliac arteries are not visualized.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No ascites.

Output: Coarse, echogenic hepatic parenchyma, consistent with hepatic steatosis or parenchymal dysfunction.


Instruction: Generate impression based on medical findings.

Input: 77-year-old female with recurrent UTIs. RIGHT KIDNEY: 11.9 cm in length. No hydronephrosis or focal lesion.LEFT KIDNEY: 13.37 m in length. No hydronephrosis or focal lesion.URINARY BLADDER: Partially collapsed which limits evaluation.OTHER: No significant abnormalities noted.

Output: No evidence of abscess, stone, or hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Hepatitis C. Evaluate for hepatocellular carcinoma. LIVER: Non-cirrhotic liver morphology. Normal parenchymal echogenicity. No suspicious hepatic lesions. A 9 mm hyperechoic focus in the right hepatic lobe statistically likely represents an hemangioma. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Cholelithiasis. Otherwise unremarkable appearance of the gallbladder. No sonographic Murphy's sign.PANCREAS: No sonographic abnormality evident in the visualized pancreatic head and neck. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney is 10.2 cm in length. The left kidney is 10.9 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 11.0 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites.

Output: 1. 9 mm hyperechoic focus in the right hepatic lobe statistically likely represents an hemangioma. Follow-up ultrasound in 6-12 months is recommended. No suspicious hepatic lesions identified otherwise.2. Cholelithiasis without evidence of cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Nontoxic multinodular goiter. Colloid nodules noted on prior thyroid biopsy. RIGHT LOBE MEASUREMENTS: 4.4 x 1.6 x 1.4 cmLEFT LOBE MEASUREMENTS: 5.5 x 1.5 x 1.0 cmISTHMUS MEASUREMENTS: 0.3 cm in AP dimensionRIGHT LOBE: Unchanged spongiform nodule measuring 10 x 6 x 8 mm.LEFT LOBE: Unchanged heterogeneous nodule measuring 15 x 10 x 12 mm, without suspicious features.ISTHMUS: Unchanged nodule measuring 10 x 13 x 8 mm, without suspicious features.PARATHYROID GLANDS: Not identified.LYMPH NODES: Benign appearance of the identified cervical lymph nodes.OTHER: No significant abnormality noted.

Output: Stable thyroid nodules and cervical lymph nodes.


Instruction: Generate impression based on medical findings.

Input: 30 years Female with left flank pain and dysuria, evaluate for pyelonephritis. RIGHT KIDNEY: Kidney measures 13.4 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 14 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.BLADDER: No significant abnormalities. OTHER: No significant abnormalities.

Output: Normal examination.


Instruction: Generate impression based on medical findings.

Input: 67-year-old female with creatinine of 3.7. Evaluate RIGHT KIDNEY: The right kidney measures 14.1 cm in length and is moderately echogenic.LEFT KIDNEY: The left kidney measures 14.4 cm and is moderately to severely echogenic.BLADDER: Foley catheter noted.

Output: Bilateral echogenic kidneys consistent with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Autoimmune hepatitis with cirrhosis. Evaluate for HCC. LIVER: Nodular liver contour and course echotexture compatible with chronic liver disease. The liver measures 17 cm in craniocaudal dimension. No suspicious focal lesion is identified. Normal hepatopedal portal venous blood flow at 19 cm/s.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation with the common duct measuring 6 mm. Status post cholecystectomy.PANCREAS: The visualized portions of the pancreas are unremarkable. Main hepatic duct is normal in caliber.SPLEEN: The spleen measures 12.1 cm length without a focal lesion.RIGHT KIDNEY: The right kidney measures 9 cm in length with new mild pelviectasis. No shadowing nephrolithiasis. OTHER: The left kidney measures 9.1 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion evident.

Output: 1. Cirrhotic liver without a suspicious lesion evident.2. New mild right-sided pelviectasis.


Instruction: Generate impression based on medical findings.

Input: 21-year-old female with postprandial pain and nausea/vomiting, evaluate for gallstone disease. LIVER: Normal echogenicity of the liver measuring 14.2 cm in length. No focal hepatic lesion. Main portal vein is patent with appropriate directional flow, however with elevated velocity up to 60 cm/s which is nonspecific on this nondedicated exam.GALLBLADDER, BILIARY TRACT: Gallbladder is normal in echogenicity with no evidence of gallstones. No gallbladder wall thickening. No pericholecystic fluid. Sonographic Murphy's sign is negative. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: The visualized portions of the pancreas are normal in echogenicity with no evidence of pancreatic ductal dilatation.RIGHT KIDNEY: Normal echogenicity of the right kidney measuring 11.6 cm in length. No hydronephrosis.OTHER: Normal echogenicity of the left kidney measuring 11.2 cm in length. No hydronephrosis. Normal echogenicity of the spleen measuring 10.2 cm in length.

Output: 1. Elevated main portal vein velocity which is nonspecific on this nondedicated exam. 2. No evidence of cholelithiasis.


Instruction: Generate impression based on medical findings.

Input: Female 18 years old; Reason: new onset hyperthyroidism History: tachycardia, anxiety, ams RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 1.2 x 1.9 x 5.4 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 1.6 x 1.6 x 4.2 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.7 cm.RIGHT LOBE: The right lobe is heavily vascular and heterogeneous. This appears slightly enlarged. No dominant nodules are identifiedLEFT LOBE: The left lobe is also heavily vascular, heterogeneous, and appears slightly enlarged. No dominant nodules are identified.ISTHMUS: The isthmus is heterogeneous, asymmetric, and lobular.LYMPH NODES: No suspicious adenopathy is noted. There is a right level 3 cervical lymph node that measures 0.4 x 1.1 x 2.9 cm. This is hypoechoic, slender, and has a fatty hilum. On the left at level 3/4, another lymph node is identified that is hypoechoic and has a fatty hilum. This measures 0.7 cm x 1.5 cm x 4.2 cm.OTHER: No significant abnormality noted.

Output: The thyroid appears diffusely heterogeneous with increased blood flow consistent with thyroiditis. No dominant nodules are seen. Several benign-appearing lymph nodes but no suspicious adenopathy is identified.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male with worsening renal function. Evaluate size and echogenicity. RIGHT KIDNEY: Measures 11.3 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. The largest right renal cyst measuring 2.1 cm in diameter has a thin septation but no solid component. LEFT KIDNEY: Measures 11.8 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. 2.7 cm exophytic cyst in the mid polar region has a thin septation but no solid component.URINARY BLADDER: Incompletely distended without focal abnormality. OTHER: No significant abnormalities noted.

Output: 1. Increased renal echogenicity consistent with medical renal disease. 2. Minimally complex renal cysts as described above. No nephrolithiasis, hydronephrosis, or suspicious solid lesions.


Instruction: Generate impression based on medical findings.

Input: 65-year-old male with gram-negative rod sepsis. Evaluate for biliary cause. LIVER: The liver is mildly coarse in echogenicity. It is normal in size measuring 15.8 cm in the craniocaudal dimension. No intrahepatic biliary ductal dilatation or focal hepatic lesion is evident. Normal hepatopetal portal venous blood flow at 31 cm/sec.BILIARY TRACT: A normally distended gallbladder is present without wall thickening, or pericholecystic fluid. Evaluation for focal tenderness is limited by the patient's mental status.Minimal sludge and possible non-shadowing gallstone.No extrahepatic biliary ductal dilatation, measuring 4 mm.PANCREAS: The visualized pancreatic body and head are unremarkable. There is mild dilatation of the pancreatic duct, measuring 3 mm. There may be a small amount of peripancreatic fluid posteriorly, correlate with lipase.SPLEEN: The spleen measures 10.2 cm in length without a discrete abnormality.RIGHT KIDNEY: The right kidney measures 11.6 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident.OTHER: The left kidney measures 11.5 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident. Color Doppler demonstrates hilar blood flow.Bilateral pleural effusions are noted.

Output: 1. Biliary sludge and possible gallstone without other specific findings of acute cholecystitis, given the limited evaluation for focal tenderness in the patient's current state.2. Mild pancreatic ductal dilatation and possible peripancreatic fluid. Correlate with lipase.3. No biliary ductal dilatation.4. Bilateral pleural effusions.