Instruction: Generate impression based on medical findings.

Input: 62-year-old female with a history of hyperparathyroidism, evaluate thyroid nodules. RIGHT LOBE MEASUREMENTS: 3.5 x 1.4 x 1.5 cmLEFT LOBE MEASUREMENTS: 3.3 x 1.2 x 1.4 cmISTHMUS MEASUREMENT: 0.2 cmRIGHT LOBE: Heterogeneous, spongiform-appearing, dominant right-sided thyroid nodule without vascular flow measuring 1.6 x 1.2 x 1 cm. No definite microcalcifications. Scattered subcentimeter hypoechoic foci suggestive of colloid cysts.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.LYMPH NODES: Scattered benign-appearing lymph nodes. For reference, right-sided level three lymph node measuring 0.5 x 0.4 x 1.3 cm. Left level two lymph node measures 1.0 x 0.4 x 2.6 cm. Left level three lymph node measures 1.3 x 0.5 x 1.8 cm.OTHER: No significant abnormality noted.

Output: 1. Spongiform-appearing right thyroid nodule suggestive of a colloid nodule. Given its size of greater than 1.5 cm, follow-up is recommended in 6 months or as clinically warranted. 2. No sonographic evidence of a parathyroid adenoma.


Instruction: Generate impression based on medical findings.

Input: Male 43 years old Reason: mass of soft tissue History: mass of soft tissue There is a well-circumscribed 4.6 x 4.5 x 1.9 cm soft tissue mass in the musculature of the right lower back, although nonspecific this lesion may represent an intramuscular myxoma.

Output: Nonspecific benign-appearing intramuscular lesion in the right lower back, which may represent an intramuscular myxoma.


Instruction: Generate impression based on medical findings.

Input: Male 74 years old; evaluate gallbladder and common bile duct. History: History of choledocholithiasis LIVER: The liver is normal in echogenicity and echotexture. No focal hepatic lesions. Hepatic length measures 15.1 cm. The main portal vein is patent with normal hepatopetal flow with a velocity of 28.5 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 2 mm. The common bile duct is dilated up to the level of the pancreatic head, measuring up to 9.5 mm in diameter. No definite evidence of choledocholithiasis. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 11.5 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 9.6 cm with no hydronephrosis. The left kidney measures 8.5 cm with no hydronephrosis. 4.3 x 4.5 x 3.8 cm anechoic focus in the lower pole of the left kidney is compatible with renal cyst.OTHER: No significant ascites.

Output: Dilatation of the common bile duct up to the level of the pancreatic head, without definite sonographic evidence of choledocholithiasis. If there is continued clinical concern, MRI/MRCP can be utilized for further evaluation.


Instruction: Generate impression based on medical findings.

Input: 69-year-old female with acute kidney injury. Reason: Evaluate for hydronephrosis. RIGHT KIDNEY: The right kidney measures 7.6 cm. Echogenic parenchyma without mass, stone or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.2 cm. Echogenic parenchyma without mass, stone or hydronephrosis.OTHER: Bladder is nondistended.

Output: Atrophic right kidney and bilaterally echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone or hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Female 34 years old; Reason: abnormal thyroid function tests History: none RIGHT LOBE MEASUREMENTS: 7.0 x 2.6 x 1.9 cmLEFT LOBE MEASUREMENTS: 4.2 x 1.0 x 0.9 cmISTHMUS MEASUREMENT: 0.2 cmRIGHT LOBE: There are multiple hypoechoic nodules in the right thyroid lobe. The largest measures 10 x 7 mm located in the interpolar midportion of the gland has subtle internal horizontal septations and has imaging features suggestive of spongiform colloid nodule.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.LYMPH NODES: Nonenlarged small perivascular lymph nodes.OTHER: No significant abnormality noted.

Output: 1.Status post partial left thyroid lobe resection. Multiple small right thyroid lobe nodules some with imaging features of colloid nodule.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old. Reason: assess liver morphology History: as above LIVER: Liver measures 15.9 cm in length. Coarse hepatic parenchymal echotexture is present. No focal mass or ascites. Main portal vein is patent with a normal direction of flow.BILIARY TRACT: Common bile duct measures 4 mm. Gallbladder is unremarkable. No biliary ductal dilatation.PANCREAS: The visualized portion of the pancreas is unremarkable. The distal body and tail are obscured by overlying bowel gas.SPLEEN: The spleen measures 11.7 cm in length with normal echotexture.RIGHT KIDNEY: Right kidney measures 11.2 cm in length with normal cortical echogenicity. No hydronephrosis, shadowing calculi, or mass. OTHER: Left kidney measures 12.4 cm in length with normal cortical echogenicity. No hydronephrosis, shadowing calculi, or mass.

Output: Coarse hepatic parenchyma suggests parenchymal dysfunction/fatty infiltration. No suspicious hepatic mass or biliary ductal dilatation.


Instruction: Generate impression based on medical findings.

Input: Male 25 years old Reason: ? cholecystitis History: RUQ pain LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 17 cm in length. The parenchyma is normal in echotexture . No suspicious hepatic lesions. Main portal vein is patent.BILIARY TRACT: No cholelithiasis. Trace sludge. Wall measures 2 mm in thickness. No pericholecystic fluid. Common duct measures 3 mm. PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 11.9 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 12.1 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 11.6 cm. in length. OTHER: No significant abnormalities noted.

Output: 1.No sonographic findings of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Male 51 years old Reason: Evaluate for biliary obstruction, duodenal obstruction, CT showed Common bile duct and gallbladder obstruction History: hyperbilirubinemia, dilated gallbladder and LIMITED ABDOMENBILIARY TRACT: The gallbladder contains layering sludge. Wall is mildly thickened measuring 5 mm, nonspecific. Negative sonographic Murphy sign. Common duct measures 6 mm. OTHER: Moderate abdominopelvic ascites is present better appreciated on recent CT.

Output: Gallbladder sludge with negative sonographic Murphy sign. Mild gallbladder wall thickening may be due to the presence of ascites or low osmotic state.


Instruction: Generate impression based on medical findings.

Input: 74 year old female with AKI. Evaluate flow, hydronephrosis RIGHT KIDNEY: The right kidney measures 10.7 cm in length. The cortex is increased in echogenicity. No shadowing calculi or hydronephrosis is present. Benign appearing cyst is noted and measures 1.0 cm x 1.0 cm x 0.7 cm. LEFT KIDNEY: The left kidney measures 8.5 cm in length. The cortex is increased in echogenicity. No shadowing calculi or hydronephrosis is present. URINARY BLADDER: Foley catheter in a decompressed bladder limits evaluation.OTHER: No significant abnormalities noted.

Output: Increased echogenicity of the kidneys suggestive of parenchymal dysfunction. No obstruction. Benign appearing right renal cyst.


Instruction: Generate impression based on medical findings.

Input: Reason: masses, nodes History: thyroid s/p surgery RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE BED: There are multiple subcentimeter hypoechoic lesions within the right thyroid bed. The largest measures 0.4 x 0.3 x 0.4 cm. This may represent residual thyroid tissue however cannot definitively exclude neoplastic process.LEFT LOBE BED: There is a hypoechoic, vascular lesion within the left thyroid bed which measures 0.6 x 0.6 x 0.7 cm. This lesion is suspicious for recurrence.ISTHMUS BED: No focal lesions.PARATHYROID GLANDS: Status post parathyroidectomy.LYMPH NODES: There is a 1.7 x 1.1 x 2.4 cm lymph node within the left lateral neck. Although no definite fatty hilum is visualized, this node appears to be benign.OTHER: No significant abnormality noted.

Output: 1. Status post thyroidectomy. There is a lesion within the left thyroid bed which appears suspicious for recurrence. Will biopsy later today.2. Several hypoechoic lesions are noted within the right thyroid bed. While these may represent residual thyroid tissue foci, recommend special attention on future surveillance scans.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o cholecystitis and lithiasis, eval R kidney for hydro History: ruq and r flank pain; history of left kidney removal LIVER: Liver measures 12.8 cm with normal echogenicity. Portal vein is patent with normal direction and velocity of 0.26 m/s. No suspicious hepatic mass is noted.BILIARY TRACT: Common bile duct measures 2-3 mm. Gallbladder wall measures 1.4 mm. No pericholecystic fluid collection. No gallstones noted.PANCREAS: Distal pancreas is obscured by overlying bowel gas. Visualized part is within normal limits.SPLEEN: Spleen measures point cm and is normal in echogenicity and configuration.KIDNEYS: Right kidney measures 14 cm with normal echogenicity and without hydronephrosis. No renal calculi identified. OTHER: No significant abnormalities noted.

Output: 1.Normal-appearing liver and gallbladder without cholelithiasis.2.Normal-appearing right kidney without hydronephrosis or renal calculi.


Instruction: Generate impression based on medical findings.

Input: Female 37 days old Reason: Assessment for pseudoobstruction History: Poor stoma output in a patient with megacystis microcolon hypoperistalsis syndrome.EXAMINATION: MR enterography without IV contrast 7/23/2015 A gastrostomy tube is in place. The proximal portions of small bowel in the right upper quadrant demonstrated robust peristalsis; however, the loop of bowel just proximal to the stoma appears patulous, featureless and demonstrates little to no peristalsis.Grade 2 left and grade 1 right hydronephrosis is noted, appearing similar to the prior sonographic exam. The urinary bladder was initially noted to be moderately/markedly dilated, extending into the left lower and left upper quadrants, abutting the stomach. Following cannulation, the bladder was decompressed.

Output: 1.Patulous, featureless, aperistaltic bowel seen just proximal to the stoma with robust peristalsis seen in the proximal portions of the small bowel.2.Grade 2 left and grade 1 right hydronephrosis, similar to the prior exam.3.Moderate/markedly dilated urinary bladder, decompressed after a catheter placement.


Instruction: Generate impression based on medical findings.

Input: 72-year-old female Reason: right sides nodules; compare to 2011 History: right sides nodules; compare to 2011 RIGHT LOBE MEASUREMENTS: 9.5 x 5.6 x 6.0 cm previously measured 5.6 x 5.6 x 0.1 cm.LEFT LOBE MEASUREMENTS: Status post partial thyroidectomy.ISTHMUS MEASUREMENTS: Status post partial thyroidectomy.RIGHT LOBE: The right thyroid gland appears diffusely heterogeneous. However, no discrete right thyroid nodule is identified.LEFT LOBE: In the area of the left surgical bed is diffusely heterogenous thyroid tissue without a discrete thyroid nodule identified. This measures approximately 6.3 x 3.0 x 3.3 cm, previously appeared to be a subcentimeter nodule and appears to have increased in size when compared to the prior exam. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval increase in size of diffusely heterogeneous thyroid gland with no discrete nodule identified.


Instruction: Generate impression based on medical findings.

Input: Male 41 years old; Reason: 41yo M w/ ESRD, evaluate for etiology History: as above RIGHT KIDNEY: The right kidney measures 11.3 cm in length. The cortex is of increased echogenicity. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 10.7 cm in length. The cortex is of increased echogenicity. No shadowing calculi or hydronephrosis is present. URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.

Output: 1.Echogenic kidneys bilaterally without evidence of nephrolithiasis or hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old. Reason: please evaluate incidental finding of thyroid mass on recent CT scan in patient with metastatic pancreatic neuroendocrine tumor History: thyroid mass RIGHT LOBE MEASUREMENTS: 4.4 x 1.3 x 1.3 cmLEFT LOBE MEASUREMENTS: 3.6 x 1.1 x 1.5 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: 0.2 x 0.3 x 0.4 cm hypoechoic right isthmic nodule.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Subcentimeter hypoechoic right isthmic nodule. No regional adenopathy.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male 64 years old Reason: tense ascites, AKI, evaluate for cirrhosis, evaluate kidneys for hydronephrosis Suboptimal exam secondary to patient's difficulty breath-holding and lying flat secondary to shortness of breath.LIVER: Liver measures 16.9 cm in length. The parenchyma is increased in echogenicity. Nodular hepatic contour, suggestive of underlying cirrhosis. No focal liver lesion delineated. Patent main portal vein with normal direction of flow, velocity decreased, measuring 10 cm/sec. BILIARY TRACT: Gallbladder not definitely seen, correlation with patient's surgical history recommended. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Not well seen due to overlying bowel gas.KIDNEYS: The right kidney measures 9.7 cm. The left kidney measures 10.9 cm. Left renal cyst measuring up to 2.1 cm. No hydronephrosis. Increased renal cortical echogenicity. SPLEEN: The spleen measures 12.6 cm. in length. ABDOMINAL AORTA AND INFERIOR VENA CAVA: IVC not well seen due to adjacent bowel gas. Visualized proximal abdominal aorta measures up to 1.4 cm. OTHER: Incompletely imaged ascites and bilateral pleural effusion formation. Visualized bladder unremarkable.

Output: 1. Suboptimal exam secondary to patient's difficulty breath-holding and lying flat secondary to shortness of breath.2. Liver parenchyma increased in echogenicity, likely reflecting underlying parenchymal dysfunction/hepatic steatosis. Nodular hepatic contour, suggestive of underlying cirrhosis. Decreased portal vein velocity. 3. Increased renal cortical echogenicity, consisted with medical renal disease.4. Incompletely imaged ascites and pleural effusion formation.


Instruction: Generate impression based on medical findings.

Input: Heart failure; please evaluate abdominal aorta and IVC Examination severely technically limited due to overlying gas. Only the proximal IVC and abdominal aorta could be visualized which were both patent. The mid and distal aorta and IVC could not be visualized.

Output: Examination severely technically limited due to overlying gas. Only the proximal IVC and abdominal aorta could be visualized which were both patent. The mid and distal aorta and IVC could not be visualized.


Instruction: Generate impression based on medical findings.

Input: Male 52 years old Reason: assess for abnormalities in liver, biliary tree History: h/o hep C and possible cirrhosis LIMITED ABDOMENLIVER: The liver has a nodular contour with widened fissures. Liver measures 19 cm in length. The parenchyma is moderately coarse and echogenic . No focal hepatic lesions. Portal vein is patent with normal direction of flow.BILIARY TRACT: The gallbladder has echogenic calculi with posterior acoustic shadowing. Wall measures 3 mm in thickness. Trace pericholecystic fluid/ascites. Common duct measures 6 mm. PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 10.4 cm. The cortex is thinned and mildly echogenic. No shadowing calculi or hydronephrosis is present. The left kidney measures 11.9 cm. The cortex is thinned and mildly echogenic. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 15.1 cm. in length. OTHER: Trace upper abdominal ascites.

Output: 1.Cirrhotic liver without focal hepatic mass and patent portal vein.2.Cholelithiasis without specific evidence of acute cholecystitis.3.Splenomegaly and trace upper abdominal ascites suggests portal hypertension4.No hydronephrosis


Instruction: Generate impression based on medical findings.

Input: Male 60 years old Reason: Eval for cholecystitis History: CT with e/o fat stranding around gallbladder, hard to correlate clinically 2/2 habitus and vague pain LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 17.3 cm in length. The parenchyma is normal in echotexture. No focal lesion is identified. The portal vein is patent.BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 6 mm in thickness. The common bile duct measures 4 mm. Murphy's sign is negative.

Output: Gallbladder wall thickening, with no stones and negative Murphy's sign. No evidence for acute inflammation or ductal dilatation. Gallbladder thickening may be related to fluid status,


Instruction: Generate impression based on medical findings.

Input: Female 49 years old; Reason: r/o adenopathy, recurrence History: h/o thyroid cancer. Following some small thyroid bed lesions. 1 year follow up study RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENT: Status post thyroidectomy.RIGHT LOBE: No evidence of residual thyroid or recurrent disease.LEFT LOBE: Again seen are several small hypoechoic foci in the thyroid bed with no significant change in morphology and size as compared to the prior exam. The inferior thyroid bed hypoechoic area measures 0.5 x 0.2 cm on long axis, with difficulty obtaining measurement on transverse axis, previously 0.4 x 0.2 x 0.6 cm. The mid thyroid bed hypoechoic focus measures 0.4 x 0.2 cm with difficulty obtaining transverse measurement, previously 0.4 x 0.5 x 0.2 cm. The superior hypoechoic focus measures 0.3 x 0.2 x 0.3 cm, previously 0.2 x 0.2 x 0.3 cm.ISTHMUS: Status post thyroidectomy with no residual thyroid or recurrent disease.LYMPH NODES: No regional lymphadenopathy. Bilateral morphologically benign appearing lymph nodes are noted.OTHER: No significant abnormality noted.

Output: No interval change in small hypoechoic foci in left thyroid bed with no other evidence of residual thyroid or recurrent disease.


Instruction: Generate impression based on medical findings.

Input: Male 73 years old Reason: stones History: stones RIGHT KIDNEY: The right kidney measures 9.9 cm. No shadowing calculi or hydronephrosis is present. Renal cortical scarring. No perinephric free fluid. LEFT KIDNEY: The left kidney measures 11.6 cm. Located in lower pole is an echogenic focus measuring 1 x 0.8 0.4 cm with corresponding clinical artifact and mild posterior acoustic shadowing seen. Renal cortical scarring. No perinephric free fluid.BLADDER: Visualized portions unremarkable. OTHER: Prominent prostate measuring 4.9 x 4.6 x 4 cm.

Output: Nonobstructing left intrarenal lower pole calculus (may correspond to same stone seen on prior exam). No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Male 34 years old Reason: LVAD workup History: LVAD workup Patient unable to move into decubitus position.LIVER: Mild hepatomegaly, liver measures 18.5 cm in length. The parenchyma is coarse in echotexture, no suspicious lesion delineated. Main portal vein patent with normal directional flow, velocity measures 29 cm/s. Prominent IVC and hepatic veins, may be due in part to underlying right-sided heart failure. BILIARY TRACT: Gallbladder unremarkable. No significant gallbladder distention, wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Not well seen in entirety due to overlying bowel gas.KIDNEYS: The right kidney measures 9 cm. The left kidney measures 10.5 cm. Increased renal parenchymal echogenicity. SPLEEN: The spleen measures 11.7 cm. in length. OTHER: Proximally abdominal aorta measures up to 1.8 cm in AP dimension by 1.8 cm in transverse dimension, at midportion measures up to 1.8 cm in AP dimension by 1.8 cm in transverse dimension, and distally measures up to 1.8 cm in AP dimension by 1.7 cm in transverse dimension. Common iliac arteries measure 1.6 cm and 1.6 cm on left and right, respectively. Peak systolic velocity in aorta measures 117 cm/s. Visualized IVC unremarkable. Visualized portions of bladder unremarkable given underdistended state.

Output: Vascular measurements as above.Mild hepatomegaly. Coarse liver parenchymal echotexture, no suspicious lesion delineated.Increased renal cortical echogenicity consistent with underlying medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Female 76 years old Reason: neutropenic pt w/ RUQ pain, please eval for hepatic/gallbladder abnormality History: RUQ pain, neutropenic LIMITED ABDOMENLIVER: The liver measures 11.8 cm in length. Mildly echogenic liver parenchyma. No focal hepatic lesions. The portal vein is patent with normal directional flow.BILIARY TRACT: The common bile duct measures 10 mm in diameter with possible echogenic filling defect; incompletely characterized. No intrahepatic biliary ductal dilation. No evidence of cholelithiasis. The gallbladder wall is normal thickness without pericholecystic fluid.PANCREAS: No significant abnormality noted.KIDNEYS: Right kidney measures 9.1 cm. Small upper pole cyst measures up to 0.9 cm. The left kidney measures 9.3 cm. No hydronephrosis.SPLEEN: The spleen measures 6.7 cm.OTHER: No significant abnormalities noted.

Output: 1.Dilated common bile duct measures 10 mm with possible intraluminal filling defect; incompletely characterized. MRCP is suggested for further evaluation. 2.Hepatic lesions on CT are not evident on current ultrasound.


Instruction: Generate impression based on medical findings.

Input: Female 40 years old Reason: Follow up of previous fluid collections History: Pain in lower abd LIMITED ABDOMENDecreased size of fluid collections, with only 2 of the previous collections now identified within the edematous subcutaneous tissue. The largest is located on the right along an abdominal scar and measures 1.8 x 0.3 x 2.8 cm, previously 10.0 x 1.2 x 5.2 cm. Within the left subcutaneous tissue, a fluid collection measures 0.7 x 0.2 x 0.5 cm, previously 0.9 x 0.6 x 1.0 cm.

Output: Decreased size and number of simple fluid collections within mildly edematous abdominal subcutaneous tissue.


Instruction: Generate impression based on medical findings.

Input: 51-year-old male, assess liver for ascites History: increased abdominal girth. Decreased appetite. Cirrhotic morphology of the liver is again visualized. Anechoic foci within the right lobe of the liver are compatible with hepatic cysts. Large volume ascites is visualized in all 4 quadrants of the abdomen.

Output: Large volume intra-abdominal ascites.


Instruction: Generate impression based on medical findings.

Input: Abdominal pain. Evaluate for gallstones or cholecystitis. LIVER: Hepatomegaly with the liver measuring 20.0 cm in length. There is mildly increased hepatic parenchymal echotexture which is most commonly seen in hepatic steatosis. No focal mass lesion is identified. The portal vein is patent with adequate flow and a velocity of 29 cm/s.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended. No gallbladder wall thickening or pericholecystic fluid. No gallstones are identified. No intrahepatic or extrahepatic biliary ductal dilatation. The common bile duct measures 3 mm in diameter.PANCREAS: Poorly visualized due to overlying bowel gas.RIGHT KIDNEY: Right kidney measures 12.1 cm in length. There aren't stable superior and inferior pole simple cysts measuring up to 1.6 cm in diameter. The renal parenchyma is echogenic compatible with chronic parenchymal dysfunction.OTHER: Evaluation of the spleen and left kidney is limited by the limited due to positioning the patient. The spleen measures 10.1 cm in length.

Output: 1. Hepatomegaly. There is diffusely increased hepatic parenchymal echotexture most commonly seen in hepatic steatosis.2. No cholelithiasis or evidence of cholecystitis.3. Echogenic renal parenchyma compatible with chronic parenchymal dysfunction.


Instruction: Generate impression based on medical findings.

Input: Reason: Goiter? History: Hypothyroidism RIGHT LOBE MEASUREMENTS: 4.4 x 1.1 x 1.2 cm.LEFT LOBE MEASUREMENTS: 4.5 x 1.2 x 1.8 cm.ISTHMUS MEASUREMENTS: 0.3 cm.RIGHT LOBE: Mildly heterogeneous gland with increased vascularity. No discrete nodule is identified.LEFT LOBE: Mildly heterogeneous gland with increased vascularity. No discrete nodule is identified.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Right level 2 lymph node measuring 0.7 x 0.3 x 1.4 cm with normal fatty hilum.OTHER: No significant abnormality noted.

Output: Mildly heterogeneous gland with increased vascularity. These findings may be compatible with thyroiditis. No discrete nodule is identified.


Instruction: Generate impression based on medical findings.

Input: Right upper quadrant pain. Rule out cholangitis. LIVER: There is upper limit normal in size measuring 17.6 cm in length. The parenchymal echotexture is mildly increased compatible with hepatic steatosis. No focal parenchymal lesion. The portal vein is patent with normal hepatopedal flow measuring 23 cm/s.GALLBLADDER, BILIARY TRACT: There is prominent circumferential gallbladder wall thickening measuring 6.9 mm. The gallbladder however is nondistended, there are no stones, no pericholecystic fluid, and the sonographic Murphy sign is negative. This gallbladder wall thickening is nonspecific and can be seen in recent IV hydration, adjacent hepatic dysfunction, or edematous states.No intrahepatic or extrahepatic biliary ductal dilatation. The common duct measures 5 mm in diameter.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Kidneys normal in size measuring 11.9 cm in length. No hydronephrosis.LEFT KIDNEY: Left kidney is normal in size measuring 12.4 cm in length. No hydronephrosis.OTHER: The spleen is normal in size measuring 10.6 cm in length.

Output: 1.Gallbladder wall thickening as described. This is nonspecific and can be seen in recent IV hydration, adjacent hepatic dysfunction, or edematous states. If there is clinical concern for acalculus cholecystitis, a nuclear medicine HIDA scan can be considered.2.Hepatic steatosis


Instruction: Generate impression based on medical findings.

Input: Male 91 years old Reason: asses for cholecystitis, choledocholithiasis History: as above LIMITED ABDOMENLIVER: There is intrahepatic biliary ductal dilatation, similar to recent CT. Liver measures 15.4 cm in length. The parenchyma is normal in echotexture.BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 7 mm in thickness. There is small volume of pericholecystic fluid. There is a positive Murphy's sign.PANCREAS: Only part of the pancreatic head is visualized, and appears normal. The remaining pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 10.9 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. A right lower pole cyst measures 2.1 x 2.2 x 1.4 cm.The left kidney is partially obscured, due to patient positioning/anatomy. The cortex is echogenic. No shadowing calculi or hydronephrosis is present.SPLEEN: The spleen measures 10 cm in length. OTHER: No significant abnormalities noted.

Output: 1.Gallbladder wall thickening with small volume pericholecystic fluid and positive Murphy's sign, compatible with acute acalculus cholecystitis.2.Echogenic kidneys, probably medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate left axillary mass. Sonographic evaluation of the left axilla demonstrates 2 lymph nodes. The superficial lymph node measures 2.1 x 0.8 x 2.2 cm and demonstrates an echogenic center suggestive of fatty hilum, likely reflecting a reactive etiology. Posterior to the enlarged lymph node is a small lymph node with normal morphology.

Output: Enlarged left axillary lymph node with fatty hilum, suggestive of reactive etiology.


Instruction: Generate impression based on medical findings.

Input: 56-year-old man with history of liver failure, now with acute respiratory distress syndrome. LIVER: Cirrhotic morphology of the liver. A hypoechoic round structure within the left lobe of the liver measures 1.8 x 1.7 x 1.6 cm and contains no internal septations, debris or calcifications. No focal hepatic lesion or mass. The liver measures 14.6 cm in length. The portal vein is not optimally evaluated but appears grossly patent. The main portal vein shows normal hepatopedal flow direction with flow velocity of 25 cm/s. There is mildly pulsatile portal venous flow.GALLBLADDER, BILIARY TRACT: A small amount of sludge is seen within the gallbladder. No cholelithiasis. The gallbladder wall is normal in appearance, measuring 0.4 cm in thickness. No dilatation or cystic changes are noted of the intrahepatic or extrahepatic biliary ducts. The common bile duct measures 0.3 cm in diameter. No choledocholithiasis.PANCREAS: The pancreas is not visualized due to bowel gas.RIGHT KIDNEY: The right kidney measures 12.5 cm in length and shows normal echotexture. No mass, stone or hydronephrosis.LEFT KIDNEY: The left kidney measures 12.6 cm in length and shows normal echotexture. No mass, stone or hydronephrosis.SPLEEN: The spleen is normal in echogenicity and measures 16.2 cm in length. OTHER: Large volume ascites. Bilateral pleural effusions.

Output: 1.Cirrhotic morphology of the liver with large volume ascites. Normal hepatopedal flow, waveform and velocity in the main portal vein. Evaluation of the portal vein is slightly limited by patient positioning. If there is continued clinical concern, CT could be considered.2.Bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 67-year-old female, evaluate for renal failure. RIGHT KIDNEY: The right kidney is slightly echogenic and measures 9.0 cm in length. Corticomedullary differentiation is maintained. No shadowing calculi or hydronephrosis is present.LEFT KIDNEY: The left kidney is not well-visualized, however, no gross hydronephrosis is identified.URINARY BLADDER: The visualized portion of the urinary bladder is unremarkable.OTHER: Large volume of ascites.

Output: 1.Slightly echogenic right kidney suggestive of medical renal disease. The left kidney is not well-visualized, however, no gross hydronephrosis is identified.2.Large volume of ascites.


Instruction: Generate impression based on medical findings.

Input: Female 56 years old with fevers, evaluate for acalculous cholecystitis LIVER: Mild increase in hepatic parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions. Hepatic length measures 17.4 cm. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of 20 cm/s. GALLBLADDER/BILIARY TRACT: Gallbladder is not visualized. The common bile duct measures 2 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen is not well visualized.KIDNEYS: The right kidney is not well visualized, however, there appears to be asymmetric scarring. The right kidney length is approximately 11.2 cm. Normal vascular flow is present. The left kidney measures 11.1 cm with normal vascular flow and corticomedullary differentiation. OTHER: No significant abnormality noted.

Output: 1. Gallbladder is not visualized.2. Suboptimal evaluation of the right kidney with apparent asymmetric scarring. No evidence of hydronephrosis or calculi.3. Mild increase in hepatic parenchymal echogenicity with coarsened echotexture consistent with fatty liver/hepatic parenchymal dysfunction. No hepatic mass or ductal dilatation identified.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male presents with UTI and concern for outlet obstruction. RIGHT KIDNEY: The right kidney measures 11 cm in length. Corticomedullary differentiation is maintained. No shadowing calculi or hydronephrosis is present.LEFT KIDNEY: The left kidney measures 12 cm in length. Corticomedullary differentiation is maintained. No shadowing calculi or hydronephrosis is present.URINARY BLADDER: The visualized portions of the urinary bladder are unremarkable. Prior to voiding the bladder volume was approximately 71 mL. Post-void urinary bladder volume was 4 mL. OTHER: Partially visualized mild prostatomegaly.

Output: No significant post-void residual.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old. Reason: Rule out recurrence. History: h/o thyroid cancer RIGHT LOBE MEASUREMENTS: Status post thyroidectomyLEFT LOBE MEASUREMENTS: Status post thyroidectomyISTHMUS MEASUREMENTS: Status post thyroidectomyRIGHT LOBE: Status post thyroidectomy without evidence of recurrent or residual disease.LEFT LOBE: Status post thyroidectomy without evidence of recurrent or residual disease.ISTHMUS: Status post thyroidectomy without evidence of recurrent or residual disease.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No regional lymphadenopathy.OTHER: No significant abnormality noted.

Output: Status post thyroidectomy without evidence of recurrent or residual disease.


Instruction: Generate impression based on medical findings.

Input: Female 70 years old Reason: HCC on CT abdomen with known cirrhosis History: HCC on CT abdomen with known cirrhosis LIMITED ABDOMENLIVER: Slightly coarsened echotexture. No focal hepatic lesion.BILIARY TRACT: Status post cholecystectomy. Intra and extrahepatic biliary dilatation. The common duct measures up to 1.5 cm and is dilated all the way to the pancreatic head.PANCREAS: Visualized portions of pancreas are unremarkable. No obvious pancreatic head mass is seen.KIDNEYS: Both kidneys are atrophic with no obvious hydronephrosis of the left kidney. Right kidney is difficult to visualize. SPLEEN: The spleen is atrophic.OTHER: No significant abnormalities noted.

Output: 1.Slightly coarsened hepatic echotexture likely related to known cirrhosis. No focal hepatic lesion.2.Intra and extrahepatic biliary dilatation with no obvious mass or stone. While this may be related to cholecystectomy, if there is clinical concern, MRI/ MRCP can be performed to further evaluate the biliary dilatation.


Instruction: Generate impression based on medical findings.

Input: 69-year-old female monitoring prior thyroid nodules RIGHT LOBE MEASUREMENTS: The right lobe measures 2.2 cm x 1.9 cm.LEFT LOBE MEASUREMENTS: The left lobe measures 2 cm x 1.6 cm.ISTHMUS MEASUREMENTS: The isthmus measures 0.3 cm.RIGHT LOBE: There is a nodule noted in the right superior thyroid that measures 0.8 cm x 0.7 cm and the spongiform in appearance. Additionally, there is a second nodule in the right mid thyroid that measures 0.5 cm x 0.3 cm and is primarily cystic. There is a very small hypoechoic nodule in the right inferior thyroid.LEFT LOBE: There is a nodule in the left superior thyroid measures 0.9 x 0.5 cm and is partially cystic.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There is a benign-appearing lymph node at level 1B. This measures 0.7 cm x 0.4 cm. No suspicious adenopathy is noted

Output: Findings as above, accounting for differences in technique this exam is unchanged from prior exam in 2014.


Instruction: Generate impression based on medical findings.

Input: History of HCV, surveillance for HCC LIVER: Liver measures 19.5 cm with coarse echogenicity. Portal vein is patent with normal direction and velocity of 0.3 m/s. No suspicious hepatic mass is noted.BILIARY TRACT: Common bile duct measures 4 mm. Patient is status post cholecystectomy.PANCREAS: Distal pancreas is obscured by overlying bowel gas. Visualized part is within normal limits.SPLEEN: Spleen measures 12.6 cm and is normal in echogenicity and configuration.KIDNEYS: Right kidney measures 11.5 cm with normal echogenicity and without hydronephrosis. Left kidney measures 11.5 cm with normal echogenicity and without hydronephrosis. No renal calculi identified. OTHER: No significant abnormalities noted.

Output: Coarse echotexture of the liver with hepatomegaly consistent with chronic hepatitis. No suspicious lesion.


Instruction: Generate impression based on medical findings.

Input: Female 60 years old; Reason: rule out thyroid nodule History: none RIGHT LOBE MEASUREMENTS: 5.1 x 1.7 x 1.8 cmLEFT LOBE MEASUREMENTS: 5.0 x 1.8 x 1.9 cmISTHMUS MEASUREMENT: 6 mmRIGHT LOBE: Heterogeneous right thyroid gland, with several small nodules. The largest nodule is located within the right upper pole, and measures 1.2 x 0.7 x 0.9 cm, with spongiform appearance, without associated calcification or vascularity. LEFT LOBE: Heterogeneous left thyroid gland, with several small nodules. The largest nodule is located within the left mid pole, and measures 0.9 x 0.6 x 0.7 cm, with spongiform appearance, without associated calcification or vascularity.ISTHMUS: There is a 1.4 x 1.2 x 0.8 cm nodule within the isthmus, without associated vascularity or calcification.LYMPH NODES: Right level 2 lymph node measures 1.1 x 1.0 x 0.4 cm, with normal morphology.OTHER: No significant abnormality noted.

Output: Few benign-appearing thyroid nodules. No suspicious thyroid nodule or regional adenopathy.


Instruction: Generate impression based on medical findings.

Input: 42-year-old female. Dr. reports fullness in lower outer quadrant. Patient reports right 9 o'clock lump x 1 month. Personal history of carcinoid syndrome. Three standard views of both breasts and additional spot compression ML and CC 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. Triangular marker denoting area of palpable abnormality was placed over the right 9 o'clock posterior depth. No underlying mammographic abnormality seen on full field or spot compression views. Focal asymmetry in the left upper outer quadrant persists on spot compression views.No suspicious microcalcifications in either breast. BILATERAL SONOGRAPHIC

Output: Focal asymmetry in the left upper outer quadrant, which persists on spot compression views. No sonographic correlate identified. Comparison with prior outside examinations is recommended to document stability. Results and recommendations were discussed with the patient. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: O - Old Study For Comparison.


Instruction: Generate impression based on medical findings.

Input: Female 76 years old; Reason: follow up on size of the renal cyst History: no hematuria RIGHT KIDNEY: The right kidney measures 11 cm in length. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 12 cm in length. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. Redemonstrated exophytic 12.8 x 8.4 x 9.7 cm predominantly anechoic cyst in the left kidney with no definite nodularity. There may be a thin septation.URINARY BLADDER: UnremarkableOTHER: No significant abnormalities noted.

Output: 1.Slight interval increase in size of minimally complex cyst. Otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Post LVAD. Evaluate for fluid collection at abdominal incision. Few heterogeneous epigastric collections are identified left of midline within the subcutaneous tissues, with no internal flow on color Doppler imaging. The two largest collections measure up to 6.5 x 2.2 x 8.2 cm and 5.7 x 4.1 x 6.8 cm.

Output: Few heterogeneous collections along the epigastric incision, probably hematomas/postprocedural collections. No surrounding hypervascularity but superimposed infection not excluded, correlate with patient's clinical history/laboratory values.


Instruction: Generate impression based on medical findings.

Input: Male 71 years old Reason: elevated liver enzymes History: elevated liver enzymes LIMITED ABDOMENLIVER: Numerous echogenic hepatic masses compatible with known metastatic disease. BILIARY TRACT: No biliary dilatation. No gallbladder wall thickening or pericholecystic fluid.PANCREAS: KIDNEYS: The right kidney is not visualized.The left kidney measures 14 cm. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 7 cm. in length. OTHER: No significant abnormalities noted.

Output: 1.Known hepatic metastatic disease without biliary dilatation.


Instruction: Generate impression based on medical findings.

Input: Female 64 years old Reason: Evaluate biliary ducts. History of cholecystectomy. Elevated bilirubin. LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 17.5 cm in length. The parenchyma is normal in echotexture. BILIARY TRACT: There is intrahepatic biliary ductal dilatation, with no obstructing stone identified. The common bile duct measures 14 mm. The gallbladder is surgically absent.PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 13.5 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 13.7 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 9.6 cm in length, and is normal in appearance.OTHER: No significant abnormalities noted.

Output: Postcholecystectomy with nonspecific intra and extrahepatic biliary ductal dilatation. No obstructing stone is identified. MRCP is recommended for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Female 81 years old; Reason: 81 y.o. F with a history of Right thyroid nodule. Please a History: thyroid nodule RIGHT LOBE MEASUREMENTS: 5.6 x 1.4 x 1.8 cmLEFT LOBE MEASUREMENTS: 4.5 x 1.4 x 1.6 cmISTHMUS MEASUREMENT: 0.1 cmRIGHT LOBE: In the midpole of the right thyroid lobe there is a mostly solid mildly hypoechoic nodule measuring 1.8 x 1.5 x 0.9 cm; previously, 1.7 x 1.3 x 1.1 cm.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.LYMPH NODES: No enlarged cervical lymphadenopathy.OTHER: No significant abnormality noted.

Output: 1.No significant change in the right thyroid nodule.


Instruction: Generate impression based on medical findings.

Input: 19-year-old female with hypertension. KIDNEYS  Cortical Echogenicity: Normal   Medullary Echogenicity: Normal   Pelvicaliceal System -- SFU Grade*  Right: 0 Left: 0  Length*** Right: 11.4 cm Left: 10.5 cm   Mean for age: 11 cm  Range for age: 8.0 - 13.5 cmADDITIONAL OBSERVATIONS: None.

Output: Normal examination of the kidneys.*SFU grading system: Grade: 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: Male 22 years old Reason: NAFLD. Eval liver to rule out lesions and masses History: LIVER: The liver measures 20.2 cm in length and demonstrates increased parenchymal echogenicity. No intrahepatic or extrahepatic biliary ductal dilatation is evident and no focal mass lesions are seen. The main portal vein is patent and demonstrates hepatopedal flow with a velocity of 0.3 m/s. GALLBLADDER, BILIARY TRACT: No cholelithiasis or choledocholithiasis is seen. The common duct measures 0.3 cm in diameter. PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 9.6 cm in length and demonstrates normal parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.LEFT KIDNEY: The left kidney measures 10.0 cm in length and demonstrates normal parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.SPLEEN: The spleen measures 12.3 cm in length.OTHER: No significant abnormalities noted.

Output: Increased but appreciable echogenicity consistent with hepatic steatosis and/or chronic liver disease.


Instruction: Generate impression based on medical findings.

Input: Female 77 years old Reason: hyperbilirubinemia, evidence of liver dz? Biliary obstruction? History: hyperbilirubinemia Limited examination secondary to patient ability to follow instructions. Within these limitations, the finding observations are made: LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 18.2 cm in length. The parenchyma is mildly echogenic . Portal flow is hepatopedal.BILIARY TRACT: The gallbladder has echogenic calculi with posterior acoustic shadowing. Wall measures 5 mm in thickness. Common duct measures 3 mm.PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 10.4 cm. The cortex is incompletely evaluated on this exam. No shadowing calculi or hydronephrosis is present. The left kidney was not visualized on this examination. SPLEEN: The spleen measures 9.4 cm. in length. OTHER: Bilateral pleural effusions and ascites.

Output: 1.Severely limited examination without specific evidence of intrahepatic biliary ductal dilation. Echogenic liver may be sequelae of steatosis.2.Cholelithiasis without specific findings of cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Male 55 years old Reason: pt has AKI in setting of ventricular failure on LVAD support, r/u any intrinsic issues History: elevated cr RIGHT KIDNEY: The right kidney measures 11.0 cm. There is mild increased renal cortical echogenicity which likely reflects medical renal disease. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 11.8 cm. There is mild increased renal cortical echogenicity which likely reflect medical renal disease. No shadowing calculi or hydronephrosis is present. BLADDER: No significant abnormality.OTHER: No significant abnormalities noted.

Output: Bilateral mild increased renal cortical echogenicity may reflect medical renal disease. No hydronephrosis or shadowing renal calculi.


Instruction: Generate impression based on medical findings.

Input: Persistent wrist pain following surgery. Evaluate dorsal extensor tendons, left wrist. The patient indicates pain along the dorsal aspect of her wrist extending toward the MCP joints, with her pain most notable at the second MCP joint. The dorsal extensor tendons were evaluated from the proximal margin of the patient's dorsal wrist/forearm scar (when applicable) to the MCP joints (when applicable). The first compartment tendons are within normal limits. The second compartment tendons appear slightly enlarged and hypoechoic at the level of Lister's tubercle which may reflect mild tendinosis, but the current clinical significance of this is uncertain. The extensor pollicis longus tendon is within normal limits. The extensor digitorum tendons appear normal, although there is a incomplete hypoechoic rim surrounding the tendons suggesting mild tenosynovitis. There are multiple hyperechoic foci deep to the extensor digitorum tendons as they cross the dorsal aspect of the wrist that likely reflect bone graft material and/or heterotopic mineralization seen on radiographs. The soft tissues surrounding these tendons also appears slightly hypervascular suggesting mild inflammation, but I see no focal fluid collection to indicate an abscess. There is poorly defined hypoechoic tissue between the extensor digitorum tendons and the second compartment tendons that I suspect represents scar tissue. However, I see no findings to suggest entrapment of the tendons. The extensor digiti minimi tendon appears normal. There is mild tenosynovial thickening along the extensor carpi ulnaris tendon as it courses along the ulnar margin of the wrist suggesting mild tenosynovitis, but otherwise the tendon is within normal limits. Scanning of the second MCP joints shows what I suspect are small osteophytes projecting from the dorsal aspect of the second metacarpal head, but the joint itself appears normal with no hypervascularity to suggest synovitis.

Output: There is perhaps mild tenosynovitis of the extensor digitorum tendons and extensor carpi ulnaris tendon, and perhaps mild tendinosis of the second dorsal compartment tendons; but the clinical significance of these findings is uncertain. There is mild generalized hypervascularity of the soft tissues surrounding the extensor digitorum tendons suggesting mild inflammation, as well as poorly defined hypoechoic tissue between the tendons of the second and fourth compartments suggesting scarring, and multiple hyperechoic foci along the dorsum of the wrist deep to the extensor digitorum tendons suggesting bone graft or heterotopic ossification; but I see no fluid collection nor do I see any findings to suggest tendon entrapment.


Instruction: Generate impression based on medical findings.

Input: Reason: 57-year-old man with acute on chronic renal failure, history of hepatocellular carcinoma RIGHT KIDNEY: The right kidney measures 11.1 cm in length. Normal echogenicity and echotexture. No hydronephrosis, masses, or shadowing calculi.LEFT KIDNEY: The left kidney measures 11.9 cm in length. Normal echogenicity and echotexture. No hydronephrosis, masses, or shadowing calculi.OTHER: Moderate to large volume ascites with nodular liver contour, consistent with cirrhosis. The bladder is well distended. The ureteral jets are not visualized.

Output: 1. No acute renal abnormality or hydronephrosis.2. Cirrhosis with moderate to large volume of ascites.


Instruction: Generate impression based on medical findings.

Input: 71-year-old female Reason: Please evaluate the right thyroid gland History: Tender mass in the region of the right lobe of the thyroid gland RIGHT LOBE MEASUREMENTS: 7.0 x 3.2 x 4.0 cm.LEFT LOBE MEASUREMENTS: 5.0 x 1.3 x 2.1 cm.ISTHMUS MEASUREMENTS: 0.7 cm.RIGHT LOBE: At the mid pole of the right thyroid lobe is a large predominantly cystic appearing nodule which measures 3.9 x 3.1 x 2.6 cm and demonstrates thick internal septations and does not demonstrate internal vascularity.LEFT LOBE: At the inferior pole of the left thyroid lobe is a predominantly solid nodule and measures 1.0 x 0.8 x 1.6 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A right neck level 2 lymph node measures 1.4 x 0.6 x 1.9 cm. A right neck level 3 lymph node measures 0.7 x 0.5 x 1.2 cm. Both these lymph nodes are benign in appearance and likely reactive. OTHER: No significant abnormality noted.

Output: 1.Minimally complex appearing cystic nodule in the right thyroid lobe. This would be amenable to fine needle aspiration if clinically warranted. 2.Left thyroid lobe solid appearing nodule as described above.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female Reason: assess size of nodule. r/o worrisome characteristics. Please compare with prior US History: h/o left sided thyroid nodule RIGHT LOBE MEASUREMENTS: 2.6 x 1.8 x 2.4 cm.LEFT LOBE MEASUREMENTS: 2.6 x 1.9 x 1.7 cm.ISTHMUS MEASUREMENTS: 0.4 cm.RIGHT LOBE: Right thyroid lobe appears heterogenous. No discrete nodule is identified.LEFT LOBE: Left thyroid lobe is heterogenous in appearance. The inferior pole of left thyroid lobe is a predominantly solid heterogenous appearing nodule which is iso to hypoechoic when compared to the background thyroid that measures 1.7 x 1.5 x 1.5 cm, and is not significantly changed in appearance or size when compared to the prior exam when it measured 1.7 x 1.8 x 1.5 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Heterogenous and nodular appearing thyroid gland with left inferior pole nodule previously biopsied, overall unchanged in appearance and size on this exam. No new nodules are identified on this exam.


Instruction: Generate impression based on medical findings.

Input: Status post right thyroidectomy and parathyroidectomy RIGHT LOBE: Status post right-sided thyroidectomy.LEFT LOBE: Left lobe measures 4.5 x 1.9 x 1.5 cm. Stable left-sided hypoechoic thyroid nodule, measuring 9 x 7 x 6 mm.ISTHMUS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: Interval right parathyroidectomy.

Output: Postsurgical changes and unchanged left-sided subcentimeter thyroid nodule as above.


Instruction: Generate impression based on medical findings.

Input: Male 39 years old with chronic HBV, screen for HCC LIVER: Mild increase in hepatic parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions. Hepatic length measures 15.6 cm. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of 27.2 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 3 mm. The common bile duct measures 4 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 7.7 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 12.2 cm and has normal vascular flow. The left kidney measures 11.3 cm and has normal vascular flow. OTHER: No significant abnormality noted.

Output: Mild increase in hepatic parenchymal echogenicity with coarsened echotexture consistent with fatty liver/hepatic parenchymal dysfunction. No morphological evidence of cirrhosis. No hepatic mass or ductal dilatation identified.


Instruction: Generate impression based on medical findings.

Input: Male 40 years old Reason: 40M w/ history of DM1 s/p islet cell transplant - rule out hematoma or portal vein thrombosis History: - LIVER: Liver measures 17.3 cm in length. Main, left and right portal veins patent with normal directional flow. Velocities measure 17 to 23 cm/s, unchanged compared to prior.BILIARY TRACT: Gallbladder unremarkable, no evidence of cholelithiasis. No significant gallbladder distention, wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Not well seen in entirety due to overlying bowel gas. KIDNEYS: The right kidney measures 11 cm. The left kidney measures 11.4 cm. No hydronephrosis or perinephric free fluid.SPLEEN: The spleen measures 14 cm in length. OTHER: Small right pleural effusion. Tiny amount of free fluid.

Output: Visualized portal veins are patent with normal directional flow. Service is aware of this finding.


Instruction: Generate impression based on medical findings.

Input: Male 54 years old; Reason: Patient with acute renal failure, please evaluate for hydronephrosis/ obstruction, evidence of medical renal disease History: As above RIGHT KIDNEY: The right kidney measures 10.9 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. Right kidney cyst measures 9 mm.LEFT KIDNEY: The left kidney measures 11.3 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present.  URINARY BLADDER: The bladder is obscuredOTHER: No significant abnormalities noted.

Output: 1.Echogenic renal cortices compatible with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: 65-year-old female with a history of primary hyperparathyroidism, evaluate for thyroid nodule. RIGHT LOBE MEASUREMENTS: 4.4 x 1.7 x 2.3 cmLEFT LOBE MEASUREMENTS: 4.2 x 1.2 x 1.7 cmISTHMUS MEASUREMENT: 0.4 cmRIGHT LOBE: Well-circumscribed, probably solid, vascular mid thyroid nodule with mixed hypoechoic and hyperechoic components measures 1.9 x 1.5 x 2.4 cm. No definite microcalcifications.LEFT LOBE: Predominantly solid upper pole nodule with peripheral vascularity and no definite microcalcifications measures 0.8 x 0.6 x 0.6 cm. Additional subcentimeter nearly anechoic focus with central echogenicity measures 0.5 x 0.5 x 0.6 cm and is compatible with a colloid cyst.ISTHMUS: Solid hypoechoic nodule with cystic components and significant internal vascularity measures 1.3 x 0.4 x 1.3 cm.LYMPH NODES: No significant abnormality noted.OTHER: Extrathyroidal hypoechoic focus posteroinferior to the right thyroid measures 1.4 x 0.8 x 1.2 cm, consistent with a parathyroid adenoma.

Output: 1.Extrathyroidal hypoechoic focus posteroinferior to the right thyroid gland compatible with a parathyroid adenoma. 2.Multifocal thyroid nodules.


Instruction: Generate impression based on medical findings.

Input: Male 55 years old; Reason: thyroid nodules seen on CT neck. RIGHT LOBE MEASUREMENTS: 4.1 x 2 x 2.1 cmLEFT LOBE MEASUREMENTS: 3.3 x 2 x 1.7 cmISTHMUS MEASUREMENT: 1 cmRIGHT LOBE: The thyroid gland is heterogeneous in echotexture. Focus of coarse calcification is noted in the right mid thyroid pole measuring 0.3 x 0.4 cm with no distinct nodule.LEFT LOBE: Thyroid gland is heterogeneous in echotexture, with a more discrete heterogenous solid nodule in the mid thyroid pole measuring 1.8 x 1.4 x 1.2 cm.ISTHMUS: Heterogeneous nodule in the inferior isthmus measuring 3.5 x 0.9 cm with rim calcification is noted.LYMPH NODES: Right level 2 lymph node measuring 1.4 x 0.9 x 2.4 cm and left level 3 lymph node measuring 1.2 x 0.9 x 1.6 cm are noted, demonstrating a benign morphology.OTHER: No significant abnormality noted.

Output: Heterogenous thyroid gland with bilateral nodules. The left thyroid lobe nodule is amenable to fine-needle aspiration biopsy.


Instruction: Generate impression based on medical findings.

Input: Right upper quadrant pain. LIVER: The liver is normal in size measuring 16.6 cm in length. Normal parenchymal echotexture. No focal parenchymal lesion. Main portal vein is patent with hepatopedal flow and a velocity of 29 cm/s.GALLBLADDER, BILIARY TRACT: The gallbladder contains a small amount of debris, but no stones. No intrahepatic or extrahepatic biliary ductal dilatation. The common bile duct measures 2 mm in diameter.PANCREAS: No significant abnormalities noted.KIDNEYS: Right kidney is lower limit of normal in size measuring 7.2 cm length and has uniformly increased echotexture suggestive of medical renal disease. The left kidney is also lower limit of normal in size measuring 6.4 cm in length and it also demonstrates increased echogenicity suggestive of medical renal disease. No hydronephrosis.OTHER: The spleen is upper limit of normal in size measuring 10.10 cm in length.

Output: 1.Debris/sludge within the gallbladder without evidence of cholelithiasis or acute cholecystitis.2.Small echogenic kidneys compatible with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Female 62 years old; Reason: kidney stone History: stone RIGHT KIDNEY: The right kidney measures 10.2 cm in length. The cortex is normal in echogenicity. Numerous shadowing calculi are again noted. There is no hydronephrosis.LEFT KIDNEY: The left kidney measures 9.0 cm in length. The cortex is normal in echogenicity. Numerous shadowing calculi are again noted. There is no hydronephrosis.URINARY BLADDER: The bladder appears normal.OTHER: No significant abnormalities noted.

Output: Bilateral nephrolithiasis without obstruction.


Instruction: Generate impression based on medical findings.

Input: Male 61 years old Reason: elevated LFTs / hx pancreatitis History: elevated LFTs LIVER: Liver measures 16.7 cm in length. The parenchyma is echogenic. No suspicious lesion delineated. Main portal vein patent with normal directional flow, velocity measures 27 cm/s. BILIARY TRACT: Gallbladder unremarkable. No significant gallbladder distention, wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Not well seen secondary to overlying bowel gas. KIDNEYS: The right kidney measures 11.2 cm. The left kidney measures 8.9 cm. No hydronephrosis.SPLEEN: The spleen measures 7.6 cm. in length. OTHER: Ill-defined hypoechogenicity seen deep to liver and above right kidney, of uncertain etiology and significance.

Output: Suboptimal study secondary to overlying bowel gas.Echogenic liver, related to hepatic steatosis/parenchymal dysfunction. Ill-defined focal area of hypoechogenicity seen deep to liver and above right kidney, of uncertain etiology and significance, uncertain whether artifactual; would be better evaluated with dedicated contrast enhanced CT.


Instruction: Generate impression based on medical findings.

Input: Male 66 years old Reason: aki RIGHT KIDNEY: Status post right nephrectomy.LEFT KIDNEY: The left kidney measures 15.1 cm. No shadowing calculi or hydronephrosis is present. No perinephric free fluid. Exophytic simple appearing cystic lesion measuring 1.7 x 1.5 x 1.4 cm, posterior acoustic enhancement seen.BLADDER: Visualized portions of bladder unremarkable.OTHER: Incompletely imaged hepatic metastatic disease.

Output: Status post right nephrectomy. Compensatory hypertrophy of left kidney. Simple appearing exophytic left renal lower pole cystic lesion.Incompletely imaged hepatic metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male 47 years old with elevated liver function tests, evaluate for cirrhosis LIVER: Mild increase in hepatic parenchymal echogenicity with coarsened echotexture. Smooth liver contour noted. No focal hepatic lesions. Hepatic length measures 14.2 cm. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of 21.5 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 2 mm. The common bile duct measures up to 5 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 6.3 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 12.1 cm and has normal vascular flow. The left kidney measures 9.8 cm and has normal vascular flow. OTHER: No significant abnormality noted.

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


Instruction: Generate impression based on medical findings.

Input: Male 34 years old Reason: concern for mass (nothing palpable on exam) History: testicular pain, concern for possible malignancy as pt has mediastinal/retroperitoneal mass, no palpable mass RIGHT TESTIS: The right testis measures 3.3 x 2.5 x 1.6 cm. Hypoechoic focus, which appears to extend from the mediastinum testis suggestive of a prominent rete testis. No definite mass lesion identified. Testicular microlithiasis is notedLEFT TESTIS: The left testicle measures 2.6 x 2.4 x 1.4 cm. Testicular microlithiasis is noted.RIGHT EPIDIDYMIS: Right epididymal head cyst measures 0.3 x 0.4 x 0.2 cm. The right epididymis measures 1.4 x 0.5 x 0.8 cm and demonstrates normal parenchyma echogenicity and blood flow.LEFT EPIDIDYMIS: Left epididymis measures 1.1 x 0.5 x 0.7 cm and demonstrates appropriate parenchymal echogenicity and blood flow.OTHER: No significant abnormalities noted.

Output: 1.Testicular microlithiasis.2.Hypoechoic focus in the right testicle appears to represent prominent rete testis.


Instruction: Generate impression based on medical findings.

Input: Occasional arm pain, subcutaneous nodules, increased in size and number In right forearm, ovoid 4 x 2.9 x 0.6 cm, previously measured 3.3 x 2.4 x 0.6 cm.In right upper arm, rounded structure measuring 2.1 x 1.8 x 1.1 cm.In left forearm, ovoid 1.8 x 1.6 x 0.5 cm focus, previously measured approximately 1.6 x 1.5 x 0.5 cm.Another left forearm ovoid lesion seen measuring 2.8 x 2.5 x 0.9 cm.In upper arm, rounded 1.1 x 1.3 x 0.7 cm focus.Appearance of these structures consistent with lipomas.

Output: Mild interval increase in size of previously seen bilateral forearm lipomas, additional bilateral upper extremity lipomas also seen as above.


Instruction: Generate impression based on medical findings.

Input: Female 30 years old Reason: cause of left lower quadrant pain overlying transplant site. History: LLQ pain. RENAL TRANSPLANT: The renal transplant measures 13.3 cm in length.LOCATION: Left iliac fossaPERITRANSPLANT TISSUES: Interval resolution of the previously seen perinephric fluid collection.KIDNEY: No significant abnormality notedCOLLECTING SYSTEM/URETER: There is persistent mild hydronephrosis, not significantly changed.URINARY BLADDER: No significant abnormality notedVASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels No significant abnormality notedOTHER: The native kidneys are echogenic and atrophic measuring 7.3 cm on the right, and 8.7 cm on the left.

Output: Interval resolution of the previously seen perinephric fluid collection. Persistent mild hydronephrosis of the transplant kidney, but normal parenchyma echogenicity.


Instruction: Generate impression based on medical findings.

Input: Female 69 years old; Reason: worsening Cr postop, has ureteral stents in place History: worsening Cr RIGHT KIDNEY: The right kidney measures 11.1 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 10.1 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present.  URINARY BLADDER: The bladder is decompressed by a Foley catheter. Right nephroureteral stent terminates within the bladder.OTHER: No significant abnormalities noted.

Output: 1.No hydronephrosis.2.Echogenic renal cortices compatible with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Female 69 years old; Reason: AKI History: Elevated Creatanine RIGHT KIDNEY: The right kidney measures 9.8 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. The right kidney has several cysts the largest at the upper pole measuring 3.6 cmLEFT KIDNEY: The left kidney measures 10.1 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. The left kidney has several cysts. URINARY BLADDER: No significant abnormality notedOTHER: No significant abnormalities noted.

Output: 1.Echogenic renal cortices compatible with medical renal disease.2.No nephrolithiasis or hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old. Reason: Assess for signs of cholecystitis, other hepatobiliary disease. History: Epigastric pain, elevated AST/ALT, conjugated bilirubin LIVER: Liver is enlarged and measures 18.3 cm in length. The hepatic parenchyma is echogenic. No hepatic mass or ascites. Main portal vein is patent with a normal direction of flow.BILIARY TRACT: Multiple shadowing gallstones fill the gallbladder lumen limiting evaluation for gallbladder wall thickening. Small amount of pericholecystic fluid. Sonographic Murphy sign is equivocal given the patient's prior analgesic administration. No evidence of biliary ductal dilatation. Common bile duct measures 2 mm.PANCREAS: The visualized portions are unremarkable. The distal body and tail are obscured by overlying bowel gas.SPLEEN: Spleen is mildly enlarged and measures 12.2 cm in length with no leak or texture.RIGHT KIDNEY: Right kidney measures 10.7 cm in length with normal cortical echogenicity. No hydronephrosis, shadowing calculi, or mass.OTHER: Left kidney measures 12 cm in length with normal cortical echogenicity. No hydronephrosis, shadowing calculi, or mass.

Output: 1. Multiple shadowing gallstones with trace pericholecystic fluid. Sonographic Murphy sign is equivocal given the patient's prior analgesic administration. Acute cholecystitis cannot be excluded.2. Mild hepatomegaly with echogenic liver parenchyma suggests parenchymal dysfunction/fatty infiltration. No evidence of biliary ductal dilatation.


Instruction: Generate impression based on medical findings.

Input: Male 68 years old Reason: kidney stone History: stone RIGHT KIDNEY: The right kidney measures 11.3 cm. No shadowing calculi or hydronephrosis is present. Mildly increased renal cortical echogenicity. No perinephric free fluid.LEFT KIDNEY: The left kidney measures 11.7 cm. Lower pole intrarenal calculus, measuring approximately 5 mm, seen in same location as on outside exam. No hydronephrosis is present. Mildly increased renal cortical echogenicity. No perinephric free fluid. BLADDER: Visualized portions unremarkable. Ureteral jets visualized.OTHER: No significant abnormalities noted.

Output: Left renal lower pole nonobstructing stone.Mildly increased renal cortical echogenicity, correlate clinically for medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Female 45 years old; Reason: Assess hydronephrosis and renal parenchyma History: AKI due to obstruction RIGHT KIDNEY: The right kidney measures 6.4 cm in length. The cortex is thinned and echogenic. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 10.6 cm in length. The cortex is echogenic. There is mild left hydronephrosis. A stent is in place.  URINARY BLADDER: The bladder is obscuredOTHER: Upper abdominal ascites. Liver is heterogeneous.

Output: 1.Atrophic right kidney.2.Mild left hydronephrosis with a stent in place.


Instruction: Generate impression based on medical findings.

Input: 64-year-old female with mild gallbladder wall thickening on prior CT and epigastric pain. Please rule out cholecystitis. LIMITED ABDOMENLIVER: The liver has a smooth contour. The parenchyma is normal in echotexture.BILIARY TRACT: Non-mobile nodules are seen on the gall bladder wall, consistent with polyps. Further, shadowing calculi are visualized within the lumen. For example, measures 0.4 x 0.4 x 0.4 cm. Comet tail artifacts are also seen. No significant gallbladder wall thickening or pericholecystic fluid. No biliary ductal dilation.OTHER: None.

Output: 1.Cholelithiasis without specific evidence for cholecystitis. No biliary ductal dilation.2.Multiple gallbladder polyps.3.Gallbladder adenomyomatosis.


Instruction: Generate impression based on medical findings.

Input: Female 45 years old Reason: Hx of ETOH. Evaluate known hepatomegaly. R/o focal liver lesions History: screening LIVER: Hepatomegaly, liver measures 19.4 cm in longitudinal dimension, previously measured 21.3 cm. The parenchyma is increased in echogenicity. No suspicious liver lesion. Main portal vein patent, normal directional flow, velocity measures 30 cm/s. BILIARY TRACT: Gallbladder unremarkable without evidence of shadowing stones. No significant gallbladder distention, wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Not well assessed in entirety secondary to overlying bowel gas. KIDNEYS: The right kidney measures 12 cm. The left kidney measures approximately 12 cm., poles of kidney not well assessed secondary to bowel gas. No hydronephrosis or perinephric free fluid. SPLEEN: The spleen measures 8.3 cm. in length.

Output: Hepatomegaly, echogenic liver, likely reflecting underlying hepatic steatosis/parenchymal dysfunction. No suspicious liver lesion.


Instruction: Generate impression based on medical findings.

Input: Male 19 years old Reason: elevated LFts History: none Limited study, patient unable to lie flat.LIVER: Liver measures 15.9 cm in length. The parenchyma is increased echogenicity which is nonspecific but may reflect diffuse infiltrative disease. Main portal vein is patent with hepatopedal flow but demonstrates mildly decreased velocity. BILIARY TRACT: Gallbladder unremarkable. No significant gallbladder distention, wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Pancreas nonvisualized due to overlying bowel gas.KIDNEYS: The right kidney measures 9.3 cm. The left kidney measures 11.3 cm. No evidence of hydronephrosis or shadowing renal calculus.SPLEEN: The spleen measures 13.1 cm. in length. OTHER: No significant abnormality noted.

Output: 1. Increased echogenicity of liver parenchyma is nonspecific but may reflect diffuse infiltrative disease such as fatty liver disease. 2. There is mildly decreased velocity of the main portal vein flow.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for renal abscess or worsening hydronephrosis History: recurrent UTI, History of cervical cancer, bilateral ureteral stents RIGHT KIDNEY: Atrophic right kidney measuring 6.9 cm with increased in echogenicity. No hydronephrosis. No evidence of renal calculi. Ureteral stent noted.LEFT KIDNEY: Left kidney measures 12.1 cm and is normal in echogenicity with mild to moderate hydronephrosis. No evidence of renal calculi. Ureteral stent noted.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.

Output: Atrophic right kidney. Left kidney with mild to moderate hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Female 58 years old Reason: Abdominal pain, eval for biliary dilatation History: abd pain Suboptimal exam secondary to patient's body habitus and overlying bowel gas.LIVER: Liver measures 16 cm in length. The parenchyma is coarsened in echotexture, appearance may reflect underlying hepatic steatosis/parenchymal dysfunction. Main portal vein patent with normal directional flow, velocity somewhat diminutive measuring 10 cm/s. BILIARY TRACT: Evaluation of gallbladder demonstrates shadowing cholelithiasis. No secondary signs of acute cholecystitis. No significant gallbladder distention, wall thickening or pericholecystic fluid. Per ultrasound technologist, negative sonographic Murphy's sign. No intrahepatic or extrahepatic biliary duct dilatation. PANCREAS: Not well seen secondary to obscuration by bowel gas. KIDNEYS: The right kidney measures 11.3 cm. The left kidney measures 10.3 cm. No hydronephrosis.SPLEEN: The spleen measures 8.1 cm. in length. OTHER: No significant abnormality noted.

Output: Suboptimal study secondary to patient's body habitus and overlying bowel gas.No biliary duct dilatation. Cholelithiasis, no secondary signs of acute cholecystitis.Coarsened echotexture of liver, may reflect underlying hepatic steatosis/parenchymal dysfunction.


Instruction: Generate impression based on medical findings.

Input: Female 42 years old; Reason: AKI on CKD History: AKI RIGHT KIDNEY: The right kidney measures 10.7 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 12.5 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present.  URINARY BLADDER: No significant abnormality notedOTHER: No significant abnormalities noted.

Output: 1.Echogenic renal cortices compatible with medical renal disease. No sonographic findings of nephrolithiasis or hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Female 77 years old; Reason: R/O HCC History: Hx of HCV; liver bx in 2005 showed bridging fibrosis LIVER: Increase in hepatic parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions. Hepatic length measures 16.2 cm. The main portal vein is patent with normal hepatopetal flow with a velocity of 29 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 1 mm. The common bile duct measures 1 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 9.5 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 9.9 cm with no hydronephrosis. Simple appearing cyst in the midpole of the right kidney measures 0.7 x 0.6 cm. The left kidney measures 11.9 cm with no hydronephrosis. Simple cyst in the midportion of left kidney measures 4.3 x 3.4 x 2.9 cm, similar to prior exam.OTHER: No ascites.

Output: 1.Increase in hepatic parenchymal echogenicity with coarsened echotexture consistent with chronic liver disease with no focal hepatic mass.2.Bilateral renal cysts, as above.


Instruction: Generate impression based on medical findings.

Input: Female 75 years old; Reason: r/o adenopathy, recurrence History: h/o recurrent thyroid cancer. Has some thyroid bxed lesions. This is a 9 month follow up study to r/o growth RIGHT LOBE MEASUREMENTS: Status post thyroidectomy. Two hypoechoic foci within the thyroidectomy bed. The superior focus measures 0.9 x 0.4 x 0.2 cm, previously 0.5 x 0.4 x 0.4 cm. The mid focus measures 0.9 x 0.6 x 0.4 cm, previously 0.6 x 0.3 x 0.2 cm. While these appear slightly more prominent than on most recent prior they are not significantly changed compared to more remote studies 12/07/12.LEFT LOBE MEASUREMENTS: Status post thyroidectomy. No focal mass is identified.ISTHMUS MEASUREMENT: Status post thyroidectomy.LYMPH NODES: Multiple benign appearing lymph nodes are identified right neck. A subcentimeter right level 3 node inferior to the vessels measures 0.3 x 0.2 x 0.4 cm. A normal fatty hilum is not demonstrated, likely due to the small size however attention can be paid to this on follow-up imaging.OTHER: No significant abnormality noted.

Output: 1.Status post thyroidectomy. Stable appearance of thyroid bed nodules. A subcentimeter right level 3 lymph node does not demonstrate a normal the hilum. While this is likely due to the small size, continued surveillance is recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old. Reason: elevated creatinine in patient with former increase in urine microalbuminuria. RIGHT KIDNEY: Right kidney measures 8.4 cm in length with increased cortical echogenicity. No hydronephrosis, shadowing calculi, or mass.LEFT KIDNEY: Left kidney measures 8.7 cm in length with increased cortical echogenicity. No hydronephrosis, shadowing calculi, or mass.URINARY BLADDER: Urinary bladder is decompressed. Probable bladder diverticulum arises off the superior aspect of the bladder. OTHER: No significant abnormalities noted.

Output: Atrophic kidneys with increased parenchymal echogenicity suggests medical renal disease/parenchymal dysfunction. No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Male 33 years old Reason: aki History: aki RIGHT KIDNEY: The right kidney measures 11.6 cm. Cortex echogenic. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 11.9 cm. Cortex echogenic. No shadowing calculi or hydronephrosis is present. BLADDER: Underdistended state, making evaluation suboptimal.OTHER: No significant abnormalities noted.

Output: Kidneys echogenic, likely reflecting underlying medical renal disease. No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Female 71 years old Reason: elevated lipase, wbc, r/u pancreatitis History: abdominal pain LIVER: Liver measures 16.6 cm in length. The parenchyma is moderately echogenic which is nonspecific but may reflect fatty liver infiltration. No ascites.Main portal vein is patent with hepatopetal flow.BILIARY TRACT: A small amount of biliary sludge is seen in the dependent aspect of the gallbladder. No evidence of gallstones, no significant gallbladder distention, wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Limited evaluation of the pancreatic head shows no significant abnormality. The pancreatic body and tail are obscured due to overlying bowel gas.KIDNEYS: The right kidney measures 12.1 cm. The left kidney measures 10.7 cm. The bilateral renal cortices are echogenic. No evidence of hydronephrosis or shadowing renal calculus.SPLEEN: The spleen measures 7.7 cm. in length. OTHER: No significant abnormality noted.

Output: 1.Biliary sludge. No evidence of cholelithiasis or cholecystitis.2.Limited evaluation of the pancreatic head shows no significant abnormality. However if there is continued concern for pancreatitis further evaluation with cross-sectional imaging is recommended.3.Bilateral renal cortical echogenicity may reflect medical renal disease.4.Hyperechoic liver parenchyma is nonspecific but may reflect fatty liver infiltration.


Instruction: Generate impression based on medical findings.

Input: 56-year-old male presents with a fever and soft tissue mass in the right lateral foot. Complex, partially calcified, questionable multicystic, mass in the subcutaneous tissues overlying the right lateral foot. Minimal amount of vascularity is appreciated peripherally. Differential as previously mentioned on the prior radiograph report includes tumoral calcinosis, gouty tophus, or dystrophic calcification.

Output: Complex, partially calcified mass in the subcutaneous tissues overlying the right lateral foot. Differential includes tumoral calcinosis, gouty tophus, or dystrophic calcification.


Instruction: Generate impression based on medical findings.

Input: Female 56 years old; Reason: Acute on CKD, r/o obstruction Limited evaluation due to patient position in the upright position as patient could not lie supine. RIGHT KIDNEY: Difficult to visualize however measures 8.6 cm in length no obvious hydronephrosis. LEFT KIDNEY: Difficult to visualize however measures 7.2 cm in length with no obvious hydronephrosis. URINARY BLADDER: No significant abnormality noted. OTHER: No significant abnormalities noted.

Output: Limited exam due to patient positioning however no obvious hydronephrosis is identified.


Instruction: Generate impression based on medical findings.

Input: 72-year-old male with history of partial right nephrectomy. Reason: Evaluate for renal cyst/mass. RIGHT KIDNEY: The right kidney measures 10.6 cm. There is a heterogeneous mass associated with internal vascularity measuring 3.8 x 3.6 x 3.3 cm, concerning for renal cell carcinoma. There are several nodules within the right kidney, largest measuring 3.6 x 2.9 x 2.8 cm, appearing to be cysts.LEFT KIDNEY: The left kidney is incompletely imaged, and appears to measure approximately 17.1 cm. Given this limitation, there are numerous nodules within the left kidney with the largest measuring 4.4 x 3.6 x 3.8 cm. Some of the nodules appear to be cysts, while others appear more heterogenous and cannot be fully characterized.OTHER: Bladder is nondistended.

Output: Heterogeneous mass associated with internal vascularity of the right kidney, concerning for renal cell carcinoma. There are also numerous renal nodules bilaterally, some of which appear to be cysts while others appear more heterogenous and cannot be fully characterized given the limitations of this study. Recommend further evaluation with cross-sectional imaging.These results were relayed to and acknowledged by Dr. TARPLIN, SARAH by phone at the time of this dictation.


Instruction: Generate impression based on medical findings.

Input: Female 33 years old; Reason: please evaluate for thyroid nodules History: questionable nodule on the right RIGHT LOBE MEASUREMENTS: 4.9 x 1.3 x 1.3 cmLEFT LOBE MEASUREMENTS: 4.5 x 1.2 x 1.4 cmISTHMUS MEASUREMENT: 0.1 cmRIGHT LOBE: There is normal homogenous gland parenchyma echotexture. No focal nodules or lesions.LEFT LOBE: Within the mid left lobe of the thyroid there is a predominantly cystic nodule measuring 0.4 x 0.2 x 0.3 cm. No associated vascularity. The background gland has normal homogenous echotexture.ISTHMUS: No significant abnormality noted.LYMPH NODES: Normal appearing bilateral cervical lymph nodes with preserved fatty hila.OTHER: No significant abnormality noted.

Output: 1.Single 4 mm nodule in the left lobe of the thyroid without suspicious imaging features.


Instruction: Generate impression based on medical findings.

Input: Reason: 45y.o. F with thyroid nodule. Please evaluate History: thyroid nodule RIGHT LOBE MEASUREMENTS: 6.0 x 2.4 x 2.5 cmLEFT LOBE MEASUREMENTS: 5.2 x 1.0 x 0.9 cmISTHMUS MEASUREMENTS: 1 1-cm APRIGHT LOBE: In the inferior right thyroid, there is a 3.3 x 2.3 x 2.2 cm nodule which is stable in size and morphology. This nodule is very vascular and predominantly solid with a few cystic components.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing right level 3 lymph node.OTHER: No significant abnormality noted.

Output: Stable right thyroid nodule as described above. This has been percutaneously biopsied on 12/7/2015


Instruction: Generate impression based on medical findings.

Input: 73-year-old female with history of thyrotoxicosis. RIGHT LOBE MEASUREMENTS: 10.0 x 6.5 x 5.4 cm, previously 9.5 x 6.0 x 5.6 cm.LEFT LOBE MEASUREMENTS: Status post partial left thyroidectomy.ISTHMUS MEASUREMENT: 0.4 cm.RIGHT LOBE: Mildly heterogeneous thyroid without discrete nodule identified. LEFT LOBE: Status post left thyroidectomy. In the area of the left surgical bed there is diffusely heterogeneous tissue without discrete nodule identified. The area measures 6.7 x 3.8 x 3.3 cm, previously 6.3 x 3.0 x 3.3 cm.ISTHMUS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable diffusely heterogeneous thyroid gland with no discrete nodule identified.


Instruction: Generate impression based on medical findings.

Input: Male 70 years old; Reason: eval for lesions, assess hepatic vessel patency History: s/p OLT 9/10 for HCV cirrhosis, recurrent cirrhosis LIVER: Increase in hepatic parenchymal echogenicity with coarsened echotexture. Scattered subcentimeter hypoechoic foci compatible with hepatic cysts.. Hepatic length measures 13.8 cm. GALLBLADDER/BILIARY TRACT: The common bile duct measures 3 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Hypoechoic focus in the body of the pancreas measuring 1.4 x 1.3 cm appears similar to the prior examination. Retrospective analysis of prior CT examinations confirms presence of the lesion which may represent a side branch IPMN and. SPLEEN: The spleen measures 13 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 9.5 cm and demonstrates renal cortical thinning and has normal vascular flow. The left kidney measures 9.1 cm and has normal vascular flow. Left renal stent is noted.OTHER: No significant abnormality noted.

Output: 1. Increase in hepatic parenchymal echogenicity with coarsened echotexture consistent with fatty liver/hepatic parenchymal dysfunction. Scattered subcentimeter hepatic cysts. Patent hepatic vasculature. 2. Stable hypoechoic focus in the body of the pancreas. If further imaging is clinically warranted, a MRI/MRCP may be considered.


Instruction: Generate impression based on medical findings.

Input: 44-year-old male with left testicular pain. RIGHT TESTIS: No significant abnormalities noted. Vascular flow remains intact.LEFT TESTIS: No significant abnormalities noted. Vascular flow remains intact.RIGHT EPIDIDYMIS: No significant abnormalities noted. Vascular flow remains intact.LEFT EPIDIDYMIS: The left epididymis is enlarged and demonstrates asymmetrically increased vascular flow.OTHER: No significant abnormalities noted.

Output: Findings consistent with left epididymitis. No testicular torsion.These findings were discussed with Jeremy O'Connor via telephone on 1/21/2016 at 3:18 PM by the radiology resident.


Instruction: Generate impression based on medical findings.

Input: 36-year-old male status post liver transplant, now with fever and elevated GGT. Reason: Evaluate liver. LIVER: The liver is mildly enlarged and measures 18.1 cm in length. Transplant liver with mildly increased echogenicity, but without mass or intrahepatic ductal dilatation. Hepatic vessels are patent with normal directional flow.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. No extrahepatic ductal dilatation noted.PANCREAS: The visualized portion of the pancreas is without significant abnormalities.RIGHT KIDNEY: The right kidney measures 12 cm. The cortex is of normal echogenicity. No shadowing calculi or hydronephrosis is present.LEFT KIDNEY: The left kidney measures 12.8 cm. The cortex is of normal echogenicity. No shadowing calculi or hydronephrosis is present.SPLEEN: The spleen is mildly enlarged and measures 16.3 cm.OTHER: No significant abnormalities noted.

Output: 1. Mildly echogenic transplant liver suggestive of parenchymal dysfunction/fatty infiltration without focal lesion or ductal dilatation.2. Patent hepatic vessels with normal directional flow.3. Mild hepatosplenomegaly.


Instruction: Generate impression based on medical findings.

Input: Reason: 50 y.o. F with multiple thyroid nodule. Please evaluate. History: thyroid nodules RIGHT LOBE MEASUREMENTS: 3.8 x 1.0 x 1.4 cm. Very heterogenous parenchyma.LEFT LOBE MEASUREMENTS: 4.0 x 1.0 x 1.3 cm. Very heterogenous parenchyma.ISTHMUS MEASUREMENTS: 0.2 cm. Very heterogenous parenchyma.RIGHT LOBE: A 1.0 x 1.1 x 1.0 cm calcified nodule in the superior right thyroid lobe is stable from prior exam. A more rounded density in the inferior right thyroid actually is the same echogenicity as the remaining heterogeneity of the gland, and is likely a part of that.LEFT LOBE: A 0.4 x 0.2 x 0.4 cm calcified nodule is seen in the upper left thyroid. This was not imaged on outside institution ultrasound.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing nodes.OTHER: No significant abnormality noted.

Output: Stable right calcified thyroid nodule. 4 mm calcified left thyroid nodule was not imaged on outside institution comparison scan. The thyroid gland itself is very heterogenous and shrunken, most compatible with chronic sequela of thyroiditis.


Instruction: Generate impression based on medical findings.

Input: Female 55 years old Reason: follow up of renal cell cancer RIGHT KIDNEY: Status post right renal mass excision, site of postoperative bed unremarkable without definite soft tissue echogenicity to suggest recurrent neoplasm. The right kidney measures 10.8 cm. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 13 cm. No shadowing calculi or hydronephrosis is present. BLADDER: Visualized portions unremarkable.OTHER: No significant abnormalities noted.

Output: Right renal postoperative changes, unremarkable study otherwise.


Instruction: Generate impression based on medical findings.

Input: Female 75 years old; Reason: CKD now with AKI; eval for post renal cause History: AKI RIGHT KIDNEY: The right kidney measures 8.2 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 10.3 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. URINARY BLADDER: The bladder is decompressed by a Foley catheter.OTHER: No significant abnormalities noted.

Output: 1.Echogenic renal cortices. No hydronephrosis is evident.


Instruction: Generate impression based on medical findings.

Input: Female 60 years old; Reason: Change in nodules? History: Multinodular goiter, previous benign FNA left hypoechoic nodule RIGHT LOBE MEASUREMENTS: 4.9 x 2.3 x 1.6 cmLEFT LOBE MEASUREMENTS: 5.2 x 1.9 x 1.7 cmISTHMUS MEASUREMENT: 0.1 cmRIGHT LOBE: Right lobe is heterogeneous with multiple nodules. Some of the nodules have features compatible with colloid.Reference cystic nodule measures 1.6 x 0.5 x 1.1 cm previously, 1.6 x 0.6 x 1.6 cmSolid nodule near the lower pole with calcifications measures 1.0 x 0.8 x 0.8 cm previously, 1.0 x 0.8 x 0.8 cmLEFT LOBE: Left lobe is heterogeneous multiple nodules. Some of the nodules have features compatible with colloid.Reference partially cystic nodule measures 0.9 x 0.4 x 0.6 cm previously, 0.8 x 0.5 x 0.5 cmMixed echogenicity solid nodule in the lower pole measures 0.9 x1.0 x 0.9 cm previously, 1.1 x 0.8 x 1.0 cm.ISTHMUS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multinodular thyroid gland with many of the nodules exhibiting features compatible with colloid. Reference lesions are provided above without significant size change.


Instruction: Generate impression based on medical findings.

Input: Female 59 years old Reason: abdominal pain unspecified location History: abdominal pain LIVER: No evidence of hepatomegaly. The liver parenchyma is echogenic. Subcentimeter cyst. Main portal vein patent with normal directional flow, velocity measures 29 cm/s. BILIARY TRACT: Gallbladder unremarkable. No significant gallbladder distention, wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Not well seen in entirety due to overlying bowel gas but visualized portions unremarkable. KIDNEYS: The right kidney measures 10.5 cm. The left kidney measures 11 cm. No hydronephrosis. SPLEEN: The spleen measures 7.9 cm. in length. OTHER: No significant abnormality noted.

Output: Echogenic liver, likely reflecting underlying hepatic steatosis/parenchymal dysfunction.Gallbladder unremarkable. No evidence of cholelithiasis or acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: 46-year-old Reason: r/o recurrence. Please compare to prior US History: h/o thyroid cancer RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: Again seen are multiple hypoechoic lesions in the right thyroidectomy bed. A superior hypoechoic nodule measures 0.6 x 0.4 x 0.3 cm previous dimensions 0.7 x 0.4 x 0.3 cm. A mid lobe bed hypoechoic nodule measures 0.5 x 0.5 x 0.4 cm previously measured 0.5 x 0.5 x 0.4 cm. An inferior lobe bed hypoechoic nodule measures 0.7 x 0.4 x 0.4 cm and previously measured 0.4 x 0.3 x 0.6 cm. And a right inferior lateral lobe bed hypoechoic nodule measures 0.4 x 0.4 x 0.6 cm previously measured 0.5 x 0.6 x 0.6 cm.LEFT LOBE: A left thyroid bed nodule is hypoechoic and measures 0.2 x 0.3 x 0.5 cm and previously measured 0.2 x 0.3 x 0.5 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A left neck level 2 lymph node measures 1.1 x 0.8 x 0.6 cm and previously measured 0.9 x 0.7 x 0.6 cm and has benign-appearing features. Second left neck level 2 lymph node measures 0.7 x 0.7 x 0.4 cm and measured 0.8 x 0.7 x 0.4 cm and has benign-appearing features.OTHER: No significant abnormality noted.

Output: Stable right and left surgical bed hypoechoic nodules are not significantly changed in size or appearance from the prior study. However, if clinically warranted, fine needle aspiration can be considered in the appropriate clinical setting.


Instruction: Generate impression based on medical findings.

Input: Male 65 years old; Reason: obstructive uropathy w/ AKI, UTI, bacteremia. Now with rising WBC despite abx. concern for renal or perinephric abscess. History: No abd or flank pain, no fevers. RIGHT KIDNEY: The right kidney measures 11.5 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. There is no perinephric fluid collection. An anechoic cyst measures 1.1 x 0.9 x 0.9 cm.LEFT KIDNEY: The left kidney measures 11.8 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. There is no perinephric fluid collection. An anechoic cyst measures 1.4 x 1.2 x 1.1 cm.URINARY BLADDER: The bladder is empty, precluding evaluation.OTHER: No significant abnormalities noted.

Output: No perinephric fluid collection. No hydronephrosis. Simple renal cysts unchanged.


Instruction: Generate impression based on medical findings.

Input: Female 52 years old Reason: r/o gallstones History: abd pain post prandial LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 17 cm in length. The parenchyma is normal in echotexture there are no suspicious hepatic lesions. Main portal vein is patent.BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 2 mm in thickness. Common duct measures 5 mm. PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 8.6 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. A small cyst near the upper pole measures 1 cm.The left kidney measures 9.8 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 7.4 cm. in length. OTHER: No upper abdominal ascites.

Output: 1.No findings of cholelithiasis.