Instruction: Generate impression based on medical findings.

Input: 66-year-old female with papillary thyroid carcinoma. RIGHT LOBE MEASUREMENTS: 2.2 x 2.3 x 5.3 cmLEFT LOBE MEASUREMENTS: 2.1 x 1.9 x 4.9 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Right lobe is diffusely heterogeneous in echotexture. In the midportion of the right lobe there is a poorly defined hypoechoic area with dense associated calcification measuring at least 0.4 x 0.8 x 1 cm. Posterior margin cannot be adequately visualized due to shadowing from calcification.LEFT LOBE: Left lobe is diffusely heterogeneous in echotexture without focal mass.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Ill-defined right lobe mass with calcification. No adenopathy.


Instruction: Generate impression based on medical findings.

Input: Male 54 years old; Reason: 54 yo with abnl LFT History: none LIVER: The liver measures 23.0 cm in length. There is increased echogenicity of the liver parenchyma. No focal hepatic lesions. No intrahepatic ductal dilation is seen. The main portal vein is patent with normal hepatopetal flow measured at 20.0 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 1.6 mm. No stones are seen. There is a small amount of sludge present. No pericholecystic fluid. The common bile duct measures 3.5 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 12.8 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 11.0 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 11.7 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.

Output: 1. Hepatomegaly is present.2. The liver has increased echogenicity compatible with fatty infiltration/hepatocellular dysfunction. Although no new worrisome masses are seen, the liver's significant degree of echogenicity decreases the sensitivity for detecting masses on ultrasound. If clinically indicated may consider further cross-sectional imaging for evaluation of any hepatic masses.3. No evidence of cholelithiasis or acute cholecystitis. No intrahepatic ductal dilation.


Instruction: Generate impression based on medical findings.

Input: Male 47 years old Reason: r/o hydronephrosis, pyelonephriits History: AKI, leukocytosis LIVER:Echogenic liver, compatible with fatty infiltration. Liver is enlarged measuring 18 cm. No focal liver lesions.GALLBLADDER, BILIARY TRACT: No significant abnormality noted. No evidence of intra or extrahepatic biliary dilatation. Gallbladder is contracted, therefore, cannot be optimally evaluated.PANCREAS: Not well visualized due to overlying bowel gas.SPLEEN: Spleen measures 7 cm.KIDNEYS: Bilateral slightly echogenic kidneys. Right kidney measures 11.1 cm. Left kidney measures 10.4 cm. No evidence of hydronephrosis or focal lesions. ABDOMINAL AORTA: No significant abnormality noted.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: Small right-sided pleural effusion.Doppler findings:Hepatic veins and IVC are patent. Main portal vein and its branches are patent with normal flow direction. Hepatic artery is patent.

Output: Mild hepatomegaly and echogenic liver. Bilateral echogenic kidneys.Normal Doppler findings.


Instruction: Generate impression based on medical findings.

Input: 1-year-old female with thyromegaly and subclinical hyperthyroidism. RIGHT LOBE MEASUREMENTS: 5.5 x 1.8 x 1.8 cmLEFT LOBE MEASUREMENTS: 5.7 x 2.1 x 1.6 cmISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: Diffusely heterogeneous in echotexture with small hypoechoic area in the upper pole measuring 0.4 x 0.5 x 0.6 cm which is not specific in appearance.LEFT LOBE: Diffusely heterogeneous in echotexture with ill-defined focal region in the mid left lobe which has a spongiform type appearance..ISTHMUS: Heterogeneous in echotexture.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There are prominent but morphologically normal lymph nodes in the neck bilaterally. Patient complains of upper respiratory infection.OTHER: No significant abnormality noted.

Output: Diffusely heterogeneous thyroid with small right nodule and ill-defined , spongiform appearing left nodule.


Instruction: Generate impression based on medical findings.

Input: Ms. Edwards submitted outside mammogram/ultrasound examinations dated 7/3/2014, 8/15/2014, and 8/29/2014, from Northwestern Memorial Hospital. Submitted outside studies were compared to the current mammogram dated 11/4/2016. The breast parenchyma is composed of scattered fibroglandular density (BiRads Density Category B), unchanged in pattern and distribution.Previously identified circumscribed mass in the right lower inner breast is stable when compared to prior examinations (mammograms + ultrasounds) dating back to 7/2014 and with a benign pathology result of UDH/fibroadenomatous change (per outside pathology report).Previously identified asymmetry in the left upper breast is also stable when compared to prior mammogram from 07/2014.There is no significant change between these studies.

Output: Benign biopsy of the right breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually, due next in November 2017.BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: 45-year-old man with history of papillary thyroid cancer status post thyroidectomy 6 years ago. The patient is status post total thyroidectomy.RIGHT THYROID BED: No significant abnormality noted.LEFT THYROID BED: There is a hyperechoic area in the upper left thyroid bed measuring 0.6 x 0.5 x 0.4 cm, stable from the prior examination. Additionally, there is a hyperechoic 0.5 x 0.2 cm area also stable from the prior examination.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy noted.OTHER: No significant abnormality noted.

Output: Stable examination without evidence of recurrent disease or lymphadenopathy.1.


Instruction: Generate impression based on medical findings.

Input: 29-year-old female. Metastatic brain mass and mediastinal/retroperitoneal/pelvic lymphadenopathy. Evaluate for a primary breast malignancy. A nodular enhancing focus was seen in the right inferior breast on recent MRI. A whole bilateral breast ultrasound was performed. In the right inferior breast at the 5 o'clock position 7 cm from the nipple, there is a hypoechoic solid mass with internal vascularity, suspicious for malignancy. It measures 1.3 x 1.3 x 1.5 cm. No solid or cystic mass is identified in the left breast.

Output: Right breast hypoechoic solid mass, suspicious for malignancy and for which ultrasound guided percutaneous biopsy is recommended.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on medical findings.

Input: 51-year-old male with history of thyroid cancer. Evaluate for recurrent disease or adenopathy. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomy no massesRIGHT LOBE: No massesLEFT LOBE: No massesISTHMUS: No massesPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No enlarged or abnormal lymph nodes.OTHER: No significant abnormality noted.

Output: No evidence for recurrent disease.


Instruction: Generate impression based on medical findings.

Input: Ms. Elaine Harris is a 75 year-old female with a personal history of right breast mass for 2 year duration. MAMMOGRAM:Three standard views and 2 spot compression views of both breasts as well as one exaggerated CC view of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density(BiRads Density Category B).There is a large, circumscribed dense mass in the upper outer right breast, posterior depth, measuring 5.4 x 6.4 cm. Two focal asymmetries in the upper outer left breast do not persist with spot compression. A right axillary lymph node is partially visualized.ULTRASOUND:On physical examination, a large mass is palpated in the right upper outer breast.A targeted right ultrasound was performed for the palpable and mammographic area of concern. In the right breast, 10:00 position, 8 cm from the nipple, there is a large complex cystic and solid mass measuring 4.5 x 3.4 cm. The solid component of this complex mass demonstrates increased blood flow and measures 1.2 x 3.4 cm, which could be the target for ultrasound-guided biopsy. Debris is also layering in this complex mass. Normal appearing lymph nodes are noted in the right axilla.

Output: A large dense complex cystic and solid mass in the right breast 10:00 position measuring up to 6.4 cm mammographically. Ultrasound-guided biopsy of the solid component is recommended. Patient is on aspirin and she is advised that it will be optimal to withhold her aspirin for 5 days before biopsy, as long as it is reasonable for her primary physician who prescribed the medicine.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on medical findings.

Input: Heart transplant workup LIVER:Coarse echogenic liver parenchyma without mass. Liver length 18 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatationPANCREAS: No significant abnormality noted.SPLEEN: No significant abnormality noted. 10.7 cm in length KIDNEYS: Right renal minimally complex cyst. No hydronephrosis. Subcentimeter nonobstructing renal stone. Right kidney 12.1 cm in length; left kidney 12.2 cm in length ABDOMINAL AORTA: Distal aorta obscured by gasINFERIOR VENA CAVA: No significant abnormality noted.OTHER: No ascites

Output: Mild hepatomegaly with coarse echogenic liver parenchyma consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Cholelithiasis without acute inflammation. No ascites. Distal aorta are obscured by gas. Nonobstructing right nephrolithiasis.


Instruction: Generate impression based on medical findings.

Input: Cirrhosis with elevated CEA LIVER: Cirrhotic morphology without worrisome mass. Stable complex hepatic cyst right lobe. Liver length 15.5 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.9 cm in lengthOTHER: Left kidney 10.4 cm in length. Spleen 14.2 cm in length. No ascites.

Output: Stable cirrhotic morphology without worrisome mass or ductal dilatation. No ascites.


Instruction: Generate impression based on medical findings.

Input: 45-year-old male with thyroid cancer status post surgery. Evaluate for abnormal masses RIGHT LOBE MEASUREMENTS: Status post thyroidectomyLEFT LOBE MEASUREMENTS: Status post thyroidectomyISTHMUS MEASUREMENTS: Status post thyroidectomyRIGHT LOBE: Hyperechoic focus in the right thyroidectomy bed measures 1.0 cm x 0.6 cm x 0.3 cm.; stable.LEFT LOBE: No discrete nodules or masses in the left thyroidectomy bed. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable benign hyperechoic focus in the right thyroidectomy bed.


Instruction: Generate impression based on medical findings.

Input: Female 47 years old; Reason: enlarged thyroid on exam - evaluate History: enlarged thyroid RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 5.4 x 1.5 x 1.9 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 4.7 x 1.1 x 1.5 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.4 cm.RIGHT LOBE: Right lobe is heterogeneous. A hypoechoic, possibly complex cystic nodule is seen in the right superior thyroid lobe. This measures 0.3 x 0.5 x 0.5 cm. A second cystic nodule demonstrating comet tail artifact is found in the midportion of the right lobe. This nodule measures 0.6 cm x 0.3 cm x 0.4 cm.LEFT LOBE: The left lobe is heterogeneous with no dominant nodules identified.ISTHMUS: No significant abnormalities are noted.LYMPH NODES: No suspicious adenopathy noted. A level 3 lymph node is identified on the right that measures 2.5 cm x 0.5 cm x 0.8 cm. This is slender, hypoechoic, and has a fatty hilum

Output: 1.Two right-sided thyroid nodules are seen. In the superior portion of the right lobe, there is a possibly complex cystic nodule measuring 0.3 cm x 0.5 cm x 0.5 cm. Inferior to that is a another nodule representing a colloid cyst measuring 0.6 cm x 0.3 cm x 0.4 cm. No dominant nodules are seen on the left. No suspicious adenopathy.


Instruction: Generate impression based on medical findings.

Input: Male 69 years old; Reason: Nodule size and characteristics History: thyroid nodules on CT RIGHT LOBE MEASUREMENTS: 4.6 x 2.0 x 1.5 cm.LEFT LOBE MEASUREMENTS: 3.7 x 0.9 x 1.2 cm.ISTHMUS MEASUREMENT: 0.5 cm.RIGHT LOBE: There is round solid complex nodule measuring 2.0 x 1.5 cm in the inferior aspect of the right lobe with foci of increased echogenicity. No other nodules are seen in the right thyroid.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.LYMPH NODES: No adenopathy noted. OTHER: No significant abnormality noted.

Output: Complex nodule in right lobe of thyroid; recommend correlation with ultrasound-guided biopsy.


Instruction: Generate impression based on medical findings.

Input: 70-year-old male requires evaluation prior to heart surgery. He has elevated bilirubin, bilateral lower extremity edema, dyspnea. LIVER: The liver measures 14.7 cm. The liver has coarse and increased echogenicity. No masses. No intrahepatic ductal dilatation. The portal vein is patent.BILIARY TRACT: The gallbladder is significantly dilated and is 7.2 cm at its maximum diameter. No stones. No pericholecystic fluid. Negative Murphy's. The gallbladder wall is measured at 1.9 m. The common bile duct is 6.22 mm, within normal limits for this patient's age.PANCREAS: Evaluation limited by overlying bowel gas.SPLEEN: The spleen measures 11.2 cm. No significant abnormalities noted.KIDNEYS: The right kidney measures 11.5 cm. The left kidney measures 12.1 cm. The cortex has normal echogenicity. No masses, stones, or hydronephrosis. OTHER: No significant abnormalities noted.

Output: 1. Distended gallbladder without acute inflammation at this time. No ductal dilatation.2. Increased and coarse echotexture of liver consistent with chronic liver disease/parenchymal dysfunction. No mass or ascites.


Instruction: Generate impression based on medical findings.

Input: 43-year-old female patient with epigastric pain, gassiness. Evaluate for gallbladder disease. LIVER: The liver measures 11.6 cm in length. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.3 m/sec.GALLBLADDER, BILIARY TRACT: There are no gallstones, gallbladder wall thickening, or pericholecystic fluid. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 3 mm in diameter.PANCREAS: The head and body of the pancreas demonstrate normal echogenicity. The tail is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 10.4 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 10.5 cm in length. No evidence of hydronephrosis.The spleen measures 8.7 cm in length.

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


Instruction: Generate impression based on medical findings.

Input: 65-year-old male with history of elevated creatinine. A right iliac fossa transplant kidney is visualized. Two passes were performed. Post-biopsy imaging demonstrates nonspecific increased echogenicity adjacent to the transplant kidney which is nonspecific. There is a 2.2 cm cyst in the transplant kidney with internal septations.

Output: 1. Technical assistance provided for renal biopsy.2. Possible peritransplant collection is incompletely characterized. If further imaging evaluation is warranted clinically, at CT is recommended for further evaluation. 3. Transplant renal cyst with thin internal septations.


Instruction: Generate impression based on medical findings.

Input: Female 78 years old Reason: evaluate kidney History: renal insuffiencey. RIGHT KIDNEY: The right kidney measures 8.2 cm. The renal cortex is hyperechoic. There is no hydronephrosis. There is a 3.7 x 3.2 x 3.0 cm simple cyst at the upper pole of the right kidney.LEFT KIDNEY: The left kidney measures 8.3 cm. The renal cortex is hyperechoic. There is no hydronephrosis. There is a mildly complex cystic lesion at the mid/lower pole of the left kidney which measures 1.0 x 1.0 x 1.0 cm. There is a thin septation at the superior portion and a suggestion of a small calcification dependently within the lesion. This is stable/minimally increased compared to a prior CT 08/05/12.OTHER: The bladder is incompletely distended.

Output: 1. No hydronephrosis.2. Hyperechoic renal cortex bilaterally suggestive of medical renal disease. 3. Mildly complex left renal cyst, stable/mildly increased compared to prior CT 08/05/12. This remains nonspecific but warrants ongoing imaging follow-up.4. Stable right upper pole simple cyst.


Instruction: Generate impression based on medical findings.

Input: History of right thyroid lobe nodules. RIGHT LOBE MEASUREMENTS: 6.2 x 2.5 x 1.8 cmLEFT LOBE MEASUREMENTS: 5.6 x 1.9 x 1.7 cmISTHMUS MEASUREMENTS: 3 mmRIGHT LOBE: The background thyroid parenchyma is homogeneous and normal in echogenicity. 1.7 x 1.4 x 0.9 cm superior pole isoechoic solid nodule with mild vascularity but no definite microcalcifications. Previously this measured 1.6 x 1.4 x 1.0 cm.Inferior and more dorsal to the above lesion is a hypoechoic 7 x 6 x 5 mm nodule with suspected microcalcifications. The lesion previously measured 7 x 6 x 5 mm.LEFT LOBE: 4 mm cyst in the interpolar region. The thyroid parenchyma is normal in echogenicity.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable size of the 2 right thyroid lobe nodules. Correlate with prior outside hospital biopsy results.


Instruction: Generate impression based on medical findings.

Input: History of a left thyroid lobe nodule. FNA dated 3/6/2013 thyroid nodule demonstrated a colloid nodule. RIGHT LOBE MEASUREMENTS: 4.6 x 1.6 x 1.2 cmLEFT LOBE MEASUREMENTS: 3.4 x 1.2 x 1.1 cmISTHMUS MEASUREMENTS: 2 mmRIGHT LOBE: The right thyroid lobe is normal in echogenicity morphology and size without a discrete nodule.LEFT LOBE: The left thyroid lobe is of normal echogenicity morphology and size with an anterior interpolar mildly hypoechoic well-defined nodule measuring 7 x 5 x 6 mm, unchanged from prior. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable left thyroid lobe nodule.


Instruction: Generate impression based on medical findings.

Input: 43 year old female who was recalled from screening mammogram for a partially circumscribed oval mass in the right lower central breast. Mammogram: An ML view and two spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density(BiRads Density Category B). 24 mm oval circumscribed isodense mass persist in the right lower outer quadrant. No associated calcifications noted.Ultrasound: Targeted right lower outer quadrant ultrasound was performed that showed an oval circumscribed benign morphology hypoechoic mass with central hyperechogenicity that measures 1.8 x 0.6 x 1.2 cm corresponding to the mammographic abnormality. Mass is located at 7:00 position, 5 cm from the nipple. No definite blood flow is identified within the mass. This could either represent a benign intramammary lymph node or fibroadenolipoma.

Output: Benign morphology mass in the right breast 7:00 position on mammogram and ultrasound.No mammographic evidence of malignancy. As long as patient's physical examination remains unchanged, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: Female 46 years old; Reason: Diffuse goiter, check for nodules History: goiter RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 1.5 x 1.9 x 6.1 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 5.9 x 3.7 x 8.9 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.4 cm.RIGHT LOBE: Right lobe is heterogeneous with a predominantly solid nodule with cystic components measuring 2.4 cm x 1.3 cm x 1.7 cm in the mid/lower pole. There are punctate echogenic foci seen but no discrete calcifications.LEFT LOBE: The left lobe is predominantly a conglomerate of solid and highly complex cystic/spongiform nodules. The largest measures 3.3 cm x 2.4 cm x 3.6 cm and the cystic portion has complex internal echogenicity. There are several other smaller hyperechoic cyst in the left lobe.ISTHMUS: No significant abnormality noted.LYMPH NODES: No suspicious adenopathy noted.

Output: 1.Multinodular goiter with no suspicious regional adenopathy identified.2.The left lobe is primarily a conglomerate of solid and highly complex cystic/spongiform nodules. A component of this may represent a hemorrhagic cyst.3.In the right lobe there is a predominantly solid nodule with cystic components which is amenable to percutaneous biopsy.


Instruction: Generate impression based on medical findings.

Input: Acute renal insufficiency RIGHT KIDNEY: Mildly echogenic parenchyma without mass, stone, or hydronephrosis. Right kidney 10.5 cm in lengthLEFT KIDNEY: Mildly echogenic parenchyma without mass, stone, or hydronephrosis. Left kidney 10.7 cm in lengthOTHER: Bladder nondistended

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


Instruction: Generate impression based on medical findings.

Input: Male 58 years old; Reason: R thyroid nodule r/o thyroid cancer vs. goiter History: asymptomatic nodule RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 1.7 x 1.7 x 7.9 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 1.6 x 1.5 x 5.0 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.7 cm.RIGHT LOBE: Along the inferior border between the right lobe and isthmus a predominantly cystic dominant nodule is visualized with internal mural nodularity. This measures 3.2 cm x 2.1 cm x 3.2 cm. No internal vascularity is seen.LEFT LOBE: There is a hypoechoic subcentimeter nodule in the left inferior thyroid lobe. Additionally, in the inferior left thyroid lobe there is a hyperechoic nodule measuring 0.7 cm x 0.4 cm x 1.1 cm. This has minimal internal vascularity.ISTHMUS: No significant abnormality noted.LYMPH NODES: No suspicious adenopathy noted. On the left at level 3, a lymph node with a fatty hilum is seen measuring 0.5 cm x 0.3 cm x 1.2 cm.

Output: 1.At the inferior border between the right lobe and isthmus a dominant nodule is identified measuring 3.2 cm x 2.1 cm x 3.2 cm. This nodule is predominantly cystic with some mural internal nodularity; the nodular solid component is amenable to ultrasound-guided percutaneous biopsy.2.Two subcentimeter nodules are seen on the left thyroid lobe, as above.3.No suspicious regional adenopathy is identified.


Instruction: Generate impression based on medical findings.

Input: 20 year-old female with a history of thyroid cancer post thyroidectomy and radioactive iodine. Enlarged submandibular lymph nodes identified on prior study. There is a heterogeneous right submandibular lymph node measuring 1.1 x 2.7 by 2.5 cm with punctate internal echogenic foci. Several of these areas demonstrate comet tail artifact. This is decreased in size when compared to the prior exam.There is a heterogeneous left submandibular lymph node measuring 0.9 x 1.7 x 2.2 cm without significant change. There are several punctate internal echogenic foci, at least a few of which may also demonstrate comet tail artifact.OTHER: No significant abnormality noted.

Output: No change or slight decrease in submandibular lymph nodes.


Instruction: Generate impression based on medical findings.

Input: Please evaluate the right breast, upper lateral area for abscess/signs of soft tissue infection. Patient is admitted for abscess, unclear source. She has area of mild induration and redness in the right upper lateral area approximately 10:00 position from the areola. On physical examination, a superficial skin ulcer (patient has a habit of picking herself) in the right breast medially approximately 4:00 position, 5 cm from the nipple. A 3 cm mobile palpable lump is identified in the right breast 10:00 position, 8 cm from the nipple. Right breast appears red and warm.A targeted right ultrasound was performed for the patient’s area of concern at 10:00 position. Ultrasound demonstrates skin thickening and edema. At 10:00 position there are 2 adjacent oval to round hypoechoic to anechoic areas with few areas of through transmission, measuring 1.6 x 1.3 x 1.6 cm and 1.6 x 1.1 x 1.1 cm. Adjacent to these 2 hypoechoic areas is an area of increased echogenicity. Patient denies history of trauma and is not on any blood thinners.

Output: 2 adjacent hypoechoic areas with adjacent hyperechogenicity in the right breast 10:00 position corresponding to the palpable abnormality most likely represents area of hematoma/fat necrosis versus abscess. Also noted is right breast skin thickening and edema consistent with cellulitis.Surgical consultation to be performed if clinically indicated. Findings and recommendations were discussed with Dr. Ram Krishnamoorthi at pager 4111.After patient completes her course of antibiotics if things resolve, follow-up ultrasound can be performed.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation.


Instruction: Generate impression based on medical findings.

Input: Right upper quadrant abdominal pain. LIVER: Non-cirrhotic liver morphology. Normal parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Multiple 8-10 mm gallstones noted, with a small amount of biliary sludge. No evidence of cholecystitis. No sonographic Murphy's sign.PANCREAS: No sonographic abnormality evident in the visualized pancreatic head and neck. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney is 9.9 cm in length. The left kidney is 9 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 9.2 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No abdominal free fluid is identified.

Output: Cholelithiasis without cholecystitis.


Instruction: Generate impression based on medical findings.

Input: History of hepatomegaly on CT in 2011 now with right lower quadrant and flank pain. LIVER: The liver measures 15.1 cm in length. The liver parenchymal echotexture is normal. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating pulsatile hepatopetal flow with a velocity of 0.31 m/s.BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 3 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: The spleen is not visualized likely related to close approximation to the diaphragm as seen on 2011 CT.RIGHT KIDNEY: Kidney measures 10.8 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 12.8 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.

Output: 1.No evidence of acute cholecystitis, hydronephrosis, or other specific findings to account for patient's symptoms.2.Pulsatile blood flow in the portal vein raising the possibility of elevated right heart pressures.


Instruction: Generate impression based on medical findings.

Input: 82-year-old male patient with right upper quadrant pain, gram-negative bacteremia. Evaluate gallbladder. LIVER: The liver measures 17.0 cm in length. Hepatic parenchymal echogenicity is coarsened and increased. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: There are no gallstones, gallbladder wall thickening, or pericholecystic fluid. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 3 mm in diameter.PANCREAS: The head and body of the pancreas demonstrate normal echogenicity. The tail is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 9.6 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 9.7 cm in length. No evidence of hydronephrosis.The spleen measures 6.1 cm in length.

Output: 1. Coarsened hepatic echogenicity which can be seen with hepatic parenchymal dysfunction.2. No cholelithiasis.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old. Worsening renal function. RIGHT KIDNEY: The right kidney measures 11.7 cm in length, with increased cortical echogenicity. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.0 cm in length, with increased cortical echogenicity. No shadowing stones or hydronephrosis.OTHER: The bladder is incompletely distended.

Output: Increased renal cortical echogenicity compatible with medical renal disease. No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 73-year-old male with hepatitis C and nausea and epigastric pain. LIVER: Liver is normal in size and appears mildly and coarsely echogenic which is nonspecific. Liver was not grossly cirrhotic and no focal abnormality is identified.GALLBLADDER, BILIARY TRACT: Gallbladder contains comet tail artifact consistent with adenomyomatosis/cholesterol deposition. No shadowing gallstones, wall thickening or pericholecystic fluid. Biliary tract is normal in caliber.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: Mildly complex left renal cyst. Focal echogenic region in the left kidney may represent nonobstructive calcification.

Output: Probable adenomyosis involving the gallbladder. There is no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: 23 year old male with collection near gallbladder on prior CT. Complains of recurrent abdominal pain. LIVER: The liver measures 16.6 cm in length. It demonstrates normal echotexture without focal lesions or biliary ductal dilatation. The main portal vein is patent and demonstrates hepatopedal flow with velocity of 0.2 m/s.GALLBLADDER, BILIARY TRACT: There is wall thickening of the gallbladder fundus, with numerous associated echogenic foci along the gallbladder wall. The region of abnormality measures 5.1 x 1.5 x 2.5 cm. Findings likely represent fundal adenomyomatosis. No evidence of fluid collection/abscess. No shadowing gallstones. No sonographic Murphy sign.PANCREAS: No significant abnormalities noted.OTHER: No ascites.

Output: Findings compatible with focal fundal adenomyomatosis as described above.


Instruction: Generate impression based on medical findings.

Input: 74 year old female with asymmetric swelling and tenderness of the right lower portion of the neck. Evaluate for thyroid enlargement. RIGHT LOBE MEASUREMENTS: 3.0 x 1.2 x 1.3 cmLEFT LOBE MEASUREMENTS: 3.6 x 1.5 x 1.2 cmISTHMUS MEASUREMENTS: 3 mmRIGHT LOBE: The right thyroid lobe is normal in morphology, echogenicity, and size without a discrete nodule.LEFT LOBE: The left thyroid lobe is normal in morphology, echogenicity, and size without a discrete nodule.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Normal thyroid examination.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female with acute kidney injury RIGHT KIDNEY: Measures 10.9 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. LEFT KIDNEY: Measures 10.8 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. URINARY BLADDER: Incompletely distended without focal abnormality. OTHER: Bilateral renal stents in place.

Output: 1.Increased renal echogenicity consistent with medical renal disease.2.Renal stents in place without hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 75 years old, Female, Reason: rule out thyroid nodules History: none RIGHT LOBE MEASUREMENTS: 4.3 x 1.4 x 1.8 cmLEFT LOBE MEASUREMENTS: 4.2 x 2.0 by 2.4 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Multiple nodules on the right some of which are calcified. The lower calcified nodule measures 1.0 x 0.6 x 0.7 cm.LEFT LOBE: Multiple nodules on the left. Inferior medial solid appearing nodule along the left isthmus measures 2.1 x 1.3 x 1.7 cm and is amenable to biopsy. Another left thyroid nodule is mixed cystic and solid in appearance measuring 1.5 x 1.2 cm and is also amenable to biopsy.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multiple subcentimeter right thyroid nodules, some of which are calcified.2.Multiple left thyroid nodules which are amenable to biopsy.


Instruction: Generate impression based on medical findings.

Input: 47-year-old female presents to evaluate referring nurse palpated mass in the left breast 12:00 position. Donna Christian on physical examination has marked with a black marker the palpable area of concern. A targeted left ultrasound was performed for the palpable area of concern. Small 4 x 5 mm complex cyst is identified at 12:00 position corresponding to the palpable abnormality. No suspicious mass noted.

Output: Complex cyst measuring 5 mm in the left breast 12:00 position corresponding to the palpable abnormality.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: A patient submitted outside study for review. Submitted for review are diagnostic mammograms and ultrasounds (7/7/16) along with post procedural mammograms (7/13/16) performed at Northwestern Lake Forest Hospital. Three standard views of both breasts were obtained along with spot compression and spot magnification views of the bilateral breasts. Subsequent ultrasound was also performed. The breast parenchyma is heterogeneously dense.Right:Three areas of concern are described on the right:1. Loosely scattered calcifications are seen in the lower, inner quadrant. These calcifications span 3.4 cm on the MLO spot magnification view. Few benign coarse calcifications are noted within this cluster. On corresponding ultrasound, within the right lower, inner quadrant a corresponding 10 x 7 x 3 mm mass is demonstrated that was subsequently biopsied and consistent with benign fibroadenoma which is concordant. A coil shaped clip is present adjacent to the coarse and other loosely scattered calcifications. Specimen radiograph were not obtained to confirm calcifications but the post procedure mammogram shows that a few calcifications were removed at the time of biopsy. 6 month follow up mammogram is recommended of this area of calcifications to confirm stability. 2. A benign subcentimeter intramammary lymph node is identified in the right upper-outer quadrant with a correlate seen on ultrasound subsequently.Left:Four areas of concern are described on the left:1. Patient palpable mass at the 5:00 position does not show any abnormality on mammogram or targeted ultrasound.2. A cluster of calcifications within the left axillary tail measures up to 8 mm on mammogram. This area was biopsied, marked by a heart shaped clip that has been medially displaced about 3 cm. Pathology corresponds to focal ALH at this area. This is concordant. Specimen radiograph shows cores with calcifications. 3. A tight cluster of calcifications measuring 4 mm is seen at the 6:00 position. This area was subsequently biopsied marked by an x= shaped clip and was consistent with fibroadenoma with fibrocystic change. This is concordant. Specimen radiograph shows cores with calcifications. 4. Within the posterior depth at 12:00 position a 14 mm mass with associated calcifications is identified best on MLO views (partially visualized on CC view). This area was unable to be biopsied secondary to depth and overlying vasculature. A correlate was not found on ultrasound.

Output: On the right, six-month follow-up is recommended for the loosely scattered calcifications adjacent to the coil clip with benign results. On the left, ultrasound is recommended to further characterize the mass within the posterior depth of the breast.Surgical consultation is recommended for the left axillary tail calcifications that showed focus of ALH. Heart shaped clip is medially displaced by 3 cm. No definite residual calcifications are seen. No abnormality noted corresponding to the palpable area of concern in the left breast. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: 36 year old female with history of nephrolithiasis. Presents with right upper quadrant pain. LIVER: The liver is normal in morphology, echogenicity and size, measuring 15.3 cm in craniocaudal length. An 8mm echogenic shadowing parenchymal calcification is noted. There is no suspicious focal hepatic lesion or intrahepatic biliary ductal dilatation. Normal hepatopetal portal venous blood flow at 30 cm/sec.GALLBLADDER, BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common bile duct measuring 3 mm. Normally distended gallbladder without wall thickening, pericholecystic fluid or cholelithiasis.PANCREAS: The visualized portions of the pancreas are unremarkable.RIGHT KIDNEY: The right kidney appears slightly atrophic, measuring approximately 8.3 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident.LEFT KIDNEY: The left kidney is normal in size, measuring 12.6 cm without hydronephrosis, shadowing calculus or discrete lesion evident.SPLEEN: The spleen measures 12.6 cm in length without a focal lesion.AORTA: The aorta is ectatic without aneurysmal dilatation. The right and left iliac vessels are mildly ectatic measuring 1 and 1.1 cm, respectively.INFERIOR VENA CAVA: The visualized portions of the vena cava are patent.URINARY BLADDER: Partially distended urinary bladder. The left ureteral jet is visualized. OTHER: A right ovarian cyst measuring 2.6 x 2.1 cm is noted.

Output: No hydroureteronephrosis or shadowing calculus. 2.6-cm right ovarian cyst. Mildly ectatic aorta without aneurysmal dilatation.


Instruction: Generate impression based on medical findings.

Input: Enlargement of left scrotum RIGHT TESTIS: 3.7 x 1.9 x 2.8 cm. No intratesticular mass. Bilaterally symmetric Doppler flow characteristics.LEFT TESTIS: 4.4 x 2.2 x 3 cm. No intratesticular mass. Bilaterally symmetric Doppler flow characteristicsRIGHT EPIDIDYMIS: No significant abnormalities noted.LEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: Large left hydrocele. Benign left scrotal pearl.

Output: No intratesticular mass. Bilaterally symmetric Doppler flow characteristics. Large left hydrocele. Benign left scrotal pearl.


Instruction: Generate impression based on medical findings.

Input: History of liver abscess LIVER: No significant abnormalities noted. Specifically, no evidence for hepatic mass lesion or abscess. Liver length 16 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: Pancreatic head mass again noted.RIGHT KIDNEY: Large upper pole right renal mass measuring 5 x 4.6 x 5.3 cm again noted. Right kidney 10.3 cm in lengthOTHER: Lower pole left renal mass measuring 1.7 x 1.7 x 2 cm again noted. Left kidney 9.6 cm in length. Spleen 8 cm in length. No ascites.

Output: No evidence for liver mass or abscess. No ductal dilatation. No ascites. Bilateral renal masses and pancreatic mass again noted.


Instruction: Generate impression based on medical findings.

Input: Painful right submandibular mass RIGHT LOBE MEASUREMENTS: 5.4 x 1.4 x 2.6 cmLEFT LOBE MEASUREMENTS: 4.7 x 1.3 x 2.4 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Enlarged but morphologically normal appearing bilateral submandibular/level 1 lymph nodes bilaterally.OTHER: No significant abnormality noted.

Output: Enlarged but morphologically normal appearing bilateral submandibular/level 1 lymph nodes bilaterally. Findings consistent with benign reactive adenopathy. No worrisome mass lesion or cyst. Normal thyroid gland.


Instruction: Generate impression based on medical findings.

Input: Left upper quadrant discomfort and popping sensation along the angle of the rib cage No abdominal wall defects, hernia, or soft tissue abnormalities are visualized in the area of the patient's described discomfort.

Output: Negative examination, as above.


Instruction: Generate impression based on medical findings.

Input: 52-year-old female with right upper quadrant pain. Evaluate gallbladder. LIVER: Increased echogenicity of the liver measuring 20.4 cm in length. No focal hepatic lesions. Main portal vein is patent with appropriate directional flow; peak velocity measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: Normal echogenicity the gallbladder. No gallbladder wall thickening. No pericholecystic fluid. Common duct measures 4 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Tail of the pancreas is obscured by overlying bowel gas. The remaining visualized portions are unremarkable.RIGHT KIDNEY: Measures 12.5 cm in length. There is a shadowing stone at the mid to upper pole measuring 1.8 cm x 1.2 cm x 1.7 cm which likely corresponds to the stone seen on CT dated 4/22/2014. No hydronephrosis is noted.OTHER: Left kidney measures 12.1 cm in length. No hydronephrosis or shadowing calculi are noted. Normal echogenicity of the spleen measuring 12.0 cm in length.

Output: 1. Hepatomegaly with increased echogenicity suggestive of parenchymal dysfunction/fatty infiltration. No focal hepatic lesions. 2. Non obstructing right nephrolithiasis appears similar to CT dated 4/22/2014. 3. No evidence of cholecystitis.


Instruction: Generate impression based on medical findings.

Input: 50-year-old male with acute kidney injury, evaluate for obstruction. RIGHT KIDNEY: Measures 9.9 cm in length. No hydronephrosis, nephrolithiasis, or solid lesion. Normal echotexture.LEFT KIDNEY: Measures 9.8 cm in length. No hydronephrosis, nephrolithiasis, or solid lesion. Normal echotexture.URINARY BLADDER: Incompletely distended.OTHER: No significant abnormalities noted.

Output: No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Ms. Goodman is a 21 year old female presenting with bilateral palpable masses. Patient has had prior FNA of the left breast revealing fibroadenoma in 2013. She currently states that these masses have decreased in size since compared to prior examination. Upon physical exam of the right breast, at least 3 palpable masses are identified, the largest of which is in the right lower inner breast.Targeted right breast ultrasound is performed for the patient's areas of concerns.- 5 o'clock location: 3.0 x 1.6 x 2.4 cm, compared to 3.1 x 1.6 x 2.2 cm.- 9 o'clock location: 1.6 x 1.2 x 1.7 cm, compared to 1.6 x 1 .0 x 1.7 cm.- 10 o'clock location: 0.8 x 0.5 x 0.9 cm, compared to 1.0 by 0.4 x 1.2 cmUpon physical exam of left breast, at least for palpable masses are identified, the largest of which is in the left lower inner breast.Targeted left breast ultrasound is performed for the patient's area of concerns.- 7 o'clock location: 3.4 x 1.5 x 3.4 cm, compared to 3.2 x 1.2 x 3.6 cm.- 3 o'clock location: 1.0 x 0.7 x 1.2, compared to 1.1 x 0.7 x 1.2 cm- 12 o'clock location: 2.4 x 1.6 x 1.5 cm, compared to 0.9 x 0.8 cm.- 12 o'clock location: 1.8 x 1.6 x 1.8 cm, compared to 1.1 x 0.6 cm.

Output: Interval increase in size of two left breast masses. Multiple additional bilateral masses are relatively unchanged in size, all of which likely represent fibroadenomata. Continued surgical observation is recommended for this patient. All results and recommendations were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation.


Instruction: Generate impression based on medical findings.

Input: As per discussion of the interdisciplinary conference, patient presents for right axillary ultrasound. History of right lumpectomy for breast cancer in 2013, now with new biopsy-proven cancer in the right central breast. A targeted right axillary ultrasound was performed. Patient has a history of prior sentinel lymph node biopsy. A bilobed hypoechoic lesion in the right lower axilla measures 8 x 4 x 4 mm with minimal to no blood flow. This could represent an abnormal lymph node. Another smaller lymph node measures 4 x 2 x 4 mm. A large lymph node with fatty hilum is identified in the right higher axilla that measures 12 x 7 mm.

Output: Two suspicious subcentimeter lymph nodes in the right axilla one of them amenable to ultrasound-guided biopsy. Patient is on Coumadin. Findings discussed with Dr. Barrera and Donna Christian at the time of dictation.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: History of Hashimoto's thyroiditis. RIGHT LOBE MEASUREMENTS: 5.0 x 1.5 x 2.2 cmLEFT LOBE MEASUREMENTS: 4.8 x 1.7 x 1.9 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: The right thyroid lobe is diffusely heterogeneous in echotexture without a discrete dominant nodule. It is mildly hypervascular.LEFT LOBE: The left thyroid lobe is diffusely heterogeneous in echo texture without a discrete dominant nodule. An echogenic 5 x 2 x 5 mm nodule is noted without suspicious sonographic features. Note is made of a 7 x 4 x 5 mm hypoechoic nodule dorsal to the inferior aspect of the left thyroid lobe which may represent a small parathyroid adenoma or exophytic thyroid nodule.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Note is made of a 7 x 4 x 5 mm hypoechoic nodule dorsal to the inferior aspect of the left thyroid lobe which may represent a small parathyroid adenoma or exophytic thyroid nodule.LYMPH NODES: No pathologically enlarged or morphologically suspicious cervical lymph nodes.OTHER: No significant abnormality noted.

Output: Diffusely heterogeneous thyroid gland without a discrete dominant nodule measuring greater than 1 cm, compatible with patient's history of Hashimoto's thyroiditis. Note is made of a 7 x 4 x 5 mm hypoechoic nodule dorsal to the inferior aspect of the left thyroid lobe which may represent a small parathyroid adenoma or exophytic thyroid nodule. Alternatively this may represent a small lymph node as there is a questionable fatty hilum on CINE imaging.


Instruction: Generate impression based on medical findings.

Input: 76 years old, Male, Reason: evaluate biliary tree for obstruction; evaluate pancreas for abscess/pseuodocyst History: sepsis, elevated liver enzymes Technically difficult exam, especially in the left upper quadrant, due to patient's inability to lay decubitus and large body habitus.LIVER: The liver is enlarged measuring 22.1 cm in length. Innumerable confluent hypoechoic masses within the hepatic parenchyma are suspicious for metastatic malignancy. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.15 m/s.BILIARY TRACT: The gallbladder is collapsed without definite evidence of cholelithiasis. No evidence of cholecystitis. No evidence of intrahepatic or extra hepatic biliary ductal dilatation. The common bile duct measures 6 mm in diameter.PANCREAS: The pancreas is not well-visualized on this exam.SPLEEN: The spleen is not well visualized on this exam. RIGHT KIDNEY: Kidney measures 13.9 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: The left kidney is not well visualized.OTHER: No significant abnormalities noted.

Output: 1.Innumerable confluent hypoechoic masses in the liver are consistent with metastatic malignancy. 2.The gallbladder appears contracted without evidence of cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Hypothyroidism RIGHT LOBE MEASUREMENTS: 1.9 x 1.9 x 5 cmLEFT LOBE MEASUREMENTS: 1.9 x 1.9 x 4.8 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Atrophic gland with diffusely heterogeneous echotexture with multiple regions of hypoechogenicity surrounded by increased echogenicity without discrete mass. No increased vascularityLEFT LOBE: Atrophic gland with diffusely heterogeneous echotexture with multiple regions of hypoechogenicity surrounded by increased echogenicity without discrete mass. No increased vascularityISTHMUS: Atrophic gland with diffusely heterogeneous echotexture with multiple regions of hypoechogenicity surrounded by increased echogenicity without discrete mass. No increased vascularityPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Atrophic gland with diffusely heterogeneous echotexture with multiple regions of hypoechogenicity surrounded by increased echogenicity without discrete mass. No increased vascularity. Findings suggestive for chronic thyroiditis. No regional adenopathy.


Instruction: Generate impression based on medical findings.

Input: Right upper quadrant pain. LIVER: Non-cirrhotic liver morphology. Normal parenchymal echogenicity. Subcentimeter anechoic hepatic lesions, likely representing cysts. No suspicious hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. 2 mm hyperechoic focus along the nondependent gallbladder wall, possibly representing a polyp. Otherwise unremarkable appearance of the gallbladderPANCREAS: No sonographic abnormality evident in the visualized pancreatic head and neck. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney is 10.1 cm in length. The left kidney is 9.5 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 9.1 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted.

Output: No cholelithiasis. No specific findings to account for the patient's right upper quadrant abdominal pain.


Instruction: Generate impression based on medical findings.

Input: 51 year old who is called back from screening mammogram for developing calcifications. Family history of mother and sister with breast cancer. An ML view and two spot magnification views of the left breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. There are pleomorphic calcifications at posterior lower inner left breast, measuring 28 x 40 mm, distributing segmentally. No masses or distortions are associated with these calcifications.Focused ultrasound study was performed for the left breast lower inner quadrant. There are no solid or cystic masses. No increased blood flow is present.

Output: Pleomorphic calcifications at lower inner quadrant in the left breast. Stereotactic core needle biopsy is recommended. Results and recommendations were discussed with the patient and her husband. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on medical findings.

Input: Bilateral breast tenderness. A whole breast ultrasound was performed bilaterally for the patient’s areas of concern. The breast parenchyma and subcutaneous soft tissues are sonographically normal. No solid or cystic mass is identified.

Output: No sonographic abnormality evident. Breast pain should managed clinically.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on medical findings.

Input: 50 years old, Female, Reason: r/o adenopathy, recurrence History: h/o thyroid cancer MEASUREMENTS: Patient status post thyroidectomyRIGHT LOBE AREA: Again seen is a very small hypoechoic focus measuring 0.2 x 0.1 x 0.2 cm which is not significant change from prior exam.LEFT LOBE AREA: No evidence of local recurrence.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign appearing right level 3 lymph node measures 0.9 x 0.3 x 0.2 cm. benign appearing left level 3 lymph node measures 1.3 x 0.6 x 0.2 cm.OTHER: No significant abnormality noted.

Output: 1. Stable very small hypoechoic focus in the right thyroid bed.2. No significant lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Ms. Rosenberger is a 51 year old female with a personal history of left breast mastectomy for left breast cancer and sentinel lymph node biopsy in 2005. Patient presents with a new self-palpated left axillary lump. Upon physical exam at the patient's area of concern, nodular tissue is identified.Targeted ultrasound of the left axilla at the area of concern was performed. There is no sonographic abnormality to correlate with the palpable area of concern. No abnormal lymph nodes are noted.

Output: No sonographic evidence of malignancy. The patient should follow up with her primary care physician as clinically warranted, presuming these results are concordant with the physical exam findings. All results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on medical findings.

Input: Right hydrocele RIGHT TESTIS: 3.8 x 4.8 x 1.5 cm. No worrisome intratesticular mass. Subcentimeter peripheral benign cyst. Bilaterally symmetric Doppler flow characteristics.LEFT TESTIS: 3.7 x 2.6 x 4.1 cm. No intratesticular mass. Bilaterally symmetric Doppler flow characteristicsRIGHT EPIDIDYMIS: Epididymal cysts.LEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: Bilateral moderate hydroceles. Left hydrocele demonstrates internal complexity.

Output: No worrisome intratesticular mass. Bilaterally symmetric Doppler flow characteristics. Right epididymal benign cysts. Bilateral moderate hydroceles. Left hydrocele demonstrates internal complexity which can be seen as sequela of prior inflammatory or traumatic mechanisms.


Instruction: Generate impression based on medical findings.

Input: 40 year-old female with a renal transplant presents with fevers and AKI. LOCATION: Right iliac fossa.PERITRANSPLANT TISSUES: No perinephric fluid noted.KIDNEY: Transplant kidney measures 12.1cm. No significant abnormality notedCOLLECTING SYSTEM/URETER: No hydronephrosis.URINARY BLADDER: Bladder is nondistended.VASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels and demonstrate patent vasculature.OTHER: No significant abnormality noted

Output: Normal ultrasound of kidney transplant without hydronephrosis or a perinephric fluid collection.


Instruction: Generate impression based on medical findings.

Input: 58-year-old female with elevated LFTs. LIVER: Increased hepatic echogenicity without discrete focal lesion.BILIARY TRACT: No gallbladder wall thickening, cholelithiasis, or pericholecystic fluid. No ductal dilation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.

Output: Increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease. No discrete lesions identified.


Instruction: Generate impression based on medical findings.

Input: Reason: Assess for Kidney stones. Patient with Primary HPT. RIGHT KIDNEY: The right kidney measures 9.3 cm in length. 0.6 x 0.4 x 0.5 cm hyperechoic parenchymal stone in the mid right kidney. No evidence of obstruction or hydronephrosis.LEFT KIDNEY: Left kidney measures 9.2 cm in length. No shadowing stones or hydronephrosis. 1.6 x 1.6 x 1.8 cm anechoic cyst.OTHER: The urinary bladder is poorly distended, limiting evaluation.

Output: Focal right parenchymal calcification without evidence of obstruction or nephrolithiasis.


Instruction: Generate impression based on medical findings.

Input: Right-sided flank pain RIGHT KIDNEY: 9.6 cm in length. Unremarkable renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: 9.9 cm in length. Unremarkable renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.BLADDER: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Reason: History of radiation as a child. Please assess for malignancy History: History of radiation as a child. Please assess for malignancy RIGHT LOBE MEASUREMENTS: 4.1 x 1.5 x 1.8 cm.LEFT LOBE MEASUREMENTS: 3.5 x 1.2 x 1.7 cm.ISTHMUS MEASUREMENTS: 0.2 cm.RIGHT LOBE: Normal echogenicity, morphology, and sinus without discrete nodules or masses.LEFT LOBE: Normal echogenicity, morphology, and sinus without discrete nodules or masses.ISTHMUS: Normal echogenicity, morphology, and sinus without discrete nodules or masses.PARATHYROID GLANDS: Not visualized.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Normal appearing thyroid without interval change.


Instruction: Generate impression based on medical findings.

Input: 65-year-old female with prior imaging with ascites. Evaluate liver parenchyma, signs of ascites or congestion. LIVER: Mildly enlarged and echogenic liver. The liver measures 17.3 cm in length. No focal hepatic mass is identified. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: Dependent gallstones are identified. Gallbladder wall is diffusely and mildly thickened, measuring up to 6 mm, and nonspecific in the setting of ascites. No evidence of intrahepatic or extrahepatic periductal dilatation. Common bile duct measures 5 mm in diameter.PANCREAS: No significant abnormalities noted.SPLEEN: Not visualized due to limitations with patient's position.RIGHT KIDNEY: Echogenic right kidney measuring 8.3 cm in length. Renal calcifications may be vascular in etiology. No evidence of hydronephrosis. OTHER: Moderate ascites.

Output: 1.Mildly enlarged and echogenic liver, suggestive of fatty infiltration. No focal hepatic mass is identified.2.Echogenic right kidney, suggestive of medical renal disease.3.Cholelithiasis without evidence of acute cholecystitis. Diffusely mildly thickened gallbladder wall is nonspecific in the setting of ascites.4.Moderate ascites.


Instruction: Generate impression based on medical findings.

Input: Epigastric pain LIMITED ABDOMENLIVER: Normal parenchymal echogenicity without mass. Liver length 13.8 cmBILIARY TRACT: Status post cholecystectomy. No significant ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 8.3 cm in length RIGHT KIDNEY: No significant abnormalities noted. 10.6 cm in lengthOTHER: Left kidney 10.3 cm in length. No ascites.

Output: Unremarkable Limited right upper quadrant ultrasound. No hepatobiliary abnormality. No ascites. Patent hepatic vessels with normal directional flow. Unremarkable hepatic artery waveforms without evidence for increased diastolic dampening or increased resistance pattern.


Instruction: Generate impression based on medical findings.

Input: History of regional enteritis with abnormal liver enzymes LIVER: Mildly coarse and echogenic liver parenchyma without mass. Liver length 16.5 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.7 cm in lengthOTHER: Left kidney 12.3 cm in length. Spleen 9.3 cm in length. No ascites.

Output: Mildly coarse and echogenic parenchyma raises the possibility of fatty infiltration/parenchyma dysfunction without mass or ductal dilatation. No ascites.


Instruction: Generate impression based on medical findings.

Input: 22-year-old female with proteinuria RIGHT KIDNEY: 12.2 cm in length. Increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis. Trace nonspecific perinephric fluid identified.LEFT KIDNEY: 11.8 cm in length. Increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.BLADDER: Collapsed. Foley catheter identified.OTHER: Bilateral pleural effusions, partially imaged.

Output: 1. Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease.2. Bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: check liver size, rule out cirrhosis History: portal hypertension, gastropathy and anemia, elevated AST LIVER: The liver measures 11.4 cm in length. Limited evaluation due to poor windows, however hepatic parenchyma appears coarse and echogenic with a peripheral nodular contour. The portal vein is patent with normal directional hepatopedal portal venous blood flow, peak velocity 19.7 cm/s. No focal masses.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted. The common bile duct measures 0.7 cm, within normal limits for age. No biliary ductal dilatation.PANCREAS: Obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 10.6 cm in length. No hydronephrosis or shadowing stones.LEFT KIDNEY: The left kidney measures 10.6 cm in length. No hydronephrosis or shadowing stones.OTHER: Moderate volume ascites. The spleen measures 13.2 cm in length. The bladder is poorly distended, limiting evaluation.

Output: 1. Findings consistent with hepatic steatosis and suspicious for cirrhosis. No biliary ductal dilatation.2. Moderate volume ascites.


Instruction: Generate impression based on medical findings.

Input: 44-year-old male patient with epigastric pain. Evaluate for cholelithiasis. LIVER: The liver measures 16.8 cm in length. Hepatic parenchymal echogenicity is slightly coarsened. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: There are no gallstones, gallbladder wall thickening, or pericholecystic fluid. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 3 mm in diameter.PANCREAS: The head and body of the pancreas demonstrate normal echogenicity. The tail is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 11 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 11.4 cm in length. No evidence of hydronephrosis.The spleen measures 7.6 cm in length.

Output: No cholelithiasis or sonographic evidence of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: 36-year-old male patient with recent acute pancreatitis. Evaluate for gallstones, CBD dilatation, peripancreatic fluid collection. LIVER: The liver measures 18 cm in length and demonstrates increased parenchymal echogenicity. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: There is a gallstone near the neck of the gallbladder which moves with dependent positioning. There is no significant gallbladder wall thickening or pericholecystic fluid. The common duct measures 9 mm in diameter, appearing larger in diameter compared to prior MRCP. The duct is not visualized distally.PANCREAS: Heterogeneous echogenic material is noted within the region of the pancreatic head consistent with inflammatory changes of pancreatitis. No discrete fluid collection is noted within this region.RIGHT KIDNEY: The right kidney measures 11.7 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 12.7 cm in length. No evidence of hydronephrosis.The spleen is not adequately visualized on this examination. Fluid is noted within the left upper quadrant.

Output: 1. Echogenic material within the region of the pancreatic head consistent with history of pancreatitis. No discrete collection is seen in this region, however, CT is a better means of evaluation for complications of pancreatitis.2. Common bile duct dilatation, increased in size compared to prior studies; MRCP may be considered for further evaluation. 3. Cholelithiasis without sonographic evidence of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Thyroid cancer status post resection RIGHT LOBE: Status post thyroidectomy without massLEFT LOBE: Status post thyroidectomy without massISTHMUS: Status post thyroidectomy without massPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Status post thyroidectomy without worrisome mass or regional adenopathy.


Instruction: Generate impression based on medical findings.

Input: Female 90 years old; Reason: History of cholelithiasis with persistent RUQ pain. Evaluate for cholecystitis. History: As above GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 1.8 mm. No stones are seen. No pericholecystic fluid. Negative sonographic Murphy sign. The common bile duct measures 1.9 mm in diameter. OTHER: Limited views of the liver were obtained with any significant abnormalities noted. The portal vein is patent with hepatopetal flow.

Output: No evidence of cholelithiasis or acute cholecystitis are seen on ultrasound. This study was partially limited due to patient cooperation with positioning.


Instruction: Generate impression based on medical findings.

Input: 61 years old, Female, Reason: evaluate ruq for biliary stones, patient presented with pancreatitis History: pancreatitis LIVER: The liver is mildly enlarged measuring 19.4 cm in length. Increased echogenicity of the liver is consistent with fatty infiltration. Small hepatic cyst is again identified similar appearance recent CT of the abdomen. No suspicious focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.2 m/s.BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. The sonographic Murphy's sign is negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 5 mm in diameter.PANCREAS: Increased heterogeneity of the pancreas is consistent with known pancreatitis.SPLEEN: No significant abnormalities noted. The spleen measures 7.6 cm in length. RIGHT KIDNEY: Kidney measures 10.1 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 10.8 cm in length. Normal echotexture. No hydronephrosis or shadowing calculus. Mildly complex bilobed renal cyst seen on this ultrasound is not definitely seen on the prior CT.OTHER: No significant abnormalities noted.

Output: 1.Normal gallbladder and biliary tract with no evidence of cholelithiasis or cholecystitis.2.Mildly complex bilobed renal cyst seen on this ultrasound is not definitely identified on the prior CT. Follow-up is recommended at 6 months to ensure stability.3.Fatty infiltration of the liver. Stable hepatic cysts.


Instruction: Generate impression based on medical findings.

Input: Left flank pain RIGHT KIDNEY: 9.3 cm in length. Mildly echogenic renal parenchyma. 19 mm benign-appearing cyst noted in the midpole. No renal stone identified. No suspicious lesions. No hydronephrosis.LEFT KIDNEY: 10.8 cm in length. Mildly echogenic renal parenchyma. 13 mm benign-appearing cyst noted in the inferior pole. No renal stone identified. No suspicious lesions. No hydronephrosis.BLADDER: No significant abnormality noted.OTHER: No significant abnormalities noted.

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


Instruction: Generate impression based on medical findings.

Input: 60 year old female who was recalled from screening mammogram for new focal asymmetry in the right upper central breast. Mammogram: An ML view and two spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density(BiRads Density Category B), unchanged in pattern and distribution. 13 mm focal asymmetry in the right breast 12:00 position persists on spot compression views. No associated calcifications noted. On spot compression views the asymmetry demonstrates irregular margins.Ultrasound: Ultrasound demonstrates hypoechoic mass at 12:00 position, with apical blood flow measuring 6 x 6 x 5 mm. A possible hyperechoic septation is noted within the mass. Differential includes a complicated cyst however given that no definite posterior acoustic enhancement is noted, presence of apical blood flow, and suspicious morphology on mammogram, ultrasound-guided core biopsy is recommended.

Output: Screening detected mass right breast 12:00 position with sonographic correlate, ultrasound-guided core biopsy is recommended for further evaluation.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on medical findings.

Input: HCV LIVER: Coarse echogenic liver echotexture without mass. Liver length 14.8 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.2 cm in lengthOTHER: Left kidney 11.7 cm in length. Spleen 11 cm in length. No ascites.

Output: Coarse echogenic liver echotexture consistent with chronic liver disease without mass or ductal dilatation. No ascites


Instruction: Generate impression based on medical findings.

Input: 76-year-old male with hyperparathyroidism, history of thyroidectomy. RIGHT LOBE MEASUREMENTS: Status post thyroidectomyLEFT LOBE MEASUREMENTS: Status post thyroidectomyISTHMUS MEASUREMENTS: Status post thyroidectomyRIGHT LOBE: Echogenic material in the thyroid bed favored to represent post surgical scarring.LEFT LOBE: Echogenic material in the thyroid bed favored to represent post surgical scarring.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No discrete lesions to indicate parathyroid adenoma identified. LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Status post thyroidectomy. Echogenic material in the thyroid bed favored to represent post surgical scarring.2. No discrete parathyroid adenoma identified. Please refer to concurrently performed nuclear medicine examination for further characterization.


Instruction: Generate impression based on medical findings.

Input: 54-year-old female patient with history of thyroid cancer. Three year follow-up study. Evaluate for adenopathy, recurrence. RIGHT LOBE: Status post thyroidectomy without evidence of residual parenchymal tissue.LEFT LOBE: Status post thyroidectomy without evidence of residual parenchymal tissue.ISTHMUS: Status post thyroidectomy without evidence of residual parenchymal tissue.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-morphology lymph nodes are noted bilaterally.OTHER: No significant abnormality noted.

Output: Status post thyroidectomy without evidence of disease recurrence or lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: 31-year-old female with diastasis recti is status post 2 pregnancies. Bloating and intermittent abdominal pain. There is wide separation of the rectus muscles just superior to the umbilicus, compatible with diastasis recti. There is a focal 2 cm ventral herniation of mesenteric fat, without bowel. No associated fluid is identified. These findings do not change with Valsalva maneuver.

Output: Diastasis recti and small mesenteric fat ventral hernia without evidence of complication.


Instruction: Generate impression based on medical findings.

Input: 47 year old female patient with history of thyroid cancer. Evaluate for recurrence. RIGHT LOBE: Status post thyroidectomy without recurrent or residual tissue identified. LEFT LOBE: Status post thyroidectomy. A hypoechoic focus in the mid left thyroid bed measures 0.5 x 0.3 x 0.6 cm, previously 0.5 x 0.2 x 0.6 cm, and is similar in morphology.ISTHMUS: Status post thyroidectomy.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign morphology right level II and left level III lymph nodes are noted. An additional benign morphology left level IV lymph node is noted, not definitely visualized on the prior study.OTHER: No significant abnormality noted.

Output: Stable hypoechoic focus in the left thyroid bed without specific evidence of disease recurrence or lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Status post liver transplant with history of portal vein stenosis requiring stent placement LIMITED ABDOMENLIVER: Mildly coarse and heterogeneous liver echotexture without mass. Liver length 15.1 cm.BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: Stable mild splenomegaly; spleen length 17 cm RIGHT KIDNEY: No significant abnormalities noted. 8.5 cm in lengthOTHER: Left kidney 10 cm in length. No ascites

Output: Stable examination. Patent portal vein with normal directional flow. Patent portal vein stent without significant stenosis or gradient. No ascites. Stable mild splenomegaly.


Instruction: Generate impression based on medical findings.

Input: Elevated LFTs LIVER: Coarse echogenic liver parenchyma without mass. Liver length 16.5 cm.GALLBLADDER, BILIARY TRACT: Gallbladder sludge without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 12.6 cm in lengthOTHER: Left kidney 12.8 cm in length. Mild ascites

Output: Coarse echogenic liver parenchyma consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Gallbladder sludge without acute inflammation. Mild ascites.


Instruction: Generate impression based on medical findings.

Input: History left thyroid nodule RIGHT LOBE MEASUREMENTS: 1.2 x 4.1 x 1.2 cm.LEFT LOBE MEASUREMENTS: 1.2 x 3.5 x 1.1 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: 0.5 x 2 x 0.2 cm hypoechoic nodule with central increased echogenicity within the upper pole of the left thyroid gland.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Subcentimeter hypoechoic nodule with central increased echogenicity within the upper pole left thyroid gland. No regional adenopathy. The subcentimeter nodule will be biopsied later today.


Instruction: Generate impression based on medical findings.

Input: 19-year-old female with palpable mass in the left breast for 2-3 weeks. Family history of breast carcinoma in her maternal and paternal grandmother. With physical exam, a small soft mobile mass is palpated at 11:00 position in the left breast. With focused ultrasound, there is an oval, circumscribed hypoechoic mass measuring 15 x 8 mm with increased blood flow at left 11:00 position, likely a fibroadenoma.

Output: Palpable mass in the left breast, which is likely a fibroadenoma. Clinical correlation is recommended.Results and recommendations were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on medical findings.

Input: 32 year-old female with right upper and lower quadrant pain, early satiety, anorexia. Evaluate for appendicitis. The appendix is visualized and appears normal in caliber and echogenicity and is compressible. No free fluid or lymphadenopathy.The visualized liver appears normal in echogenicity. There as stones in the gallbladder with no evidence of cholecystitis. No gallbladder wall thickening. No pericholecystic fluid. No intra-or extrahepatic biliary ductal dilatation.

Output: 1. Cholelithiasis with no evidence of cholecystitis.2. No evidence of appendicitis.


Instruction: Generate impression based on medical findings.

Input: 45-year-old female with history of thyroid carcinoma status post thyroidectomy. RIGHT LOBE MEASUREMENTS: Surgically absentLEFT LOBE MEASUREMENTS: Surgically absentISTHMUS MEASUREMENTS: Surgically absentRIGHT LOBE: No significant abnormality noted.LEFT LOBE: Unchanged appearance of the left inferior thyroid bed compared with prior studies, no new masses or suspicious lesions.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 60 year-old female complaining of right-sided pain and mass which has increased in size. History of prior fine needle aspiration of the right breast mass with findings of fat necrosis. A targeted right ultrasound was performed for the patient’s area of concern, as marked by Dr. Chhablani. Vague hypoechoic areas with internal hyperechogenicity are present throughout the upper central and outer right breast, compatible with fat necrosis. There is no solid or cystic mass is identified.

Output: Vague areas of mixed echogenicity in the area of concern within the right breast, compatible with fat necrosis. No sonographic evidence for malignancy. Findings are discussed with Dr. Chhablani at the time of the examination. Results and recommendations were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on medical findings.

Input: Elevated LFTs with acute renal insufficiency LIVER:Coarse echogenic liver echotexture without mass. Liver length 11.7 cmGALLBLADDER, BILIARY TRACT: No significant abnormality noted.PANCREAS: No significant abnormality noted.SPLEEN: No significant abnormality noted. 8.6 cm in lengthKIDNEYS: Echogenic renal parenchyma again noted without worrisome mass, stone, or hydronephrosis. Right kidney 9.5 cm in length; left kidney 9.8 cm in length. ABDOMINAL AORTA: No significant abnormality noted.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No ascites

Output: Coarse echogenic liver parenchyma consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites. Echogenic renal parenchyma again noted consistent with medical renal disease/parenchymal dysfunction without mass, stone, or hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female for follow-up thyroid nodule. RIGHT LOBE MEASUREMENTS: 4.3 x 1.6 x 1.2 cmLEFT LOBE MEASUREMENTS: 4.6 x 1.5 x 1 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Again noted in the right lobe is a mildly heterogeneous solid nodule with internal cystic components. There are internal bright reflectors some of which are clearly comet tail artifacts consistent with colloid. The mass is not significantly changed when compared to the prior study measuring 2.1 x 2.2 x 2.8 cm.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable right lobe nodule. No adenopathy.


Instruction: Generate impression based on medical findings.

Input: Stent removal with mild hydronephrosis RIGHT KIDNEY: Stable renal cyst. No worrisome mass, stone, or hydronephrosis. 11.8 cm in length.LEFT KIDNEY: No change in mild left hydronephrosis. Stable renal cyst. Left kidney 12 cm in length.OTHER: Bladder nondistended.

Output: No significant change in mild left hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 40-year-old female with history of bilateral benign biopsies in 2000 and 2014. No current breast complaints Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is extremely dense, which lowers the sensitivity of mammography.Linear scar markers overlie both breasts. There are multiple bilateral asymmetries with scattered areas of calcification in the left upper central breast posteriorly. Given the extremely dense breast tissue, screening bilateral whole breast ultrasound both breasts was subsequently performed.Ultrasound of the right breast demonstrated a circumscribed, parallel hypoechoic mass without significant vascularity measuring 1.3 x 0.7 x 1.1 cm at the 12:00 position, 3 cm from the nipple.Ultrasound of the right breast demonstrated a circumscribed, parallel hypoechoic mass without significant vascularity measuring 0.9 x 0.5 x 0.8 cm at the 4:00 position, 3 cm from the nipple.Ultrasound of the left breast demonstrated 2 adjacent circumscribed, parallel hypoechoic masses without significant vascularity measuring 1.0 x 0.7 x 1.1 cm and 0.5 x 0.3 x 0.8 cm at the 10:00 position, 6 cm from the nipple.

Output: Multiple bilateral circumscribed masses likely represent fibroadenomas. Recommend 6 month follow-up ultrasound to document stability.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on medical findings.

Input: Male 64 years old Reason: Evaluate chronic elevated transaminases r/o fatty liver vs cirrhosis History: Chronic elevated transaminases LIVER: Liver measures 13.4 cm. Normal echogenicity. No focal liver lesions.BILIARY TRACT: Cholelithiasis without sonographic evidence of cholecystitis. There is mild gallbladder wall thickening likely secondary to chronic changes. No evidence of intra or extrahepatic biliary dilatation.PANCREAS: Not well visualized due to overlying bowel gas.SPLEEN: No significant abnormalities noted. Spleen measures 8.9 cm.RIGHT KIDNEY: Bilateral echogenic kidneys. Right kidney measures 6.3 cm. No evidence of hydronephrosis. OTHER: No significant abnormalities noted.

Output: Cholelithiasis. Slight atrophic and echogenic right kidney.


Instruction: Generate impression based on medical findings.

Input: Intra-abdominal and pelvic swelling, patient with a cherry sized ovoid mass between the umbilicus and pubic symphysis No focal suspicious cystic or solid mass noted. Abdominal fat noted.

Output: No focal suspicious cystic or solid mass within the palpable area of concern


Instruction: Generate impression based on medical findings.

Input: Reason: kidney stone, or other pathology History: left sided abdominal pain, left lumbar area RIGHT KIDNEY: The right kidney measures 10.3 cm in length. Normal renal echogenicity. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 9.8 cm in length. Normal renal echogenicity. No shadowing stones or hydronephrosis.OTHER: Ureteral jets not visualized. Unremarkable bladder.

Output: No acute renal abnormality. No renal calculi or hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 77-year-old female with history of palpable breast mass and new right breast abnormality on screening mammogram. Patient has a history of right chest wall injections for pain as recently as 7/2/2015. Physical exam demonstrated a palpable mobile mass in the right breast at the 12 o'clock position approximately 10 cm from the nipple. The patient reported a palpable mass in the right breast 12 o'clock position approximately 6 cm from the nipple. A targeted right ultrasound was performed in the aforementioned locations.At the 12 o'clock position approximately 10 cm from the nipple, an oval, cystic lesion with internal echogenic foci and linear septations was present measuring 1.8 x 0.8 x 1.7 cm. There was no internal vascularity.At the 12 o'clock position approximately 6 cm from the nipple in the area of the patient's reported palpable mass, normal breast tissue is appreciated. No suspicious masses identified.

Output: 1. Cystic lesion with internal echogenic foci and septations likely representing an injection granuloma from recent pain injection. Follow-up ultrasound in 3 months and surgical consult is recommended.2. In the area of the patient's pain at the 12:00 position of the right breast 6 cm from the nipple, no suspicious masses or abnormalities were noted.Results and plan were discussed with the patient at length.BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation.


Instruction: Generate impression based on medical findings.

Input: 22 year old with right breast mass for 3 months and bilateral breast pain. A targeted right ultrasound was performed for the patient’s area of concern. There is no solid or cystic mass seen in the area identified as palpable by the patient. At this site, and throughout the right upper inner quadrant, very dense breast tissue is noted.

Output: No sonographic evidence for malignancy. Dense breast tissue at the site of concern. Clinical correlation is recommended to ensure that these results are concordant with physical exam. Clinical follow-up is also recommended for the patient's bilateral breast pain.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with increased LFTs, evaluate for steatosis, fibrosis, portal hypertension. LIVER: Measures 18.6 cm in length. Markedly increased hepatic echogenicity without discrete focal lesion. Note that the hepatic echotexture limits penetration and evaluation of deeper structures on this examination. Patent main portal vein with antegrade flow measures 0.2 m/s.BILIARY TRACT: No cholelithiasis or gallbladder wall thickening, pericholecystic fluid, or sonographic Murphy sign. No biliary ductal dilation.PANCREAS: The pancreas is obscured by bowel gas. The imaged portions of the pancreas appear unremarkable.SPLEEN: No significant abnormalities noted.KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.

Output: Increased hepatic echogenicity consistent with steatosis or parenchymal disease.


Instruction: Generate impression based on medical findings.

Input: 47 year old female who has a complaint of palpable left breast cyst. Personal history of right mastectomy for malignant phylloides tumor, left implant exchange, and left breast cysts. A targeted left ultrasound was performed for the palpable area of concern. Multiple simple cysts were identified in the left breast, the largest of which measures 3.9 x 3.8 x 1.7 cm and is located in the retroareolar region. No discrete solid mass identified.

Output: Multiple benign simple cysts in the left breast along the palpable area of concern along the areola. Consider cyst aspiration if patient experiences worsening pain. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: 71-year-old female with HCV. Evaluate for chronic liver disease. LIVER: Coarse echotexture of the liver measuring 15.7 cm in length. No focal hepatic lesions are identified.GALLBLADDER, BILIARY TRACT: There is sludge in the gallbladder. No pericholecystic fluid. Gallbladder wall measures 2 mm in thickness. Common bile measures 6 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: The visualized portions of the pancreas are normal in echogenicity with no pancreatic ductal dilatation.RIGHT KIDNEY: Right kidney measures 10.3 cm in length with increased echogenicity of the renal cortex. A cyst in the upper full measures 2.4 cm x 1.7 cm x 2.0 cm.OTHER: Left kidney measures 10.6 cm in length with increased echogenicity of the renal cortex.Spleen is normal in echogenicity measuring 7.2 cm in length.

Output: 1. Findings suggestive of hepatic steatosis but no focal hepatic lesions. 2. Increased bilateral renal echogenicity raises the possibility of parenchymal dysfunction. There is a benign appearing cyst in the upper pole of the right kidney. 3. Sludge in the gallbladder with no evidence of cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Reason: ruq pain with nausea and vomiting for 3 weeks History: as above LIVER: The liver measures 14.4 cm in length. Unremarkable hepatic parenchymal echogenicity and echotexture. The portal vein is patent with normal directional hepatopedal flow, peak velocity is 34.3 cm/s. No focal mass.GALLBLADDER, BILIARY TRACT: The gallbladder is decompressed without evidence of shadowing stones or pericholecystic inflammation. The gallbladder wall measures 0.2 cm. The common bile duct measures 0.3 cm. No significant intrahepatic or extrahepatic biliary ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 10.1 cm in length. The left kidney measures 9.4 cm in length. Unremarkable renal parenchymal echogenicity and echotexture. No hydronephrosis. There is a small nonobstructive hyperechoic left mid pole renal calculus measuring up to 5 mm.OTHER: The spleen measures 9.0 cm in length.

Output: 1. Small nonobstructive left renal stone. No hydronephrosis.2. No acute hepatobiliary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male 34 years old Reason: eval of neoscrotum History: swelling s/p phalloplasty Soft tissue of the neoscrotum has some vascularity which would be expected. Tissues appear somewhat indurated and heterogenous, but there are no loculated fluid collections to suggest abscess. Continued follow-up advised with this study serving as a baseline.

Output: No definite abscess collection.


Instruction: Generate impression based on medical findings.

Input: 22 year old female with right-sided constant abdominal pain, per patient in the right upper quadrant, no right lower quadrant pain. LIVER: Normal echogenicity of the liver measuring 15.3 cm in length. No focal hepatic lesions. Portal vein is patent with appropriate directional flow; peak velocity at 35.9 cm/sec.BILIARY TRACT: Normal echogenicity of the gallbladder. No gallbladder wall thickening or pericholecystic fluid. No shadowing stones or sludge. Sonographic Murphy sign is negative. Common bile duct measures 2 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Normal echogenicity of the visualized pancreas.SPLEEN: Normal echogenicity of the spleen measuring 11.8 cm in length.RIGHT KIDNEY: The right kidney is rotated anteriorly measuring 12.6 cm in length. No hydronephrosis or shadowing calculi.OTHER: Left kidney measures 12.1 cm in length and is normal in echogenicity. No hydronephrosis or shadowing calculi.

Output: Unremarkable examination.


Instruction: Generate impression based on medical findings.

Input: Painless jaundice with a large liver LIVER: No obvious discrete liver mass. Liver length 18.5 cm.GALLBLADDER, BILIARY TRACT: Severe bilobar intrahepatic ductal dilatation associated with severe extrahepatic ductal dilatation. Debris versus tumor within the extrahepatic duct noted. Associated with large porta hepatis mass measuring approximately 4.6 x 3 x 3 cm.PANCREAS: Atrophy of pancreatic body. The pancreas head is not well visualized due to overlying gas.RIGHT KIDNEY: Echogenic parenchyma with multiple cysts. No stone, worrisome mass, stone, or hydronephrosis. Right kidney 9.6 cm in length.OTHER: No ascites. Spleen 7.7 cm in length.

Output: Severe bilobar intrahepatic as well as extrapelvic biliary dilatation secondary to obstruction by large porta hepatis mass. Differential diagnosis includes malignancy either of pancreatic or biliary origin. Would recommend correlation with dedicated cross-sectional imaging.Echogenic renal parenchyma suggestive for medical renal disease/parenchymal dysfunction without worrisome mass, stone, or obstruction.Dr. Woodruff notified of findings 2/13/2015; 11:30 am.


Instruction: Generate impression based on medical findings.

Input: Severe hypertension. Evaluate kidneys. RIGHT KIDNEY: The right kidney is normal in morphology, echogenicity and size measuring 10.2 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow.LEFT KIDNEY: The left kidney is normal in morphology, echogenicity and size measuring 10.4 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion evident. Color Doppler demonstrates hilar blood flow.OTHER: Contracted urinary bladder.

Output: The right and left kidneys measure 10.2 and 10.4 cm in length, respectively without hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 29-year-old with known right breast fibroadenoma presents for follow-up. A targeted right ultrasound was performed for the known fibroadenoma. An oval circumscribed mass compatible with a fibroadenoma in the right breast 1:00 position today measures 1.7 x 1.0 x 1.7 cm, slightly increased from prior measurements of 1.5 x 0.8 x 1.5 cm.

Output: Slight interval increase in size of known fibroadenoma. The patient will be seen in surgical clinic for additional follow-up today.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: 56-year-old male with prior lipoma resection left, now with sensation of mass. Ultrasound evaluation adjacent to the scar medial to the left scapula demonstrates no underlying mass.

Output: No mass identified by ultrasound.


Instruction: Generate impression based on medical findings.

Input: Status post total thyroidectomy, evaluate for parathyroid adenoma, history of hypercalcemia RIGHT LOBE MEASUREMENTS: Status post thyroidectomyLEFT LOBE MEASUREMENTS: Status post thyroidectomy ISTHMUS MEASUREMENTS: Status post thyroidectomyRIGHT LOBE: No focal lesion suggestive of recurrence.LEFT LOBE: Ill-defined hypodensity in the thyroidectomy bed with increased blood flow, does not hold up its morphology in the orthogonal plane most likely represents scar tissue over recurrence.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Normal morphology left little1. The right neck lymph node measures 1.6 x 0.5 x 0.3 cm. Level 2 left neck lymph node measures 1.1 x 0.5 x 0.3 cm.OTHER: No significant abnormality noted.

Output: Ill-defined hypodensity in the thyroidectomy bed, favor scar tissue over recurrence


Instruction: Generate impression based on medical findings.

Input: 40-year-old female presents for evaluation of incidental thyroid nodules found on prior CT. RIGHT LOBE MEASUREMENTS: 6.0 x 2.3 x 2.5 cm.LEFT LOBE MEASUREMENTS: 6.8 x 2.5 x 2.6 cm.ISTHMUS MEASUREMENTS: 0.6 cm.RIGHT LOBE: There are several noncomplex cystic nodules spread throughout the right lobe of similar appearance. The background parenchyma is homogenous.LEFT LOBE: There are several noncomplex cystic nodules throughout the left lobe of similar appearance. The background parenchyma is homogenous.ISTHMUS: There is a large noncomplex cystic nodule measuring approximately 2.1 x 1.0 x 2.3 cm. which is the dominant nodule in the thyroid. The parenchyma is homogenous.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Multinodular thyroid. Findings suggestive of benign cystic colloid nodules.


Instruction: Generate impression based on medical findings.

Input: Thyroid nodule seen on CT RIGHT LOBE MEASUREMENTS: 4.7 x 1.9 x 2.5 cmLEFT LOBE MEASUREMENTS: 6.0 x 2.1 x 2.3 cmISTHMUS MEASUREMENTS: 3 mm in AP dimensionRIGHT LOBE: No significant abnormality noted.LEFT LOBE: A 12 mm solid nodule is identified in the left midpole. The nodule is homogeneous and well marginated, without suspicious calcifications or vascularity.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not identified.LYMPH NODES: Benign-appearing cervical lymph nodes identified.OTHER: No significant abnormality noted.

Output: 12 mm left thyroid nodule identified, without suspicious features.


Instruction: Generate impression based on medical findings.

Input: Parathyroidectomy. Papillary thyroid carcinoma was also noted on pathology report. RIGHT LOBE MEASUREMENTS: 3.8 x 1.3 x 1.6 cm. Normal in size with normal background vascularity.LEFT LOBE MEASUREMENTS: 2.9 x 1.6 x 1.7 cm. Normal in size with normal background vascularity.ISTHMUS MEASUREMENTS: 3 mm in AP dimension.RIGHT LOBE: Two right-sided nodules identified. A cystic nodule in the lower pole measures 7 mm. A spongiform nodule in in the mid pole measures 4 mm. These nodules are similar to the prior outside ultrasound and do not demonstrate suspicious characteristics. LEFT LOBE: A spongiform nodule in the midpole measures 6 mm. This is similar to the prior outside ultrasound and does not demonstrate suspicious characteristics.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Benign-appearing cervical lymph nodes identified.OTHER: No significant abnormality noted.

Output: Stable subcentimeter thyroid nodules, without suspicious features.