Instruction: Generate impression based on medical findings.

Input: Female 81 years old Reason: hx of left renal mass, evaluate for change in size History: see above RIGHT KIDNEY: The right kidney measures 8.6 cm. Mildly increased renal cortical echogenicity. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 9.3 cm. Mildly increased renal cortical echogenicity. Rounded hypoechoic mildly complex structure, containing internal echoes that may reflect septations (better seen on current exam than on prior study), structure measures 1.5 x 1.4 x 1.3 cm, without significant change accounting for differences in technique. No shadowing calculi or hydronephrosis is present. BLADDER: Visualized bladder unremarkable.OTHER: No significant abnormalities noted.

Output: Essentially stable hypoechoic left renal lesion, see above.Mildly increased renal cortical echogenicity, likely secondary to underlying medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Evaluate for interval change of right-sided thyroid nodule RIGHT LOBE: Measures 4.7 x 2.2 x 1.7 cm. Hypoechoic midpole nodule seen measuring 0.7 x 0.6 x 0.6 cm, some internal vascularity, no internal calcifications, accounting for differences in the technique nodule without significant change (previously measured 0.7 x 0.5 x 0.5 cm).LEFT LOBE: Measures 4.8 x 1.8 x 1.6 cm. No discrete thyroid nodule seen.ISTHMUS: Measures 0.2 cm.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable hypoechoic right-sided thyroid nodule as above.


Instruction: Generate impression based on medical findings.

Input: Male 78 years old Reason: 78yo man with new intermittent RUQ abdominal pain that radiates down his leg(?). History: see above LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 12.5 cm in length. The parenchyma is moderately echogenic the probable cyst in the right lobe of the liver measuring 1.5 cm. Main portal vein is patent.BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 2 mm in thickness. Common duct measures 4 mm. PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 9.1 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 11.1 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 6.8 cm. in length. OTHER: No ascites

Output: 1.No sonographic findings of cholelithiasis.2.Probable fatty infiltration of the liver.


Instruction: Generate impression based on medical findings.

Input: Male 68 years old Reason: evaluate for ascites History: abdominal distention There is no ascites.Postsurgical changes of neobladder.There is a fascial defect in the midline anterior abdominal wall just anterior and superior to the neobladder. This contains a loop of nondistended bowel.

Output: 1.No ascites.2.Anterior abdominal wall hernia containing a nonobstructed loop of bowel.


Instruction: Generate impression based on medical findings.

Input: Female 71 years old Reason: Abdominal hematoma History: hypotension LIMITED ABDOMENIn the left abdominal wall there is a prominently hypoechoic collection of fluid which measures approximately 20 x 11 cm. Within this collection there are dependent areas of slightly increased echogenicity.

Output: Large left abdominal wall hematoma.


Instruction: Generate impression based on medical findings.

Input: 82-year-old male with worsening kidney function, evaluate for obstruction. RIGHT KIDNEY: The right kidney measures 11.4 cm in length. The cortex is thinned and echogenic. No shadowing calculi or hydronephrosis is present. Note is made of the 0.7 x 0.8 x 0.8 cm anechoic area in the midpole of the right kidney, which is too small to characterize but most compatible with cyst.LEFT KIDNEY: The left kidney measures 11.8 cm in length. The cortex is thinned and echogenic. No shadowing calculi or hydronephrosis is present.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.

Output: Thinning and increased echogenicity of bilateral kidneys, compatible with medical renal disease, without evidence of hydronephrosis or obstructing calculi.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female 66 years old Reason: acute renal failure, was recently treated for a UTI at OSH History: acute renal failure Per ultrasound technologist, suboptimal exam secondary to patient's unresponsive state and her being unable to move into decubitus position.RIGHT KIDNEY: The right kidney measures 9.5 cm. No shadowing calculi or hydronephrosis is present. Increased renal cortical echogenicity. LEFT KIDNEY: The left kidney not well assessed due to overlying bowel gas and rib shadowing, kidney measures approximately 11.1 cm. No shadowing calculi or hydronephrosis is present. Increased renal cortical echogenicity. BLADDER: Not well assessed secondary to placement of Foley catheter, possible wall thickening and/or soft tissue echogenicity related to adjacent uterus.OTHER: Partially imaged ascites.

Output: No hydronephrosis. Echogenic kidneys, consistent with medical renal disease.Additional findings as above.Partially imaged moderate to large amount of ascites.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old. Reason: New ascites. History: Ascites, left abdominal tenderness, distension. No evidence of ascites in the visualized abdomen. Urinary bladder is underdistended without significant abnormality noted.

Output: No evidence of ascites.


Instruction: Generate impression based on medical findings.

Input: Female 59 years old; Reason: Evaluate for dominant thyroid nodule. RIGHT LOBE MEASUREMENTS: 6.6 x 2.6 x 2.4 cm, previously 7 x 2 x 3 cm.LEFT LOBE MEASUREMENTS: 6.7 x 2.6 x 2.7 cm, previously 2.6 x 2.7 cm.ISTHMUS MEASUREMENT: 0.8 cmRIGHT LOBE: The thyroid is diffusely heterogenous, with a right superior pole mixed cystic and solid nodule measuring 1.5 x 0.7 x 0.9 cm and demonstrating a spongiform morphology, appearing similar to prior exam.LEFT LOBE: Diffusely heterogenous gland with left superior predominantly cystic nodule measuring 0.9 x 0.5 x 0.6 cm and the dominant left inferior pole mixed cystic and solid nodule measuring 2.0 x 1.2 x 1.1 cm and demonstrating a spongiform morphology.ISTHMUS: Hypoechoic cystic-appearing nodule measuring 0.7 x 0.7 x 0.9 cm.LYMPH NODES: No regional lymphadenopathy.OTHER: No significant abnormality noted.

Output: Stable bilateral thyroid nodules demonstrating a predominantly spongiform morphology and favored to be benign.


Instruction: Generate impression based on medical findings.

Input: Female 18 years old Reason: evidence of cholelithiasis, choledocholithiasis History: R-sided abdominal pain, N/V, report of "stones" per pt report LIVER: Liver measures 16 cm in length. The parenchyma is mildly increased in echogenicity. Main portal vein patent with normal directional flow, velocity measures 20 cm/sec. BILIARY TRACT: Multiple layering gallstones in gallbladder. Gallbladder unremarkable otherwise without evidence of acute cholecystitis. No significant gallbladder distention, wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Not well seen in entirety due to overlying bowel gas particularly tail.KIDNEYS: The right kidney measures 10.6 cm. The left kidney measures 10.8 cm. No hydronephrosis. SPLEEN: The spleen measures 13 cm. in length.

Output: Cholelithiasis. No evidence of acute cholecystitis.Mildly echogenic liver, may reflect underlying parenchymal dysfunction and correlation with patient's clinical history and laboratory values recommended.


Instruction: Generate impression based on medical findings.

Input: 48-year-old male presents with right upper quadrant pain, nausea/vomiting, and elevated liver enzymes. Evaluate for cholecystitis/liver pathology. Please note exam is extremely limited by body habitus.LIVER: Markedly echogenic liver consistent with fatty infiltration. Hepatomegaly. GALLBLADDER, BILIARY TRACT: Cholelithiasis. Possible layering sludge in the gallbladder. The common bile duct is upper limits of normal. No gallbladder wall thickening or pericholecystic fluid. PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney is normal in echotexture and size (13 cm). LEFT KIDNEY: The left kidney is normal in echotexture and size (14 cm). SPLEEN: Normal in echotexture and size. OTHER: No significant abnormalities noted.

Output: 1. Cholelithiasis without overt signs of cholecystitis given limitations described above. 2. Fatty liver.


Instruction: Generate impression based on medical findings.

Input: Male 68 years old Reason: r/o hydronephrosis History: acute on chronic CKD RIGHT KIDNEY: The right kidney measures 9.1 cm. There is increased echogenicity of the renal cortex compatible with medical renal disease. Again seen in the right inferior pole is a cyst with an internal septation which measures 3.9 x 3.6 x 2.5 cm previously measured 4.5 x 3.1 x 2.5 cm. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 10.1 cm. There is increased echogenicity of the renal cortex compatible with medical renal disease. Again seen are multiple anechoic lesions with posterior acoustic enhancement compatible with simple cysts. No shadowing calculi or hydronephrosis is present. BLADDER: Foley catheter in place. No significant abnormality.OTHER: Prostate appears mildly enlarged with extrinsic compression on bladder. The prostate measures 3.2 x 3.7 x 3.7 cm.

Output: 1.No evidence of hydronephrosis or shadowing renal calculus bilaterally. Increased cortical echogenicity of the bilateral kidneys is compatible with medical renal disease.2.Bilateral renal cysts, not significantly changed from the prior exam.3.Mildly enlarged prostate.


Instruction: Generate impression based on medical findings.

Input: Female 61 years old Reason: strong family history of pancreatic cancer History: family history of pancreatic cancer LIVER: Liver measures 13.7 cm in length. The parenchyma is mildly echogenic which is nonspecific but may reflect diffuse infiltrative disease.BILIARY TRACT: A small amount of sludge is again seen in the gallbladder lumen. No significant gallbladder distention, wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Pancreatic head, neck, and visualized portion of the pancreatic body are unremarkable. No pancreatic ductal dilatation is seen in the visualized portions of the pancreas. The distal pancreatic body and tail are not well visualized due to overlying bowel gas.KIDNEYS: The right kidney measures 9.9 cm. The left kidney measures 9.3 cm. No shadowing renal calculus or hydronephrosis.SPLEEN: The spleen measures 8.5 cm. in length. OTHER: No significant abnormality noted.

Output: 1.Gallbladder sludge.2.Again seen is mildly hyperechoic liver parenchyma is nonspecific but may reflect diffuse infiltrative disease.3.Visualized pancreatic head, neck, and proximal body are unremarkable.


Instruction: Generate impression based on medical findings.

Input: Female 58 years old Reason: 58 y.o with ALL undergoing treatment with RUQ tenderness; h/o of elevated LFTs History: RUQ tenderness with flank tenderness, h/o elevated LFTs LIVER: The liver measures 17.2 cm in length and demonstrates increased parenchymal echogenicity. No intrahepatic or extrahepatic biliary ductal dilatation is evident and no focal mass lesions are seen. The main portal vein is patent and demonstrates hepatopedal flow with a velocity of 0.2 m/s. GALLBLADDER, BILIARY TRACT: No cholelithiasis or choledocholithiasis is seen. The common duct measures 0.3 cm in diameter. PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 9.2 cm in length and demonstrates normal parenchymal echogenicity, with slight cortical thinning. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.LEFT KIDNEY: The left kidney measures 10.4 cm in length and demonstrates normal parenchymal echogenicity with slight cortical thinning. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.SPLEEN: The spleen measures 9.7 cm in length.OTHER: Nonspecific hypoechoic area in the subcutaneous soft tissues in the right lower quadrant measuring 2.3 x 0.5 cm with circumferential edema may relate to injection site.

Output: 1.Increased hepatic parenchymal echogenicity consistent with hepatic steatosis or mild chronic liver disease.2.Bilateral renal cortical thinning.3.Hypoechoic collection in the subcutaneous soft tissues of the right lower quadrant likely related to medication injection site.


Instruction: Generate impression based on medical findings.

Input: Female 79 years old Reason: Obstruction History: AKI RIGHT KIDNEY: The right kidney measures approximately 8.4 cm. No shadowing stone or hydronephrosis is present. No perinephric free fluid.LEFT KIDNEY: The left kidney measures 9.9 cm. No shadowing stone or hydronephrosis is present. No perinephric free fluid. BLADDER: Visualized bladder unremarkable.OTHER: No significant abnormalities noted.

Output: No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Female 63 years old Reason: please evaluate for malignancy and interval change in cysts History: 63 yo F with hep B, s/p failed IFN therapy but spontaneous seroconversion LIVER: Liver measures 13.3 cm in length. The parenchyma is heterogeneous in appearance which is nonspecific and can be seen in diffuse infiltrative disease. A small simple appearing hepatic cyst in the right lobe measures 1.7 x 0.8 x 1.4 cm. BILIARY TRACT: Status post cholecystectomy. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: No significant abnormalities, evaluation is limited due to overlying bowel gas.KIDNEYS: The right kidney measures 7.2 cm and demonstrates increased echogenicity when compared to the liver suggestive of medical renal disease. The left kidney measures 10.0 cm. And demonstrates decrease in corticomedullary differentiation. There is limited evaluation of the right lower quadrant transplant kidney, which measures 8.4 cm and grossly appears unremarkable.SPLEEN: Patient is status post splenectomy.ABDOMINAL AORTA AND INFERIOR VENA CAVA: Not well seen due to overlying bowel gas. OTHER: No significant abnormality noted.

Output: 1.Heterogeneous appearing liver parenchyma nonspecific but can be seen in diffuse infiltrative disease.2.Left hepatic lobe simple appearing cyst.


Instruction: Generate impression based on medical findings.

Input: Reason: R/o gallstones + portal vein History: Elevated alkaline phosphatase and bilirubin LIVER: The liver measures 15 cm in length. There is fatty infiltration with an area of decreased echogenicity in the periphery, not well delineated on 2/6/15 CT study but sonographic appearance suggestive of focal sparing.BILIARY TRACT: The common bile duct is not dilated, measuring 0.4 cm in caliber. There is no evidence of cholelithiasis. The gallbladder wall is not thickened, measuring 0.2 cm. There is a small 0.4 cm polyp noted on the lateral aspect of the wall of the gallbladder body.PANCREAS: Poorly visualized. Unable to adequately assess due to overlying bowel gas.SPLEEN: The spleen measures 11.5 cm in length. Normal echogenicity. There are no focal lesions visualized.KIDNEYS: The right kidney measures 11.2 cm in length, the left kidney measures 11.6 cm in length. There is no hydronephrosis. OTHER: The portal vein is patent with flow towards the liver and a normal waveform. Velocity is 0.2 m/s.

Output: 1. No evidence of cholelithiasis.2. Small polyp noted within the gallbladder. No further workup is needed.3. Portal vein is patent.4. Hepatic steatosis with peripheral area of sparing suggested, see discussion above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male 54 years old; Reason: urinary obstruction d/t likely metastatic prostate cancer, recent bilateral hydro and AKI , ?improvement s/p Foley decompression History: urinary obstruction d/t likely metastatic prostate cancer, recent bilateral hydro and AKI , ?improvement s/p Foley decompression RIGHT KIDNEY: The right kidney measures 11.0 cm in length. The cortex is mildly echogenic. No shadowing calculi. There is moderate right hydronephrosis. LEFT KIDNEY: The left kidney measures 9.7 cm in length. The cortex is mildly echogenic. No shadowing calculi. There is moderate left hydronephrosis.  URINARY BLADDER: Bladder is decompressed by Foley catheter. The bladder wall is severely thickened.OTHER: No significant abnormalities noted.

Output: 1.Moderate bilateral hydronephrosis with an empty bladder.2.Thickened bladder wall.


Instruction: Generate impression based on medical findings.

Input: Female 48 years old; Reason: 48 yo with rising creatinine - please look at kidney size shape and echo History: 48 yo with rising creatinine - please look at kidney size shape and echo RIGHT KIDNEY: The right kidney measures 10 cm in length. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 10 cm in length. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. OTHER: Mildly contracted gallbladder limits evaluation with no significant visualized abnormality of the visualized bladder

Output: 1.No hydronephrosis or abnormal echogenicity.


Instruction: Generate impression based on medical findings.

Input: 54-year-old male with transaminitis on chemotherapy with multiple myeloma. Reason: Evaluate for NAFLD. LIVER: The liver is mildly enlarged and measures 18.5 cm. Echogenic liver parenchyma without focal lesion or ductal dilatation.Portal vein is patent with normal hepatopedal directional flow and peak velocity of 0.2 m/s.GALLBLADDER, BILIARY TRACT: No evidence of gallstones, gallbladder wall thickening, pericholecystic fluid or ductal dilatation. Negative sonographic Murphy's sign.PANCREAS: The pancreas is not well visualized due to overlying bowel gas.RIGHT KIDNEY: The right kidney measures 14.5 cm. The cortex is of normal echogenicity. No shadowing calculi or hydronephrosis is present.LEFT KIDNEY: The left kidney measures 13.5 cm. The cortex is of normal echogenicity. No shadowing calculi or hydronephrosis is present.SPLEEN: The spleen measures 11.8 cm.OTHER: No ascites.

Output: Mild hepatomegaly with echogenic liver parenchyma consistent with fatty infiltration/parenchymal dysfunction without focal lesion or ductal dilatation. This appears to be an interval development when compared to the prior PET study performed on December 16, 2014.


Instruction: Generate impression based on medical findings.

Input: Male 21 years old Reason: Gallstones, cholecystitis History: RUQ abd pain, hx of pancreatitis. LIVER: Liver measures 16.3 cm in length. No focal liver lesion. Main portal vein patent with normal directional flow, velocity measures 30 cm/s.BILIARY TRACT: Gallbladder unremarkable. No gallstones seen. No significant gallbladder distention, wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Pancreas not well seen in entirety due to overlying bowel gas.KIDNEYS: The right kidney measures 11.8 cm. The left kidney measures 11.6 cm. No hydronephrosis.SPLEEN: The spleen measures 6.5 cm. in length. OTHER: No significant abnormality noted.

Output: Unremarkable study. No evidence of cholelithiasis or acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Male 49 years old Reason: see below History: pre-cardiac transplant evaluation Suboptimal exam due to patient's inability to move into decubitus position and partial obscuration of structures secondary to patient's balloon pump.LIVER: Liver measures 16 cm in length. The parenchyma is increased in echogenicity. Main portal vein patent with normal directional flow and velocity measures 21 cm/sec.BILIARY TRACT: No significant gallbladder distention, wall thickening or pericholecystic fluid. No sonographic evidence of acute cholecystitis. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Not well assessed due to overlying bowel gas.KIDNEYS: The right kidney measures 10.5 cm. The left kidney measures 9.5 cm. No hydronephrosis.SPLEEN: The spleen measures 7.6 cm. in length. ABDOMINAL AORTA AND INFERIOR VENA CAVA: Incompletely imaged intra-aortic balloon pump. IVC not well assessed. Not well seen due to overlying bowel gas.

Output: Echogenic liver, likely related to underlying hepatic steatosis/parenchymal dysfunction.


Instruction: Generate impression based on medical findings.

Input: Male 83 years old; Reason: aki, rule out obstruction History: aki rule out obstruction RIGHT KIDNEY: The right kidney measures 9 cm in length. The cortex is slightly echogenic. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 11 cm in length. The cortex is slightly echogenic. No shadowing calculi or hydronephrosis is present. OTHER: Bladder is decompressed limiting evaluation.

Output: 1.Slightly echogenic kidneys can be seen in nonspecific medical renal disease. No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 59-year-old man with HBV. LIVER: Echogenicity of the hepatic parenchyma is diffusely increased. No focal hepatic lesion or mass. The liver measures 18.6 cm in length. The main portal vein is patent with normal hepatopedal flow and velocity of 19 cm/s.GALLBLADDER, BILIARY TRACT: Multiple gallstones are seen in the dependent position within the gallbladder. The gallbladder wall is normal in appearance, measuring 0.3 cm in thickness. There is no pericholecystic fluid.  No dilatation or cystic changes are noted of the intrahepatic or extrahepatic biliary ducts. The common bile duct measures 0.4 cm in diameter. No choledocholithiasis.PANCREAS: The head and proximal body of the pancreas are normal. The tail is obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 11.3 cm in length and shows normal echotexture. No mass, stone or hydronephrosis.LEFT KIDNEY: The left kidney measures 11.1 cm in length and shows normal echotexture. No mass, stone or hydronephrosis.SPLEEN: The spleen is normal in echogenicity and measures 12.6 cm in length. OTHER: There is no free or loculated fluid.

Output: 1. Uncomplicated cholelithiasis.2. Diffusely increased echogenicity and coarse echotexture of the hepatic parenchyma, consistent with fatty liver/hepatic parenchymal dysfunction. No hepatic mass or ductal dilatation.


Instruction: Generate impression based on medical findings.

Input: Evaluate for abdominal aortic aneurysm. Shortness of breath. The proximal aorta measures up to 3.4 cm in diameter and contains calcification. The mid abdominal aorta measures up to 3.1 cm and contains calcification. The distal aorta measures up to 3.1 cm. The common iliac arteries are mildly ectatic.

Output: Arterial calcification and mild ectasia of the abdominal aorta.


Instruction: Generate impression based on medical findings.

Input: Female 65 years old Reason: evaluate for malignancy, complications of cirrhosis History: 65 Hep C cirrhosis LIMITED ABDOMENLIVER: Heterogenous hepatic parenchyma.BILIARY TRACT: No biliary dilatation. Layering sludge and shadowing gallstones. No gallbladder wall thickening or pericholecystic fluid.PANCREAS: Visualized portions are unremarkable.KIDNEYS: The right kidney measures 11 cm. The cortex is of normal echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 11 cm. The cortex is of normal echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 10 cm. in length. OTHER: No significant abnormalities noted.

Output: 1.No focal hepatic lesions. Heterogenous hepatic parenchyma, nonspecific, but suggestive of diffuse infiltrative disease.


Instruction: Generate impression based on medical findings.

Input: 84-year-old male presents with right-sided flank pain for the past 3-4 weeks. RIGHT KIDNEY: The right kidney is echogenic and measures 13 cm in length. Corticomedullary differentiation is maintained. No shadowing calculi or hydronephrosis is present. Anechoic focus arising from the right kidney measures 3.7 x 3.6 x 3.2 cm compatible with a renal cyst.LEFT KIDNEY: The left kidney is echogenic and measures 12 cm in length. Corticomedullary differentiation is maintained. No shadowing calculi or hydronephrosis is present. Anechoic focus arising from the left kidney measures 1.8 x 1.5 x 1.7 cm compatible with a renal cyst.URINARY BLADDER: The visualized portions of the urinary bladder are unremarkable.OTHER: No significant abnormalities noted.

Output: 1. Echogenic kidneys suggestive of medical renal disease. 2. Bilateral renal cysts. No evidence of hydronephrosis or worrisome mass.


Instruction: Generate impression based on medical findings.

Input: Inability to extend left thumb. EPL rupture left thumb? The extensor pollicis longus tendon is abnormally enlarged and hypoechoic distal to where it crosses over the extensor carpi radialis brevis and longus tendons. The enlarged EPL tendon tapers abruptly superficial to the extensor carpi radialis longus tendon, and the EPL tendon appears heterogeneous and disorganized superficial to the extensor carpi radialis brevis tendon. These findings are compatible with the suspected clinical diagnosis of EPL rupture, as the EPL tendon crosses the second extensor compartment tendons. The extensor pollicis longus tendon appears slightly thickened and hypoechoic just proximal to Lister's tubercle, but otherwise intact. Portions of the distal extensor pollicis longus tendon are difficult to visualize on static images, perhaps due to atrophy; however, the distal tendon can be seen to move with passive flexion and extension of the interphalangeal joint on the cine clips. There is a small amount of fluid in the extensor carpi radialis longus tendon sheath as the extensor pollicis longus tendon courses over it. The extensor pollicis brevis tendon appears intact.

Output: Rupture of the extensor pollicis longus tendon as it courses over the second extensor compartment tendons, with enlarged retracted tendon just distal to the site of crossover, and hypoechoic but otherwise normal-appearing tendon just proximal to Lister's tubercle.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old. Reason: Gallstones History: RUQ pain LIVER: Liver is enlarged and measures 18.8 cm in length. Liver parenchyma is mildly coarse and echogenic. Right lobe liver cyst is 2.6 x 0.8 x 0.5 cm. Main portal vein is patent with a normal direction of flow.BILIARY TRACT: No biliary ductal dilatation. Gallbladder is not distended. No gallbladder wall thickening or pericholecystic fluid. Common bile duct measures 2 mm.PANCREAS: Pancreatic head and neck are unremarkable. The body and tail are obscured by overlying bowel gas.SPLEEN: Spleen measures 10.2 cm in length with normal echotexture.RIGHT KIDNEY: Right kidney measures 11.2 cm in length with normal cortical echogenicity. No hydronephrosis, shadowing calculi, or mass.OTHER: Left kidney measures 10.9 cm in length with normal cortical echogenicity. No hydronephrosis, shadowing calculi, or mass.

Output: Mild hepatomegaly with mildly coarse and echogenic liver parenchyma suggests chronic liver disease/fatty infiltration.


Instruction: Generate impression based on medical findings.

Input: 57-year-old female with cholecystostomy tube placed in September 2015 having increased output and abdominal pain. LIMITED ABDOMENLIVER: The liver has a smooth contour. The parenchyma is normal in echotexture. Liver measures 16.6 cm in length. Portal flow is hepatopedal. No suspicious masses.BILIARY TRACT: The gallbladder has an anechoic lumen and cholecystostomy tube is visualized. Mild gallbladder wall thickening without pericholecystic fluid. Multiple shadowing stones are visualized in the common bile duct. No biliary ductal dilation.PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 9.1 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.The left kidney measures 10.2 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.SPLEEN: The spleen measures 8.0 cm. in length without significant abnormality.OTHER: None.

Output: 1.Findings compatible with choledocholithiasis. No biliary ductal dilation is seen.2.The gallbladder demonstrates an anechoic lumen with a cholecystostomy tube in place.


Instruction: Generate impression based on medical findings.

Input: 83-year-old man with worsening renal function RIGHT KIDNEY: The right kidney measures 8.6 cm in length. The parenchyma is echogenic and atrophic in appearance. Again seen is a shadowing stone in the right renal pelvis which measures 1.5 x 0.6 x2.0 cm. Minimal right hydronephrosis.LEFT KIDNEY: The left kidney measures 8.6 cm in length. The parenchyma is echogenic and atrophic in appearance. No mass, shadowing calculi or hydronephrosis.URINARY BLADDER: The urinary bladder is decompressed, with Foley balloon noted, limiting evaluation of the bladder wall.OTHER: There is no free or loculated fluid.

Output: 1.Improved right hydronephrosis, now minimal, with shadowing stone in the right renal pelvis again seen.2.Increased echogenicity of the renal parenchyma consistent with medical renal disease/parenchymal dysfunction.


Instruction: Generate impression based on medical findings.

Input: Male 63 years old; Reason: kidney stones growth or new formation History: has had many kidney stones RIGHT KIDNEY: The right kidney measures 11.9 cm in length. The cortex is normal echogenicity. 1.7 cm lower right renal stone. LEFT KIDNEY: The left kidney measures 12 cm cm in length. The cortex is normal echogenicity. 1.1 cm stone in the lower left kidney. No hydronephrosis in either kidney.URINARY BLADDER: Mildly decompressed, but grossly unremarkable.OTHER: No significant abnormalities noted.

Output: 1.Bilateral nonobstructing renal stones as above.


Instruction: Generate impression based on medical findings.

Input: Evaluate for ductal obstruction. Patient is post liver transplant. Patient is post liver transplant. The liver measures 19.3 cm. The liver parenchyma is increased in echogenicity. There is no significant biliary ductal dilatation. There is a left hepatic 2.0 x 2.2 x 1.3 cm anechoic lesion, with through transmission, new from prior. Hepatic artery demonstrates normal flow with resistive index of 0.7. The hepatic veins and IVC appear patent, with hepatofugal flow. The portal vein is patent. The common bile duct measures 2 mm. PANCREAS: The pancreas is obscured by bowel gas. SPLEEN: The splenic vein and artery appear intact.OTHER: There is ascites and pleural effusion.

Output: 1.Nonspecific new left hepatic anechoic lesion post liver transplant. This may represent a biloma or hematoma.2.Increased hepatic parenchymal echogenicity, may represent fatty infiltration versus parenchymal dysfunction.3.Hepatic vasculature patent.4.Ascites and pleural effusion noted.


Instruction: Generate impression based on medical findings.

Input: Female 71 years old; Reason: history of breast cancer now with metastatic disease, workup should enlarged PET positive right thyroid please evaluate for thyroid mass History: history of breast cancer now with metastatic disease, workup should enlarged PET positive right thyroid please evaluate for thyroid mass RIGHT LOBE MEASUREMENTS: 7.6 x 2.4 x 3.3 cmLEFT LOBE MEASUREMENTS: 5.1 x 1.5 x 2.0 cmISTHMUS MEASUREMENT: 0.1 cmRIGHT LOBE: There are 2 predominantly solid nodules with cystic components. The largest nodule is most superior and measures 1.3 x 1.0 x 1.0 cm.LEFT LOBE: There are 2 predominantly solid nodules. The largest and most superior nodule measures 1.3 x 1.0 x 1.1 cm.ISTHMUS: No significant abnormality noted.LYMPH NODES: In the left neck lymph nodes in levels 2 through 4 are of normal morphology but contain calcifications.OTHER: No significant abnormality noted.

Output: 1.There are no particularly worrisome characteristics of the mixed solid and cystic right thyroid nodules however these are amenable to ultrasound-guided biopsy if clinically warranted.2.Lymph nodes in the left neck contain calcifications but are of normal morphology which favors a benign etiology such as prior granulomatous disease.


Instruction: Generate impression based on medical findings.

Input: Female 56 years old Reason: 56F with pancreatic head cancer with biliary obstruction s/p metal stent placement who now presents with RUQ pain, evaluate cause of sudden onset of pain History: abdominal pain LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 16.9 cm in length. The parenchyma is normal in echotexture. No focal hepatic lesion is identified.BILIARY TRACT: The gallbladder contains layering sludge. Wall measures 2 mm in thickness. The common bile duct measures 3 mm. There is no intrahepatic biliary ductal dilatation. Murphy's sign is negative.PANCREAS: Mass present within the pancreatic head, with margins not well evaluated on ultrasound. There is pancreatic ductal dilatation measuring up to 7 mm.KIDNEYS: The right kidney measures 14 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. No suspicious lesion is identified.The left kidney is not identified.SPLEEN: The spleen measures 7.8 cm in length.OTHER: No significant abnormalities noted.

Output: 1.Primary pancreatic mass identified, with upstream pancreatic ductal dilatation.2.Sludge layering within the gallbladder, without evidence of acute inflammation. No intrahepatic biliary ductal dilatation.3.Left kidney not identified (atrophic on CT 10/17/16).


Instruction: Generate impression based on medical findings.

Input: Status post thyroidectomy RIGHT LOBE: Status post thyroidectomy. Located in right thyroid bed is rounded soft tissue focus measuring 0.4 x 0.3 x 0.3 cm, probably stable accounting for differences in technique, previously measured 0.6 x 0.4 x 0.3 cm.LEFT LOBE: Status post thyroidectomy.ISTHMUS: Status post thyroidectomy.LYMPH NODES: No suspicious adenopathy.OTHER: No significant abnormality noted.

Output: Stable exam as above.


Instruction: Generate impression based on medical findings.

Input: 83-year-old male with history of UTI. Reason: Evaluate for obstruction, renal pathology, verify nephrostomy placement and patency. RIGHT KIDNEY: The right kidney measures 8.8 cm. The cortex is of normal echogenicity without mass, calculi, or hydronephrosis.LEFT KIDNEY: The left kidney measures 9.4 cm. The cortex is mildly echogenic without mass or calculi. Again demonstrated is moderate hydronephrosis. Left stent is present.OTHER: The bladder is nondistended.

Output: Chronic hydronephrosis of the left kidney, appearing stable when compared to prior study.


Instruction: Generate impression based on medical findings.

Input: Female 78 years old Reason: evaluate for hydronephrosis History: acute kidney injury Per ultrasound technologist, patient uncooperative and in addition to overlying bowel gas resultant exam suboptimal.RIGHT KIDNEY: The right kidney measures 10.2 cm. Moderate hydronephrosis. Mild renal cortical thinning. No shadowing calculi present. Renal cysts seen on prior imaging not visualized. LEFT KIDNEY: The left kidney measures 10.6 cm. Moderate hydronephrosis. Mild renal cortical thinning. No shadowing calculi is present. Renal cysts seen on prior imaging not visualized. BLADDER: Distended fluid containing structure in pelvis likely patient's ileal conduit as patient is status post cystectomy.OTHER: No significant abnormalities noted.

Output: Bilateral moderate hydronephrosis.Renal cysts seen on prior imaging not visualized.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old. Reason: Evaluate for liver lesions. History: HCV Ab + LIVER: The liver is enlarged and measures 20.4 cm in length. The hepatic parenchyma is mildly coarse. Liver capsule is smooth. No focal hepatic mass or ascites. Main portal vein is patent with a normal direction of flow.BILIARY TRACT: No cholelithiasis, gallbladder wall thickening or pericholecystic fluid. No ductal dilatation. Common bile duct measures 3 mm.PANCREAS: The visualized portions of the pancreas are unremarkable. The pancreatic tail is obscured by overlying bowel gas. Oval, hypoechoic focus in the pancreatic head measures 1.5 x 0.6 x 1.7 cm and likely represents a prominent peripancreatic lymph node.SPLEEN: Spleen measures 10.9 cm in length with normal echotexture.RIGHT KIDNEY: Right kidney measures 11.2 cm in length with normal cortical echogenicity. No hydronephrosis, shadowing calculi or mass.OTHER: Left kidney measures 10.5 cm in length with normal cortical echogenicity. No hydronephrosis, shadowing calculi or mass.

Output: Hepatomegaly with coarse hepatic echotexture suggests chronic liver disease. No suspicious hepatic mass or ascites.


Instruction: Generate impression based on medical findings.

Input: Male 36 years old Reason: cholecystitis History: septic LIVER: Hepatomegaly, liver measures 22 cm in longitudinal dimension. No focal liver lesion. Main portal vein patent with normal directional flow, velocity measures 30 cm/s. BILIARY TRACT: No evidence of acute cholecystitis, no gallstones seen, sludge present. No significant gallbladder wall thickening or pericholecystic fluid. No biliary duct dilatation.PANCREAS: Not well seen in entirety due to overlying bowel gas but visualized portions unremarkable. Visualized pancreas duct measures upper limits of normal at 3 mm. KIDNEYS: Evaluation of native kidneys demonstrate atrophic echogenic kidneys, consistent with medical renal disease. Right iliac fossa transplanted kidney measures 10.5 cm, no hydronephrosis, no perinephric free fluid.SPLEEN: The spleen measures 11.8 cm. in length. OTHER: No significant abnormality noted.

Output: No evidence of acute cholecystitis, sludge-containing gallbladder seen.Stable hepatomegaly.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with rising ammonia level, multiple myeloma status post stem cell transplant. Reason: Evaluate for portal vein thrombosis. LIVER: The liver is 19.2 cm in length. Coarse echogenic liver echotexture without mass or ductal dilatation. Portal vein is patent.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: The visualized pancreas is without significant abnormalities.RIGHT KIDNEY: The right kidney measures 11.1 cm. Echogenic parenchyma without mass, stone, or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.8 cm. Echogenic parenchyma without mass, stone, or hydronephrosis.SPLEEN: The spleen measures 9.7 cm.OTHER: No significant abnormalities noted.

Output: 1. Echogenic coarse liver echotexture consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation.2. Portal vein is patent.3. Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old. Reason: Abdominal distention concern for possible renal obstruction. History: abdominal distension, volume overload, HTN RIGHT KIDNEY: Right kidney measures 13.5 cm in length with increased cortical echogenicity. Septated, adjacent upper pole cysts appear grossly similar to prior study and measure 4.9 x 4.9 x 5.1 cm. Exact comparison and measurements are difficult with sonography. No hydronephrosis or shadowing calculi.LEFT KIDNEY: Left kidney measures 13.8 cm in length with increased cortical echogenicity. Left mid pole renal cyst measures 1.8 x 1.4 x 1.7 cm. No hydronephrosis or shadowing calculi.URINARY BLADDER: Urinary bladder is mildly distended without significant abnormality noted. Enlarged prostate.OTHER: No significant abnormalities noted.

Output: Echogenic renal cortical parenchyma bilaterally suggests medical renal/parenchymal dysfunction. No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Female 69 years old with left renal mass seen on CT RIGHT KIDNEY: The right kidney measures 11.0 cm in length. Anechoic right renal cyst measuring 5.0 x 4.3 x 4.8 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. Normal vascularity.LEFT KIDNEY: The left kidney is not well visualized and measures approximately 11.0 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. Normal vascularity.URINARY BLADDER: The bladder is decompressed by a Foley catheter.OTHER: No significant abnormalities noted.

Output: 1. The left kidney is not well visualized. Outside hospital images are unavailable for review, however, CT dated 10/19/2013 and 9/30/2010 demonstrates renal scarring without evidence of mass. 2. Simple right renal cyst measuring up to 5 cm.3. No evidence of calculi or hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Female 54 years old; Reason: left neck nodule History: left neck nodule RIGHT LOBE MEASUREMENTS: 5.7 x 2.4 x 1.8 cmLEFT LOBE MEASUREMENTS: 5.2 x 1.7 x 2.0 cmISTHMUS MEASUREMENT: 0.5 cmRIGHT LOBE: There is a 1.5 x 1.1 x 0.8 cm mixed solid and cystic nodule in the superior right thyroid lobe with punctate echogenic foci demonstrating ring down artifact. The appearance is suggestive of a colloid nodule. There is a larger predominantly solid nodule, with a subtle incomplete halo, in the mid/inferior right thyroid lobe measuring 2.3 x 1.6 x 1.1 cm. LEFT LOBE: Heterogeneous left thyroid lobe without discrete measurable nodule.ISTHMUS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: Inferiormedial to the left submandibular gland there is a 2.5 x 1.6 x 1.8 cm mixed solid and cystic lesion with peripheral vascularity.

Output: 1.2.5-cm mixed solid and cystic lesion inferomedial to the left submandibular gland. This is nonspecific but primary or secondary malignancy arising from the submandibular gland versus pathological lymph node are differential considerations and cross-sectional imaging plus/minus US guided sampling is recommended.2.Two right thyroid lobe nodules. The largest is predominantly solid and consideration should be given to US guided FNA.


Instruction: Generate impression based on medical findings.

Input: Female 44 years old; Reason: r/o growth of nodules, adenopathy, suspicious features History: multiple thyroid nodules. 1 year follow up study RIGHT LOBE MEASUREMENTS: 7.0 x 2.4 x 3.2 cmLEFT LOBE MEASUREMENTS: 7.9 x 2.6 x 2.9 cmISTHMUS MEASUREMENT: 1.5 cmRIGHT LOBE: Right thyroid lobe has at least 3 thyroid nodules.#1 solid nodule at the upper pole measures 2.7 x 2.5 x 3.1 cm, previously 2.5 x 3.1 x 2.5 cm#2 solid nodule at the interpolar region measures 2.3 x 2.4 x 2.3 cm previously 2.3 x 2.5 x 2.7 cm#3 solid nodule at the lower pole measures 1.5 x 1.7 x 2.0 cmLEFT LOBE: Left lobe is replaced by multiple thyroid nodules.#1 upper pole thyroid solid nodule measures 3.1 x 2.5 x 1.9 cm previously, 2.6 x 2.1 x 2.5 cm#2 mostly solid lower pole thyroid nodule measures 4.3 x 3.7 x 3.2 cm previously, 4.0 x 3.1 x 2.7 cmISTHMUS: Isthmus nodule which is mostly solid measures 2.5 x 1.3 x 3.2 cm previously, 2.1 x 1.3 x 3.2 cmLYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multinodular goiter without significant size change.


Instruction: Generate impression based on medical findings.

Input: 39-year-old female Reason: Change in nodes History: thyroid cancer with previous node metastases aden abnormal nodes on US RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: Again seen in the right thyroid bed is a lobulated hypoechoic nodule with punctate echogenic foci that suggest microcalcifications. This nodule measures 0.6 x 0.8 x 1.1 cm previously measured 1.0 x 0.5 x 0.7, and does not appear to significantly changed when compared to the prior exam when accounting for differences in technique.LEFT LOBE: No suspicious lesions are identified in the left thyroid bed.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Again seen is a right level 2 neck lymph node that measures 1.5 x 0.5 x 2.1 cm previous and measured 1.9 x 1.3 x 0.4 cm.OTHER: No significant abnormality noted.

Output: Right thyroid hypoechoic nodule with echogenic foci suggestive of microcalcification. While unchanged from the prior exam, this nodule remains suspicious for recurrent disease and is amenable to biopsy.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old. Reason: abdominal donor site seroma s/p IR sclerosis with recurrent bulge and low grade fever History: bulge Predominantly anechoic fluid collection with areas of nodularity and complexity which measures 27.5 x 1.5 cm, previously 23.9 x 1.2 cm. There is minimal peripheral vascularity.

Output: Slight interval increase in size of the minimally complex, loculated fluid collection within the subcutaneous tissues along the length of the patient's scar.


Instruction: Generate impression based on medical findings.

Input: Reason: abd pain History: pain and distention LIVER: The liver is not enlarged, measuring 16 cm in length. Increased echogenicity consistent with fatty infiltration. No focal lesions. No intrahepatic ductal dilation.BILIARY TRACT: There is sludge noted within the dependent portion of the gallbladder. No cholelithiasis. The gallbladder wall is not thickened, measuring 0.1 cm. The common bile duct is not dilated, measuring 0.4 cm.PANCREAS: Poorly visualized. Unable to be adequately assessed.SPLEEN: Unable to be visualized.KIDNEYS: The right kidney measures 9 cm in length. Normal echogenicity. No focal lesions. No hydronephrosis.The left kidney measures 10.7 cm. Normal echogenicity. No focal lesions. No hydronephrosis. OTHER: The portal vein is patent with a normal waveform and hepatopetal flow. The velocity is within normal limits, measuring 0.2 m/s.No ascites.

Output: 1. Fatty liver.2. Biliary sludge within the gallbladder. No evidence of acute cholecystitis.3. No ascites.


Instruction: Generate impression based on medical findings.

Input: Soft tissue swelling right mid back No mass, loculated fluid collection, or abscess

Output: No mass, loculated fluid collection, or abscess within subcutaneous tissues right posterior mid back.


Instruction: Generate impression based on medical findings.

Input: Female 78 years old; Reason: CKD History: proteinuria Exam limited due to patient mobility and overlying bandages.RIGHT KIDNEY: The right kidney measures 11.4 cm in length and demonstrates increased echogenicity. No shadowing calculi or hydronephrosis is present. No masses. LEFT KIDNEY: The left kidney measures 10.3 cm in length and demonstrates increased echogenicity. No shadowing calculi or hydronephrosis is present. No masses.URINARY BLADDER: The bladder is collapsed and a Foley catheter is noted within the bladder.OTHER: Incidental note is made of shadowing gallstones within the gallbladder.

Output: 1.Increased echogenicity of bilateral kidneys, suggestive of medical renal disease without hydronephrosis or shadowing calculi.2.Cholelithiasis.


Instruction: Generate impression based on medical findings.

Input: Female 50 years old Reason: multinodular goiter History: as above RIGHT LOBE MEASUREMENTS: 6.0 x 2.7 x 2.3 cm.LEFT LOBE MEASUREMENTS: 7.4 x 3.2 x 2.3 cm.ISTHMUS MEASUREMENTS: 0.5 cm thickRIGHT LOBE: The right lobe of the thyroid demonstrates heterogeneous parenchymal echogenicity. Spongiform nodule in the medial right lower lobe measures 1.1 x 1.1 x 0.8 cm, previous 0.6 x 0.6 x 0.5 cm.LEFT LOBE: The left lobe of the thyroid demonstrates heterogeneous parenchymal echogenicity. Dominant heterogeneous predominantly solid, but partially cystic inferior lobe thyroid nodule now measures 4.2 x 4.0 x 3.3 cm, previously 4.4 x 4.0 x 3.5 cm.ISTHMUS: Spongiform nodule in the isthmus now measures 1.4 x 1.2 x 1.0 cm, previously 0 x 0.8 x 0.5 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable dominant left lobe thyroid nodule. Additional small spongiform nodules slightly increased in size.


Instruction: Generate impression based on medical findings.

Input: 70-year-old male with history of LVAD drive line infection, concern for sepsis 2/2 recurrent/worsening drive line infection, could not get contrast CT A/P for evaluation given high Cr, got non-con without evidence of infection. Evaluate for fluid collection around LVAD driveline. Sonographic evaluation demonstrates fluid collection visualized around the drive line extending from the superficial soft tissues to the deeper soft tissues.

Output: Fluid collection surrounding the drive line extending from the superficial aspect and extending to visualized deep soft tissues. Infection is not excluded.


Instruction: Generate impression based on medical findings.

Input: MSSA abscess with persistent pain and induration At site of clinical concern in left groin, there is a ovoid hypoechoic collection, measuring 4.4 x 2.8 x 1.2 cm. Some posterior acoustic enhancement seen and internal heterogeneity noted, may be due in part to septations. Mild surrounding vascularity as well as overlying subcutaneous edema and adjacent reactive lymph nodes seen.

Output: 4.4 cm complex fluid collection, consistent with an abscess given patient's clinical history.


Instruction: Generate impression based on medical findings.

Input: Male 76 years old Reason: assess for cholecystitis History: ABD pain LIMITED ABDOMENLIVER: Liver measures 13.9 cm in length. The parenchyma is slightly coarse with normal echotexture. Limited interrogation of the main portal vein with color Doppler demonstrates blood flow towards the liver. Mild intrahepatic ductal dilatation.BILIARY TRACT: No intrahepatic or extrahepatic biliary ductal dilatation. The gallbladder is mildly distended although there is no wall thickening, pericholecystic fluid, or cholelithiasis. Wall measures 2 mm in thickness. The common bile duct measures 3 mm.PANCREAS: The visualized head and neck of the pancreas is within normal limits.KIDNEYS: The right kidney measures 9.4 cm. The cortex is slightly echogenic. No shadowing calculi or hydronephrosis is present. Simple cyst within the inferior pole of the right kidney measures 1.4 x 1.2 x 1.5 cm.The left kidney is difficult to visualize. No hydronephrosis. SPLEEN: The spleen is difficult to visualize due to difficulty in positioning the patient.OTHER: No significant abnormalities noted.

Output: 1.No sonographic evidence of acute cholecystitis.2.Mild intrahepatic ductal dilatation.3.Echogenic right kidney compatible with medical renal disease without evidence of hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 45 year-old female with history of right iliac fossa transplant kidney presents with acute kidney injury, evaluate for hydronephrosis. RENAL TRANSPLANT: LOCATION: Right iliac fossa.PERITRANSPLANT TISSUES: Unchanged small perinephric fluid collection.KIDNEY: Stable mild to moderate hydronephrosis of the echogenic right iliac fossa transplant kidney.COLLECTING SYSTEM/URETER: Mild to moderate hydronephrosis. Apparent complex fluid within the collecting system may represent hemorrhage, debris, or pyonephrosis. URINARY BLADDER: The visualized portions of the decompressed urinary bladder are unremarkable.OTHER: No significant abnormality noted

Output: 1. Stable mild to moderate hydronephrosis of the right iliac fossa transplant kidney. Apparent complex fluid within the collecting system may represent hemorrhage, debris, or pyonephrosis. The kidney is diffusely echogenic suggestive of parenchymal disease.2. Unchanged anterior perinephric fluid collection.


Instruction: Generate impression based on medical findings.

Input: Male 32 years old with thrombocytopenia, evaluate spleen and liver, history of sickle cell, beta thalassemia, and splenomegaly LIVER: Mild increase in hepatic parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions. Hepatic length measures 19.8 cm. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of 23 cm/s. GALLBLADDER/BILIARY TRACT: Echogenic and nonmobile shadowing focus within the anterior gallbladder wall measuring 7 x 4 x 4 mm, not significantly changed from prior exam. The gallbladder is normal in echotexture with the wall measuring 1 mm. The common bile duct measures 2 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 16.9 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 12.3 cm and has normal vascular flow. The left kidney measures 12.4 cm and has normal vascular flow. OTHER: No significant abnormality noted.

Output: 1. Stable appearing echogenic shadowing focus within the gallbladder wall, which may represent an adherent stone or polyp.2. Continued hepatosplenomegaly with mildly increased hepatic parenchymal echogenicity and coarsened echotexture consistent with fatty liver/hepatic parenchymal dysfunction.


Instruction: Generate impression based on medical findings.

Input: 44-year-old male with questionable cirrhosis. Reason: Evaluate liver. LIVER: The liver measures 17.5 cm in length. Heterogenous liver parenchyma with slight nodularity of the liver contour, but without focal lesion or ductal dilatation. Portal vein is patent.GALLBLADDER, BILIARY TRACT: Cholelithiasis and gallbladder sludge without acute inflammation or biliary ductal dilatation. Negative sonographic Murphy's sign. Trace fluid in the gallbladder fossa.PANCREAS: The pancreas is not well-visualized due to overlying bowel gas.RIGHT KIDNEY: The right kidney measures 8.2 cm. Severely echogenic parenchyma without mass, stones, or hydronephrosisLEFT KIDNEY: The left kidney measures 7.9 cm. Severely echogenic parenchyma without mass, stones, or hydronephrosis.SPLEEN: The spleen measures 13.1 cm.OTHER: Trace ascites.

Output: 1. Heterogenous liver parenchyma with slight nodularity of the liver contour. Cirrhosis cannot be excluded.2. Cholelithiasis and gallbladder sludge without acute inflammation or biliary ductal dilatation.3. Atrophic and severely echogenic renal parenchyma without mass, stones, or hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 56-year-old male status post liver transplant, now with rising creatinine. Reason: Evaluate for hydronephrosis, medical renal disease, other. RIGHT KIDNEY: The right kidney measures 11.3 cm. Echogenic parenchyma without mass, stone or hydronephrosis.LEFT KIDNEY: The left kidney measures 12.2 cm. Echogenic parenchyma without mass, stone or hydronephrosis.OTHER: The bladder is nondistended.

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


Instruction: Generate impression based on medical findings.

Input: Female 32 years old Reason: history of enlarged liver History: Crohn's disease LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 14.8 cm in length. The parenchyma is normal in echotexture. No focal liver lesion is identified. The main portal vein is patent and demonstrates hepatopetal flow with a velocity of 2.2 m/s. BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 0.2 cm in thickness. Common duct measures 2 mm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The imaged head and body of the pancreas is normal. The tail is obscured by bowel gas.KIDNEYS: The right kidney measures 10.7 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 11.9 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 8.5 cm. in length.

Output: 1.Normal exam without evidence of hepatomegaly.


Instruction: Generate impression based on medical findings.

Input: Female 13 years old; Reason: PTC History: PTC Sonography is performed of the left neck from the level of the mastoid to the clavicular head. The highest node level 5 and the posterior inferior level 5 lymph nodes were marked with 0.1 cc of methylene blue each.Findings were discussed with Dr. Angelos.

Output: 1.Intraoperative localization of malignant lymph nodes.


Instruction: Generate impression based on medical findings.

Input: 19-year-old female with fever, evaluate for cholestasis pattern. LIVER: Echogenicity of the hepatic parenchyma is normal . No focal hepatic lesion or mass. The liver measures 19 cm in length. The main portal vein is patent with normal hepatopedal flow and velocity of 34 cm/s.GALLBLADDER, BILIARY TRACT: Underdistended gallbladder. The gallbladder wall is irregularly thickened and measures up to 0.8 cm in thickness.There is no pericholecystic fluid. No cholelithiasis.  No dilatation or cystic changes are noted of the intrahepatic or extrahepatic biliary ducts. The common bile duct measures 0.3 cm in diameter. No choledocholithiasis.PANCREAS: The head and proximal body of the pancreas are normal. The tail is obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 13.3 cm in length and shows normal echotexture. No mass, stone or hydronephrosis.LEFT KIDNEY: The left kidney measures 13.7 cm in length and shows normal echotexture. No mass, stone or hydronephrosis.SPLEEN: The spleen is normal in echogenicity and measures 11.7 cm in length. OTHER: There is no free or loculated fluid.

Output: Underdistended gallbladder. Thickened gallbladder wall without cholelithiasis, biliary ductal dilatation or pericholecystic free fluid.


Instruction: Generate impression based on medical findings.

Input: Female 71 years old; Reason: stones History: stones RIGHT KIDNEY: The right kidney measures 10.2 cm in length. The cortex is echogenic. Multiple shadowing, echogenic calculi are noted including one in the inferior pole which measures 0.6 x 0.5 cm. There is no hydronephrosis.LEFT KIDNEY: The left kidney measures 10.3 cm in length. The cortex is echogenic. Multiple shadowing, echogenic calculi are noted including one in the mid left kidney measuring 0.6 x 0.5 cm. There is no hydronephrosis.URINARY BLADDER: The bladder is distended and unremarkable.OTHER: No significant abnormalities noted.

Output: 1.Bilateral nephrolithiasis without hydronephrosis.2.Echogenic kidneys suggesting medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Female 70 years old Reason: eval for change in multinodular goiter History: Hx of thyroid nodules, 3 year surveillance RIGHT LOBE MEASUREMENTS: 2.6 x 5.5 x 2.0 cm.LEFT LOBE MEASUREMENTS: 2.6 x 5.3 x 2.4 cm.ISTHMUS MEASUREMENTS: 0.6 cm in thickness.RIGHT LOBE: The right lobe of the thyroid demonstrates normal parenchymal echogenicity. Spongiform nodule in the right lobe of the thyroid measures 0.9 x 0.8 x 1.0 cm, previously 1.0 x 0.8 x 1.0 cm.LEFT LOBE: The left lobe of the thyroid demonstrates normal parenchymal echogenicity. Subcentimeter anechoic nodules in the left lobe of the thyroid are not significantly changed.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple bilateral benign-appearing thyroid nodules not significantly changed from the prior examination as detailed above.


Instruction: Generate impression based on medical findings.

Input: VP shunt placement with recent drainage from right upper quadrant port site No loculated fluid collection, hematoma, or abscess associated with right upper quadrant port site

Output: No loculated fluid collection, hematoma, or abscess associated with right upper quadrant port site


Instruction: Generate impression based on medical findings.

Input: Reason: assess for infection/mass History: neck pain Increased echogenicity and thickening of the right neck deep to the patient's area of palpation, when compared to the left neck. No loculated fluid collection. On physical palpation, this area is also harder to touch compared to the left neck.

Output: Right neck swelling with no underlying discrete loculated fluid collection, further described above.


Instruction: Generate impression based on medical findings.

Input: 76-year-old female with worsening renal function. Reason: Evaluate for hydronephrosis or other etiology. RIGHT KIDNEY: The right kidney measures 9 cm. Echogenic parenchyma without shadowing calculi or hydronephrosis. There is a hypoechoic focus measuring 2.1 x 2 x 1.9 cm, compatible with a mildly complex cyst.LEFT KIDNEY: The left kidney measures 9.3 cm. Echogenic parenchyma without shadowing calculi or hydronephrosis. OTHER: The bladder is nondistended.

Output: 1. Echogenic renal parenchyma compatible with medical renal disease/parenchymal dysfunction without worrisome mass, stone, or hydronephrosis.2. Mildly complex cyst in the right kidney. Follow-up is recommended.


Instruction: Generate impression based on medical findings.

Input: Male 52 years old Reason: 52 y/o M with NICM now with possible ascites, please eval for free abd fluid History: Increased abd girth LIMITED ABDOMENSmall amount of upper abdominal ascites and a pleural effusion.Imaged portion of the right kidney shows no hydronephrosis.

Output: 1.Small amount of upper abdominal ascites.


Instruction: Generate impression based on medical findings.

Input: 42 year old female with hematuria and renal failure. RIGHT KIDNEY: The right kidney measures 11.7 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.LEFT KIDNEY: The left kidney measures 11.5 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.URINARY BLADDER: No significant abnormalities noted.OTHER: Left pleural effusion.

Output: 1.No hydronephrosis.2.Left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male 60 years old Reason: RUQ US History: pain LIVER: Liver measures 18.5 cm in length. The parenchyma is echogenic. Main portal vein patent with normal directional flow, velocity measures 17 cm/s. BILIARY TRACT: Multiple gallstones, seen to level of gallbladder neck. No secondary signs of acute cholecystitis. No significant gallbladder distention, wall thickening or pericholecystic fluid. Intrahepatic and extrahepatic biliary duct dilatation seen. Dilated CHD/CBD measures up to 11 mm.PANCREAS: Not well seen in entirety due to overlying bowel gas. No pancreatic ductal dilatation delineated.KIDNEYS: The right kidney measures 9.3 cm. The left kidney measures 11.5 cm. SPLEEN: The spleen measures 8.6 cm. in length. OTHER: No significant abnormality noted.

Output: Intrahepatic and extrahepatic biliary duct dilatation with latter measuring up to 11 mm. Possible stone in proximal common hepatic duct.Cholelithiasis, seen to level of gallbladder neck. No secondary signs of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old. Reason: Urothelial carcinoma, increasing sCr, eval for hydronephrosis/hydroureter RIGHT KIDNEY: Right kidney measures 12.6 cm in length with normal cortical echogenicity. No hydronephrosis, shadowing calculi, or mass.LEFT KIDNEY: Left kidney measures 11.5 cm in length with normal cortical echogenicity. No hydronephrosis, shadowing calculi, or mass.URINARY BLADDER: Debris is present within the distended urinary bladder.OTHER: Moderate ascites. Markedly echogenic liver parenchyma suggestive of severe fatty infiltration.

Output: 1. No hydronephrosis, shadowing stones, or renal mass.2. Markedly echogenic liver parenchyma suggestive of severe fatty infiltration. Moderate ascites.


Instruction: Generate impression based on medical findings.

Input: Cutaneous nodules. No discoloration.EXAMINATION: Interpretation of outside exam -- MR right humerus without and with intravenous contrast, MR left humerus without and with intravenous contrast performed at Advocate Christ Hospital on 11/04/16 Along the medial anterior surfaces of the proximal arms, an abnormality in the skin is present bilaterally right larger than left. The lesions consist of fat globules surrounded by inflammation. The borders on the left are much less well-defined than on the right. The right skin lesion measures 1.9 x 0.8 x 2.5 cm (transverse x anteroposterior x longitudinal). The left skin lesion measures 1.2 x 1.0 x 3.5 cm.

Output: Fat-containing masses with surrounding inflammation. Subcutaneous fat necrosis is a possibility.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old. Reason: r/o growth of lesions, adenopathy History: multinodular goiter. 2 year follow up study RIGHT LOBE MEASUREMENTS: 4.8 x 1.5 x 1.1 cmLEFT LOBE MEASUREMENTS: 5.2 x 1.7 x 1.4 cmISTHMUS MEASUREMENTS: 0.4 cm.RIGHT LOBE: Heterogenous echotexture with a subcentimeter predominantly cystic nodule with a small echogenic focus centrally which measures 0.5 x 0.4 x 0.2 cm, previously 0.4 x 0.2 x 0.3 cm, unchanged in size or appearance. Additional posterior hypoechoic extrathyroidal nodule measures 0.7 x 0.4 x 0.4 cm, previously 0.6 x 0.4 x 0.4 cm.LEFT LOBE: Heterogenous echotexture with a spongiform nodule in the mid/inferior left lobe which measures 1.6 x 1.4 x 1.1 cm, previously 1.9 x 1.1 x 1.7 cm. This likely represents the previously biopsied colloid nodule. A more superiorly located, predominantly solid, spongiform nodule measures 0.9 x 0.6 x 0.6, previously 0.7 x 0.7 x 0.7 cm.ISTHMUS: Small right isthmus nodule is stable and measures 0.5 x 0.6 x 0.3 cm, previously 0.4 x 0.6 x 0.3 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing right level 3 neck lymph node measures 1.0 x 0.7 x 0.4 cm. Additional benign-appearing left level 4 lymph node measures 0.5 x 0.5 x 0.5 cm.OTHER: No significant abnormality noted.

Output: Stable and mildly increased size of multiple bilateral thyroid nodules.


Instruction: Generate impression based on medical findings.

Input: Reason: Acute on CKD - r/o obstruction History: AKI ULTRASOUND KIDNEYSRIGHT KIDNEY: The right kidney measures 7.2 cm in length. Mildly increased echogenicity. No focal lesions. No hydronephrosis.LEFT KIDNEY: The left kidney measures 8.7 cm in length. Mildly increased echogenicity. No focal lesions. No hydronephrosis.OTHER: The bladder is visualized and appears nondistended.

Output: 1. Mildly increased echogenicity of the kidneys bilaterally, consistent with medical renal disease/parenchymal dysfunction. There is no evidence of obstruction.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old. Reason: evaluating 2 well circumscribed masses in right forearm, ?cyst, calcification, lipoma, no known trauma. Pt is Right hand dominant History: pt with 2 small nodules in the right forearm, ventral surface. 1 present x 1 yr w/o changes, but the other is new x several days. Clinically slight ttp, they are mobile, well circumscribed, firm each approx 7mm x 7 mm, no overlying skin changes. Well-circumscribed, predominantly hypoechoic foci with a fatty hilum are present in the soft tissues of the right proximal forearm laterally and the right mid forearm medially. They are located anterior to the fascia. The focus in the right lateral proximal forearm measures 1.3 x 0.3 x 1.3 cm. No surrounding inflammatory changes are present. No loculated fluid collections are present.The focus in the right mid forearm medially measures 1.1 x 0.2 x 1.0 cm. No surrounding inflammatory changes are present. No loculated fluid collections are present.

Output: Two well-circumscribed foci in the right forearm likely represent benign-appearing lymph nodes.


Instruction: Generate impression based on medical findings.

Input: Hepatitis C with steatohepatitis. Evaluate for cirrhosis, malignancy, or portal hypertension. LIVER: The liver is normal in size measuring 12.4cm in length. The parenchymal echotexture is mildly coarsened echogenic compatible with the stated history of steatosis. No focal suspicious parenchymal lesion. The liver surface contour remains normal. The main portal vein is patent with hepatopedal flow however the velocities the lower limits normal measuring 10 cm/s.GALLBLADDER, BILIARY TRACT: No intrahepatic or extrahepatic biliary ductal dilatation. The gallbladder is unremarkable. The common bile duct measures 2 mm.PANCREAS: No significant abnormalities noted.KIDNEY: Right kidney measures 9.5 cm in length. The left kidney measures 10.5 cm in length. No hydronephrosis.OTHER: Spleen is normal in size measuring 6.4 cm in length.

Output: Hepatic steatosis without evidence of cirrhosis, malignancy, or portal hypertension.


Instruction: Generate impression based on medical findings.

Input: Female 57 years old; Reason: right renal ultrasound to rule out hydronephrosis History: R flank pain, h/o nephrolithiasis RIGHT KIDNEY: The right kidney measures 11.4 cm in length. The cortex is normal in echogenicity. Small echogenic nonobstructing lower pole calculus measures 5 mm. LEFT KIDNEY: The left kidney measures 11.5 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. URINARY BLADDER: No significant abnormality notedOTHER: No significant abnormalities noted.

Output: 1.5 mm nonobstructive right lower pole renal calculus.2.No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Female 55 years old Reason: please screen for HCC, evaluate portal HTN History: 55 yo EtOH and Hep C cirrhosis LIVER: Liver measures 18.3 cm in length. The parenchyma is heterogeneous, severely coarse and echogenic with a nodular liver contour. No focal hepatic lesion is identified, however diffuse heterogeneity of the liver limits sensitivity of detection on ultrasound. No ascites.Main portal vein is patent with hepatopedal flow and peak velocity of 0.1 m/s.BILIARY TRACT: There is diffuse symmetric thickening of the gallbladder wall and possible edema which was present on the prior study, and is likely due to hepatic disease or hypoalbuminemia. The gallbladder wall measures up to 0.6 cm, however there is no significant gallbladder distention or pericholecystic fluid. Negative sonographic Murphy's sign. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 10.6 cm. The left kidney measures 12.0 cm. No shadowing renal calculus or hydronephrosis.SPLEEN: The spleen measures 14.7 cm. in length. OTHER: No significant abnormality noted.

Output: 1.Mild hepatomegaly with cirrhotic appearing liver. No focal hepatic lesion is identified, however diffuse heterogeneity of the liver limits sensitivity of detection ultrasound. No ascites.2.Cholelithiasis. Gallbladder wall is again noted to be mildly thickened without secondary signs of cholecystitis, and is likely due to hepatic disease or hypoalbuminemia.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with acute renal failure RIGHT KIDNEY: The right kidney measures 11 cm. Echogenic parenchyma without mass, stone or hydronephrosis.LEFT KIDNEY: The left kidney measures 12 cm. Echogenic parenchyma without mass, stone or hydronephrosis.OTHER: Bladder is nondistended. Moderate ascites.

Output: 1. Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone or hydronephrosis.2. Moderate ascites.


Instruction: Generate impression based on medical findings.

Input: Reason: RUQ fullness associated with fatty food -- assess for gallstones LIVER: Liver measures 16 cm with mildly increased echogenicity. Portal vein is patent with normal direction and velocity of 0.3 m/s. No suspicious hepatic mass is noted.BILIARY TRACT: Common bile duct measures 3 mm. Gallbladder wall measures 1.7 mm. No pericholecystic fluid collection. No gallstones noted.PANCREAS: Distal pancreas is obscured by overlying bowel gas. Visualized part is within normal limits.SPLEEN: Spleen measures 8.9 cm and is normal in echogenicity and configuration.KIDNEYS: Right kidney measures 10.3 cm with normal echogenicity and without hydronephrosis. There is mildly complex right renal cyst measuring 2.5 x 2.2 x 2.5 cm. Left kidney measures 10.7 cm with normal echogenicity and without hydronephrosis. No renal calculi identified. OTHER: No significant abnormalities noted.

Output: Increased hepatic parenchymal echogenicity suggestive for chronic liver disease/fatty infiltration without mass or ductal dilatation. No cholelithiasis or acute inflammation of the gallbladder. There is mildly complex 2.5 cm right renal cyst. Follow up to establish stability is recommended.


Instruction: Generate impression based on medical findings.

Input: Female 55 years old Reason: renal mass, stones, bladder History: as above RIGHT KIDNEY: The right kidney measures 9.5 cm. No shadowing calculi or hydronephrosis is present. No renal lesion delineated.LEFT KIDNEY: The left kidney measures 9.1 cm. No shadowing calculi or hydronephrosis is present. No renal lesion delineated.BLADDER: Underdistended bladder, making assessment suboptimal.OTHER: No significant abnormalities noted.

Output: No renal stone or lesion seen. No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Male 61 years old Reason: HBV, eval for HCC History: HBV LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 14.1 cm in length. The parenchyma is moderately echogenic the portal vein is patent with normal hepatopetal flow and a velocity of 30 cm/sec.BILIARY TRACT: The gallbladder is collapsed resulting in apparent wall thickening of 4 mm. No intrahepatic or extrahepatic biliary ductal dilatation. The common bile duct measures 5 mm in diameter.PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 10.8 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 11.4 cm. The cortex is normal in echogenicity. A 5-mm nonobstructing calculus is present in the interpolar region. SPLEEN: The spleen measures 8.2 cm. in length. OTHER: No significant abnormalities noted.

Output: 1.Echogenic hepatic parenchyma which can be seen in hepatic steatosis. No focal suspicious parenchymal lesion.2.Cholelithiasis without evidence of acute cholecystitis.3.Nonobstructing left renal calculus.


Instruction: Generate impression based on medical findings.

Input: Male 67 years old; Reason: Question of stone in kidney or ureter History: History hyperparathyroidism and renal stones RIGHT KIDNEY: The right kidney measures 11.1 cm in length. The cortex has slightly increased echogenicity. No shadowing calculi or hydronephrosis is present. No worrisome mass is seen.LEFT KIDNEY: The left kidney measures 11.2 cm in length. The cortex has slightly increased echogenicity. No shadowing calculi or hydronephrosis is present. No worrisome mass is seen.URINARY BLADDER: The urinary bladder is visualized without any significant abnormalities noted.OTHER: Only limited views of the liver were obtained however there appears to be heterogeneously increased echogenicity and a focal echogenic focus measuring 1.3 cm x 1.7 cm x 1.8 cm. This represents a hemangioma previously characterized on MRI.

Output: 1.Bilaterally there is slight increased echogenicity of the kidneys compatible medical renal disease. No evidence of renal calculi or hydronephrosis.2.Small right hepatic lobe hemangioma, previously characterized by MRI. There is mildly increased echogenicity of the liver parenchyma compatible with fatty infiltration/hepatocellular dysfunction.


Instruction: Generate impression based on medical findings.

Input: Male 30 years old Reason: Evaluate for acute cholelithiasis History: Recurrent pancreatitis, elevated lipase LIVER: Main portal vein patent with normal directional flow, velocity elevated measuring 56 cm/s. BILIARY TRACT: Gallbladder unremarkable. No intraluminal mobile echogenic foci seen to suggest underlying cholelithiasis. No significant gallbladder distention, wall thickening or pericholecystic fluid. Per ultrasound technologist, negative sonographic Murphy's sign. No intrahepatic or extrahepatic biliary duct dilatation.OTHER: No significant abnormality noted.

Output: No evidence of cholelithiasis or biliary duct dilatation. Gallbladder is normal in appearance.


Instruction: Generate impression based on medical findings.

Input: Status post thyroidectomy for cancer RIGHT LOBE: Status post thyroidectomy. 0.7 x 0.6 x 0.5 cm echogenic focus in right thyroid bed, previously measured 0.7 x 0.5 x 0.5 cm.LEFT LOBE: Status post thyroidectomy. 1 x 0.7 x 0.4 cm echogenic focus in left thyroid bed, previously measured 1.3 x 0.8 x 0.6 cm.ISTHMUS: Status post thyroidectomy.LYMPH NODES: Benign-appearing left level 4 lymph node. Additional left level 3 lymph node measuring 0.8 x 0.6 x 0.3 cm, possible tiny fatty hilum, increased vascularity also seen, nonspecific.OTHER: No significant abnormality noted.

Output: Stable and decreased size of echogenic foci in thyroid bed, may reflect residual thyroid tissue.No definitive evidence of metastatic nodal disease.


Instruction: Generate impression based on medical findings.

Input: 30 year-old female with epigastric pain and nausea. LIMITED ABDOMENLIVER: The liver has a smooth contour and parenchyma appears within normal limits. Liver measures 15.3 cm in length.BILIARY TRACT: The gallbladder has an anechoic lumen. No gallbladder wall thickening or pericholecystic fluid is seen. No biliary ductal dilatation. PANCREAS: No significant abnormality.KIDNEYS: The right kidney measures 9.4 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.The left kidney measures 10.5 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.SPLEEN: The spleen measures 10.4 cm. in length without significant abnormality.OTHER: No significant abnormalities noted.

Output: 1.No associated findings to explain patient's epigastric pain/nausea.


Instruction: Generate impression based on medical findings.

Input: Female 59 years old Reason: r/o recurrence History: h/o thyroid cancer RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: Status post thyroidectomy. There is a 0.4 x 0.3 x 0.5 cm hypoechoic lesion in the right thyroidectomy bed, which was equivocally present on the prior examination. Although nonspecific, special attention at follow-up is recommended.LEFT LOBE: Status post thyroidectomy.ISTHMUS: Status post thyroidectomy.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No suspicious cervical lymphadenopathy is evident.OTHER: No significant abnormality noted.

Output: Subcentimeter hypoechoic lesion in the right thyroidectomy bed. Although nonspecific, special attention at follow-up is recommended.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate mass effect on bladder or rectum from uterine fibroids History: prior h/o constipation, urinary urgency Multiple large fibroids are noted within the uterus. No significant mass effect is noted on the bladder.

Output: Multiple large fibroids within the uterus without significant mass effect on the bladder.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with hematuria RIGHT KIDNEY: The right kidney measures 10.4 cm. Echogenic parenchyma without worrisome mass, stone or hydronephrosis. There are multiple anechoic foci compatible with simple renal cysts, the largest measuring 3.1 x 3.4 x 2.8 cm.LEFT KIDNEY: The left kidney measures 9.7 cm. Echogenic parenchyma without worrisome mass, stone or hydronephrosis. There are multiple anechoic foci compatible with simple renal cysts, the largest measuring 5.6 x 4.3 x 4.3 cm.OTHER: Bladder is nondistended with foley in place.

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


Instruction: Generate impression based on medical findings.

Input: 37-year-old male with hyperthyroidism and a choking sensation. RIGHT LOBE MEASUREMENTS: 2.9 x 1.7 x 6.9 cm.LEFT LOBE MEASUREMENTS: 2.5 x 1.4 x 6.1 cm.ISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Heterogeneous appearance of the right thyroid.LEFT LOBE: Heterogeneous appearance of the left thyroid.ISTHMUS: Heterogeneous appearance of the isthmus.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A benign-appearing 1.8 cm left level 3 lymph node .OTHER: Posterior to the left thyroid, the esophagus appears flattened.

Output: 1. The thyroid appears heterogeneous and is symmetrically enlarged, which may be consistent with given clinical history of hyperthyroidism. 2. The esophagus appears flattened anteriorly by the thyroid which may explain patient symptomatology of choking sensation.


Instruction: Generate impression based on medical findings.

Input: 53-year-old female presents with transaminitis. LIVER: Mild increase in hepatic parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions. Hepatic length measures 17 cm. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of 24 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 3 mm. The common bile duct measures 3 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified. No pericholecystic fluid.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 10 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 11 cm and has normal vascular flow. The left kidney measures 12 cm and has normal vascular flow. OTHER: Partially visualized right-sided pleural effusion.

Output: 1. Mild increase in hepatic parenchymal echogenicity with coarsened echotexture consistent with fatty liver/hepatic parenchymal dysfunction. No hepatic mass or ductal dilatation identified.2. Partially visualized right-sided pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male 52 years old; Reason: CKD History: CKD RIGHT KIDNEY: The right kidney measures 13 cm in length. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 14 cm in length. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. 2 cm simple left renal cyst.OTHER: Visualized portions of the urinary bladder are unremarkable.

Output: 1.No hydronephrosis. Normal renal echogenicity. Simple left renal cyst.


Instruction: Generate impression based on medical findings.

Input: Female 41 years old; Reason: Patient with ETOH cirrhosis presenting from OSH with suspected hepatorenal syndrome, decreased urine output, elevated Cr RIGHT KIDNEY: The right kidney measures 8.6 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 9.9 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. URINARY BLADDER: The bladder is decompressed by a Foley catheter.OTHER: The liver is incompletely imaged but has a nodular surface and appears heterogeneous. There is a large amount of ascites in all 4 quadrants. Bilateral pleural effusions.

Output: 1.Echogenic kidneys compatible with medical renal disease. No hydronephrosis.2.Incompletely imaged liver appears cirrhotic. There is a large amount of ascites in all 4 quadrants.3.Bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old. Reason: Concern for portal hypertension based on EGD. Exclude cirrhosis, focal liver lesions History: Concern for portal hypertension based on EGD. Exclude cirrhosis, focal liver lesions. LIVER: Liver measures 13.1 cm in length. Hepatic parenchyma is coarse and echogenic. The liver contour is micronodular. No suspicious mass or ascites. Main portal vein is patent with a normal direction of flow.BILIARY TRACT: No biliary ductal dilatation. Common bile measures 3 mm. Gallbladder is underdistended with no cholelithiasis, gallbladder wall thickening, or pericholecystic fluid.PANCREAS: Obscured by overlying bowel gas.SPLEEN: Spleen is upper limit of normal in size and measures 13.6 cm in length with normal echotexture.RIGHT KIDNEY: Right kidney measures 10.2 cm in length with normal cortical echogenicity. No hydronephrosis, shadowing calculi, or mass.OTHER: Left kidney measures 10.8 cm in length with normal cortical echogenicity. No hydronephrosis, shadowing calculi, or mass.

Output: Hepatic parenchyma is coarse and echogenic with micronodularity of the liver capsule raising the possibility of early cirrhosis. No suspicious hepatic mass.


Instruction: Generate impression based on medical findings.

Input: Male 69 years old Reason: RUQ evaluation; history of HCV. Rising LFT's History: rising LFTs LIVER: Liver is enlarged and measures 20.7 cm in length. The parenchyma is coarse and severely echogenic. A heterogeneous focus in the right hepatic lobe measures approximately 5 x 3 cm and appears suspicious for an underlying mass. No ascitesMain portal vein is patent with hepatopedal flow.BILIARY TRACT: Gallbladder unremarkable. No significant gallbladder distention, wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 11.1 cm. The left kidney measures 10.6 cm. There is mildly increased echogenicity of the bilateral renal cortices. No shadowing renal calculus or hydronephrosis bilaterally.SPLEEN: The spleen measures 13.7 cm. in length. OTHER: No significant abnormality noted.

Output: 1.Hepatomegaly with coarse and echogenic liver parenchyma with a focal area of heterogeneity measuring approximately 5 x 3 cm and the right hepatic lobe, questionably seen on CT dated 12/10/2014 appear suspicious for an underlying mass or lesion. Further evaluation with a triple phase CT or MRI is recommended.2.Bilateral increased renal cortical echogenicities may reflect medical renal disease.3.Findings discussed with Dr. Sahota via telephone by Dr. Kannan


Instruction: Generate impression based on medical findings.

Input: Female 57 years old Reason: follow up on right thyroid nodule, Hurthle cell History: none RIGHT LOBE MEASUREMENTS: 5.1 x 1.4 x 1.4 cm.LEFT LOBE MEASUREMENTS: 4.2 x 1.1 x 1.4 cm.ISTHMUS MEASUREMENTS: 0.3 cm thick.RIGHT LOBE: The right lobe of the thyroid demonstrates normal parenchymal echogenicity. Multiple thyroid nodules again seen in the right lobe, with the suspicious appearing inferior pole nodule with rim calcifications measuring 0.9 x 0.8 x 0.7 cm, previously 1.0 x 0.9 x 1.0 cm.LEFT LOBE: The left lobe of the thyroid demonstrates normal parenchymal echogenicity. Benign-appearing spongiform nodule in the lower pole of the left lobe measures 1.2 x 0.7 x 0.7 cm, previously 1.1 x 0.7 x 0.5 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple stable appearing thyroid nodules, with the suspicious-appearing right inferior lobe nodule also without substantial interval change.


Instruction: Generate impression based on medical findings.

Input: 32-year-old male with AKI on CKD. RIGHT KIDNEY: The right kidney measures 9 cm in length and shows mildly increased echogenicity with normal architecture. No mass, shadowing calculi or hydronephrosis.LEFT KIDNEY: The left kidney measures 11.0 cm in length and shows mildly increased echogenicity with normal architecture. No mass, shadowing calculi or hydronephrosis.URINARY BLADDER: The urinary bladder is normal in appearance.OTHER: There is no free or loculated fluid.

Output: Increased echogenicity of the renal parenchyma consistent with nonspecific medical renal disease.


Instruction: Generate impression based on medical findings.

Input: 56-year-old male with abdominal distention and right upper quadrant pain LIVER: Echogenicity of the hepatic parenchyma is diffusely increased. No focal hepatic lesion or mass. The liver measures 17.1 cm in length. The main portal vein is patent with normal hepatopedal flow and velocity of 36 cm/s.GALLBLADDER, BILIARY TRACT: The gallbladder is normal in appearance. There is no pericholecystic fluid. No cholelithiasis. The gallbladder wall is normal in appearance, measuring 0.5 cm in thickness. No dilatation or cystic changes are noted of the intrahepatic or extrahepatic biliary ducts. The common bile duct measures 0.3 cm in diameter. No choledocholithiasis.PANCREAS: The head and proximal body of the pancreas are normal. The tail is obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 10.9 cm in length and shows increased echogenicity. No mass, stone or hydronephrosis.LEFT KIDNEY: The left kidney measures 11.6 cm in length and shows increased echogenicity. No mass, stone or hydronephrosis.SPLEEN: The spleen is normal in echogenicity and measures 9.8 cm in length. OTHER: There is no free or loculated fluid.

Output: 1.Diffusely increased echogenicity and coarse echotexture of the hepatic parenchyma, consistent with fatty liver/hepatic parenchymal dysfunction. No hepatic mass or ductal dilatation.2.Increased echogenicity of the renal parenchyma consistent with medical renal disease/parenchymal dysfunction without obstructing stone or hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Male 29 years old Reason: Evaluate for obstruction History: hyperbilirubinemia Suboptimal exam secondary to patient's discomfort/"soreness," was unable to be situated in a decubitus position.LIVER: Liver measures 16 cm in length. Possible micronodular contour, may be seen in setting of underlying cirrhosis and correlation with patient's clinical history/laboratory values recommended. Mildly coarsened echotexture of liver similar to prior study. Main portal vein patent with normal directional flow, velocity measures 27 cm/sec.BILIARY TRACT: Nonvisualization of gallbladder, presumably related to prior cholecystectomy. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Visualized portions of pancreas unremarkable. KIDNEYS: Small echogenic right kidney, kidney measures 5.7 cm, no hydronephrosis. The left kidney is not well seen. SPLEEN: Not seen with certainty.

Output: No biliary ductal dilatation.Micronodular hepatic contour suggested, may be seen in setting of underlying cirrhosis and correlation with patient's clinical history/laboratory values recommended. Mildly coarsened echotexture of liver similar to prior study. Small echogenic right kidney, compatible with chronic renal disease.Nonvisualization of left kidney and spleen.


Instruction: Generate impression based on medical findings.

Input: Female 38 years old; Reason: kidney stone History: stone RIGHT KIDNEY: The right kidney measures 10.9 cm in length. The cortex is normal in echogenicity. Minimally complex cyst measuring 1.6 x 1.2 x 1.6 cm along the lower pole. Shadowing calculus measuring 0.9 x 0.6 was 0.2 cm without evidence of hydronephrosis. Normal vascularity.LEFT KIDNEY: The left kidney measures 12.3 cm in length. The cortex is normal in echogenicity. Minimally complex subcentimeter cyst. No shadowing calculi or hydronephrosis is present. Normal vascularity.URINARY BLADDER: No significant abnormality noted.OTHER: No significant abnormalities noted.

Output: Stable left renal stone without evidence of hydronephrosis. Bilateral minimally complex left renal cysts.


Instruction: Generate impression based on medical findings.

Input: Hematuria RIGHT KIDNEY: Right kidney measures 10.4 cm and is normal in echogenicity without hydronephrosis. No evidence of renal calculi.LEFT KIDNEY: Left kidney measures 11.0 cm and is normal in echogenicity without hydronephrosis. Left mid exophytic mildly complex lobulated lesion with septations suggested, lesion measures 4.3 x 4.3 x 5.2 cm.No evidence of renal calculi.URINARY BLADDER: Bilateral ureteral jets noted. No significant abnormalities noted.OTHER: Enlarged prostate measuring 5.1 cm noted.

Output: No evidence of hydronephrosis or renal calculi. Left mid exophytic mildly complex lobulated septated lesion. Dedicated CT with contrast is recommended for better characterization.Findings discussed with Dr. Tarplin (pager 9772) on 6/26/2015 4:27 PM.


Instruction: Generate impression based on medical findings.

Input: Male 76 years old Reason: eval for medical renal disease vs obstruction History: worsening renal function RIGHT KIDNEY: The right kidney measures 9.1 cm. Kidney is echogenic. Subcentimeter renal cyst. Thinned renal cortex. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 9 cm. 2.8 x 2.7 x 2.2 cm mid pole renal cyst. Kidneys echogenic. Thinned renal cortex. No shadowing calculi or hydronephrosis is present. BLADDER: Mildly thick-walled bladder, may be due in part to element of underdistention.OTHER: No significant abnormalities noted.

Output: Findings compatible with underlying medical renal disease. No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Reason: screening for research trial 15-0058, history of liver transplant LIVER: Liver measures 16.4 cm with increased echogenicity. Portal vein is patent with normal direction and velocity of 0.2 m/s. No suspicious hepatic mass is noted.BILIARY TRACT: Common bile duct measures 4 mm. Patient is status post cholecystectomy.PANCREAS: Distal pancreas is obscured by overlying bowel gas. Visualized part is within normal limits.SPLEEN: Spleen measures 11.4 cm and is normal in echogenicity and configuration. Adjacent splenules noted measuring 1.1 x 1.4 x 1.2 cm and 0.6 x 0.9 x 0.8 cm.KIDNEYS: Right kidney measures 8.5 cm with mildly increased echogenicity and without hydronephrosis. Left kidney measures 9.1 cm with mildly increased echogenicity and without hydronephrosis. No renal calculi identified. OTHER: No evidence of ascites.

Output: 1.Mildly increased liver echogenicity, compatible with hepatic steatosis. 2.Bilateral mildly increased renal echogenicity is compatible with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Female 61 years old Reason: RUQ, eval for gallstones History: RUQ billary colic LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 13.8 cm in length. The parenchyma is normal in echotexture. Portal flow is within normal limits.BILIARY TRACT: The gallbladder has at least two, large echogenic calculi with posterior acoustic shadowing. Wall measures 2 mm in thickness. Common duct measures 3 mm. No pericholecystic fluid is seen.PANCREAS: The imaged pancreas is without significant abnormality. The pancreatic duct measures about 3 mm.KIDNEYS: The right kidney measures 9.9 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present.The left kidney measures 9.4 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 9.4 cm. in length.OTHER: No significant abnormalities noted.

Output: 1.Cholelithiasis without evidence of cholecystitis.2.Bilateral echogenic kidneys are consistent with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Female 68 years old Reason: renal cysts concerning for PCKD noted on research MRI - please evaluate for liver cysts LIVER: Liver measures approximately 13.8 cm in length. No liver cyst delineated. Main portal vein patent with normal directional flow, velocity measures 29 cm/s. BILIARY TRACT: Gallbladder not seen. CBD mildly dilated measuring up to 9 mm. No gross intrahepatic biliary duct dilatation.PANCREAS: Not well seen in entirety due to overlying bowel gas. KIDNEYS: The right kidney measures 12 cm. Upper pole renal cyst measuring 4 x 3.7 cm. The left kidney measures 12 cm. Left renal simple cyst measuring 7 x 7.2 x 5.5 cm.SPLEEN: The spleen measures 9 cm. in length. OTHER: No significant abnormality noted.

Output: Dominant cyst seen in each of the kidneys as above. No liver cysts seen.Gallbladder not visualized, presumably related to prior cholecystectomy. CBD mildly dilated measuring up to 9 mm, may be due in part to postcholecystectomy state and age-related. No gross intrahepatic biliary duct dilatation.


Instruction: Generate impression based on medical findings.

Input: 39 year-old female with the history of hepatitis B, hepatocellular carcinoma surveillance. LIVER: Mild increase in hepatic parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions. Hepatic length measures 17 cm. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of 25 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 2 mm. The common bile duct measures 4 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 12 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 11 cm and has normal vascular flow. The left kidney measures 10 cm and has normal vascular flow. OTHER: No significant abnormality noted.

Output: Mild increase in hepatic parenchymal echogenicity with coarsened echotexture consistent with fatty liver/hepatic parenchymal dysfunction, likely due to patient's underlying hepatitis B. No hepatic mass or ductal dilatation identified.