Instruction: Generate impression based on medical findings.

Input: Female 32 years old Reason: evidence of Fitz-Hugh-Curtis History: RUQ pain LIVER: Liver measures 15.9 cm in length. Small perihepatic free fluid. Main portal vein patent with normal directional flow, velocity measures 36 cm/s. BILIARY TRACT: Gallbladder not visualized. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Visualized portions of pancreas unremarkable. KIDNEYS: The right kidney measures 12.6 cm. The left kidney measures 14.3 cm. SPLEEN: The spleen measures 7.8 cm. in length. OTHER: No significant abnormality noted.

Output: Small perihepatic ascites, nonspecific.Status post cholecystectomy. No biliary duct dilatation.


Instruction: Generate impression based on medical findings.

Input: Reason: 58yo female, postop day 7 from upper vaginectomy with left ureteral stent and foley catheter in place, with AKI and good urine output History: Creatinine 1.4 (baseline 0.7) RIGHT KIDNEY: The right kidney measures 12.5 cm in length and shows normal echotexture. Mild right hydronephrosis. No mass or shadowing renal calculi.LEFT KIDNEY: The left kidney measures 12.8 cm in length and shows normal echotexture. No mass, shadowing calculi or hydronephrosis.URINARY BLADDER: Foley bladder in a decompressed urinary bladder.OTHER: There is no free or loculated fluid.

Output: Mild right hydronephrosis. No renal mass. No shadowing renal calculi.


Instruction: Generate impression based on medical findings.

Input: 40-year-old male with hepatitis B. Reason: HCC screening. LIVER: The liver measures 15.8 cm in length. Coarse echogenic liver echotexture without mass or ductal dilatation. Portal vein is patent.GALLBLADDER, BILIARY TRACT: No gallstones, gallbladder wall thickening, pericholecystic fluid or ductal dilatation.PANCREAS: The visualized pancreas is without significant abnormalities.RIGHT KIDNEY: The right kidney measures 11.5 cm. No mass, stone or hydronephrosis.LEFT KIDNEY: The left kidney measures 12.6 cm. No mass, stone or hydronephrosis.SPLEEN: The spleen measures 13.1 cm.OTHER: No ascites.

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


Instruction: Generate impression based on medical findings.

Input: Reason: Please assess L arm mass along antecubital fossa History: L arm mass, enlarging, no recent history of IV There is a 2.4 x 2.7 x 2.6 cm heterogenous mass which appears primarily solid with mixed internal cystic components. There is some internal vascularity noted within the mass in addition to what appears to be a large feeding artery.

Output: 1. Large heterogenous mass noted within the left antecubital fossa. Given the clinical history, this is concerning for a metastatic lymph node. The lesion was FDG avid on the recent exam.


Instruction: Generate impression based on medical findings.

Input: Status post thyroidectomy Midline neck suboptimally assessed secondary to patient's tracheostomy.RIGHT LOBE: Status post thyroidectomy.LEFT LOBE: Status post thyroidectomy.ISTHMUS: Not well assessed secondary to patient's tracheostomy.LYMPH NODES: Nonspecific right level 2 lymph node measuring 0.9-0 0.7 x 0.3 cm, however not abnormal based on size or morphologic criteria. Left level 4 lymph node measuring 0.7 x 0.2 x 0.2 cm, also not abnormal based on size or morphologic criteria.

Output: Suboptimal assessment of mid neck secondary to patient's tracheostomy. However, no definite evidence of local tumor recurrence or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 67-year-old female with a history of neurogenic bladder. RIGHT KIDNEY: The right kidney is echogenic and measures 10 cm in length. Corticomedullary differentiation is maintained. No shadowing calculi or hydronephrosis is present. Anechoic focus which is partially septated along the upper pole measures 1.5 x 1.2 x 1.5 cm. Additional subcentimeter anechoic focus arising from the midpole.LEFT KIDNEY: The left kidney is echogenic and measures 9 cm in length. Corticomedullary differentiation is maintained. No shadowing calculi or hydronephrosis is present. Mild prominence of the left collecting system.URINARY BLADDER: Visualized portions of the urinary bladder are unremarkable.OTHER: No significant abnormalities noted.

Output: 1.Echogenic kidneys suggestive of medical renal disease.2.Partially septated right renal cyst.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o liver cirrhosis History: abnormal lfts LIVER: Liver measures 18.4 cm with increased echogenicity. Liver surface is mildly nodular. No suspicious hepatic mass is noted.BILIARY TRACT: Common bile duct measures 4 mm. Gallbladder wall measures 3 mm. Gallbladder polyp noted measuring 0.6 x 0.5 x 0.5 cm. No pericholecystic fluid collection. PANCREAS: Pancreas is not well seen due to overlying bowel gas.SPLEEN: Limited view of the spleen due to overlying bowel gas. Spleen measures 9.7 cm and is normal in echogenicity and configuration.KIDNEYS: Right kidney measures 12.2 cm with normal echogenicity and without hydronephrosis. Left kidney measures 11.1 cm with normal echogenicity and without hydronephrosis. Left mid simple cyst measuring 1.6 x 1.1 x 1.3 cm. No renal calculi identified. OTHER: Trace ascites. Questionable left pleural effusion.

Output: 1.Nodular contour of the liver with increased echogenicity and borderline enlargement suggestive of cirrhosis.2.Reversal flow of the portal vein with recanalized umbilical vein compatible with portal hypertension.3.Gallbladder polyp noted. 6 month follow-up can be obtained to establish stability.4.Questionable left pleural effusion.5.Findings discussed with Dr. Syema Sheikh on 6/24/2015 11:35 AM.


Instruction: Generate impression based on medical findings.

Input: 71-year-old male with a history of right ventricular failure and rising creatinine, evaluate for hydronephrosis/obstruction. RIGHT KIDNEY: The right kidney measures 10.8 cm. The renal cortical echogenicity is within normal limits. No shadowing to suggest renal calculi. No hydronephrosis is identified.LEFT KIDNEY: Left kidney measures 11.6 cm. The renal cortical echogenicity is within normal limits. No shadowing to suggest renal calculi. No hydronephrosis is identified.OTHER: Decompressed bladder limiting evaluation. Small amount of ascites is visualized.

Output: No sonographic evidence of hydronephrosis or obstruction. Small amount of ascites.


Instruction: Generate impression based on medical findings.

Input: Female 72 years old Reason: RUQ pain, nausea, vomiting, PO intolerance History: above LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 15.2 cm in length. The parenchyma is mildly echogenic . No focal hepatic lesions. Main portal vein is patent.BILIARY TRACT: The gallbladder contains layering sludge. Wall measures 3 mm in thickness. Common duct measures 7 mm. PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 9.3 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. Cyst at the upper pole measures 2.1 cmThe left kidney measures 10.1 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 7.9 cm. in length. OTHER: No ascites.

Output: 1.Findings suggestive of fatty infiltration of the liver.2.Gallbladder sludge.3.Echogenic renal cortices.


Instruction: Generate impression based on medical findings.

Input: Reason: hx rectus sheath hematoma, assess for evolution History: pain Hematoma right rectus sheath again seen measuring 15.6 x 8.8 cm. Compared to prior ultrasound, the hematoma appears to be organizing with more complex appearance. Hematoma appears roughly similar in size.

Output: Evolving right rectus sheath hematoma.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for cirrhosis History: HCV LIVER: The size of the liver is at the lower limit of normal, measuring 13 cm in length. Normal echogenicity. No focal lesions. No intrahepatic ductal dilation.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. The common hepatic duct is not dilated, measuring 0.4 cm in caliber. The common bile duct is not dilated, measuring 0.3 cm in caliber.PANCREAS: The pancreas is poorly visualized due to overlying bowel gas.KIDNEYS: The right kidney measures 10.6 cm in length. Normal echogenicity. There is an echogenic focus within the inferior pole of the right kidney. This likely represents a nonobstructing stone. No hydronephrosis.The left kidney measures 9.8 cm in length. Normal echogenicity. No focal lesions. No hydronephrosis.SPLEEN: The size of the spleen is within normal limits, measuring 9.7 cm in length. Normal echogenicity. No focal lesions.OTHER: No significant abnormality.

Output: 1. No sonographic evidence of cirrhosis. No focal lesions noted within the liver.2. Incidental nonobstructing stone noted within the inferior pole of the right kidney.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old. Reason: Evaluate for kidney stone. RIGHT KIDNEY: Right kidney measures 10.1 cm in length with normal cortical echogenicity. No hydronephrosis, shadowing calculi, or mass.LEFT KIDNEY: Left kidney measures 11.6 cm in length with normal cortical echogenicity. Multiple hyperechoic, shadowing foci are present which likely represent nonobstructing calculi. Largest calculus in the left lower pole measures 0.8 x 0.7 cm. No hydronephrosis or mass.URINARY BLADDER: The urinary bladder is collapsed.OTHER: No significant abnormalities noted.

Output: Multiple nonobstructing subcentimeter left renal calculi. No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 36-year-old female with kidney stone status post removal on 11/20/2015. RIGHT KIDNEY: The right kidney measures 13.0 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.LEFT KIDNEY: The left kidney measures 11.6 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. There is discontinuity of the central echo complex, which may be representative of a duplicated collecting system.OTHER: The bladder is within normal limits. Bilateral ureteral jets are visualized.DOPPLER

Output: 1.No nephrolithiasis or hydronephrosis.2.Discontinuity of the left central echo complex may be representative of a duplicated collecting system.


Instruction: Generate impression based on medical findings.

Input: Female 67 years old Reason: 67 yoAAF with h/o MF on Jakafi and come with abd pain, need to evaluate liver History: abd pain and elevation of LFTs LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 14.0 cm in length. The parenchyma is mildly echogenic. Portal flow is hepatopedal.BILIARY TRACT: The gallbladder is absent. Common duct measures 4 mm.PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 8.4 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 hydronephrosis is present. A punctate area of increased echogenicity measuring 0.7 x 0.4 x 0.8 cm. There is no posterior shadowing or twinkle artifact.SPLEEN: The spleen measures 9.9 cm. in length. OTHER: No significant abnormalities noted.

Output: 1.Increased echogenicity of the liver is consistent with fatty infiltration.2.Echogenic focus within the left kidney may represent a nonshadowing, nonobstructing stone or a parenchymal calcification.


Instruction: Generate impression based on medical findings.

Input: Female 34 years old; Reason: 34 y.o. F with HPT. History: HPT RIGHT LOBE MEASUREMENTS: 5.6 x 2.0 x 2.0 cmLEFT LOBE MEASUREMENTS: 6.0 x 1.4 x 1.5 cmISTHMUS MEASUREMENT: 0.2 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: There is a hypoechoic nodule measuring 0.6 x 0.5 x 0.4 cm without increased vascularity or calcifications.ISTHMUS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: There is a circumscribed, complex but predominantly hypoechoic 2.1 x 1.8 x 1.0 cm soft tissue lesion immediately posterior to the left lobe of the thyroid with moderately increased vascularity.

Output: Isolated parathyroid mass posterior to the inferior left thyroid lobe.


Instruction: Generate impression based on medical findings.

Input: Male 59 years old Reason: HEP b AND hiv, SCREEN FOR HSS History: same LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 13.8 cm in length. The parenchyma is mildly coarse and echogenic. No focal hepatic lesion is identified. BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 1 mm in thickness. The common bile duct measures 6 mm.PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 9.1 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. An anechoic lesion with through transmission measures 2.7 x 2.6 x 2.7 cm, compatible with simple cyst.The left kidney measures 9.4 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. A cyst containing few thin septations measures 2.6 x 2.4 x 2.4 cm, previously measuring 2.5 x 2.0 x 2.3 cm. Septations were not evident on prior study.SPLEEN: The spleen measures 9.9 cm in length.OTHER: No significant abnormalities noted.

Output: 1.Diffuse mildly coarse and echogenic liver, may represent nonspecific fatty infiltration/parenchymal disease.2.Increased size of mildly complex left renal cyst, with new septations. Recommend dedicated cross-sectional imaging for further evaluation.3.Echogenic kidneys, compatible with medical renal disease.Findings discussed with Dr. Reddy at 9:50 AM on 11/2/2016.


Instruction: Generate impression based on medical findings.

Input: Male 51 years old; Reason: CKD History: None RIGHT KIDNEY: The right kidney measures 10.7 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 9.1 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. URINARY BLADDER: Mildly distended and normal in appearance.OTHER: No significant abnormalities noted.

Output: Echogenic kidneys suggesting medical renal disease without hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Chronic hepatitis C. Evaluate for cirrhosis, malignancy, or portal hypertension. LIVER: Liver is normal in size measuring 12.1 cm in length. No focal parenchymal mass lesions. The portal vein is patent with normal hepatopedal flow and a velocity of 30 cm/s. The surface contour is smooth and without evidence of cirrhosis.GALLBLADDER, BILIARY TRACT: The gallbladder is unremarkable. The wall measures 2 mm in thickness. No cholelithiasis. No intrahepatic or extrahepatic biliary ductal dilatation. The common duct measures 3 mm in diameter.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney is normal in size and echotexture measuring 9.7 cm in length. No hydronephrosis. Left kidney is normal in size and echotexture measuring 9.6 cm in length. No hydronephrosis.OTHER: Spleen is upper limit of normal measuring 10.1 cm in length.

Output: Essentially normal right upper quadrant ultrasound without evidence of cirrhosis, malignancy, or portal hypertension.


Instruction: Generate impression based on medical findings.

Input: 46-year-old female with elevated liver function tests, evaluate for autoimmune hepatitis. LIVER: Increase in hepatic parenchymal echogenicity with coarsened echotexture and nodular contour, compatible with cirrhosis. No focal hepatic lesions. Hepatic length measures 17 cm. The main portal vein is patent with normal hepatopetal flow with a velocity of 33.8 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 2.2 mm. A gallstone is noted within the gallbladder, without evidence of pericholecystic fluid. Sonographic Murphy's sign was negative. The common bile duct measures 3.9 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 13.4 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 13.8 cm with no hydronephrosis. The left kidney measures 12.6 cm with no hydronephrosis. OTHER: No significant ascites.

Output: 1.Increase in hepatic parenchymal echogenicity with coarsened echotexture and nodular contour, compatible with cirrhosis. No hepatic mass or ductal dilatation identified.2.Cholelithiasis without evidence of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Female 65 years old Reason: Evaluate for hydronephrosis or any other abnormalities History: Worsening renal function RIGHT KIDNEY: The right kidney measures 12 cm. Mildly increased renal cortical echogenicity. Upper pole simple cyst, measuring 2 x 1.4 x 1.3 cm. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 12.8 cm. Mildly increased renal cortical echogenicity. Lower pole echogenic focus measuring 1.4 x 1.3 x 1.1 cm, may be an angiomyolipoma. Additional small renal cysts seen. No shadowing calculi or hydronephrosis is present. BLADDER: Underdistended bladder, making assessment suboptimal.OTHER: Vascular structure intervening between left kidney and spleen, splenorenal shunting may have this appearance in the proper clinical sitting but suboptimally assessed on this nondedicated and sonographic study.

Output: Mildly increased renal cortical echogenicity, consistent with medical renal disease. Vascular structure intervening between left kidney and spleen, splenorenal shunting may have this appearance in the proper clinical sitting but suboptimally assessed on this nondedicated and sonographic study. Correlation with patient's clinical history recommended and if clinically desired, further evaluation with contrast enhanced CT suggested.


Instruction: Generate impression based on medical findings.

Input: Reason: assess hydrocele and inguinal hernia History: large scrotal sac, hydrocele TESTIS: Given the size of the scrotal enlargement, it is difficult to distinguish the testes. Only one testis is clearly identified, likely the left. This testicle measures 3.8 x 2.3 x 4.8 cm. Bowel contents are noted within the scrotum consistent with an inguinal hernia. There is a hypoechoic focus with calcifications noted within the testis which measures 0.9 x 0.8 x 0.9 cm, concerning for neoplastic etiology.EPIDIDYMIS: Given the size of the scrotal enlargement, it is difficult to distinguish the separate epididymides as discussed above. Only one epididymis is clearly identified, likely the left. This epididymis measures 0.9 x 0.6 x 1.3 cm. Normal echogenicity. No focal lesions.OTHER: Hydrocele.

Output: 1. There is a large inguinal hernia containing bowel occupying much of the scrotum.2. Hypoechoic focus with calcification is noted within the testis, concerning for neoplastic etiology.


Instruction: Generate impression based on medical findings.

Input: Male 66 years old Reason: RUQ ultrasoudn to assess elevated transaminitis History: elevated AST/ALT LIMITED ABDOMENLIVER: No focal hepatic lesions. The parenchyma is slightly coarsened and heterogenous.BILIARY TRACT: Gallbladder is mildly contracted limiting evaluation. Gallstones without pericholecystic fluid or gallbladder wall thickening. Negative sonographic Murphy sign. . PANCREAS: Vision as portions are unremarkable.KIDNEYS: The right kidney is atrophic. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. Simple right upper renal cyst.The left kidney measures 7 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 9 cm. in length. OTHER: Ascites. Mobile debris in the bladder. Left pleural effusion.

Output: Cholelithiasis without sonographic signs of acute cholecystitis. Slightly coarsened echotexture of the liver is nonspecific, but can be seen in diffuse parenchymal destruction.Mild ascites and left pleural effusion. Bilateral atrophic kidneys. Right renal cortex is echogenic, which is nonspecific, but can be seen with medical renal disease.Debris in the urinary bladder.


Instruction: Generate impression based on medical findings.

Input: Male 87 years old; Reason: kidney stone History: stone RIGHT KIDNEY: The right kidney measures 9.2 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 8.8 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present.  URINARY BLADDER: No significant abnormality notedOTHER: No significant abnormalities noted.

Output: 1.Echogenic renal cortices.2.No sonographic findings of nephrolithiasis or hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Female 70 years old; Reason: elevated liver enzymes of unclear etiology History: abnormal liver enzymes LIVER: Mild increase in hepatic parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions. Hepatic length measures 19.1 cm. The main portal vein is patent with normal hepatopetal flow with a velocity of 25 cm/s. GALLBLADDER/BILIARY TRACT: Multiple echogenic shadowing foci are present within the gallbladder, compatible with cholelithiasis. Trace pericholecystic fluid is present. Sonographic Murphy sign is negative. The gallbladder does not appear distended. Gallbladder wall approximately measures 4 mm in diameter. The common bile duct measures 5 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 10.5 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 13.9 cm with no hydronephrosis. The left kidney measures 13.2 cm with no hydronephrosis. OTHER: No significant ascites.

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.Collapse gallbladder with cholelithiasis, minimal pericholecystic fluid, and mild gallbladder wall thickening. These findings are considered nonspecific for acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Male 67 years old; Reason: 67M s/p TPC with uro stent placement, now with AKI History: Cr 2.9, anuric please evaluate for hydronephrosis. RIGHT KIDNEY: The right kidney is not visualized and per patient has been surgically removed.LEFT KIDNEY: The left kidney measures 13.2 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. No masses.URINARY BLADDER: Foley catheter is noted within the bladder and the bladder is collapsed.OTHER: No significant abnormalities noted.

Output: Normal sonographic evaluation of the left kidney. The right kidney is not visualized and has been surgically removed per patient.


Instruction: Generate impression based on medical findings.

Input: Male 63 years old; Reason: eval for hydronephrosis History: AKI, anuric RIGHT KIDNEY: The right kidney measures 9.8 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 10.3 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present.  URINARY BLADDER: The bladder is decompressed by a Foley catheter.OTHER: No significant abnormalities noted.

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


Instruction: Generate impression based on medical findings.

Input: Reason: r/o hcc History: hcv, elevated fibrospect LIVER: Liver measures 12.5 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 3 mm. Patient is status post cholecystectomy.PANCREAS: Distal pancreas is obscured by overlying bowel gas. Visualized part is within normal limits.SPLEEN: Spleen measures 6.6 cm and is normal in echogenicity and configuration.KIDNEYS: Right kidney measures 8.6 cm with increased echogenicity and without hydronephrosis. Right inferior pole simple cyst measuring 0.7 x 1.0 x 0.9 cm. Left kidney measures 9.2 cm with increased echogenicity and without hydronephrosis. No renal calculi identified. OTHER: No significant abnormalities noted.

Output: 1.Increased echogenicity of the liver compatible, may reflect hepatic steatosis/parenchymal dysfunction. No suspicious mass is identified.2.Increased echogenicity of the bilateral kidneys compatible with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Ms. Shea is a 51 year old woman who presents for sonographic evaluation of an incidental finding at the left 1:00 position described on previous outside hospital sonogram. Sonographic evaluation of the left upper outer quadrant was performed. No solid or cystic mass or other abnormality is identified. The breast parenchyma appears within normal limits, with normal vascularity as assessed with color flow Doppler.

Output: No sonographic evidence of malignancy. As previously recommended, a short term 6-month follow-up with left unilateral diagnostic mammogram is recommended in order to ensure stability of these findings. All results and recommendation were discussed with the patient. BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on medical findings.

Input: Female 24 years old Reason: please eval for cholecystitis and cholelithiasis History: fever, RUQ pain LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 17 cm in length. The parenchyma is normal in echotexture no suspicious hepatic lesions. There is a calcification in segment 7 of the liver. Main portal vein is patent.BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 3 mm in thickness. No pericholecystic fluid. Common duct measures 3 mm. PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 12.7 cm. The cortex is mild heterogeneous in echotexture. No shadowing calculi or hydronephrosis is present. The left kidney measures 10.4 cm. The cortex is mildly heterogeneous in echotexture. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 10.9 cm. in length. OTHER: No ascites.

Output: 1.No sonographic findings of cholelithiasis or acute cholecystitis.2.Mild heterogeneous echotexture of the renal parenchyma - clinical correlation for pyelonephritis is suggested.


Instruction: Generate impression based on medical findings.

Input: Reason: please assess for fluid collection around drive line site History: drainage at drive line site No fluid collection is seen at the drive line site

Output: No fluid collection is seen at the drive line site


Instruction: Generate impression based on medical findings.

Input: Male 78 years old; Reason: post op day 1 from partial nephrectomy with low urine output History: low urine output RIGHT KIDNEY: The right kidney measures 8.7 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. Postsurgical changes in the lower pole from partial nephrectomy.LEFT KIDNEY: The left kidney measures 11.9 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. URINARY BLADDER: No significant abnormality notedOTHER: No significant abnormalities noted.

Output: 1.No evidence of hydronephrosis or nephrolithiasis. Postsurgical changes in the lower pole of the right kidney.


Instruction: Generate impression based on medical findings.

Input: 53-year-old female presented for follow-up ultrasound after CT neck soft tissue demonstrates traumatically with coarse calcification and left nodules. RIGHT LOBE MEASUREMENTS: 4.6 x 1.6 x 1.7 cm.LEFT LOBE MEASUREMENTS: 5.3 x 1.9 x 2.2 cm.ISTHMUS MEASUREMENTS: 0.3 cm in AP dimensionRIGHT LOBE: Focal coarse calcification is seen within the right mid thyroid gland, measuring 0.4 x 0.1 cm. No adjacent nodularity or irregularity of the thyroid is seen.LEFT LOBE: In the lower pole of the left lobe, a dominant left solid nodule with focal internal cystic regions and subtle hypoechoic rim is seen measuring 2.3 x 2.0 x 2.0 cm. There are no internal calcifications.ISTHMUS: A small isoechoic nodule at the margin of the isthmus and the right lobe measures 0.5 x 0 0.3 to 0.8 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A left level 3 lymph node measures 1.7 cm in long axis and 0.7 cm in short axis shows questionable fatty hilum and may be reactive in etiology.OTHER: No significant abnormality noted.

Output: 1. Focal coarse calcification is seen within the right mid gland, without adjacent nodularity or irregularity of the gland.2.Dominant left lower pole predominantly solid nodule.3. A left level 3 lymph node measures 1.7 cm in long axis and 0.7 cm in short axis shows questionable fatty hilum and may be reactive in etiology.


Instruction: Generate impression based on medical findings.

Input: Female 75 years old with erythema surrounding G-tube, concerning for infection, assess for evidence of fluid pocket/abscess surrounding G-tube Small amount of subcutaneous fluid surrounds the G-tube without evidence of loculation, hematoma, or abscess.

Output: No evidence of loculated fluid collection, hematoma, or abscess.


Instruction: Generate impression based on medical findings.

Input: Female 53 years old; Reason: R/o hydronephrosis History: R/o hydronephrosis RIGHT KIDNEY: The right kidney measures 12.0 cm in length. The cortex has increased echogenicity. No shadowing calculi or hydronephrosis is present. No worrisome mass is seen.LEFT KIDNEY: The left kidney measures 12.0 cm in length. The cortex has increased echogenicity. No shadowing calculi or hydronephrosis is present. No worrisome mass is seen.URINARY BLADDER: Inferior bladder is visualized without any significant abnormalities noted.OTHER: Adjacent to the bladder is a heterogeneous area is seen which likely represents a partially visualized fibroid uterus.

Output: 1 Bilaterally the kidneys have increased echogenicity compatible with medical renal disease. No evidence hydronephrosis is seen.2. Adjacent to the bladder a heterogeneous area is seen which likely represents a partially visualized fibroid uterus.


Instruction: Generate impression based on medical findings.

Input: Male 73 years old; Reason: 73 y/o with acute renal failure, rhabdo, eval for obstruction vs abscess History: renal failure RIGHT KIDNEY: The right kidney measures 11.8 cm in length. The cortex has normal echogenicity. Mild hydronephrosis is seen without any shadowing calculi. No worrisome masses are seen.LEFT KIDNEY: The left kidney measures 11.4 cm in length. The cortex has normal echogenicity. Mild hydronephrosis without any shadowing calculi. No worrisome masses are seen.URINARY BLADDER: The urinary bladder is poorly visual with Foley in place. The bladder is mostly decompressed however the bladder wall may be thickened. Since the bladder is decompressed this is difficult to evaluate however.OTHER: Trace ascites is seen superior to the spleen.

Output: 1.Mild hydronephrosis is seen bilaterally without any calculi or worrisome masses.2.The bladder wall may be thickened, however this is difficult to evaluate since the bladder is decompressed with a Foley catheter.3.Trace ascites is seen.


Instruction: Generate impression based on medical findings.

Input: Female 65 years old; Reason: r/o kidney stone, eval for pyelo History: persistent UTI, continued fever, crystals on U/A RIGHT KIDNEY: The right kidney measures 10 cm in length. The cortex is increased in echogenicity. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 10 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. URINARY BLADDER: Foley catheter in decompressed urinary bladder limiting evaluation.OTHER: Gallbladder sludge and stones with pericholecystic fluid.

Output: 1.Echogenic kidneys compatible with nonspecific medical renal disease.2.Gallbladder sludge and stones with pericholecystic fluid incidentally noted. If clinically indicated or concern for cholecystitis, dedicated gallbladder ultrasound can be obtained.These findings were discussed with Dr. Sridharan at 2:14pm on 12/23/2016


Instruction: Generate impression based on medical findings.

Input: Male 50 years old Reason: Transaminitis and AKI History: Abdominal fullness LIVER: Mild hepatomegaly, liver measures 18.6 cm in length. There is a heterogeneous echogenic left-sided mass measuring 4.9 x 4.1 x 4.1 cm. No definite posterior acoustic enhancement or shadowing seen. Main portal vein patent with normal directional flow, velocity measures 15 cm/s, waveform pulsatile, which may be seen in setting of right-sided heart failure.BILIARY TRACT: Gallbladder unremarkable. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Not well seen in entirety due to overlying bowel gas.KIDNEYS: The right kidney measures 10.3 cm. The left kidney measures 10.3 cm. No hydronephrosis. Mildly increased renal cortical echogenicity.SPLEEN: The spleen measures 9.5 cm. in length. VASCULAR: Visualized proximal abdominal aorta measures up to 2.5 cm in AP dimension and mid abdominal aorta measures up to 2.9 cm, distal abdominal aorta not well seen secondary to bowel gas. Visualized IVC patent.OTHER: Visualized bladder unremarkable.

Output: Indeterminant heterogeneous echogenic liver mass as above, for which further evaluation contrast-enhanced CT or MRI recommended.Patent main portal vein, pulsatile flow, nonspecific but may be seen in setting of right-sided heart failure.Increased renal cortical echogenicity, likely reflecting underlying medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Acute abdominal pain. Vomiting. No bowel movement.VIEW: Abdomen AP (one view) 07/25/15 A small to moderate amount of feces is present in the colon. No dilated bowel loops are seen. No abnormal calcification is present.

Output: Normal examination.


Instruction: Generate impression based on medical findings.

Input: Female 43 years old Reason: ? HSM. Eval for splenomegaly SPLEEN: The spleen measures up to 12.2 cm. Parenchymal echogenicity within normal limits. No focal lesion seen. Patent splenic artery and splenic vein.OTHER: No significant abnormality noted.

Output: Normal spleen, no evidence of splenomegaly.


Instruction: Generate impression based on medical findings.

Input: Female 71 years old Reason: stones RIGHT KIDNEY: The right kidney measures 10.4 cm. Presumed prominent column of Bertin. Right renal cyst formation, measuring up to 1.6 x 1.4 x 1.4 cm at mid pole. No shadowing calculi or hydronephrosis is present. No perinephric free fluid. LEFT KIDNEY: The left kidney measures 11 cm. Presumed dromedary hump. No shadowing calculi or hydronephrosis is present. No perinephric free fluid. BLADDER: Visualized portions unremarkable.OTHER: Partially imaged echogenic liver.

Output: No evidence of nephrolithiasis.Presumed normal variants as above. Please note that if there is clinical concern for underlying mass, further evaluation with dedicated contrast-enhanced CT or MRI should be pursued.


Instruction: Generate impression based on medical findings.

Input: Male 73 years old; Reason: kidney stone History: stone RIGHT KIDNEY: The right kidney measures 10.5 cm in length. The cortex has normal echogenicity. No hydronephrosis is present. A subcentimeter nonobstructing shadowing renal stone is seen near the superior pole. A simple renal cyst is seen at the lower pole measuring 0.9 cm x 0.8 cm x 0.8 cm.LEFT KIDNEY: The left kidney measures 9.7 cm in length. The cortex has normal echogenicity. New mild to moderate hydronephrosis is seen. A shadowing echogenic subcentimeter renal stone is seen in the area of the lower pole. No worrisome masses seen. A simple renal cyst is seen measuring 1.7 cm x 1.3 cm x 1.8 cm.URINARY BLADDER: The urinary bladder is visualized without any significant abnormalities.OTHER: Unable to evaluate the distal ureter due to overlying bowel gas, therefore a renal calculi or obstruction located distally is not able to be visualized.

Output: 1.There is new mild to moderate hydronephrosis seen in the left kidney. A subcentimeter nonobstructing renal stone is seen in the lower pole. The distal ureter cannot be evaluated due to overlying bowel gas, therefore a distal stone or obstruction cannot be excluded. If clinically indicated, recommend a CT abdomen/pelvis without IV contrast for further evaluation.2.There is a subcentimeter nonobstructing renal calculus seen in the right kidney without hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old. Reason: HCV, eval for HCC History: HCV LIVER: Liver measures 15.2 cm with coarse echotexture. No suspicious hepatic mass or ascites. Main portal vein is patent with a normal direction of flow.BILIARY TRACT: No biliary ductal dilatation. No cholelithiasis, wall thickening, or pericholecystic fluid. Common bile duct measures 6 mm.PANCREAS: The visualized portions of the pancreas are unremarkable. Pancreatic tail is obscured by overlying bowel gas.SPLEEN: Spleen measures 9.6 cm in length with normal echotexture.RIGHT KIDNEY: Right kidney measures 9.2 cm length with normal cortical echogenicity. No hydronephrosis or shadowing calculi. OTHER: Left kidney measures 9.1 cm in length with normal cortical echogenicity. No hydronephrosis or shadowing calculi.

Output: Coarse hepatic echotexture suggests chronic liver disease/parenchymal dysfunction. No suspicious hepatic lesion.


Instruction: Generate impression based on medical findings.

Input: Male 31 years old Reason: ruq abd pain, sepsis LIVER: Liver measures 16.8 cm in length. The parenchyma is heterogeneous and coarsened echotexture. No focal liver lesion. Main portal vein patent with normal directional flow, velocity measures 20 cm/s.BILIARY TRACT: Status post cholecystectomy. Small pneumobilia, particularly on left side. No definite biliary duct dilatation, visualized common hepatic duct normal in size, measuring 3 mm. PANCREAS: Pancreas not well seen in entirety due to overlying bowel gas.KIDNEYS: Nonvisualization of right kidney. Left kidney measures 13.8 cm. No hydronephrosis or perinephric fluid, renal cortical echogenicity within normal limits.SPLEEN: Splenomegaly, measures 15.9 cm.

Output: Heterogeneous and coarsened hepatic parenchymal echotexture. No focal liver lesion.Small pneumobilia, presumably related to patient's surgical history. No definite biliary duct dilatation.Splenomegaly.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o recurrence History: h/o thyroid cancer Patient is status post thyroidectomy. RIGHT LOBE: No nodules are seen in the bed.LEFT LOBE: No nodules are noted in the resection bed.ISTHMUS: No nodules are noted in the resection bed.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Essentially stable benign-appearing lymph nodes. A left level 4 lymph node is also likely benign, grossly stable in appearance from prior exam, but has a few speckled foci within it.OTHER: No significant abnormality noted.

Output: No evidence of tumor recurrence or suspicious of adenopathy. Attention to a left level 4 lymph node on subsequent surveillance imaging is suggested.


Instruction: Generate impression based on medical findings.

Input: Female 53 years old Reason: r/o choledocholithiasis History: abdominal pain LIVER: The liver measures 17 cm in length and demonstrates slightly 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 0.4 m/s. GALLBLADDER, BILIARY TRACT: The gallbladder is not identified. The common duct measures 0.3 cm in diameter. RIGHT KIDNEY: The right kidney measures 10.1 cm in length and demonstrates normal parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.LEFT KIDNEY: The left kidney measures 10.5 cm in length and demonstrates normal parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.SPLEEN: The spleen measures 11.5 cm in length.OTHER: No significant abnormalities noted.

Output: 1.The gallbladder is not identified.2.Slight increased hepatic parenchymal echogenicity suggestive of hepatic steatosis.


Instruction: Generate impression based on medical findings.

Input: Occasional pain in left ventral abdominal area, assess for lipoma In left abdomen there is an ovoid soft tissue lesion measuring 4 x 3.8 x 1.6 cm. Internal linearity is parallel to overall longitudinal plane of lesion, supporting diagnosis of a lipoma.

Output: At site of clinical interest is soft tissue lesion with imaging appearance consistent with that of a lipoma.


Instruction: Generate impression based on medical findings.

Input: 51-year-old male with polyposis, evaluate. RIGHT LOBE MEASUREMENTS: 1.5 x 3.8 x 1.1 cmLEFT LOBE MEASUREMENTS: 1.9 x 4.6 x 1.2 cmISTHMUS MEASUREMENT: 0.2 cmRIGHT LOBE: Right lobe of the thyroid is normal in echotexture and echogenicity.LEFT LOBE: Left lobe of thyroid is normal in echogenicity and echotexture.ISTHMUS: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy.OTHER: No significant abnormality noted.

Output: Normal examination.


Instruction: Generate impression based on medical findings.

Input: 70-year-old female with a known nonoccluding thrombus in the main portal vein in context of further decompensated cirrhosis. LIVER:The hepatic parenchyma appears heterogeneous and coarsened. Nodular liver contour.PANCREAS: The pancreas is obscured by overlying bowel gas.SPLEEN: No significant abnormality noted. OTHER: Abdominal ascites appears similar to prior examination.

Output: 1. Main and right portal vein thrombosis. The left portal vein is not well-visualized, thrombosed state not excluded. 2. Cirrhotic liver.3. Ascites.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old. Reason: Hyperparathyroidism. Evaluate abnormal glands History: elevated Ca and PTH RIGHT LOBE MEASUREMENTS: 2.1 x 1.7 x 5.5 cmLEFT LOBE MEASUREMENTS: 1.9 x 1.9 x 5.5 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Heterogeneous gland without focal nodule.LEFT LOBE: Heterogeneous gland without focal nodule.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Nonspecific hypoechoic nodule with a hyperechoic focus centrally is located posterior to the right thyroid lobe. This is atypical in appearance for a parathyroid adenoma. This measures 0.9 x 0.7 x 1.6 cm. LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Nonspecific hypoechoic nodule posterior to the right thyroid lobe which has an atypical appearance for a parathyroid adenoma. Please refer to concurrent nuclear medicine parathyroid study for further characterization.2. Heterogeneous thyroid gland without focal nodule.


Instruction: Generate impression based on medical findings.

Input: 53-year-old man with AKI RIGHT KIDNEY: The right kidney measures 12.7 cm in length and shows increased echogenicity. No mass, shadowing calculi or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.2 cm in length and shows increased echogenicity. No mass, shadowing calculi or hydronephrosis.URINARY BLADDER: The urinary bladder is not distended, making assessment of the wallOTHER: The liver shows increased echogenicity and extremely heterogeneous appearance.

Output: 1.Increased echogenicity of the renal parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass, stone or hydronephrosis.2.The liver is incompletely imaged, but shows increased echogenicity and extremely heterogeneous echotexture.


Instruction: Generate impression based on medical findings.

Input: 28-year-old male with history of diabetes with DKA and recurrent pancreatitis. Evaluate for gallbladder pathology. LIVER: Hepatic parenchyma is normal in echotexture without evidence of focal lesions. Portal venous flow is hepatopetal with velocities measuring 23 cm/s. GALLBLADDER, BILIARY TRACT: No evidence of intrahepatic biliary ductal dilatation. The common bile duct measures 0.2 cm. No evidence of cholelithiasis, pericholecystic fluid, or gallbladder wall thickening.PANCREAS: Limited evaluation of the pancreas due to overlying bowel gas. Within this limitation, the pancreas looks mildly edematous.KIDNEY: The right kidney measures 11 cm in length and the left kidney measures 12 cm in length without evidence of hydronephrosis.OTHER: The spleen is normal in echogenicity and measures 10 cm in length.

Output: 1.No evidence of gallbladder or biliary pathology.2.Limited evaluation of the pancreas due to overlying bowel gas. Within this limitation, the pancreas looks mildly edematous consistent with history of pancreatitis.


Instruction: Generate impression based on medical findings.

Input: Female 53 years old Reason: ?gallstones History: pt with epigastric and ruq pain increase lipase LIVER: Liver measures 14.6 cm in length. The parenchyma and contour is unremarkable. A hyperechoic homogenous round focus with lobulated edges seen in the left liver lobe measures 2.5 x 1.5 x 2.2 cm and is favored to represent a hepatic hemangioma.Main portal vein is patent with hepatopedal blood flow.BILIARY TRACT: Limited visualization of the gallbladder due to significant shadowing suggestive of a large gallstone. No significant gallbladder distention, wall thickening or pericholecystic fluid. There is mild intrahepatic and extrahepatic ductal dilatation. The common bile duct measures 0.6 mm in the largest diameter.PANCREAS: Pancreatic head and body are unremarkable. Tail is is not visualized due to overlying bowel gas.KIDNEYS: The right kidney measures 10.7 cm. The left kidney measures 10.0 cm. Bilateral renal cortices are normal in echogenicity. No evidence of hydronephrosis or shadowing renal calculi.SPLEEN: The spleen measures 8.5 cm. in length. OTHER: No significant abnormality noted.

Output: 1.Cholelithiasis without specific evidence of cholecystitis.2.Right lobe hyperechoic lesion is favored to be a hepatic hemangioma in this patient population. If further evaluation is clinically warranted, an MRI is recommended.


Instruction: Generate impression based on medical findings.

Input: Reason: Right Thigh: Evaluate for abscess, deep infection History: indurated, tender, erythematous Ill-defined linear fluid collection that extends from the groin to the medial superior thigh, longest measuring 9 x 1 cm. Enlarged lymph node also noted. This appears to correspond to cellulitis with soft tissue edema seen on prior CT.

Output: Ill-defined linear fluid collection that extends from the groin to the medial superior thigh, corresponding to cellulitis seen on prior CT. This may represent phlegmon or early abscess formation.


Instruction: Generate impression based on medical findings.

Input: Reason: Hyperthyroidism History: History of Hyperthyroidism. RIGHT LOBE MEASUREMENTS: 6 x 2 x 1.7 cm.LEFT LOBE MEASUREMENTS: 4.7 x 1.8 x 2.2 cm.ISTHMUS MEASUREMENTS: 0.4 cm.RIGHT LOBE: Heterogenous, multinodular gland. There is a nodule within the superior portion of the right lobe of the thyroid which measures 1.1 x 0.8 x 0.7 cm. There is also a nodule within the midportion of the right of the thyroid which measures 0.9 x 0.8 x 1 cm. Another nodule is noted within the inferior portion of the right lobe of thyroid which measures 0.9 x 1 x 1.4 cm. Each of these nodules is spongiform in appearance with mixed cystic/solid components and small echogenic foci with common tail artifact. LEFT LOBE: Heterogenous, multinodular gland. There is a nodule within the mid portion of the left of the thyroid which measures 1.1 x 1.1 x 1.1 cm. A second nodule is also noted within the midportion of the left thyroid, slightly lateral to the first which measures 1.7 x 0.7 x 1.2 cm. There is another nodule within the medial inferior portion of the left lobe of thyroid measures 1. 4 x 1.3 x 1.4 cm. Each of these nodules is spongiform in appearance with mixed cystic/solid components and small echogenic foci with common tail artifact. ISTHMUS: Heterogenous. No focal lesions.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There is a benign-appearing 0.8 x 0.3 x 2.5 cm lymph node at level 2 within the left neck.OTHER: No significant abnormality noted.

Output: 1. Multinodular thyroid. Favor benign colloid nodules.


Instruction: Generate impression based on medical findings.

Input: Possible perirectal abscess on CT Diffuse edema without loculated fluid collection or mass

Output: Diffuse edema without loculated fluid collection or mass


Instruction: Generate impression based on medical findings.

Input: Female 58 years old Reason: Elevated alkaline phosphatase. Nausea and abdominal discomfort with oral intake. History: As above LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 15 cm in length. The parenchyma is moderately echogenic BILIARY TRACT: The gallbladder has echogenic calculi with posterior acoustic shadowing. Wall measures 3 mm in thickness. Common duct measures 5 mm. PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 10.7 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. The left kidney measures 11.4 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 9.6 cm. in length. OTHER: No significant abnormalities noted.

Output: 1.Cholelithiasis without definite sonographic evidence of acute cholecystitis.2.If choledocholithiasis is clinical concern consider MRCP.3.Thickening renal cortices compatible with medical renal disease.4.Echogenic hepatic parenchyma.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old. Reason: Assess for cirrhosis and HCC. History: cirrhosis, NAFLD, hemochromatosis LIVER: Liver is enlarged and measures 19.5 cm in length with a slightly nodular contour. Markedly echogenic hepatic parenchyma. No focal lesion is appreciated. No ascites. Main portal vein is patent with a normal direction of flow.BILIARY TRACT: Status post cholecystectomy. Common bile duct measures 1 cm. Mild prominence of the biliary ducts likely related to postcholecystectomy state.PANCREAS: The visualized portions of the pancreas are unremarkable. Pancreatic body and tail are obscured by overlying bowel gas.SPLEEN: Spleen is mildly enlarged and measures 15.3 cm in length.RIGHT KIDNEY: Right kidney measures 13.8 cm with normal cortical echogenicity. No hydronephrosis, shadowing calculi, or mass.OTHER: Left kidney measures 14.2 cm with normal cortical echogenicity. No hydronephrosis, shadowing calculi, or mass.

Output: Mildly cirrhotic morphology with markedly echogenic hepatic parenchyma. No obvious hepatic lesion is visualized. Given the degree of echogenicity, sensitivity to detect a subtle lesion is decreased. Contrast-enhanced cross-sectional imaging may be helpful if there is clinical suspicion for a hepatic lesion.


Instruction: Generate impression based on medical findings.

Input: Lower abdominal pain with palpable lesion right lower quadrant subcutaneous tissues. 1.6 x 1.6 x 1.6 cm complex loculated fluid collection within the right lower quadrant subcutaneous tissues. This loculated collection demonstrates no increased vascularity. An additional 1.2 x 1.4 x 2.2 cm hypoechoic focus within the subcutaneous tissue which may represent a loculated nonvascular fluid collection is also noted.

Output: 1 possibly 2 small complex nonvascular loculated fluid collections within the right lower quadrant subcutaneous tissues. These collections are best considered indeterminate; however benign etiology such as resolving hematoma is favored over abscess.


Instruction: Generate impression based on medical findings.

Input: The basis. Follow-up per urology. RIGHT KIDNEY: The right kidney measures 9.8 cm. There is a right upper pole exophytic simple cyst measuring 7.3 x 7.0 x 6.9 cm. No hydronephrosis or renal calculus is identified.LEFT KIDNEY: The left kidney measures 10.8 cm. There are multiple left simple renal cysts and other too small to characterize lesions, probably unchanged. No hydronephrosis or renal calculus is identified.OTHER: No significant abnormalities noted.

Output: Bilateral simple renal cysts. No suspicious lesion, hydronephrosis or renal calculus identified.


Instruction: Generate impression based on medical findings.

Input: History of thyroid cancer, six-month follow-up study to assess thyroid bed lesion RIGHT LOBE: Status post thyroidectomy.LEFT LOBE: Status post thyroidectomy. Soft tissue echogenicity focus in left thyroid bed measuring 0.5 x 0.3 x 0.2 cm, unchanged in size and appearance.ISTHMUS: Status post thyroidectomy.LYMPH NODES: Right level 2 lymph node measuring 2.6 x 1.8 x 0.5 cm with fatty hilum. Left lateral neck lymph nodes, measuring up to 2.2 x 1.7 x 0.6 cm in level 2, with fatty hila.OTHER: No significant abnormality noted.

Output: No suspicious lymph nodes.Stable ovoid soft tissue focus in left thyroid bed.


Instruction: Generate impression based on medical findings.

Input: Dysphagia, assess for goiter RIGHT LOBE: Measures 5 x 1.6 x 1.6 cm. Small bilateral colloid nodules present.LEFT LOBE: Measures 3.7 x 1.3 x 1.2 cm. Subcentimeter bilateral colloid nodules seen.ISTHMUS: Mildly thickened measuring 0.4 cm.LYMPH NODES: No significant abnormality noted.OTHER: Incidentally noted 3 x 3 x 3 mm rounded hypoechoic focus located posterior and inferior to lower pole of left lobe, no definite thyroid parenchyma seen surrounding lesion to suggest intrathyroidal location. Lesion may reflect a parathyroid adenoma in the proper clinical setting.

Output: 1. Subcentimeter thyroid colloid nodules.2. Incidentally seen 3 mm hypoechoic nodular focus located posteroinferior to lower pole of left lobe, may represent a parathyroid adenoma in the proper clinical setting. Correlation with patient's clinical history and laboratory values recommended. If indicated further assessment with nuclear medicine scintigraphy may be pursued.


Instruction: Generate impression based on medical findings.

Input: Female 73 years old; patient with history of multiple myeloma; presenting with new onset elevated LFTs. Please evaluate cause. LIVER: Mild increase in hepatic parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions. Hepatic length measures 15.2 cm. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of 37 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 3 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 7 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. Thr right kidney measures 10 cm and has normal vascular flow. The left kidney measures 10.8 cm and has normal vascular flow. The kidneys appear mildly echogenic.OTHER: No significant abnormality noted.

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.Mild echogenicity of kidneys, suggestive of medical renal disease.


Instruction: Generate impression based on medical findings.

Input: 33-year-old female with hypertensive emergency and acute kidney injury. RIGHT KIDNEY: The right kidney measures 10.1 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. A 1.1 x 1.1 x 0.9 cm hypoechoic lesion is visualized in the mid right kidney, likely cyst.LEFT KIDNEY: The left kidney measures 9.3 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present.OTHER: The bladder is without significant abnormality. Bilateral ureteral jets are visualized.

Output: 1.Bilateral echogenic kidneys consistent with medical renal disease. No evidence of hydronephrosis or nephrolithiasis.


Instruction: Generate impression based on medical findings.

Input: 47 year old male with acute kidney injury, anuria. Evaluate for decreased kidney perfusion or hydronephrosis. RIGHT KIDNEY: No significant abnormalities noted. No evidence of hydronephrosis. The right kidney measures 11.1 cm in length.LEFT KIDNEY: The left kidney is not well visualized which may be related to the patient's body habitus.OTHER: No significant abnormalities noted.

Output: Unremarkable ultrasound examination of the right kidney. No evidence of hydronephrosis, as clinically questioned. Limited evaluation of the left kidney, which may be related to the patient's body habitus.


Instruction: Generate impression based on medical findings.

Input: Evaluate for Nash Limited exam due to large body habitus.LIVER: Liver measures 17.9 cm with heterogenous coarse echotexture. Portal vein demonstrates normal flow directionality and patency. No focal lesions noted. No intrahepatic biliary ductal dilatation noted.BILIARY TRACT: Gallbladder is well-distended with one echogenic focus adhering to the gallbladder wall most likely representing polyp. No evidence of shadowing suggestive of gallstones.Gallbladder wall thickness is within normal limits. Sonographic Murphy sign is negative. No evidence of pericholecystic fluid.PANCREAS: No significant abnormality in the body of the pancreas, head and tail of pancreas is not visualized due to overlying bowel gas.SPLEEN: Spleen measures 12.2 cm without any focal lesions.KIDNEY: Right kidney measures 12.4 and left kidney measures 13.5 cm. Both kidneys demonstrate mild increased echogenicity suggestive of chronic medical renal disease. No hydronephrosis or focal lesion. OTHER: No ascites

Output: 1. Coarse heterogenous echotexture of the liver without any focal lesions.2. Gallbladder polyp without evidence to evidence of cholelithiasis or cholecystitis. Surveillance with ultrasound in 6 months is recommended.3. Mild increased echogenicity of the kidneys consistent with chronic medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate liver for pathology History: elevated liver enzymes LIVER: The liver measures 17.1 cm in length. Mildly coarse, echogenic hepatic parenchyma. The portal vein is patent with normal hepatopedal directional blood flow, peak velocity 28.3 cm/s. No focal mass.GALLBLADDER, BILIARY TRACT: The gallbladder is not visualized. The common bile duct measures 0.4 cm. No biliary ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 10.47 m in length. The left kidney measures 10.3 cm in length. Small simple cyst in the mid left kidney measures 0.8 x 0.9 x 0.9 cm. No hydronephrosis or shadowing stones.OTHER: No ascites. The spleen measures 9.5 cm in length.

Output: Mildly coarse, echogenic liver, consistent with hepatic steatosis or parenchymal dysfunction.


Instruction: Generate impression based on medical findings.

Input: Ms. Alston is a 69 year old female status post bilateral mastectomy in August 2014. She now presents with a palpable lump in the left lateral reconstructed breast. The physician palpated area of concern in the left lateral breast is marked. Upon physical exam, there is a palpable superficial mobile mass present.A targeted left ultrasound was performed for the palpable area of concern. There is an ovoid hyperechoic solid mass measuring 2.1 x 0.6 x 2.8 cm. This mass is not associated with any vascularity. It is superficially located. There is no suspicious solid or cystic mass identified.

Output: Sonographic findings compatible with fat necrosis in the left lateral reconstructed breast. No sonographic evidence for malignancy. Patient may continue to follow-up with surgery as clinically warranted. All results and recommendations were relayed to the patient and Sarah Petraitis at the time of dictation.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Abdominal swelling. Evaluate for ascites. No ascites identified.

Output: No ascites identified.


Instruction: Generate impression based on medical findings.

Input: 60-year-old female with acute kidney injury on chronic kidney disease. Please evaluate for hydronephrosis, sizes of the kidneys, and echogenicity. RIGHT KIDNEY: The right kidney measures 8.3 cm in length (prior 8.6 cm). Borderline hyperechoic renal parenchyma. No hydronephrosis, shadowing calculi, or worrisome masses.LEFT KIDNEY: The left kidney measures 9.2cm (prior 9.4 cm). Borderline hyperechoic renal parenchyma. No hydronephrosis, shadowing calculi, or suspicious masses.URINARY BLADDER: The urinary bladder is collapsed and not well evaluated.OTHER: No significant abnormalities noted.

Output: 1. Borderline hyperechoic renal parenchyma consistent with medical renal disease. No hydronephrosis.2. Relatively small kidneys, but stable in size.


Instruction: Generate impression based on medical findings.

Input: Septic shock LIVER: Stable cirrhotic morphology. No mass lesion. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow. Liver length 17.3 cmBILIARY TRACT: Gallbladder absent. No ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 9.4 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 12.3 cm in lengthOTHER: Left kidney 12.9 cm in length. No ascites. Right pleural effusion.

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


Instruction: Generate impression based on medical findings.

Input: 48 year old female with history of right upper quadrant pain. Evaluate for gallbladder pathology. LIVER: Hepatic steatosis, without focal abnormality.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.

Output: Hepatic steatosis, without additional abnormality.


Instruction: Generate impression based on medical findings.

Input: Sepsis, pyuria, urinary retention, evaluate for hydronephrosis RIGHT KIDNEY: Status post right nephrectomy many years ago as per the patient. Kidney is not visualized in the right renal bed.LEFT KIDNEY: Left kidney measures 14 cm with normal echotexture. No hydronephrosis noted. No focal lesions noted.OTHER: No significant abnormalities noted.

Output: Status post right nephrectomy.No hydronephrosis in the left kidney.


Instruction: Generate impression based on medical findings.

Input: 75-year-old female with a right-sided thyroid nodule incidentally seen on a PET/CT. RIGHT LOBE MEASUREMENTS: 4.0 x 0.9 x 1.2 cmLEFT LOBE MEASUREMENTS: 2.7 x 0.8 x 0.9 cmISTHMUS MEASUREMENTS: 2 mmRIGHT LOBE: There is a 5 x 5 x 8 mm isoechoic solid nodule in the interpolar region with a thin hypoechoic rim and mild vascularity. No associated calcifications. Additional subcentimeter nodules are noted. Otherwise, the right lobe is normal in morphology, echogenicity, and size.LEFT LOBE: The left thyroid lobe is normal morphology, echogenicity, and size without a dominant nodule evident.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Morphologically unremarkable and normal-sized cervical lymph nodes are noted.OTHER: No significant abnormality noted.

Output: 8mm right thyroid solid nodule without specific suspicious sonographic features.


Instruction: Generate impression based on medical findings.

Input: Male 49 years old Reason: 49 year old male with history of ulcerative colitis and abnormal LFTs, evaluate for biliary ductal dilation/PSC or changes in liver architecture. History: abnormal LFTs LIVER: Liver measures 17.5 cm, enlarged. Echogenicity of the liver is slightly increased. IVC and hepatic veins are dilated likely secondary to heart failure.BILIARY TRACT: Cholelithiasis. Contracted gallbladder. No evidence of fracture or extrahepatic biliary dilatation.PANCREAS: Not well visualized due to overlying bowel gas.SPLEEN: No significant abnormalities noted. Spleen measures 9.4 cm.RIGHT KIDNEY: Shadowing hyperechoic focus in the lower pole of the left kidney likely represents a small stone. No evidence of hydronephrosis. Right kidney measures 11.5 cm. Left kidney measures 11.7 cm.OTHER: No significant abnormalities noted.

Output: Cholelithiasis without evidence of biliary dilatation. Right nephrolithiasis.


Instruction: Generate impression based on medical findings.

Input: Two focal asymmetries seen in the right breast and two focal asymmetries seen in the left breast on screening mammogram. Family history of breast cancer in paternal grandmother and two maternal great aunts. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. The two circumscribed masses in the right lateral and retroareolar breast persist on spot compression images. The two focal asymmetries in the left upper outer breast partially disperse on spot compression images.ULTRASOUND

Output: 1. 9 mm indeterminate left lateral breast mass. Ultrasound guided biopsy is recommended.2. Bilateral simple breast cystsBIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male with acute kidney injury. RIGHT KIDNEY: The right kidney measures 10.6 cm in length. No hydronephrosis. Mildly echogenic renal parenchyma. No discrete lesions.LEFT KIDNEY: The left kidney measures 12.6 cm in length. No hydronephrosis. Mildly echogenic renal parenchyma. No discrete lesions.URINARY BLADDER: Partially distended urinary bladder without acute abnormality.OTHER: No significant abnormalities noted.

Output: Mildly echogenic renal parenchyma suggesting chronic renal disease. No hydronephrosis or discrete lesions.


Instruction: Generate impression based on medical findings.

Input: 20-year-old pregnant female complaining of left upper inner breast tenderness. Patient denies any new palpable lump. Targeted ultrasound of the left upper inner breast, 11:00 12 cm from the nipple in patient's area of concern, reveals no cystic or solid mass.

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


Instruction: Generate impression based on medical findings.

Input: 5-month-old female with hip dysplasia.VIEWS: Pelvis AP (one views) 01/20/15 Faint ossification of the femoral epiphysis bilaterally. The femurs are symmetric and appear to be well seated in the acetabula.

Output: Normal examination.


Instruction: Generate impression based on medical findings.

Input: 34-year-old male patient with left flank pain. History of left renal cyst. RIGHT KIDNEY: The right kidney measures 11.5 cm in length. No evidence of hydronephrosis. There is a 1.6 x 1.1 cm right lower pole simple renal cyst.LEFT KIDNEY: The left kidney measures 12.7 cm in length. There is no evidence of hydronephrosis. There is a 5.1 x 3.1 cm complex left lower pole renal cyst.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.

Output: Complex left lower pole renal cyst which may represent multiple cysts or a single cyst with multiple septations; further evaluation with MRI is suggested.


Instruction: Generate impression based on medical findings.

Input: 50 years, Male, pain for 10 years. RIGHT TESTIS: 3.9 x 2.0 x 3.1 cm. Normal echotexture and vascularity. No intratesticular mass evident.LEFT TESTIS: 3.3 x 2.1 x 2.0 cm. Normal echotexture and vascularity. No intratesticular mass evident.RIGHT EPIDIDYMIS: No significant abnormalities noted.LEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: Small bilateral hydroceles and small left-sided varicocele

Output: Small bilateral hydroceles and small left-sided varicoceleI 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 49 years old Reason: eval for gallbladder/liver etiology History: severe RUQ tenderness, elevated LFTs, fevers LIVER: Partially visualized liver is normal in appearance.BILIARY TRACT: No evidence of acute inflammation of the gallbladder. No gallstones. Gallbladder wall is within normal limits measuring 2 mm. No pericholecystic fluid. Common bile duct is normal measuring 4 mm. Negative sonographic Murphy's sign. OTHER: No significant abnormalities noted.

Output: No evidence of acute cholecystitis, cholelithiasis, or specific findings to account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Ms. Ann Balling is a 61 year old female with personal history of left breast cancer, status post chemotherapy. She presents today for imaging evaluation of treatment response. A targeted left ultrasound was performed for the patient’s area of concern, site of a known cancer. In the left breast, 2:00 position, 5 cm from the nipple, there is a subtle hypoechoic area measuring 10 x 12 mm, which could represent the residua of the known cancer and/or treated tissue. This mass previously measured 37 x 18 x 28 mm. A few lymph nodes are noted in the left axilla. The index lymph node now measures 11 x 9 mm versus 16 x 7 mm on the prior ultrasound.

Output: Interval decrease in size of the left breast cancer and left axillary index lymph node as described above. Also refer to today's separately dictated MRI. Surgical consultation is recommended. Results and recommendations were discussed with the patient. BIRADS: 6 - Known cancer.RECOMMENDATION: B - Surgical Consultation.


Instruction: Generate impression based on medical findings.

Input: Hepatocellular carcinoma screening. Hepatitis C. LIVER: 13.9 cm in length. Non-cirrhotic liver morphology. Coarsened parenchymal echogenicity. Simple and complex-appearing cysts noted. No lesions suspicious for hepatocellular carcinoma are evident. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Normal appearance of the gallbladderPANCREAS: No sonographic abnormality evident in the visualized pancreatic head and neck. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney is 11.3 cm in length. A 6.2 x 5.5 x 5.6 cm soft tissue mass is noted at the superior pole. An additional 4 mm simple appearing cyst is noted in the superior pole. No hydronephrosis is present.The left kidney is 9.0 cm in length. A 10 mm benign appearing cyst is noted in the midpole. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 7.3 cm in length, without focal lesions evident.

Output: 1. Simple and complex-appearing hepatic cysts. No lesions suspicious for hepatocellular carcinoma evident. 2. 6.2 cm right renal mass, suspicious for renal cell carcinoma. Evaluation with renal-protocol CT or MRI is recommended for further evaluation. Findings were text paged to ordering physician Dr. Rao at 9:00 AM on 12/16/2015.px3wr


Instruction: Generate impression based on medical findings.

Input: 56-year-old female patient with right lower quadrant pain and a transplant kidney. Evaluate for vascular patency. RENAL TRANSPLANT: LOCATION: Right iliac fossa.PERITRANSPLANT TISSUES: No perinephric fluid collection is identified.KIDNEY: The right kidney measures 10.6 cm in length.COLLECTING SYSTEM/URETER: No evidence hydronephrosis.URINARY BLADDER: No significant abnormality noted.VASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels The transplant right renal artery is patent. Peak systolic velocity at the anastomosis measures approximately 1.1 m/s with RI of 0.81. Intrarenal resistive indices range from 0.65 to 0.76. The transplant right renal vein is patent.OTHER: No significant abnormality noted

Output: 1. No evidence of hydronephrosis.2. Patent transplant renal vasculature.


Instruction: Generate impression based on medical findings.

Input: Ms. Collins is a 60 year old female with a personal history of leukemia who presents for evaluation of a persistently palpable right axillary mass which was previously shown to represent a benign lymph node as recently as 10/15/2015. On physical exam at the patient's area of concern, a small movable mass is identified in the right axillary region.Targeted right breast ultrasound was performed in the right axillary region. A single normal appearing lymph node is noted with normal hilar vascular flow, measuring 1.3 x 0.5 cm.

Output: Single normal-appearing lymph node in right axillary region. No sonographic evidence for malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually, due next in April 2017. All results and recommendations were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: 21-year-old female with history of right quadrant pain. Concern for biliary dilatation or acute ischemia of the liver. Status post cholecystectomy. LIVER: The liver measures approximately 18 cm in length. Gallbladder is surgically absent. No significant intrahepatic biliary dilatation.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy.PANCREAS: Limited evaluation of the pancreas reveals no significant abnormality. RIGHT KIDNEY: The right kidney measures 10.5 cm in length, without hydronephrosis or hydroureter.OTHER: Left kidney measures 10.4 cm in length, without hydronephrosis or hydroureter. The spleen is autoinfarcted, with internal calcifications. Equivocal node in the hepatic hilum, may represent hepatic parenchyma, nonspecific.

Output: Status post cholecystectomy, with autoinfarcted spleen. No additional significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Elevated LFTs. History stem cell transplant LIMITED ABDOMENLIVER: Coarse echogenic parenchyma again noted without mass. Liver length 18.9 cmBILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 12.1 cm in length RIGHT KIDNEY: No significant abnormalities noted. Right kidney 10.9 cm in lengthOTHER: Left kidney 11.9 cm in length. No ascites.

Output: Echogenic coarse liver echotexture again noted consistent with fatty infiltration/parenchymal dysfunction. Mild hepatomegaly. No worrisome mass lesion or ductal dilatation. Hepatic vessels patent with normal directional flow. No ascites.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female with known thyroid cancer presents for evaluation of adenopathy. RIGHT LOBE MEASUREMENTS: 1.5 x 1.6 x 4.4 cm.LEFT LOBE MEASUREMENTS: 1.5 x 1.6 x 3.4 cm.ISTHMUS MEASUREMENTS: 0.6 cm.RIGHT LOBE: The right lobe appears normal with homogeneous parenchyma.LEFT LOBE: There are 2 nodules in the left mid pole of the thyroid. The larger nodule measures approximately 0.7 x 0.6 x 0.8 cm, is solid, round and has a mixed echogenicity. There is a hypoechoic rim. The other nodule is similar in appearance and has dimensions approximately 0.5 x 0.4 x 0.4 cm.ISTHMUS: There is an approximately 0.7 x 0.4 x 0.6 cm round hypoechoic solid nodule in the isthmus.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No regional adenopathy.OTHER: No significant abnormality noted.

Output: 1. Multinodular thyroid as above consistent with patient's known thyroid cancer. No regional adenopathy.


Instruction: Generate impression based on medical findings.

Input: Elevated LFTs LIVER: Coarse echogenic liver echotexture without mass. Liver length 21.9 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 13.2 cm in lengthOTHER: Left kidney 12.4 cm in length. Spleen 9.6 cm in length. No ascites

Output: Coarse echogenic liver echotexture consistent with fatty infiltration/parenchymal dysfunction. Moderate hepatomegaly. No mass or ductal dilatation. No ascites.


Instruction: Generate impression based on medical findings.

Input: Hepatic fibrosis. Evaluate for hepatocellular carcinoma. LIVER: Non-cirrhotic liver morphology. Unremarkable parenchymal echogenicity. 13 cm in length. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Cholelithiasis and biliary sludge noted in the gallbladder. No gallbladder wall thickening, pericholecystic fluid, or sonographic Murphy's sign elicited.PANCREAS: No sonographic abnormality evident in the visualized pancreatic head and neck. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney is 10.6 cm in length. The left kidney is 9.6 cm in length. The previously seen left hepatic cyst is not evident on the current exam, possibly due to technical factors. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 8.5 cm in length, without focal lesions evident. Splenule noted.OTHER: No significant abnormalities noted. No ascites.

Output: Cholelithiasis without specific evidence of cholecystitis. No suspicious hepatic lesion identified.


Instruction: Generate impression based on medical findings.

Input: Reason: elevated liver enzymes History: rule out steatohepatitis -check liver and spleen and rule out cirrhosis or hepatitis LIVER: The liver measures 16.7 cm in length. Mildly increased parenchymal echogenicity is suggestive of fatty infiltration/parenchymal dysfunction. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.15 m/s.BILIARY TRACT: Cholelithiasis without associated gallbladder wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 3 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 10.5 cm in length. RIGHT KIDNEY: Kidney measures 9.5 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 10.4 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.

Output: 1.Mildly increased hepatic echogenicity suggestive of fatty infiltration/parenchymal dysfunction.2.Cholelithiasis without evidence of cholecystitis.


Instruction: Generate impression based on medical findings.

Input: 21-year-old male with swelling over the lumbar spine area. Assess fluid collection. There is an approximately 3.2 x 0.4 x 0.9 cm uncomplicated fluid collection. There are some internal echoes. There is posterior acoustic shadowing. The fluid collection is very well-defined. Its depth is about 0.4 cm. It is approximately 0.2 cm from the skin surface.

Output: 1. Nonspecific fluid collection in lower back as described above.


Instruction: Generate impression based on medical findings.

Input: Elevated creatinine Interval decrease in size of perinephric hematoma, now measuring 5.1 x 2.9 cm. No stone or significant hydronephrosis. OTHER: Bladder nondistended.

Output: Interval decrease in size of perinephric hematoma. No significant hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Gallbladder polyp LIVER: Non-cirrhotic liver morphology. Normal parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. The gallbladder polyp measures 7 x 7 x 6 mm, previously 8 x 5 x 4 mm. Although the measurements do not vary significantly, the polyp demonstrates a broader base and increasingly convex contours, suggestive of some interval growth. No significant internal flow seen on color Doppler evaluation. The gallbladder is otherwise unremarkable.PANCREAS: No sonographic abnormality evident in the visualized pancreatic head and neck. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney is 10.2 cm in length. The left kidney is 10.4 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 9.6 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No abdominal free fluid identified.

Output: Slightly increased sized of the gallbladder polyp, which is nonspecific. Continued follow up is recommended.


Instruction: Generate impression based on medical findings.

Input: 21 year old female with known bilateral fibroadenomas presents for follow up ultrasound of right breast. Ultrasound was performed for the known masses at two o'clock position and 6 o'clock position. At two o'clock position, fourth and technique judged from nipple, there is a oval hypoechoic mass measuring 19 x 6 x 16 mm (previous measurement: 17 x 5 x 17 mm). At 6 o'clock position, 2 cm from the nipple, there is a oval hypoechoic mass measuring 11 x 5 x 10 mm (previous measurement: 15 x 5 x 10 mm). There is no significant change in its appearance in both masses.

Output: Benign masses at two o'clock position and 6 o'clock position in the right breast.  BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on medical findings.

Input: 31-year-old male with prior left thyroidectomy. Evaluate for recurrent neoplasm. RIGHT LOBE MEASUREMENTS: 4.8 x 1.4 x 2 cmLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: No massesLEFT LOBE: No mass in the thyroidectomy bedISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence recurrent mass post left lobectomy.


Instruction: Generate impression based on medical findings.

Input: 41 years old, Female, Reason: R shoulder pain after eating, eval for cholecystitis History: R shoulder pain after eating, AIH LIVER: The liver measures 12.7 cm in length. Hepatic parenchymal echogenicity is within normal limits. Multiple anechoic foci within the liver of varying sizes the largest of which measures 1.9 x 1.4 x 2.0 cm and is located in the right hepatic lobe. These lesions are indeterminate by ultrasound but are favored to represent hepatic cysts. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.2 m/s.BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. The sonographic Murphy's sign is negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures two mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 11.2 cm in length. RIGHT KIDNEY: Kidney measures 9.9 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 10.2 cm in length. Normal echotexture. Nohydronephrosis. Nonobstructing shadowing calculus in the left kidney measures up to 6 mm.OTHER: No significant abnormalities noted.

Output: 1.Normal gallbladder and biliary tract with no evidence of cholelithiasis or cholecystitis.2.Nonobstructing shadowing calculus in the left kidney measures up to 6 mm.3.Multiple anechoic foci within the hepatic parenchyma are indeterminate on this ultrasound exam although are favored to represent cysts.


Instruction: Generate impression based on medical findings.

Input: 59-year-old female with coagulopathy and ascites. Evaluate for liver disease. LIVER: Liver measures 16 cm in length. Echotexture is mildly coarsened, and the contour is scalloped. There is widening of fissures and enlargement of the lateral segment left lobe. The appearance is consistent with cirrhosis. There is no focal hepatic mass. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein. Tracing is pulsatile which may be seen with congestive heart failure.BILIARY TRACT: Gallbladder contains dependent stones and sludge. Gallbladder wall thickness is upper normal but this is not specific in the face of ascites.PANCREAS: Inadequately visualized due to bowel gas.SPLEEN: Normal in size.RIGHT KIDNEY: No significant abnormalities noted. OTHER: Mild to moderate ascites.

Output: Cirrhotic liver without mass. Main portal vein patent.Gallstones.


Instruction: Generate impression based on medical findings.

Input: 30-year-old female with enlarged gland on exam. RIGHT LOBE MEASUREMENTS: 5.7 x 2.2 x 1.0 cm.LEFT LOBE MEASUREMENTS: 5.1 x 2.2 at 1.2 cm.ISTHMUS MEASUREMENTS: 0.5 cm.RIGHT LOBE: Right thyroid lobe echogenicity is homogeneous without dominant lesion.LEFT LOBE: Left thyroid lobe echogenicity is homogeneous without focal lesion.ISTHMUS: Isthmus demonstrates homogeneous echogenicity without focal lesion.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Small perivascular lymph nodes are noted.OTHER: A subcentimeter nodule posterior and inferior to the right thyroid lobe may represent an exophytic thyroid nodule, parathyroid gland, or lymph node.

Output: No dominant thyroid lesion is identified.


Instruction: Generate impression based on medical findings.

Input: Thyroid carcinoma status post thyroidectomy with palpable lymph node left lateral neck RIGHT LOBE: Status post thyroidectomy without mass.LEFT LOBE: Status post thyroidectomy without mass.ISTHMUS: Status post thyroidectomy without mass.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: 2.1 x 1.1 cm complex mixed cystic and solid focus within the superior aspect of level 5 on the left. The appearance of this mixed cystic and solid focus is very different from the previously noted posterior left lateral neck cystic focus.OTHER: No significant abnormality noted.

Output: Complex mixed cystic and solid focus within the superior aspect of level 5 on the left. The appearance of this focus is very different from the previously noted posterior left lateral complex cystic focus. While this may represent postoperative change, it is best considered indeterminate. This lesion is amenable to ultrasound-guided percutaneous biopsy; alternatively if biopsy is not performed, would pay special attention to this lesion on future surveillance scans.


Instruction: Generate impression based on medical findings.

Input: Abdominal pain with elevated lipase LIVER: Cirrhotic morphology again noted without mass. Liver length 16.1 cmGALLBLADDER, BILIARY TRACT: Gallbladder wall thickening and pericholecystic fluid with biliary sludge and possible stones again noted.PANCREAS: Obscuration of peripancreatic fat planes; no obvious peripancreatic loculated fluid collection or pancreatic ductal dilatationRIGHT KIDNEY: No significant abnormalities noted. 13.6 cm in lengthOTHER: Spleen 18.4 cm in length. Moderate ascites

Output: Obscuration of peripancreatic fat planes; no obvious peripancreatic loculated fluid collection or pancreatic ductal dilatation. Cannot assess for pancreatic necrosis; would recommend correlation with contrast CT if the presence of necrosis is clinically suspected. Cirrhotic morphology again noted without mass or ductal dilatation. Gallbladder abnormalities again noted and unchanged. Moderate ascites.


Instruction: Generate impression based on medical findings.

Input: Evaluate for HCC. History of hepatitis C. LIVER: The liver is mildly echogenic and measures 14.8 cm in length. No focal hepatic lesion. Normal hepatopedal portal venous blood flow at 24 cm/s.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation with the common duct measuring 4 mm. Normally distended gallbladder without gallstones, wall thickening pericholecystic fluid or focal tenderness.PANCREAS: The visualized portions of the pancreatic head and body are unremarkable.SPLEEN: The spleen measures 9.6 cm without a focal lesion.RIGHT KIDNEY: The right kidney measures 9.8 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Stable mild pelvocaliectasis.OTHER: The left kidney measures 10.6 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion.

Output: 1. Mildly echogenic liver parenchyma suggestive of parenchymal dysfunction and/or fatty infiltration without a focal lesion.2. Stable minimal right pelvocaliectasis.


Instruction: Generate impression based on medical findings.

Input: 55 years old, Female, Reason: Rule out hydronephrosis RIGHT Native KIDNEY: Kidney measures 10.0 cm in length. The cortex is thinned with moderate to severe hydronephrosis which is likely chronic in etiology. There is a nonobstructing rounded calculus within a calix of the superior pole.LEFT KIDNEY: The left native kidney is not well seen on this examination.Transplanted kidney: The transplanted kidney in the right iliac fossa measures 11.7 cm. There is a simple appearing cyst measuring 1.4 x 1.1 by 1.8 cm. Mild dilatation of the collecting system, appearing similar to the recent abdominal CT. No perinephric fluid collections. No evidence of shadowing calculus, or mass within the transplanted kidney. Pigtail catheter is visualized within the pelvis of the transplanted kidney.Bladder: The bladder is nondistended.

Output: 1.Mild dilatation in the transplanted kidney, unchanged from recent abdominal CT.2.Moderate to severe chronic hydronephrosis in the native right kidney.3.Nonobstructing right renal calculus.


Instruction: Generate impression based on medical findings.

Input: History Graves' disease RIGHT LOBE MEASUREMENTS: 2.4 x 1.9 x 4.9 cmLEFT LOBE MEASUREMENTS: 1.6 x 1.9 x 5.9 cmISTHMUS MEASUREMENTS: 0.7 cmRIGHT LOBE: Diffusely heterogeneous gland without discrete nodule. No increased vascularity.LEFT LOBE: Diffusely heterogeneous gland without discrete nodules. No increased vascularityISTHMUS: Diffusely heterogeneous gland without discrete nodules. No increased vascularityPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Diffusely heterogeneous gland without discrete nodules. No increased vascularity.


Instruction: Generate impression based on medical findings.

Input: Reason: hydronephrosis History: decreased urine output, aki The transplanted kidney measures 11.2 cm in length. Unremarkable parenchymal echogenicity and echotexture. No hydronephrosis or shadowing renal calculi. Small anechoic cyst measures 1.2 x 1.1 x 1.0 cm. The bladder is mildly distended with fluid and otherwise unremarkable.

Output: Unremarkable ultrasound examination of the transplanted kidney. No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 22-year-old female looking for a shunt related pseudocyst /CSF-oma. History of prior pseudocyst. Presents with abdominal pain. Targeted ultrasound of the right and left upper and lower quadrants was performed. There is no discrete fluid collection identified to suggest pseudocyst formation.Note is made of the gastrojejunostomy tube balloon.

Output: No fluid collection to suggest pseudocyst formation.


Instruction: Generate impression based on medical findings.

Input: 52-year-old female patient with history of right breast cancer and benign mass seen on surveillance imaging. A targeted right breast ultrasound was performed. In the 10 o'clock position of the right breast 5 cm from the nipple there is a 0.6 x 0.3 x 1.0 cm parallel circumscribed oval hypoechoic mass is present, previously 0.8 x 0.8 x 0.3 cm. The previously seen lesion in the 11 o'clock position was not seen on the current examination.

Output: Stable benign lesion in the 10 o'clock position of the right breast. Previously identified lesion in the 11 o'clock position was not visualized on today's examination. Recommend diagnostic bilateral mammogram in 6 months.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: 53 year old female with history of hepatitis C and cirrhosis. LIVER: Subtle increased hepatic echotexture, suggestive of hepatic steatosis. No focal masses or other significant abnormality. The liver measures 16.3 cm.GALLBLADDER, BILIARY TRACT: No biliary dilatation or other significant abnormality. Postcholecystectomy.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. The right kidney measures 11.1 cm, and there is a small 0.5-cm right kidney simple cyst.OTHER: No significant abnormalities noted. Left kidney measures 11.7 cm, and is within normal limits.

Output: Findings suggestive of hepatic steatosis, similar to prior. No focal mass or other significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 24-year-old female with personal history of right breast carcinoma with axillary lymph node involvement, status post right lumpectomy and sentinel lymph node biopsy in October 2014 for invasive ductal carcinoma, presents for right axillary ultrasound for physician palpated right axillary lymph node. Patient complains of right axillary tenderness. A targeted right axillary ultrasound was performed for the palpable area of concern. A single normal morphology right axillary lymph node is appreciated with normal hilar flow, measuring 0.6 x 0.4 x 0.5 cm. No abnormal solid or cystic mass is identified.

Output: Single normal morphology right axillary lymph node. No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on medical findings.

Input: Reason: Right thigh/hip region, hx of Girdlestone. Developed abscess. S/p IR drain. Eval for reaccumulation of fluid. Needed prior to OR tomorrow. Complex superficial heterogenous collection measuring 1 cm is noted lateral to the drain. This collection appears to connect to a deep collection in the upper/outer part of the thigh measuring approximately 5.7 x 3.9 cm.

Output: Superficial heterogenous collection which appears to be connected to a deep complex collection in the upper/outer part of the thigh, as above.


Instruction: Generate impression based on medical findings.

Input: 30 yo female with loosely clustered calcifications in the right breast 3:00 position. Family history of breast cancer diagnosed in sister at age 27. A targeted right ultrasound was performed for the mammographic area of concern. There is no solid or cystic mass identified. Fibrocystic change with multiple calcifications are identified in the mammographic area of concern, which will be targeted for biopsy under ultrasound guidance. BIOPSY

Output: Successful ultrasound-guided core biopsy of the right breast calcifications and clip placement. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: 79-year-old female with metastatic breast cancer and abnormal liver function. LIVER: Hepatic size is normal upper normal. There is diffuse replacement of hepatic parenchyma by metastatic disease. BILIARY TRACT: The patient has had a cholecystectomy. There is no obvious, focal biliary tract dilatation and the common bile duct is normal in caliber.PANCREAS: Poorly visualized due to bowel gas.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: Spleen not visualized. Patient has had a left nephrectomy.

Output: Diffuse metastatic replacement of hepatic parenchyma without biliary abnormality.


Instruction: Generate impression based on medical findings.

Input: 74-year-old male with long-standing hypertension, renal dysfunction, with new CHF. Evaluate for hydronephrosis RIGHT KIDNEY: The right kidney measures 9.4 cm and is normal in echogenicity. No evidence of hydronephrosis.LEFT KIDNEY: Left kidney measures 8.9 cm and is normal in echogenicity. No evidence of hydronephrosis.BLADDER: No significant abnormalities noted.

Output: No hydronephrosis as clinically questioned.


Instruction: Generate impression based on medical findings.

Input: Right-sided nephrolithiasis with flank pain. RIGHT KIDNEY: 0.6 cm nonobstructing stone within the right renal pelvis. No worrisome mass or hydronephrosis. Right kidney 11.9 cm in lengthLEFT KIDNEY: No significant abnormalities noted. 12.1 cm in length OTHER: Bladder nondistended

Output: Subcentimeter nonobstructing stone within the right renal pelvis. No worrisome mass or hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 29-year-old female patient with previous large subcapsular hematoma resolving in August, but now with pain and liver enlargement. Reevaluate status. LIVER: The liver measures 17.6 cm in length and demonstrates mildly coarsened, increased parenchymal echogenicity. A previously demonstrated perihepatic collection is smaller in size measuring approximately 7.4 x 1.9 cm. Main portal vein flow is hepatopetal and measures 0.3 m/sec.GALLBLADDER, BILIARY TRACT: The gallbladder is absent. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 4 mm in diameter.PANCREAS: The head and body of the pancreas demonstrate normal echogenicity. The tail is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 12.5 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 12.9 cm in length. No evidence of hydronephrosis.The spleen is not visualized.

Output: Decreased size of the perihepatic collection.