Instruction: Generate impression based on medical findings.

Input: Female 72 years old Reason: Change in abnormal node History: Thyroid cancer MEASUREMENTS: Patient is status post thyroidectomy.RIGHT RESECTION BED: In the mid right thyroid bed there is a small hypoechoic nodule with internal hyperechogenicity measuring 0.3 x 0.4 x 0.3 cm, possibly representing a small lymph node. In the superior right thyroid bed there is a another small hypoechoic nodule measuring 0.4 x 0.3 x 0.3 cm.LEFT RESECTION LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: The previously noted left level 3 lymph node is not definitely identified on this exam. However, there is a left level 4 lymph node with punctate internal hyperechogenic foci which may represent calcifications. This lymph node measures 0.8 x 0.5 x 0.3 cm. OTHER: No significant abnormality noted.

Output: Left level 4 lymph node with suspicious features. There are also 2 new subcentimeter hypoechoic nodules in the right thyroidectomy bed; recurrent disease cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Papillary thyroid carcinoma RIGHT LOBE MEASUREMENTS: 7.4 x 2 x 2 cmLEFT LOBE MEASUREMENTS: 6.1 x 2 x 1.6 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: 1.5 x 1.1 x 1 cm solid left upper pole thyroid nodule with internal coarse calcificationsISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Abnormal appearing lymph nodes from level 1B to level 4 on the left. A representative left level 1B lymph node measures 1.9 x 1.9 x 1.9 cm. A representative left level 2 lymph node measures 3.6 x 1.4 x 0.8 cm. A representative left level 3 lymph node measures 1.8 x 1.2 x 0.8 cm. Multiple subcentimeter abnormal appearing lymph nodes within left level 4 are also appreciated.OTHER: No significant abnormality noted.

Output: Solitary solid nodule with internal coarse calcifications left thyroid gland consistent with known papillary thyroid carcinoma primary. Associated with extensive left cervical regional metastatic adenopathy as described from left level 1B to left level 4.


Instruction: Generate impression based on medical findings.

Input: Female 32 years old; Reason: 32 y/o 7 weeks pregant with right breast Ca, need ultrasound of thyroid for further eval History: 32 y/o 7 weeks pregnant with right breast Ca, need ultrasound of thyroid for further eval RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 4.6 x 2.0 x 1.7 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 4.7 x 2.6 x 1.8 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.13 cm.RIGHT LOBE: There are 2 nodules in the right lobe of the thyroid.Nodule #1: There is a round hypoechoic nodule without microcalcifications or internal vascularity in the mid right thyroid that measures approximately 0.6cm in diameter.Nodule #2: There is a mixed solid and cystic but predominately cystic appearing hypoechoic round lesion measuring approximately 9mm in diameter.LEFT LOBE: There is one nodule in the left thyroid.Nodule #1: There is a heterogenous nodule with scattered cystic spaces, no significant internal vascularity or definite microcalcifications measuring approximately 1.7 cm x 1.5 cm.ISTHMUS: There is one nodule in the isthmus of the thyroid.Nodule #1: There is echogenic lesion with peripheral vascularity and no definite microcalcifications measuring approximately 8mm in diameterLYMPH NODES: No suspicious adenopathy noted. OTHER: The thyroid has a diffusely heterogeneous echotexture.

Output: 1.Multinodular thyroid as above. Background heterogenicity could be due to thyroiditis. Please correlate with laboratory values.


Instruction: Generate impression based on medical findings.

Input: 5-year-old male with VOD and ascites ABDOMENLIVER: The liver measures 13.1 cm in length. Increased echogenicity of the liver, unchanged. No focal hepatic lesions or masses are identified.GALLBLADDER, BILIARY TRACT: Mild pericholecystic edema, likely related to ascites. No intrahepatic or extrahepatic biliary ductal dilatation is present. Sludge is present within the gallbladder, unchanged.PANCREAS: No significant abnormalities are noted in the visualized head of the pancreas. The body and tail of the pancreas are obscured by bowel gasOTHER: Moderate to large amount of ascites, unchanged. DOPPLER: Color and spectral Doppler were performed on inflow and outflow vessels.PORTAL VENOUS: Patent with hepatofugal flow. Hepatofugal flow is identified in the right, left, and main portal veins. Velocities of main, right, and left portal veins measure 0.2, 0.2, 0.1 m/sec, respectively.HEPATIC ARTERIES: Patent with normal arterial waveform. Common hepatic artery: Peak systolic velocity of 1.5 m/sec. Resistive index 0.9. Right hepatic artery: Peak systolic velocity of 0.6 m/sec. Resistive index 0.8.Left hepatic artery: Peak systolic velocity of 0.4 m/sec. Resistive index 0.8.HEPATIC VEINS: Hepatic veins are patent with normal phasic waveform.INFERIOR VENA CAVA: Non-dilated with no significant abnormalities noted.

Output: Persistent hepatofugal flow throughout the portal venous system. Mildly increased resistive indices in hepatic arterial system. Moderate to large amount of ascites, unchanged. Gallbladder sludge.


Instruction: Generate impression based on medical findings.

Input: 86 years old, Male, Reason: 86 yo with cirrhosis please screen for HCC History: none LIVER: The liver has a cirrhotic morphology. No focal hepatic lesions or masses are identified. No significant ascites is present. The liver measures 8.6 cm in length. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.1 m/s.BILIARY TRACT: There is minimal intra-and mild extrahepatic ductal dilatation. There is a stone or sludge in the area of the neck of the gallbladder without gallbladder wall thickening, or pericholecystic fluid. The sonographic Murphy's sign is negative. The common bile duct measures 4 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: 1 cm hypodensity in the spleen is again noted and unchanged since CT dated 6/7/14. The spleen measures 9.5 cm in length. RIGHT KIDNEY: Kidney measures 10.2 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 10.7 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.

Output: 1.Cirrhotic morphology of the liver without focal hepatic lesion identified.2.Mild intra-and extra hepatic biliary ductal dilatation is present.


Instruction: Generate impression based on medical findings.

Input: Patient with known malignancy of the left breast from outside hospital presents for a left unilateral diagnostic mammogram to confirm clip placement and repeat left breast ultrasound to evaluate additional SPECT relate mass identified on the mammogram. Mammogram: Three standard views of the left breast and 2 spot compression views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density(BiRads Density Category B), unchanged in pattern and distribution. Clip identified within the left upper-outer quadrant with a confluent hematoma measuring 3 cm around it. Spiculated mass measuring 14 mm is identified immediately posterior to it. Probably the clip has migrated anterolateral to the mass x 6 mm.A 15 mm focal asymmetry is identified in the left central posterior breast best seen on the ML view with a possible correlate in the lateral cc view. It is located 2.7 cm posterior to the previously biopsied mass. Multiple scattered oil cysts identified in the left breast.Ultrasound: Targeted left breast ultrasound was performed. Previously biopsied suspicious mass now with probably organizing hematoma adjacent to it measures 1.2 x 0.9 x 1.6 cm with peripheral blood flow. A clip is identified within a hematoma located slightly lateral to it. The hematoma approximately measures 1.6 x 1.8 cm.Sonographic correlate to the focal asymmetry seen on the mammogram is identified at 4:30 o'clock position, 9 cm from the nipple that measures 1.1 x 1.2 x 0.9 cm with apical blood flow. This appears suspicious and ultrasound-guided core biopsy is recommended.

Output: Biopsy-proven cancer in the left breast 4:00 position with clip located within it hematoma adjacent to it.New spiculated mass identified on the mammogram and ultrasound of the left breast 4:30 o'clock position, 9 cm from the nipple that needs ultrasound-guided core biopsy.Given the multifocality of the mass, breast MRI can be considered for further evaluation. BIRADS: 6 - Known cancer.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on medical findings.

Input: 73 year old female who was recalled from screening mammogram for focal asymmetry in the left lower inner breast . Mammogram: An ML view and two spot compression views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. 5 mm oval circumscribed mass persists on spot compression views.Ultrasound: Targeted left lower inner quadrant ultrasound was performed. A 6 x 2 mm simple cyst is identified in the left breast at 8:00 position. No suspicious solid mass noted.

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


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with biopsy proven cancer in the right breast and a questionable right axillary lymph node on outside hospital ultrasound, presents for repeat right axillary ultrasound. A right axillary ultrasound was performed. A lymph node low in the right axilla (designated 2 on the final image) measures 1.2 x 0.4 x 0.8 cm and has a partial fatty hilum and normal vascularity however there is focal cortical thickening up to 7 mm. An adjacent benign lymph node measures 1.8 x 0.6 x 0.4 cm with a fatty hilum and thin cortex.

Output: Focal eccentric cortical thickening of a low right axillary lymph node. Ultrasound-guided core needle biopsy may be performed if clinically indicated.BIRADS: 6 - Known cancer.RECOMMENDATION: B - Surgical Consultation.


Instruction: Generate impression based on medical findings.

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

Output: Status post thyroidectomy without mass or regional adenopathy.


Instruction: Generate impression based on medical findings.

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

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


Instruction: Generate impression based on medical findings.

Input: 26 years old, Female, Reason: elevated Cr History: elevated Cr Transplanted kidney: Renal transplant is identified in the right iliac fossa. Echogenic renal parenchyma is consistent with medical renal disease. No hydronephrosis is identified. No focal mass or shadowing calculus. No perinephric fluid collection.Doppler exam:Color and spectral Doppler were performed on inflow and outflow vessels. No significant abnormality noted. Peak velocities and resistive indices appear similar to the prior exam.Peak systolic velocities are as follows:Right iliac artery: 1.0 m/sec.Anastomosis: 0.8 m/sec, resistive index of 0.8Renal arteryproximal: 0.6 m/secmid: 0.6 m/secdistal: 0.5 m/secIntrarenal resistive indices measure from 0.5 to 0.68Urinary bladder: No significant abnormalities noted.

Output: 1.Increased parenchymal echogenicity of the kidneys consistent with medical renal disease.2.No evidence of hydronephrosis or evidence of stenosis within the transplant vasculature.


Instruction: Generate impression based on medical findings.

Input: Thyroid carcinoma RIGHT LOBE: Status post thyroidectomy without worrisome mass.LEFT LOBE: Status post thyroidectomy without massISTHMUS: Status post thyroidectomy without massPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

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


Instruction: Generate impression based on medical findings.

Input: Hyperthyroidism RIGHT LOBE MEASUREMENTS: 4.6 x 1.6 x 1.9 cmLEFT LOBE MEASUREMENTS: 5.2 x 1.1 x 1.3 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: 1.5 x 0.8 x 1.2 cm spongiform nodule with comet tail artifact.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Right spongiform nodule with benign characteristics. Otherwise unremarkable thyroid gland. No evidence for thyromegaly or increased vascularity. No regional adenopathy.


Instruction: Generate impression based on medical findings.

Input: Reason: Abdominal fullness in RLQ with history of multiple abdominal surgeries. Within the superficial soft tissues of the lower anterior abdominal wall, there is a large ovoid hypoechoic collection with thin internal septations as well as low level internal echoes. Overall, the collection measures approximately 28 x 5 cm. The collection is composed of a larger right component measuring approximately 17.8 cm in length and is smaller left component measuring 9.6 cm in length. The collection lacks internal vascularity or surrounding increased vascularity.

Output: Large collection within the anterior abdominal wall measuring up to 28 cm, favor postoperative collection such as seroma.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female patient with pancreatitis. Evaluate for gallstones. LIVER: The liver measures 17.3 cm in length. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: There are no gallstones, gallbladder wall thickening, or pericholecystic fluid. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 3 mm in diameter.PANCREAS: The head and body of the pancreas demonstrate normal echogenicity. The tail is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 6.3 cm in length and demonstrates increased cortical echogenicity. No evidence of hydronephrosis. There is a 1.4 x 1.0 cm right midpole renal cyst. OTHER: The left kidney measures 7.2 cm in length and demonstrates increased cortical echogenicity. No evidence of hydronephrosis. There is a 0.9 x 0.8 x 1.0 cm renal sinus cyst.The spleen measures 10.4 cm in length.

Output: 1. No cholelithiasis. 2. Medical renal disease with atrophic kidneys and bilateral renal cysts.


Instruction: Generate impression based on medical findings.

Input: Thyromegaly RIGHT LOBE MEASUREMENTS: 4.3 x 3.8 x 8.1 cmLEFT LOBE MEASUREMENTS: 4.8 x 4.7 x 7.6 cmISTHMUS MEASUREMENTS: 0.7 cmRIGHT LOBE: Enlarged diffusely heterogeneous gland. 5.6 x 3.6 x 5.8 cm dominant mixed cystic and solid nodule LEFT LOBE: Enlarged diffusely heterogeneous gland. 4.4 x 3.7 x 4.5 cm dominant mixed cystic and solid noduleISTHMUS: Enlarged diffusely heterogeneous gland. 2.2 x 2.4 x 2.7 cm predominantly solid nodule arising from the isthmus.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Thyromegaly with diffusely heterogeneous gland. Bilateral mixed cystic and solid nodules as described. Predominantly solid isthmic nodule.


Instruction: Generate impression based on medical findings.

Input: 54 years old, Female, Reason: hx pancreatis/ abdominal pain. per pt previuos u/s OSH stones History: abdominal pain LIVER: The liver measures 16.4 cm in length. Coarse echogenicity of the liver. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.3 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 4 mm in diameter.PANCREAS: Pancreas is not fully evaluated on this ultrasound examination to overlying bowel gas. The visualized portion of the pancreas is heterogeneous without ductal dilatation and may be a sequela of known pancreatitis. SPLEEN: No significant abnormalities noted. The spleen measures 12.8 cm in length. RIGHT KIDNEY: Kidney measures 12.2 cm in length. Normal echotexture. Nohydronephrosis or shadowing calculus.LEFT KIDNEY: Kidney measures 11.5 cm in length. Normal echotexture. Nohydronephrosis or shadowing calculus.OTHER: No significant abnormalities noted.

Output: 1.Normal gallbladder and biliary tract with no evidence of cholelithiasis or cholecystitis. Coarse liver parenchyma suggestive of chronic liver disease/fatty infiltration without mass.2.Pancreas is not fully evaluated on this ultrasound examination due to overlying bowel gas. The visualized portion of the pancreas is heterogeneous without ductal dilatation.


Instruction: Generate impression based on medical findings.

Input: Thyroid nodules, RIGHT LOBE MEASUREMENTS: 7 x 1.5 x 2.6 cmLEFT LOBE MEASUREMENTS: 6.1 x 1.7 by 2.4 cmISTHMUS MEASUREMENTS: 2 mmRIGHT LOBE: A predominantly cystic circumscribed, oval nodule measures 0.4 by 0.3 x 0 .4 cm in the upper pole. An irregularly-shaped hypoechoic nodule right, adjacent to it measures 1.1 x 1 x 0.8 cm possibly colloid in nature. However, few specks of calcifications are noted within it, further evaluation with ultrasound guided FNA is recommended. Also, comparison with prior ultrasound should be performed to look for interval changeLEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Normal morphology, level 2 right neck lymph nodes identified.OTHER: No significant abnormality noted.

Output: Atypical features in an irregularly-shaped hypoechoic right upper pole nodule possibly colloid in nature however, few specks of calcifications within it. Further evaluation with ultrasound guided FNA is recommended. If prior imaging is submitted, comparison with prior ultrasound should be performed to look for interval change


Instruction: Generate impression based on medical findings.

Input: Palpable thyroid enlargement RIGHT LOBE MEASUREMENTS: The right lobe measures 4.8 cm x 2.1 cm x 1.8 cm.LEFT LOBE MEASUREMENTS: The left thyroid measures 5 cm x 1.6 cm x 1.8 cm.ISTHMUS MEASUREMENTS: The isthmus measures 0.3 cm.RIGHT LOBE: Multiple solid nodules in the right lobe with similar character, all homogeneously isoechoic with the gland without any cystic components, calcifications or ring down and all demonstrating a hypoechoic rim. They were hypovascular on color Doppler imaging.The first is located in the superior portion and measures 1.4 cm x 1.1 cm x 0.9 cm.The second is located in the middle portion and measures 1.3 x 1 cm x 1.0 cm.The third nodule is located inferiorly and measures1.3 cm x 0.8 cm x 1.2 cm.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: None visualized on this study.LYMPH NODES: Several small superficial benign-appearing lymph nodes. No suspicious adenopathy.

Output: Three solid nodules are redemonstrated in the right thyroid lobe appear to be slightly enlarged from prior ultrasound. No suspicious adenopathy.


Instruction: Generate impression based on medical findings.

Input: History of high calcium and nephrolithiasis. Evaluate for parathyroid adenoma. RIGHT LOBE MEASUREMENTS: 5.6 x 1.9 x 1.9 cmLEFT LOBE MEASUREMENTS: 6.1 x 2.0 x 1.6 cmISTHMUS MEASUREMENTS: 4 mmRIGHT LOBE: The right thyroid lobe parenchyma is normal in echogenicity. Along the dorsal aspect of the inferior right thyroid lobe pole is a 8 mm hypoechoic oval lesion with central echogenicity most compatible with a benign appearing lymph node.LEFT LOBE: The left thyroid lobe parenchyma is normal in echogenicity. A 6 mm cyst is noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No lesion suspicious for a parathyroid adenoma is visualized. Note is made of a benign lymph node along the dorsal aspect of the inferior right thyroid lobe with a fatty hilum.


Instruction: Generate impression based on medical findings.

Input: Low TSH RIGHT LOBE MEASUREMENTS: 5.8 x 1.3 x 1.7 cmLEFT LOBE MEASUREMENTS: 5.0 x 1.5 x 1.5 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Multiple benign-appearing spongiform nodules. A representative lower pole right nodule measures 1.2 x 0.8 x 0.8 cmLEFT LOBE: Multiple benign-appearing spongiform nodules. A representative mid pole nodule measures 0.9 x 0.7 x 0.8 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Bilateral spongiform nodules; favor benign etiology. No regional adenopathy.


Instruction: Generate impression based on medical findings.

Input: Elevated liver function tests. LIVER: Non-cirrhotic liver morphology. Coarsened liver echogenicity, compatible with parenchymal dysfunction. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: Minimal biliary ductal dilation, likely reflecting prior cholecystectomy.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 13.1 cm in length, with minimal hydronephrosis. The left kidney is 11.2 cm in length, without hydronephrosis. The renal parenchymal echogenicity is increased bilaterally, markedly so on the left. No suspicious renal lesions are evident. SPLEEN: Not visualized.OTHER: No significant abnormalities noted. No significant ascites is identified.

Output: 1. Coarsened liver echogenicity, compatible with parenchymal dysfunction. 2. Increased renal parenchymal echogenicity, markedly on the left, compatible with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Secondary hyperparathyroidism RIGHT LOBE MEASUREMENTS: 4.7 x 1.8 x 1.3 cmLEFT LOBE MEASUREMENTS: 4.1 x 2 x 1.2 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: 1.5 x 1.9 x 2.5 cm hypoechoic focus arising the superior aspect of the left thyroid gland; it is unclear whether not this lesion is separate from our arising from the left thyroid gland.1.4 x 0.9 x 0.8 cm hypoechoic extrathyroidal focus projecting inferior and posterior to the left thyroid gland.1.3 x 0.9 x 0.9 cm mixed echogenicity focus right level 4 which does not morphologically correspond to a normal lymph nodeLYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Hypoechoic extrathyroidal focus projecting inferior and posterior to the left thyroid gland suspicious for clinically suspected parathyroid hyperplasia/adenoma. Larger hypoechoic focus arising from the superior aspect of the left thyroid gland; it is unclear whether not this lesion arises from the left thyroid gland or is separate and extrathyroidal; a large parathyroid adenomas/hyperplasia cannot be excluded.An additional mixed echogenicity focus right level 4 which is not morphologic correspond to normal lymph node; a parathyroid adenoma focus cannot be excluded.No regional adenopathy.


Instruction: Generate impression based on medical findings.

Input: Islet cell transplant 2 years ago LIVER: Mildly coarse liver texture again noted without mass. Liver length 11.5 cm. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow.BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 7.2 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 8.9 cm in lengthOTHER: Left kidney 9.4 cm in length. No ascites.

Output: Stable examination. Mildly coarse liver echotexture again noted without mass or ductal dilatation. No ascites.


Instruction: Generate impression based on medical findings.

Input: Renal transplant RENAL TRANSPLANT: LOCATION: Left iliac fossaPERITRANSPLANT TISSUES: 5.2 x 3.5 x 2.9 cm hypoechoic focus anterior to the iliac vessels on the left separate from the transplanted kidney. This lesion demonstrates internal vascularity.KIDNEY: The transplanted left iliac fossa kidney could not be evaluated due to extensive overlying gas.COLLECTING SYSTEM/URETER: Not visualized due to overlying gasURINARY BLADDER: No significant abnormality notedVASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels Vessels could not be interrogated due to extensive overlying gasOTHER: No significant abnormality noted

Output: Left iliac fossa renal transplant could not be visualized and vessels could not be interrogated due to persistent extensive overlying bowel gas.Indeterminate hypoechoic lesion anterior to the iliac vessels. This lesion could not be fully characterized due to overlying gas.


Instruction: Generate impression based on medical findings.

Input: 21-year-old male with elevated LFTs and jaundice. LIVER: Echogenicity of the hepatic parenchyma is increased. The liver measures 16.9 centimeters in length. No dilatation or cystic changes are noted of the intrahepatic or extrahepatic biliary ducts.The main portal vein is patent with normal direction of flow towards the liver and velocity of 32.3 cm/s.GALLBLADDER, BILIARY TRACT: Debris is noted within the gallbladder.. There is no pericholecystic fluid or gallbladder wall thickening. Tthe common bile duct measures 0.3 cm in diameter. OTHER: There is no free or loculated fluid.

Output: Debris within the gallbladder without ductal dilatation. Fatty infiltration of the liver.


Instruction: Generate impression based on medical findings.

Input: 64-year-old female with abnormal thyroid function and thyroid nodules. Prior treatment for multinodular goiter with radioactive iodine. RIGHT LOBE MEASUREMENTS: 4 x 1.7 x 1.8 cmLEFT LOBE MEASUREMENTS: 2.9 x 0.9 x 1.1 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Anterior, solid nodule with peripheral calcification in the right lobe measures 1.3 x 1.5 x 2 cm without significant change.Significantly hypoechoic, solid nodule in the posterior, lower pole or adjacent to the lower pole measures 1.1 x 1.0 x 1.5 cm without significant change.Ovoid, hypoechoic nodule, likely representing summation of 2 nodules in the medial right lobe/isthmus measures 0.3 x 0.5 x 1 cm without change.LEFT LOBE: Hypoechoic, rounded nodule in the left lower pole measures 0.4 x 0.4 x 0.5 cm without change.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable appearance of bilateral thyroid nodules. Again, the hypoechoic right nodule could be extrathyroidal.


Instruction: Generate impression based on medical findings.

Input: Female 60 years old Reason: Palpable approximately 1 x 1 cm vertically oriented firm lesion in the left anterior cervical chain. ? Lymph node. Please evaluate. History: As above Probable nodule is identified is an elliptical hypoechoic solid area consistent with a lymph node measuring 1.7 x 0.3 cm by 0.6-cm. Homogeneous texture. Fatty hilum not clearly identified. Mild vascularity and color Doppler imaging.

Output: Based on shape likely benign superficial lymph node corresponds to the palpable abnormality.


Instruction: Generate impression based on medical findings.

Input: Male 44 years old Reason: left upper thigh lesion, c/w lipoma, large, over 6 cm, enlarging causing discomfort. History: as above Ultrasound shows echogenic material only suggestive of possible lipoma. There are no fluid density areas. The tissue is relatively hypovascular color Doppler imaging. If clinically indicated, lipoma could be confirmed with CT or MR.

Output: Palpable abnormality is solid echogenic material.


Instruction: Generate impression based on medical findings.

Input: 54-year-old male with history of kidney stones. RIGHT KIDNEY: The right kidney measures 12.2 cm in length. Normal parenchymal echogenicity. No evidence of renal stone, hydronephrosis, or renal mass.LEFT KIDNEY: The left kidney measures 12.9 cm in length. Normal parenchymal echogenicity. A 1.3 x 1.0 cm stone is identified in the lower pole, similar to that seen on previous CT. No evidence of hydronephrosis or renal mass.OTHER: Hyperechoic, coarse liver echotexture suggestive of hepatic steatosis.

Output: 1.Nonobstructing 1.3 cm left inferior pole renal stone.2.Hepatic steatosis.


Instruction: Generate impression based on medical findings.

Input: Polycystic disease RIGHT KIDNEY: Numerous cysts of varying sizes. No worrisome complexity within a cyst appreciated. The largest cyst measures 7.6 x 9.8 x 6.8 cm. No worrisome mass, stone, or hydronephrosis. Right kidney 24.3 cm in lengthLEFT KIDNEY: Numerous cysts of varying sizes. No worrisome complexity within the cyst appreciated. The largest cyst measures 7.6 x 4.7 x 6.6 cm. No worrisome mass or hydronephrosis. Possible subcentimeter nonobstructing left renal calculi. Left kidney 24.1 cm in length.OTHER: Bladder nondistended.

Output: Numerous bilateral renal cysts consistent with known polycystic disease. No worrisome cyst complexity or mass. Possible subcentimeter nonobstructing left renal calculi. No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate right renal mass History: 25lb weight loss, stage IV Chronic renal disease, renal mass seen on non contrast CT RIGHT KIDNEY: Exophytic predominantly anechoic mass arising from the right kidney measuring 4.2 cm x 4.2 cm x 3.6 cm with internal septation and questionable solitary mural nodule seen dorsal to the area of septation on a few of the images. Increased echogenicity of the renal parenchyma suggestive of medical renal disease. No hydronephrosis.LEFT KIDNEY: Increased echogenicity of the renal parenchyma suggestive of medical renal disease. No hydronephrosis.OTHER: No significant abnormalities noted.

Output: Exophytic predominantly cystic mass with internal septation and questionable mural nodule. Continued follow-up in 4 months is recommended to ensure no increase in size of the mural nodule.


Instruction: Generate impression based on medical findings.

Input: Baseline exam for heart transplant evaluation LIVER:Liver is 16.4 cm with normal echotexture. No intrahepatic biliary ductal dilatation noted. No focal lesions.Main portal vein demonstrates normal flow directionality and patency.GALLBLADDER, BILIARY TRACT: Gallbladder is well-distended without any focal lesions. No pericholecystic fluid collection. Gallbladder wall thickness measures within 3 mm.PANCREAS: Head and body of pancreas appears unremarkable. Tail of pancreas not visualized to overlying bowel gas.SPLEEN: Kidney measures 9.6 cm with normal morphology. No focal lesions noted.KIDNEYS: Right kidney measures 7.9 cm the left kidney measures 12 cm. Mild increased echogenicity of both kidneys. No hydronephrosis or focal lesionsABDOMINAL AORTA: Abdominal aorta measures 2.1 x 1.8 cm proximally, 1.6 x 1.4 cm in the midportion and distally 1.5 x 1.5 cm. No evidence of any atherosclerotic plaques noted.INFERIOR VENA CAVA: PatentOTHER: No ascites

Output: Mild increased echogenicity of the kidneys suggestive of underlying chronic medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Rule out recurrence history of thyroid cancer 2 year follow-up RIGHT LOBE MEASUREMENTS: Status post thyroidectomyLEFT LOBE MEASUREMENTS: Status post thyroidectomyISTHMUS MEASUREMENTS: Status post thyroidectomyRIGHT LOBE: No suspicious areas of recurrence or residual tumor noted.LEFT LOBE: No suspicious foci or residual tumor notedISTHMUS: No suspicious areas of recurrence or residual tumor notedPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Normal morphology lymph nodes are again noted in the right level 1B and in the left neck level 3. Both these lymph nodes are stable from prior examOTHER: No significant abnormality noted.

Output: Stable examination without evidence of residual/recurrent disease


Instruction: Generate impression based on medical findings.

Input: Reason: Assess driveline on LVAD History: prior driveline infections, hypotension There is a small amount of fluid adjacent to the driveline and within the left anterior abdominal wall. No focal fluid collections are identified.

Output: Small amount of fluid adjacent to the driveline is nonspecific. No focal fluid collection or abscess is identified.


Instruction: Generate impression based on medical findings.

Input: Reason: AKI in setting of DKA/dehydration Limited exam due to poor patient cooperation and delirium RENAL TRANSPLANT: The transplanted kidney measures 12.6 cm in length. Unremarkable echotexture and echogenicity. No hydronephrosis.LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality noted. No perinephric fluid.COLLECTING SYSTEM/URETER: Poorly visualized, however no evidence of hydronephrosis.URINARY BLADDER: Poorly visualized.VASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels normal color Doppler flow is visualized, however accurate evaluation of the peak velocities and relative indices is limited by patient movement. The inflow and outflow vessels are patent.Right iliac artery peak velocity is 82.5 cm/s, relative index 0.75.Renal artery mid segmental peak systolic velocity is 41.1 cm/s, relative index 0.58Renal artery inferior segmental peak velocity is 53.8 cm/s, relative index 0.63.Renal artery at the anastomosis peak systolic velocity is 62.6 cm/s, relative index 0.79 cm

Output: Limited vascular examination due to patient movement, however the inflow and outflow vessels are patent. No perinephric fluid collections or hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 42-year-old female with thyromegaly. RIGHT LOBE MEASUREMENTS: 7 x 2.8 x 2.2 cmLEFT LOBE MEASUREMENTS: 7 x 2.9 x 2.3 cmISTHMUS MEASUREMENTS: 0.7 cmRIGHT LOBE: Within the mid right lobe there is a small complex cystic nodule measuring 0.5 x 0.6 cm. Parenchyma mildly heterogeneous LEFT LOBE: Parenchyma mildly heterogeneousISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Diffuse thyromegaly. Small complex cystic mass right thyroid.


Instruction: Generate impression based on medical findings.

Input: Right hydronephrosis status post nephrostomy tube ULTRASOUND KIDNEYSRIGHT KIDNEY: The right kidney measures 9.9 cm in length. Moderate right hydronephrosis. Right nephrostomy tube has been inadvertently removed. Stone again noted in the mid ureter.LEFT KIDNEY: The left kidney measures 7.4 cm in length and appears echogenic compatible medical renal disease. No hydronephrosis in the left kidney. 4 cm lower pole cyst again noted.OTHER:Bladder was collapsed around a Foley catheter and cannot be evaluated.

Output: Moderate right hydronephrosis with obstructing ureteral calculus. The right nephrostomy tube has been inadvertently removed. Medical renal disease of the left kidney. Findings discussed with interventional radiology.


Instruction: Generate impression based on medical findings.

Input: 74-year-old male with thrombocytopenia. Evaluate for hepatomegaly and splenomegaly. LIVER: Increased echogenicity of the liver measuring 16.0 cm in length. No focal hepatic lesions. Portal vein is patent with appropriate directional flow; peak velocity measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: Normal echogenicity of the gallbladder. No gallbladder wall thickening. No pericholecystic fluid. Common duct measures 4 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Not well assessed.RIGHT KIDNEY: Right kidney measures 12.0 cm in length. No hydronephrosis or shadowing calculus are noted.OTHER: Spleen is mildly enlarged measuring 12.1 cm in length.Left kidney measures 12.2 cm in length. No hydronephrosis or shadowing calculus are noted.

Output: 1. Increased echogenicity of the liver suggestive of parenchymal dysfunction/fatty infiltration. 2. Borderline splenomegaly.


Instruction: Generate impression based on medical findings.

Input: Hyperparathyroidism RIGHT LOBE MEASUREMENTS: 5.1 x 1.7 x 1.7 cmLEFT LOBE MEASUREMENTS: 5.4 x 1.2 x 1.6 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: No significant change in multiple subcentimeter predominantly cystic nodules. The largest nodule is within the superior pole measuring 0.8 x 0.5 x 0.6 cm.LEFT LOBE: Relatively stable upper pole isoechoic nodule measuring 1 x 0.9 x 1 cm.ISTHMUS: Stable subcentimeter hypoechoic nodules.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable bilateral thyroid nodules. No convincing extrathyroidal focus identifiable as a parathyroid lesion.


Instruction: Generate impression based on medical findings.

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

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


Instruction: Generate impression based on medical findings.

Input: Renal cysts on MRI RIGHT KIDNEY: Measures 11.5 cm in length. No hydronephrosis or mass.LEFT KIDNEY: Measures 10.8 cm in length. No hydronephrosis. Left kidney midpole cyst measures 1.2 x 1.2 x 1.3 cm. An additional subcentimeter cyst is present.OTHER: The bladder is unremarkable.

Output: Left renal cysts.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Ms. Mazza is a 33-year-old female presenting with a physician detected mass in the left upper outer breast. Patient denies any overlying skin changes or nipple discharge.Of note, the patient's physician declined obtaining a baseline mammogram for this patient. Of note, the patient's physician declined obtaining a baseline mammogram for this patient.Upon physical exam at the palpable area of concern, no discrete mass is appreciated.A targeted left breast ultrasound was performed for the palpable area of concern. In the left breast 2:00 location, approximately 4 cm nipple, no cystic or solid mass is identified.

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


Instruction: Generate impression based on medical findings.

Input: 59-year-old male with history of right thyroid nodule. RIGHT LOBE MEASUREMENTS: 4.4 x 1.6 x 1.4 cmLEFT LOBE MEASUREMENTS: 3.7 x 1.3 x 1.1 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Solid and cystic circumscribed exophytic nodule in the right lower pole measures 2.5 x 1.5 x 2.1 cm.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Scattered cervical lymph nodes with overall benign appearing morphologic features.OTHER: No significant abnormality noted.

Output: Solid and cystic right inferior pole exophytic nodule which is amenable to biopsy.


Instruction: Generate impression based on medical findings.

Input: 49-year-old man with history of renal cancer. Evaluate for recurrence. RIGHT KIDNEY: The right kidney measures 11.4 cm in length and shows normal echotexture. No mass, stone or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.7 cm in length and shows normal echotexture. There is a 1.6 x 1.9 x 1.2 cm simple cyst within the cortex of the left midpole kidney which does not contain internal septations, debris or calcifications. No mass, stone or hydronephrosis.URINARY BLADDER: The urinary bladder is normal in appearance.OTHER: A round hyperechoic focus within the right lobe of the liver measures 1.5 x 1.5 x 1.4 cm.

Output: 1.Simple cyst within the cortex of the left midpole kidney without internal septations, debris or calcifications. No mass is seen of either kidney. No hydronephrosis.2.A round hyperechoic focus within the right lobe of the liver presumably represents a hemangioma described on previous imaging.


Instruction: Generate impression based on medical findings.

Input: Male 60 years old Reason: 60 yo M w/ AML with neutropenic fever and sepsis w unclear source, CT abd on admit w/ cholelithiasis and ?acute cholecystitis but no abd pain, now has abd pain; pls eval for e/o acute cholecystitis History: see above LIVER: Partially visualized liver is normal in appearance. Main portal vein is patent with normal directional flow.BILIARY TRACT: Shadowing gallstone is present in the gallbladder. Gallbladder wall is within normal limits measuring 2 mm. No pericholecystic fluid. Negative sonographic Murphy's sign. Common bile duct is normal measuring 3 mm. No intra or extrahepatic biliary ductal dilatation.OTHER: No perihepatic ascites

Output: Cholelithiasis without evidence of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: 72 old female with thyroid nodules. RIGHT LOBE MEASUREMENTS: 1.8 x 2.0 x 5.8 cmLEFT LOBE MEASUREMENTS: 1.4 x 2.5 x 5.0 cmISTHMUS MEASUREMENTS: 4 mmRIGHT LOBE: There are numerous right thyroid lobe nodules. Most of these are nearly completely cystic with small echogenic peripheral foci compatible with colloid cysts. The largest measures 1.6 x 1.3 x 1.0 cm and contains dependent debris. The margins are well-defined without calcifications or other specific suspicious sonographic features.LEFT LOBE: The left thyroid lobe contains numerous nodules, most are nearly completely cystic with small echogenic peripheral foci, compatible with colloid cysts. There is a 1.2 x 1.1 x 1.9 cm nodule with coarse calcifications and obscured posterior margins. The visualized margins are well-defined. There is no increased vascularity. This nodule is stable to slightly decreased in size compared to the prior study (from 2003) where it measured 1.6 x 1.4 x 2.0 cm.ISTHMUS: 2.0 x 0.8 x 1.8 cm cystic colloid nodule in the right aspect of the isthmus.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Morphologically unremarkable and normal size lymph nodes are noted bilaterally.OTHER: No significant abnormality noted.

Output: 1. Coarsely calcified 1.9-cm left thyroid lobe nodule, stable to slightly decreased in size compared to 2003, benignity is favored. 2. Multiple bilateral colloid cysts.


Instruction: Generate impression based on medical findings.

Input: Male 53 years old Reason: Metastatic pancreatic cancer on IRB 14-0081; needs biopsy of liver mass, 3-4 cores 17 gauge or larger, Laura Hoffman 7912 to provide kit and to pick up sample. History: Metastatic pancreatic cancer Previously seen ascites has been removed. Previously identified lesion in the inferior aspect of the right lobe of the liver is not visible by ultrasound. Noted is made of decrease SUV in that lesion on most recent PET/CT suggesting response to therapy. On the noncontrast CT portion of that PET/CT, the lesion is visible but ill-defined and small probably not amenable to CT-guided biopsy.

Output: Plan biopsy canceled for reasons described above. Discussed with clinical service at the time.


Instruction: Generate impression based on medical findings.

Input: Male 30 years old; Reason: Elevated transaminases, eval liver, gall bladder, pancreas History: None LIVER: The liver measures 19.4 cm in length. There is increased echogenicity of the liver parenchyma. No focal hepatic lesions. No intrahepatic ductal dilation is seen. The main portal vein is patent with normal hepatopetal flow measured at 23.6 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 3.0 mm. No stones or sludge are seen. No pericholecystic fluid. The common bile duct measures 2.6 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 13.1 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 10.0 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 11.7 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: No significant abnormality noted.

Output: 1. There is increased echogenicity of the liver compatible with fatty infiltration/hepatocellular dysfunction. No focal hepatic lesions are seen.2. Mild hepatomegaly is present, the spleen size is at the upper limits of normal.3. No evidence of cholelithiasis or acute cholecystitis are seen.


Instruction: Generate impression based on medical findings.

Input: Assess for renal artery stenosis; hypertension and acute renal insufficiency RENAL TRANSPLANT: LOCATION: Left iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: No significant abnormality noted. 10.8 cm in lengthCOLLECTING SYSTEM/URETER: No significant abnormality notedURINARY BLADDER: No significant abnormality notedVASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels Patent renal transplant vasculature without evidence for inflow or outflow compromise.OTHER: No significant abnormality noted

Output: Patent renal transplant vasculature without evidence for inflow or outflow compromise.


Instruction: Generate impression based on medical findings.

Input: Thyroid nodules RIGHT LOBE MEASUREMENTS: 7.7 x 4.6 x 3.6 cmLEFT LOBE MEASUREMENTS: 6.2 x 1.7 x 1.6 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Diffusely heterogeneous gland again noted and unchanged.LEFT LOBE: Stable discrete mixed cystic and solid nodules. Upper pole nodule measures 1.8 x 0.8 x 1.3 cm. Mid pole nodule measures 1 x 0.9 x 0.7 cm. More medially located mid pole nodule measures 0.9 x 0.8 x 0.9 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable thyroid nodules and heterogeneous thyroid gland. No regional adenopathy.


Instruction: Generate impression based on medical findings.

Input: 15-year-old male presents with a history of left renal stricture status post pyeloplasty presents with left flank pain. BLADDER  Wall Thickness: Normal  Contents: Distended and normal. Distal Ureter -- SFU Grade**  Right: 0  Left: 0   Ureteral Jets Right: Not observed  Left: Not observedKIDNEYS  Cortical Echogenicity: Normal   Medullary Echogenicity: Normal   Pelvicaliceal System -- SFU Grade*  Right: 0 Left: 3, appearing similar to the prior examination.   Length*** Right: 11 cm Left: 13 cm   Mean for age: 10.2 cm  Range for age: 9 - 11.5 cmADDITIONAL OBSERVATIONS: Echogenic focus with posterior shadowing in the left kidney measuring 1.2 x 1 cm.

Output: 1. Non-obstructing left renal calculus. 2. Chronic grade 3 hydronephrosis. *SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning. **SFU grading system retrovesical ureter: Grade 0: No ureteral dilatation. Grade 1: Ureter less than 7 mm. Grade 2: Ureter is 7-10 mm. Grade 3: Ureter is over 10 mm. Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469


Instruction: Generate impression based on medical findings.

Input: 56-year-old male with history of thyroid cancer status post thyroidectomy complains of neck swelling. RIGHT LOBE, LEFT LOBE, ISTHMUS: The thyroid has been surgically removed. No evidence of recurrence or masses.LYMPH NODES: Normal lymph nodes in the right and left neck.OTHER: No significant abnormality noted.

Output: Surgical changes of a thyroidectomy without no evidence of recurrence, masses, or regional adenopathy.


Instruction: Generate impression based on medical findings.

Input: 39-year-old female with abdominal pain. Evaluate for cholelithiasis. LIVER: The liver measures 14.4 cm in length. Mild increased hepatic echogenicity without discrete focal lesion.GALLBLADDER, BILIARY TRACT: No cholelithiasis. No gallbladder wall thickening, pericholecystic fluid, or sonographic Murphy sign. No biliary ductal dilation.PANCREAS: No significant abnormalities noted.KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.

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


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old. Creatinine elevation RIGHT KIDNEY: The right kidney measures 8.9 cm in length, with increased cortical echogenicity. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 11.5 cm in length, with mildly increased cortical echogenicity. A mid to upper pole exophytic simple cyst measures 1.8 x 1.8 x 1.8 cm area of shadowing stones or hydronephrosis.OTHER: Prevoid bladder volume is approximately 207 mL. Post void bladder volume is approximately 95 mL.

Output: 1.Increased renal cortical echogenicity, compatible with medical renal disease. No hydronephrosis.2.Post void residual: 95 mL.


Instruction: Generate impression based on medical findings.

Input: Abdominal pain LIVER: Coarse echogenic liver parenchyma. No mass lesion. Liver length 22 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11 cm in length.OTHER: Left kidney 11.7 cm in length. Spleen 10 cm in length. No ascites.

Output: Hepatomegaly with coarse echogenic liver parenchyma suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites.


Instruction: Generate impression based on medical findings.

Input: Female 70 years old Reason: assess for liver pathology History: RUQ tenderness to palpation in pt with AML on chemotherapy LIVER: Mildly coarsened appearance of the liver which is nonspecific but can be seen in the setting of fatty infiltration or diffuse hepatic dysfunction. No focal hepatic mass. Main portal vein is patent with normal directional flow and peak velocity of 32 cm/s.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. The common bile duct measures 5 mm. No gallbladder, possibly removed.PANCREAS: The visualized portions of the pancreas are within normal limits.SPLEEN: Spleen measures 13.3 cm and is normal in appearance.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Right kidney measures 9.4 cm. Cyst in superior pole of the left kidney measures 3.2 x 2.8 x 2.7 cm. Left kidney measures 10.4 cm. OTHER: No significant abnormalities noted.

Output: Mildly coarsened appearance of the liver without focal mass. No intra or extrahepatic biliary ductal dilatation.


Instruction: Generate impression based on medical findings.

Input: Obstruction of bile duct, malignant neoplasm of the pancreas. Evaluate for jaundice On call after hours exam performed.LIVER: The liver measures 16.1 cm in length. No focal liver lesions. Presumed pneumobilia is noted making evaluation of the intrahepatic bile ducts somewhat limited. These appear to be mildly dilated. Portal vein is patent with flow towards the liver on color Doppler imaging.GALLBLADDER, BILIARY TRACT: Gallbladder sludge and wall thickening. Patient did not have a sonographic Murphy sign. The common duct measured 5 mm in diameter; metal stent noted.PANCREAS: There is a mass in head of the pancreas measuring approximately 3.8 cm in diameter. Pancreatic duct appears dilated Correlation with cross-sectional imaging is advised.RIGHT KIDNEY: No hydronephrosis of either kidney.OTHER: Right pleural effusion.

Output: Pancreatic mass with mild intrahepatic and pancreatic ductal dilatation. Correlation with CT or MRI is advised. Right pleural effusion. Gallbladder sludge.


Instruction: Generate impression based on medical findings.

Input: History of right buttock soft tissue injury. Surrounding induration. Evaluate for abscess. Targeted grayscale and color Doppler evaluation of the region of erythema and induration demonstrates a small hypoechoic focus measuring 1.1 x 0.4 x 1.0 cm which appears slightly decreased in size from the prior. No significant surrounding inflammatory changes. Shadowing is noted from the adjacent packed wound.

Output: Probable 1.1 cm complex poorly loculated fluid collection within the subcutaneous soft tissues is too small to drain.


Instruction: Generate impression based on medical findings.

Input: 23-year-old female with history of thyroid cancer status post thyroidectomy and iodine-131 ablation. Thyroid measurements are not obtained as this patient is status post thyroidectomy.RIGHT THYROID BED: There are 2 hypoechoic nodules seen in the right thyroid bed. The first is located inferiorly and measures 0.3 cm x 0.3 cm x 0.4 cm. The second is also located at the inferior portion measuring 0.8 cm x 0.5 cm x 0.4 cm. Both of these nodules were identified on the prior study and appear stable in size.LEFT THYROID BED: There is a hypoechoic nodule seen in the left thyroid bed inferiorly. This measures 1.2 cm x 0.6 cm x 0.7 cm. This was seen on prior ultrasound and appears stable in size.PARATHYROID GLANDS: Not visualized on this study.RIGHT LYMPH NODES: There is a level 2 lymph node identified measuring 0.7 cm x 0.8 cm x 1.7 cm. This is hypoechoic and has a fatty hilum. There is also a level 3 lymph node measuring 0.3 cm x 0.5 cm x 1.4 cm. This is slender and hypoechoic.LEFT LYMPH NODES: No suspicious adenopathy seen.

Output: Previously seen hypoechoic nodules in the thyroidectomy bed are stable in appearance from prior ultrasound. No suspicious adenopathy is identified.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for intra-renal etiology for acute kidney injury RIGHT KIDNEY: The right kidney measures 10.7 cm in length. Normal renal parenchymal echogenicity. Mid pole cyst measures 2.4 x 1.4 x 1.8 cm and is cystic with a small septation or solid component. No hydronephrosis or shadowing stones.LEFT KIDNEY: The left kidney measures 10.1 cm in length. Normal renal parenchymal echogenicity. No hydronephrosis or shadowing stones.OTHER: The urinary bladder is poorly distended, limiting its evaluation. Small amount of free pelvic fluid. Ureteral jets not visualized.

Output: 1. No acute renal abnormality.2. Minimally complex right midpole cyst as described above.


Instruction: Generate impression based on medical findings.

Input: Male; 60 years old. Reason: h/o hemangioma, assess for interval change LIVER: The liver has a nodular contour. Liver measures 18.0 cm in length. The parenchyma is normal in echotexture. There is no focal hepatic mass identified.The portal vein is patent and demonstrates normal directional flow with a peak velocity of 0.25 m/sec.BILIARY TRACT: The gallbladder contains layering sludge. There is no cholelithiasis, wall thickening or pericholecystic fluid. Common duct measures 3 mm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 6.9 cm. The cortex is normal in echogenicity but thin. No shadowing calculi or hydronephrosis is present. 1.2 x 0.9 x 1.3 cm slightly hypoechoic structure is seen in the right kidney. There is no associated abnormally increased vascular flow. The left kidney measures 13.8 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 12.6 cm. in length. OTHER: Bilateral pleural effusions.

Output: 1.Hepatomegaly.2.No hepatic hemangioma is identified and no prior imaging was available for comparison at the time of this dictation.3.Right kidney lesion likely represents a prominent column of Bortan but follow up with contrast-enhanced CT or MRI is recommended to exclude underlying neoplasm.4.Bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 36-year-old female with acute kidney injury, evaluate for hydronephrosis. RIGHT KIDNEY: Measures 13.3 cm in length. There is marked multifocal dilation of the renal calyces and infundibula, without dilation of the renal pelvis or ureter, progressively increased compared with prior studies. The cortex is markedly thinned with increased echogenicity. Additionally, there is now debris within these dilated calyces which has not been seen previously.LEFT KIDNEY: Measures 9.4 cm in length. Increased echogenicity without hydronephrosis. Left inferior pole 1.4 cm cyst without septation or solid component. URINARY BLADDER: Ileal conduit incompletely distended. OTHER: No significant abnormalities noted.

Output: 1. Marked right multifocal calyceal and infundibular dilation as described above. Dating back to 2005, this has been a progressive process and is an unusual and atypical presentation for hydronephrosis. This appearance suggests multifocal infundibular stenosis, and could represent infundibular pelvic dysgenesis (part of the spectrum of multicystic dysplastic kidney). 2. The presence of debris within these dilated calices raises suspicion of infection. 3. Increased left renal echogenicity consistent with medical renal disease, without hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Reason: History of renal transplant with worsening Cr and poor UOP. Please evaluate. History: As above, evaluate transplant concern for hydronephrosis RENAL TRANSPLANT:LOCATION: Left iliac fossa.PERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: No significant abnormality noted..COLLECTING SYSTEM/URETER: Mild expected prominence of the collecting system, not significantly changed. No significant hydronephrosis.URINARY BLADDER: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant hydronephrosis of the transplant kidney.


Instruction: Generate impression based on medical findings.

Input: Hematuria. Transplant kidney. TRANSPLANT KIDNEY: Located in the right iliac fossa. 10.5 cm in length. Unremarkable renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis. The transplant renal artery and vein are patent with normal velocities and waveforms.OTHER: No significant abnormality noted.

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


Instruction: Generate impression based on medical findings.

Input: Male; 56 years old. Reason: elevated LFTs (AST>ALT), hx EtOH abuse; eval for cirrhotic liver History: see above LIVER: Hepatomegaly with the right lobe of the liver measuring 20.4-cm in length. Diffusely coarsened echotexture of the liver, most suggestive of fatty infiltration. No focal liver lesions. No intrahepatic biliary ductal dilation. Main portal vein is patent with normal directional flow.BILIARY TRACT: Unremarkable appearance of the gallbladder. No extrahepatic biliary ductal dilation. The common bile duct measures 5 mm.PANCREAS: No gross abnormalities of the pancreatic head. The remainder of the pancreas is obscured by overlying bowel gas.SPLEEN: Spleen is 11.4-cm in length. No focal splenic lesions.RIGHT KIDNEY: Right kidney is 9.5-cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: Left kidney is 9.8-cm in length. Normal cortical echotexture. No hydronephrosis.

Output: Hepatomegaly and fatty infiltration of the liver.


Instruction: Generate impression based on medical findings.

Input: 53 year old woman with history of left breast cancer, enhancing lesion seen in right breast on pre-treatment MRI. A targeted right ultrasound was performed for the MR/mammographic area of concern. There is a hypoechoic, circumscribed oval mass measuring 1.1 x 1.0 x 0.6 cm in the 9:00 position of the right breast 7 cm from the nipple, corresponding to the MR/mammographic findings. Mild peripheral flow is noted. The lesion is consistent with fibroadenoma. No additional or suspicious findings noted.

Output: Right breast fibroadenoma for which a biopsy is not needed. Recommend follow-up with Breast Surgery, results discussed with patient.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: 71-year-old male. Assess change in left lower pole complex cyst. GFR 37. Contrast relatively contraindicated. RIGHT KIDNEY: The right kidney measures 9.8 cm in length. No hydronephrosis. Increased echogenicity of the renal parenchyma. Multiple renal cysts are again seen. The largest cyst on the right measures 6 x 6.5 x 7.3 cm (prior 6.1 x 6.3 x 6.1 cm). LEFT KIDNEY: The left kidney measures 12.1 cm in length. No hydronephrosis. Increased echogenicity of the renal parenchyma. Left lower pole heterogenous lesion measuring 1.3 x 1.2 x 1.3 cm (prior 1.5 x 1.3 x 1.4 cm).URINARY BLADDER: The urinary bladder is collapsed and incompletely evaluated.OTHER: No significant abnormalities noted.

Output: Stable appearance of the left lower pole heterogenous lesion. Further evaluation with dedicated CT or MRI is recommended (half dose contrast administration is available for GFR between 30 and 60).


Instruction: Generate impression based on medical findings.

Input: 54 years old, Male, Reason: 54yo M with significant etoh abuse and abnormal labs concerning for cirrhosis. History: etoh use, hepatomegaly LIVER: The liver size is within normal limits measuring 15.4 cm in length. Increased echogenicity of the liver is consistent with fatty infiltration. No significant nodularity of the liver. No focal hepatic lesion identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.3 m/s. No evidence of ascites.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 4 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 8.6 cm in length. RIGHT KIDNEY: Kidney measures 10.6 cm in length. No evidence of hydronephrosis. Echogenic focus in the right kidney with posterior shadowing likely represents a renal calculus.LEFT KIDNEY: Kidney measures 10.8 cm in length. No evidence of hydronephrosis.

Output: 1.Increased echogenicity of the liver is consistent with fatty infiltration. No definite capsular nodularity of the liver or widening of the fissures to suggest cirrhosis.2.Echogenic focus in the right kidney with posterior shadowing is favored to represent a renal calculus.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male with history of viral hepatitis B, evaluate for liver cancer. LIVER: No focal hepatic lesions or biliary dilatation. The liver is normal in size, measuring approximately 11 cm.GALLBLADDER, BILIARY TRACT: Several mobile gallstones are seen.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.

Output: Cholelithiasis without findings of cholecystitis. No focal hepatic masses.


Instruction: Generate impression based on medical findings.

Input: Female 22 years old Reason: include liver and pancreas, ER visit 4/20/16, r/o pancreatitis, c/o abdominal pain, hx small bowel obstruction History: include liver and pancreas, ER visit 4/20/16, r/o pancreatitis, c/o abdominal pain, hx small bowel obstruction LIVER: Liver is normal in size and echogenicity. No focal liver lesions.GALLBLADDER, BILIARY TRACT: Gallbladder is mildly contracted but otherwise unremarkable. No evidence of biliary dilatation.PANCREAS: Not well visualized due to overlying bowel gas.RIGHT KIDNEY: No significant abnormalities noted. Right kidney measures 9 cm. Left kidney measures 9.2 cm.OTHER: No significant abnormalities noted. Spleen measures 8.3 cm.

Output: Unremarkable ultrasound.


Instruction: Generate impression based on medical findings.

Input: 36 year-old female with renal cysts. RIGHT KIDNEY: The right kidney measures 11.7 cm in length. Echotexture within normal limits. There is a 2.8 x 3.5 x 2.9 cm cyst in the midpole the right kidney with a smaller, adjacent smaller cyst or a septated component. This is unchanged or minimally increased compared are seen. No hydronephrosis, shadowing calculus or solid mass.LEFT KIDNEY: Left kidney measures 11.2 cm in length and appears unremarkable. No hydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.

Output: Right renal cysts as previously noted either unchanged or minimally larger not requiring follow up.


Instruction: Generate impression based on medical findings.

Input: 62 year old male patient with history of thyroid nodules. RIGHT LOBE MEASUREMENTS: 6.1 x 2.4 x 2.0 cm.LEFT LOBE MEASUREMENTS: 5.3 x 1.5 x 1.6 cm.ISTHMUS MEASUREMENTS: 6 mm in thickness.RIGHT LOBE: A right lower pole spongiform-appearing nodule measures 0.6 x 0.6 x 0.7 cm, previously 0.7 x 0.6 x 0.5 cm.LEFT LOBE: No new discrete thyroid nodule is identified in the left lobe.ISTHMUS: A spongiform-appearing, previously biopsied left isthmic nodule measures 1.5 x 0.9 x 1.5 cm, previously 1.3 x 0.9 x 1.4 cm. A more solid right isthmus nodule measures 1.4 x 1.0 x 1.7 cm, previously 1.3 x 0.9 x 1.5 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Stable solid right isthmic nodule, which is amenable to biopsy if clinically indicated.2. Stable right lower pole and left isthmic nodules.


Instruction: Generate impression based on medical findings.

Input: Female; 35 years old. Reason: pt w hyperthyroidism, to assess gland anatomy and thyroid volume to calculate RAI dose History: hyperthyroidism RIGHT LOBE MEASUREMENTS: 4.3 x 2.0 x 1.7 cmLEFT LOBE MEASUREMENTS: 2.8 x 1.4 x 1.3 cmISTHMUS MEASUREMENTS: 0.19 cmRIGHT LOBE: The right lobe is nodular and certain nodular portions are hypervascular.LEFT LOBE: The left lobe is atrophic and hypervascular.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Left level 3 lymph node measures 1.6 x 0.7 cm and has a fatty hilum.OTHER: No significant abnormality noted.

Output: 1.Nodular, partially hypervascular right thyroid lobe and atrophic, hypervascular left thyroid lobe, suspicious for thyroiditis.2.Measurements as above.


Instruction: Generate impression based on medical findings.

Input: Sarcoid with acute renal insufficiency RIGHT KIDNEY: Right pelvic kidney. Mildly echogenic parenchyma without mass, stone, or hydronephrosis. 10.2 cm in lengthLEFT KIDNEY: Mildly echogenic parenchyma without mass, stone, or hydronephrosis. 12.1 cm in lengthOTHER: Bladder nondistended

Output: Mildly echogenic renal parenchyma suggestive for medical renal disease/parenchymal dysfunction without mass, stone, or hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 45 year old female with history of hepatitis B virus. Evaluate for HCC. LIVER: The liver measures 15 cm, and is normal in echotexture. No focal masses are identified. Small left liver cyst, unchanged from prior, measures 1.8 x 1.5 x 2 cm.GALLBLADDER, BILIARY TRACT: The gallbladder is within normal limits. No biliary dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. The right kidney measures 10.60 m.OTHER: No significant abnormalities noted. The left kidney is within normal limits, measuring 11.4 cm.

Output: No focal mass or biliary dilatation to suggest tumor.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old. Rising Cr RIGHT KIDNEY: The right kidney measures 9.8 cm in length, with lobular contour, focal parenchymal loss, and additional focal areas of parenchymal thickening. No definite mass lesion is identified. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 8.8 cm in length, with lobular contour. No shadowing stones or hydronephrosis.OTHER: The bladder is decompressed. Diffusely increased hepatic echogenicity is noted.

Output: 1.Lobulated contour of the kidneys, without hydronephrosis.2.Increased hepatic echogenicity, compatible with fatty infiltration or parenchymal dysfunction.


Instruction: Generate impression based on medical findings.

Input: Reason: acute pancreatitis, evaluate for gallstones LIVER: The liver measures 14 cm in length. There are multiple well-defined, round hypoechoic-to-isoechoic solid hepatic lesions. Two representative lesions in the right lobe measure 4.5 x 3.9 x 4.6 cm and 3.8 x 3.4 x 2.8 cm. The portal vein is patent with normal directional hepatopedal portal venous blood flow, peak velocity 28 cm/s.GALLBLADDER, BILIARY TRACT: Multiple shadowing gallstones in the dependent aspect of the gallbladder and gallbladder neck. No pericholecystic fluid or evidence of acute inflammation. The gallbladder wall measures 0.2 cm. The common bile duct measures 0.4 cm. No biliary ductal dilatation.PANCREAS: Obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 11 cm in length. No hydronephrosis or stones.LEFT KIDNEY: The left kidney measures 11.2 cm in length. No hydronephrosis or stones.OTHER: Left pleural effusion.

Output: 1. Multiple solid hepatic lesions as described above, suspicious for metastases. MRI of the liver is recommended for further evaluation.2. Cholelithiasis without evidence of acute inflammation.


Instruction: Generate impression based on medical findings.

Input: 59 year-old male with a history of chronic kidney disease, Stage III. Hypertension. RIGHT KIDNEY: No significant abnormalities noted.LEFT KIDNEY: No significant abnormalities noted. There is a 1.9 x 1.9 x 1.8 cm simple cyst in the interpolar region of the left kidney. There is no internal vascularity.OTHER: The bladder is incompletely distended.

Output: Unremarkable ultrasound examination of the kidneys.


Instruction: Generate impression based on medical findings.

Input: Evaluate for renal stone. RIGHT KIDNEY: Right kidney measures 7.3 cm. The cortex is echogenic. Few small renal calculi are identified, the largest measuring 4 mm. No hydronephrosis is identified. Right simple cyst measures 1.1 x 1.0 x 1.0 cm. LEFT KIDNEY: Limited visualization of the left kidney. Left kidney measures 6.1 cm. The cortex is echogenic. There are probable tiny echogenic calculi, without hydronephrosis. Left renal cysts, the largest measuring 1.4 x 1.4 x 1.4 cm, with probable thin septation.URINARY BLADDER: No significant abnormalities noted.OTHER: Incidentally noted simple hepatic cyst measuring 1.7 x 1.7 x 2.0 cm. Gallbladder with layering sludge, without evidence of acute inflammation.

Output: 1.Echogenic kidneys, compatible with medical renal disease. 2.Few bilateral renal calculi, probably mostly vascular given findings on CT chest 12/19/2015. No hydronephrosis. 3.Bilateral simple cysts and additional left cyst with probable thin septations, probably benign.


Instruction: Generate impression based on medical findings.

Input: Cirrhosis LIVER: Cirrhotic morphology again noted without mass. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow. Liver length 16 cm.BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 20 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 12.9 cm in lengthOTHER: Left kidney 12.8 cm in length. No ascites.

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


Instruction: Generate impression based on medical findings.

Input: 45-year-old male with umbilical hernia. Grayscale and color ultrasound of the anterior abdominal wall soft tissues demonstrates a fat-containing umbilical hernia which does not significantly change with Valsalva maneuver, and does not contain bowel. The hernia defect measures approximately 1.5 cm in diameter.

Output: Fat-containing umbilical hernia as described above.


Instruction: Generate impression based on medical findings.

Input: 51-year-old female patient with upper quadrant pain, ascites. LIVER: The liver measures 14.1 cm in length. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.2 m/s.GALLBLADDER, BILIARY TRACT: The gallbladder is not visualized. There is no intra- or extrahepatic biliary ductal dilatation. The common bile duct measures 3 mm in diameter.PANCREAS: There is a 2.9 x 2.1 x 2.9 cm cystic lesion near the head of the pancreas with thick walls and dependent debris within it.RIGHT KIDNEY: The right kidney measures 10.1 cm in length. No evidence of hydronephrosis.OTHER: The left kidney measures 9.7 cm in length. No evidence of hydronephrosis.The spleen measures 7.3 cm in length.

Output: Cystic lesion near the head of the pancreas for which dedicated contrast enhanced CT is recommended.


Instruction: Generate impression based on medical findings.

Input: Hepatitis C. Large amount of ascites in the past. Hernia repair. A mild-to-moderate amount of ascites is identified.Cirrhotic liver with nodular contours and coarsened parenchymal echogenicity noted.

Output: Mild to moderate amount of ascites.


Instruction: Generate impression based on medical findings.

Input: 71 years old, Female, Reason: assess left renal cyst History: assess left renal cyst RIGHT KIDNEY: Kidney measures 9.5 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Previously described left renal mass in the upper/mid kidney is not visualized on this ultrasound examination. Kidney measures 9.3 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus.OTHER: No significant abnormalities noted.

Output: Previously described left renal mass or cyst is not well visualized on this ultrasound examination.


Instruction: Generate impression based on medical findings.

Input: 26-year-old female with sickle cell anemia, abdominal pain. Evaluate for cholelithiasis. LIVER: The liver is enlarged measuring 22 cm in length. No discrete hepatic lesions are identified.GALLBLADDER, BILIARY TRACT: Cholelithiasis without gallbladder wall thickening or pericholecystic fluid. No sonographic Murphy sign was elicited during the examination. There is no biliary ductal dilation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.SPLEEN: Measures 9.4 cm in length without focal lesion.OTHER: No significant abnormalities noted.

Output: 1.Cholelithiasis without evidence of acute cholecystitis.2.Hepatomegaly.


Instruction: Generate impression based on medical findings.

Input: 48-year-old male patient with chronic HCV. Evaluate for any suspicious lesions/findings. LIVER: The liver measures 13.8 cm in length. Hepatic parenchymal echotexture is slightly coarsened. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: There are no gallstones, gallbladder wall thickening, or pericholecystic fluid. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 5 mm in diameter.PANCREAS: The head and body of the pancreas demonstrate normal echogenicity. The tail is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 10.3 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 10.5 cm in length. No evidence of hydronephrosis.The spleen measures 8.9 cm in length.

Output: No hepatic mass is identified.


Instruction: Generate impression based on medical findings.

Input: Assess for abdominal aortic aneurysm Extensive atherosclerotic calcification involving the abdominal aorta without evidence for significant aneurysmal dilatation. Maximal AP diameter of the abdominal aorta 2.2 cm

Output: Extensive atherosclerotic calcification involving the abdominal aorta without evidence for significant aneurysmal dilatation.


Instruction: Generate impression based on medical findings.

Input: Male 69 years old Reason: Patient has a AAA, and is a smoker. Please tell me if it's getting bigger History: AAA, asymptomatic ABDOMINAL AORTA: The proximal and mid aorta demonstrate a normal direction of flow without atherosclerotic changes. The distal aorta demonstrates a normal direction of flow. It is aneurysmally dilated (measurements below) with atherosclerotic plaques but stable in size compared to the prior study.Proximal: 2.2 x 3.0 x 2.4 cmMid: 2.3 x 2.6 x 2.3 cmDistal: 2.7 x 2.9 x 2.2 cmRight common iliac artery: 0.8 1.1 x 0.8 cmLeft common iliac artery: 0.9 x 1.1 x 1.0 cmOTHER: Note is made of a fatty liver.

Output: 1.Stable infrarenal abdominal aortic aneurysm.


Instruction: Generate impression based on medical findings.

Input: Reason: LLE cellulitis - assess for drainable fluid collection. Within the left lower extremity anteriorly along the lateral aspect at the area of palpable abnormality there is a hypoechoic somewhat heterogeneous irregular collection measuring 7 mm x 7 mm x 6 mm which may represent a possible small abscess.

Output: Possible small abscess as described above not be amenable to drainage.


Instruction: Generate impression based on medical findings.

Input: 13-year-old female with bilateral fibroadenomas; clinical decrease in size of the right breast mass with increase in size of the known left breast mass. On physical examination, an additional mass is noted within the lower left breast. Ultrasound is requested for characterization of the new left breast mass, and to demonstrate stability of the known bilateral masses. A targeted left ultrasound was performed for the palpable areas of concern. At the one o'clock position of the left breast, 3 cm from the nipple, there is redemonstration of a parallel, circumscribed oval hypoechoic mass measuring 2.1 x 0.9 x 2.2 cm (previously 1.1 x 0.5 x 1.1 cm). This mass demonstrates mild peripheral vascularity. At the 6 o'clock position of the left breast, 5 cm from the nipple, there is a parallel, circumscribed, oval hypoechoic mass measuring 1.7 x 0.7 x 1.4 cm. The mass demonstrates increased vascularity.A targeted right ultrasound is performed for the palpable area of concern. At the 10 o'clock position of the right breast, 2 cm from the nipple, there is a 1.5 x 0.6 x 1.9 cm parallel, macrolobulated hypoechoic mass decreased in size from prior examination (previously 2.1 x 1.2 cm). This mass demonstrates minimal peripheral vascularity.

Output: 1. Increase in size of the previously demonstrated mass at the one o'clock position of the left breast, measuring 2.2 cm on today's examination. This finding likely represents a fibroadenoma. 2. New circumscribed hypoechoic mass at the 6 o'clock position of the left breast measuring 1.7 cm. This finding likely represents a fibroadenoma. 3. Decrease in size of the previously identified right breast mass now measuring 1.9 cm, corresponding to biopsy proven fibroadenoma.BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old. S/p cystectomy+ileal conduit now with acute renal failure. RIGHT KIDNEY: The right kidney measures 12.2 cm in length, with increased cortical echogenicity. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.2 cm in length, with increased cortical echogenicity. Slight left renal pelvic fullness. No hydronephrosis or shadowing stones.OTHER: The urinary bladder is surgically absent.

Output: Increased renal cortical echogenicity, compatible with medical renal disease or parenchymal dysfunction. No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 48-year-old male with right vocal cord small cell carcinoma. Evaluate for thyroid mass/neuroendocrine tumor. Thyroid incompletely imaged due to substernal extent.RIGHT LOBE MEASUREMENTS: 4.7 x 3 x 6.8 cmLEFT LOBE MEASUREMENTS: 5.3 x 4.1 x 8.5 cmISTHMUS MEASUREMENTS: 1.3 cmRIGHT LOBE: Enlarged and diffusely heterogeneous in echotexture. There is a 1 x 0.7 x 1.1 cm nodule which is predominantly isoechoic with the remainder of the thyroid and with an incomplete hypoechoic rim.LEFT LOBE: Enlarged and diffusely heterogeneous in echotexture. Complex cystic nodule in the mid left lobe measuring 0.6 x 1.4 x 1.4 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: At level 3-4 on the right there is a 1 x 1.8 x 1.3 cm lymph node which is more rounded than typical and without definite hilum. Second nondescript and smaller node at level 3 on the right.OTHER: Extensive, incompletely occlusive thrombus in the right internal jugular vein associated with catheter.

Output: Goiter with substernal extension. Solid right nodule, complex cystic left nodule. Right nodule would be amenable to biopsy if desired.At least one abnormal-appearing right cervical lymph node at level 3-4.Extensive thrombus right internal jugular vein.These results were discussed with Maureen Crowley, pager 5508 at 11:30 AM.


Instruction: Generate impression based on medical findings.

Input: 38-year-old male with neuro muscular dysfunction of bladder. RIGHT KIDNEY: The right kidney is difficult to visualize due to severe scoliosis, an accurate length cannot be assessed. However, no hydronephrosis or gross shadowing calculus or mass.LEFT KIDNEY: The left kidney measures 9.3 cm in length. Echotexture is normal. No hydronephrosis, shadowing calculus or mass.URINARY BLADDER: No significant abnormalities noted. Bilateral ureteral jets identified.OTHER: No significant abnormalities noted.

Output: Stable appearance the kidneys and bladder. No hydronephrosis or bladder wall thickening.


Instruction: Generate impression based on medical findings.

Input: Increasing LFTs LIVER: Mildly coarse heterogeneous echotexture without mass. Liver length 18 cmGALLBLADDER, BILIARY TRACT: Gallbladder sludge and stones without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. Right kidney 10.3 cm in length OTHER: Left kidney 10.7 cm in length. Spleen 12.8 cm in length. No ascites.

Output: Mildly coarse heterogeneous echotexture suggestive for parenchymal dysfunction/fatty infiltration without mass or ductal dilatation. Gallbladder sludge and stones without acute inflammation. No ascites.


Instruction: Generate impression based on medical findings.

Input: 72-year-old female with chronic viral hepatitis and cirrhosis. Evaluate for hepatocellular carcinoma. LIVER: Overall hepatic size is within normal limits. The hepatic contour scalloped with enlargement of the left lobe and caudate consistent with cirrhosis. Echotexture is highly heterogeneous. No focal mass is identified. Main portal vein is patent with appropriate flow direction.BILIARY TRACT: No biliary tract dilatation. Gallbladder appears unremarkable without cholelithiasis, wall thickening or pericholecystic fluid.PANCREAS: Prominence the pancreatic duct, likely within normal limits.SPLEEN: Upper normal to mildly enlarged.RIGHT KIDNEY: Echogenic without hydronephrosis. OTHER: Left kidney is echogenic with mild prominence of the upper pole renal collecting system which is unchanged from prior renal ultrasound dated 4/13/2015Trace ascites.

Output: Cirrhotic liver without mass.Echogenic kidneysTrace ascites


Instruction: Generate impression based on medical findings.

Input: Inflammatory bowel disease with abdominal pain and fatigue LIVER: No significant abnormalities noted. 15.4 cm in length BILIARY TRACT: Probable adenomyomatosis of gallbladder. No evidence for acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 10.9 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 10 cm in lengthOTHER: Left kidney 11.2 cm in length. No ascites.

Output: Probable adenomyomatosis of gallbladder without evidence for acute inflammation or ductal dilatation. No acute hepatobiliary abnormality. No ascites.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with history of hepatitis C. LIVER: Mildly increased echogenicity of the liver parenchyma, without focal mass or other significant abnormality. The liver measures approximately 16 cm in length.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. Right kidney measures 9.6 cm.OTHER: Status post splenectomy. Left kidney measures 10 cm.

Output: No focal masses or findings of portal hypertension.


Instruction: Generate impression based on medical findings.

Input: Hydronephrosis seen on outside imaging RIGHT KIDNEY: 11.3 cm in length. Unremarkable renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: 12.8 cm in length. Unremarkable renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.NEOBLADDER: Collapsed. OTHER: No significant abnormality noted.

Output: No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: History of right renal calculus. RIGHT KIDNEY: The right kidney measures 11.3 cm in length with minimal pelvicalyceal fullness and splaying, improved from the prior. No shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow.LEFT KIDNEY: The left kidney measures 12.1 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow.URINARY BLADDER: Normally distended urinary bladder. A right ureteral jet is noted.OTHER: No significant abnormalities noted.

Output: Minimal pelvicalyceal fullness and splaying on the right, improved from the prior. No shadowing nephrolithiasis or discrete lesion.


Instruction: Generate impression based on medical findings.

Input: 61-year-old alcoholic cirrhosis of liver without ascites screen for HCC LIVER: Liver measures 17 cm, mild heterogenous echotexture with mild nodularity suggestive of cirrhotic morphology without any focal lesions. No intrahepatic delivery ductal dilatation.GALLBLADDER, BILIARY TRACT: Common bile duct measures up to 3 mm. The gallbladder is well distended without gallbladder wall thickening. No evidence of gallstones.PANCREAS: No significant abnormalities noted.KIDNEY: Right kidney measures 9 cm the left kidney measures 10 cm. No hydronephrosis or focal lesions. Previously described left renal stone is not seen on today's imagingOTHER: Spleen measures 11 cm without any focal lesions.

Output: Cirrhotic morphology of the liver without any focal lesion. No ascites.


Instruction: Generate impression based on medical findings.

Input: 40 year old female with history of cervical cancer. Elevated creatinine and history of hydronephrosis. RIGHT KIDNEY: The right kidney measures 14.5 cm in length. There is moderate hydronephrosis, increased from the prior studies. No shadowing calculus or discrete lesion is evident. Color Doppler demonstrates hilar blood flow.LEFT KIDNEY: The left kidney measures 14.4 cm in length with minimal collecting system prominence, similar to the prior study. Color Doppler demonstrates hilar blood flow. No focal lesion or shadowing calculus is identified.URINARY BLADDER: The urinary bladder is partially distended. No ureteral jets are visualized.OTHER: No significant abnormalities noted.

Output: Moderate right hydronephrosis has slightly progressed and minimal left collecting system prominence is similar to the prior study.These findings were relayed to the ordering service (Dr. Hassenfritz) at 1010 on 01/07/2015.


Instruction: Generate impression based on medical findings.

Input: 81 year-old female who is recalled from screening for further evaluation of focal asymmetry with calcifications in the retroareolar right breast. No current breast complaints. RIGHT BREAST DIGITAL DIAGNOSTIC MAMMOGRAM: Right breast ML and two spot compression views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. The right retroareolar focal asymmetry with calcifications partially disperses with spot compression.RIGHT BREAST ULTRASOUND: On physical examination, no palpable masses were present of the right breast. Targeted right breast ultrasound at the 9 o'clock position demonstrates no suspicious solid or cystic mass.

Output: High probability benign focal asymmetry in the right retroareolar region. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended in 6 months. Results and recommendation were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (6 Months).


Instruction: Generate impression based on medical findings.

Input: Thrombocytopenia; right heart failure LIVER: Coarse heterogeneous liver without mass. Liver length 17.9 cm. Prominent hepatic veins. Limited Doppler interrogation demonstrates a patent main portal vein with normal directional flow.BILIARY TRACT: Prominent extra hepatic duct without intrahepatic ductal dilatation.. Gallbladder not visualized.PANCREAS: No significant abnormalities noted.SPLEEN: 17.3 cm in lengthRIGHT KIDNEY: Mild cortical atrophy. Right kidney 10.3 cm in length. No hydronephrosis. OTHER: Mild left renal cortical atrophy. Left kidney 10.7 cm in length. No ascites.

Output: Coarse heterogeneous liver with prominent hepatic veins consistent with liver congestion. No mass or intrahepatic ductal dilatation. Mild splenomegaly. Bilateral renal cortical atrophy without hydronephrosis. No ascites.


Instruction: Generate impression based on medical findings.

Input: Known history of myeloid circumflex, with palpable area of concern marked by the clinical service in the right axilla. A targeted ultrasound was performed for the right axillary palpable area of concern marked by the service. At this site, there is a superficially located predominantly hyperechoic area measuring 9 x 8 mm which is highly suggestive of a benign process like fat necrosis. There is no solid or cystic mass identified.

Output: Hyperechoic area in the right axilla is highly suggestive of fat necrosis. Further management for this finding will be directed by Dr. Jaskowiak. If clinically desired, ultrasound-guided biopsy can be performed.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation.


Instruction: Generate impression based on medical findings.

Input: Ms. Patti Tyc is a 53 years old female with a personal history of palpable lump in the left breast of 2 weeks duration. History of cysts. MAMMOGRAM: Three standard views of both breasts and 2 additional spot compression views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses(BiRads Density Category C), unchanged in pattern and distribution. A triangular marker is placed at 12 o'clock position of left breast, indicating the area of palpable concern. A multilobular mass or multiple adjacent masses are noted in the 12:00 position of the left breast, corresponding to the palpable concern. Another smaller focal asymmetry is noted in the 6:00 position of the left breast. In the right breast upper outer quadrant, there is a focal asymmetry noted in the posterior depth, likely an additional cyst given her history of cysts. Elsewhere, stable benign masses scattered in each breast are noted. ULTRASOUND:On physical examination, a mass is palpated in the left breast 12:00 position.A targeted left ultrasound was performed for the palpable and new mammographic areas of concern. In the left breast, 12:00 position, 3 cm from the nipple, there is redemonstration of the clustered cyst, now measuring 2.5 x 2.0 x 2.7 cm (previously 1.8 x 1.7 x 1.2 cm), corresponding to the palpable and mammographic concern. In the left breast, 6:00 position 3 cm from the nipple, there is a 0.8 x 0.6 x 0.8 cm cyst, corresponding to the mammographic finding.A targeted right ultrasound was performed for the new mammographic area of concern. In the right breast, 10:00 position, 5 cm from the nipple, there is a 0.8 x 1.1 cm cyst, corresponding to the mammographic finding.

Output: No mammographic evidence of malignancy. Multiple cysts in both breasts. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: 65-year-old male with PET positive low, midline nodule in the neck on PET. Metastatic renal cell carcinoma to pancreas. RIGHT LOBE MEASUREMENTS: 4.3 x 1.7 x 1.6 cmLEFT LOBE MEASUREMENTS: 4.8 x 1.5 x 1.8 cm.ISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: In the upper pole of the right lobe of the thyroid there is a 0.3 x 0.4 x 0.5 nodule which is likely complex cystic.LEFT LOBE: Inseparable from the lower pole of the left lobe is a 1.5 x 1.1 x 1.7 cm rounded, vague and hypoechoic but mildly heterogeneous mass. This may be exophytic, arising from the lower pole or even potentially extra thyroidal. Two small cystic nodules are present within the left lobe as well.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Prominent, morphologically normal level 3 lymph node on the right measuring 0.8 x 1.6 x 1.5 cm.OTHER: At midline in the suprasternal region there is a hypoechoic mass with some central increased echogenicity. This measures 1.5 x 1.9 cm corresponding to the PET positive abnormality. This appears separate from thyroid.

Output: PET positive abnormality corresponds to a suprasternal, solid mass.Vague, hypoechoic mass lower pole left lobe of the thyroid.


Instruction: Generate impression based on medical findings.

Input: Evaluate for thyromegaly RIGHT LOBE MEASUREMENTS: 6. 2 x 2 x 2 cm, heterogenous echotextureLEFT LOBE MEASUREMENTS: 5.1 x 2.7 x 2.7 cm, heterogenousISTHMUS MEASUREMENTS: 1.1 cmRIGHT LOBE: 2 subcentimeter nodules identified in the right lobe mid pole, one which appears completely cystic and measures 6 x 4 x 5 mm and the other nodule that appears hypoechoic/solid that measures 7 x 5 x 3 mm.LEFT LOBE: Large heterogenous lobulated solid mass with microcalcifications involving the mid to inferior pole of the left lobe measures 1.6 x 2 x 1.9 cm. A second solid nodule has been measured in the midpole which appears to be contiguous with the larger inferior pole nodule. A cystic small nodule in the midpole measures 9 x 5 x 6 mm.ISTHMUS: Solid nodule involving the isthmus measures 3.1 x 1.3 x 0.8 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Multiple enlarged level 3 and 4 left neck lymph nodes with effaced hila, largest measuring 5.7 x 1.2 x 2.5 cmLevel 2 and level 3 right neck lymph nodes with normal morphology noted.OTHER: No significant abnormality noted.

Output: Suspicious left inferior pole nodule with microcalcifications needs further evaluation with ultrasound-guided FNA. Multiple enlarged left level 3 and 4 neck nodes.