Instruction: Generate impression based on medical findings.

Input: 48-year-old female with abdominal pain and question calcification on an outside plain film. RIGHT KIDNEY: The right kidney measures 10.6 cm in length. Echotexture is normal. There is no hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: The left kidney measures 10.9 cm in length. There is a very small, septated cyst in the midportion of the left kidney. In the upper pole of the kidney extending to the periphery of the cortex there are shadowing calcifications. There is focal parenchymal loss adjacent to this. Findings are suggestive of chronic calyceal stones. No associated mass is identified.OTHER: Bladder is decompressed.

Output: Calcifications left kidney associated with parenchymal cortical loss. Presumably, chronic stone disease.


Instruction: Generate impression based on medical findings.

Input: 38-year-old male with history of hepatitis B. Evaluate for HCC. LIVER:Measures 14.5 cm. Parenchyma is coarse and echogenic. There is approximately 1.3 x 1.0 hyperechoic lesion seen in the right lobe that was not present on the prior study. It was only able to be imaged in one oblique plane. Otherwise, no ascites or intrahepatic biliary dilation. Portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: Gallbladder is nondistended. The wall measures 0.2 cm. No stones, sludge, or pericholecystic fluid. The common bile duct measures 0.2 cm.PANCREAS: Unable to fully evaluate due to overlying bowel gas.SPLEEN: Measures 11.0 cm without sonographic abnormalities.KIDNEYS: Right kidney measures 10.1 cm. Kidney measures 10.8 cm. Kidneys are mildly echogenic. No shadowing calculi, hydronephrosis, or focal mass. OTHER: No significant abnormality noted.

Output: 1. Hyperechoic lesion seen in the right lobe of the liver that was not present on the prior study of uncertain etiology. Further characterization with MRI is recommended.2. Increased, coarse echotexture of liver consistent with chronic liver disease/parenchymal dysfunction.3. Increased echogenicity of the kidneys consistent with medical renal disease/parenchymal dysfunction.


Instruction: Generate impression based on medical findings.

Input: Acute leukemia with hepatic dysfunction LIVER: Slightly increased echogenicity without mass. Liver length 17.5 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.6 cm in lengthOTHER: Left kidney 10.1 cm in length. Spleen 10.5 cm in length.

Output: Slightly increased echogenicity of liver parenchyma suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites.


Instruction: Generate impression based on medical findings.

Input: 46 year old female with pain along right of umbilicus. Evaluate for hernia. In the region of the palpable area noted by the patient along the right periumbilical area is a benign appearing lymph node measuring 1.8-cm x 1.0 cm x 0.3 cm. No solid or cystic masses noted in this region. No evidence of hernia.

Output: Benign appearing lymph node in the right periumbilical region corresponding to the palpable area noted by the patient.


Instruction: Generate impression based on medical findings.

Input: Right upper quadrant pain LIVER: No significant abnormalities noted. 14.9 cm in lengthGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.3 cm in lengthOTHER: Left kidney 11.2 cm in length. Spleen 8.4 cm in length. No ascites

Output: Cholelithiasis without acute inflammation or duct dilatation.


Instruction: Generate impression based on medical findings.

Input: 55-year-old male with transaminitis and and symptoms of new or failure. LIVER:The liver measures 19 cm in length. The liver is coarse with increased echogenicity. No new worrisome masses are seen. There is no intrahepatic ductal dilation. No ascites. The portal vein is patent with hepatopetal flow measuring 17.1 cm/s.GALLBLADDER, BILIARY TRACT: There is sludge seen within the gallbladder. The gallbladder wall measures 0.3 cm, this is normal. Negative sonographic Murphy sign. The common bile duct measures 0.3 cm.PANCREAS: The pancreas is not well-visualized due to bowel gas.SPLEEN: No significant abnormality noted.RIGHT KIDNEY: The right kidney measures 12.2 cm in length. The cortex has normal echogenicity. There is no hydronephrosis, stones, or new worrisome masses seen. LEFT KIDNEY: The left kidney measures 12.2 cm in length. The cortex is of normal echogenicity. There is no hydronephrosis, stones, or new worrisome masses noted within the left kidney.OTHER: There is a small right pleural effusion noted.

Output: 1. Mild hepatomegaly will coarse increased echogenicity within the liver which is compatible with fatty liver/parenchymal dysfunction. No worrisome masses. No intrahepatic ductal dilation, and no ascites is seen.2. Sludge is seen within the gallbladder without signs of cholelithiasis or acute cholecystitis.3. Small right pleural effusion is visualized.


Instruction: Generate impression based on medical findings.

Input: Female 70 years old; Reason: new onset ascites, evaluate liver and its vasculature History: ascites LIVER: Liver is normal in echotexture and echogenicity. No focal hepatic lesions. Hepatic length measures 17 cm. The main portal vein is patent with normal hepatopedal flow and a peak velocity of 25 cm/s. Hepatic veins appear prominent.GALLBLADDER/BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 3 mm. A small nonshadowing focus is noted in the gallbladder which is mobile, likely representing a stone. The common bile duct measures 1 mm in diameter. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 10.8 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. Thr right kidney measures 11.1 cm and has normal vascular flow. No hydronephrosis. The right kidney demonstrates slightly increased echogenicity.The left kidney is not wall visualized secondary to ascites. The left kidney measures 10.1 cm and has normal vascular flow. No hydronephrosis.OTHER: Moderate amount of ascites is noted in the upper quadrants. Enlarged heart is partially visualized.

Output: 1.Normal echotexture and echogenicity of the liver with moderate ascites in the upper quadrants.2.Partial visualization of the enlarged heart with enlarged hepatic veins, suggestive of right-sided heart failure.3.Cholelithiasis.4.Slight increased echogenicity of the right kidney, which is nonspecific and may be seen with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Palpable abnormality noted by patient in the right lateral breast. Bilateral painful breasts, right greater than left. Physical examination revealed a diffusely tender right breast without palpable mass or notable skin changes.A whole right breast ultrasound was performed with special attention paid to the patient’s area of concern. There is no solid or cystic mass identified. There is no sonographic abnormality noted otherwise.

Output: No sonographic abnormality identified. Clinical follow-up is recommended. Results and recommendations were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with left upper pole renal mass for further evaluation. RIGHT KIDNEY: The right kidney measures approximately 12.1 cm in length. No hydronephrosis, shadowing calculus or mass. Echotexture is normal.LEFT KIDNEY: The left kidney measures 12.3 cm in length. Echotexture is normal. No hydronephrosis or shadowing calculus. There is a very small cyst in the lower pole of left kidney. The mass identified on CT cannot be seen on today's ultrasound study due to position of the left kidney.OTHER: Large focus of accessory splenic tissue in the left upper quadrant.

Output: Left renal mass not adequately visualized between ribs.


Instruction: Generate impression based on medical findings.

Input: Abnormal liver enzymes LIVER: Numerous confluent bilobar metastases again noted. Liver length 21.6 cm. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. No ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.4 cm in lengthOTHER: Left kidney 12.6 cm in length. Spleen 17.4 cm in length. Trace ascites. Extensive porta hepatis and peripancreatic metastatic adenopathy again noted.

Output: Hepatosplenomegaly again noted with extensive bilobar metastatic hepatic lesions again noted. No ductal dilatation. Extensive regional metastatic adenopathy again noted. Trace ascites.


Instruction: Generate impression based on medical findings.

Input: 58 year-old female with anemia. Mildly prominent renal collecting systems on prior study. A targeted ultrasound was performed of the 4 quadrants of the abdomen and midline. There is a moderate volume of ascites. Small effusions.

Output: Moderate volume ascites. Ultrasound is inadequate for evaluation of a retroperitoneal bleed; CT is recommended when feasible if there is continued clinical concern of a retroperitoneal bleed.


Instruction: Generate impression based on medical findings.

Input: 74-year-old male patient with history of thyroid cancer and large high-grade adenoma. Surgically resected. RIGHT LOBE: Status post thyroidectomy without evidence of disease recurrence. An echogenic focus within the right thyroid bed is unchanged.LEFT LOBE: Status post thyroidectomy without evidence of disease recurrence.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A lymph node in the left thyroid surgical bed is not significantly changed in size measuring 1.3 x 0.4 x 0.4 cm. A benign morphology right level three lymph node measures 1.4 x 0.4 x 0.9 cm, previously 1.5 x 0.4 x 0.9 cm. There is a benign morphology left level two lymph node measuring 1.5 x 0.8 x 0.3 cm.OTHER: No significant abnormality noted.

Output: Status post thyroidectomy without evidence of disease recurrence.


Instruction: Generate impression based on medical findings.

Input: Female 94 years old; Reason: 94 yo F w/ new onset signs of heart failure, please eval for ascites and liver pathology History: abdominal distension LIVER: The liver measures 15.6 cm in length. There is coarse and 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. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 2.8 mm. No stones are seen. No pericholecystic fluid. The common bile duct measures 5.8 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 8.5 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 10.4 cm in length. The cortex has mildly increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 11.0 cm in length. The cortex has mildly increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: Of note, this exam is limited by body habitus and inability to optimally position the patient.

Output: 1. Mildly echogenic kidneys consistent with diffuse renal parenchymal dysfunction.2. No fluid or ascites noted.


Instruction: Generate impression based on medical findings.

Input: Asymptomatic female with dense breasts presents for whole breast ultrasound for dense breast screening. Family history of breast cancer in mother, diagnosed at the age of 77. 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: Female 33 years old; Reason: r/o thyroid cysts History: none RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 6.2 x 1.5 x 1.1 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 6.1 x 1.8 x 1.1 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.15 cm.RIGHT LOBE: No significant abnormality noted.LEFT LOBE: There are 2 nodules noted in the left lobe of the thyroid.Nodule 1: There is a round 0.7 x 0.4 x 0.6 predominantly cystic nodule in the superior aspect of the left lobe without microcalcifications or internal vascularity.Nodule 2: There is a complex round 0.8 x 0.4 x 0.3 predominately cystic nodule in the inferior aspect of the left lobe without microcalcifications or internal vascularity.ISTHMUS: No significant abnormality noted.LYMPH NODES: No suspicious adenopathy noted. OTHER: No significant abnormality noted.

Output: 1.Multinodular thyroid as above. Follow with serial ultrasounds.


Instruction: Generate impression based on medical findings.

Input: 54-year-old female patient with cirrhosis. Assess patency of blood vessels. HCC screening. LIMITED ABDOMENLIVER: The liver measures 15.6 cm in length, is nodular in contour, and demonstrates coarsened heterogeneous echogenicity. No focal hepatic lesion is identified.BILIARY TRACT: There are no gallstones, pericholecystic fluid, or gallbladder wall thickening. There is no intra or extrahepatic biliary ductal dilatation. The common duct measures 6 mm in diameter.PANCREAS: No significant abnormalities noted.SPLEEN: The spleen measures 16.6 cm in length. RIGHT KIDNEY: The right kidney measures 10.7 cm in length. No evidence of hydronephrosis.OTHER: The left kidney measures 11.1 cm in length. No evidence of hydronephrosis.

Output: 1. Cirrhotic morphology of the liver with complete reversal of the portal venous system. 2. Splenomegaly and numerous peripancreatic/perisplenic collateral vessels.


Instruction: Generate impression based on medical findings.

Input: 60-year-old female with thyroid nodules RIGHT LOBE MEASUREMENTS: 4.9 cm x 1.4 cm x 1.8 cmLEFT LOBE MEASUREMENTS: 4.8 cm x 1.7 cm x 1.9 cmISTHMUS MEASUREMENTS: 7 mm in thicknessRIGHT LOBE: Heterogeneous echotexture with multiple hypoechoic subcentimeter nodules.LEFT LOBE: Heterogeneous echotexture. Small hyperechoic nodule favors a benign etiology. Additional solid nodule at the mid pole measures 1.8 cm x 1.3 cm x 1.6 cm which is heterogeneous in appearance likely sequela of prior biopsy.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign appearing lymph nodes in the neck. No pathologic lymphadenopathy. OTHER: No significant abnormality noted.

Output: Heterogeneous thyroid gland with multiple subcentimeter hypoechoic nodules in the right lobe. Two solid nodules in the left lobe, one of which is small and hyperechoic favoring a benign etiology, and the other larger nodule which is heterogeneous in appearance likely sequelae of prior biopsy.


Instruction: Generate impression based on medical findings.

Input: 35-year-old female with epigastric pain. Evaluate gallbladder for stones, infection. LIVER: Normal echogenicity of the liver measuring 14.8 cm in length. No focal hepatic lesions. Main portal vein is patent with appropriate directional flow; peak velocity measures 0.3 m/sec.GALLBLADDER, BILIARY TRACT: Nonmobile echogenic focus with no acoustic shadowing along the gallbladder wall measures 4 mm x 3 mm consistent with a polyp. No gallbladder wall thickening. No pericholecystic fluid. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Tail of the pancreas obscured by overlying bowel gas. The remaining visualized portions are unremarkable.RIGHT KIDNEY: Measures 12.1 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Spleen measures 11.1 cm in length and is normal in echogenicity. Left kidney measures 12.3 cm in length. No hydronephrosis or shadowing calculi are noted.

Output: Subcentimeter gallbladder polyp.


Instruction: Generate impression based on medical findings.

Input: Neck pain over thyroid RIGHT LOBE MEASUREMENTS: 5.4 x 1.6 x 1.7 cmLEFT LOBE MEASUREMENTS: 4.6 x 1.3 x 1.9 cmISTHMUS MEASUREMENTS: 2 mmRIGHT LOBE: Multiple nodules identified in the right lobe, measuring less than 1 cm.Nodule 1 appears complex measures 0.6 x 0.5 x 0.6 cm, previously measured 0.5 x 0.3 x 0.5 cm.Nodule 2 appears partly cystic partly solid, measures 0.6 x 0.3 0.5 cm, previously measured 0.7 x 0.4 x 0.5 cm.LEFT LOBE: Subcentimeter nodules identified. A new nodule is also identified in the inferior pole which appears partly cystic partly solid, measuring 0.6 x 0.3 x 0.5 cm.Nodule 1 in the liver lower pole predominantly cystic with ringdown artifact measures 0.4 x 0.3 x 0.4 cm, previously measured 0.4 x 0.2 x 0.4 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Normal morphology lymph nodes especially level 2 and on the right lateral neck and level 2 and level 3 in the left neck are unchanged.OTHER: No significant abnormality noted.

Output: No increase in size of measured subcentimeter thyroid nodules. A new subcentimeter nodule identified in the left gland inferior pole. Continued surveillance is recommended. No dominant nodule noted.


Instruction: Generate impression based on medical findings.

Input: History of ulcerative colitis and prior abnormal LFTs. LIVER: The liver is normal in morphology, echogenicity and size, measuring 15 cm in length. No focal lesion or intrahepatic biliary ductal dilatation. Normal hepatopedal portal venous blood flow at 0.3 m/s. BILIARY TRACT: Normally distended gallbladder without gallbladder wall thickening, pericholecystic fluid, gallstones or focal tenderness. The common duct measures 3 mm, within normal limits.PANCREAS: No significant abnormalities noted of the pancreatic head and proximal body. Otherwise the pancreas is obscured by overlying bowel gas.SPLEEN: The spleen measures 9.3 cm without a focal lesion.RIGHT KIDNEY: The right kidney measures 12.1 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. OTHER: The left kidney measures 11.9 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion.

Output: Unremarkable right upper quadrant ultrasound.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate for cholecystitis History: Abdominal pain, nausea, vomiting. Also history of pancreatitis. LIVER: The liver measures 12.9 cm in length. The liver demonstrates increased parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.27 m/s.BILIARY TRACT: Cholelithiasis without associated 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: Within the proximal pancreatic body, there is a well-defined hypoechoic mass measuring 3.4 x 3.0 x 3.5 cm which appears solid but lacks visible internal vascularity. The more distal pancreas is obscured by bowel gas. The more proximal pancreatic duct does not appear dilated.SPLEEN: No significant abnormalities noted. The spleen measures 9.2 cm in length. RIGHT KIDNEY: Kidney measures 11.1 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 11.9 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No significant abnormalities noted.

Output: 1.Cholelithiasis without sonographic evidence of acute cholecystitis.2.Pancreatic lesion measuring up to 3.5 cm which is incompletely characterized. Differential considerations include pancreatic cancer or pseudocyst. MRCP is recommended for additional evaluation.3.Increased hepatic echogenicity suggestive of parenchymal dysfunction/fatty infiltration.Discussed with Dr. JACOBS, JEFFREY.


Instruction: Generate impression based on medical findings.

Input: Papillary thyroid carcinoma status post thyroidectomy RIGHT LOBE: Status post thyroidectomy. Stable 0.6 x 0.7 x 0.3 cm thyroidectomy bed hypoechoic focus.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. Stable subcentimeter right thyroidectomy bed hypoechoic focus


Instruction: Generate impression based on medical findings.

Input: Male 50 years old abdominal pain LIVER: The liver is coarse and hyperechoic consistent with fatty infiltration. No focal mass. Main portal vein is patent with normal directional flow and a peak velocity of 19.6 cm/s. No definite sonographic evidence of cirrhosis.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. Gallbladder is normal in appearance. No gallstones. Common bile duct is not well-visualized.PANCREAS: Head of the pancreas is normal in appearance without pancreatic ductal dilatation. Body and tail of the pancreas are obscured by overlying bowel gas.SPLEEN: Spleen is normal measuring 9.6 cm.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Right kidney measures 13.4 cm. Left kidney measures 13.2 cm. OTHER: No ascites.

Output: Coarsened hyperechoic liver is consistent with fatty infiltration.


Instruction: Generate impression based on medical findings.

Input: 53-year-old female status post lung transplant now with liver failure, coagulopathy, elevated LFTs. Evaluate liver blood flow. LIMITED ABDOMENLIVER: Increased echogenicity of the liver measuring 17.8 cm in length. No focal hepatic lesions. BILIARY TRACT: Gallbladder is filled with sludge. No gallbladder wall thickening. No pericholecystic fluid. No intra-or extrahepatic biliary ductal dilatation. PANCREAS: Visualized pancreas is normal in echogenicity. SPLEEN: Not well visualized.  RIGHT KIDNEY: Normal echogenicity measuring 9.6 cm in length. No hydronephrosis or shadowing calculi. OTHER: Normal echogenicity of the left kidney measuring 9.6 cm in length. No hydronephrosis or shadowing calculi. Perihepatic ascites.

Output: 1. Partial thrombus in main portal vein. No flow is seen in the common hepatic artery, left hepatic artery, and left portal vein. 2. Increased echogenicity of the liver suggestive of parenchymal dysfunction/fatty infiltration. Perihepatic ascites. 3. Gallbladder sludge. Findings were discussed with Dr. Todd Dodick by phone on 3/12/2015 at 3:25 PM.


Instruction: Generate impression based on medical findings.

Input: Reason: History of liver cyst. Needs monitoring LIVER: The liver measures 12.7 cm in length. Hyperechoic, homogenous hepatic parenchyma. The portal vein is patent with normal directional hepatopetal flow, peak velocity 20.1 cm/s. No focal mass. No cystic lesions are identified.GALLBLADDER, BILIARY TRACT: The gallbladder is distended and folded upon itself. No shadowing stones. No biliary ductal dilatation. Negative sonographic Murphy's sign.PANCREAS: The pancreatic duct measures 0.2 cm.RIGHT KIDNEY: The right kidney measures 8.9 cm in length. The left kidney measures 9.0 cm in length. No shadowing stones or hydronephrosis.OTHER: The spleen is heterogeneous, which is nonspecific on ultrasound but may be consistent with prior granulomatous disease.

Output: 1. Findings consistent with hepatic steatosis or parenchymal dysfunction. No focal cystic lesions or masses are identified.2. Heterogeneous appearing spleen which is nonspecific on ultrasound but may be consistent with prior granulomatous disease.


Instruction: Generate impression based on medical findings.

Input: No urine output. Decreased GFR. RIGHT KIDNEY: 14.4 cm in length. Increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: 13.6 cm in length. Benign-appearing 1.7 cm cyst again noted. Increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.BLADDER: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: 72-year-old male with acute kidney failure. Ultrasound guidance was provided for biopsy of left kidney.

Output: Ultrasound guidance.


Instruction: Generate impression based on medical findings.

Input: Male 65 years old Reason: Is there metastatic papillary thyroid carcinoma to the cervical lymph nodes bilaterally History: Papillary thyroid carcinoma LYMPH NODES: Patient has known, previously biopsied papillary thyroid carcinoma in the left thyroid lobe. Multiple small, benign-appearing lymph nodes are again seen. These lymph nodes are all subcentimeter with normal fatty hila. Based on small size and benign appearance of lymph nodes, biopsy of these lymph nodes is felt to be unnecessary. Discussed with patient and ordering physician.Incidental note is made of a tardus parvus waveform in the right common carotid.OTHER: No significant abnormality noted.

Output: 1.Multiple small benign-appearing lymph nodes, all of which are subcentimeter in short axis. Discussed with patient and Dr. Grogan.2.Tardus parvus waveform in the right common carotid. Recommend dedicated carotid duplex.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male with history of thyroid cancer. Evaluate for recurrence. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: No masses in the thyroid bed.LEFT LOBE: No masses in the thyroid bed.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: At level 1B on the left, there are 2 rounded hypoechoic masses which are adjacent, one measuring 0.8 x 0.8 x 0.9 cm and the second 0.6 x 0.8 x 0.7 cm. These do not have normal nodal morphology and are rounded in nature, and therefore worrisome for nodal recurrence given the position. It is also possible that this represents a single lobulated mass. OTHER: No significant abnormality noted.

Output: Abnormal lymph nodes left neck. No abnormality in the thyroid beds.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for fluid collection History: swelling around transplanted kidney RENAL TRANSPLANT: 11.3 cmLOCATION: Right iliac fossaPERITRANSPLANT TISSUES: There is a complex appearing perinephric collection with multiple septations along the right lateral aspect of the iliac fossa transplant.. This measures 3.1 cm in width and 5.7 cm in craniocaudal dimension. There is 1 cm simple fluid medial to the transplant.KIDNEY: No parenchymal lesions. Normal cortical medullary differentiation.COLLECTING SYSTEM/URETER: No hydronephrosis.URINARY BLADDER: Not visualized.VASCULAR DOPPLER DATA: Color Doppler were performed on inflow and outflow vessels No significant abnormality notedOTHER: No significant abnormality noted

Output: Complex perinephric fluid collection measuring up to 5.7 cm, likely a resolving hematoma.


Instruction: Generate impression based on medical findings.

Input: Mr. Cochran is a 63-year-old man presenting for ultrasound-guided biopsy of a previously identified right high axillary mass. A targeted right axillary ultrasound was performed for the previously identified axillary mass on ultrasound from 11/11/2015. After thorough examination of the high right axillary region, no such mass was able to be reproduced on today's examination. In addition, a second radiologist confirmed the absence of this axillary mass.At this point, a decision was made to abort the exam as no such mass could be reproduced on today's examination.

Output: No sonographic evidence of malignancy in the high right axillary region. The patient should follow up with his primary care physician as clinically warranted. BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on medical findings.

Input: sacral cellulitis concern for abscessVIEW: Ultrasound of the gluteal region Dedicated ultrasound of the gluteal region superior to the gluteal cleft was performed. There is a small hypoechoic area measuring 2.2 x 1 cm at this region. There is marked soft tissue edema.

Output: Hypoechoic area superior to the gluteal cleft which may represent a phlegmon. There is no drainable fluid collection.


Instruction: Generate impression based on medical findings.

Input: Abnormal coagulation profile LIVER: Coarse echogenic liver echotexture without mass. Liver length 25 cm. Limited interrogation of main portal vein demonstrates a patent main portal vein with normal directional flow.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 13 cm in lengthOTHER: Left kidney 12.8 cm in length. Spleen 18.8 cm in length.

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


Instruction: Generate impression based on medical findings.

Input: Ms. Victorya Harlan is a 29 year old female presents for evaluation of a palpable and painful concern in her right breast. As she has a strong family history of breast cancer in her mother (diagnosed at the age of 32), maternal great aunt, maternal great great aunt, paternal great aunt, paternal grandmother, and paternal great grandmother. ULTRASOUND:On physical examination, no discrete mass is palpated.A targeted right ultrasound was performed for the palpable area of concern, which is at the 6:00, 7 cm from the nipple.. There is no solid or cystic mass identified.

Output: No mammographic evidence of malignancy. Further evaluation of a clinically suspicious abnormality should not delayed by negative imaging. Rather, negative imaging may serve to reinforce a negative clinical impression. Therefore, continued clinical management is recommended. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually at age of 40 or based on patient's risk assessment. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: History of right lumpectomy and reconstruction. New palpable area of concern in the medial inferior right breast marked by the clinical service. A targeted right ultrasound was performed for the area marked by the clinical service. There is a mixed echogenicity lesion, predominantly cystic in appearance, with hyperechoic components as well. This measures 1.0 x 1.1 cm. The finding is likely related to fat necrosis/oil cyst formation.

Output: Findings are most compatible with fat necrosis/oil cyst formation. The patient will be following up with Dr. Jaskowiak today for further management which will include palpably guided FNA.BIRADS: 3 - Probably benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Abdominal pain LIVER: Non-cirrhotic liver morphology. Normal parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Normal appearance of the gallbladder. No sonographic Murphy's sign.OTHER: No perihepatic free fluid identified.

Output: Normal appearing gallbladder and biliary ducts.


Instruction: Generate impression based on medical findings.

Input: Fifth finger injury The central slip is visualized inserting upon the tuberosity at the base of the middle phalanx dorsally and there is no evidence of central slip disruption. The tendon appears slightly enlarged and edematous which may represent a mild strain, but this is equivocal. The overlying subcutaneous soft tissues also appear edematous. The ulnar collateral ligament appears edematous, perhaps representing a mild sprain.

Output: Possible mild edema of the central slip extensor tendon but without evidence of tear.


Instruction: Generate impression based on medical findings.

Input: 43-year-old male with history of acute kidney injury. RIGHT KIDNEY: Measures 9.7 cm in length. 1.2 cm right renal cyst without septation or nodular component. Increased echogenicity without hydronephrosis, calculus or solid mass.LEFT KIDNEY: Measures 10.2 cm in length. 3.3 x 3.0 cm left renal cyst without septation or nodular component. Increased echogenicity without hydronephrosis, calculus or solid mass.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.

Output: Increased renal echogenicity consistent with medical renal disease. No hydronephrosis or nephrolithiasis. Renal cysts as described above, without suspicious features.


Instruction: Generate impression based on medical findings.

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

Output: Status post thyroidectomy without mass or regional adenopathy


Instruction: Generate impression based on medical findings.

Input: 42 year-old female with small palpable nodule in the subcutaneous tissues of the right shoulder. Ultrasound evaluation in the region of the palpable abnormality demonstrates a very small immediately subcutaneous hypoechoic nodule. Differential considerations include small lipoma or sebaceous cyst, measuring 6 mm in maximum diameter.

Output: Small, superficial nodule, likely sebaceous cyst or lipoma.


Instruction: Generate impression based on medical findings.

Input: 76-year-old female with chronic kidney disease, stage V. Evaluate for hydronephrosis. RIGHT KIDNEY: The right kidney is highly echogenic consistent with parenchymal disease. Size is difficult to measure due to echotexture but on today's study the kidney appears to measure approximately 10.5 cm in length, larger than on the prior study due to poor visualization. There are multiple simple-appearing cysts present, the largest measuring 3.2 cm in greatest diameter. No hydronephrosis, shadowing calculus or solid mass.LEFT KIDNEY: The left kidney is highly echogenic consistent with parenchymal disease. Size is difficult to measure but the kidney approximates 9.3 cm in length. There are multiple simple-appearing cysts present, the largest measuring 2.4 cm in greatest diameter. There is no hydronephrosis, shadowing calculus or solid mass.OTHER: Bladder is decompressed.

Output: Highly echogenic kidneys as noted previously. There has been interval enlargement of renal cysts.


Instruction: Generate impression based on medical findings.

Input: Right upper quadrant pain. Pancreatic mass. Status post ERCP. LIVER: Diffusely heterogeneous parenchymal echogenicity with focal lesions suggestive of metastatic disease. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: The biliary ductal dilation is markedly decreased status post stent placement. Cholelithiasis. No gallbladder wall thickening or sonographic Murphy's sign.PANCREAS: Pancreatic head prominence compatible with the patient's known pancreatic head mass is partially visualized due to overlying bowel gas. KIDNEYS: The right kidney is 6.0 cm in length. The left kidney is 5.8 cm in length. The renal parenchyma is markedly echogenic. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 8.3 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted.

Output: 1. Decreased biliary ductal dilation status post stent placement.2. Cholelithiasis without specific evidence of cholecystitis.3. Diffusely heterogeneous liver lesions suggestive of metastatic disease.4. Diminutive kidneys with echogenic renal parenchyma, compatible with chronic renal disease.


Instruction: Generate impression based on medical findings.

Input: HCC screening. Cirrhosis. LIVER: Grossly unremarkable liver morphology. 12.3 cm in length. Slightly coarsened hepatic echogenicity, compatible with parenchymal dysfunction. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. 14 mm gallstone noted. Otherwise unremarkable appearance of the gallbladder.PANCREAS: No sonographic abnormality evident in the visualized pancreatic head and neck. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney is 10.8 cm in length. A 3.7 cm cyst is noted in the inferior pole, with an echogenic focus, possibly representing a calcified septation.The left kidney is 10.6 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 12.5 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No abdominal free fluid is identified.

Output: 1. No suspicious hepatic lesions identified.2. Cholelithiasis.


Instruction: Generate impression based on medical findings.

Input: 50-year-old female with nausea and vomiting, abdominal pain LIVER: Measures 17.6 cm in length. Coarse liver without discrete focal lesion.BILIARY TRACT: Status post cholecystectomy. No biliary ductal dilation.PANCREAS: Portions of the pancreas are not clearly seen due to body habitus and bowel gas. The imaged portions of the pancreas are unremarkable.SPLEEN: No significant abnormalities noted.KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.

Output: Coarse liver. Status post cholecystectomy. Otherwise, no specific findings to account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: History oncocytoma and right renal lesion RIGHT KIDNEY: 3.1 x 2.3 x 3.3 cm solid mass arising from the lower pole the right kidney again noted and relatively unchanged from the recent CT. No stone or hydronephrosis. Right kidney 10.1 cm in lengthLEFT KIDNEY: 7.5 x 7.5 x 7.2 cm solid mass arising from the upper pole the left kidney again noted unchanged from the recent CT. No hydronephrosis. No stone. Left kidney 12.2 cm in length.OTHER: Bladder nondistended

Output: No change in bilateral solid renal masses. No hydronephrosis or stone.


Instruction: Generate impression based on medical findings.

Input: Acute renal insufficiency RIGHT KIDNEY: Unremarkable echogenicity for age. No worrisome mass, stone, or hydronephrosis. Minimally complex cysts. Right kidney 12.6 cm in lengthLEFT KIDNEY: Unremarkable echogenicity for age. No worrisome mass, stone, or hydronephrosis. Minimally complex cysts. Left kidney 11.3 cm in lengthOTHER: Enlarged prostate. Bladder nondistended.

Output: No evidence for worrisome renal mass, stone, or obstruction.


Instruction: Generate impression based on medical findings.

Input: 33-year-old male with Burkitt's lymphoma and HIV and chemotherapy with right groin swelling and pain. Limited evaluation of the right groin demonstrates a highly complex and capsulated fluid collection with internal septation measuring approximately 3.3 X 6 x 6 cm. No gross internal flow by color Doppler

Output: Complex fluid collection right groin. Differential considerations would include a hematoma/infected hematoma, frank abscess or even suppurative lymph node.


Instruction: Generate impression based on medical findings.

Input: Provided history of right upper quadrant pain. Status post cholecystectomy. LIVER: The liver parenchyma is coarse and mildly echogenic compatible with fatty infiltration. The liver measures 15.2 cm in craniocaudal dimension, within normal limits. No focal lesion is identified. Focal fatty sparing near the falciform ligament. Normal hepatopedal portal venous blood flow at 0.3 m/s.BILIARY TRACT: The patient is status post cholecystectomy. The common bile duct measures 4 mm in caliber, within normal limits.PANCREAS: The visualized pancreatic head is unremarkable. The remainder of the pancreas is obscured by overlying bowel gas shadowing.SPLEEN: The spleen is normal in size without a focal lesion, measuring 10.5 cm.RIGHT KIDNEY: The right kidney is normal in size and appearance measuring 11.3 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. OTHER: The left kidney is normal in size measuring 10.8 cm without hydronephrosis, shadowing nephrolithiasis or discrete lesion.

Output: Findings compatible with fatty infiltration of the liver without a focal lesion or biliary ductal dilatation.


Instruction: Generate impression based on medical findings.

Input: 62 year old female. History of thyroid cancer with new positive TG antibodies. Also biochemical evidence of hyperparathyroidism. Please assess thyroid bed lymph nodes and parathyroids. Thyroid has been surgically resected. Echogenic soft tissue focus just inferior to the left thyroid bed in the supraclavicular region is 0.9 x 0.7 x 0.5 cm, previously 1.1 x 0.7 x 0.5 cm, unchanged. No internal vascularity in this lesion on Doppler exam.PARATHYROID GLANDS: No lesions suspicious for a parathyroid adenoma are identified.LYMPH NODES: Benign-appearing left level 3 lymph node is 1.9 x 1.1 x 0.6 cm. No suspicious or enlarged lymph nodes are identified.OTHER: No significant abnormality noted.

Output: Stable echogenic soft tissue focus in the left supraclavicular region. Benign-appearing left level 3 lymph node. No new masses or lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Status post LVAD with history of drive line infection. There is 1.9 x 2.3 cm hypoechoic fluid collection extending superficially from the drivelineto the skin surface, new from the prior study. This may follow the tract of previous instrumentation. There are no significant surrounding hyperemic changes.

Output: Fluid tracking from the transplant to the skin surface. Superinfection of this fluid cannot be ruled out. The fluid may be filling a tract from prior instrumentation.


Instruction: Generate impression based on medical findings.

Input: Ms. Dalrymple is a 68 year old female with a personal history of benign right cyst aspiration in 2013. Family history of breast cancer in mother, diagnosed at the age of 48. She currently presents for ultrasound evaluation of a palpable mass was detected by Dr. Jaskowiak. Upon physical exam of the left breast, a site has been marked on the skin at the area of palpable concern. Targeted left breast ultrasound was performed. In the left breast 10:30 location, approximately 10 cm from the nipple, there is a oval hyperechoic mass measuring 1.1 x 0.5 x 0.8 cm. There is no associated vascularity. Sonographic findings are compatible with fat necrosis.

Output: Benign fat necrosis of the left breast. No sonographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. All results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: 60-year-old female patient with biopsy-proven left breast IDC on chemotherapy. UNILATERAL LEFT DIAGNOSTIC MAMMOGRAM:Three standard 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(BiRads Density Category A), unchanged in pattern and distribution. Again seen is in irregular mass with spiculated margins in the left lower outer breast that measures 1.4 x 1.7 cm on CC view, previously 1.8 x 2.1 cm when measured similarly. A percutaneous clip is noted along the posterior margin of the mass. Few benign calcifications are noted distant from the mass.In the left axilla there is a percutaneous clip immediately posterior to a lymph node that measures 0.7 x 1.0 cm, previously measuring 1.4 x 1.9 cm.LEFT BREAST AND AXILLARY ULTRASOUND:In the 4:00 position 5 cm from the nipple there is an irregular hypoechoic mass that measures 1.5 x 1.4 x 1.8 cm, previously 2.2 x 2.2 cm on ultrasound dated 09/18/2015.In the left axilla there are two abnormal appearing lymph nodes. One lymph node measures 0.8 x 0.7 x 0.8 cm. The previously biopsied lymph node with posterior clip measures 1.6 x 0.5 x 0.6 cm, previously measuring up to 1.6 cm on 10/08/2015. However, this lymph node node is decreased in volume compared to prior.

Output: Interval decrease in size of known left breast cancer as well as interval decrease in size of left axillary lymph nodes. Findings were discussed with the patient.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Ms. Toy is a 46-year-old female who presents for short-term follow-up of mass in upper outer quadrant of left breast. A targeted left ultrasound was performed at the site of the previously described mass.In the left breast 1:00 location, approximately 4 cm the nipple, there is a circumscribed, lobulated hypoechoic mass most likely representing a benign fibroadenoma measuring 1.2 x 0.7 x 1.0 cm, previously 1.2 x 0.6 x 1.0 cm.

Output: High probability benign mass of the left breast, likely representing a fibroadenoma. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram and possible left breast ultrasound is recommended in 6 months in order to ensure stability of these findings. All results and recommendation were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on medical findings.

Input: Male 59 years old Reason: Patient w/ recent PD cath removal, notes abd distension, fluid, concern for passive hepatic congestion vs dwelling dialysate History: abd distension LIVER: Increased liver echogenicity with a mildly coarse appearance which can be secondary to fatty infiltration or diffuse hepatic dysfunction. No focal mass. Liver measures 16.1 cm. Main portal vein is patent with normal directional flow and a normal waveform. Peak velocity at the portal vein is 35 cm/s. No specific evidence of cirrhosis.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. The gallbladder appears contracted with shadowing stones. The gallbladder wall is slightly thickened measuring 4 mm, however this is likely secondary to contraction. Common bile duct measures 5 mm. Negative Murphy's sign.PANCREAS: Visualized portions of the pancreas are normal in appearance.SPLEEN: Spleen is slightly enlarged measuring 14.9 cm. Small splenule is present.KIDNEYS: Kidneys are atrophic and echogenic. No hydronephrosis or mass is identified. OTHER: Large volume ascites with multiple septations, some of which may be loculated.

Output: 1.Large volume ascites with septations, suggesting it may be loculated.2.Nonspecific mildly increased echogenicity of the liver may be secondary to fatty infiltration or diffuse hepatic dysfunction. Portal vein is patent with normal directional flow.


Instruction: Generate impression based on medical findings.

Input: History of Crohn's disease with portal vein thrombosis LIVER: Diffusely heterogeneous coarse and echogenic liver parenchyma without mass. Liver length 17.5 cm Limited Doppler interrogation of the portal vein again demonstrates cavernous transformation of the portal veinGALLBLADDER, BILIARY TRACT: Status post cholecystectomy.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.7 cm in length OTHER: Left kidney 11.4 cm in length. Spleen 12.7 cm in length. No ascites.

Output: Diffusely heterogeneous coarse and echogenic liver parenchyma consistent with parenchymal dysfunction/chronic liver disease without mass or ductal dilatation. Cavernous transformation of the portal vein again noted.


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 suspicious 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: 54-year-old female recalled from baseline screening mammogram for an ovoid circumscribed mass in the upper outer quadrant of the right rest at mid depth. Family history of breast cancer in the patient's mother. An ML view and two spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD, 8.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Ovoid asymmetry persists on the spot compression view. The appearance is compared patible with a mass or cyst at the 2:00 position. Ultrasound: Targeted ultrasound performed for the area of mammographic concern at the 2:00 position of the right breast. There is a a 3 mm simple benign cyst at the 9:00 periareolar position at superficial depth.There is a 0.8 x 0.4 x 0.6 cm cyst located approximately 8 cm from the nipple along the 9:00 radian at mid to posterior depth. On transverse imaging, there are internal echoes which cannot be eliminated.

Output: Highly probable benign cyst at the 9:00 position of the right breast. Ultrasound-guided aspiration and repeat mammogram recommended both to confirm that this is a simple cyst and 2 prove that this explains the asymmetry on the mammogram. The results and recommendations were discussed with the patient at the completion of the exam, and the patient elected to schedule the procedure. She was instructed that our nurse will contact her to set up an appointment.BIRADS: 3 - Probably benign finding.RECOMMENDATION: H - Percutaneus Biopsy/Aspiration.


Instruction: Generate impression based on medical findings.

Input: 59-year-old female with noncirrhotic portal hypertension. HCC screening. Evaluate for cirrhosis. LIVER: The liver measures 23.2 cm in craniocaudal diameter, indicating hepatomegaly. Coarse echogenic liver parenchyma without focal lesion or mass. Portal vein with normal hepatopedal flow, peak velocity of 25.1 cm/s.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. The common bile duct measures 0.2 cm in diameter. Partially distended gallbladder containing shadowing intraluminal stones and no wall thickening (0.3 cm). Negative sonographic Murphy's sign.PANCREAS: The visualized portion of the pancreas are within normal limits. Limited visualization of the pancreatic body and tail due to overlying bowel gas.SPLEEN: The spleen measures 7 cm in length.RIGHT KIDNEY: The right kidney measures 10.6 cm in length. No hydronephrosis, masses, or shadowing calculi. OTHER: The left kidney measures 11.3 cm in length. No hydronephrosis, masses, or shadowing calculi.

Output: 1. Coarse echogenic liver parenchyma, consistent with chronic liver disease or parenchymal dysfunction. No discrete masses.2. Cholelithiasis without sonographic evidence for acute cystitis.


Instruction: Generate impression based on medical findings.

Input: 45-year-old female with known right breast mass, and clinical palpable findings within the right retroareolar region and right axilla presents for ultrasound examination. A targeted right ultrasound was performed for the palpable areas of concern. At the area of palpable concern at the 12 o'clock position of the right areolar border, there is a circumscribed anechoic cyst measuring 1.1 x 0.6 x 1.3 cm.Within the right axilla, for normal morphology lymph nodes are present in with normal fatty hila. The largest lymph node identified measures 1.2 cm and demonstrates thin cortex with normal fatty hilum and vascularity.

Output: 1. Simple cyst at the 12 o'clock position of the right breast, corresponding to area of palpable concern. 2. Normal right axillary lymph nodes.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: History of multinodular goiter by biopsy, patient states slowly enlarging RIGHT LOBE MEASUREMENTS: 7 x 3 x 2.8 cm, enlarged and heterogenousLEFT LOBE MEASUREMENTS: 0.9 x 1.1 x 2.1 cmISTHMUS MEASUREMENTS: 11 mmRIGHT LOBE: Multiple heterogenous nodules throughout the right perihilar gland, mostly in the mid to inferior pole. The largest nodule with few cystic changes measures 5 x 3.1 x 5.3 cm.LEFT LOBE: A small hypoechoic nodule identified in the midpole of the left lobe that measures 1 x 0.6 x 0.8 cm.ISTHMUS: A heterogenous nodule noted within the isthmus and measures 2.4 x 1.2 x 1.3 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No abnormal lymph nodes identified in the neckOTHER: No significant abnormality noted.

Output: Heterogenous multiple thyroid nodules predominantly in the right lobe and the isthmus most likely multinodular goiter. Comparison with prior ultrasound is recommended to confirm stability.


Instruction: Generate impression based on medical findings.

Input: 38-year-old female patient with history of thyroid nodules. RIGHT LOBE MEASUREMENTS: 5.4 x 1.4 x 1.5 cmLEFT LOBE MEASUREMENTS: 4.4 x 1.2 x 1.5 cmISTHMUS MEASUREMENTS: 6 mm in thicknessRIGHT LOBE: The right thyroid lobe is heterogeneous in echogenicity without dominant thyroid lesion. The gland is hypervascular on color Doppler imaging, unchanged.LEFT LOBE: The left thyroid lobe is heterogeneous in echogenicity without dominant thyroid lesion. The gland is hypervascular on color Doppler imaging, unchanged. ISTHMUS: There is a ovoid, solid hypoechoic nodule within the right isthmus measuring 0.6 x 0.4 x 1.1 cm, previously 0.7 x 0.5 x 0.2 cm. An additional solid hypoechoic nodule within the left isthmus measures 0.4 x 0.2 x 0.2 cm, previously 0.6 x 0.5 x 0.3 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There is a 1.3 cm right level 3/4 lymph node. There is a 0.4 x 0.4 x 0.8 cm lymph node inferior to the left thyroid lobe and left level II lymph node.OTHER: No significant abnormality noted.

Output: 1. Two solid hypoechoic nodules within the isthmus. 2. Hypervascular thyroid gland, which is unchanged; correlate with history of thyroiditis.


Instruction: Generate impression based on medical findings.

Input: History of multinodular goiter, evaluate for change in nodules. RIGHT LOBE MEASUREMENTS: 6.9 x 3.4 x 3.1 cm.LEFT LOBE MEASUREMENTS: 5.6 x 2.2 x 2.3 cm.ISTHMUS MEASUREMENTS: Up to 0.6 cm in thickness.RIGHT LOBE: Heterogeneous echotexture with multiple nodules. Dominant mixed solid and cystic nodule centered in the mid pole measures 3.3 x 2.0 x 2.5 cm, unchanged.LEFT LOBE: Heterogeneous echotexture with multiple nodules. Dominant mixed solid and cystic inferior pole nodule measures 2.2 x 2.2 x 1.4 cm, previously 1.9 x 1.8 x 1.6 cm, perhaps minimally increased in size when allowing for differences in technique.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multinodular goiter appearing similar to prior examination. Minimal increase in size of benign-appearing left inferior pole dominant nodule.


Instruction: Generate impression based on medical findings.

Input: 74-year-old male with history of right adrenal mass and bilateral renal cysts. RIGHT KIDNEY: The right kidney measures approximately 10.4 cm, and demonstrates no hydronephrosis or shadowing stones. Several small cysts are seen. No internal vascularity, and no significant interval change.LEFT KIDNEY: Left kidney measures approximately 11.8 cm, without renal calculus or hydronephrosis. Several small cysts are again noted. No internal vascularity, and no significant interval change.OTHER: Urinary bladder is within normal limits, unchanged.Right adrenal nodule measures approximately 3.8 x 3 x 2.6 centimeters, nonspecific but likely myelolipoma and is unchanged.

Output: Multiple bilateral renal cysts and right adrenal myolipoma, unchanged.


Instruction: Generate impression based on medical findings.

Input: Nausea vomiting and elevated bilirubin LIVER: Coarse echogenic liver echotexture without mass. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow. Liver length 15.5 cmBILIARY TRACT: Mildly prominent extra hepatic duct without intrahepatic ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: Old splenic infarct. 11.2 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 8.9 cm in lengthOTHER: Left kidney 9.6 cm in length

Output: Coarse echogenic liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or significant ductal dilatation. No ascites.


Instruction: Generate impression based on medical findings.

Input: 36-year-old female with protruding palpable mass in epigastric region. Sonographic images of the subcutaneous tissues underlying the epigastric region show no focal mass in the area of palpable concern. Specifically, no cystic or solid lesion is identified. There is prominent subcutaneous fat. Underlying tissues are within normal limits. No free fluid.

Output: No specific findings to account for the patient's symptoms in the area of palpable concern.


Instruction: Generate impression based on medical findings.

Input: Chronic kidney disease RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 9.8 cm in length.LEFT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 10.2 cm in lengthOTHER: Bladder nondistended

Output: Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction.


Instruction: Generate impression based on medical findings.

Input: 74-year-old male with alcoholic cirrhosis, ascites, and acute kidney failure. LIVER: Cirrhotic liver contour with significant perihepatic ascites. The liver measures up to 14 cm in length. The main portal vein demonstrates normal hepatopedal flow and measures 15 cm/s.GALLBLADDER, BILIARY TRACT: The gallbladder is partially collapsed, which limits evaluation for wall thickening. Shadowing gallstones are suspected. Normal common bile duct measuring 2 mm in diameter.PANCREAS: Pancreas is obscured due to overlying bowel gas.SPLEEN: The spleen measures 12.4 cm in length, and a 1.8 x 1.7 cm splenule is noted.KIDNEYS: The right kidney measures 10.7 cm in length, and there is no hydronephrosis. The left kidney measures approximately 10 cm in length, and no hydronephrosis is identified. Nonspecific mild increased echogenicity of the bilateral renal parenchyma. ABDOMINAL AORTA: Proximal abdominal aorta measures 2.3 cm in AP diameter.INFERIOR VENA CAVA: Poor evaluation with color Doppler.OTHER: Prominent ascites, which is more evident of the upper abdomen.

Output: 1. Cirrhotic contour of the liver with prominent upper abdominal ascites.2. Cholelithiasis without sonographic evidence for acute cholecystitis.3. No hydronephrosis. Mildly increased echogenicity of the renal parenchyma could represent chronic renal disease.


Instruction: Generate impression based on medical findings.

Input: 25-year-old female with right upper quadrant pain. LIVER: Liver is normal in size and is mildly to moderately echogenic. This may be due to fatty infiltration although not specific. There is a rounded, small and echogenic 6 mm mass arising from the posterior lateral segment of left lobe consistent with hemangioma. No other abnormality is limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal veinGALLBLADDER, BILIARY TRACT: Gallbladder is well-visualized and appears normal without cholelithiasis, wall thickening or pericholecystic fluid. The intrahepatic biliary tract is normal in caliber and the common duct is normal the level of the porta hepatis. More distally, the common duct increases to 9 mm which is above normal range for this age although no obstructing mass or stone is seen.PANCREAS: Pancreas is normal in size but appears heterogeneous in echotexture.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.

Output: 1. Enlargement of distal common bile duct without intrahepatic dilatation of uncertain significance.2. Presumed fatty liver.3. Small hepatic hemangioma.4. Heterogeneous pancreatic parenchymaGiven the above findings, correlation with liver function enzymes would be useful.


Instruction: Generate impression based on medical findings.

Input: Pulsatile nodule in the right thyroid, needs follow-up RIGHT LOBE MEASUREMENTS: 3.7 x 1.2 x 1.5 cm heterogenous echotexture, atrophicLEFT LOBE MEASUREMENTS: 4.3 x 1.2 x 1.1 cm, heterogenous echotexture, atrophicISTHMUS MEASUREMENTS: 3 mmRIGHT LOBE: Right mid pole there is a heterogenous hypoechoic nodule that measures 0.6 x 0.3 x 0.5 cm, unchanged from prior examination.LEFT LOBE: Heterogenous and atrophic glandISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Stable right mid thyroid lobe subcentimeter nodule2. Atrophic and heterogenous thyroid gland seen in the setting of thyroiditis.


Instruction: Generate impression based on medical findings.

Input: Primary hyperparathyroidism with high PTH and calcium RIGHT KIDNEY: Mildly echogenic parenchyma echogenicity without worrisome mass. Multifocal parenchymal based echogenic foci somewhat more conspicuous on the current study. Benign renal cyst. No hydronephrosis or renal stones. Right kidney 11.7 cm in lengthLEFT KIDNEY: Mildly echogenic parenchymal echogenicity without worrisome mass. Multifocal parenchymal base echogenic foci somewhat more conspicuous on the current study. No hydronephrosis or renal stones. Left kidney 11.1 cm in length.OTHER: Bladder nondistended

Output: Interval appearance of mildly increased parenchymal echogenicity with more conspicuous multifocal parenchymal base echogenic foci. Findings raise the possibility of parenchymal dysfunction with nephrocalcinosis without nephrolithiasis or obstruction.


Instruction: Generate impression based on medical findings.

Input: Female; 26 years old. Reason: r/o goiter, nodules History: enlarge thyroid RIGHT LOBE MEASUREMENTS: 4.6 x 1.7 x 1.7 cmLEFT LOBE MEASUREMENTS: 3.9 x 1.4 x 1.0 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: Heterogeneous thyroid with innumerable small hypoechoic nodules. There is no dominant nodule. The background gland is hypervascular.LEFT LOBE: Heterogeneous thyroid with innumerable small hypoechoic nodules. There is no dominant nodule. The background gland is hypervascular.ISTHMUS: Heterogeneous thyroid with innumerable small hypo echoic nodules. There is no dominant nodule. The background gland is hypervascular.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Prominent left level 3 lymph node measures 2.1 x 0.6 x 0.3 cm with a fatty hilum.OTHER: No significant abnormality noted.

Output: 1.Hypervascular, heterogeneous thyroid gland with innumerable small hypoechoic nodules compatible with thyroiditis.2.Prominent left level 3 lymph node has a normal ultrasound appearance and is likely reactive in etiology.


Instruction: Generate impression based on medical findings.

Input: 90-year-old male with acute kidney failure and urinary tract infection. Evaluate for anatomic abnormalities, hydronephrosis, urinary retention. RIGHT KIDNEY: The right kidney measures approximately 9.5 cm in length. There is a complex cyst arising from the upper pole with a single thin to moderate septation. This was present on the prior study but is slightly larger, measuring 3.1 x 3.4 x 3.1 cm on today's exam. No obvious solid component. 2 other smaller cortical cysts are identified.Echotexture likely slightly increased. No hydronephrosis or shadowing calculus.LEFT KIDNEY: Left kidney is difficult to visualize due to positioning and a large lobulated cyst. The major component of this measures 7.3 x 9.8 x 9.9 cm, significantly increased in size when compared to the prior exam. This may also have a septation or adjacent smaller cyst. Limited visualization of the left kidney demonstrates no gross hydronephrosis.OTHER: Urinary bladder is collapsed with Foley catheter.

Output: Limited exam with mild increase in renal echogenicity. Bilateral cysts with complex cyst upper pole right kidney and very large exophytic cyst arising from the left kidney.


Instruction: Generate impression based on medical findings.

Input: 54-year-old female patient with palpable mass in the bilateral supraclavicular space. RIGHT LOBE MEASUREMENTS: 1.7 x 2.0 x 4.3 cm.LEFT LOBE MEASUREMENTS: 1.1 x 1.8 x 4.3 cm.ISTHMUS MEASUREMENTS: 4 mm in thickness.RIGHT LOBE: The right thyroid lobe is homogeneous in echogenicity and contains two subcentimeter nodules with imaging features favoring a benign etiology.LEFT LOBE: The left thyroid lobe is homogeneous in echogenicity. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: Normal subcutaneous fat is identified in the region of the patient's palpable abnormality in the mid-thyroid region.

Output: 1. No dominant thyroid lesion.2. Area of patient palpable abnormality correlates to normal subcutaneous fat.


Instruction: Generate impression based on medical findings.

Input: Female; 49 years old. Reason: 49 yo with HCV with GB polyps. LIVER: The liver measures 14.8 cm. Liver echogenicity is mildly increased. The liver capsule is smooth in contour. No mass lesion is identified within the liver. The main portal vein is patent with normal directional flow a peak velocity of 40 cm/sec.GALLBLADDER, BILIARY TRACT: Again seen is a small, echogenic, non-shadowing, non-mobile focus along the gallbladder wall which measures 5 x 5 x 4 mm.PANCREAS: Mild diffuse fatty infiltration the pancreas is again seen.SPLEEN: The spleen measures 9.5 cm in length.LEFT KIDNEY: Limited views of the left kidney show no hydronephrosis or shadowing renal calculus. The kidney measures 11.6 centimeters in length. At the superior pole of the left kidney is a 2.4 x 2.0 x 2.1 cm simple cyst.OTHER: No significant abnormalities noted.

Output: Stable exam with no focal hepatic lesion.


Instruction: Generate impression based on medical findings.

Input: Female; 44 years old. Reason: abdominal pain associated with food, negative EGD History: abdominal pain LIVER: The liver measures 14.4 cm in length. The liver surface is smooth, the parenchyma is mildly increased in echogenicity but normal in echotexture. Within the right lobe of liver is a 1.3 x 1.2 x 1.3 cm hyperechoic focus with no flow on color Doppler.The main portal vein is patent with hepatopetal flow and a peak velocity of 0.2 m/sec.BILIARY TRACT: The gallbladder is normal in appearance. There is no cholelithiasis, wall thickening or pericholecystic fluid. The common duct measures 0.1 cm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The head and body of the pancreas are unremarkable. The tail is obscured by overlying bowel gas.SPLEEN: The spleen measures 9.4 cm in length.KIDNEYS: The right kidney measures 10.6 cm in length, the left measures 10.7 cm in length. There is no hydronephrosis or shadowing renal stone bilaterally.

Output: 1.No cholelithiasis or evidence of cholecystitis.2.1.3 cm echogenic focus in the right lobe of the liver. Benign etiologies such as focal fat or hemangioma are favored.


Instruction: Generate impression based on medical findings.

Input: Reason: Assess soft tissue region anterior to thyroid History: small growth of mass by thyroid In the subcutaneous tissue anterior to the thyroid there is a well-circumscribed nonvascular echogenic lesion measuring 3.2 x 1.8 x 3.6 cm. The thyroid is uninvolved.

Output: Soft tissue lesion in the neck which could represent a lipoma, however in this age group ultrasound is relatively nonspecific. If clinically indicated, MRI could be obtained for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Gas pain LIVER: Non-cirrhotic liver morphology. Mildly coarsened parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Biliary sludge noted. Otherwise unremarkable appearance of the gallbladderPANCREAS: Obscured by bowel gas.KIDNEYS: The right kidney is 10.8 cm in length. The left kidney is 11.2 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 5.9 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No abdominal free fluid identified.

Output: 1. Mildly coarsened liver echogenicity, compatible with parenchymal dysfunction.2. Biliary sludge.


Instruction: Generate impression based on medical findings.

Input: Reason: please evaluate liver to assess for liver disease/cirrhosis History: elevated INR, low albumin LIVER: The liver measures 16.5 cm in length. Echogenic hepatic parenchyma with smooth peripheral contour. The portal vein is patent with normal directional hepatopedal flow, peak velocity 32.4 cm/s. The hepatic veins appear dilated. No focal mass.GALLBLADDER, BILIARY TRACT: Echogenic debris in the dependent aspect of the gallbladder may represent sludge. No shadowing stones. The gallbladder wall measures 0.2 cm. The common bile duct measures 0.2 cm. No biliary ductal dilatation.PANCREAS: Obscured by bowel gas.KIDNEYS: The right kidney measures 12.7 cm in length. The left kidney measures 9.9 cm in length. Echogenic renal parenchyma. No shadowing stones or hydronephrosis.OTHER: The spleen measures 8.5 cm in length. Trace ascites. Bilateral pleural effusions.

Output: 1. Echogenic liver, consistent with parenchymal dysfunction or chronic liver disease.2. Bilateral pleural effusions and trace ascites.3. Dilated hepatic veins, suggestive of CHF.4. Echogenic debris in the dependent portion of the gallbladder may represent sludge.


Instruction: Generate impression based on medical findings.

Input: 64-year-old female with a history of cirrhosis. Evaluate for HCC. LIVER: Coarse echotexture and nodular morphology compatible with cirrhosis. The liver is mildly shrunken, measuring 13.8 cm in craniocaudal dimension. No focal hepatic lesion is identified. No intrahepatic biliary ductal dilatation. Normal hepatopetal portal venous blood flow at 20 cm/sec.GALLBLADDER, BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common duct measuring 4 mm. Cholelithiasis within a normally distended gallbladder. Mild gallbladder wall thickening is nonspecific in the setting of ascites. No focal tenderness.PANCREAS: The pancreas is obscured by overlying bowel gas shadowing.RIGHT KIDNEY: The right kidney is normal in size, measuring 9.8 cm without hydronephrosis, shadowing nephrolithiasis, or discrete lesion. The cortex is echogenic.OTHER: The spleen is normal in size, measuring 11.4 cm.The left kidney measures 10 cm without hydronephrosis, shadowing nephrolithiasis, or discrete lesion. The cortex is echogenic.Small volume ascites.

Output: 1. Cirrhosis without discrete hepatic lesion or biliary duct dilatation. Small volume ascites.2. Cholelithiasis without specific evidence of acute cholecystitis. 3. Medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Reason: 83M with soft mass on LLQ area, ? Spigelian hernia History: soft LLQ abdominal mass In the left inguinal region, there is an apparent defect in the abdominal wall which appears to contain peristaltic bowel compatible with an inguinal hernia.

Output: Findings compatible with left inguinal hernia. CT abdomen/pelvis with intravenous and enteric contrast may be considered for additional evaluation as clinically warranted.Findings discussed with patient and daughter. Patient not currently experiencing acute obstructive symptoms and was counseled to seek care at the emergency department if symptoms worsen.


Instruction: Generate impression based on medical findings.

Input: Fullness in the left axilla. FNA performed or earlier positive for malignancy in the left breast. A targeted left axillary ultrasound was performed. 3 lymph nodes are seen in the left axilla. The largest and most suspicious of these is located inferiorly and somewhat deep in the axilla and measures 1.5 x 1.8 cm. Normal hilar fat is not seen within this node. There is also an eccentrically thickened lymph node located more superiorly which measures up to 1.7 cm and has mild nonhilar blood flow, also somewhat suspicious. An additional normal morphology lymph node measuring 2.5 cm is seen further superiorly.

Output: One highly suspicious and 1 moderately suspicious left axillary lymph node. The findings were discussed with the patient and Donna Christian. The surgical service will consider ultrasound-guided lymph node biopsy.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Callback from whole breast ultrasound to evaluate a hypoechoic mass in the right breast 9:30 o'clock position. A targeted right ultrasound was performed at 9 to 10:00 position 7 to 9 cm from the nipple. There is no solid or cystic mass identified. Normal glandular tissue noted.

Output: No sonographic evidence for malignancy in the right breast 9 to 10:00 position.Annual screening mammogram and whole breast ultrasound is recommended, due in November 2015Findings and recommendations were discussed with the patient in detail.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female with elevated liver function tests. LIVER: Enlarged liver measures 22.7 cm in length. Markedly increased hepatic echogenicity without discrete focal lesion.BILIARY TRACT: Small amount of layering material in the gallbladder without posterior acoustic shadowing most likely represents sludge. No gallbladder wall thickening or pericholecystic fluid. No biliary ductal dilation.PANCREAS: The pancreas is incompletely visualized. The imaged portions of the pancreas appear unremarkable.SPLEEN: No significant abnormalities noted.KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.

Output: 1. Hepatomegaly with increased echogenicity consistent with hepatic steatosis or parenchymal disease. 2. No evidence of acute biliary pathology.


Instruction: Generate impression based on medical findings.

Input: 46-year-old male with autoimmune pancreatitis presents for follow-up. LIVER:Measures 16.2 cm. Increased, coarse echogenicity. No ascites, focal mass, or intrahepatic biliary dilation. The main portal vein is patent with hepatopedal flow measured at 27.1 cm/s.GALLBLADDER, BILIARY TRACT: The gallbladder is absent.PANCREAS: The pancreas is absent.SPLEEN: The spleen is absent.KIDNEYS: Right kidney measures 10.4 cm. Left kidney measures 11.9 cm. Unremarkable echogenicity. No shadowing calculi, hydronephrosis, or focal mass. OTHER: No significant abnormality noted.

Output: 1. Increased, coarse echogenicity of the liver consistent with chronic liver disease/parenchymal dysfunction. No mass or ascites.2. Patent portal vein with hepatopedal flow.3. Surgical changes of a splenectomy, pancreatectomy, and a cholecystectomy.


Instruction: Generate impression based on medical findings.

Input: Fever, transaminitis LIVER: Measures 19.2 cm. No focal hepatic masses. The portal vein is patent.GALLBLADDER, BILIARY TRACT: Gallbladder sludge without wall thickening or biliary dilation.PANCREAS: No significant abnormality noted.SPLEEN: Measures 11.9 cm.KIDNEYS: Right kidney measures 13.4 centers. Left kidney measures 14.0 cm. No hydronephrosis or mass.

Output: Gallbladder sludge without evidence of cholecystitis.


Instruction: Generate impression based on medical findings.

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

Output: No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Elevated liver enzymes. LIVER: Non-cirrhotic liver morphology. 20 cm in length. Mildly increased parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Mildly distended gallbladder, without wall thickening, pericholecystic fluid, or gallstones. No sonographic Murphy sign.PANCREAS: No sonographic abnormality evident in the visualized pancreatic head and neck. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney is 11.1 cm in length. The left kidney is 12.0 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 12.5 cm in length, without focal lesions evident.OTHER: Small right pleural effusion, partially imaged. No ascites identified.

Output: 1. Mildly hepatic echogenicity compatible with parenchymal dysfunction and/or steatosis, without biliary ductal dilation.2. Mildly distended gallbladder without evidence of cholecystitis, per clinical query.


Instruction: Generate impression based on medical findings.

Input: 20 years old, Male, Reason: s/p Right inguinal hernia repair, 1 day h/o right groin pain History: groin pain and bulgin reminiscent of inguinal hernia pain before repair No evidence of bowel or fat in an inguinal hernia. No evidence of other type of hernia in this area. Benign-appearing lymph nodes are noted within the inguinal area measuring up to 1.1 cm. Inguinal hernia was unable to be produced on standing and Valsalva.

Output: No evidence of hernia sac despite valsalva and manipulation. No specific findings to account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: LIVER: Liver is normal in size and echotexture. No focal hepatic abnormality.GALLBLADDER, BILIARY TRACT: Gallbladder is poorly distended without wall thickening, stones or pericholecystic fluid. Visualized biliary tract is normal in caliber.PANCREAS: Limited exam. Bowel gas precludes full visualization.RIGHT KIDNEY: Small right renal cyst. No hydronephrosis.OTHER: Splenic size normal. Simple left renal cyst. No hydronephrosis.

Output: Bilateral renal cysts.Normal liver.Poorly distended gallbladder but otherwise normal biliary tract otherwise.


Instruction: Generate impression based on medical findings.

Input: Abnormal gallbladder seen on recent CT BILIARY TRACT: Cholelithiasis with trace pericholecystic fluid and mild diffuse gallbladder wall thickening. Negative Murphy's sign. No ductal dilatation.OTHER: No significant abnormalities noted.

Output: Cholelithiasis with trace pericholecystic fluid and mild diffuse gallbladder wall thickening. Negative Murphy's sign. Findings are suggestive for chronic gallbladder inflammation; equivocal evidence for acute inflammation.


Instruction: Generate impression based on medical findings.

Input: 41 y.o. male presents with RUQ. Evaluate hepatobiliary system. LIVER:The liver measures approximately 20.1 cm. There is coarse and increased echogenicity of the parenchyma. No mass, ascites, or intrahepatic biliary dilation. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder length measures approximately 13.9 cm. Echogenic dependent material within the gallbladder likely represents sludge. No stones. The gallbladder wall thickness is 0.2 cm. No pericholecystic fluid. The common bile duct measures 7.5 mm. Negative sonographic Murphy's sign.PANCREAS: Evaluation limited by overlying bowel gas.SPLEEN: The spleen measures 11.8 cm. No sonographic abnormalities.KIDNEYS: The right kidney measures 12.1 cm. The cortex has normal echogenicity. No shadowing calculi, hydronephrosis, or worrisome mass. The left kidney measures approximately 10.8 cm. The cortex has normal echogenicity. No shadowing calculi, hydronephrosis, or worrisome mass. OTHER: No significant abnormality noted.

Output: 1. Coarse and increased echogenicity of the parenchyma in the liver consistent with chronic liver disease/parenchymal dysfunction. No mass or ascites.2. Hepatomegaly.3. Gallbladder sludge without signs of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Asymptomatic female with dense breast underwent whole breast ultrasound on 9/18/2015 that demonstrated a questionable solid mass in the left breast 6:00 position for which hand-held ultrasound is recommended. Multiple simple cyst were identified in both breasts. A targeted left ultrasound was performed for the whole breast ultrasound area of concern. A complicated cyst with through transmission posteriorly is identified at 6:00 position of the left breast measuring 10 x 5 x 8 mm. This most likely corresponds to the lesion in question on the whole breast ultrasound. Multiple large simple cysts identified in the left upper-outer quadrant which was imaged as per patient's request due to prior history of cyst aspirations in that region. Largest cyst measures 2.3 x 1.7 x 2.4 cm.No suspicious solid mass noted.

Output: Complicated cyst in the left breast 6:00 position. Multiple simple cyst identified in the left upper outer quadrant.Annual screening mammogram with tomo synthesis is recommended for further evaluation.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: 66-year-old with two recent right breast biopsies showing invasive mammary carcinoma and invasive lobular carcinoma. Postbiopsy mammograms. Three standard views of right 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, unchanged in pattern and distribution. Interval placement of a long biopsy clip at the 10:00 position in an area of previously noted distortion. An additional short biopsy clip is noted at the 11:00 position corresponding to the lesion seen on ultrasound overlying an area of dense tissue. The distance between clips is 22 mm.

Output: Biopsy clips noted at the 11:00 and 10:00 positions.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Patient submitted outside mammograms for review. 6 mm round circumscribed mass is identified in the left breast upper-outer quadrant mid depth which appears minimally increased from prior studies dating back to 2013. Outside Hospital ultrasound has not been submitted. Repeat left breast ultrasound was recommended. A targeted left upper-outer quadrant ultrasound was performed. A round hypoechoic lesion with minimal through transmission measuring 5 x 5 x 5 mm identified at 3:00 position most likely corresponding to the mammographic abnormality. No suspicious solid mass noted.

Output: Simple cyst identified in the left breast 3:00 position most likely corresponding to the mammographic abnormality in question. Patient prefers the cyst to be aspirated over a 6 month follow-up. Patient will be scheduled for a left breast cyst aspiration and a postprocedure mammogram. Findings were conveyed to Donna Christian at the time of dictation.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on medical findings.

Input: Increasing LFTs LIVER: Coarse echogenic liver echotexture without mass. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow. Liver length 14.6 cm.BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. Spleen 11.6 cm in length.RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. Right kidney 9.7 cm in lengthOTHER: Echogenic left renal parenchyma without mass, stone, or hydronephrosis. Left kidney 10.5 cm in length. No ascites

Output: Coarse echogenic liver echotexture suggestive for parenchymal dysfunction/fatty infiltration without mass or ductal dilatation. No ascites. Echogenic renal parenchyma suggestive for medical renal disease/parenchymal dysfunction without hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 66 year old male, evaluation for heart transplant. Baseline exam LIVER: Coarse echogenicity of the liver measuring 17.2 cm in length. No focal hepatic lesions. Main portal vein is patent with appropriate directional flow; peak velocity measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: Normal echogenicity of the gallbladder. No gallbladder wall thickening. Common duct measures 4 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Not well-visualized overlying bowel gas.SPLEEN: Normal echogenicity of the spleen measuring 11.6 cm in length.KIDNEYS: Right kidney measures 11.1 cm in length. Non obstructing nephrolithiasis is noted. Left kidney measures 11.3 cm in length. No hydronephrosis or shadowing calculi are noted.ABDOMINAL AORTA: Atherosclerotic abdominal aorta with measurements as follows: proximal aorta measures 2.8 cm x 2.4 cm, the mid abdominal aorta measures 2.0 cm x 2.3 cm and the distal abdominal aorta measures 1.9 cm x 2.1 cm.INFERIOR VENA CAVA: The visualized IVC is patent with appropriate directional flow.OTHER: Small amount of ascites.Incompletely imaged bilateral pleural effusions.

Output: 1. Hepatomegaly with coarse echotexture suggestive of parenchymal dysfunction/fatty infiltration. No focal hepatic lesions. 2. Non obstructing right nephrolithiasis.3. Small amount of ascites and incompletely imaged bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male patient with history of hepatitis C, prekidney transplant evaluation. LIVER: The liver measures 17.0 cm in length and is mildly nodular in contour. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.3 m/sec.GALLBLADDER, BILIARY TRACT: The gallbladder is filled with stones. No gallbladder wall thickening or pericholecystic fluid is identified. 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. A peripancreatic lymph node measures 1.4 x 1.2 x 1.2 cm.RIGHT KIDNEY: The right kidney measures 7.9 cm in length and demonstrates increased cortical echogenicity. No evidence of hydronephrosis. There is a 1.6 x 1.2 x 1.4 cm mid to lower pole exophytic renal cyst.OTHER: The left kidney measures 9.0 cm in length and demonstrates increased cortical echogenicity. No evidence of hydronephrosis. There is a 2.3 x 2.2 x 2.5 cm cystic lesion within the mid left kidney with a few internal echogenic foci but no significant internal vascularity. An additional 1.1 x 1.3 x 1.3 cm lower pole renal cyst is noted.

Output: 1. Mildly nodular liver contour consistent with cirrhosis. 2. Cholelithiasis without sonographic evidence of acute cholecystitis.3. Bilateral simple renal cysts and minimally complex left midpole renal cyst.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with history of NASH cirrhosis evaluated for HCC. LIVER: Measures 20 cm in length. Cirrhotic hepatic morphology and increased echogenicity without discrete focal lesion.BILIARY TRACT: Mild biliary sludge but no cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. No biliary ductal dilation.PANCREAS: No significant abnormalities noted.SPLEEN: Enlarged spleen measures 17.6 cm in length without focal lesion.KIDNEY: Bilateral renal cysts without septation or suspicious nodular component. No hydronephrosis.OTHER: Trace ascites.

Output: 1.Cirrhotic liver morphology and increased hepatic echogenicity consistent with chronic liver disease, without evidence of discrete lesion.2.Hepatosplenomegaly and trace ascites.


Instruction: Generate impression based on medical findings.

Input: 48-year-old female with left breast palpable area, presents for follow-up ultrasound. On physical examination, there is a firm palpable area at the two o'clock position of the left breast, 5 cm from the nipple.A targeted left ultrasound was performed for the palpable area of concern, as marked by Dr. Chhablani. Focal area of dense breast tissue is identified subjacent to the area of palpable concern. There is no solid or cystic mass identified.

Output: Focus of dense breast tissue at the site of palpable abnormality in the left breast. The patient was instructed to discuss the need for any further follow up with Dr. Chhablani.If the patient's physical exam remains unchanged, bilateral screening mammogram is recommended annually, for which the patient will be due in June 2015.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: Ultrasound images were obtained intraoperatively. There is a tube noted within the bladder.

Output: Intraoperative images showing tube placement within the bladder.


Instruction: Generate impression based on medical findings.

Input: Reason: Re-assessment of abdominal aortic aneurysm size History: AAA noted on screening LIVER: The liver is echogenic, suggesting hepatic steatosis. Partially imaged hepatic cysts.AORTA: The maximum abdominal aortic diameter measurement is 3.4 cm just superior to the iliac bifurcation. Prior maximum diameter of 3 cm.The proximal common iliac arteries measure 1.3 x 1.3 cm and 1.8 x 1.9 cm in maximum diameter.The arterial wave form is normal, velocity measures 94.8 cm/s.

Output: Aneurysmal dilatation of the abdominal aorta with maximum diameter of 3.4 cm just superior to the iliac bifurcation (prior maximum diameter was 3 cm on 5/14/2015).


Instruction: Generate impression based on medical findings.

Input: 54-year-old female with thrombocytopenia. LIVER: Measures 20.1 cm in length. Increased hepatic echogenicity without discrete focal lesion, though with this degree of increased echogenicity or subtle lesion could be missed. Patent portal vein with antegrade flow. BILIARY TRACT: No cholelithiasis. No gallbladder wall thickening, pericholecystic fluid, or biliary ductal dilation. PANCREAS: The pancreas is incompletely imaged due to bowel gas. The imaged portions of the pancreas appear unremarkable. SPLEEN: Unremarkable in size and echogenicity. KIDNEY: No hydronephrosis, nephrolithiasis, or solid mass. OTHER: No significant abnormalities noted.

Output: Hepatomegaly with markedly increased echogenicity consistent with hepatic steatosis. No discrete focal lesion, though with this degree of fatty infiltration a subtle lesion could be missed.


Instruction: Generate impression based on medical findings.

Input: 73-year-old male with hepatic failure and lymphoma. LIVER: There is hepatomegaly with the liver measuring at least 20 cm in length. Liver parenchyma is is mildly and heterogeneously echogenic which is non-specific, although this may be seen in irregular fatty infiltration. The caudate appears somewhat hypoechoic but this may be due to focal sparing rather than mass. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein. GALLBLADDER, BILIARY TRACT: There is no biliary tract dilatation. The gallbladder contains at least one 0.6 cm polyp. There is also a small echogenic focus involving the anterior wall which may represent cholesterolosis. No definite shadowing gallstones. Gallbladder wall is not thickened.PANCREAS: Limited. There is significant peripancreatic/retroperitoneal adenopathy.RIGHT KIDNEY: 3.8 cm complex cyst arising from the midpole of the right kidney with thin to moderate septations. No definite soft tissue component. Smaller cyst present as well. No hydronephrosis.OTHER: Presumed small cyst in the lower pole of the left kidney. No hydronephrosis.Mild ascites.Splenectomy.

Output: 1. No biliary obstruction.2. Gallbladder polyp.3. Complex right renal cyst. Hepatomegaly.4. Ascites.5.


Instruction: Generate impression based on medical findings.

Input: 79-year-old male with history of childhood radiation. RIGHT LOBE MEASUREMENTS: 3.4 x 1.9 x 1.6 cmLEFT LOBE MEASUREMENTS: 3.3 x 1.9 x 1.2 cmISTHMUS MEASUREMENTS: 3 mmRIGHT LOBE: The right thyroid lobe is normal in morphology, echogenicity, and size without a discrete nodule.LEFT LOBE: The left thyroid lobe is normal in morphology, echogenicity and size without a discrete nodule.ISTHMUS: The isthmus is normal in morphology, echogenicity and size without a discrete nodule.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Normal appearing thyroid.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male with abnormal liver function. LIVER: Liver is enlarged, measuring at least 24 cm in length and demonstrates significant and mildly heterogeneous increased attenuation due to fatty infiltration. There are areas of focal sparing about the gallbladder fossa. There is no focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: Small amount of dependent sludge in the gallbladder. No gallstones or wall thickening. The biliary tract is normal in caliber.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: Left kidney and spleen appear unremarkable.

Output: Irregular fatty infiltration of the liver with hepatomegaly.


Instruction: Generate impression based on medical findings.

Input: A patient submitted outside study for review. Submitted for review are screening mammogram dated 3/30/2015 and diagnostic mammogram and ultrasound dated 4/2/2015 performed at Franciscan Healthcare-Munster. Screening mammogram 3/30/2015: Two standard views of both breasts were obtained. The breast parenchyma is mostly fatty replaced, distributes fairly symmetrically in both breasts. The patient was recalled for an ovoid circumscribed asymmetry measuring 4 mm in the medial right breast seen only on the CC view with no definite correlate is seen on MLO view. Diagnostic mammogram and ultrasound dated 4/2/2015:Mammogram: The asymmetry in the medial breast persists on spot compression views and has benign morphology. On the MLO full field view a correlate is identified in the inferior breast. Ultrasound: A possible pseudolesion was identified in the inferior right breast at 6:00.

Output: Repeat right breast ultrasound is recommended to evaluate the benign morphology asymmetry seen on mammography and evaluate for a correlate for the questionable lesion seen on prior ultrasound at 6:00 position.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: 52-year-old female complains of right flank pain x1 month. There is clinical concern for cholelithiasis versus nephrolithiasis. LIVER:The liver measures 16.6 cm. There is coarse and increased echogenicity of the hepatic parenchyma. No mass or ascites. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended, the wall measures 1.8 mm, there is no pericholecystic fluid, there are no stones or sludge. The common bile duct measures 2.3 mm. The common hepatic duct measures 2.4 mm.PANCREAS: The pancreas is mostly obscured by overlying bowel gas. The visualized portions are normal in appearance.SPLEEN: The spleen measures 9.9 cm. No abnormalities noted.KIDNEYS: Right kidney measures 10.8 cm. The cortex has normal echogenicity. No shadowing calculi or hydronephrosis present. Left kidney measures 11.2 cm. The cortex has normal echogenicity. No shadowing calculi or hydronephrosis present. OTHER: No significant abnormality noted.

Output: 1. Coarse echogenic liver consistent with chronic liver disease/parenchymal dysfunction. No mass or ascites.2. No sonographic evidence of cholelithiasis or nephrolithiasis.


Instruction: Generate impression based on medical findings.

Input: Right upper quadrant pain; history of leukemia LIVER: Coarse echogenic liver echotexture without mass. Liver length 16.5 cm. Limited Doppler interrogation of the main portal vein demonstrates a patent portal vein with normal directional flowGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.7 cm in lengthOTHER: Left kidney 11.3 cm in length. Spleen 11.8 cm in length. Porta hepatis regional adenopathy. No ascites.

Output: Coarse echogenic liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Unremarkable gallbladder. No ascites. Porta hepatis regional adenopathy.