Instruction: Generate impression based on medical findings.

Input: 41-year-old male patient with history of cirrhosis. Evaluate for HCC. LIVER: The liver measures 17.6 cm in length. No focal hepatic lesion is identified. The liver is nodular in contour with coarsened echotexture. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: There is cholelithiasis. No pericholecystic fluid is identified. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 3 mm in diameter.PANCREAS: The head and body of the pancreas demonstrate normal echogenicity. The tail is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 10.7 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 11.1 cm in length. No evidence of hydronephrosis.The spleen measures 16.3 cm in length.

Output: 1. Cirrhotic morphology of the liver without focal lesion.2. Splenomegaly.3. Cholelithiasis without sonographic evidence of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Ms. Tabituha Cox is a 22 year old female with a personal history of bilateral masses and status post left breast mass excision. RIGHT BREAST: (Compared to the prior exam 3/31/2015)On physical examination, 2 masses are palpated to in the right breast at 2:00 and 6:00 position.A targeted right ultrasound was performed for the palpable area of concern. --In the right breast, 2:00 position, 4 cm from the nipple, a circumscribed hypoechoic mass, 1.9 x 0.6 x 1.6 cm, unchanged in size from the prior.--In the right breast, 6:00 position, 2 cm from the nipple, a circumscribed hypoechoic mass, 1.1 x 0.5 x 1 cm, unchanged in size from the prior.LEFT BREAST: ( Compared to the prior exam 7/16/2013)On physical examination, no discrete mass is palpated in the left breast. A targeted left ultrasound was performed at the sites of the previously identified masses. --In the left breast, 9:00 position, 1 cm from the nipple, a circumscribed hypoechoic mass, 0.8 x 0.4 x 0.6 cm, unchanged in size from the prior.--In the left breast, 12:00 position, 2 cm from the nipple, a circumscribed hypoechoic mass, 0.8 x 0.6 x 1.4 cm, unchanged in size from the prior.Of note, the previously identified large 2.5 cm mass had been surgically removed.

Output: Multiple stable bilateral masses, compatible with fibroadenomata. Clinical follow up is recommended. Results and recommendations were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: Evaluate liver and evaluate for ascites. Hypoalbuminemia, edema, shortness of breath LIVER: Liver measures 18.5 cm with diffuse coarse echotexture without any focal lesions. No hepatic cirrhotic morphology noted. Normal flow directionality and patency of the portal vein noted. No biliary ductal dilatation. BILIARY TRACT: Gallbladder Is partially distended, incompletely evaluated without any gallstones within it. Common duct is nondilated measures up to 2 mm. No pericholecystic fluid.PANCREAS: Not well visualized due to overlying bowel gas.SPLEEN: Spleen measures 11.8 cm with normal echo texture.RIGHT KIDNEY: Right kidney measures 12.1 cm and left kidney measures 11.4 cm. Simple cyst identified in both kidneys, cyst in the right kidney measures 1.1 x 1 x 1 cm, and cyst in the left kidney measures 0.9 x 1.3 x 1.3 cm.OTHER: No significant abnormalities noted.

Output: Mild coarse echotexture of the liver without any focal lesion.Partially distended gallbladder, limited evaluation without evidence of gallstones.


Instruction: Generate impression based on medical findings.

Input: 63 year old female with history of T2N0 SCC vocal cord cancer. Right cervical palpable lymph node on exam which was marked by clinical service. In the region of palpable lesion which was marked by the clinical service in the right neck there is mild asymmetric thickening of the subcutaneous soft tissues in comparison with the left. No cystic or solid masses are identified in this region. Right thyroid hypoechoic nodule is noted measuring 9 mm x 7 mm x 6 mm.

Output: 1. Mild subcutaneous soft tissue thickening in the region of palpable abnormality with no discrete mass identified.2. Right thyroid hypoechoic subcentimeter nodule.


Instruction: Generate impression based on medical findings.

Input: 38 year old female with history of hernia. Evaluate for umbilical hernia. Bowel is noted coursing posteriorly along a shallow defect in the anterior abdominal wall near the umbilicus, however no bowel is seen herniating into the anterior wall.

Output: Intraperitoneal bowel adjacent to a shallow anterior abdominal wall defect, without frank herniation.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old. Acute on chronic CKD, persistent hyperkalemia. RIGHT KIDNEY: The right kidney measures 10.4 cm in length, with normal cortical echotexture. Multiple small nonobstructing renal calcifications are noted, the largest in the upper pole measuring up to 7 x 4 x 6 mm. No focal cortical lesion or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.4 cm in length, with is normal cortical echotexture. Multiple small nonobstructing renal calcifications are noted, the largest in the lower pole measuring up to 7 x 5 x 4 mm. No hydronephrosis. A lower pole simple cyst measures 1.4 x 1.2 x 1.1 cm.OTHER: The bladder is distended.

Output: Bilateral nonobstructing renal calcifications. No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Acute renal insufficiency with worsening creatinine ULTRASOUND KIDNEYSRIGHT KIDNEY: Mildly echogenic renal parenchyma without mass, stone, or hydronephrosis. Large perinephric hematoma again noted measuring 12.2 x 8.7 x 12 cm. Right kidney 9.1 cm in length.LEFT KIDNEY: Mildly echogenic renal parenchyma without mass, stone, or hydronephrosis. 12 cm in lengthOTHER:Bladder nondistended.

Output: Echogenic renal parenchyma consistent with medical renal disease/clinical dysfunction without mass, stone, or hydronephrosis. No change in the large right perinephric hematoma.Patent renal vasculature bilaterally. Specifically, no evidence for renal vein thrombosis.


Instruction: Generate impression based on medical findings.

Input: 58-year-old female with abnormal liver function. The exam is limited by patient's combativeness and motion.LIVER: Normal in size and echotexture. No focal hepatic abnormality.BILIARY TRACT: Dependent sludge in the gallbladder without shadowing stones. There are likely one or 2 very small polyps arising from the wall. No gross wall thickening. Visualized biliary tract is normal in caliber. PANCREAS: No significant abnormalities noted.SPLEEN: Cannot be imaged due to patient positioning.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.

Output: Gallbladder sludge and likely small polyps. Otherwise, normal liver and biliary tract.


Instruction: Generate impression based on medical findings.

Input: 17-year-old female with left breast lump at the 2:00 position. A targeted left breast ultrasound was performed for the palpable area of concern.At 3:00, 2 cm from the nipple, there is a 1.8 x 0.9 x 1.6 cm circumscribed oval hypoechoic mass with internal vascularity.

Output: Solid mass at the 3:00 position in the left breast, corresponding to the palpable abnormality is probably a fibroadenoma. Consultation with a breast surgeon is recommended for further management. If no further intervention is planned based on physical exam, a short term ultrasound follow up in 6 months could be considered. Results and recommendation were discussed with the patient and the patient's mother.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation.


Instruction: Generate impression based on medical findings.

Input: 56-year-old female. Follow-up thyroid ultrasound. Please evaluate for thyroid nodules, size, location, and any abnormal lymph nodes. RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 4.5 cm in length, 1.1 cm in AP, and 1.5 cm in transverse diameter.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 3.8 cm in length, 1.3 cm in AP, and 1.4 cm in transverse diameter.ISTHMUS MEASUREMENTS: The thyroid isthmus measures 0.2 cm in thickness.RIGHT LOBE: In the right lower pole, there is a stable appearing hypoechoic nodule measuring 1.1 x 1.2 x 1.4 cm (prior 1.4 x 1 x 1.3 cm).LEFT LOBE: Normal homogeneous echotexture of the left thyroid lobe. No discrete nodules.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No abnormal appearing lymph nodes.OTHER: No significant abnormality noted.

Output: Stable hypoechoic right lower pole thyroid nodule.


Instruction: Generate impression based on medical findings.

Input: 75-year-old female with right upper quadrant pain. Evaluate for biliary pathology. Of note, the exam is limited by patient's inability to hold breath during the exam and due to bowel gas.LIVER:The liver measures approximate 14.7 cm. There is coarse, increased, and heterogeneous echotexture of the parenchyma. No mass or ascites noted. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended and the wall measures 0.1cm. There is a negative Murphy's. No stones or sludge seen. No pericholecystic fluid. The common bile duct measures 3.3 mm.PANCREAS: Evaluation of the pancreas is limited due to overlying bowel gas.SPLEEN: The spleen measures 7.7 cm. No significant abnormality noted.KIDNEYS: The right kidney measures 10.4 cm. There is a round anechoic area with posterior acoustic enhancement measuring approximately 2.2 x 2.3 x 3.1 cm that is consistent with a simple cyst. No concerning mass or shadowing calculi. No hydronephrosis. The left kidney measures 9.4 cm. There is a round anechoic area with posterior acoustic enhancement measuring approximately 2.3 x 2.1 x 1.9 cm and is consistent with a simple cyst. No concerning mass or shadowing calculi. No hydronephrosis. The kidneys appear atrophic bilaterally. OTHER: No significant abnormality noted.

Output: 1. Coarse and echogenic liver consistent with chronic liver disease/parenchymal dysfunction. No ductal dilatation, mass, or ascites.2. Atrophic kidneys consistent with chronic medical renal disease/parenchymal dysfunction.3. No evidence of cholelithiasis or gallbladder disease.


Instruction: Generate impression based on medical findings.

Input: 28-year-old female with conjugated hyperbilirubinemia who presents with evaluation for hepatobiliary pathology LIVER: The liver is normal in echogenicity and measures 21 cm in length.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. The common bile duct measures 0.3 cm in diameter. There is a septated complex fluid collection inferior to the liver, adjacent to the gallbladder. Pericholecystic fluid and gallbladder wall thickening measuring 5 mm is most likely secondary to the adjacent fluid collection. No evidence of cholelithiasis.PANCREAS: No significant abnormalities noted.SPLEEN: The spleen is normal in echogenicity and measures 10.6 cm in length.KIDNEYS: The right kidney measures 12.3 cm in length and the left kidney measures 13.9 cm in length without evidence of hydronephrosis. OTHER: Partially visualized right pleural effusion.

Output: 1.Complex pericholecystic fluid collection adjacent to the gallbladder. 2.Edematous gallbladder wall is likely secondary to the adjacent complex fluid collection as above.3.Partially visualized right pleural effusion.4.Hepatomegaly.


Instruction: Generate impression based on medical findings.

Input: Elevated liver enzymes, history of gallbladder carcinoma. Exam mildly limited by inability to optimally position patient.LIVER: The liver measures 15.9 cm in length. The known previously described liver lesion adjacent to the gallbladder fossa measures 4.9 x 3.6 x 4.6 cm, increased in size from approximately 2.4 x 2.3 cm on recent CT. Previously described portacaval reference mass now measures approximately 3.1 x 3.3 x 3.3 cm, measured approximately 2.7 x 4.7 cm on recent CT. The portal vein is attenuated at the porta hepatis and is patent within the liver with a velocity of 0.25 m/s.BILIARY TRACT: A large stone is present within the gallbladder. The gallbladder wall is not thickened. The sonographic Murphy's sign is negative. There is mild intrahepatic biliary ductal dilatation. The common bile duct measures 3 mm in diameter.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.The spleen measures 10.3 cm in length. RIGHT KIDNEY: Kidney measures 10.8 cm in length. The parenchymal echogenicity is increased. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 9.5 cm in length. The parenchymal echogenicity is increased. No hydronephrosis, shadowing calculus or mass.OTHER: Bilateral pleural effusions and ascites.

Output: 1.Interval increase in size of hepatic mass adjacent to gallbladder. Mild intrahepatic biliary ductal dilatation, similar to prior. 2.Persistent ascites and pleural effusions.3.Echogenic kidneys suggesting medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Ms. Mary Shade is a 63 years old female with a palpable mass in the right breast. MAMMOGRAM: Three standard views and additional spot compression views of both breasts and the right axilla (a total of 14 images) were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density(BiRads Density Category B). A partially visualized spiculated mass with few possible faint calcifications is identified in the upper inner right breast far posterior depth. This mass measures 3 cm anteroposteriorly on the ML view. A prominent 12 mm intramammary lymph node is identified in the right axillary tail. In addition, a 12 mm focal asymmetry is identified in the upper outer left breast which persists with spot compression.Prominent right axillary lymph node noted.ULTRASOUND:On physical examination, an fixed mass is palpated in the right upper inner breast.A targeted right ultrasound was performed for the mammographic and palpable area of concern. In the right breast, 2:00 position, 5 cm from the nipple, there is a heterogeneously hypoechoic mass with irregular margin which measures 2.6 x 2.1 x 2.3 cm. There is increased vascular flow to this mass. In addition, a 1.1 x 0.7 x 1 cm hypoechoic mass is identified in the right breast 11:00 position, 8 cm from the nipple, which correlates with the low lying intramammary lymph node on the mammogram. A lymph node is identified in the right axilla measuring 1.4 x 1.2 x 0.5 cm, which has diffuse cortical thickening (3 mm) and nonhilar flow.A targeted left ultrasound was performed for the mammographic area of concern. In the left breast, 2:00 position, 3 cm from the nipple, there is a 1.2 x 0.5 x 1.3 cm lobulated hypoechoic correlation mass, which corresponds to the mammographic finding. There is no definite vascular flow associated with this mass.

Output: --2.6 cm palpable right breast mass concerning for malignancy. Ultrasound-guided biopsy or FNA is recommended.--1.1 cm suspicious right intramammary lymph node concerning for metastatic disease. Ultrasound-guided biopsy is recommended.--Borderline suspicion of right axillary lymph node.--1.3 cm lobulated mass in the left breast with low suspicion for malignancy, this could represent a benign fibroadenoma. Ultrasound-guided biopsy is recommended.Surgical consultation is recommended.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on medical findings.

Input: 53-year-old female with sickle cell disease, nephrolithiasis, hematuria. RIGHT KIDNEY: Measures 10.8 cm in length. Mildly prominent echogenic renal pyramids. No nephrolithiasis or hydronephrosis.LEFT KIDNEY: Measures 11.8 cm in length. Mildly prominent echogenic renal pyramids. 1.4 cm left renal cyst without septation or solid component. No nephrolithiasis or hydronephrosis.URINARY BLADDER: Incompletely distended without focal abnormality. OTHER: No significant abnormalities noted.

Output: 1.No evidence of nephrolithiasis or hydronephrosis.2.Mildly enlarged kidneys with echogenic renal pyramids may represent sickle cell nephropathy.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female with worsening renal function, hematuria RIGHT KIDNEY: Measures 10.2 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. Stent visualized in the renal pelvis.LEFT KIDNEY: Measures 10.2 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. Stent visualized in the renal pelvis.URINARY BLADDER: Incompletely distended without focal abnormality. Bilateral distal stent catheters visualized in the bladder lumen.OTHER: No significant abnormalities noted.

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


Instruction: Generate impression based on medical findings.

Input: Female 32 years old Reason: emesis throughout pregnancy, evaluate for liver etiologies History: nausea, vomiting LIVER: Liver measures 17.2 cm in length. There is increased echogenicity of the liver suggesting fatty infiltration or diffuse hepatic dysfunction. No focal hepatic mass. Main portal vein is patent with normal directional flow and a peak velocity of 19.2 cm/s.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. Gallbladder is normal in appearance. No gallstones. No gallbladder wall thickening. No evidence of acute inflammation. Common bile duct measures up to 6 mm, within normal limits.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 in appearance measuring 9.5 cm.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Minimal fullness of the left renal pelvis. Right kidney measures 10.8 cm. Left kidney measures 12.2 cm.OTHER: No significant abnormalities noted.

Output: Increased echogenicity of the liver suggesting fatty infiltration or diffuse hepatic dysfunction. No gallstones or acute inflammation of the gallbladder.


Instruction: Generate impression based on medical findings.

Input: 70-year-old male with a history of multiple renal cysts and angioleiomyoma, request follow up image study. RIGHT KIDNEY: The right kidney measures 13.4 cm in length and is noted to have a 7.0 x 6.1 x 5.3 cm simple cyst which previously measured 7.6 x 6.1 x 5.2 cm. An additional smaller cyst in the upper pole of the right kidney measures 2.0 x 2.5 x 3.1 cm, previously measured 3.6 x 3.2 x 2.8 cm.LEFT KIDNEY: The left kidney measures 14.0 cm in length and demonstrates a 6.3 x 5.6 x 5.0 cm cyst with a thin internal septation in the lower pole and which measured 7.6 x 5.8 x 5.1 cm previously. There is a 2.6 x 3.0 x 2.4 cm hyperechoic area in the superior pole of the right kidney which previously measured 2.6 x 3.0 x 2.0 cm and likely represents a angiomyolipoma.OTHER: Fluid in the midabdomen correlates with the patient's penile reservoir seen on previous CT.

Output: 1.Left renal angiomyolipoma which is not significantly changed in size.2.Multiple similar appearing bilateral renal cysts.


Instruction: Generate impression based on medical findings.

Input: Reason: U/S of posterior Thoracic Soft Tissue Mass - Back, Tiny in Size - ? Lipoma Well-defined hypoechoic lesion with internal striations measures 5.2 x 1.6 x 5.7 cm. Several nonspecific nodular hypoechoic components are noted in deep aspect of the lesion. No internal vascularity or microcalcifications.

Output: Findings suggestive of lipoma with mild heterogeneity. If of clinical concern, follow-up ultrasound can be obtained as indicated.


Instruction: Generate impression based on medical findings.

Input: 67 year old female with physician palpated left breast area. Recent, unremarkable screening mammogram. On physical examination, a ridge of dense breast tissue is noted at the approximate 12 to one o'clock position of the left breast. No further palpable abnormality is identified.A targeted left ultrasound of the upper outer quadrant was performed for the palpable area of concern. There is no solid or cystic mass identified. A band of dense parenchymal tissue is noted at the approximate one o'clock position, 2 cm from the nipple. No abnormal vascularity is associated with this area.

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


Instruction: Generate impression based on medical findings.

Input: Right thyroid nodule RIGHT LOBE MEASUREMENTS: 5.9 x 1.9 x 1.7 cmLEFT LOBE MEASUREMENTS: 4.3 x 1.3 x 1.7 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Diffusely heterogeneous gland. Predominantly solid lower pole nodule measuring 2 x 1.5 x 1.5 cm.LEFT LOBE: Diffusely heterogeneous gland without nodule.ISTHMUS: Diffusely heterogeneous gland without nodulePARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Diffusely heterogeneous thyroid gland. Predominantly solid right lower lobe thyroid nodule as described. No regional adenopathy.


Instruction: Generate impression based on medical findings.

Input: Male; 31 years old. Reason: 31 y/o M with unexplained nausea, vomiting, RUQ u/s requested to rule out gallstones or other etiology History: as above LIVER: The liver has a smooth contour, the parenchyma is normal in echogenicity. It measures 17.7 cm in length. The main portal vein is patent and demonstrates normal direction of flow with a peak velocity of 20 cm/sec.BILIARY TRACT: The gallbladder is unremarkable with no cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. The common bile duct measures 2 mm. There is no intrahepatic biliary ductal dilatation.PANCREAS: The visualized head of the pancreas is unremarkable. The body and tail of the pancreas obscured by overlying bowel gas.SPLEEN: The spleen measures 13.2 cm in length.RIGHT KIDNEY: Right kidney measures 10.6 cm in length. The renal cortex is normal in echogenicity. There is no hydronephrosis. OTHER: The left kidney measures 10.8 cm in length. The renal cortex is normal in echogenicity. There is no hydronephrosis.

Output: No cholelithiasis or other ultrasound finding to explain the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Reason: History of hepatitis C, assess for cirrhosis LIVER: Echogenic liver and coarse echotexture may reflect parenchymal dysfunction/hepatic steatosis. Small volume of ascites. The portal vein is patent. Normal portal venous hepatopedal blood flow, 22.8 cm/s. The liver measures 16.3 cm in length.BILIARY TRACT: No significant abnormalities noted. No intrahepatic or extrahepatic biliary ductal dilatation. No stones or intraluminal sludge. The gallbladder is contracted, limiting evaluation of wall thickness. The common hepatic duct measures 4 mm.PANCREAS: Obscured by bowel gas.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 10.9 cm in length. Small 1.1 x 7 cm anechoic cyst. No hydronephrosis.LEFT KIDNEY: The left kidney measures 10.9 cm in length. No hydronephrosis. OTHER: No significant abnormalities noted.

Output: Echogenic liver may reflect parenchymal dysfunction/hepatic steatosis. Small volume ascites.


Instruction: Generate impression based on medical findings.

Input: Multinodular goiter RIGHT LOBE MEASUREMENTS: 6.0 x 2.7 x 1.9 cm, not significantly changed.LEFT LOBE MEASUREMENTS: 5.8 x 1.9 x 1.8 cm, not significantly changed.ISTHMUS MEASUREMENTS: 5 mm in AP dimension, not significant changed.RIGHT LOBE: Unchanged size of the slightly hyperechoic predominantly solid nodule with cystic components nodule in the inferior pole measuring 2.7 x 1.7 x 2.3 cm, with slightly decreased cystic elements.LEFT LOBE: Unchanged size and appearance of the homogeneous slightly hyperechoic solid nodule in the inferior pole measuring 1.2 x 1.4 x 1.3 cm.ISTHMUS: Unchanged size and appearance of the solid nodule with hypoechoic rim measuring 0.5 x 0.5 x 0.4 cm.PARATHYROID GLANDS: Not identified.LYMPH NODES: Benign morphology cervical lymph nodes identified.OTHER: No significant abnormality noted.

Output: Unchanged size of three thyroid nodules, without development of new suspicious features.


Instruction: Generate impression based on medical findings.

Input: Ms. Miller is a 46 year old female with a personal history of 2 prior excisional biopsies of the right breast and 4 prior excisional biopsies of the left breast, one of which showed atypia. Patient previously took tamoxifen for 5 years and stopped in 2012. She 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. Numerous benign simple cysts are identified bilaterally. No suspicious cystic or solid mass is identified.This exam was interpreted by two radiologists.

Output: No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: 23-year-old female with flank pain. RIGHT KIDNEY: The right kidney measures 10.3 cm in length. Echotexture is normal. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Left kidney measures 11.6 cm in length. Echotexture is normal. No hydronephrosis, shadowing calculus or mass.OTHER: Shadowing gallstones within the gallbladder without wall thickening or pericholecystic fluid.Liver parenchyma appears moderately echogenic which may be due to fatty infiltration.

Output: No evidence for urolithiasis or hydronephrosis.Fatty liver.Gallstones.Report to Dr. Sharon Mangum Fax 773 834 0162


Instruction: Generate impression based on medical findings.

Input: 65 year old male with diminished urine output. Transplant kidney. Evaluate for obstruction. RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: Transplanted kidney measures 12.2 cm in length. No parenchymal abnormality.COLLECTING SYSTEM/URETER: No significant abnormality notedURINARY BLADDER: Poorly distendedOTHER: No significant abnormality noted

Output: No hydronephrosis. No change from prior exam.


Instruction: Generate impression based on medical findings.

Input: Male; 65 years old. Reason: elevated LFT History: as above LIVER: The liver measured 13.1 cm in length. The liver contour is smooth, the parenchyma is coarse in echotexture and diffusely increased in echogenicity. No worrisome mass is identified.The main portal vein is patent and demonstrates hepatopetal flow with a peak velocity of 0.2 m/sec.BILIARY TRACT: There is no cholelithiasis or gallbladder wall thickening. The common duct measures 3 mm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The pancreas is obscured by overlying bowel gas.SPLEEN: The spleen measures 9.0 cm in length.RIGHT KIDNEY: Right kidney measures 10.0 cm in length. The renal cortex is normal in echogenicity. There is no hydronephrosis or shadowing renal stone. No worrisome renal mass is identified. OTHER: The left kidney measures 11.1 cm in length. The renal parenchyma is normal in echogenicity. There is no hydronephrosis or shadowing renal stone. No worrisome renal mass is identified.

Output: Echogenic liver compatible with hepatic steatosis.


Instruction: Generate impression based on medical findings.

Input: Elevated creatinine RIGHT KIDNEY: Echogenic renal parenchyma without mass, stone, or hydronephrosis. Right kidney 8.8 cm in lengthLEFT KIDNEY: Echogenic renal parenchyma without mass, stone, or hydronephrosis. Left kidney 9 cm in lengthOTHER: Bladder mildly distended

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


Instruction: Generate impression based on medical findings.

Input: 42-year-old female with lump in the right breast. Three standard views of the right breast with spot compression were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses(BiRads Density Category C), unchanged in pattern and distribution. A palpable marker is placed over an asymmetry in the right breast which persists with spot compression, for which ultrasound was subsequently performed.ULTRASOUND

Output: Circumscribed mass in the right breast is most consistent with a benign fibroadenoma. A six-month follow-up ultrasound examination is recommended to confirm stability.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on medical findings.

Input: 42-year-old male with elevated INR. Evaluate for hepatic disease. LIVER: Exam somewhat limited by body habitus. The liver demonstrates irregular increased echogenicity centrally most suggestive of irregular fatty infiltration. No gross, focal mass identified. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: Gallbladder is normal without cholelithiasis, wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.

Output: Irregularly echogenic liver, likely due to irregular fatty infiltration.


Instruction: Generate impression based on medical findings.

Input: Abdominal pain nausea and vomiting BILIARY TRACT: Cholelithiasis again noted without acute inflammation or ductal dilatation. Negative Murphy's sign.OTHER: Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow

Output: Cholelithiasis again noted without acute inflammation or ductal dilatation.


Instruction: Generate impression based on medical findings.

Input: Reason: familial adenomatous polyposis; increased risk of thyroid cancer. RIGHT LOBE MEASUREMENTS: 6.1 x 2.1 x 2.2 cm.LEFT LOBE MEASUREMENTS: 4.9 x 2.0 x 1.5 cm.ISTHMUS MEASUREMENTS: Measures up to 0.2 cm in thickness.RIGHT LOBE: Normal background parenchymal echotexture without discrete nodules.LEFT LOBE: Normal background parenchymal echotexture without discrete nodules.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No suspicious cervical lymphadenopathy identified.OTHER: No significant abnormality noted.

Output: No worrisome thyroid nodule or regional adenopathy.


Instruction: Generate impression based on medical findings.

Input: Male 74 years old Reason: hematuria History: hematuria RIGHT KIDNEY: The right kidney measures 11.1 cm. There is a heterogeneous, vascular, solid mass arising from the midpole of the right kidney with deformity of the renal contour. This measures 3.1 x 3.1 x 3.6 cm and is suspicious for renal cell carcinoma.LEFT KIDNEY: The left kidney measures 12.1 cm. There is no hydronephrosis. URINARY BLADDER: The bladder is poorly distended.OTHER: No significant abnormalities noted.

Output: Solid 3.6 cm renal mass, suspicious for renal cell carcinoma. Further evaluation with renal protocol CT is recommended.Findings discussed by myself Dr. Ward with Dr. Christopher Riedinger 01/30/15.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male follow-up on AAA ABDOMINAL AORTA: Proximal: 3.4 cm in AP dimension (3.6 cm previously)Mid: 3.6 cm in AP dimension (3.9 cm previously)Distal: 4.4 cm in AP dimension (4.1 cm previously)Plaque is seen within the distal abdominal aorta representing approximately 40% narrowing. Flow is patent throughout the aorta.ILIAC ARTERY: Left iliac artery measures 2.0 cm x 3.0 cm x 1.8 cm. The right iliac artery measures 2.4 cm x 2.5 cm x 2.3 cm.

Output: Abdominal aortic aneurysm is stable without significant change from prior study. Plaque is seen within the distal aorta representing the 40% narrowing. There is mild dilatation of the right common iliac artery.


Instruction: Generate impression based on medical findings.

Input: 53-year-old male with history of flank pain, ureteral reimplantation. RIGHT KIDNEY: Measures 10.6 cm in length. No hydronephrosis. Increased renal echogenicity.LEFT KIDNEY: Measures 12.2 cm in length. Minimal left hydronephrosis unchanged since the prior study. Increased renal echogenicity.BLADDER: Partially collapsed, otherwise unremarkable.OTHER: No significant abnormalities noted.

Output: 1.Minimal left hydronephrosis without significant interval change.2.Resolution of right hydronephrosis since the prior study.3.Increased renal echogenicity consistent with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD. The breast parenchyma is composed of scattered fibroglandular density (BiRads Density Category B), unchanged in pattern and distribution. Diffuse scattered calcifications in both breasts particularly in the upper outer quadrants are not changed.

Output: No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: 70 year-old male with history of transaminitis. Evaluate for mass or other abnormality. LIVER: Slightly increased echogenicity of the liver parenchyma. The liver measures 22 cm. No biliary dilatation or focal masses.BILIARY TRACT: Cholelithiasis. No biliary dilatation or significant abnormality otherwise.PANCREAS: No significant abnormalities noted.SPLEEN: The spleen is enlarged, measuring 14.5 cm.RIGHT KIDNEY: No significant abnormalities noted. Right kidney measures 11.8 cm.OTHER: No significant abnormalities noted. Left kidney measures 13.7 cm.

Output: 1.Hepatosplenomegaly, with slightly increased echogenicity of the liver parenchyma, may reflect hepatic steatosis/parenchymal dysfunction.2.Cholelithiasis without biliary dilatation or significant abnormality otherwise.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with cystectomy, right upper quadrant pain. LIVER: No significant abnormalities noted.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. Common bile duct appears normal in caliber. No choledocholithiasis is identified.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: The patient noted tenderness to palpation over his surgical scars during the examination.

Output: Postoperative changes of cholecystectomy. No specific sonographic findings to account for the patient's pain.


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 30. 3-D whole breast ultrasound was performed for both breasts and images were reviewed on an independent workstation. Bilateral saline implants are identified. No suspicious solid or cystic mass is seen.

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


Instruction: Generate impression based on medical findings.

Input: 70-year-old male with history of cirrhosis, evaluate for HCC. LIVER: Measures 13.8 cm in length. Cirrhotic morphology with increased hepatic echogenicity, without focal lesion.BILIARY TRACT: No significant abnormalities noted.PANCREAS: 1.0 x 0.7 x 0.6 cm cystic structure in the proximal pancreatic body with a thin internal septation, not seen on prior studies. No pancreatic ductal dilation. The pancreatic tail is not clearly visualized due to bowel gas.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: Right renal cyst measuring 7.8 x 7.3 x 6.1 cm, and left renal cyst measuring 1.8 x 1.8 x 2.3 cm, without internal septation or solid component, not significantly changed compared to prior studies. OTHER: No significant abnormalities noted.

Output: 1. Cirrhotic liver with increased hepatic echogenicity consistent with chronic liver disease, without discrete lesion identified. 2. 1.0 cm septated cystic lesion in the pancreatic body not seen on prior studies is nonspecific and may represent a side branch IPMN. Further imaging with MRCP may be considered for further characterization as warranted clinically.


Instruction: Generate impression based on medical findings.

Input: Thyroid nodule RIGHT LOBE MEASUREMENTS: 4 x 1.3 x 1.6 cmLEFT LOBE MEASUREMENTS: No significant abnormality noted.ISTHMUS MEASUREMENTS: No significant abnormality noted.RIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: US THYROID, 4/6/2015 9:03 AMCLINICAL INFORMATION:Thyroid noduleCOMPARISON: 7/12/2013 TECHNIQUE: Thyroid ultrasoundFINDINGS:RIGHT LOBE MEASUREMENTS: 4 x 1.3 x 1.6 cmLEFT LOBE MEASUREMENTS: 4.4 x 1.4 x 1.1 cmISTHMUS MEASUREMENTS: Zero .1 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: Little significant change in the dominant solid left thyroid nodule now measuring 1.6 x 0.8 x 1 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.


Instruction: Generate impression based on medical findings.

Input: History: thyroid cancer s/p surgery RIGHT LOBE: No nodules or masses in the thyroidectomy bed.LEFT LOBE: No nodules or masses in the thyroidectomy bed.ISTHMUS: No nodules or masses in the thyroidectomy bed.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Multiple benign appearing prominent cervical lymph nodes with fatty hila:Right level 3 cervical lymph node measures 1.5 x 0.7 x 0.7 cm, previously 1.1 x 0.7 x 0.7 cm.Left level 3 cervical lymph node measures 1.8 x 0.6 x 0 1.1 cm, previously 2.0 x 1.0 x 0.8 cm.Left level 3 cervical lymph node measures 1.9 x 0.5 x 1.1 cm, without prior measurement for correlation.OTHER: No significant abnormality noted.

Output: 1. Stable exam without evidence of new suspicious nodules or masses.2. Prominent benign-appearing cervical lymph nodes without interval change.


Instruction: Generate impression based on medical findings.

Input: Thyroid nodule RIGHT LOBE MEASUREMENTS: 1.3 x 1.1 x 3.2 cmLEFT LOBE MEASUREMENTS: 1.6 x 1.3 x 3.5 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Heterogeneous gland without mass.LEFT LOBE: Heterogeneous gland. 1.1 x 0.8 x 1.4 solid mid pole nodule.ISTHMUS: Heterogeneous glandPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Heterogeneous thyroid gland with solid left midpole nodule. This nodule is amenable to ultrasound-guided biopsy. No regional adenopathy.


Instruction: Generate impression based on medical findings.

Input: Palpable right testicular nodule RIGHT TESTIS: 3.9 x 2.2 x 1.5 cm. Multiple well-circumscribed anechoic peripheral cystic lesions associated with the right testis consistent with tunica cysts. The largest measures 1 x 0.9 x 1.1 cm.LEFT TESTIS: 4.2 x 2.8 x 1.9 cm. No intratesticular mass.RIGHT EPIDIDYMIS: Benign-appearing right epididymal cyst/spermatoceleLEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: No significant abnormalities noted.

Output: Multiple right benign tunica cysts. No worrisome intratesticular mass.


Instruction: Generate impression based on medical findings.

Input: LVAD with chronic kidney disease LIVER: Mildly coarse and echogenic liver without mass. Liver length 21 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Echogenic parenchyma. Right renal cyst. No worrisome mass, stone, or obstruction. Right kidney 11.7 cm in length.OTHER: Echogenic left renal parenchyma. Left renal cyst. No left renal hydronephrosis. Bilateral pleural effusions. Trace ascites. Spleen 11.2 cm in length.

Output: Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass, stone, or obstruction. Hepatomegaly with mildly coarsened echogenic liver suggestive for liver parenchymal dysfunction; no ductal dilatation. Trace ascites.


Instruction: Generate impression based on medical findings.

Input: Reason: NASH cirrhosis evaluate for HCC History: cirrhosis LIVER: The liver measures 12.1 cm in length. Coarse liver echotexture is redemonstrated. Anechoic focus in the right hepatic lobe is again seen measuring, 1.1 x 1.1 x 1.1 cm, previously 0.8 x 0.7 x 0.7 cm. No new suspicious masses. The portal vein is patent with normal hepatopedal portal venous blood flow, maximum flow rate 23.1 cm/s.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted. No intrahepatic or extrahepatic biliary ductal dilatation. The gallbladder wall measures 0.1 cm. The common hepatic duct measures 0.3 cm. Negative sonographic Murphy sign.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 8.7 cm in length. No hydronephrosis.LEFT KIDNEY: The left kidney measures 8.1 cm in length. No hydronephrosis.OTHER: No ascites.

Output: 1. Persistent coarse liver echotexture, consistent with hepatic parenchymal dysfunction, hepatic steatosis, or chronic liver disease.2. Stable right hepatic cyst. No new masses.


Instruction: Generate impression based on medical findings.

Input: 32 year-old female with right upper quadrant pain. Evaluate for abscess underneath right upper quadrant incision. LIVER: The liver is normal in morphology, echogenicity and size, measuring 16 7 cm in craniocaudal dimension. No intrahepatic biliary ductal dilatation or focal hepatic lesion is evident. There is normal hepatopetal portal venous blood flow at 20 cm/sec.BILIARY TRACT: A 1.3 cm mobile gallstone is noted in a normally distended gallbladder without wall thickening, pericholecystic fluid, or focal tenderness. No extrahepatic biliary duct dilatation with the common bile duct measuring up to 3 mm.PANCREAS: The visualized pancreatic head and body are unremarkable.SPLEEN: The spleen measures 10.5 cm in length without a discrete abnormality.RIGHT KIDNEY: The right kidney measures 10.2 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident. Color Doppler demonstrates hilar blood flow. OTHER: Targeted ultrasound was performed of the right upper quadrant incision site and demonstrates no discrete fluid collection.The left kidney measures 10.8 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident. Color Doppler demonstrates hilar blood flow.

Output: Cholelithiasis without evidence of acute cholecystitis. No fluid collection at the site of the patients right upper quadrant incision.


Instruction: Generate impression based on medical findings.

Input: Hematuria and pyuria with increasing creatinine RIGHT KIDNEY: Normal echogenicity without mass, stone, or hydronephrosis. 12.9 cm in lengthLEFT KIDNEY: Normal echogenicity without stone or hydronephrosis. 13.7 cm in length. Increased prominence of parenchyma mid poleOTHER: Bladder nondistended

Output: Increased prominence of mid pole left renal parenchyma. A subtle mass lesion cannot be excluded. Would pay special attention to this region on future scans; alternatively, correlation with dedicated cross sectional renal study would be helpful.


Instruction: Generate impression based on medical findings.

Input: 26-year-old male with cystic fibrosis and right upper quadrant pain. LIVER: Normal in size and echotexture. No focal abnormality. Limited spectral and color Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: Gallbladder appears unremarkable without cholelithiasis, wall thickening or pericholecystic fluid, although a small portion of the fundus is poorly visualized due to adjacent bowel gas. The biliary tract is normal in caliber.PANCREAS: Inadequately visualized due to bowel gasRIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.

Output: No evidence for cholelithiasis.


Instruction: Generate impression based on medical findings.

Input: Ms. Kiawana Lagrone is a 23 year old female who presents for evaluation of intermittent left superior breast shooting pain for months. She denies associated skin change, nipple discharge or palpable lump. ULTRASOUND:On physical examination, no discrete mass is palpated.A targeted left ultrasound was performed for the patient’s area of pain in the superior left breast. There is no solid or cystic mass identified.

Output: No sonographic evidence of malignancy in the left breast at site of pain. The patient should follow up with her primary care physician as clinically warranted, presuming these results are concordant with the physical exam findings. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually at age of 40 years. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: Acute renal insufficiency RIGHT KIDNEY: Echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Benign renal cyst. 7.6 cm in length.LEFT KIDNEY: Echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Benign-appearing renal cyst. 10 cm in lengthOTHER: Bladder nondistended. Moderate ascites.

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


Instruction: Generate impression based on medical findings.

Input: History of hyperparathyroidism. RIGHT LOBE MEASUREMENTS: 6.3 x 2.2 x 2.2 cmLEFT LOBE MEASUREMENTS: 6.5 x 2.5 x 2.0 cmISTHMUS MEASUREMENTS: 6 mmRIGHT LOBE: The right thyroid lobe is homogeneous and normal in echogenicity without a discrete nodule.LEFT LOBE: The left thyroid lobe is homogeneous and normal in echogenicity without a discrete noduleISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Immediately inferior to the left thyroid lobe is a 1.4 x 0.9 x 1.0 cm hypoechoic nodule without significant hypervascularity.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.4 cm hypoechoic nodule immediately inferior to the left thyroid lobe may represent a parathyroid adenoma. Correlate with nuclear medicine study.


Instruction: Generate impression based on medical findings.

Input: 45-year-old male with abdominal mesothelioma. Evaluate for hydronephrosis. UTI, febrile after removal of percutaneous nephrostomy tubes. RIGHT KIDNEY: The right kidney measures 13.3 cm in length. Right ureteral stent partially visualized. No hydronephrosis. Echogenic renal parenchyma.LEFT KIDNEY: The left kidney measures 11.9 cm in length. Mild hydronephrosis on the left. A left ureteral stent partially visualized. Echogenic renal parenchyma.URINARY BLADDER: Partially distended urinary bladder, and ureteral stents are partially visualized.OTHER: No significant abnormalities noted.

Output: Mild hydronephrosis on the left. Bilateral ureteral stents in place.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for HCC History: HCV cirrhosis LIVER: The liver measures 14.3 cm in length and is nodular in contour. 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 0.2 m/s.BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 5 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: The spleen measures 14.7 cm in length. Coarse calcification within the spleen.RIGHT KIDNEY: Kidney measures 11.0 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 11.3 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No ascites.

Output: Cirrhotic liver morphology without focal lesions identified. Mild splenomegaly. No ascites.


Instruction: Generate impression based on medical findings.

Input: Reason: left renal mass, evaluate for change in size or characteristics. RIGHT KIDNEY: Kidney measures 10.5 cm in length. Normal parenchymal echotexture. No hydronephrosis, shadowing calculus or mass. Multiple cysts including septated cyst in the lower pole measuring up to 1.7 cm, not significantly changed.LEFT KIDNEY: Kidney measures 10.3 cm in length. Normal parenchymal echotexture. Heterogeneous predominately solid left renal mass with vascularity measuring 2.4 x 2.2 x 2.0 cm, previously 2.3 x 2.5 x 2.3 cm, not significantly changed.OTHER: No significant abnormalities noted. Bilateral ureteral jets are visualized.

Output: Solid left renal mass which remains highly suspicious for neoplasm, not significantly changed in size.


Instruction: Generate impression based on medical findings.

Input: Rule out hydronephrosis, AKI Limited evaluation due to body habitus and patient positioningRIGHT KIDNEY: Upper pole and midpole the right kidney is visualized with mild increased echogenicity consistent with chronic medical renal disease. Lower pole of the right kidney is not visualized due to overlying bowel gas. No hydronephrosis.LEFT KIDNEY: Left kidney is not visualized due to overlying bowel gas and patient positioning.OTHER: Foley catheter noted within the bladder

Output: Incompletely visualized left kidney and lower pole of the right kidney. Mild increased echogenicity of the visualized right kidney consistent with chronic medical renal disease.


Instruction: Generate impression based on medical findings.

Input: 28-year-old female presents with right upper quadrant pain. LIVER:Measures 14.5 cm. Normal echogenicity. No intrahepatic biliary dilation, focal mass, or ascites. Portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: Gallbladder is nondistended with an anechoic lumen. Wall measures 0.1 cm. No pericholecystic fluid, stones, or sludge. Negative sonographic Murphy's sign. Common hepatic duct measures 0.2 cm. Common bile duct measures 0.3 cm.PANCREAS: Evaluation the pancreas limited due to overlying bowel gas.SPLEEN: The spleen measures 9.8 cm without sonographic abnormalities.KIDNEYS: Right kidney measures 10.6 cm. Left kidney measures 9.2 cm. Normal echogenicity. No shadowing calculi, hydronephrosis, or focal mass. OTHER: No significant abnormality noted.

Output: 1. Normal ultrasound of the abdomen. No sonographic evidence of cholelithiasis or cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Female 54 years old Reason: pls study liver, spleen in pt w severe CHF and 1 month h/o abd 'bloating' History: no periph edema; no crackles in lungs, but increasing upper abd fullness x 1 mo in pt w severe CHF LIMITED ABDOMENLIVER: Liver is enlarged measuring 15 cm. Hepatic veins and IVC are dilated. These findings are secondary to patient's known congestive heart failure. No evidence of focal liver lesions. Liver echogenicity is unremarkable.BILIARY TRACT: Gallbladder wall is thickened likely secondary to heart failure. No evidence of cholelithiasis.PANCREAS: Not well visualized due to overlying bowel gas.SPLEEN: Spleen measures 12 cm. There is a hyperechoic area within the spleen measuring 7 mm likely representing a hemangioma. RIGHT KIDNEY: Right kidney measures 11.7 cm. Normal echogenicity. No focal lesions or hydronephrosis.OTHER: Left kidney measures 12 cm.

Output: Hepatomegaly, dilated hepatic veins and IVC secondary to patient's known history of congestive heart failure. Mild splenomegaly. Likely a small hemangioma within the spleen.


Instruction: Generate impression based on medical findings.

Input: 59-year-old female with transaminitis/jaundice. The exam is limited by patient positioning and inability to breath-hold.LIVER: Liver is normal in size and echotexture. No focal hepatic abnormality. Limited Doppler evaluation demonstrates patency and appropriate flow direction in the main portal vein. Pulsatility of waveform may be seen in congestive heart failure.BILIARY TRACT: Mild prominence the biliary tract without gross ductal dilatation. Common duct is normal in caliber. The gallbladder is incompletely distended but asymmetrically thick-walled associated with a trace of pericholecystic fluid. Small echogenic foci in the gallbladder likely represent small calculi. This cannot be verified due to inability to change patient's position. PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: Mildly echogenic as previously noted.OTHER: Bilateral pleural effusions. Mildly echogenic left kidney.

Output: There is mild, but asymmetric gallbladder wall thickening associated with a trace of pericholecystic fluid and perhaps small gallstones. Evaluation is limited by breathing and inability to appropriately change patient's position. This should be correlated with patient's symptomatology, since this could be the result of inflammation, adenomyosis or other mass.Mildly echogenic kidneys


Instruction: Generate impression based on medical findings.

Input: Renal insufficiency RIGHT KIDNEY: 7.8 cm in length. The renal parenchyma is markedly echogenic. No focal lesions or hydronephrosis is present.LEFT KIDNEY: 8.6 cm in length. The renal parenchyma is markedly echogenic. A 2 cm simple appearing cyst is noted in the midpole. No suspicious lesion or hydronephrosis is present.BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.

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


Instruction: Generate impression based on medical findings.

Input: Thyroid cancer, evaluate for adenopathy or recurrence RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: No suspicious lesions in the right thyroid bed.LEFT LOBE: No suspicious lesions in the left thyroid bed.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No specific evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 66 year old male with history of tachycardia, altered metal status, immunosuppression. Evaluate for infection source. LIVER: Heterogeneous liver parenchyma echogenicity. The liver measures 21 cm. No focal masses are seen.BILIARY TRACT: Cholelithiasis and gallbladder sludge, without gallbladder wall thickening or pericholecystic fluid.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. The spleen measures 10.4 cm.RIGHT KIDNEY: No significant abnormalities noted. The right kidney measures 13 cm.OTHER: No significant abnormalities noted. The left kidney is within normal limits, and the measures 12 cm.

Output: Hepatomegaly and findings of fatty liver infiltration. Gallbladder cholelithiasis without findings of cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Cirrhosis LIVER: Stable cirrhotic morphology without mass. Liver length 13.8 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.7 cm in lengthOTHER: Left kidney 13.2 cm in length. Spleen 15.7 cm in length. Trace ascites

Output: Stable cirrhotic morphology without mass or ductal dilatation. Trace ascites. Stable mild splenomegaly


Instruction: Generate impression based on medical findings.

Input: Transaminitis LIVER: Non-cirrhotic liver morphology. Mildly coarsened hepatic echogenicity, compatible with parenchymal dysfunction. 13 mm homogeneously hyperechoic lesion in the posterior right lobe likely represents a hemangioma. No suspicious hepatic lesions noted. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Normal appearance of the gallbladderPANCREAS: No sonographic abnormality evident in the visualized pancreatic head and neck. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney is 10.9 cm in length. The left kidney is 11.2 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 9.4 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No abdominal free fluid identified.

Output: Mildly coarsened hepatic echogenicity, compatible with parenchymal dysfunction. No specific findings otherwise to account for the patient's presentation.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with hepatitis C. Evaluate for mass. LIVER: Hepatomegaly with liver measuring 22 cm in length. The parenchyma is heterogeneously echogenic. No focal mass. No obvious cirrhotic morphology. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: Normal gallbladder and biliary tract.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: Small cyst. OTHER: Dromedary hump left kidney with small cyst.

Output: Coarsely echogenic, enlarged liver.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old. Elevated creatinine and potassium. Evaluate for hydronephrosis. RIGHT KIDNEY: The right kidney measures 11.6 cm in length, with mildly increased cortical echogenicity. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 12.1 cm in length, with mildly increased cortical echogenicity. No shadowing stones or hydronephrosis.OTHER: The urinary bladder is not visualized.

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


Instruction: Generate impression based on medical findings.

Input: Viral hepatitis C LIMITED ABDOMENLIVER: Cirrhotic morphology. 4.8 x 4 cm hyperechoic mass within the right lobe with indistinct margins. Liver length 21.3 cmBILIARY TRACT: Gallbladder sludge and stones without ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: Spleen length 18.5 cm RIGHT KIDNEY: No significant abnormalities noted. 9.6 cm in lengthOTHER: Left kidney 11.5 cm in length. Moderate ascites.

Output: Cirrhotic morphology with worrisome right lobe hepatic mass highly suspicious for hepatocellular carcinoma. Gallbladder sludge and stones without acute inflammation or ductal dilatation. Moderate splenomegaly with moderate ascites.Extensive collaterals in region of main portal vein suggestive for cavernous transformation. Main portal vein demonstrates reversal of portal venous flow.


Instruction: Generate impression based on medical findings.

Input: Female 23 years old with an enlarged thyroid gland RIGHT LOBE MEASUREMENTS: 7.7 x 4.9 x 4 cmLEFT LOBE MEASUREMENTS: 6.1 x 1.7 x 2 cmISTHMUS MEASUREMENT: 1 cmRIGHT LOBE: Dominant lower pole cystic nodule with mural nodularity measuring 4.7 x 4.7 x 3.3 cm.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Dominant right lower pole cystic nodule with mural nodularity. This nodule would be amenable to ultrasound-guided percutaneous biopsy. No regional adenopathy.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: 20-year-old female with history of bilateral palpable breast lumps. Patient denies any breast lump at the time of this diagnostic ultrasound evaluation. Bilateral breast ultrasound was performed for the areas of previous palpable concern as indicated by the patient. Patient denies any breast lump at the time of this diagnostic study.Targeted ultrasound of the medial and lateral breasts reveals no cystic or solid mass.

Output: Normal targeted diagnostic ultrasound evaluation of both breasts. No sonographic evidence for malignancy. 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: Congestive heart failure; transplant candidate LIVER:Mildly heterogeneous liver echotexture without mass. Liver length 16 cmGALLBLADDER, BILIARY TRACT: No significant abnormality noted.PANCREAS: No significant abnormality noted.SPLEEN: No significant abnormality noted. Spleen length 8.9 cmKIDNEYS: No significant abnormality noted. Right kidney 10.4 cm in length. Left kidney 9.2 cm in length.ABDOMINAL AORTA: No significant abnormality noted.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No significant abnormality noted. No ascites

Output: Mildly heterogeneous liver echotexture without mass or ductal dilatation. No ascites.


Instruction: Generate impression based on medical findings.

Input: Hepatitis B LIVER: Normal parenchymal echogenicity without mass. 15.4 cm in lengthGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.2 cm in lengthOTHER: Left kidney 10.3 cm in length. Spleen 9.2 cm in length. No ascites.

Output: Stable negative examination. No hepatic mass or ductal dilatation. No ascites.


Instruction: Generate impression based on medical findings.

Input: 20-year-old male with renal insufficiency and abnormal, heterogeneous kidneys on prior CT. RIGHT KIDNEY: The right kidney measures approximately 11.6 cm in length. Cortex is abnormally echogenic and mildly heterogeneous. There is no evidence for renal mass, hydronephrosis or shadowing calculus.LEFT KIDNEY: The left kidney measures approximately 11.2 cm in length. Cortex is abnormally echogenic and mildly heterogeneous. There is no evidence for renal mass, hydronephrosis or shadowing calculus.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.

Output: Echogenic kidneys consistent with parenchymal [disease.] Preservation of renal size suggests that this is relatively acute.


Instruction: Generate impression based on medical findings.

Input: 37-year-old female with right upper quadrant pain and diarrhea. LIVER: Hepatomegaly without significant change when compared to prior exam. Mildly coarsened echotexture of the liver which is nonspecific and without change. No focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: Gallbladder is well-visualized appears normal without cholelithiasis, wall thickening or pericholecystic fluid.PANCREAS: The head and body appear normal. The tail was not well seen due to bowel gas.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.

Output: Hepatomegaly with coarsened liver echotexture without change. Normal gallbladder and biliary tract.


Instruction: Generate impression based on medical findings.

Input: Thyroid nodule seen on CT RIGHT LOBE MEASUREMENTS: 1.4 x 1.6 x 5.1 cmLEFT LOBE MEASUREMENTS: 1.5 x 1 x 4.9 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Subcentimeter benign-appearing spongiform nodules mid thyroid glandLEFT LOBE: 1.1 x 0.7 x 1.2 cm spongiform nodule corresponding to the lesion seen on the recent CT.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: 0.7 x 0.6 x 1.1 cm extrathyroidal mixed echogenicity nodule posterior and inferior to the right thyroid gland.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Spongiform nodule corresponding to the lesion seen on the recent CT left thyroid gland; favor benign etiology. Subcentimeter benign-appearing spongiform nodules mid right thyroid gland. No regional adenopathy.Extrathyroidal mixed echogenicity nodule posterior and inferior to the right thyroid gland; cannot exclude parathyroid adenoma. Would recommend correlation with calcium and PTH levels.


Instruction: Generate impression based on medical findings.

Input: Right testicular pain and swelling RIGHT TESTIS: 3.0 x 2.9 x 2.9 cm. Normal parenchymal echotexture. A moderate sized right hydrocele is noted. Subcentimeter extratesticular calcification may represent prior microtrauma or prior torsion of the appendix of the testicle.LEFT TESTIS: 2.8 x 2.6 x 4.2 cm. Normal parenchymal echotexture.RIGHT EPIDIDYMIS: No significant abnormalities noted.LEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: Mobile soft tissue in the right hemiscrotum appears to be bowel, suggestive of an indirect hernia.DOPPLER

Output: 1. No evidence of testicular torsion.2. Right hydrocele.3. Mobile soft tissue in the right hemiscrotum appears to be bowel, suggestive of an indirect hernia.


Instruction: Generate impression based on medical findings.

Input: Questionable right thyroid nodule RIGHT LOBE MEASUREMENTS: 6.3 x 2.7 x 3.7 cmLEFT LOBE MEASUREMENTS: 9 x 3.5 x 4 cmISTHMUS MEASUREMENTS: 2.4 cmRIGHT LOBE: Enlarged diffusely heterogeneous gland without discrete nodule. No increased vascularity.LEFT LOBE: Enlarged diffusely heterogeneous gland without discrete nodule. No increased vascularity.ISTHMUS: Enlarged diffusely heterogeneous gland without discrete nodule. No increased vascularity.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Enlarged diffusely heterogeneous gland without discrete nodule. No increased vascularity. No regional adenopathy.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with history of hepatitis C, screening for HCC and cirrhosis LIVER: Measures 17.8 in length. Increased hepatic echogenicity without discrete focal lesion. 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: Atrophic kidneys with markedly increased echogenicity. 1.6 cm right superior pole cyst without septation or nodular component. No hydronephrosis, nephrolithiasis, or solid mass. OTHER: No significant abnormalities noted.

Output: 1. Increased hepatic echogenicity consistent with chronic liver disease, without discrete focal lesion. 2. Atrophic kidneys with markedly increased echogenicity consistent with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: 26 year old female with history of renal stone. RIGHT KIDNEY: The right kidney measures 10.3 cm, and has mild hydronephrosis. Multiple small right renal stones are seen, the largest of which measures approximately 6 mm in diameter.LEFT KIDNEY: The left kidney measures 10.2 cm, and also has mild hydronephrosis. Multiple small left renal stones are seen.OTHER: Incidentally noted right adnexal physiologic cyst.

Output: Bilateral mild hydronephrosis, with small renal stones.


Instruction: Generate impression based on medical findings.

Input: Female 66 years old; Reason: assess for thrombosis/duct dilation History: assess for thrombosis/ duct dilation The study was very limited due to patient's intubated status.LIVER: The liver appears coarse, echogenic, nodular and shrunken. The known mass of the hepatic dome is not visualized due to incomplete inspiration. No intrahepatic ductal dilation is seen. The main portal vein is patent with decreased hepatopetal flow measured at 9.7 cm/s. Large volume ascites is noted.GALLBLADDER/BILIARY TRACT: The gallbladder is surgically absent. The common bile duct measures 6.6 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen is enlarged measuring 14.2 cm and no acute abnormalities are noted.RIGHT KIDNEY: The right kidney measures 10.3 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen. There is suboptimal visualization due to incomplete inspiration.LEFT KIDNEY: The left kidney measures 12.2 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.Dopplers:MAIN PORTAL VEIN: The portal vein is not well-visualized but appears to be patent with hepatopetal flow measuring 9.7 cm/s, which is decreased.HEPATIC ARTERIES: The common hepatic artery is patent with hepatopetal flow and peak systolic velocity measured at 136.2 cm/s and RI of 0.7. The left hepatic artery is patent with hepatopetal flow and peak systolic velocity of 84.1 cm/s and RI of 0.7. Normal spectral Doppler wave forms are noted. The right hepatic artery was difficult to evaluate, and a normal spectral Doppler waveform was obtained.The right hepatic vein, main hepatic vein, left hepatic vein were unable to be evaluated with spectral Doppler interrogation.SPLENIC ARTERY: The splenic artery is patent with anterior grade flow to the spleen measured at peak systolic velocity of 125.7 cm/s and RI of 0.7.SPLENIC VEIN: The splenic vein is patent with hepatopedal flow.IVC: The inferior vena cava is patent.

Output: 1. The known mass at the hepatic dome was not visualized due to incomplete inspiration. Cirrhotic contour is noted. Large volume ascites, splenomegaly, and decreased velocity of the main portal vein are compatible with portal hypertension.2. Incomplete visualization and interrogation of the hepatic veins due to technical limitations. The hepatic arteries, splenic artery, splenic vein, and IVC are patent.3. No evidence for intrahepatic ductal dilatation.


Instruction: Generate impression based on medical findings.

Input: Female 31 years old Reason: 1 cm nodule of the L upper back/shoulder History: NUB v lipoma v cyst v other Very small hypoechoic focus measuring 0.4 x 0.3 x 0.4 cm in the subcutaneous fat.

Output: Findings likely represent a benign process such as a small lipoma.


Instruction: Generate impression based on medical findings.

Input: 39-year-old woman with clinical concern of enlarged right axillary lymph nodes presents for right axilla ultrasound. A targeted right axilla ultrasound was performed for the patient’s area of concern.There are two normal size and morphology lymph nodes identified in the right axilla. The first lymph node is seen in the mid axilla, posterior depth with normal hilar flow and cortical thickness measuring 1.6 x 0.7 cm. The second lymph node is seen in the low axilla middle depth with normal hilar flow measuring 1.5 x 1.4 cm, also with normal cortical thickness.

Output: Morphologically normal right axilla lymph nodes.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Reason: Screening for hepatocellular carcinoma History: cirrhosis; hx of HCV LIVER: The liver measures 19.35 cm in length and is nodular in contour. 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 0.19 m/s.BILIARY TRACT: Nonmobile, non-shadowing focus along the gallbladder wall likely representing a polyp measuring up to 4 mm, unchanged. No gallbladder wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 5 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 12.3 cm in length. RIGHT KIDNEY: Kidney measures 13.4 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 14.9 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No ascites.

Output: 1.Hepatomegaly and cirrhotic liver morphology without focal hepatic lesions. No ascites.2.4 mm gallbladder polyp is stable.


Instruction: Generate impression based on medical findings.

Input: 50-year-old female patient with hyperparathyroidism. RIGHT LOBE MEASUREMENTS: 6.1 x 1.8 x 1.6 cm.LEFT LOBE MEASUREMENTS: 5.9 x 1.5 x 1.2 cm.ISTHMUS MEASUREMENTS: 2 mm in thickness.RIGHT LOBE: The right thyroid lobe is homogeneous in echogenicity without dominant lesion.LEFT LOBE: The left thyroid lobe is homogeneous in echogenicity with a few scattered subcentimeter colloid nodules.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: There is a 0.6 x 0.5 x 1.1 cm well circumscribed, hypoechoic nodule posterior the lower pole of the left thyroid gland.LYMPH NODES: Benign morphology lymph nodes noted.OTHER: No significant abnormality noted.

Output: Parathyroid adenoma candidate posterior to the lower pole of the left thyroid gland.


Instruction: Generate impression based on medical findings.

Input: 45 year old female presents for follow-up of known left breast cysts. Previously had pain associated with these cysts, however has no complaints of pain today. No family history of breast cancer. On physical examination, no discrete palpable abnormality is identified.A targeted left ultrasound was performed for the patient's area of concern. Multiple tiny (<0.5 cm) benign cysts are visualized, unchanged from prior examination. No ultrasound features are present to suggest malignancy. No increased vascularity. No solid mass is appreciated.

Output: Multiple tiny, benign left breast cysts, unchanged from prior examination. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually, for which the patient is due in September 2015. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male with history of thyroid cancer post surgery. Evaluate for recurrent disease. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: No massesLEFT LOBE: No massesISTHMUS: No massesPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No interval change. No evidence for recurrent disease.


Instruction: Generate impression based on medical findings.

Input: Abdominal pain LIVER: No significant abnormalities noted.GALLBLADDER, BILIARY TRACT: Gallbladder sludge without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.OTHER: No ascites

Output: Gallbladder sludge without acute inflammation or ductal dilatation.


Instruction: Generate impression based on medical findings.

Input: 43-year-old female gross hematuria, hypertension RIGHT KIDNEY: Measures 10.9 cm in length. Unremarkable echogenicity without hydronephrosis, nephrolithiasis, or solid mass. LEFT KIDNEY: Measures 10.7 cm in length. Unremarkable echogenicity without hydronephrosis, nephrolithiasis, or solid mass. URINARY BLADDER: Incompletely distended without focal abnormality. OTHER: No significant abnormalities noted.

Output: No nephrolithiasis, hydronephrosis, or suspicious lesion.


Instruction: Generate impression based on medical findings.

Input: Right upper quadrant pain LIVER: Non-cirrhotic liver morphology. Normal parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Multiple subcentimeter gallstones identified. Very mild gallbladder wall thickening. Positive sonographic Murphy's sign elicited.PANCREAS: Obscured by bowel gas.KIDNEYS: The right kidney is 10.8 cm in length. The left kidney is 10.5 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 8.4 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites.

Output: Cholelithiasis with mild gallbladder wall thickening and positive sonographic Murphy's sign, likely representing mild cholecystitis.


Instruction: Generate impression based on medical findings.

Input: 41-year-old female status post right mastectomy for DCIS in 2011 presents with 2 palpated lumps in the right implant. ULTRASOUND

Output: Successful ultrasound-guided core biopsy of the right breast lesion and clip placement, 2 sites as described. Both masses are suspicious for recurrence. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: 56 years old, Female, Reason: thyroid nodule seen on ct History: RIGHT LOBE MEASUREMENTS: 1.2 by 5.2 x 1.6 cmLEFT LOBE MEASUREMENTS: 1.4 by 4.7 x 1.2 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: The right lower lobe is normal in architecture and without nodules.LEFT LOBE: The left thyroid lobe contains multiple subcentimeter hypoechoic nodules. A single predominantly cystic nodule with internal complexity, without internal vascularity is present in the inferior pole measuring 1.0 x 0.5 x 0.9 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing level 2 lymph node measures 0.8 by 1.5 x 0.5 cm.OTHER: No significant abnormality noted.

Output: Predominantly cystic nodule with internal complexity in the left lower pole of the thyroid.


Instruction: Generate impression based on medical findings.

Input: 45-year-old female with history of left thyroid nodule. RIGHT LOBE MEASUREMENTS: 2.4 x 1.9 x 6.9 cm.LEFT LOBE MEASUREMENTS: 2.9 x 2.3 x 6.9 cm.ISTHMUS MEASUREMENTS: 0.7 cm.RIGHT LOBE: There is a spongiform lesion measuring 0.7 x 0.6 x 0.7 cm in the right inferior thyroid that does not demonstrate calcification or vascularity.LEFT LOBE: Heterogeneous, nonvascular left thyroid nodule with hypoechoic rim measuring 1.8 x 1.5 x 2.1 cm. This lesion is amenable to biopsy as indicated.ISTHMUS: No significant abnormality noted.LYMPH NODES: Bilateral benign-appearing lymph nodes.OTHER: No significant abnormality noted.

Output: Right thyroid nodule without specific suspicious features. Left thyroid nodule as described above amenable to biopsy as indicated.


Instruction: Generate impression based on medical findings.

Input: Renal stones. RIGHT KIDNEY: 12.1 cm in length. Normal renal parenchymal echogenicity. No hydronephrosis. A 5 x 4 x 5 mm stone is noted in the lower pole. No suspicious renal masses are identified. LEFT KIDNEY: 12.4 cm in length. Normal renal parenchymal echogenicity. No hydronephrosis. No stones identified. No suspicious renal mass is identified.BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.

Output: 5 mm nonobstructing right renal stone.


Instruction: Generate impression based on medical findings.

Input: 48-year-old with known left breast cancer who is receiving neoadjuvant chemotherapy presents for ultrasound study to evaluate the response. Focused ultrasound of the left breast tumor is performed. Again visualized is an irregularly shaped hypoechoic mass with increased vascularity measuring 19 x 15 x 14 mm (previously 47 x 26 x 43 mm) at 2:00 position, 8 cm from the nipple.

Output: Decrease in size of the known cancer in the left breast. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: Reason: Epigastric pain, exclude pancreaticobiliary abnormalities History: Epigastric pain, exclude pancreaticobiliary abnormalities LIVER: The liver measures 18.5 cm in length, enlarged. Heterogeneous, hyperechoic hepatic parenchyma. The portal vein is patent with normal directional hepatopedal flow, peak velocity 47.1 cm/s. The portal venous waveform is pulsatile and the hepatic veins appear dilated. No focal masses.GALLBLADDER, BILIARY TRACT: Small polyp on the nondependent aspect of the gallbladder body. No shadowing stones or sludge. No significant biliary ductal dilatation. The gallbladder wall measures 0.3 cm. The common bile duct measures 0.2 cm.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 12.5 cm in length. The left kidney measures 12.6 cm in length. No hydronephrosis or shadowing stones.OTHER: No ascites. The spleen measures 14.2 cm.

Output: 1. Findings consistent with hepatic steatosis or parenchymal dysfunction. 2. Dilated hepatic veins and pulsatile portal venous waveform are suggestive of hepatic congestion or some degree of congestive heart failure.3. Gallbladder polyp should be followed up with repeat ultrasound in 3-6 months.


Instruction: Generate impression based on medical findings.

Input: Female 57 years old Reason: right upper quadrant pain with previous possible hemangioma but dye allergy History: right upper quadrant pain LIVER: Liver has normal homogeneous echogenicity. There is a hyperechoic lesion in the liver compatible with hemangioma, previously seen on CT measuring 1.2 x 1.2 x 1.4 cm. Main portal vein is patent with normal directional flow and a with a peak velocity of 24.7 cm/s. No evidence of hemorrhage or perihepatic fluid.BILIARY TRACT: No intra or extravascular dilatation. The gallbladder wall is normal. No pericholecystic fluid. Negative Murphy's sign.PANCREAS: The visualized portions of the pancreas are normal.SPLEEN: Spleen is normal in appearance measuring 7.1 cm.KIDNEYS: Right kidney measures 9.47 m. Kidney measures 10.1 cm. No shadowing calculus or hydronephrosis.OTHER: No significant abnormalities noted.

Output: 1.No evidence of cholelithiasis or cholecystitis.2.Unchanged hemangioma in the liver without evidence of complication.


Instruction: Generate impression based on medical findings.

Input: 46-year-old female presents for MR-directed ultrasound for the left breast. History of bilateral mastectomies for left breast cancer in 2015. Focused ultrasound was performed for the left medial breast. There is a hypoechoic mass with irregular margins with increased blood flow at 9:00 position measuring 9 x 4 x 6 mm (prior measurement: 5 x 3 x 5 mm). This lesion corresponds to MR findings.

Output: MR directed ultrasound detected a suspicious lesion at 9:00 position in the left breast, correlating to the MR findings. Ultrasound-guided biopsy is recommended.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on medical findings.

Input: Female 59 years old; Reason: thyroid nodules. RIGHT LOBE MEASUREMENTS: 4.8 x 2.0 x 1.8 cm.LEFT LOBE MEASUREMENTS: 4.2 x 2.0 x 1.6 cm.ISTHMUS MEASUREMENT: 0.2 cm.RIGHT LOBE: Normal echogenicity of the right lobe without mass. The previously noted nodule is not visualized on the current study.LEFT LOBE: There are 2 nodules noted in the left thyroid.Nodule 1: measures approximately 0.6 x 0.5 x 0.2 cm and is in the superior, anterior aspect of the left thyroid. This is an oval, well-defined, and hypoechoic lesion. No calcifications or internal vascularity. It appears similar in appearance to the prior study.Nodule 2: Measures approximately 0.9 x 0.7 x 0.5 cm in size in the middle left thyroid lobe. It is round, well-defined, heterogenous and spongiform. Appears similar to the prior study.ISTHMUS: No significant abnormality noted.LYMPH NODES: Lymph node is again noted in the right level 3 neck, measuring approximately 0.5 x 0.2 cm in a similar appearance to the prior study; favor benign etiology.OTHER: There is a round hypoechoic echogenicity anterior and posterior to the left thyroid favored to be a parathyroid gland.

Output: 1.Multinodular thyroid as described above similar in appearance to the prior study.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female patient with 6 cm right-sided nodule. RIGHT LOBE MEASUREMENTS: 8.6 x 3.6 x 4.8 cm.LEFT LOBE MEASUREMENTS: 6.9 x 1.6 x 2.5 cm.ISTHMUS MEASUREMENTS: 6 mm in thickness.RIGHT LOBE: The right thyroid lobe is predominantly replaced by a complex nodule measuring approximately 6.9 x 5.9 x 3.8 cm, previously 6.1 x 5.6 x 3.1 cm. A smaller solid peripherally calcified nodule within the right upper pole measures 0.7 x 0.6 x 1 cm, previously 0.8 x 0.7 x 0.7 cm.LEFT LOBE: No focal thyroid lesion is identified.ISTHMUS: A previously described isthmus nodule likely reflects extension of the dominant right thyroid nodule.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Similar appearance of a dominant complex right thyroid nodule, which was previously biopsied.


Instruction: Generate impression based on medical findings.

Input: 30-year-old female patient status post islet cell transplant. Two year follow-up. LIVER: The liver measures 15.4 cm in length and is increased in parenchymal echogenicity. A few well circumscribed echogenic foci, likely calcified, within the right hepatic lobe appear similar to the prior study and are likely benign in etiology. The main portal vein is patent with hepatopetal flow measuring approximately 16 cm/s.BILIARY TRACT: There are no gallstones, gallbladder wall thickening, or pericholecystic fluid. There is no intra or extrahepatic biliary duct dilatation. The common bile duct measures 1 mm in diameter.PANCREAS: The head and proximal body of the pancreas appear normal in echogenicity. The tail is obscured by overlying bowel gas.SPLEEN: The spleen measures 10 cm in length.RIGHT KIDNEY: The right kidney measures 10.6 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 10.9 cm in length. No evidence of hydronephrosis.

Output: 1. Patent portal vein with stable, likely benign echogenic foci within the right hepatic lobe.2. Increased hepatic parenchymal echogenicity suggestive of hepatic steatosis.


Instruction: Generate impression based on medical findings.

Input: Male 68 years old; Reason: history of familial non-medullary thyroid carcinoma, personal history of microcarcinoma History: none RIGHT LOBE MEASUREMENTS: The right lobe is surgically absent.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 1.8 x 2.4 x 5.7 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.3 cm.RIGHT THYROIDECTOMY BED: No lesions within the thyroidectomy bed suspicious for recurrence.LEFT LOBE: No significant abnormality noted. No nodules are identified.ISTHMUS: No significant abnormality noted.LYMPH NODES: No suspicious adenopathy noted.

Output: Stable exam status post right thyroidectomy. No lesions suspicious for recurrence. No suspicious adenopathy or new nodules are identified.


Instruction: Generate impression based on medical findings.

Input: 36 year old female at 22 weeks gestation presents for right breast ultrasound. Patient states she had warm, erythematous, and extremely tender right breast two weeks ago, which has somewhat resolved with warm compresses. Physician palpated right breast nodule. On physical examination, there is diffuse nodular pattern of glandular tissue appreciated, compatible with the patients gravid state. No discrete palpable mass is identified.A targeted right ultrasound was performed for the patient’s area of concern. There is no solid or cystic mass identified.

Output: No sonographic evidence for malignancy. If the patients physical examination remains normal, she should return for annual screening mammograms, beginning at age 40. Result and recommendations were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: 32 year-old female with hyperthyroidism. RIGHT LOBE MEASUREMENTS: 3.2-cm x 6.4 cm x 2.5 cmLEFT LOBE MEASUREMENTS: 2.9 cm x 5.8 cm x 2.5 cmISTHMUS MEASUREMENTS: 1.0-cm in thickness.RIGHT LOBE: Markedly heterogeneous in echotexture and hypervascular. No discrete nodules are identified. LEFT LOBE: Markedly heterogeneous in echotexture and hypervascular. No discrete nodules are identified.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Multiple bilateral benign-appearing lymph nodes likely reactive.OTHER: No significant abnormality noted.

Output: Enlarged, heterogeneous and hypervascular thyroid gland, appearance consistent with thyroiditis. Multiple likely reactive lymph nodes in the neck.


Instruction: Generate impression based on medical findings.

Input: 40-year-old male with right upper quadrant pain LIVER: Echotexture likely mildly increased which is non--- specific. No gross mass on limited exam.GALLBLADDER, BILIARY TRACT: Gallbladder is poorly distended without wall thickening, definite stones or pericholecystic fluid. However, the exam is limited due to under distention and bowel gas.PANCREAS: Limited due to bowel gas.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.

Output: Limited exam without gallbladder abnormality.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: 62 year old female presents for follow-up and possible aspiration of a right lower axillary cyst. Personal history of left lumpectomy in 1997 for DCIS. No current breast complaints. A targeted right axillary ultrasound was performed for the imaging area of concern. Within the right mid to lower axilla there is redemonstration of a oval, parallel, anechoic lesion which is smaller than on prior examination, today measuring 0.6 x 0.1 x 0.3 cm, suggesting resorbing cyst.

Output: High probability benign right axillary cyst. Given the interval decrease in size and the benign appearance, follow-up right axillary ultrasound is recommended in 6 months to further assess stability. Additionally, right breast mammogram should also be performed at this time to assess stability of high probability benign calcifications in the right breast, as recommended on prior study dated March 25, 2015. Results and recommendations were discussed with the patient the time of her examination.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on medical findings.

Input: 44-year-old female with thyroidectomy for thyroid cancer. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: No massLEFT LOBE: No massISTHMUS: No massPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence for recurrent disease


Instruction: Generate impression based on medical findings.

Input: 89-year-old male with history of thyroid cancer status post thyroidectomy. RIGHT LOBE MEASUREMENTS: Status post thyroidectomyLEFT LOBE MEASUREMENTS: Status post thyroidectomyISTHMUS MEASUREMENTS: Status post thyroidectomyRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Elevated creatinine RIGHT KIDNEY: Normal parenchymal echogenicity without mass, stone, or hydronephrosis. Right kidney 13.2 cm in length.LEFT KIDNEY: Normal parenchymal echogenicity without mass, stone, or hydronephrosis. Left kidney 13.5 cm in length.OTHER: Bladder nondistended. Mild ascites. Moderate right pleural effusion.

Output: Normal renal ultrasound. Unremarkable renal parenchymal echogenicity without mass, stone, or obstruction. Mild ascites. Moderate right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 49-year-old male with left upper pole renal mass and prior lumbar spine CT RIGHT KIDNEY: The right kidney measures 10.7 cm in length. There are shadowing calcifications without hydronephrosis which may be due to nonobstructing stones or medullary calcification. No mass identified.LEFT KIDNEY: The left kidney measures 10.8 cm in length. There is an ovoid simple -- appearing cyst arising from the extreme upper pole corresponding to the CT abnormality measuring 1.8 cm in greatest diameter. Presumably this represented a complicated cyst on prior CT. Very small lower pole simple cyst. No hydronephrosis or shadowing calculus.OTHER: No significant abnormalities noted.

Output: Left renal cyst corresponding to CT abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: abdominal pain LIVER: The liver measures 15.9 cm in length. Coarse, echogenic hepatic parenchyma. The portal vein is patent with normal hepatopetal directional flow, peak velocity 21.3 cm/s. No focal mass.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. The common bile duct measures 0.3 cm. No biliary ductal dilatation.PANCREAS: No significant abnormalities noted. The body and tail of the pancreas are obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 10.3 cm in length. No hydronephrosis, shadowing stones, or mass.LEFT KIDNEY: The left kidney measures 11.2 cm in length. There is a complex cystic lesion in the left lower pole measuring 2.0 x 1.6 x 1.6 cm with internal septation. No hydronephrosis or shadowing stones.OTHER: No ascites.

Output: 1. Cystic lesion in the lower pole of the left kidney is of indeterminate complexity. Follow-up evaluation with dedicated contrast-enhanced CT scan is recommended.2. Coarse, echogenic liver, consistent with hepatic steatosis or parenchymal dysfunction.


Instruction: Generate impression based on medical findings.

Input: Reason: 51F with no known history of kidney disease, now with rising creatinine RIGHT KIDNEY: The right kidney measures 13.8 cm in length. Mildly echogenic renal parenchyma. No focal mass, hydronephrosis, or shadowing stones.LEFT KIDNEY: The left kidney measures 13.8 cm in length. Mildly echogenic renal parenchyma. No focal mass, hydronephrosis, or shadowing stones. There is a simple cyst in the superior pole of the left kidney measuring 4.8 x 3.3 cm.OTHER: No significant abnormalities noted.

Output: Mildly echogenic renal parenchyma, possibly consistent with medical renal disease. No evidence of obstruction.


Instruction: Generate impression based on medical findings.

Input: 48-year-old male status post LVAD with drainage around the drive line. Evaluate for fluid collection. A targeted portable ultrasound was performed of the left lower quadrant along the course of the LVAD drive line. There is no discrete fluid collection.

Output: No discrete fluid collection.


Instruction: Generate impression based on medical findings.

Input: Weight loss and upper abdominal pain LIVER: No significant abnormalities noted. Bilobar hepatic cysts again noted. 0.7 x 0.6 cm subcentimeter echogenic focus within the peripheral aspect of the right lobe of the liver; a benign etiology such as hemangioma is favored. Liver length 18.8 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.1 cm in length OTHER: Left kidney 11.9 cm in length. Left renal cysts again noted, unchanged. No ascites

Output: Mild hepatomegaly without mass or ductal dilatation. Cholelithiasis without acute inflammation. No ascites.


Instruction: Generate impression based on medical findings.

Input: Hepatitis B. Evaluate for hepatocellular carcinoma. LIVER: 14.3 cm in length. Non-cirrhotic liver morphology. Mildly coarsened and increased parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Normal appearance of the gallbladderPANCREAS: No sonographic abnormality evident in the visualized pancreatic head and neck. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney is 9.5 cm in length in length. The left kidney is 9.4 cm in length in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 9.0 cm in length in length, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites identified.

Output: Mildly increased hepatic echogenicity, compatible with parenchymal dysfunction. No suspicious lesions identified.