Instruction: Generate impression based on medical findings.

Input: Male; 33 years old. Reason: eval for obstruction, reason for AKI History: AKI RENAL TRANSPLANT: LOCATION: Right iliac fossa.PERITRANSPLANT TISSUES: Continued decrease in size of the complex fluid collection along the posterior portion of the transplanted kidney. This currently measures 1.8 x 1.9 x 0.8 cm (previously 2.3 x 1.4 x 1.3 cm).KIDNEY: The transplanted kidney measures 12.7 cm in length. The cortex is echogenic. There is no shadowing renal stone.COLLECTING SYSTEM/URETER: Persistent mild dilatation of the transplant collecting system appearing similar to the prior study.URINARY BLADDER: The bladder wall appears thickened however the bladder is not fully distended.VASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels.The iliac artery and anastomoses are patent. The renal arteries are patent with velocities of 0.4-0.9 m/sec (resistive indices 0.63-0.80). The segmental arteries are patent with velocities of 0.3-0.5 m/sec (resistive indices 0.61-0.66).The arcuate arteries are patent with velocities of 0.2-0.4 m/sec (resistive index 0.62-0.68).The iliac vein and renal vein are patent. OTHER: No significant abnormality noted

Output: 1.Mild hydronephrosis not significantly changed compared to the prior ultrasound.2.Patent transplant renal vasculature.3.Continued decrease in size of perinephric hematoma.


Instruction: Generate impression based on medical findings.

Input: Term cell tumor status post right colectomy now with left testicular lesion RIGHT TESTIS: Status post orchiectomyLEFT TESTIS: 0.6 x 0.5 x 0.6 cm hypoechoic discrete mass within the left testicle. This lesion does not appear to be associated with the mediastinum.RIGHT EPIDIDYMIS: Status post orchiectomyLEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: Moderate left hydrocele

Output: Subcentimeter hypoechoic discrete mass within the left testicle not associated with the mediastinum. This finding is worrisome for a neoplastic focus, including malignancy.


Instruction: Generate impression based on medical findings.

Input: Liver transplant LIMITED ABDOMENLIVER: Stable coarse liver echotexture without mass. Liver length 21 cm.BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 12.7 cm in length RIGHT KIDNEY: No significant abnormalities noted. 7.7 cm in lengthOTHER: Left kidney 9.6 cm in length. No ascites.

Output: Patent hepatic vessels with normal directional flow. No hepatic mass or ductal dilatation. No ascites.


Instruction: Generate impression based on medical findings.

Input: 69-year-old female with hypercalcemia, hyperparathyroidism. Evaluate for abnormal parathyroids. RIGHT LOBE MEASUREMENTS: 4.3 cm x 1.2 cm x 1.4 cmLEFT LOBE MEASUREMENTS: 4.5 cm x 0.9 cm x 1.4 cmISTHMUS MEASUREMENTS: 3 mm in thicknessRIGHT LOBE: Multiple nodules are noted. At the mid to upper pole a hypoechoic cystic appearing nodule measures 7 mm x 5 mm x 3 mm. Additional hypoechoic mixed solid cystic nodule at the inferior pole measures 4 mm x 4 mm x 6 mm. A second inferior pole mixed solid cystic hypoechoic nodule measures 1.0 cm x 0.8 cm x 0.6 cm. LEFT LOBE: Hypoechoic mixed solid cystic nodule at the mid pole measures 4 mm x 2 mm x 4 mm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Bilateral thyroid nodules as described above. No sonographic evidence of parathyroid adenoma. Please refer to same day nuclear medicine parathyroid SPECT/CT study for additional findings.


Instruction: Generate impression based on medical findings.

Input: History of renal cell carcinoma status post right partial nephrectomy. RIGHT KIDNEY: The right kidney measures 9.3 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion.LEFT KIDNEY: The left kidney measures 13.3 cm in length without hydronephrosis, shadowing nephrolithiasis or suspicious lesion. Note is made of a 1.7 cm left superior pole simple cyst.OTHER: Contracted bladder. Partially imaged echogenic liver.

Output: No suspicious renal lesion is evident.


Instruction: Generate impression based on medical findings.

Input: Nephrotic range proteinuria RIGHT KIDNEY: 13.1 cm in length. Increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: 14.0 cm in length. Increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.BLADDER: No significant abnormality noted.OTHER: Left pleural effusion, partially imaged.

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


Instruction: Generate impression based on medical findings.

Input: Cirrhosis LIVER: Cirrhotic liver again noted without mass. Liver length 14.4 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. Right kidney 9.7 cm in lengthOTHER: Left kidney 11.2 cm in length. Spleen 14.6 cm in length. Trace ascites.

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


Instruction: Generate impression based on medical findings.

Input: Assess for ascites, portal vein thrombosis, patient with abdominal pain LIVER: Liver is enlarged in size measures 22.6 cm with a large heterogenous mixed echogenic irregular mass arising from the left lobe of liver, it appears very indistinct and difficult to measure but within these limitations the mass approximately measures 8.3 x 5.2 x 8 cm.Background liver parenchyma appears heterogenous, coarse with mild ascites around it.Portal vein demonstrates very slow flow without typical waveform, underlying portal vein thrombosis cannot be ruled out.Common duct is not dilated.BILIARY TRACT: No intrahepatic or extra hepatic biliary ductal dilatation.Gallbladder is distended with sludge and a few stones within it. Gallbladder wall is not thickened.PANCREAS: Not significantly visualized due to overlying bowel gas.SPLEEN: Mild splenomegaly noted, spleen measures 13.5 cm.RIGHT KIDNEY: Right kidney measures 11.8 cm and left kidney measures 11.9 cm. No evidence of hydronephrosis or focal lesions. OTHER: Ascites noted.

Output: Heterogenous large 8.3 cm mass arising from the left lobe of liver with a background of coarse heterogenous liver.Slow flow within the portal vein without difficulty form, underlying portal vein thrombosis cannot be ruled out.Mild splenomegaly and ascites


Instruction: Generate impression based on medical findings.

Input: Male 62 years old Reason: Evaluate soft tissue mass on midline back of neck (C5-8) History: Painless, soft lump on neck for over a year High and medium frequency grayscale and color Doppler ultrasound the region of the lump the back of the neck fails to reveal discrete measurable mass. Soft tissues and muscle planes appear normal.

Output: No mass visible by ultrasound. Consider re-evaluation of MRI of the head and neck of 2/28/15 in light of this clinical finding.


Instruction: Generate impression based on medical findings.

Input: 45-year-old female patient with history of thyroid nodule. Follow-up for interval change. RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 5.5 x 2.0 x 1.5 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 6.7 x 2.3 x 1.4 cm.ISTHMUS MEASUREMENTS: The isthmus measures 0.6 cm in thickness.RIGHT LOBE: No significant abnormality noted.LEFT LOBE: There is a dominant nodule in the left inferior pole measuring 2.5 x 2.2 x 2.7 cm, previously 2.3 x 2.3 x 1.7 cm. The nodule is relatively well-circumscribed, heterogeneous in echotexture, and contains multiple cystic spaces.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Morphologically normal lymph nodes are noted in the neck bilaterally.OTHER: No significant abnormality noted.

Output: No significant interval change in a dominant left inferior pole thyroid nodule.


Instruction: Generate impression based on medical findings.

Input: 63-year-old female with acute hepatitis. LIVER: Measures 19.2 cm in length. Increased hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: Collapsed gallbladder. 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: Not well visualized due to bowel gas. KIDNEY: 1.0 cm right renal cyst without septation or solid component No hydronephrosis, nephrolithiasis, or solid mass. OTHER: No significant abnormalities noted.

Output: 1. Mild hepatomegaly and increased echogenicity may represent hepatic steatosis or parenchymal disease. 2. Patent portal vein.


Instruction: Generate impression based on medical findings.

Input: 48 year-old female with a history of umbilical hernia with pain. Evaluate for umbilical hernia. Note is made of a small fat containing umbilical hernia which slightly increases in size with Valsalva maneuvers. There are no loops of bowel identified within the hernia sac with or without Valsalva maneuver.

Output: Small fat-containing umbilical hernia.


Instruction: Generate impression based on medical findings.

Input: 55 year old female with multiple right breast masses and right axillary adenopathy who was recalled from interpretation of outside examination for left breast asymmetry. History of ovarian cancer in sister diagnosed at age 45. LEFT UNILATERAL DIGITAL DIAGNOSTIC MAMMOGRAM: A ML view and 3 spot compression views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. There is redemonstration of a 1 cm mass in the the medial central left breast, which persists on compression imaging.LEFT BREAST ULTRASOUND: A targeted left ultrasound was performed for the mammographic area of concern. At the 9 o'clock position of the left breast, 3 cm from the nipple, there is a benign morphology intramammary lymph node measuring 0.7 cm, with normal color flow, corresponding to the finding on mammogram. At the 3 o'clock position of the left breast, 4 cm from the nipple, there is a 0.4 x 0.4 x 0.2 cm hypoechoic mass with ill-defined margins.

Output: Ill-defined hypoechoic 0.4 cm mass at the 3 o'clock position of the left breast. While this may represent benign lesion, fine-needle aspiration with possible ultrasound guided core needle biopsy is recommended for definitive histologic diagnosis. Results and recommendations were discussed with the patient.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on medical findings.

Input: Female 83 years old; Reason: Parathyroid adenoma in the setting of hypercalcemia and high PTH levels History: Hypercalcemia RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 4.4 x 2.4 x 1.9 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 4.3 x 2.1 x 1.6 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.1 cm.RIGHT LOBE: The right thyroid lobe is heterogeneous. No dominant nodules are identified.LEFT LOBE: The left thyroid lobe is heterogeneous. No dominant nodules identified.ISTHMUS: No significant abnormality noted.LYMPH NODES: No suspicious adenopathy noted. There is a right level 3 lymph node visualized with a fatty hilum measuring 1.4 cm 1.5 cm x 0.4 cm.

Output: 1.No evidence of a parathyroid adenoma visualized on this study. This ultrasound is partially limited due to patient's positioning/movement.2. Thyroid gland is heterogeneous but no dominant nodules are identified. No suspicious lymphadenopathy is seen.


Instruction: Generate impression based on medical findings.

Input: Female 70 years old; Reason: 70 year old female with persistent epigastric abdominal pain and recent normal upper endoscopy. Please assess for cholelithiasis or pancreatic abnormalities. History: epigastric pain LIVER: The liver measures 16.9 cm in length. There is normal echogenicity of the liver parenchyma. No focal hepatic lesions. No intrahepatic ductal dilation is seen. The main portal vein is patent with normal hepatopetal flow. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 2.0 mm. No stones are seen. No pericholecystic fluid. The common bile duct measures 1.5 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 9.4 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 10.0 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 10.5 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: No significant abnormality noted.

Output: 1. Normal abdominal ultrasound without hepatobiliary pathology.


Instruction: Generate impression based on medical findings.

Input: 55-year-old male with history of elevated LFTs. Evaluate for biliary obstruction. LIVER: No intrahepatic or extrahepatic biliary dilatation. The portal vein is tortuous, as seen on prior CT.GALLBLADDER, BILIARY TRACT: Cholelithiasis, without evidence of cholecystitis.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.

Output: Cholelithiasis, and portal vein tortuosity as above.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male with history of metastatic pancreatic cancer presents with a right groin mass. Evaluate for hernia. The right inguinal canal contains fat and vessels with no bowel. On Valsalva, the hernia orifice opens without protrusion of bowel.There are enlarged right inguinal lymph nodes.

Output: 1. Right inguinal hernia without bowel.2. Right inguinal lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: 50 year-old female with hyperparathyroidism. Evaluate for parathyroid adenoma. RIGHT LOBE MEASUREMENTS: 4.7 x 1.5 x 1.1 cmLEFT LOBE MEASUREMENTS: 4.9 x 1.6 x 1.1 cmISTHMUS MEASUREMENTS: 0.5-cmRIGHT LOBE: Ovoid 0.3 x 0.5 x 0.8 solid nodule. Heterogeneous echotexture.LEFT LOBE: No significant abnormality noted. Heterogeneous echotexture.ISTHMUS: Heterogeneous echotexture.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Heterogeneous thyroid with at least one discrete small right-sided solid nodule.No extrathyroidal mass.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate right thyroid nodule History: right thyroid nodule, benign RIGHT LOBE MEASUREMENTS: 6.4 x 3.0 x 2.2 cm.LEFT LOBE MEASUREMENTS: 6.1 x 2.1 x 1.3 cm.ISTHMUS MEASUREMENTS: Up to 0.3 cm in thickness.RIGHT LOBE: Normal background parenchymal echotexture. Mixed cystic, predominantly solid nodule involving the mid to lower pole measures 4.4 x 1.9 x 2.9 cm, not significant changed in size. Mild internal blood flow. No suspicious microcalcifications.LEFT LOBE: Mildly heterogeneous background parenchymal echotexture. No dominant left thyroid nodule.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign morphology left level 2 cervical lymph node.OTHER: No significant abnormality noted.

Output: Dominant right thyroid nodule measuring up to 4.4 cm, not significantly changed in size.


Instruction: Generate impression based on medical findings.

Input: 50 year old female, baseline exam as part of heart transplant evaluation. LIVER: Coarse echotexture of the liver measuring 16.1 cm in length with no focal hepatic lesions.GALLBLADDER, BILIARY TRACT: Cholelithiasis and sludge within the gallbladder. No pericholecystic fluid. Gallbladder wall measures 2 mm in thickness, within normal limits. Sonographic Murphy's sign is negative. No intra or extra hepatic biliary ductal dilatation. Common duct measures 2 mm in caliber, within normal limits.PANCREAS: The tail of the pancreas is obscured by overlying bowel gas. The remaining visualized portions are normal in echogenicity. No pancreatic ductal dilatation.SPLEEN: Normal echogenicity of the spleen measuring 10.0 cm in length.KIDNEYS: The right kidney measures 10.8 cm in length and is normal in echogenicity. No hydronephrosis or nephrolithiasis. The left kidney measures 9.9 cm in length and is lobular in contour with normal echogenicity. No hydronephrosis or nephrolithiasis.ABDOMINAL AORTA: The proximal aorta measures 1.6 cm x 1.8 cm x 1.7 cm, the mid aorta measures 1.4 cm x 1.5 cm x 1.5 cm, and the distal aorta measures 1.3 cm x 1.6 cm x 1.4 cm.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Coarse echotexture of the liver with no focal hepatic lesions. 2. Cholelithiasis with no evidence of cholecystitis.


Instruction: Generate impression based on medical findings.

Input: 86-year-old female with abdominal pain after eating. Evaluate for gallstones. LIVER: No significant abnormalities noted.GALLBLADDER, BILIARY TRACT: Mild gallbladder sludge but no cholelithiasis or evidence of cholecystitis. No biliary ductal dilation.PANCREAS: No significant abnormalities noted.KIDNEY: Atrophic echogenic kidneys consistent with chronic medical renal disease. No hydronephrosis.OTHER: No significant abnormalities noted.

Output: 1.No evidence of cholelithiasis or cholecystitis.2.Atrophic echogenic kidneys consistent with chronic medical renal disease.


Instruction: Generate impression based on medical findings.

Input: 19 year old with history of left breast mass, biopsy proven as fibroadenoma. A targeted left ultrasound was performed for the area of concern. At the left breast 4 o'clock position, the known mass is slightly increased in size, today measuring 3.6 x 1.8 x 2.6 cm. Previous measurements from August were 3.2 x 1.6 x 2.5 cm.

Output: Continued interval increase in the left breast mass. Surgical consultation is recommended and the patient will see Dr. Chhablani today.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with history of acute kidney injury. RIGHT KIDNEY: Measures 10.9 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. LEFT KIDNEY: Not clearly seen presumably due to bowel gas.URINARY BLADDER: Incompletely distended without focal abnormality. OTHER: Small left pleural effusion.

Output: 1. Technically limited examination due to bowel gas, with nonvisualization of the left kidney. Unremarkable right kidney.2. Small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 51-year-old female with small left renal mass for follow-up. RIGHT KIDNEY: The right kidney measures 11.1 cm in length. Echotexture is normal. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: The left kidney measures 10.9 cm in length. Echotexture is normal. No hydronephrosis or shadowing calculus. There is again noted a small, exophytic mass arising from the upper pole measuring 0.6 x 0.7 x 0.8 cm without significant change. This is rounded and hypoechoic although definite cystic characteristics cannot be demonstrated.OTHER: No significant abnormalities noted.

Output: Stable, small left renal mass.


Instruction: Generate impression based on medical findings.

Input: 71 years old, Female, Reason: 71F with history of thyroid nodule History: no symptoms RIGHT LOBE MEASUREMENTS: 3.6 by 0.7 x 1.3 cmLEFT LOBE MEASUREMENTS: 3.7 x 1.2 x 0.8 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Heterogeneous right thyroid lobe with multiple subcentimeter hypoechoic foci. No dominant lesion is identified.LEFT LOBE: Heterogeneous left thyroid lobe. No focal nodules.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Heterogeneous thyroid bilaterally with multiple subcentimeter hypoechoic foci in the right thyroid lobe which are indeterminate on this exam but are favored to represent benign colloid cysts. No dominant lesion is identified.


Instruction: Generate impression based on medical findings.

Input: 52 year old female with lupus nephritis, needs ultrasound guidance for biopsy Ultrasound guidance was provided for right kidney biopsy performed by the renal service.

Output: Ultrasound guidance was provided for right kidney biopsy performed by the renal service.


Instruction: Generate impression based on medical findings.

Input: 45-year-old female status post 4 cycles of chemotherapy for left breast cancer. Interval follow-up. A targeted left breast ultrasound was performed at the 11:00 position, 6 cm from the nipple at the site of the known malignancy. On today's exam, the margins are less convex and the mass currently measures 1.2 x 0.9 x 0.7 cm compared to 1.3 x 1.1 x 0.8 cm on the prior study. There was marginal flow to the mass on the prior exam. No flow is seen on today's exam on color Doppler imaging.

Output: Interval small decrease in the size of the mass as discussed above.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: 62-year-old female with some dysphasia. Rule out thyroid nodules. RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 4.9 x 1.8 x 1.7 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 5.5 x 2.7 x 2.5 cm.ISTHMUS MEASUREMENTS: The isthmus measures 0.6 cm in thickness.RIGHT LOBE: In the right mid thyroid pole, there is a 1.1 x 0.6 x 0.8 cm spongiform nodule.LEFT LOBE: Heterogenous echotexture the left thyroid lobe. In the left mid pole, there is a 2 x 1.8 x 2.3 cm spongiform nodule. In the left lower pole, there is a solid and cystic nodule measuring 1.2 x 0.8 x 0.9 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No suspicious cervical lymphadenopathy.OTHER: No significant abnormality noted.

Output: Bilateral thyroid nodules with the largest on the left measuring up to 2.3 cm in diameter and has a spongiform appearance, favoring benign etiology


Instruction: Generate impression based on medical findings.

Input: Hepatitis B LIVER: Coarse echogenic liver echotexture without mass; liver length 14.8 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis again noted without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.3 cm in lengthOTHER: Left kidney 9.8 cm in length. No ascites.

Output: Coarse echogenic liver echotexture consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Stable cholelithiasis without acute inflammation. No ascites.


Instruction: Generate impression based on medical findings.

Input: Reason: transaminitis History: abnormal LFTs Limited exam due to bandages overlying abdomen. LIVER: The liver measures 15.5 cm in length. The liver parenchymal echotexture is course and echogenic. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.26 m/s.BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. Repeating linear reflectors at the gallbladder lumen are favored to artifactual, but also could be related to cholecystostomy catheter if one is present; correlate with procedural history. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 3.7 mm in diameter.PANCREAS: Not visualized. SPLEEN: Not visualized. RIGHT KIDNEY: Not visualized. LEFT KIDNEY: Not visualized. OTHER: No significant abnormalities noted.

Output: 1.Limited exam. 2.Echogenic liver suggestive of parenchymal dysfunction/fatty infiltration. 3.No sonographic evidence of acute cholecystitis or biliary ductal dilatation.


Instruction: Generate impression based on medical findings.

Input: 7 day old male with encephalocele and meningomyelocele status post repair on 6/11; patient now has seizure like activity in the upper extremities. Patient needs head CT. There is no evidence of intracranial hemorrhage, mass or edema. Panventricular dilatation that is stable when compared to ultrasound obtained 6/13/2008.Wavy contour of the inner table of the calvarium consistent with Luckenschadel skull.Interdigitation of the interhemispheric fissure.Corpus callosum present.The visualized paranasal sinuses are normally pneumatized.

Output: 1. Imaging features associated with Chiari malformation including Luckenschadel skull and interdigitation of the cerebral hemispheres.2. Stable panventricular dilatation compared to ultrasound obtained 6/13/2008.


Instruction: Generate impression based on medical findings.

Input: Left upper quadrant LVAD drive line site wound There are no focal fluid collections in or surrounding the drive line bed.

Output: No evidence of fluid collections.


Instruction: Generate impression based on medical findings.

Input: 50 year old female with a thyroid cyst, fatigue. Evaluate for progression RIGHT LOBE MEASUREMENTS: 5.3 cm x 2.4 cm x 2.7 cmLEFT LOBE MEASUREMENTS: 5.1 cm x 1.4 cm x 2.4 cmISTHMUS MEASUREMENTS: 0.3 cm in thicknessRIGHT LOBE: At the upper pole there is a mixed solid cystic nodule measuring 1.6 cm x 0.9 cm x 1.7 cm previously measured 1.5 cm x 1.7 cm x 1.9 cm. At the inferior pole there is an additional heterogeneous vascular nodule measuring 1.2 cm x 0.7 cm x 1.6 cm previously measured 1.2 cm x 0.8 cm x 1.7 cm. LEFT LOBE: At the midpole there is a heterogeneous nodule measuring 0.6 cm x 0.3 cm x 0.6 cm, previously measured 0.7 cm x 0.6 cm x 0.4 cm. there is no internal vascularity or definite microcalcifications. At the inferior pole there is an additional solid nodule measuring 0.7 cm x 0.4 cm x 0.6 cm previously measured 0.7 cm x 0.5 cm x 0.6 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign appearing right neck level 2 lymph node measures 6 mm x 3 mm x 10 mmOTHER: No significant abnormality noted.

Output: No significant interval change in the bilateral thyroid nodules.


Instruction: Generate impression based on medical findings.

Input: Female 51 years old Reason: r/o recurrence History: h/o hurthle cell thyroid cancer. 1 year follow up study MEASUREMENTS: Patient is status post thyroidectomy.RIGHT LOBE: No residual recurrent tissue in the right thyroid lobe.LEFT LOBE: No residual or recurrent tissue in the left thyroid lobe.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Small benign-appearing lymph nodes are present. A right level 3 lymph node measures 0.3 x 0.3 x 0.9 cm.OTHER: No significant abnormality noted.

Output: No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male 45 years old; Reason: Evaluate for parathyroid adenoma History: Secondary hyperparathyroidism RIGHT LOBE MEASUREMENTS: 5.4 x 2.2 x 2.0 cm.LEFT LOBE MEASUREMENTS: 5.0 x 1.9 x 2.1 cm.ISTHMUS MEASUREMENT: 0.6 cm.RIGHT LOBE: There is a nodule in the inferior right lobe measuring approximately 2.2 x 1.1 x 1.8 cm. It is solid with some cystic spaces and it has poorly defined borders and mixed echogenicity. Otherwise the parenchyma of the right lobe is homogenous.LEFT LOBE: There is a nodule in the inferior left lobe measuring approximately 1.4 x 1.0 x 1.4 cm. It is predominately solid with some spongiform components, well-defined, with mixed echogenicity. Otherwise parenchyma and left lobe is homogenous.ISTHMUS: Homogenous parenchyma.LYMPH NODES: No suspicious adenopathy noted. OTHER: Round hypoechoic nodule measuring approximately 1.0 x 0.5 x 0.6 cm with well-defined borders located posterior and inferior to the right thyroid is a candidate for a parathyroid adenoma.

Output: 1.Multinodular thyroid as described above. Amenable to biopsy.2.Round hypoechoic nodule as described above is candidate for right inferior parathyroid adenoma.


Instruction: Generate impression based on medical findings.

Input: BPH. Evaluate for hydronephrosis RIGHT KIDNEY: 10.1 cm in length. Mildly increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: 9.6 cm in length. Mildly increased renal parenchymal echogenicity. Renal cysts noted, the largest of which measures 18 mm. No suspicious lesions are evident. No renal stones or hydronephrosis.BLADDER: Fluid-filled with foci of debris and air, making evaluation for underlying lesion suboptimal. The Foley catheter is seen extending to the level of the prostatic urethra, however is not identified within the bladder. Mild circumferential wall thickening noted, which may be seen in the setting of BPH.OTHER: Bilateral pleural effusions, partially imaged. Prostatomegaly.

Output: 1. Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease.2. Distended bladder, without Foley catheter identified within the bladder, portion of catheter seen at level of prostatic urethra. Clinical evaluation of Foley catheter is recommended.


Instruction: Generate impression based on medical findings.

Input: Male 75 years old; Reason: r/o adenopathy, recurrence History: h/o thyroid cancer. 2.5 year follow up study RIGHT LOBE, LEFT LOBE, ISTHMUS MEASUREMENTS: The thyroid has been surgically removed.RIGHT LOBE, LEFT LOBE, ISTHMUS: The thyroid has been surgically removed. No evidence of recurrence.LYMPH NODES: No adenopathy.

Output: 1.Surgical changes of a thyroidectomy without evidence of recurrence or adenopathy.


Instruction: Generate impression based on medical findings.

Input: 56-year-old female. Follow-up of colloid nodule. RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 5 x 1.4 x 1.5 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 4.7 x 1.4 x 1.3 cm.ISTHMUS MEASUREMENTS: The thyroid isthmus measures 0.1 cm in thickness.RIGHT LOBE: Heterogenous echotexture of the right thyroid lobe. In the right lower pole, there is a stable spongiform nodule measuring 0.7 x 0.5 x 0.6 cm (prior 0.6 x 0.5 x 0.5 cm). Mild increased vascularity of the right thyroid lobe.LEFT LOBE: In the left upper/mid pole, there is a spongiform nodule measuring 0.7 x 0.7 x 0.7 cm that has decreased in size (prior 1.1 x 1 x 0.6 cm). Mild increased vascularity of the left thyroid lobe.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Decreased size of the spongiform nodule of the left upper/mid pole.2. Stable subcentimeter spongiform nodule of the right lower pole.3. Nonspecific increased vascularity of the thyroid parenchyma, which may be seen in the setting of thyroiditis; clinical correlation suggested.


Instruction: Generate impression based on medical findings.

Input: Follow-up left thyroid nodule RIGHT LOBE MEASUREMENTS: 3.7 x 1.2 x 1.3 cm.LEFT LOBE MEASUREMENTS: 3.9 x 1.4 x 1.5 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant change in size of left thyroid nodule now measuring 1.3 x 1.3 x 2.1 cm; a new central cystic component of this nodule is appreciatedISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change in size of left thyroid nodule. This nodule now demonstrates a new central cystic component. No regional adenopathy.


Instruction: Generate impression based on medical findings.

Input: 76-year-old male. Abnormal LFTs. Evaluate for obstruction. LIVER: Normal echogenicity and echotexture the liver. The liver is 12 cm in length. No focal hepatic mass. Hepatoportal venous flow.GALLBLADDER, BILIARY TRACT: No biliary ductal dilatation. Common duct is 3 mm, within normal limits. Gallbladder sludge. Trace pericholecystic fluid, nonspecific in presence of ascites. Patient is not tender over the gallbladder.PANCREAS: Visualized pancreatic head is normal in echogenicity. Remainder of the pancreas is obscured by bowel gas.RIGHT KIDNEY: Right kidney is than 20 cm in length and has a cyst. No hydronephrosis.OTHER: Large bilateral pleural effusions. Trace perisplenic fluid.

Output: No biliary ductal dilatation. Gallbladder sludge with trace pericholecystic fluid, nonspecific in presence of ascites. Large bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 59-year-old female with right upper quadrant pain and question cholecystitis. LIVER: No significant abnormalities noted. No intrahepatic biliary ductal dilation.GALLBLADDER, BILIARY TRACT: Nondistended gallbladder with gallbladder wall measuring up to 1.2 cm. Pericholecystic fluid is also visualized. 2 echogenic foci are visualized within the gallbladder neck and likely represent stones.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY/TRANSPLANT KIDNEY: The right kidney appears atrophic and fibrotic. Transplant kidney appears similar in size prior exam, 14 cm without change in morphology.OTHER: Patient is post void and there is incomplete evaluation of the bladder.

Output: In the appropriate clinical setting, findings are consistent with cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Pleuritic chest pain Nondiagnostic exam secondary to contrast extravasation. Limited images through the level of the superior mediastinum.

Output: Incomplete exam secondary to contrast extravasation. Nondiagnostic for pulmonary embolism. Limited images through the level of the superior mediastinum.


Instruction: Generate impression based on medical findings.

Input: Multinodular goiter after surgery. Microcarcinoma found on pathology. RIGHT LOBE MEASUREMENTS: Status post right lobectomyLEFT LOBE MEASUREMENTS: 4.9 x 2.7 x 3.1 cm.ISTHMUS MEASUREMENTS: 0.9 cm.RIGHT LOBE: Status post right lobectomy. Minimal residual tissue and subcentimeter lymph node LEFT LOBE: Heterogeneous gland. Dominant upper pole solid echogenic nodule with hypoechoic halo has increased slightly in size compared to prior and measures 2.3 x 1.7 x 2.3 cm. Additional small nodules are again noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: Patient was extremely anxious during examination and was unable to lay supine.

Output: Slight interval enlargement of dominant nodule left lobe. Status post right lobectomy. Findings were discussed with the patient at the time of the exam.


Instruction: Generate impression based on medical findings.

Input: 74-year-old female with bilateral thyroid nodules. RIGHT LOBE MEASUREMENTS: 6.4 x 3.4 x 2.8 cmLEFT LOBE MEASUREMENTS: 4.5 x 2.7 x 2.0 cmISTHMUS MEASUREMENTS: 0.7 cmRIGHT LOBE: Dominant solid right thyroid nodule measures 7.0 x 1.2 x 1.1 cm with peripheral hypervascularity. Two smaller hypoechoic nodules measure 4.2 x 2.4 x 3.0 cm and 1.1 x 1.1 x 0.7 cm.LEFT LOBE: Multiple thyroid nodules. An anterior hypoechoic nodule with peripheral calcification measures 1.0 x 0.6 x 0.5 cm. A more posteriorly located hyper-isoechoic nodule measures 1.5 x 1.5 x 0.9 cm. Two smaller adjacent colloid appearing nodules measure up to 1.5 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multinodular thyroid as detailed above, which was subsequently biopsied. Please see separately dictated biopsy report for complete description of procedural findings.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for hematoma of the Left Lower Extremity Sonographic images of the anterior superficial soft tissues of the left leg demonstrate a discrete area of soft tissue echogenicity measuring up to 4.8 cm which lacks internal vascularity and is associated with edema in the surrounding superficial soft tissues. The appearance is somewhat atypical for an abscess or hematoma, and is favored to represent a neoplastic process such as a lipoma.

Output: Discrete soft tissue focus within the anterior superficial soft tissues of the leg with associated surrounding soft tissue edema. Appearance is somewhat atypical for a hematoma or abscess, and a neoplastic etiology such as a lipoma is favored. MRI may be considered for additional evaluation as clinically warranted.


Instruction: Generate impression based on medical findings.

Input: Cardiac arrest. Hemodynamic instability. Concern for Graves' disease. RIGHT LOBE MEASUREMENTS: 8.6 x 5.3 x 5.6 cm. LEFT LOBE MEASUREMENTS: 7.0 x 2.8 x 3.7 cm. ISTHMUS MEASUREMENTS: 10 mm in AP dimension.RIGHT LOBE: The right lobe is markedly enlarged, nearly completely comprised of heterogeneous nodules. While some of these nodules appear to be spongiform colloid nodules, others are indeterminate. There is normal to slightly decreased background vascularity.LEFT LOBE: The left lobe is markedly enlarged, nearly completely comprised of heterogeneous nodules. While some of these nodules appear to be spongiform colloid nodules, others are indeterminate. There is normal to slightly decreased background vascularity.ISTHMUS: Enlarged.PARATHYROID GLANDS: Not identified.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multinodular goiter. If there is concern for toxic multinodular goiter, nuclear scintigraphy may be helpful if clinically feasible. These findings would be atypical for Graves' disease, per clinical query.Findings discussed with the covering endocrinology fellow at 3:30 PM on 4/21/2015.


Instruction: Generate impression based on medical findings.

Input: Elevated LFTs LIVER: Mildly coarse liver echotexture without mass. Liver length 18.2 cm.GALLBLADDER, BILIARY TRACT: Gallbladder not visualized. No ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 12.7 cm in length.OTHER: Echogenic left renal parenchyma without mass, stone, or hydronephrosis. Left kidney 12.9 cm in length. Spleen 14.2 cm in length. No ascites.

Output: Mildly coarse liver echotexture raises the possibility of fatty infiltration/parenchymal dysfunction associated with mild hepatomegaly. No mass or ductal dilatation. No ascites. Gallbladder not visualized.Echogenic renal parenchyma suggestive of medical renal disease/parenchymal dysfunction without mass or hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 60 year-old female with abnormal liver function. LIVER: Mildly echogenic. Main portal vein patent with appropriate flow direction.GALLBLADDER, BILIARY TRACT: Mild intrahepatic ductal dilatation with marked dilatation of the common duct as previously noted.PANCREAS: Limited with pancreatic ductal dilatation associate with patient's known pancreatic head mass.RIGHT KIDNEY: No significant abnormalities noted.OTHER: Spleen not visualized.

Output: Mildly echogenic liver with dilated biliary tract as previously noted. Pancreatic ductal dilatation as previously noted.


Instruction: Generate impression based on medical findings.

Input: Right lower quadrant pain. Evaluate for hernia. No hernia is present. The subcutaneous soft tissues in the patient's area of concern are unremarkable.

Output: No hernia or subcutaneous findings to account for the patient's right lower quadrant pain.


Instruction: Generate impression based on medical findings.

Input: 43 years old, Female, Reason: primary hyperparathyroidism, please eval for enlarged parathryroids History: as above RIGHT LOBE MEASUREMENTS: 5.1 x 2.1 x 1.3 cmLEFT LOBE MEASUREMENTS: 5.0 x 2.0 x 1.5 cmISTHMUS MEASUREMENTS: 0.8 cmRIGHT LOBE: Hypoechoic subcentimeter right thyroid nodule measuring 0.4 x 0.3 x 0.4 cm.LEFT LOBE: Left thyroid lobe is without significant abnormality.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Very hypoechoic nodule posterior inferior to the right thyroid lobe is favored to represent a parathyroid adenoma measuring 1.3 x 0.7 x 0.7 cm.LYMPH NODES: No significant abnormality noted.OTHER: Posterior to the left internal jugular vein and definitely separate from the left thyroid lobe is a focus that is slightly hypoechoic to normal thyroid tissue and may represent a hematoma. Special attention to this area should be paid on future scans.

Output: 1.Right posterior inferior extrathyroidal nodule consistent with clinically suspected parathyroid adenoma.2.Slightly hypoechoic to normal thyroid tissue and posterior to the left internal jugular vein focus which may represent a hematoma although is indeterminate on this examination. Special attention to this area should be paid on future scans.


Instruction: Generate impression based on medical findings.

Input: Liver failure LIMITED ABDOMENLIVER: Coarse echogenic liver echotexture without mass. Mildly irregular contour. Liver length 16.6 cm.BILIARY TRACT: Gallbladder sludge without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. RIGHT KIDNEY: No significant abnormalities noted. 11.9 cm in lengthOTHER: Left kidney 11.2 cm in length. Spleen 12.6 cm in length. Trace ascites; right pleural effusion.

Output: Coarse echogenic liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Mildly irregular liver contour raises the possibility of cirrhosis. Patent but hepatofugal portal venous flow. Trace ascites.


Instruction: Generate impression based on medical findings.

Input: Female 32 years old Reason: bilateral fibroadenomas, evaluate for changes History: biopsy proven, palpable fibroadenoma in right breast Targeted bilateral breast ultrasound was performed. At the 12 o'clock position in the right breast redemonstration of an oval, parallel orientated hypoechoic mass consistent with a proven fibroadenoma, measuring 1.5 x 2.1 x 2.5 cm (previously 27 x 29 x 23 mm). A marker clip is identified within this mass. At 9:00 position, there is a stable mass measuring 15 x 9 x 13 mm (previously annotated as 8:00 position, 14 x 7 x 13 mm). In the left breast at the 11:00 position there is an oval, parallel oriented hypoechoic mass measuring 8 x 4 x 9 mm (previously 7 x 4 x 8 mm), also consistent with fibroadenoma.

Output: Benign morphology masses in both breasts consistent with fibroadenomas as noted above. Follow-up bilateral breast research MRI is recommended.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: HPV LIVER: Coarse echogenic liver echotexture again noted without mass. Liver length 14.1 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.3 cm in length OTHER: Left kidney 10.4 cm in length. Spleen 10.2 cm in length. No ascites.

Output: Coarse echogenic liver echotexture again noted consistent with chronic liver disease without mass or duct dilatation. No ascites.


Instruction: Generate impression based on medical findings.

Input: 37-year-old male post thyroidectomy for papillary thyroid carcinoma with nodal metastases. 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: Morphologically normal lymph nodes bilaterally. A level 2 node on the right which is mildly abnormal in shape with poor visualization of fatty hilum is completely unchanged from prior exam, measuring 0.4 x 1 x 1.1 cm.OTHER: No significant abnormality noted.

Output: No evidence for local recurrence or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 53 year old female with elevated LFTs and vomiting. LIVER: The liver has normal morphology, echogenicity and size, measuring 13.4 cm in length. No focal hepatic lesion or intrahepatic biliary ductal dilatation. Normal hepatopetal portal venous blood flow at 20 cm/sec.GALLBLADDER, BILIARY TRACT: Normally distended gallbladder without gallstones, wall thickening, pericholecystic fluid, or focal tenderness.PANCREAS: The visualized pancreatic body and head are normal.RIGHT KIDNEY: The right kidney measures 10 3 cm in length without hydronephrosis, shadowing nephrolithiasis, or focal lesion evident.OTHER: Moderate splenomegaly, measuring 14.6 cm.The left kidney measures 9.9 cm without hydronephrosis, shadowing nephrolithiasis, or focal lesion evident.

Output: 1. Normal gallbladder. No biliary ductal dilatation. 2. Moderate splenomegaly.


Instruction: Generate impression based on medical findings.

Input: Female 49 years old; Reason: cyst posterior left neck, TTP, x2 weeks, RA/sarcoid - eval etiology History: as above Within the subcutaneous tissues there is a relatively encapsulated isoechoic mass measuring 3.2 x 0.9 x 3.9 cm. it does not have any cystic foci of vascularity.

Output: 1.Findings compatible with a subcutaneous lipoma.


Instruction: Generate impression based on medical findings.

Input: Female 58 years old; Reason: Change in nodules History: Multinodular goiter RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 4.9 x 1.8 x 1.3 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 6.4 x 3.0 x 2.7 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.5 cm.RIGHT LOBE: The right lobe is heterogeneous. There is a dominant nodule in the inferior portion of the right lobe. This appears hypoechoic and heterogeneous to the thyroid. No microcalcifications or internal vascularity are seen. This nodule measures 1.5 cm x 1.4 cm x 0.9 cm and is similar in appearance to prior ultrasound. LEFT LOBE: The left lobe is heterogeneous. A dominant nodule is identified in the inferior portion of the left lobe. This appears heterogeneous and iso to hyperechoic to the thyroid. No internal microcalcifications are seen. This nodule measures 3.6 cm x 2.4 cm x 2.4 cm and is similar in appearance to prior ultrasound.ISTHMUS: No significant abnormality noted.LYMPH NODES: No suspicious adenopathy noted.

Output: Stable thyroid exam from prior ultrasound in 2014. Again noted is a right dominant complex nodule measuring 1.5 cm x 1.4 cm x 0.9 cm and left dominant complex nodule measuring 3.6 cm x 2.4 cm x 2.4 cm that are both stable in size and appearance. No suspicious adenopathy is visualized.


Instruction: Generate impression based on medical findings.

Input: History of probable hematoma presents for follow-up. Per patient the area has become smaller. A targeted left ultrasound was performed for the palpable area of concern. There has been interval decrease in size of the hematoma, which now measures 3.5 x 0.4 x 4.5 cm.

Output: Decreased volume of left breast hematoma. As long as the palpable finding continues to resolve clinically, no further targeted follow-up would be necessary. An annual mammogram will be due for this patient in January 2017.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on medical findings.

Input: Male 60 years old; Reason: assess for liver abnormalities, hepatic congestion. History: increasing liver enzymes LIVER: The liver measures 16.6 cm in length. There is coarse increased echogenicity of the liver parenchyma. No focal hepatic lesions. No intrahepatic ductal dilation is seen. The main portal vein is patent with normal hepatopetal flow measured at 28.9 cm/s. There is a small amount of ascites and right pleural effusion.GALLBLADDER/BILIARY TRACT: No stones are seen in the gallbladder, only minimal sludge. The gallbladder is incompletely visualized due to LVAD. No pericholecystic fluid. The common bile duct measures 3.6 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 10.4 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 11.5 cm in length. The cortex has increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 10.2 cm in length. The cortex has increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.

Output: 1. The liver has coarse increased echogenicity which is compatible with fatty infiltration/hepatocellular dysfunction. A small amount of ascites is present as is a right pleural effusion.2. Bilaterally the kidneys have increased echogenicity which is compatible with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: 50-year-old female with right upper quadrant pain, diarrhea, vomiting. LIVER: No significant abnormalities noted.GALLBLADDER, BILIARY TRACT: No cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. No biliary ductal dilation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.

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


Instruction: Generate impression based on medical findings.

Input: Ms. Cowden is a 44-year-old female with recently diagnosed left breast cancer and prominent left axillary lymph nodes. She presents today for repeat ultrasound evaluation of these lymph nodes. A targeted left axillary ultrasound was performed. Two lymph nodes are identified in the left axilla. -The first lymph node measures approximately 1.5 x 0.6 cm with uniform cortical thickness measuring up to 0.3 cm and preserved fatty hilum. There is normal hilar vascular flow identified.-The second adjacent lymph node measures 0.9 x 0.6 cm with uniform cortical thickness measuring up to 0.3 cm and preserved fatty hilum. There is normal hilar vascular flow identified.

Output: Two mildly prominent left axillary lymph nodes, which are not typically suspicious in appearance. These are likely reactive given the sonographic appearance and recent history of multiple biopsies. BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Reason: History of HBV. Evaluate for HCC LIVER: The liver measures 14.6 cm in length. Coarse echogenic liver parenchyma, consistent with hepatic steatosis/parenchymal dysfunction. No focal masses. The portal vein is patent with normal hepatopedal directional flow and peak velocity of 32.6 cm/s.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted. No sonographic evidence of cholelithiasis or biliary ductal dilatation. Gallbladder wall measures 0.3 cm.PANCREAS: Obscured due to overlying bowel gas.RIGHT KIDNEY: Atrophic, echogenic right kidney, measuring 6.6 cm in length. No significant hydronephrosis or shadowing renal calculi.LEFT KIDNEY: Not visualized.SPLEEN: The spleen measures 13.0 cm in length.OTHER: Right iliac fossa renal transplant measures 11.8 cm in length and demonstrates normal echogenicity without shadowing renal calculi or hydronephrosis. No ascites.

Output: 1. Coarse echogenic liver echotexture, consistent with hepatic parenchymal dysfunction, hepatic steatosis, or chronic liver disease without focal mass or biliary ductal dilatation.2. Right iliac fossa renal transplant without shadowing renal calculi or hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 76-year-old female with worsening renal function. RIGHT KIDNEY: Right renal size is difficult to assess due to patient motion. Cortex is mildly echogenic as seen on the prior exam. Large, simple cyst is again identified measuring approximately 8.7 cm in greatest diameter. No hydronephrosis or shadowing calculus.LEFT KIDNEY: The left kidney measures approximately 9 cm in length. There is again noted a 4 cm cyst arising from the lower pole which appears simple with a smaller cyst arising from the lower pole that may have a single septation. The cortex is mildly echogenic as seen on the prior exam. No hydronephrosis or shadowing calculus.URINARY BLADDER: Decompressed. Patient is Foley catheter.OTHER: No significant abnormalities noted.

Output: No significant interval change. Echogenic kidneys with large, bilateral cysts.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate for suspicious lateral and central neck lymph nodes in patient with 2.7 cm papillary thyroid carcinoma. RIGHT LOBE MEASUREMENTS: 4.1 x 1.7 x 1.5 cm.LEFT LOBE MEASUREMENTS: 4.5 x 1.0 x 1.4 cm.ISTHMUS MEASUREMENTS: 0.5 cm in thickness.RIGHT LOBE: Normal background parenchymal echotexture.LEFT LOBE: Normal background parenchymal echotexture.ISTHMUS: Within the isthmus, slightly eccentric to the right, there is a nodule measuring 2.5 x 2.1 x 2.2 cm which appears solid, is predominantly hypoechoic, demonstrates internal vascularity, and contains probable microcalcifications. This nodule is compatible with reported history of papillary thyroid carcinoma.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Small, benign morphology lymph nodes identified within the right level 4 and left level 3 stations.OTHER: No significant abnormality noted.

Output: Isthmic thyroid nodule compatible with reported history of papillary thyroid carcinoma. No morphologically suspicious cervical lymph nodes identified.


Instruction: Generate impression based on medical findings.

Input: Female with right-sided thyroid enlargement, right-sided throat pain. RIGHT LOBE MEASUREMENTS: 4.9 cm x 3.1 cm x 2.4 cm. LEFT LOBE MEASUREMENTS: 3.2 cm x 1.5 cm x 2.4 cm. ISTHMUS MEASUREMENTS: 3 mm in thickness.RIGHT LOBE: Multiple spongiform colloid nodules are noted, the largest of which measures 1.4 cm x 1.3 cm x 1.2 cm.LEFT LOBE: Spongiform colloid nodule is noted measuring 1.1 cm x 0.8 cm x 1.2 cm. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Left cervical lymphadenopathy is noted, the largest of which measures 2.5 cm x 1.5 cm x 1.3 cm. The remaining measure as follows: 1.2 cm x 0.9 cm x 1.0 cm, the other measures 0.8 cm x 1.0 cm x 1.2 cm and the other visualized lymph node measures 0.9 cm x 0.7 cm x 1.0 cm. These lymph nodes are heterogeneous and hypoechoic in echotexture. OTHER: No significant abnormality noted.

Output: 1. Left cervical lymphadenopathy, morphology is worrisome for neoplastic etiology. 2. Bilateral spongiform colloid thyroid nodules favoring a benign process.


Instruction: Generate impression based on medical findings.

Input: Pleuritic chest pain Nondiagnostic exam secondary to contrast extravasation. Limited images through the level of the superior mediastinum.

Output: Incomplete exam secondary to contrast extravasation. Nondiagnostic for pulmonary embolism. Limited images through the level of the superior mediastinum.


Instruction: Generate impression based on medical findings.

Input: Elevated liver enzymes LIVER: Coarse echogenic liver echotexture without worrisome mass. Hepatic cyst. Liver length 14.9 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.1 cm in lengthOTHER: Left kidney 10.7 cm in length. Spleen 10.9 cm in length. No ascites.

Output: Coarse echogenic liver echotexture consistent with fatty infiltration/parenchymal dysfunction without mass or duct dilatation. No ascites.


Instruction: Generate impression based on medical findings.

Input: Left jaw swelling. Targeted ultrasound of the patient's site of swelling demonstrates a 2.5 x 2.0 x 2.6 cm hypoechoic mass demonstrating internal vascularity. The lesion has a central linear hyperechoic band suggesting that this may represent an abnormal infiltrated lymph node. Limited evaluation of the left cervical lymph node demonstrates normal appearing lymph nodes.

Output: 2.6 cm left submandibular area soft tissue mass may represent an abnormal infiltrated lymph node. A soft tissues of the neck CT with intravenous contrast is recommended to evaluate the aerodigestive tract for a potential primary malignancy. This mass is also amenable to ultrasound guided percutaneous biopsy.


Instruction: Generate impression based on medical findings.

Input: Male 65 years old; Reason: eval for liver disease, obstruction History: new uptrending LFTs, cholestatic pattern LIVER: The liver measures 16.8 cm in length. There is coarse increased echogenicity of the liver parenchyma. There is a anechoic cyst at the superior left portion of the liver measuring 1.9 cm x 2 cm x 2.4 cm. This corresponds to prior CT. No intrahepatic ductal dilation is seen. The main portal vein is patent with normal hepatopetal flow measured at 27.4 cm/s. There is a small volume of ascites.GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 9.2 mm and appears contracted with sludge. No stones are seen. No pericholecystic fluid. The common bile duct measures 6.3 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 12.4 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 11.2 cm in length. The cortex has increased echogenicity. Renal stent is visualized, no hydronephrosis. There is a round isoechoic lesion seen along the midportion of the right kidney measuring 3.3 cm x 2.9 cm x 3.9 cm. This was visualized on prior CT. No stones or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 11.6 cm in length. The cortex has increased echogenicity. Renal stent is visualized with mild hydronephrosis. No stones or worrisome masses are seen.OTHER: No significant abnormality noted.

Output: 1. The liver appears coarsely echogenic which is compatible with fatty infiltration/hepatocellular dysfunction. No worrisome masses are seen. There is a small volume of ascites.2. Bilateral renal stents are visualized with mild hydronephrosis seen on the left. Both kidneys demonstrate increased echogenicity which is compatible with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Viral hepatitis LIVER: Stable cirrhotic morphology without worrisome mass. Stable hepatic cyst. Liver length 15.2 cm. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow.BILIARY TRACT: Moderate dilatation of extrahepatic bile duct again noted with maximal diameter of 1.2 cm.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 12.2 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 10.8 cm in lengthOTHER: Left kidney 12.8 cm in length. No ascites.

Output: Stable cirrhotic morphology without worrisome mass. Stable moderate dilatation of extra hepatic bile duct. No ascites.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male status post ex vivo hepatectomy, now with increasing output in drains, increasing creatinine. Evaluate flow through portal vein, evaluate kidneys. LIVER: Status post right hepatectomy. Remaining liver parenchyma is increased in echogenicity and measures 16.5 cm in length. Left portal vein is patent with appropriate directional flow; peak velocity measures 0.3 m/sec.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. No intrahepatic biliary ductal dilatation. Common duct is not well visualized.PANCREAS: Visualized portions of the pancreas are unremarkable.SPLEEN: Measures 14.1 cm in length and is normal in echogenicity.KIDNEYS: Right kidney measures 12.6 cm in length and is increased in echogenicity. No hydronephrosis or shadowing calculi are noted. Left kidney measures 11.5 cm in length and is increased in echogenicity. Mild pelvicaliectasis which was seen on prior CT dated 2/10/2015. No hydronephrosis or shadowing calculi are noted. ABDOMINAL AORTA: Proximal aorta measures 2.2 cm x 1.9 cm x 2.4 cm and is patent with appropriate directional flow.INFERIOR VENA CAVA: The visualized IVC is patent with appropriate directional flow.OTHER: Right pleural effusion. Trace ascites.

Output: 1. Status post right hepatectomy with increased echogenicity of the remaining liver parenchyma suggestive of parenchymal dysfunction/fatty infiltration. Patent left portal vein. 2. Trace ascites. Right pleural effusion. 3. Increased echogenicity of the kidneys suggestive of parenchymal dysfunction. Mild left pelvicaliectasis. No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Male 24 years old Reason: Intermittent LUQ pain, assess for splenomegaly/hepatomegaly History: Intermittent LUQ pain, assess for splenomegaly/hepatomegaly LIVER: Liver parenchyma is normal. No focal mass. Liver measures 16 cm, within normal limits. Main portal vein is patent with normal directional flow and a peak velocity of 29 cm/s.BILIARY TRACT: No intra or extra hepatic biliary ductal dilatation. Common bile duct measures 3 mm. Gallbladder is normal in appearance. No gallstones.PANCREAS: Visualized portion of the pancreas are normal.SPLEEN: Spleen is normal in appearance measuring 11.5 cm.RIGHT KIDNEY: Normal cortical echogenicity. No hydronephrosis or shadowing stone. Right kidney measures 11.5 cm. LEFT KIDNEY: Normal cortical echogenicity. No hydronephrosis or shadowing stone. Left kidney measures 11.8 cm.OTHER: No significant abnormalities noted.

Output: Normal appearance of the liver and spleen. No specific findings to account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Female 62 years old; Reason: Thyroid nodules RIGHT LOBE MEASUREMENTS: 4.7 x 1.7 x 1.7 cmLEFT LOBE MEASUREMENTS: 4.1 x 1.3 x 1.6 cmISTHMUS MEASUREMENT: 0.24 cmRIGHT LOBE: Two small nodules are seen within the inferior aspect of the right thyroid lobe. The first is solid, heterogeneous but predominantly hyperechoic and measures 0.8 x 0.7 x 0.8 cm and has no increased vascularity. The second nodule is solid and hypoechoic and measures 0.9 x 0.6 x 0.8 cm.LEFT LOBE: The left lobe contains a poorly defined, heterogeneous, hypoechoic nodule with no increased vascularity which measures 3.2 x 1.1 x 1.4 cm.ISTHMUS: No significant abnormality noted.LYMPH NODES: Multiple prominent bilateral cervical nodes with fatty hila.

Output: 1.Heterogeneous, ill defined 3.2-cm left thyroid nodule and reactive cervical lymphadenopathy may be seen with thyroiditis and correlation with clinical signs/labs is recommended. If clinically warranted, this nodule is amenable to ultrasound guided biopsy.


Instruction: Generate impression based on medical findings.

Input: 63 years old, Male, Reason: eval for cirrhosis and platelet sequestration History: thrombocytopenia, NASH LIVER: The liver is enlarged measuring 19.2 cm in length. Increased echogenicity is consistent with fatty infiltration. Coarse nodular contour of the liver is consistent with cirrhosis. 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: Patient is status post cholecystectomy. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 4 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: The spleen is enlarged measuring 15.3 cm in length. RIGHT KIDNEY: Kidney measures 11 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 11.3 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.

Output: 1.Enlarged fatty liver with nodular contour consistent with cirrhosis.2.Splenomegaly.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with palpable left thyroid mass. RIGHT LOBE MEASUREMENTS: 5.6 x 1.6 x 1.8 cmLEFT LOBE MEASUREMENTS: 5.7 x 2.3 x 2.7 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Overall echotexture is homogeneous. There is 0.4 x 0.4 x 0.7 cm spongiform-appearing nodule in the upper pole. Small, benign cystic lesion in the lower pole.LEFT LOBE: Echotexture is homogeneous. There is a 2.3 x 2.7 x 3.7 cm predominantly cystic mass in the left lobe corresponding to the palpable abnormality. There are 2 focal areas of nodular wall thickening, the largest measuring 0.4 burs x 0.8 cm without obvious flow by color Doppler. Wall is otherwise smooth without significant thickening. Slightly cephalad there is a smaller cystic area without definite solid component. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Small, likely colloid nodules right lobe. Dominant complex cystic mass left lobe. Given the large size of the cystic component and small nodular components, this likely represents a complex colloid cyst. Biopsy was not performed due to the high likelihood of a nondiagnostic sample. If aspiration is desired, patient can easily be rescheduled. This was discussed with the patient.


Instruction: Generate impression based on medical findings.

Input: Male 65 years old Reason: baseline exam as part of heart transplant evaluation LIVER:Liver measures 15.7 cm. Mildly echogenic liver appearance which is nonspecific. No focal mass. Main portal vein is patent with normal directional flow and velocity 15 cm/s.GALLBLADDER, BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. The gallbladder is normal in appearance. No gallstones.PANCREAS: Head of the pancreas is normal in appearance without pancreatic ductal dilatation. Body and tail of the pancreas are scattered by overlying bowel gas. SPLEEN: Spleen is difficult to visualize but likely measures 6.2 cm.KIDNEYS: Right kidney measures 9.0 cm. Left kidney measures 11.1 cm. Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. ABDOMINAL AORTA: Proximal aorta is obscured by overlying bowel gas. The mid aorta measures 1.8 cm in diameter. The distal aorta is also obscured by overlying bowel gas.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: Bladder is nondistended.

Output: Appearance of the abdominal viscera is within normal limits.


Instruction: Generate impression based on medical findings.

Input: 66-year-old female with right upper quadrant pain, rule out Budd-Chiari syndrome, evaluate hepatic veins LIMITED ABDOMENLIVER: Cirrhotic morphology of the liver with perihepatic fluid.

Output: Patent hepatic veins.Normal liver Doppler study.Cirrhotic morphology of liver with moderate ascites and right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Hemachromatosis LIVER: Coarse echogenic liver echotexture without mass. Liver length 17.9 cm GALLBLADDER, BILIARY TRACT: Gallbladder absent. No ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 12.7 cm in lengthOTHER: Left kidney 12.1 cm in length. Spleen 13.2 cm in length. No ascites.

Output: Coarse echogenic liver echotexture consistent with chronic liver disease without mass or ductal dilatation. No ascites.


Instruction: Generate impression based on medical findings.

Input: 29-year-old female with history of multinodular goiter.Three dominant nodules. Please evaluate for interval changes. RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 5.7 x 1.8 x 2.3 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 6.4 x 3.7 x 4.8 cm.ISTHMUS MEASUREMENTS: The thyroid isthmus measures 0.4 cm in thickness.RIGHT LOBE: The right thyroid lobe has heterogenous echotexture. The dominant nodule of the right lower lobe measures 1.9 x 1 x 0.9 cm (prior 1.6 x 1 x 0.8).LEFT LOBE: Enlarged left thyroid lobe containing multiple solid/cystic nodules. The known dominant nodule of the left upper pole measures 4.9 x 2.7 x 3.8 cm (prior 4.6 x 3.5 x 2.4 cm).ISTHMUS: The heterogenous solid/cystic nodule of the isthmus measures 2.4 x 2.6 x 1.4 cm (prior 2.1 x 2 x 1.4 cm).PARATHYROID GLANDS: A hypoechoic focus posterior-inferior to the right thyroid lobe measures 1.3 x 0.8 x 0.7 cm.LYMPH NODES: No suspicious cervical lymphadenopathy.OTHER: No significant abnormality noted.

Output: 1. Thyromegaly with multiple solid/cystic nodules. These nodules are similar in appearance and stable to slightly increased in size.2. A hypoechoic focus posterior-inferior to the right thyroid lobe is a candidate for parathyroid tissue. Correlation with nuclear medicine imaging is suggested.


Instruction: Generate impression based on medical findings.

Input: 65-year-old female with a perinephric hematoma seen on CT results for further evaluation. RENAL TRANSPLANT: LOCATION: Right iliac fossa.PERITRANSPLANT TISSUES: Again seen is a large complex hematoma measuring approximately 12.7 x 8.8 x 24.2 cm. Doppler flow shows active bleeding from upper midportion of kidney.KIDNEY: Normal echogenicity. No shadowing calculi, hydronephrosis, or focal mass.COLLECTING SYSTEM/URETER: No significant abnormality notedURINARY BLADDER: The urinary bladder is nondistended.VASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Large complex perinephric hematoma with active bleeding from renal transplant as described above.


Instruction: Generate impression based on medical findings.

Input: Male 68 years old Reason: transplant kidney eval, cholecsytitis, free fluid, infrarenal aneurysm as best as able History: ruq abdominal pain, h/o renal transplant and 3 cm infrarenal aortic aneurysm and cholelithiasis LIVER: Liver measures 18.2 cm, enlarged. No focal liver lesions.BILIARY TRACT: Significant gallbladder wall thickening with small amount of pericholecystic fluid. There are multiple gallstones. These findings are compatible with acute cholecystitis. No evidence of intra or extrahepatic biliary dilatation.PANCREAS: Not well visualized due to overlying bowel gas.SPLEEN: Spleen measures 10.8 cm.RIGHT KIDNEY: No evidence of hydronephrosis bilaterally. Right iliac fossa transplant kidney measures 11.6 cm, unremarkable. Bilateral native kidneys are not well seen due to their increased echogenicity. 1.5 cm simple cyst within the echogenic left kidney. AORTA:No evidence of aortic aneurysm. IVC:Unremarkable.OTHER: No significant abnormalities noted.

Output: Cholelithiasis with acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: 25-year-old female presents with a three day history of a breast lump in the 11:00 position. No known trauma history, no additional symptoms. A targeted left breast ultrasound was performed in the area of the patient's palpable concern. At the 11:00 position 5 cm from the nipple near the area of palpable concern is a circumscribed predominantly hyperechoic mixed echogenicity lesion measuring 1.5 x 2.0 x 0.8 cm, most likely representing either fat necrosis or a hematoma.

Output: Mixed echogenicity lesion in the area of palpable concern is consistent with either fat necrosis or hematoma. A three month follow-up examination is recommended to confirm stability or resolution.These findings were discussed with the patient and Dr. Checkett at the time of this dictation. BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on medical findings.

Input: 56-year-old male with history of chronic liver disease recently on spironolactone complaining of new bilateral nipple sensations and enlargement, and pulling sensation along the lateral aspect of the left breast. Family history is positive for premenopausal breast cancer in mother. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. Bilateral central subareolar glandular tissue extending into posterior adipose tissue in a fanlike configuration slightly asymmetric to the right, compatible with gynecomastia.Triangular marker overlying the left upper outer breast indicates area of palpable concern as indicated by the patient. There is no underlying correlating mammographic finding.LEFT BREAT ULTRASOUND:Targeted ultrasound of the left upper outer breast was performed in the area of concern as indicated by the patient.No solid or cystic mass was identified.

Output: Bilateral gynecomastia. No evidence of malignancy in either breast. Suggest clinical correlation for potential causes of gynecomastia.  BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on medical findings.

Input: Reason: Concern for ventral hernia. Please evaluate. History: As above There is interruption of the anterior abdominal wall, immediately cranial to the umbilicus. There is a narrow neck fat-containing hernia measuring 7.2 cm in transverse dimension and 2.7 cm in depth. This is grossly similar to a prior CT from 2010. No bowel loops are present within the lesion.

Output: Narrow necked fat-containing ventral hernia.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: 32-year-old male with likely right varicocele RIGHT TESTIS: Measures 4.1 cm x 2.4 cm x 1.8 cm. Microcalcifications are again seen within the testicle. Arterial and venous flow are demonstrated in the right testis upon Doppler exam. LEFT TESTIS: Measures 3.6 cm x 3.0 cm x 1.7 cm. Microcalcifications are again seen within the testicle. Arterial and venous flow are demonstrated in the left testis upon Doppler exam. RIGHT EPIDIDYMIS: Measures 2.9 cm x 1.0 cm x 0.9 cm. Epididymal cyst is again noted measuring 4 mm x 3 mm x 4-mm.LEFT EPIDIDYMIS: Measures 3.2 cm x 1.6 cm x 0.8 cm. OTHER: Bilateral varicoceles, left greater than right however improved from prior study. Bilateral trace hydroceles.

Output: 1. Bilateral varicoceles, left greater than right however improved from prior study. 2. Bilateral testicular microcalcifications are again noted.


Instruction: Generate impression based on medical findings.

Input: Recurrent pyelonephritis with CVA tenderness; pregnant RIGHT KIDNEY: Slight interval increase in degree of moderate hydronephrosis. No worrisome mass or stone. No perinephric collection. Right kidney 13.2 cm in length.LEFT KIDNEY: No significant abnormalities noted. 12.7 cm in lengthOTHER: Intrauterine pregnancy. Bladder nondistended.

Output: Slight interval increase in degree of right moderate hydronephrosis. No worrisome mass, stone, or abscess.


Instruction: Generate impression based on medical findings.

Input: Bilateral renal lesions seen on recent CT RIGHT KIDNEY: The previously noted multiple right renal lesions with intrinsic high attenuation on CT can be seen to represent multiple minimally complex cysts. A representative mid pole cyst measures 1.2 x 1.1 cm. No worrisome mass, stone, or hydronephrosis. Right kidney 9.8 cm in length.LEFT KIDNEY: The previously noted multiple left renal lesions with intrinsic high attenuation CT can be seen to represent multiple mildly complex cysts. The largest mid pole cyst measures 2 x 2 x 2 cm and demonstrates moderate internal complexity. No worrisome mass, stone, or hydronephrosis. Left kidney 9 cm in length.OTHER: Bladder nondistended

Output: The previously noted multiple bilateral renal lesions with intrinsic high attenuation seen on the chest CT can be seen to represent multiple minimally complex cysts. The largest left mid pole cyst demonstrates moderate internal complexity; continued surveillance by ultrasound of this cystic lesion is recommended.


Instruction: Generate impression based on medical findings.

Input: Right upper quadrant pain LIVER: No significant abnormalities noted. Liver length 12.4 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Right renal cyst. Right kidney 10 cm in lengthOTHER: Left kidney 11.2 cm in length. Spleen 9.2 cm in length. No ascites.

Output: Negative right upper quadrant ultrasound. No hepatobiliary abnormality. No ascites.


Instruction: Generate impression based on medical findings.

Input: Reason: advanced heart failure with early satiety, assess liver/spleen, abdominal vasculature as transplant workup History: advanced HF, early satiety LIVER:The liver is normal in echogenicity and echotexture and measures 19 cm in length. No intrahepatic biliary duct dilatations. No focal mass. The portal vein demonstrates normal direction of flow and peak velocity of 27 cm/s.GALLBLADDER, BILIARY TRACT: 0.8 x 0.7 cm echogenic focus in the gallbladder with shadowing, suggestive of gallstone. Gallbladder wall is a thickness of 2 mm. No pericholecystic fluid. No evidence of extrahepatic biliary ductal dilatation. The common bile duct measures 3 mm in diameter.PANCREAS: Limited evaluation of the pancreas due to overlying bowel gas does not demonstrate any significant abnormality in the visualized portion of the pancreas.SPLEEN: Spleen is normal in echotexture and measures 9 cm in length.KIDNEYS: The right kidney demonstrates normal echogenicity and measures 10 cm in length. No hydronephrosis. Small anechoic focus in the right kidney measuring 0.5 x 0.3 x 0.5 cm is too small to characterize but likely represents a cyst.Left kidney measures 10.1 cm in length and demonstrates normal echogenicity. No hydronephrosis.ABDOMINAL AORTA: The abdominal aorta is normal in size and demonstrates a peak velocity of 97 cm/s. Iliac arteries are normal in diameter.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Echogenic shadowing focus in the gallbladder suggestive of a gallstone with no evidence of acute cholecystitis. Otherwise normal sonographic examination of the abdomen.


Instruction: Generate impression based on medical findings.

Input: 18-year-old male with history of sickle cell anemia, right upper quadrant pain LIVER: Measures 17.9 in length. Unremarkable hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: The gallbladder is mildly distended and contains sludge as well as small stones. There is mild gallbladder wall thickening with reticulation of the pericholecystic fat. No sonographic Murphy sign was elicited during the examination. There is no biliary ductal dilation.PANCREAS: The pancreas is incompletely imaged due to bowel gas. The imaged portions of the pancreas appear unremarkable. SPLEEN: Markedly increased splenic echogenicity consistent with infarction and calcification.KIDNEY: No hydronephrosis, nephrolithiasis, or solid mass. OTHER: No significant abnormalities noted.

Output: 1.No convincing evidence of acute cholecystitis, but cholelithiasis with mild gallbladder wall thickening and pericholecystic inflammatory changes raise the question of a chronic component of inflammation. 2.Splenic infarction and calcification consistent with sickle cell anemia.


Instruction: Generate impression based on medical findings.

Input: 22 years old, Male, Reason: evaluate gallbladder, ducts History: RUQ pain LIVER: The liver measures 17.3 cm in length. Echogenicity of the liver is borderline increased. No focal hepatic lesion identified. The main portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.3 m/s.BILIARY TRACT: Gallbladder sludge and possible small gallstones are present. Per ultrasound technologist, negative sonographic Murphy's sign. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct is mildly prominent measuring 7 mm in diameter. There is minimal tapering of the common bile duct at the midportion. The distal common bile duct is not well assessed on this exam and choledocholithiasis at this level cannot be entirely excluded.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 9 cm in length. RIGHT KIDNEY: Kidney measures 10.7 cm in length. No hydronephrosis.LEFT KIDNEY: Kidney measures 10.3 cm in length. No hydronephrosis.

Output: 1.Gallbladder sludge and possible small gallstones without evidence of acute cholecystitis.2.Distal common bile duct not well assessed, as above.


Instruction: Generate impression based on medical findings.

Input: 67 years old, Female, Reason: evaluate for L and/or R femoral abscess History: previous central line access; fungemia No evidence of fluid collection or abscess at sites of clinical concern.

Output: No evidence of soft tissue edema or abscess as clinically questioned.


Instruction: Generate impression based on medical findings.

Input: 90 year-old female with transaminitis postop. Evaluate portal vein and liver and for obstructive nephropathy. LIVER: Increased in echogenicity measuring 14.2 cm in length. No focal hepatic lesions. Portal vein is patent with appropriate directional flow; peak velocity measures 0.4 m/sec.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. Common hepatic duct measures 8 mm in caliber with diffuse prominence of the intrahepatic biliary ducts. No common duct dilatation. PANCREAS: Incompletely visualized. SPLEEN: Not well visualized.KIDNEYS: Right kidney measures 15.1 cm in length. Cyst at the upper pole measures 8.3 cm x 6.8 cm x 8.1 cm. No hydronephrosis or shadowing calculi are noted.Left kidney incompletely visualized containing multiple cysts, the largest of which measures approximately 7.2 cm x 5.3 cm x 6.0 cm. No definite hydronephrosis or shadowing calculi are noted.ABDOMINAL AORTA: Patent with appropriate direction of flow. The proximal aorta measures 2.6 cm x 2.3 cm x 1.9 cm. The mid aorta measures 1.9 cm x 1.9 cm x 1.6 cm.INFERIOR VENA CAVA: The visualized IVC is patent with appropriate directional flow.OTHER: No significant abnormality noted.

Output: 1. Increased echogenicity of the liver suggestive of parenchymal dysfunction/fatty infiltration. There is diffuse prominence of the intrahepatic biliary ducts with normal caliber of the common hepatic duct suggestive of hepatic hilar mass/masses or stricture. Recommend CT or MRI for further evaluation. 2. Bilateral renal cysts.


Instruction: Generate impression based on medical findings.

Input: 63-year-old female with thyromegaly and hoarseness. Evaluate for nodules. Goiter. RIGHT LOBE MEASUREMENTS: 2.4 x 2.5 x 5.6 cmLEFT LOBE MEASUREMENTS: 1.9 x 2.5 x 6 cmISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: Diffusely heterogeneous in echotexture. Multiple small cystic and complex cystic nodules, some with comet tail artifact. In the mid inferior right lobe is a complex cystic nodule measuring 0.9 x 1.4 x 1.1 cm with a large nodular component. Large cyst with a small amount of wall calcification inferomedially measures 1.4 x 2.5 x 2.1 cm. Similarly there is a. Early cystic nodule with small amount of wall calcification anteriorly in the upper pole extending into the isthmus measures 0.8 x 1.5 x 1.4 cm.LEFT LOBE: Diffusely heterogeneous in echotexture. Multiple small cystic and complex cystic nodules, some with comet tail artifact. Largest complex cystic nodule measures 0.5 x 0.6 x 0.6 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Thyromegaly with heterogeneous gland.Bilateral cystic and complex cystic nodules as described above. 2 cystic nodules on the right demonstrate a small amount of wall calcificationComplex cystic nodule on the right with eccentric, nodular soft tissue.


Instruction: Generate impression based on medical findings.

Input: Reason: rule out hepatic abnormality. Pt with elevated liver enzymes, history of hepatitis B. LIVER: The liver measures 17.6 cm in length. The liver demonstrates mildly 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 0.22 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 3 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 9.2 cm in length. RIGHT KIDNEY: Kidney measures 12.0 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 10.8 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No significant abnormalities noted.

Output: Mildly increased hepatic echogenicity suggestive of parenchymal dysfunction/fatty infiltration. No evidence of acute cholecystitis or biliary ductal dilatation.


Instruction: Generate impression based on medical findings.

Input: The patient submitted outside mammogram dated 8/7/12. Submitted outside study was compared to the current mammogram dated 12/18/15. Focal asymmetry in the right upper outer breast appears new and additional spot compression views and possibly ultrasound are recommended.

Output: New focal asymmetry in the right upper outer breast, for which additional spot compression views and possibly ultrasound are recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on medical findings.

Input: RIGHT LOBE MEASUREMENTS: 4 x 1.2 x 2.1 cmLEFT LOBE MEASUREMENTS: 4.7 x 1.5 x 2.2 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Multiple nodules identified. In the extreme upper pole there is a 0.6 x 0.7 x 1.0 cm nodule. This was clearly spongiform in the prior study although the cystic spaces are somewhat less well-visualized on today's exam. Overall this is changed little in size. Large complex cystic nodule with thick septation and slight wall irregularity measures 0.7 x 1.1 x 1.6 cm, without change. There are several, small colloid nodules with comet tail artifact. LEFT LOBE: Multiple nodules identified. In the midportion of the left lobe there is a predominantly solid nodule with some spongiform characteristic. This measures 0.7 x 1.6 x 1.6 cm without change. There is a second, inferior spongiform nodule measuring 1.3 x 1.7 x 1.6 cm also unchanged. There is some coarse calcification associated with the rim of this nodule, but there is also clear comet tail artifact. Smaller colloid nodules are identified as well as.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: The patient complained of an enlarging nodular density slightly to the right at the base the neck. Scanning demonstrates this to be an asymmetric clavicular head. There is, however, suggestion of a rounded nodular density more caudally and at midline which cannot be adequately visualized. If further information is needed, recommend CT of the neck.OTHER: No significant abnormality noted.

Output: Bilateral thyroid nodules which are mixed cystic and solid, are similar in size to prior study, most low suspicion. However, a single right superior thyroid nodule previously spongiform, now appears more solid.See above discussion of rounded nodular density in the substernal region.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male 63 years old Reason: eval cirrhosis and for ascites History: AMS, hx of NASH cirrhosis LIVER: Background liver parenchyma is hyperechogenic compatible with history of cirrhosis, with corresponding morphology. There is a 1.7 x 1.4 x 2.6 cm hypoechoic mass in the right hepatic lobe. In the setting of a cirrhotic liver, this is concerning for HCC. Although the main portal vein appears patent with hepatopedal flow, there is decreased Doppler velocity, and much of the lumen is not opacified with color Doppler. Therefore partial thrombosis cannot be entirely excluded on this exam. Portal vein branches are patent with appropriate flow direction.BILIARY TRACT: Minimally thickened gallbladder wall, which is may be seen in the setting of cirrhosis. Common bile duct measures 4 mm. No intrahepatic biliary ductal dilatation.PANCREAS: The visualized portions of the pancreas are within normal limits.SPLEEN: The spleen is enlarged measuring 15.8 cm. There are perisplenic and splenorenal varices present.KIDNEYS: Right kidney measures 10.3 cm. Left kidney measurement is limited by bowel gas. No shadowing calculi or hydronephrosis.OTHER: No significant abnormalities noted.

Output: 1.Hypoechoic lesion in a cirrhotic liver suspicious for HCC. Recommend dedicated cross-sectional liver imaging for further evaluation.2.Partial thrombus of the main portal vein cannot be excluded as there is decreased Doppler flow.3.Sequela of portal hypertension including splenomegaly and varices are present.


Instruction: Generate impression based on medical findings.

Input: Reason: cholecystitis History: critically ill, persistent reflux of bile LIVER: The liver measures 18.3 cm in length, enlarged. Diffusely heterogeneous hepatic parenchyma. The portal vein is patent with normal directional hepatopetal portal venous blood flow, peak velocity 25.8 cm/s with a pulsatile waveform. No focal mass.GALLBLADDER, BILIARY TRACT: The gallbladder is collapsed with shadowing stones. No evidence of pericholecystic fluid or inflammation. The gallbladder wall measures 0.2 cm. The common bile duct measures 0.4 cm. Negative sonographic Murphy's sign. No biliary ductal dilatation.PANCREAS: Obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 11.3 cm. Echogenic renal parenchyma. No shadowing stones or hydronephrosis. Small 1.0 x 0.9 x 1.0 cm lower pole cyst. No injury isLEFT KIDNEY: The left kidney measures 11.3 cm. Echogenic renal parenchyma. No shadowing stones or hydronephrosis.OTHER: Status post splenectomy with multiple rounded hypoechoic lesions in the left upper quadrant, representing accessory splenules. No ascites. Left pleural effusion.

Output: 1. Heterogeneous hepatic parenchyma with a pulsatile portal venous waveform, consistent with hepatic venous congestion.2. Cholelithiasis without evidence of acute cholecystitis.3. Echogenic renal parenchyma, consistent with medical renal disease.4. Left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: heart transplant w/u History: see above LIVER:Mild increased echogenicity may suggest a stenosis. No focal hepatic lesions. Portal vein is patent. Increased pulsatility of the main portal vein may suggest right-sided heart failure. Liver measures 19.2 cm in craniocaudal dimension.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy.PANCREAS: Pancreas is partially obscured.SPLEEN: Spleen measures 11.9 cm in length.KIDNEYS: Simple appearing right mid pole cyst measures 1.6 x 1.7 x 1.9 cm. Exophytic simple appearing right upper pole cyst measures 6.7 x 2.2 x 3.6 cm. Simple appearing left mid to lower pole cysts measures 5.7 x 4.9 x 5.1 cm ABDOMINAL AORTA: The proximal abdominal aorta measures 2.4 x 1.7 x 1.4 cm. The mid abdominal aorta measures 2.0 cm but is partially obscured by overlying bowel gas. The distal abdominal aorta and iliac arteries not visualized due to bowel gasINFERIOR VENA CAVA: IVC is patent.OTHER: Small bilateral effusions.

Output: 1.Increased pulsatility of the main portal vein may suggest right-sided heart failure.2.Small bilateral effusions.3.Diffuse hepatic echogenicity suggestive of steatosis.4.Simple appearing bilateral renal cysts.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Leukocytosis. Status post ERCP with stent placement. LIVER: Diffusely heterogeneous parenchymal echogenicity. 17 cm in length. The previously seen focal lesions on CT are not evident by ultrasound. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Cholelithiasis. No gallbladder wall thickening or sonographic Murphy's sign.PANCREAS: No sonographic abnormality evident in the visualized pancreatic body. The head and and tail are obscured by bowel gas, including the patient's known pancreatic head mass.KIDNEYS: The right kidney is 5.7 cm in length, with an inferior pole cyst. The left kidney is not fully visualized. The renal parenchyma is markedly echogenic. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 7.6 cm in length, without focal lesions evident.OTHER: Mild to moderate ascites is again seen.

Output: 1. No biliary ductal dilation.2. Heterogeneous hepatic echogenicity compatible with parenchymal dysfunction and/or metastatic disease, similar to prior.3. Cholelithiasis without specific evidence of cholecystitis.4. Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: 79-year-old man with history of BPH, AKA. RIGHT KIDNEY: The right kidney measures 9.6 cm in length and shows slightly increased echogenicity. No mass, stone or hydronephrosis.LEFT KIDNEY: The left kidney measures 9.5 cm in length and shows slightly increased echogenicity. No mass, stone or hydronephrosis.URINARY BLADDER: The urinary bladder is normal in appearance.OTHER: There is no free or loculated fluid. The prostate is enlarged, measuring 5.9 x 6.5 x 6.0 cm.

Output: 1.Increased echogenicity of the renal parenchyma bilaterally, consistent with medical renal disease/parenchymal dysfunction without worrisome mass, stone or hydronephrosis. 2.Enlarged prostate gland.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p liver resection with increased drain output. Please eval portal vein ONLY History: as above LIMITED ABDOMENLIVER: Echogenic, which can be seen in diffuse parenchymal dysfunction/fatty infiltration.OTHER: Minimal ascites.

Output: Limited abdominal Doppler ultrasound showing a patent portal vein. Bilateral pleural effusions and minimal ascites.


Instruction: Generate impression based on medical findings.

Input: 59 year-old female with abdominal pain. Evaluate for ascites. Four abdominal quadrants were evaluated for the presence of ascites. No evidence of ascites is noted.Partially imaged liver is increased in echogenicity.

Output: 1. Increased echogenicity of the liver suggestive of parenchymal dysfunction/fatty infiltration. 2. No ascites.


Instruction: Generate impression based on medical findings.

Input: 80-year-old female with history of NASH. Evaluate for hepatocellular carcinoma. LIVER:Liver measures 12.5 cm. There is coarse and increased echogenicity of the parenchyma. No concerning mass or ascites. Again seen is a round anechoic 1.0 x 0.8 x 0.9 cm lesion with posterior acoustic enhancement consistent with a simple cyst. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended. The gallbladder wall measures 2.0 mm. No stones, sludge, or pericholecystic fluid.PANCREAS: Examination the pancreas is limited by overlying bowel gas. The visualized portions appear normal.SPLEEN: The spleen was unable to visualized.KIDNEYS: The right kidney measures 10.4 cm. The cortex has normal echogenicity. No shadowing calculi or hydronephrosis. The left kidney measures 9.2 cm. The cortex has normal echogenicity. No shadowing calculi or hydronephrosis. OTHER: No significant abnormality noted.

Output: 1. Coarse, echogenic liver consistent with chronic liver disease/parenchymal dysfunction. No concerning mass or ascites.


Instruction: Generate impression based on medical findings.

Input: History of Graves' disease. RIGHT LOBE MEASUREMENTS: 4.0 x 1.9 x 2.2 cmLEFT LOBE MEASUREMENTS: 4.5 x 1.7 x 1.9 cmISTHMUS MEASUREMENTS: 5 mmRIGHT LOBE: The thyroid parenchyma is diffusely heterogeneous and enlarged. It is mildly hypervascular. There is a 8 x 4 x 9 mm well-defined hypoechoic nodule in the superior pole.LEFT LOBE: The thyroid parenchyma is diffusely heterogeneous and enlarged. It is mildly hypervascular. No discrete nodule.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Normal morphology right level 2 lymph node.OTHER: No significant abnormality noted.

Output: Diffusely heterogeneous and enlarged thyroid gland compatible with chronic thyroiditis/Graves' disease. 9 mm hypoechoic right superior thyroid lobe nodule.


Instruction: Generate impression based on medical findings.

Input: Right upper quadrant ultrasound post cholecystectomy pain LIVER: Liver measures 17 cm with increased echogenicity suggestive of hepatic steatosis. No focal lesions noted within the liver. Main portal vein is patent with normal flow directionality. No intrahepatic biliary ductal dilatation. BILIARY TRACT: Status post cholecystectomy. Common bile duct measures up to 6 mm within normal limits without any stones or sludge within it.PANCREAS: Head and body of pancreas appears unremarkable, tail of pancreas not visualized due to overlying bowel gas.SPLEEN: No significant abnormalities noted. Spleen measures 8.8 cmRIGHT KIDNEY: Right kidney measures 9.6 cm left kidney measures 8.2 cm. Mild increased echogenicity noted in both kidneys. No hydronephrosis or focal lesions. OTHER: No ascites

Output: Mild increased echogenicity of the liver suggestive of hepatic steatosis.Status post cholecystectomy without intrahepatic or extra biliary ductal dilatation.Mild increased echogenicity of both kidneys suggestive of chronic medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Reason: worsening kidney function RIGHT KIDNEY: The right kidney measures 8.5 cm in length. Echogenic renal parenchyma. Subcentimeter non-obstructing right upper pole shadowing renal calculus. No hydronephrosis or focal mass.LEFT KIDNEY: The left kidney measures 9.2 cm in length. Echogenic renal parenchyma. No shadowing renal calculi, hydronephrosis, or focal mass.OTHER: Unremarkable bladder. Ureteral tracts are visualized.

Output: 1. Echogenic renal parenchyma, consistent with medical renal disease.2. Subcentimeter nonobstructive left renal stone.