Instruction: Generate impression based on medical findings.

Input: Male, 71 years old. Reason: Evaluate for hydronephrosis, kidney disease History: elevated creatinine RIGHT KIDNEY: Right kidney measures 11.6 cm in length with increased cortical echogenicity. Right midpole renal cyst measures 1.7 x 1.8 x 2.2 cm. No hydronephrosis or shadowing calculi.LEFT KIDNEY: Left kidney measures 13.8 cm in length with increased cortical echogenicity. Two subcentimeter cysts are present. No hydronephrosis or shadowing calculi.URINARY BLADDER: Urinary bladder is mildly decompressed without significant abnormality noted.OTHER: Shadowing gallstones are present. No biliary duct dilatation

Output: 1. Echogenic renal parenchyma bilaterally suggests medical renal disease/parenchymal dysfunction. No hydronephrosis.2. Cholelithiasis without sonographic evidence of acute cholecystitis. No biliary ductal dilatation.


Instruction: Generate impression based on medical findings.

Input: 67-year-old female with a thyroid nodule seen on a prior CT scan. RIGHT LOBE MEASUREMENTS: 3.7 x 1.6 x 1.8 cmLEFT LOBE MEASUREMENTS: 4.7 x 1.4 x 1.8 cmISTHMUS MEASUREMENT: 0.7 cmRIGHT LOBE: Heterogeneous, nodular appearing vascular thyroid gland. Right lower pole hypoechoic, solid nodule with minimal vascularity and no definite microcalcifications measures 0.5 x 0.3 x 0.4 cm.LEFT LOBE: Heterogeneous, nodular appearing vascular thyroid gland. Left mid to upper pole complex cystic vascular nodule with significant vascularity and no definite microcalcifications measures 0.6 x 0.5 x 0.7 cm.ISTHMUS: Solid isthmus nodule with a hypoechoic rim and significant vascularity. No definite microcalcifications. The nodule measures 0.8 x 0.7 x 0.9 cm.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multifocal thyroid nodules in the setting of a heterogeneous, nodular appearing thyroid gland.


Instruction: Generate impression based on medical findings.

Input: Chronic kidney disease, assess for obstruction RIGHT KIDNEY: Echogenic, measuring 8.8 cm. No hydronephrosis. No shadowing intrarenal focus seen to suggest underlying nephrolithiasis. No definite focal renal lesion.LEFT KIDNEY: Echogenic, measuring 9.5 cm. No hydronephrosis. No shadowing intrarenal focus seen to suggest underlying nephrolithiasis. No definite focal renal lesion.OTHER: Visualized bladder unremarkable.

Output: Echogenic kidneys, compatible with underlying medical renal disease. No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 82-year-old male presents with elevated creatinine. RIGHT KIDNEY: The right kidney is mildly echogenic measures 10 cm in length. Corticomedullary differentiation is maintained. No shadowing calculi or hydronephrosis is present. Nearly anechoic focus arising from the right upper pole measures 0.9 x 0.9 x 0.8 cm compatible with a renal cyst.LEFT KIDNEY: The left kidney is mildly echogenic measures 12 cm in length. Corticomedullary differentiation is maintained. No shadowing calculi or hydronephrosis is present.URINARY BLADDER: Visualized portions of the urinary bladder are unremarkable.OTHER: No significant abnormalities noted.

Output: 1.Mildly echogenic kidneys suggestive of medical renal disease. No evidence of hydronephrosis.2.Right renal cyst.


Instruction: Generate impression based on medical findings.

Input: Female 56 years old with fever, transaminitis LIVER: Mild increase in hepatic parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions. Hepatic length measures 19.2 cm. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of 41 cm/s. GALLBLADDER/BILIARY TRACT: Status-post cholecystectomy. The common bile duct measures 4 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 13.7 cm and has a normal echotexture.KIDNEYS: The right kidney measures 9.9 cm and demonstrates cortical scarring. Normal vascular flow is present. The left kidney measures 13.3 cm and has normal vascular flow. OTHER: No significant abnormality noted.

Output: 1. Hepatomegaly with mildly increased hepatic parenchymal echogenicity and coarsened echotexture consistent with fatty liver/hepatic parenchymal dysfunction. No hepatic mass or ductal dilatation identified.2. Stable right renal scarring.


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old. Reason: LVAD evaluation. LIVER: Liver measures 14.7 cm in length with increased parenchymal echogenicity. No focal hepatic lesion or ascites. Main portal vein is patent with a normal direction of flow.BILIARY TRACT: No cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. No biliary ductal dilatation. Common bile duct measures 5 mm.PANCREAS: The visualized portions of the pancreas are unremarkable. The pancreatic tail is obscured by overlying bowel gas.SPLEEN: Spleen measures 7.4 cm in length with normal echotexture.KIDNEYS: Right kidney measures 10.4 cm in length with normal cortical echogenicity. No hydronephrosis, shadowing calculi, or mass. Left kidney measures 10.2 cm in length with normal cortical echogenicity. No hydronephrosis, shadowing calculi, or mass.ABDOMINAL AORTA: The proximal aorta measures 1.8 x 1.9 cm. The distal aorta is not visualized.INFERIOR VENA CAVA: IVC is patent.OTHER: No significant abnormality noted.

Output: Echogenic hepatic parenchyma suggests parenchymal dysfunction/fatty infiltration. No biliary ductal dilatation. Gallbladder is unremarkable.


Instruction: Generate impression based on medical findings.

Input: Reason: acute liver toxicity 2/2 to obstruction, History: abdominal ascites LIVER: The liver is enlarged, measuring 21.1 cm in length. Coarse in echotexture with nodular contour consistent with cirrhotic morphology. No focal lesions. There is mild intrahepatic ductal dilatation noted. The main portal vein is patent with hepatopetal flow and a normal waveform. The velocity measures 0.3 m/s. GALLBLADDER, BILIARY TRACT: Wall-echo-shadow complex is seen suggestive of stone filled gallbladder. Sonographic Murphy's sign is negative. There is no pericholecystic fluid. The gallbladder wall is not thickened, measuring 0.2 cm. The common bile duct is not thickened, measuring 0.3 cm in caliber.PANCREAS: There is a mildly enlarged peripancreatic lymph node noted. The visualized portions of the pancreas otherwise reveal no signal abnormality.KIDNEYS: The right kidney measures 12.4 cm in length. Normal echogenicity. No focal lesions. No hydronephrosis.The left kidney measures 11.1 cm in length. Normal echogenicity. No focal lesions. No hydronephrosis.SPLEEN: The spleen is not visualized.OTHER: Moderate amount of ascites, appears uncomplicated.Small right-sided pleural effusion, appears uncomplicated.

Output: 1. Cirrhotic liver. No focal lesions. 2. Mild intrahepatic ductal dilatation without dilatation of the distal common bile duct. This is most likely due to obstruction of the proximal common bile duct secondary to a gall stone. Alternatively, there may be obstruction from a mass, possibly neoplastic given the presence of enlarged peripancreatic lymph node. Recommend MRCP for further evaluation. 3. Stone filled gall bladder without definite sonographic evidence of acute cholecystitis. 4. Moderate ascites, uncomplicated. 5. Small right-sided pleural effusion, uncomplicated.


Instruction: Generate impression based on medical findings.

Input: Male 54 years old Reason: s/p oropharyngeal resection and free flap recon, now with drop in hgb and elevated bili, complete RUQ ultrasound to assess biliary tree History: as above LIMITED ABDOMENLIVER: Normal echogenicity.BILIARY TRACT: No biliary dilatation. The gallbladder wall thickening or pericholecystic fluid. Single mobile gallstone.PANCREAS: Visualized portions are unremarkable.KIDNEYS: The right kidney measures 12 cm. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 12 cm. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 12 cm. in length. OTHER: No significant abnormalities noted.

Output: 1.No biliary dilatation. Cholelithiasis without sonographic signs of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Female 81 years old Reason: abnormal kidney levels History: abnormal kidney levels RIGHT KIDNEY: The right kidney measures 12.4 cm in length and demonstrates slightly increased parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen. Multiple cysts are again seen, the largest measuring 1.9 x 2.0 x 1.9 cm, which contains a single septation.LEFT KIDNEY: The left kidney measures 12.6 cm in length and demonstrates increased parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen. Multiple simple renal cysts again seen.BLADDER: No significant abnormality noted.OTHER: No significant abnormalities noted.

Output: Increased renal parenchymal echogenicity consistent with medical renal disease, but no evidence of hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p OLT. elevated drain output. Please eval for portal vein patency ONLY History: as above LIMITED ABDOMENLIVER: Echogenic liver can be seen in diffuse parenchymal dysfunction/fatty infiltration. RIGHT KIDNEY: Partially visualized, but replaced with cysts, compatible with known history of autosomal polycystic kidney disease.OTHER: Ascites. Bilateral pleural effusions.

Output: Patent portal vein. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Female 30 years old; Reason: Evaluate for cholecystitis. History: nausea/vomiting LIVER: The liver is normal in echogenicity and echotexture. No focal hepatic lesions. Hepatic length measures 14.5 cm. The main portal vein is patent with normal hepatopedal flow with a peak velocity of 26.4 cm/s. GALLBLADDER/BILIARY TRACT: Multiple small gallstones are noted within the gallbladder. The gallbladder wall measures 1 mm in diameter. Sonographic Murphy's sign is negative. No evidence of pericholecystic fluid. The common bile duct measures 2 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 9.6 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 12.5 cm with no hydronephrosis. The left kidney measures 13.3 cm with no hydronephrosis. OTHER: No significant abnormality noted.

Output: Cholelithiasis without evidence of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: 52-year-old female with history of left breast cancer and ultrasound guided needle localization, now status post surgery. Orthogonal digital specimen radiographs revealed the localization spring wire to be within the specimen but no mass was identified. Sonographic evaluation of the specimen revealed the mass and localization wire to be in the specimen.

Output: Mass and localization wire within the specimen.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: Female 30 years old Reason: R/O choledocholithiasis, History: RUQ tenderness LIVER: The liver measures 13.3 cm in length and demonstrates normal parenchymal echogenicity. No intrahepatic or extrahepatic biliary ductal dilatation is evident and no focal mass lesions are seen. The main portal vein is patent and demonstrates hepatopedal flow with a velocity of 0.2 m/s. GALLBLADDER, BILIARY TRACT: The patient is status post cholecystectomy. The common duct measures 0.2 cm in maximal diameter, and there is no evidence choledocholithiasis.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 9.2 cm in length and demonstrates normal parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.OTHER: No significant abnormalities noted.

Output: No evidence of choledocholithiasis or biliary ductal dilatation as clinically questioned.


Instruction: Generate impression based on medical findings.

Input: Female 57 years old Reason: 57 yo female with hx of gallbladder polyps; please evaluate for any changes and or abnormalities History: gallbladder polyps LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 14.5 cm in length. The parenchyma is moderately coarse and echogenic. Limited interrogation of the main portal vein demonstrate blood flow towards the liver measuring 30 cm/s. No focal liver lesions.BILIARY TRACT: No intrahepatic or extrahepatic biliary ductal dilatation. The common bile duct measures 4 mm. Two small round gallbladder wall polyps are again seen measuring 5 mm and 4 mm, previously 4 mm and 3 mm, respectively. Wall measures 1 mm in thickness.PANCREAS: The visualized portions of the pancreas are normal. Overlying bowel gas obscures the distal body and tail.KIDNEYS: The right kidney measures 12.1 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 12.2 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 9.6 cm. in length. OTHER: No significant abnormalities noted.

Output: 1.No significant change in two small gallbladder wall polyps with measurements as detailed above.2.Moderately coarse and echogenic liver parenchyma compatible with fatty liver infiltration/parenchymal dysfunction without focal liver lesions.


Instruction: Generate impression based on medical findings.

Input: Male 66 years old; Reason: AKI, r/o hydronephrosis History: AKI RIGHT KIDNEY: The right kidney measures 9.8 cm in length. The cortex is echogenic. There is right pelvic caliectasis. LEFT KIDNEY: The left kidney measures 10.1 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. Cyst at the upper pole measures 2.2 cm URINARY BLADDER: No significant abnormality notedOTHER: Small amount of upper abdominal ascites.

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


Instruction: Generate impression based on medical findings.

Input: Male 65 years old Reason: hx of known renal nodule- evaluate for change in size History: none RIGHT KIDNEY: The right kidney measures 9.9 cm in length and demonstrates increased parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen. Multiple hypoechoic lesions again seen within the renal parenchyma, the largest demonstrates a single septation and measures 1.8 x 2.0 x 2.5 cm, previously 1.8 x 2.5 x 1.8 cm.LEFT KIDNEY: The left kidney measures 11.0 cm in length and demonstrates increased parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen. Multiple hypoechoic lesions are also identified within the left renal parenchyma. Mild left-sided hydronephrosis is again seen, slightly increased in the prior examination. Punctate calcification within the renal parenchyma is unchanged.BLADDER: No significant abnormality noted.OTHER: No significant abnormalities noted.

Output: 1.Multiple hepatic cysts, the largest in the right kidney demonstrating a single septation, not significantly changed from the prior examination.2.Increased renal parenchymal echogenicity consistent with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Female 89 years old Reason: increased abdominal girth, increased gas History: above LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 14.7 cm in length. The parenchyma is normal in echotexture.BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 1 mm in thickness. Common duct measures 2 mm in thickness.PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas. Pancreatic duct measures about 2 mmKIDNEYS: The right kidney measures 8.8 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.The left kidney measures 10 point cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.SPLEEN: The spleen measures 8.8 cm in length. Numerous, scattered echogenic foci within the spleen, consistent with prior granulomatous disease.OTHER: No significant abnormalities noted.

Output: No specific findings to explain patient's symptomology. No evidence of abdominal mass or cholecystitis.


Instruction: Generate impression based on medical findings.

Input: 50 year-old male presents with preoperative LVAD evaluation. LIVER: Normal hepatic parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions. Dilated hepatic veins consistent with patient's known history of congestive heart failure. Hepatic length measures 17 cm. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of 28 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 2 mm. The common bile duct is not visualized. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified. No evidence of cholecystitis.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 8 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 10 cm and has normal vascular flow. The left kidney measures 11 cm and has normal vascular flow. OTHER: No significant abnormality noted.

Output: Dilated hepatic veins consistent with patient's known history of congestive heart failure. Otherwise, unremarkable sonographic evaluation of the abdomen.


Instruction: Generate impression based on medical findings.

Input: Male 57 years old; Reason: evidence of hydronephrosis, injury to kidneys History: aki RIGHT KIDNEY: The right kidney measures 11.4 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 11.1 cm in length. The cortex is mild echogenic. No shadowing calculi or hydronephrosis is present.  URINARY BLADDER: No significant abnormalities notedOTHER: Upper abdominal and pelvic ascites which the small to moderate in volume.

Output: 1.No sonographic findings of nephrolithiasis or hydronephrosis.2.Ascites


Instruction: Generate impression based on medical findings.

Input: Status post total thyroidectomy for thyroid cancer RIGHT LOBE: Status post thyroidectomy.LEFT LOBE: Status post thyroidectomy.ISTHMUS: Status post thyroidectomy.LYMPH NODES: No suspicious lymphadenopathy.OTHER: No significant abnormality noted.

Output: No evidence of residual or recurrent disease.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old. Reason: Liver lesion seen on CT. Please evaluate. LIVER: Liver measures 17.8 cm in length. Parenchymal echogenicity is within normal limits. No focal mass corresponding to the hypodense focus on prior CT can be appreciated. No ascites. Main portal vein is patent with a normal direction of flow.BILIARY TRACT: No biliary ductal dilatation. Status post cholecystectomy. Common bile duct measures 7 mm.PANCREAS: The visualized portions of the pancreas or unremarkable. Distal pancreatic body and tail are obscured by overlying gas.SPLEEN: Spleen measures 6.3 cm with normal echotexture.RIGHT KIDNEY: Right kidney measures 10.4 cm in length with normal cortical echogenicity. No hydronephrosis, shadowing calculi, or mass. OTHER: Left kidney measures 8.5 cm in length with normal cortical echogenicity. No hydronephrosis, shadowing calculi, or mass.

Output: No focal hepatic mass can be appreciated on the current study. If there is continued clinical concern, contrast enhanced CT or MRI can be obtained.


Instruction: Generate impression based on medical findings.

Input: Reason: eval cholelithiasis History: elevated bilirubin. Exam is limited by patient's inability to turn and heavy breathing.LIVER:The liver is slightly coarsened in echotexture, with no focal mass. The liver measures 15.6 cm in length. The main portal vein is patent and demonstrates a hepatopetal flow with a velocity of 26 cm/s and a pulsatile waveform which may be seen with congestive heart failure..GALLBLADDER, BILIARY TRACT: Small amount of sludge is noted within the gallbladder without evidence of cholelithiasis. The gallbladder wall is slightly thickened measuring 4 mm in diameter. Trace pericholecystic fluid is noted. Sonographic Murphy's sign was negative. No evidence of choledocholithiasis. The common bile duct measures 2 mm in diameter. No evidence of intrahepatic or extrahepatic biliary ductal dilatation.PANCREAS: The pancreas is not well-visualized due to overlying bowel gas.SPLEEN: Spleen is normal in echotexture and measures 11.4 cm in length.KIDNEYS: The right kidney measures 11.4 cm in length and demonstrates increased echogenicity with no evidence of hydronephrosis or shadowing calculi. The left kidney measures 10.9 cm in length and demonstrates increased echogenicity without evidence of hydronephrosis or shadowing calculi. ABDOMINAL AORTA: Abdominal aorta measures 1.8 x 1.9 cm proximally, 1.6 x 1.8 cm in the midportion, and 1.2 x 1.7 cm distally. The common iliac arteries are not well visualized.INFERIOR VENA CAVA: Inferior vena cava is patent.OTHER: Trace ascites is noted in the lower quadrants. Bilateral pleural effusions are noted.

Output: 1.Slightly coarsened echotexture of the liver suggestive of fatty infiltration/parenchymal dysfunction without evidence of focal mass or intrahepatic or extrahepatic biliary ductal dilatation.2.Patent main portal vein with normal direction of flow, demonstrating pulsatile waveform, which can be seen in setting of heart failure.3.Gallbladder sludge without evidence of cholelithiasis or acute cholecystitis. Slight gallbladder wall thickening and pericholecystic fluid is likely secondary to fluid overload or heart failure, with no evidence of inflammation.4.Bilateral increased echogenicity of kidneys, suggestive of medical renal disease without evidence of shadowing calculi or hydronephrosis.5.Trace abdominal ascites and bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Acute kidney injury RIGHT KIDNEY: Measures 10.5 cm. Increased renal cortical echogenicity. No hydronephrosis. No shadowing intrarenal echogenic focus seen to suggest underlying nephrolithiasis.LEFT KIDNEY: Measures 10.2 cm. Increased renal cortical echogenicity. No hydronephrosis. No shadowing intrarenal echogenic focus seen to suggest underlying nephrolithiasis.OTHER: Underdistended bladder, making assessment suboptimal.

Output: 1. Increased renal cortical echogenicity, reflecting underlying medical renal disease. No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with kidney stones. RIGHT KIDNEY: The right kidney measures 13.1 cm in length. The cortex is normal in echogenicity. There are three shadowing calculi with mild hydronephrosis involving the upper pole collecting system similar to prior study.LEFT KIDNEY: The left kidney measures 13.4 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.

Output: 1.Right-sided nephrolithiasis with mild dilatation of upper pole collecting system not significantly changed.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: 82 year old female with bilateral flank pain status post right ureteral stent. Evaluate for hydronephrosis, ureteral obstruction. RIGHT KIDNEY: The right kidney measures 10.8 cm in length. Moderate hydronephrosis not significantly changed. No shadowing calculi are present. Right ureteral stent is noted.LEFT KIDNEY: The left kidney measures 8.5 cm in length. No shadowing calculi or hydronephrosis is present. URINARY BLADDER: Collapsed limiting evaluation for wall thickening.OTHER: No significant abnormalities noted.

Output: Right sided moderate hydronephrosis not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Male 71 years old; Reason: Asses for cirrhosis, biliary obstruction History: LE edema, abdominal distention, history of biliary and pancreatic stents. LIVER: Again noted are numerous echogenic hepatic masses compatible with known metastatic disease, largest measuring 4.3 x 4.8 x 4.4 cm. Mild increase in hepatic parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions. Hepatic length measures 22.3 cm. The main portal vein is patent with normal hepatopedal flow with a peak velocity of 16.3 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 2 mm. The common bile duct measures 3 mm in diameter. Common bile duct stent and pancreatic duct stent are noted. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 9.9 cm and has a normal echotexture.KIDNEYS: Patient is status post right nephrectomy. The left kidney measures 12.5 cm and has normal vascular flow. No hydronephrosis.OTHER: Bilateral pleural effusions noted.

Output: Numerous echogenic hepatic masses compatible with known metastatic disease, without evidence of intra or extrahepatic biliary dilatation.


Instruction: Generate impression based on medical findings.

Input: Male 47 years old Reason: history of hcv, assess for cirrhosis History: as above LIVER: The liver measures 17.7 cm in length and demonstrates slightly increased parenchymal echogenicity. No intrahepatic or extrahepatic biliary ductal dilatation is evident and no focal mass lesions are seen. The main portal vein is patent and demonstrates hepatopedal flow with a velocity of 0.2 m/s. GALLBLADDER, BILIARY TRACT: No cholelithiasis or choledocholithiasis is seen. The common bile duct measures 2.2 cm in diameter.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures approximately 11.3 cm in length and demonstrates severe hydronephrosis and result parenchymal thinning.Transplant kidney: The transplant kidney measures approximately 12.2 cm in length and demonstrates appropriate parenchymal echogenicity and is without evidence of hydronephrosis.OTHER: No significant abnormalities noted.

Output: 1.Slightly increased hepatic echogenicity suggestive of chronic liver disease.2.Severe right-sided hydronephrosis resulting in parenchymal thinning.


Instruction: Generate impression based on medical findings.

Input: Female 70 years old Reason: RUQ abdominal pain History: Pain LIVER: Liver measures 15.5 cm in length. The parenchyma is mildly echogenic which is nonspecific but may reflect diffuse infiltrative disease.Main portal vein is patent with hepatopedal flow peak velocity of 0.2 m/s.BILIARY TRACT: Gallbladder unremarkable. No significant gallbladder distention, wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation. Negative sonographic Murphy's sign.PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 11.8 cm. At the superior pole of the right kidney is an anechoic lesion with posterior acoustic enhancement compatible with a simple renal cyst and measures 2.6 x 3.4 x 2.6 cm. At the mid pole of the right kidney is an anechoic lesion with posterior acoustic enhancement compatible with a simple renal cyst . There is no hydronephrosis or shadowing renal calculus. The left kidney measures 10.7 cm. At the mid pole of the kidney is a anechoic lesion with posterior acoustic shadowing compatible with simple renal cyst and measures 1.7 x 1.2 x 1.6 cm. At the inferior pole of the left kidney is a anechoic lesion with posterior acoustic shadowing compatible with a simple renal cyst measuring 1.5 x 1.8 x 1.7 cm.SPLEEN: The spleen measures 7.3 cm. in length. OTHER: No significant abnormality noted.

Output: 1.Mildly increased echogenicity of the liver parenchyma is nonspecific but may reflect hepatic steatosis/parenchymal dysfunction.2.Bilateral simple renal cysts.


Instruction: Generate impression based on medical findings.

Input: Male 57 years old Reason: Biliary obstruction, inflammation of liver History: elevated bilirubin and transaminases, known pancreatitis Suboptimal study secondary to patient's inability to cooperate with positioning and difficulty controlling breathing, also abdominal guarding.LIVER: Hepatomegaly (measures 20 cm in craniocaudal dimension), increased pancreatic echogenicity. Main portal vein patent with normal directional flow, velocity measures 20 cm/s. BILIARY TRACT: Gallbladder suboptimally assessed but appears unremarkable, no wall thickening or significant gallbladder distention, no mobile intraluminal echogenic foci to suggest cholelithiasis. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Not well visualized.KIDNEYS: The right kidney measures 14.5 cm. Right upper pole cyst containing possible thin septation, cyst measures 3 x 2.9 x 2.2 cm. The left kidney measures 13.6 cm. No hydronephrosis.SPLEEN: The spleen measures 13.5 cm. in length. OTHER: Decompressed urinary bladder, making assessment suboptimal. Partially imaged moderate ascites.

Output: No biliary duct dilatation. Visualized gallbladder unremarkable.Hepatomegaly, echogenic liver, likely reflecting underlying hepatic steatosis/parenchymal dysfunction.3 cm right renal cyst containing possible thin calcification.Ascites.


Instruction: Generate impression based on medical findings.

Input: Male 18 years old with microscopic hematuria. Assess renal and blader morphology. BLADDER  Wall Thickness: Normal  Contents: Distended and normal. Distal Ureter -- SFU Grade**  Right: 0  Left: 0   Ureteral Jets Right: Not observed  Left: Not observedKIDNEYS  Cortical Echogenicity: Normal   Medullary Echogenicity: Normal   Pelvicaliceal System -- SFU Grade*  Right: 0 Left: 0  Length*** Right: 12.5 cm Left: 12.7 cm   Mean for age: 10.8 cm  Range for age: 9.5 - 12.0 cmADDITIONAL OBSERVATIONS: None

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


Instruction: Generate impression based on medical findings.

Input: Reported right tracheoesophageal groove nodule suspicious for exophytic thyroid nodule RIGHT LOBE: Measures 3.6 x 1.9 x 1.5 cm. Tiny colloid cyst.LEFT LOBE: Measures 3.6 x 1.3 x 1.2 cm. No discrete nodule seen.ISTHMUS: Measures 0.4 cm.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No suspicious thyroid nodule delineated.


Instruction: Generate impression based on medical findings.

Input: 74-year-old female with history of hepatitis C and cirrhosis, evaluate for liver lesions. LIVER: Increase in hepatic parenchymal echogenicity with coarsened echotexture and cirrhotic morphology. No focal hepatic mass. Left hepatic cyst measuring 1 x 0.8 x 1.1 cm is unchanged. Hepatic length measures 10.6 cm. The main portal vein is patent with normal hepatopetal flow with a velocity of 25 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 2 mm. The common bile duct measures 5 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 9.3 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 6.1 cm with no hydronephrosis. The left kidney measures 6.7 cm with no hydronephrosis. OTHER: Mild perihepatic ascites is present.

Output: 1.Increased in hepatic parenchymal echogenicity with coarsened echotexture and cirrhotic morphology. No hepatic mass or ductal dilatation identified.2.Mild ascites.


Instruction: Generate impression based on medical findings.

Input: Male 58 years old; Reason: history of varices. Exclude cirrhosis, liver lesions. LIVER: The liver demonstrates a mildly coarse echotexture with no focal hepatic lesions. Hepatic length measures 13 cm. The main portal vein is patent with normal hepatopetal flow with a velocity of 21 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 2 mm. The common bile duct measures 2 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 7.2 cm and has a normal echotexture.KIDNEYS: Transplant kidney in the right iliac fossa measures 8.9 cm and is normal in echogenicity. No evidence of hydronephrosis. No shadowing calculi noted.OTHER: No ascites.

Output: Mildly coarsened echotexture of the liver suggestive of chronic liver disease with no definite cirrhosis or focal mass.


Instruction: Generate impression based on medical findings.

Input: 38-year-old male with history of thyroid cancer status post surgery with extensive positive central compartment nodes right greater than left. Reason: Question suspicious lateral cervical nodes. RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: Status post thyroidectomy.LEFT LOBE: Status post thyroidectomy.ISTHMUS: Status post thyroidectomy.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There are several round, hypoechoic lymph nodes, suspicious for residual disease as listed below. Right level 2: 0.7 x 0.5 x 0.7 cmLeft level 1B: 0.8 x 0.8 x 1.1 cmLeft level 2: 1.1 x 0.4 x 1.4 cm is indistinctly marginated, although ovoidOTHER: No significant abnormality noted.

Output: Several lymph nodes suspicious for residual disease. The most concerning node is level 1B on the left


Instruction: Generate impression based on medical findings.

Input: Nontoxic single thyroid nodule. Evaluate. RIGHT LOBE MEASUREMENTS: 4.8 x 1.7 x 2.0 cmLEFT LOBE MEASUREMENTS: 4.3 x 1.3 x 1.9 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: There is nodule with internal echogenicity in the right inferior thyroid gland measuring approximately 0.7 x 0.3 x 0.5 cm with suggestion of spongiform morphology, unchanged.LEFT LOBE: There is a 0.9 x 0.5 x 0.7 cm which was present in retrospect and unchanged. This is almost isoechoic to the remainder of the left lobeISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Small lymph nodes again notedOTHER: No significant abnormality noted.

Output: Stable examination. One small nodule in each lobe which are unchanged


Instruction: Generate impression based on medical findings.

Input: Reason: Cirrhosis, eval for HCC History: Cirrhosis LIVER: Cirrhotic liver morphology with diffusely increased echogenicity. No worrisome hepatic mass or lesion. The liver measures 13.9 cm in length.The main portal vein is patent with normal hepatopetal flow and velocity of 25.2 cm/s.GALLBLADDER, BILIARY TRACT: Cholelithiasis. No pericholecystic fluid or gallbladder wall thickening. The common bile duct measures up to 7 mm in diameter.PANCREAS: The head and proximal body of the pancreas are normal. The proximal pancreatic duct is upper normal in diameter. The tail is obscured by bowel gas.SPLEEN: The spleen is normal in echogenicity and measures 7.0 cm in length.RIGHT KIDNEY: Status post right nephrectomy.LEFT KIDNEY: The left kidney measures 11.3 cm in length and shows normal echotexture. No mass, stone or hydronephrosis.URINARY BLADDER: The urinary bladder is normal in appearance.OTHER: There is no free or loculated fluid.

Output: Cirrhotic liver morphology without suspicious masses. Uncomplicated cholelithiasis.


Instruction: Generate impression based on medical findings.

Input: Reason: right testicular mass History: right testicle is enlarged and hardened for a few weeks. History of prostate cancer in 2003 RIGHT TESTIS: Measures 4.6 x 2.6 x 2.6 cm. Appears diffusely hypoechoic and heterogeneous. No discrete mass nor fluid collection is appreciated. Vasculature is intact.LEFT TESTIS: Measures 4.1 x 2.4 x 2.7 cm. Small peripheral anechoic lesions with peripheral acoustic enhancement suggestive of benign peripheral tunica cysts. Otherwise homogeneous in appearance. Vasculature is intact. RIGHT EPIDIDYMIS: 0.9 x 1 x 1 cm. No focal lesions.LEFT EPIDIDYMIS: 0.9 x 1 x 2.2 cm. There is a small 0.2 x 0.2 and 0.4 cm anechoic lesion with posterior acoustic enhancement noted within the head of the epididymis, consistent with benign epididymal cyst versus spermatocele.OTHER: Small right-sided varicocele.

Output: 1. Diffusely hypoechoic and heterogenous right testis with no discrete mass nor fluid collection appreciated. Likely related to chronic inflammation. There is no evidence of an acute process nor abscess.2. Benign peripheral tunica cysts within the left testis.3. Anechoic lesion within the head of the left epididymis, consistent with benign epididymal cyst versus spermatocele.4. Small right-sided varicocele.


Instruction: Generate impression based on medical findings.

Input: Female 83 years old Reason: Evaluate for hydronephrosis, other intra renal process History: AKI Suboptimal exam due to patient's body habitus.RIGHT KIDNEY: The right kidney measures 12 cm. Increased renal cortical echogenicity. No shadowing stone or hydronephrosis is present. Subcentimeter upper pole cyst.LEFT KIDNEY: The left kidney measures 10.7 cm. Mildly increased renal cortical echogenicity. Echogenic 4 mm focus in mid to lower pole of left kidney, may represent a nonobstructing stone. No hydronephrosis is present. BLADDER: Not well visualized due to collapsed state, portion of Foley catheter seen.OTHER: Hydropic gallbladder containing moderate amount of layering sludge.

Output: No hydronephrosis. Increased renal cortical echogenicity, consistent with medical renal disease.4 mm echogenic focus in left kidney, may be a nonobstructing intrarenal calculus.Hydropic gallbladder containing moderate amount of sludge.


Instruction: Generate impression based on medical findings.

Input: Late complications related to right lower extremity amputation stump (status post AKA), evaluate for fluid collection, swelling, warmth; tagged white blood cell exam with localization and concern for infection Status post right lower extremity amputation and at level of stump, heterogeneous collection measuring 6.5 x 5.8 x 3.7 cm visualized. Mild surrounding hyperemia. Adjacent moderate overlying soft tissue edema seen.

Output: 6.5 cm heterogeneous collection at level of right lower extremity stump, appearance suspicious for an abscess given adjacent hyperemia and cellulitis as well as lack of prior trauma per patient, otherwise hematoma would be another differential consideration.


Instruction: Generate impression based on medical findings.

Input: Male 30 years old Reason: Post Liver Transplant. Please evaluate all vessels for patency History: Liver Transplant LIVER: The liver measures demonstrates slightly heterogeneous parenchymal echogenicity. There is a perihepatic fluid collection, which may represent an evolving hematoma. No intrahepatic or extrahepatic biliary ductal dilatation is evident and no focal mass lesion seen. GALLBLADDER, BILIARY TRACT: No gallbladder is identified. The common duct measures 0.5 cm in diameter. PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 16.3 cm in length and demonstrates increased parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.SPLEEN: The spleen measures 14.4 cm in length.OTHER: Small volume ascites is noted.

Output: 1.Normal resistive indices, diastolic flow and waveforms of the common hepatic and left hepatic artery. The right hepatic artery demonstrates a tardus parvus waveform, but normal resistive index and diastolic flow, which may be related to postoperative edema, but continued follow-up is recommended.2.Small volume ascites.3.Perihepatic collection likely represents postoperative hematoma.


Instruction: Generate impression based on medical findings.

Input: 47-year-old female with intermittent left quadrant pain, hematuria. Evaluate for kidney stone. RIGHT KIDNEY: The right kidney measures 9.9 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.LEFT KIDNEY: The left kidney measures 10.5 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.

Output: No evidence of nephrolithiasis or hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Reason: 54 y/o man w/ cirrhosis who p/w volume overload and AKI History: Volume Overload LIVER:The size of the liver is within normal limits, measuring 14.3 cm. There is a coarsened echotexture with nodular contour, consistent with cirrhotic morphology. No focal lesions. No intrahepatic ductal dilation.GALLBLADDER, BILIARY TRACT: There is an echogenic focus with posterior acoustic shadowing noted within the neck of the gallbladder, consistent with a gallstone. The gallbladder wall is at the upper limits of normal, measuring 0.3 cm. There is a trace amount of pericholecystic fluid, which is most likely secondary to ascites rather than an inflammatory process. The common hepatic duct is not dilated, measuring 0.4 cm.PANCREAS: The pancreas is poorly visualized due to overlying bowel gas.SPLEEN: The spleen is mildly enlarged, measuring 13.7 cm in length. Normal echogenicity. No focal lesions.KIDNEYS: The right kidney measures 11.5 cm in length. Increased echogenicity. No focal lesions. No hydronephrosis.The left kidney measures 11.1 cm in length. Increased echogenicity. There is a small nearly anechoic lesion with posterior acoustic enhancement which measures 0.9 x 1 x 1.1 cm, consistent with a benign simple cyst. There is an echogenic foci with posterior acoustic shadowing within the superior portion of the left renal pelvis which measures 1 x 0.6 x 0.9 cm. This is consistent with a nonobstructing stone. No hydronephrosis. ABDOMINAL AORTA: The abdominal aorta is patent with a normal waveform. The proximal aorta measures 2.7 x 3 x 2.9 cm. The mid aorta measures 2.5 x 2.6 x 2.9 cm. The distal aorta measures 2.1 x 2 x 2 cm. The peak systolic velocity 0.6 m/s and resistive index is 0.78.INFERIOR VENA CAVA: The inferior vena cava is patent with no significant abnormality.OTHER: The main portal vein is patent with a normal waveform and hepatopetal flow. The velocity is 0.3 m/s.Marked ascites, appears uncomplicated.

Output: 1. Cirrhotic liver. No focal lesions.2. Marked ascites, appears uncomplicated.3. Cholelithiasis with no definite sonographic evidence of acute cholecystitis.4. Increased echogenicity of the kidneys bilaterally, consistent with medical renal disease/parenchymal dysfunction.5. Benign simple cyst of the left kidney.6. Nonobstructing stone within the left kidney.


Instruction: Generate impression based on medical findings.

Input: Reason: hydronephrosis? History: none RIGHT KIDNEY: The right kidney measures 12.1 cm in length. There is a 3.7 x 3.5 cm simple cyst noted in the right superior pole. There is no hydronephrosisLEFT KIDNEY: The left kidney measures 10.4 cm in length. There is a 4.1 x 4.5 cm simple cyst noted in the superior pole of left kidney. There is an echogenic focus in the inferior pole of the left kidney with twinkling and shadowing consistent with nonobstructing renal calculus. There is no hydronephrosis.OTHER: The bladder is normal in appearance.

Output: 1. Nonobstructing renal stone noted in the inferior pole of the left kidney.2. No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with abdominal distention. Reason: Evaluate for ascites. LIVER: Coarse echogenic liver parenchyma with a nodular contour.SPLEEN: The spleen appears enlarged, although measurements were not taken in this limited sonographic study.OTHER: Moderate ascites and bilateral pleural effusion.

Output: 1. Moderate ascites and bilateral pleural effusion.2. Incidentally noted coarse echogenic liver parenchyma with a nodular contour, consistent with a cirrhotic morphology.


Instruction: Generate impression based on medical findings.

Input: 72-year-old female with a history of thyroid cancer status post thyroidectomy, surveillance ultrasound. RIGHT LOBE: Status post thyroidectomy. No soft tissue echogenicity focus is identified in the right thyroid bed to suggest locoregional recurrence.LEFT LOBE: Status post thyroidectomy. Redemonstration of ovoid echogenic focus in the left thyroid bed measuring 0.6 x 0.4 x 0.9, perhaps slightly decreased in size when accounting for differences in technique and positioning.ISTHMUS: Status post thyroidectomy.LYMPH NODES: Benign-appearing level two and level three lymph nodes measuring 0.7 x 1.3 x 1.3 cm and 0.3 x 0.6 x 0.9 cm, respectively. The previously identified left level two cervical node has not significantly changed since the prior examination. The right level three cervical node was not previously identified. OTHER: No significant abnormality noted.

Output: Status post thyroidectomy with stable to slightly decreased echogenic focus in the left thyroid bed.


Instruction: Generate impression based on medical findings.

Input: Male 54 years old Reason: eval for intraabdominal infection History: abdominal distension, pain, and pancytopenia LIMITED ABDOMENLIVER: Echogenic lesion in the posterior right liver measuring 2.6 cm corresponding to a similar sized hepatic hypodensity seen on recent CT chest could represent a hemangioma.BILIARY TRACT: No biliary dilatation.PANCREAS: Unable to be visualized secondary to bowel gas.KIDNEYS: The right kidney measures 13 cm. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 13 cm. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 9 cm. In length. OTHER: No significant abnormalities noted.

Output: 1.2.6 cm echogenic lesion in the right liver could correspond to a hemangioma when correlated with recent CT Chest given age of patient. However, the CT chest was without contrast precluding a more definitive diagnosis.2.No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Synovitis of right hand. Hand lesion. Right long finger ultrasound to evaluate for foreign body. No foreign body is identified on this study. The flexor tendon apparatus of the middle finger appears normal, without evidence of tear. The flexor digitorum superficialis tendon can be identified inserting on the middle phalanx, and the flexor digitorum profundus tendon can be identified inserting on the distal phalanx. Normal gliding motion of the flexor digitorum profundus tendon at the level of the MCP joint is noted with passive DIP flexion and extension. Motion of the flexor digitorum superficialis tendon also appears normal. I see no frank tenosynovitis. The articular cartilage along the volar aspect of the head of the third metacarpal appears normal.Sonography of the finger dorsally showed no foreign body. There is normal gliding motion of the extensor tendon at the level of the MCP joint with passive flexion of the distal interphalangeal joint. The articular cartilage of the head of the third metacarpal appears normal. I see no frank synovitis.

Output: No sonographic evidence of foreign body, tendon injury, or synovitis.


Instruction: Generate impression based on medical findings.

Input: Post thyroidectomy and I-131 treatment for thyroid cancer. RIGHT LOBE: Surgically absent. LEFT LOBE: Surgically absentISTHMUS : Surgically absentPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No lymphadenopathy is identified. Lymph node in the right superior thyroid bed measures 0.4 x 0.2 x 0.5 cm, probably unchanged given differences in technique. Right level 4 cervical lymph node measures 0.4 x 0.2 x 0.4 cm, previously 0.7 x 0.7 x 0.4 cm.OTHER: No significant abnormality noted.

Output: Stable appearance of cervical lymph nodes without evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 76-year-old male with history of biliary cancer status post internal biliary drain. Please evaluate for biliary dilation in the context of rising bilirubin. LIMITED ABDOMENLIVER: The liver has a smooth contour. The parenchyma is mildly coarse and echogenic . Liver measures 14.7 cm in length. Portal flow is hepatopedal. No suspicious masses. In comparison to prior CT, there is interval increasing bilateral lobar intrahepatic biliary ductal dilation that extends to the common bile duct. Echogenic foci within the liver parenchyma could be secondary to calcified granulomata.BILIARY TRACT: The gallbladder contains layering sludge. No gallbladder wall thickening or pericholecystic fluid. The common duct measures up to 1.0 cm just proximal to the biliary stent.PANCREAS: Much of the pancreas is obscured secondary to the biliary stent and bowel gas. The pancreatic head mass is not well characterized on this examination.KIDNEYS: The right kidney measures 11.3 cm. The cortex is echogenic. The right cyst measures 1.3 x 1.5 x 1.6 cm. Right nephrolithiasis measuring 0.3 x 0.2 x 0.4 cm is seen. No evidence of hydronephrosis.The left kidney measures 11.6 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. A left renal cyst measures 2.3 x 2.1 x 2.1 cm.SPLEEN: The spleen was not well-visualized on this examination.OTHER: None.

Output: 1.Interval worsening of intrahepatic ductal dilation with the common duct measuring up to 1.0 cm.2.Redemonstration of internal biliary stent.3.Right nonobstructing nephrolithiasis as described above. Bilateral echogenic kidneys consistent with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Female 65 years old Reason: Rule out hydronephrosis History: flank pain Suboptimal study secondary to patient's inability to change position.RIGHT KIDNEY: The right kidney measures 10.1 cm. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 10.6 cm. No shadowing calculi. No definite hydronephrosis is present. Linear hypoechogenicity seen in mid to upper pole most likely artifactual/related to rib.BLADDER: Not visualized, presumably related to collapsed state.OTHER: No significant abnormalities noted.

Output: No hydronephrosis seen.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o underlying new nodules. Also assess for change in overall size History: h/o very small nodules. But now with increase in size of thyroid on exam with some irregularity. RIGHT LOBE MEASUREMENTS: 4.8 x 1.5 x 1.5 cm.LEFT LOBE MEASUREMENTS: 5 x 1.5 x 1.1 cm.ISTHMUS MEASUREMENTS: 0.5 cm.RIGHT LOBE: The right lobe appears slightly heterogenous. There are no focal lesions.LEFT LOBE: Normal echogenicity. There is a small subcentimeter hypoechoic nodule in the midportion of the left thyroid lobe; unchanged from prior exam.ISTHMUS: Normal echogenicity. The lesion noted on prior exam is no longer visualized.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There is a 1.6 x 0.3 x 0.7 cm benign-appearing lymph node in the right neck at level 3.There is a 1.3 x 0.3 x 0.6 cm benign-appearing lymph node in the left neck at level 3.OTHER: No significant abnormality noted.

Output: 1. Stable exam.2. The hypoechoic lesion in the isthmus noted on prior exam is no longer visualized.


Instruction: Generate impression based on medical findings.

Input: Female 88 years old Reason: RUQ abdominal pain x 1month LIVER: The liver measures 13.7 cm in length and demonstrates heterogenous parenchymal echogenicity. No intrahepatic or extrahepatic biliary ductal dilatation is evident and no focal mass lesions are seen. The main portal vein is patent and demonstrates hepatopedal flow with a velocity of 0.2 m/s. GALLBLADDER, BILIARY TRACT: A stone is lodged in the gallbladder neck, but there is no gallbladder wall thickening or pericholecystic fluid to suggest acute cholecystitis. The common duct measures 0.5 cm in diameter. PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 8.4 cm in length and demonstrates normal parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.LEFT KIDNEY: The left kidney measures 10.7 cm in length and demonstrates normal parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.SPLEEN: The spleen measures 7.1 cm in length.OTHER: No significant abnormalities noted.

Output: 1.Stone lodged in the gallbladder neck, but no evidence of acute cholecystitis.2.Heterogeneous renal parenchyma echogenicity suggestive of mild chronic liver disease.


Instruction: Generate impression based on medical findings.

Input: Male 78 years old; evaluate for hydronephrosis and stone History: AKI on CKD RIGHT KIDNEY: The right kidney measures 9.3 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. Right renal cyst is unchanged. No masses identified.LEFT KIDNEY: The left kidney measures 11.2 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. No masses identified.URINARY BLADDER: Visualized portions of the bladder within normal limits.OTHER: Left ureteral jet is seen.

Output: Increased cortical echogenicity of bilateral kidneys, compatible with medical renal disease, without evidence of hydronephrosis, shadowing calculi, or masses.


Instruction: Generate impression based on medical findings.

Input: Female 65 years old Reason: Abnormal LFTs. ? Etiology History: As above LIMITED ABDOMENLIVER: The liver measures 14.8 cm in length. The liver has a smooth contour. The parenchyma is mildly echogenic. No suspicious mass is identified. There is no ascites. The portal vein is patent and demonstrates hepatopetal flow with a peak velocity of 0.2 m/sec. BILIARY TRACT: There is no cholelithiasis. A fold is seen in the gallbladder wall with underlying echogenic sludge. There is no gallbladder wall thickening or pericholecystic fluid. Common duct measures 0.3 cm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 10.7 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 11.2 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 9.8 cm. in length.

Output: 1.Mildly echogenic liver parenchyma, a nonspecific finding, but can be seen in fatty liver.2.Small amount of sludge within the gallbladder but no evidence of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: History of HCV, surveillance for HCC LIVER: Liver measures 12.9 cm with coarse echogenicity. Portal vein is patent with normal direction and velocity of 0.2 m/s. No suspicious hepatic mass is noted.BILIARY TRACT: Common bile duct measures 4 mm. Patient is status post cholecystectomy.PANCREAS: Distal pancreas is obscured by overlying bowel gas. Visualized part is within normal limits.SPLEEN: Spleen measures 10.5 cm and is normal in echogenicity and configuration.KIDNEYS: Right kidney measures 10.5 cm with mildly increased echogenicity and without hydronephrosis. Left kidney measures 11.5 cm with mildly increased echogenicity and without hydronephrosis. No renal calculi identified. OTHER: No significant abnormalities noted.

Output: 1.Coarse echogenicity of the liver suggestive of fatty infiltration. No suspicious lesion.2.Bilateral mildly increased renal echogenicity suggestive of medical renal disease.


Instruction: Generate impression based on medical findings.

Input: 24-year-old female with a history of alcohol-induced acute pancreatitis, assess for gallstones. LIVER: Diffuse increase in hepatic parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions. Hepatic length measures 14 cm. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of 36 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 2 mm. The common bile duct measures 4 mm in diameter. No sonographic evidence of cholelithiasis. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 10 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 10 cm and has normal vascular flow. The left kidney measures 12 cm and has normal vascular flow. No evidence of hydronephrosis.OTHER: Trace ascites.

Output: 1. Diffuse increase in hepatic parenchymal echogenicity with coarsened echotexture consistent with fatty liver/hepatic parenchymal dysfunction. No hepatic mass or ductal dilatation identified.2. No sonographic evidence of cholelithiasis.3. Trace ascites.


Instruction: Generate impression based on medical findings.

Input: 81-year-old female with acute kidney failure RIGHT KIDNEY: The right kidney measures 9.5 cm in length. Cortical thinning is noted. A few small shadowing calculi are seen. No hydronephrosis.LEFT KIDNEY: The left kidney measures 9.3 cm in length. Cortical thinning is noted. A few small shadowing calculi are seen. No hydronephrosis.URINARY BLADDER: The urinary bladder is incompletely distended. OTHER: There is no free or loculated fluid.

Output: Multiple small shadowing calculi are seen bilaterally without hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 56-year-old female with a history of HCV, please evaluate for HCC. LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 14.5 cm in length. The parenchyma is normal in echotexture. Portal flow is hepatopedal. No masses visualized.BILIARY TRACT: The gallbladder has an anechoic lumen. No gallbladder wall thickening or pericholecystic fluid is visualized. No biliary ductal dilation.PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 11.2 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.The left kidney measures 10.4 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.SPLEEN: The spleen measures 7.7 cm. in length.OTHER: No significant abnormalities noted.

Output: 1.No masses are visualized within the liver. Normal examination.


Instruction: Generate impression based on medical findings.

Input: Interrogated palpable site of concern in area below chin LYMPH NODES: At site of clinical concern are level 1 benign fatty hila containing lymph nodes, measuring 1 x 1 x 0.6 cm and 1.1 x 0.5 x 0.3 cm, respectively.OTHER: No significant abnormality noted.

Output: Level 1 lymph nodes seen as above.


Instruction: Generate impression based on medical findings.

Input: Renal failure. Evaluate cause. RIGHT KIDNEY: Markedly echogenic right kidney measuring 8.4 cm. Few subcentimeter simple renal cysts are identified, with representative right upper pole cyst measuring 1.1 x 0.9 x 0.7 cm. No hydronephrosis or renal calculi identified.LEFT KIDNEY: Markedly echogenic left kidney measuring 7.8 cm. Few subcentimeter simple renal cysts are identified, with representative left midpole cyst measuring 0.6 x 0.5 x 0.7 cm. No hydronephrosis or renal calculi identified.URINARY BLADDER: Bladder distended with simple fluid. No abnormality identified. OTHER: No significant abnormalities noted.

Output: Echogenic bilateral kidneys, consistent with medical renal disease. Few bilateral simple cysts. No hydronephrosis or renal calculi identified.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old. Reason: Evaluation of large right-sided heterogeneous goiter seen on CT History: asymptomatic RIGHT LOBE MEASUREMENTS: 7 x 3.8 x 4 cmLEFT LOBE MEASUREMENTS: 4.8 x 2.4 x 2.6 cmISTHMUS MEASUREMENTS: 3 mmRIGHT LOBE: Dominant, predominantly solid nodule which occupies the majority of the right thyroid lobe with peripheral vascularity and a shadowing calcification. The nodule measures 5.2 x 2.7 x 3.6 cm.LEFT LOBE: Heterogeneous gland with predominantly solid nodule which is possibly spongiform appearance with internal vascularity measuring 2.7 x 1.8 x 2.0 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No regional lymphadenopathy.OTHER: No significant abnormality noted.

Output: Dominant, predominantly solid right thyroid nodule with a coarse calcification for which biopsy is recommended. No regional lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Male 39 years old Reason: concern for cholecystitis History: transaminitis LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 15.5 cm in length. The parenchyma is mildly echogenic BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 3 mm in thickness. Common duct measures 4 mm. PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 10.7 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. The left kidney measures 11.3 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 13.2 cm. in length. OTHER: No ascites.

Output: 1.No sonographic evidence of acute cholelithiasis or cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Male 74 years old Reason: spleen size History: metastatic adenocarcinoma, acute liver failure LIVER: Liver measures 14.4 cm in length. Survey imaging demonstrates liver parenchyma is increased in echogenicity and coarse, likely reflecting underlying hepatic steatosis/parenchymal dysfunction. SPLEEN: The spleen measures 9.9 cm. in length. OTHER: Bilateral pleural effusions partially imaged.

Output: Spleen normal in size measuring 9.9 cm in longitudinal dimension.


Instruction: Generate impression based on medical findings.

Input: Kidney transplant status. Hematuria. Transplant kidney identified within the right iliac fossa, measures 11.3 cm, with equivocal echogenicity of the cortex. There is an upper pole 2.2 x 1.5 x 2.5 cm exophytic cyst. There is mild hydronephrosis. No renal calculus is identified. The bladder is incompletely distended.

Output: Right sided transplanted kidney with mild hydronephrosis, but no renal calculus identified. Upper pole exophytic cyst noted.


Instruction: Generate impression based on medical findings.

Input: Female 53 years old Reason: Liver , spleen evaluation in pulm langerhans dx History: SOB LIVER: The liver measures 18.5 cm in length and demonstrates heterogeneous parenchymal echogenicity. No intrahepatic or extrahepatic biliary ductal dilatation is evident and no focal mass lesions are seen. The main portal vein is patent and demonstrates hepatopedal flow with a velocity of 0.4 m/s. GALLBLADDER, BILIARY TRACT: No cholelithiasis or choledocholithiasis is seen. The common duct measures 0.2 cm in diameter. PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 12.8 cm in length and demonstrates increased parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.LEFT KIDNEY: The left kidney measures 13.1 cm in length and demonstrates increased parenchymal echogenicity. No hydronephrosis or hydroureter is evident, and no nephrolithiasis or ureterolithiasis is seen.SPLEEN: The spleen measures 8.8 cm in length.OTHER: No significant abnormalities noted.

Output: 1.Borderline enlarged liver with heterogeneous parenchymal echogenicity suggestive of hepatic steatosis or chronic liver disease.2.Increased renal parenchymal echogenicity consistent with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Male 51 years old; Reason: cirrhosis? History: elevated AST/ALT Please note exam is limited due to patient positioning.LIVER: Within normal limits hepatic parenchymal echogenicity. No focal hepatic lesions. Hepatic length measures 14.9 cm. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of 33.5 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 0.2 mm. The common bile duct measures 0.18 mm in diameter. Cholelithiasis without evidence of cholecystitis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance. No focal lesions are identified.SPLEEN: The spleen measures 8.9 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 11.3 cm and has normal vascular flow. The left kidney measures 12.6 cm and has normal vascular flow. OTHER: No significant abnormality noted.

Output: 1. No sonographic evidence of cirrhosis or focal hepatic lesion.2. Cholelithiasis without evidence of cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Reason: history of alcohol abuse, abdominal distention pre heart transplant work up LIVER: Liver measures 13 cm with increased echogenicity. Liver surface is nodular, compatible with cirrhotic morphology. Portal vein is patent with normal direction and velocity of 0.1 m/s. No suspicious hepatic mass is noted.BILIARY TRACT: Common bile duct measures 4 mm. Gallbladder wall measures 2 mm. Small amount of gallbladder sludge noted. No pericholecystic fluid collection. No gallstones noted.PANCREAS: Distal pancreas is obscured by overlying bowel gas. Visualized part is within normal limits.SPLEEN: Spleen measures 8.5 cm and is normal in echogenicity and configuration. Adjacent splenule noted measuring 0.7 x 0.7 x 0.7 cm.KIDNEYS: Right kidney measures 10.5 cm with increased echogenicity and without hydronephrosis. Left kidney measures 11 cm with increased echogenicity and without hydronephrosis. No renal calculi identified. ABDOMINAL AORTA: Proximal aorta measures 2.1 x 2.3 x 1.6 cm. Mid aorta measures 1.6 x 1.7 x 1.8 cm. Distal aorta measures 1.5 x 1.4 x 1.5 cm. Aortic waveform is within normal limits.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: Decompressed bladder with bilateral ureteral jets. No significant abnormality noted.

Output: 1.Cirrhotic morphology and echogenicity of the liver.2.Bilateral increased echogenicity of the kidneys compatible with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: 50-year-old female with history of esophageal varices, hepatic encephalopathy secondary to acute alcoholic hepatitis. Reason: Evaluate for portal vein thrombosis. LIVER: The liver measures 14.2 cm. Coarse echogenic liver parenchyma without focal lesion or ductal dilatation. Portal vein is patent with normal hepatopetal directional flow and peak velocity of 20.8 cm/s.GALLBLADDER, BILIARY TRACT: Hydropic gallbladder with sludge. Mild pericholecystic fluid, likely to be secondary to ascites. No ductal dilatation. Unable to assess for sonographic Murphy's sign due to patient's mental status.PANCREAS: The visualized pancreas is without significant abnormalities.RIGHT KIDNEY: The right kidney measures 10.9 cm. Echogenic parenchyma without shadowing calculi or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.2 cm. Echogenic parenchyma without shadowing calculi or hydronephrosis.SPLEEN: The spleen measures 9.1 cm.OTHER: Right pleural effusion. Mild ascites.

Output: 1. Patent portal vein with normal directional flow.2. Hydropic gallbladder with sludge and mild pericholecystic fluid felt to be secondary to ascites. Unable to assess for sonographic Murphy's sign due to patient's mental status. In the appropriate clinical setting, acute cholecystitis may be considered.3. Coarse echogenic liver parenchyma consistent with fatty infiltration/parenchymal dysfunction without focal lesion or ductal dilatation.4. Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction.5. Right pleural effusion. Mild ascites.


Instruction: Generate impression based on medical findings.

Input: Reason: assess status of cyst on left and stones History: flank pain RIGHT KIDNEY: The right kidney measures 11.7 cm. Normal cortical echogenicity. No hydronephrosis or calculi. 7.3 cm simple exophytic renal cyst is again seen.LEFT KIDNEY: The left kidney measures 11 cm. Normal cortical echogenicity. No hydronephrosis or calculi.OTHER: Bladder is mildly decompressed, somewhat limiting evaluation, but no significant abnormality.

Output: Simple appearing right renal cyst, interval increase in size. No hydronephrosis or renal calculi.


Instruction: Generate impression based on medical findings.

Input: 58-year-old man with sepsis, elevated LFTs, worsening bilirubin. Evaluate for gallbladder pathology. LIVER: Mildly nodular contour of the liver. No focal hepatic lesion or mass. The liver measures 17.6 cm in length. The main portal vein is patent with normal hepatopedal direction of flow and sluggish velocity of 8.8 cm/s.GALLBLADDER, BILIARY TRACT: The gallbladder contains layering sludge. No cholelithiasis. There is mild pericholecystic fluid, associated with the patient's mild abdominal ascites. The gallbladder wall is normal in appearance, measuring 0.3 cm in thickness. No dilatation or cystic changes are noted of the intrahepatic or extrahepatic biliary ducts. The common bile duct measures 0.3 cm in diameter. No choledocholithiasis.PANCREAS: The head and proximal body of the pancreas are heterogeneous in appearance. The tail is obscured by bowel gas. The pancreatic duct measures 0.1 cm in diameter.RIGHT KIDNEY: The right kidney measures 9.7 cm in length and shows normal echotexture. No mass, stone or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.0 cm in length and shows normal echotexture. No mass, stone or hydronephrosis.SPLEEN: The spleen is normal in echogenicity and measures 10.7 cm in length. URINARY BLADDER: The urinary bladder is decompressed, with Foley balloon in place, which limits evaluation of the wall.OTHER: Mild ascites.

Output: 1.Very sluggish portal venous flow without evidence of thrombosis.2.Gallbladder sludge without cholelithiasis or biliary ductal dilatation.3.Mild ascites. Somewhat nodular contour of the liver could indicate cirrhosis.4.Heterogeneous appearance of the pancreas, a nonspecific finding.


Instruction: Generate impression based on medical findings.

Input: History of thyroid cancer status post total thyroidectomy. Thyroid: The thyroid is surgically absent. There are no suspicious residual soft tissue masses in the thyroidectomy bed.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Scattered cervical lymph nodes which have normal size and morphology.OTHER: No significant abnormality noted.

Output: Expected postoperative changes without evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Reason: rule out parathyroid adenoma History: joint aches RIGHT LOBE MEASUREMENTS: 7.5 x 1.5 x 2.0 cm, homogeneous parenchymaLEFT LOBE MEASUREMENTS: 6.3 x 1.4 x 2.1 cm, homogenous parenchymaISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: No significant abnormality noted. A couple less than 5 mm cysts are noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Posterior to the mid left thyroid, there is a 0.5 x 0.5 x 0.8 cm hypoechoic lesion with mild internal vascularity. This may represent a small lymph node or adenoma candidate.LYMPH NODES: A couple benign-appearing lymph nodes are seen. OTHER: No significant abnormality noted.

Output: 0.8 cm parathyroid adenoma candidate posterior to the mid left thyroid as described above. Correlate with same-day nuclear medicine scan. Diffuse mild prominence in size of the thyroid gland.


Instruction: Generate impression based on medical findings.

Input: Cutaneous abscess, unspecified; left abdominal/groin pain and swelling, evaluate for abscess Amorphous superficially located hypoechogenicity seen in interrogated left groin, with mildly increased vascularity of adjacent soft tissues. Hypoechoic focus measures 7 x 6 x 5 mm and extends to skin surface.

Output: Findings consistent with a small subcentimeter superficially located abscess at site of clinical concern in left groin with adjacent cellulitis suggested. Correlation with patient's clinical history and physical exam recommended.


Instruction: Generate impression based on medical findings.

Input: 84-year-old female with mild thyroid enlargement and elevated calcium. Reason: Evaluate for adenoma, thyroid nodule. RIGHT LOBE MEASUREMENTS: 4.3 x 2.2 x 1.5 cmLEFT LOBE MEASUREMENTS: 4.1 x 2.2 x 1.6 cmISTHMUS MEASUREMENTS: 0.3 cm in the AP dimensionRIGHT LOBE: Mildly heterogeneous gland with subcentimeter thyroid nodules.LEFT LOBE: Mildly heterogeneous gland with subcentimeter thyroid nodules.ISTHMUS: Mildly heterogeneous gland with subcentimeter thyroid nodules.PARATHYROID GLANDS: Hypoechoic, extrathyroidal focus located inferior to the right thyroid gland measuring 0.9 x 0.6 x 0.6 cm.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Hypoechoic, extrathyroidal subcentimeter focus inferior to the right thyroid gland. This is slightly atypical in appearance for a parathyroid adenoma. Please correlate with nuclear medicine study as clinically warranted.2. Mildly heterogeneous thyroid gland with subcentimeter thyroid nodules bilaterally.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for fluid collection in bilateral anterior shin, assess for seroma capsule History: bilateral anterior lower leg bogginess s/p liposuction Right anterior lower extremity:Sonographic evaluation of the subcutaneous soft tissues of the anterior leg demonstrates mild heterogeneity and fluid without discrete masses or drainable fluid collections.Left anterior lower extremity:Sonographic evaluation of the subcutaneous soft tissues of the anterior leg demonstrates mild heterogeneity and fluid without discrete masses or drainable fluid collections.

Output: Mild fluid, presumably postoperative, within the subcutaneous soft tissues of the bilateral anterior legs without drainable fluid collections or discrete masses.


Instruction: Generate impression based on medical findings.

Input: Reason: hx of CKD, bilateral ureteral stents removed, evaluate for perinephric stranding, hydro History: see above RIGHT KIDNEY: Somewhat poor visualization of the kidneys. Right kidney measures 8.9 cm and is increased in echogenicity without hydronephrosis. Cortical atrophy noted. Right mid renal cyst measuring 0.9 x 0.9 x 0.9 cm. No evidence of renal calculi.LEFT KIDNEY: Left kidney measures 8.5 cm and is increased in echogenicity without hydronephrosis. Cortical atrophy noted. Left renal cysts measuring 1.1 x 1.4 x 1.2 cm noted. No evidence of renal calculi.URINARY BLADDER: Partially decompressed bladder, which limits evaluation. Enlarged prostate noted with mild mass effect on the bladder.OTHER: No significant abnormalities noted.

Output: No evidence of hydronephrosis or perinephric fluid collection. Bilateral simple renal cysts noted.


Instruction: Generate impression based on medical findings.

Input: Male 53 years old Reason: portal vein thrombosis r/o History: tense ascites and liver failure in cirrhosis LIVER: Liver measures 17.9 cm in length. The parenchyma is moderately coarse and echogenic with a nodular liver contour compatible with cirrhosis. There is no focal liver lesion identified. There is a moderate amount of ascites.Main portal vein is patent with hepatopedal flow and a peak velocity of 0.3 m/s. BILIARY TRACT: Gallbladder is contracted but unremarkable. There is gallbladder wall thickening measuring up to 0.8 cm which is symmetric and nonspecific in the setting of chronic liver disease, may be reflective of hypoalbuminemia. No significant gallbladder distention or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 9.2 cm. The left kidney measures 10.9 cm. SPLEEN: The spleen measures 9.7 cm. in length. OTHER: No significant abnormality noted.

Output: 1.No portal venous thrombosis as clinically questioned.2.Cirrhotic liver with moderate amount of ascites. No focal hepatic lesion identified.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old. Reason: history of thyroid cancer, status post resection. RIGHT LOBE: Status post thyroidectomy. There is a small amount of residual thyroid tissue in the right surgical bed measuring 0.9 x 0.8 x 0.7 cm. No suspicious lesion is identified.LEFT LOBE: No residual left thyroid tissue. No recurrent lesion in the left surgical bed.ISTHMUS: No residual thyroid tissue.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Normal-appearing lymph nodes in the bilateral soft tissues of the neck.OTHER: No significant abnormality noted.

Output: Small amount of residual thyroid tissue in the right surgical bed. No suspicious lesion is identified.


Instruction: Generate impression based on medical findings.

Input: 56-year-old female with cirrhosis. Reason: HCC screening. LIVER: The liver measures 14.8 cm in length. Coarse echogenic liver parenchyma with a mildly nodular contour. No focal lesion or ductal dilatation. Hepatic lesion within segment 8 seen on prior CT is not visualized on this sonographic study. Portal vein is patent with normal hepatopetal directional flow and peak velocity of 0.2 m/s.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy.PANCREAS: The visualized pancreas is without significant abnormalities.RIGHT KIDNEY: The right kidney measures 8.5 cm. The cortex is of normal echogenicity. No shadowing calculi or hydronephrosis is present.LEFT KIDNEY: The left kidney measures 9.6 cm. The cortex is of normal echogenicity. No shadowing calculi or hydronephrosis is present. There is a cystic focus measuring 1.1 x 1 x 1 cm.SPLEEN: The spleen measures 10.6 cm.OTHER: No ascites.

Output: Cirrhotic liver morphology without focal lesion or ductal dilatation.


Instruction: Generate impression based on medical findings.

Input: Male 71 years old Reason: evaluate for biliary drain obstruction v. portal vein obstruction History: abdominal pain LIVER: Liver measures 14.8 cm in length. Main portal vein patent with normal directional flow, velocity measures 22 cm/s. BILIARY TRACT: Cholelithiasis, appear to be small stones layering along dependent gallbladder (as opposed to a dominant stone). No significant gallbladder distention, wall thickening or pericholecystic fluid. Mild intrahepatic biliary duct dilatation. CBD measures up to 9 mm.PANCREAS: Not well seen in entirety due to overlying bowel gas.KIDNEYS: The right kidney measures 10.4 cm. The left kidney measures 10 cm. SPLEEN: Not well visualized.OTHER: Left pleural effusion.

Output: Mild intrahepatic and extrahepatic biliary duct dilatation. Accounting for differences in technique, appearance may be unchanged from earlier noncontrast 2/22/2013 CT exam. However, correlation with patient's laboratory values and clinical history recommended and if there is concern for underlying obstructing stone or lesion, further evaluation with dedicated MRCP or ERCP recommended.Cholelithiasis.Portal vein patent.Left-sided pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male 77 years old; Reason: hydronephrosis? History: AKI RIGHT KIDNEY: The right kidney measures 7.5 cm in length. The cortex is thinned and echogenic. No shadowing calculi or hydronephrosis is present. Isoechoic nodular component in the upper pole measures 1.6 x 1.7 cm and may represent an area of cortical lobulation with surrounding areas of cortical atrophy. This is better seen on the CT dated 10/10/2014.LEFT KIDNEY: The left kidney measures 7.1 cm in length. The cortex is thinned and echogenic. No shadowing calculi or hydronephrosis is present. URINARY BLADDER: Bladder is inadequately distended limiting evaluation.OTHER: No significant abnormalities noted.

Output: 1.No sonographic findings of nephrolithiasis or hydronephrosis.2.Bilateral echogenic renal cortices compatible with medical renal disease.3.Probable scarring and cortical lobulation of the upper pole of the right kidney.


Instruction: Generate impression based on medical findings.

Input: 89-year-old female with hepatitis C. Evaluate for HCC. LIVER: Echogenicity of the hepatic parenchyma is diffusely increased with coarsened texture and nodular contour. No focal hepatic lesion or mass. The liver measures 17.8 cm in length. The main portal vein is patent with normal hepatopedal flow and velocity of 23.4 cm/s.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. No dilatation or cystic changes are noted of the intrahepatic or extrahepatic biliary ducts. The common hepatic duct measures 0.8 cm in diameter.PANCREAS: The head and proximal body of the pancreas are normal. The tail is obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 8.5 cm in length and shows normal echotexture. A cystic structure at the upper pole of the right kidney measures 3.1 x 2.8 x 3.1 cm, and today appears more complex with peripheral nodularity. No mass, stone or hydronephrosis.LEFT KIDNEY: The left kidney measures 9.7 cm in length and shows normal echotexture. No mass, stone or hydronephrosis.SPLEEN: The spleen is normal in echogenicity and measures 12.3 cm in length. OTHER: There is no free or loculated fluid.

Output: 1.Cirrhotic morphology of the liver without focal mass lesion. Patent portal vein with normal hepatopedal flow. No ascites.2.A cystic structure at the upper pole of the right kidney appears more complex with new peripheral nodularity seen on today's examination.


Instruction: Generate impression based on medical findings.

Input: Female 36 years old Reason: RUQ evaluate GB History: epigastric RUQ pain LIVER: Liver prominent, measuring 18.1 cm in length. Main portal vein patent, normal directional flow with velocity measuring 20 cm/s. BILIARY TRACT: Gallbladder unremarkable, no evidence of gallstones. No acute cholecystitis. No significant gallbladder distention, wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Not well seen in entirety, particularly tail, due to adjacent bowel gas but visualized portions unremarkable. KIDNEYS: The right kidney measures 11.4 cm. The left kidney measures 12.2 cm. No hydronephrosis.SPLEEN: The spleen measures 9.4 cm. in length. OTHER: No significant abnormality noted.

Output: No gallstones seen. No acute cholecystitis.Mild hepatomegaly.


Instruction: Generate impression based on medical findings.

Input: Goiter RIGHT LOBE: Measures 5 x 1.7 x 1.4 cm. Located in posterior midpole is heterogeneous hypoechoic nodule measuring 1.1 x 1 x 0.9 cm, possible peripheral calcifications present. Additional heterogeneous inferiorly located nodule containing internal echogenic foci suspicious for calcifications, nodule measures 1.1 x 1 x 0.9 cm.LEFT LOBE: Measures 4.3 x 2 x 1 cm. Subcentimeter hypoechoic nodule seen in lower pole that may be a colloid cyst.ISTHMUS: Normal in size, measuring 2 mm.LYMPH NODES: No significant abnormality noted.

Output: 1. Stable bilateral thyroid nodules, including two right-sided calcified thyroid nodules. If not already performed, fine needle aspiration biopsy recommended.


Instruction: Generate impression based on medical findings.

Input: Male; 82 years old. Reason: s/p tube placement History: urinary retention Intraoperative guidance for suprapubic catheter placement. Post procedure shows a decrease in the bladder volume. Debris is seen in the bladder in the post procedure images.

Output: Intraoperative sonographic guidance for suprapubic catheter placement. Debris in the bladder in the post procedure images may represent hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old. Reason: evaluate hepatobiliary system as etiology for hyperbilirubinemia History: deranged LFT's, altered mental status, hyperbilirubinemia LIVER: Liver measures 17.3 cm in length with coarse, echogenic parenchyma. No focal hepatic lesion or ascites. The main portal vein is patent with a normal direction of flow.BILIARY TRACT: No intrahepatic or extrahepatic biliary ductal dilatation. Common measures 3 mm. The gallbladder is mildly distended without pericholecystic fluid or gallbladder wall thickening.PANCREAS: The visualized portion of the pancreas demonstrates no significant abnormality. The pancreatic tail is obscured by overlying bowel gas.SPLEEN: Spleen measures 11.6 cm with normal echotexture.RIGHT KIDNEY: Right kidney measures 14 cm in length with normal cortical echogenicity. No hydronephrosis, mass, or shadowing calculi.OTHER: Left kidney measures 12.6 cm in length with normal cortical echogenicity. No hydronephrosis, mass, or shadowing calculi.

Output: 1. Mildly distended gallbladder without sonographic evidence of acute inflammation or biliary ductal dilatation. Consider a nuclear medicine HIDA scan if there is clinical concern for cholecystitis.2. Hepatomegaly and coarse, echogenic liver parenchyma suggests parenchymal dysfunction/fatty infiltration.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female with palpable mass of the left thigh. Patient gives further history of no change in mas over two years. 82.0 x 0.5 x 1.2 cm nodule is visualized within the subcutaneous tissues of the left thigh. This nodule appears isoechoic with surrounding subcutaneous fat without vascularity.

Output: Given the ultrasonographic appearance and stability over years, findings consistent with lipoma.


Instruction: Generate impression based on medical findings.

Input: Female 60 years old Reason: Outside Request: right upper quadrant US Re: ruq pain R/O gallstones vs other LIMITED ABDOMENLIVER: Liver measures 17.9 cm in length. The parenchyma is normal in echotexture and morphology. Portal vein flow is hepatopedal.BILIARY TRACT: The gallbladder has echogenic calculi with posterior acoustic shadowing. Wall measures 1 mm in thickness. There is no pericholecystic fluid or sonographic Murphy sign.Common duct measures 4 mm.PANCREAS: The pancreatic head, neck, and body are unremarkable.KIDNEYS: The right kidney measures 10 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 11.5 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 9.1 cm. in length. OTHER: No significant abnormalities noted.

Output: Gallstones without evidence of cholecystitis.


Instruction: Generate impression based on medical findings.

Input: 61-year-old female with history of alcohol abuse, hepatitis C presents with upper GI bleed, thrombocytopenia, and abdominal pain. LIVER: Diffuse increase in hepatic parenchymal echogenicity with coarsened echotexture. Cirrhotic liver morphology. No focal hepatic lesions. Hepatic length measures 17 cm. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of 19 cm/s. While the portal vein is patent, there is collateralization in the porta hepatis which may be due to cavernous transformation or prominent recanalized umbilical vein. GALLBLADDER/BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 2 mm. Intraluminal echogenic foci with posterior shadowing compatible with cholelithiasis. No sonographic evidence of cholecystitis. No pericholecystic fluid. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen is mildly enlarged measuring 14 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 11 cm and has normal vascular flow. The left kidney measures 12 cm and has normal vascular flow. Slight lobulation to the mid left kidney may represent a dromedary hump. OTHER: No significant abnormality noted.

Output: 1. Cirrhotic liver morphology with diffuse increase in hepatic parenchymal echogenicity suggestive of fatty liver/hepatic parenchymal dysfunction likely related to patient's underlying hepatitis C and history of alcohol abuse. No focal hepatic lesions are identified. Findings consistent with portal hypertension with recanalization of the umbilical vein and mild splenomegaly.2. Patent portal vein with collaterization in the porta hepatitis which may be due to cavernous transformation or prominent recanalization of the umbilical vein. 2. No specific findings to account for the patient's left upper quadrant pain.


Instruction: Generate impression based on medical findings.

Input: Reason: Please eval R shoulder nodule History: R shoulder nodule Deep to the patient's palpable abnormality, there is no discrete sonographic abnormality. No fluid collection or distinct lesion is noted between the skin and underlying bone.

Output: No sonographic findings corresponding to patient's palpable abnormality in the right shoulder.


Instruction: Generate impression based on medical findings.

Input: Female 74 years old Reason: of liver, hep c. screen for hcc History: same LIVER: Liver measures 16.6 cm in length. The parenchyma is coarse in echotexture, no suspicious liver lesion. Main portal vein patent with normal directional flow, velocity measures 22 cm/s. BILIARY TRACT: Gallstone measuring up to 1.9 cm seen in contracted gallbladder. No pericholecystic fluid visualized. Per ultrasound technologist, negative sonographic Murphy's sign. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Not well seen in entirety particularly tail due to overlying bowel gas.KIDNEYS: The right kidney measures 9.5 cm, right renal cyst measuring up to 1.5 cm The left kidney measures 10 cm. SPLEEN: The spleen measures 11.1 cm. in length. OTHER: No significant abnormality noted.

Output: No suspicious liver lesion.Cholelithiasis.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o portal vein thrombosis History: elevated bilirubin, necrotizing pancreatitis LIVER: Liver measures 17.5 cm with coarse echotexture and increased echogenicity. Portal vein is patent with normal direction and velocity of 0.3 m/s. No suspicious hepatic mass is noted.BILIARY TRACT: Common bile duct measures 3 mm. Gallbladder wall measures 3.5 mm. Large amount of gallbladder sludge is noted. No pericholecystic fluid collection. No gallstones noted.PANCREAS: Pancreas is not well seen due to overlying bowel gas.SPLEEN: Spleen measures 9.6 cm and is normal in echogenicity and configuration.KIDNEYS: Right kidney measures 11.5 cm with normal echogenicity and without hydronephrosis. Left kidney measures 12.9 cm with normal echogenicity and without hydronephrosis. No renal calculi identified. OTHER: Moderate abdominal ascites.

Output: Increased echogenicity of the liver and moderate abdominal ascites.


Instruction: Generate impression based on medical findings.

Input: Female 57 years old Reason: uptrending LFTs History: uptrending LFTs LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 13.4 cm in length. The parenchyma is mildly echogenic . No focal hepatic lesions. Main portal vein is patent.BILIARY TRACT: The gallbladder contains layering sludge. Wall measures 3 mm in thickness. There is mild pericholecystic edema. Common duct measures 2 mm. PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 8.9 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 9.1 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 9.7 cm. in length. OTHER: No ascites.

Output: 1.Mildly thickened gallbladder wall with gallbladder sludge. Correlate for right upper quadrant pain and possible cholecystitis.2.Mild echogenic hepatic parenchyma suggestive of fatty infiltration.


Instruction: Generate impression based on medical findings.

Input: 73-year-old female with chronic kidney disease. RIGHT KIDNEY: The right kidney measures 9.4 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present.LEFT KIDNEY: The left kidney measures 9.8 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. Left renal cyst, the largest of which measures 0.8 x 0.7 x 0.7 cm.OTHER: The bladder is without significant pathology.

Output: 1.Bilateral echogenic kidneys consistent with medical renal disease, without nephrolithiasis or hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Evaluate for obstruction, history of anuria and acute injury RIGHT KIDNEY: Measures 10.8 cm. Increased renal cortical echogenicity. No hydronephrosis. No definite shadowing intrarenal focus seen to suggest underlying calcified nephrolithiasis.LEFT KIDNEY: Measures approximately 10.2 cm, however, lower pole not well delineated due to overlying bowel gas. Increased renal cortical echogenicity. No hydronephrosis. No definite shadowing intrarenal focus seen to suggest underlying calcified nephrolithiasis.OTHER: Visualized portions of bladder unremarkable. Nonvisualization of ureteral jets. Incompletely imaged right pleural effusion.

Output: Echogenic kidneys, consistent with underlying medical renal disease. No hydronephrosis.Incompletely imaged right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female 30 years old Reason: evaluate for acute cholecystitis History: ruq pain, gallstones, fever LIVER: Liver enlarged, measuring 18.6 cm in length. The parenchyma is mildly increased in echogenicity. Main portal vein patent with normal directional flow, velocity measures 16 cm/sec. BILIARY TRACT: Gallbladder unremarkable. Multiple layering gallstones, no secondary signs of acute cholecystitis. No significant gallbladder distention, wall thickening or pericholecystic fluid. Per ultrasound technologist, unable to assess for sonographic Murphy sign due to patient's recent receipt of morphine. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Not well seen due to overlying bowel gas.KIDNEYS: The right kidney measures 11.5 cm. The left kidney measures 11 cm. No hydronephrosis. Echogenicity of renal cortex not well assessed.SPLEEN: The spleen measures 10.6 cm. in length.

Output: 1. Cholelithiasis. No secondary signs of acute cholecystitis.2. Mild hepatomegaly and increased parenchymal echogenicity of liver, suggesting underlying steatosis/parenchymal dysfunction.


Instruction: Generate impression based on medical findings.

Input: Male 73 years old; Reason: Assess kidneys (hydronephrosis), for ascites, and liver morphology. Of note patient has h/o kidney transplant and has severe AKI History: Ascites/abdominal distension, elevated creatinine LIVER: Liver is normal in density and echotexture. No focal hepatic lesions. Hepatic length measures 18.2 cm. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of 30 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 3 mm. The common bile duct measures 5 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 9.7 cm and has a normal echotexture.KIDNEYS: The native right and left kidneys are not clearly visualized. The transplant kidney measures 14.2 cm in length and is normal in echogenicity. Transplant renal artery and vein appeared patent on color Doppler imaging. No shadowing calculi or hydronephrosis is noted within the transplant kidney. AORTA: Not visualized.IVC: No significant abnormality.OTHER: No ascites noted.

Output: 1.No evidence of hydronephrosis of the transplant kidney.2.No ascites.


Instruction: Generate impression based on medical findings.

Input: 57-year-old female with elevated creatinine, evaluate. RIGHT KIDNEY: The right kidney measures 13.3 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. No masses are identified.LEFT KIDNEY: The left kidney measures 10 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. No masses are identified.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.

Output: Increase in cortical echogenicity of bilateral kidneys, compatible with medical renal disease, without evidence of hydronephrosis, shadowing calculi, or masses.