Instruction: Generate impression based on medical findings.

Input: Elevated LFTs and sepsis LIVER: Mildly heterogeneous liver echotexture without mass. Liver length 19.5 cm.GALLBLADDER, BILIARY TRACT: Cholelithiasis with mild diffuse wall thickening and mild pericholecystic fluid. No ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10 cm in lengthOTHER: Left kidney 10.2 cm in length. Spleen 9.8 cm in length. No ascites.

Output: Mildly heterogeneous liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites.Cholelithiasis with gallbladder wall thickening and pericholecystic fluid raises the possibility of acute cholecystitis. A Murphy's sign could not be assessed due to the patient's inability to cooperate.


Instruction: Generate impression based on medical findings.

Input: 70-year-old male patient with ascites and impaired synthetic function. Evaluate vasculature. Limited evaluation secondary to patient body habitus. LIMITED ABDOMENLIVER: The liver measures 15.0 cm in length, demonstrates increased parenchymal echogenicity, and is nodular in contour.BILIARY TRACT: No gallstones or gallbladder wall thickening is identified. There is no intra or extrahepatic biliary ductal dilatation. The common duct measures 3 mm in diameter.PANCREAS: The pancreas is not visualized on this examination.SPLEEN: The spleen measures 10.0 cm in length. RIGHT KIDNEY: The right kidney measures 11.1 cm in length. No evidence of hydronephrosis.OTHER: The left kidney measures 11.1 cm in length. No evidence of hydronephrosis.There is moderate ascites.

Output: 1. Cirrhotic morphology of liver with patent hepatic vasculature.2. Moderate ascites.


Instruction: Generate impression based on medical findings.

Input: 67 years old, Female, Reason: Eval for cirrhotic morphology of liver History: Low VItamin K LIVER: The liver measures 14.4 cm in length. The liver is echogenic consistent with a fatty infiltration. Multiple focal hepatic lesions are indeterminate on this ultrasound exam. Largest hypoechoic lesion in the right hepatic lobe measures 1.2 x 1.1 x 0.9cm. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.3 m/s.BILIARY TRACT: The gallbladder is nondistended. There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. The sonographic Murphy's sign is negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 4 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: The spleen is not well-visualized on this exam.RIGHT KIDNEY: Kidney measures 9.0 cm in length. Normal echotexture. No hydronephrosis. Shadowing catheter was present within the right kidney.LEFT KIDNEY: Kidney measures 9.0 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.

Output: 1. The liver is echogenic consistent with fatty infiltration.2. No nodularity to suggest cirrhosis.3. Multiple hypoechoic lesions within the liver which are indeterminate on this exam. Dedicated liver follow-up imaging is recommended.Findings discussed with Dr. Minic at time of dictation.


Instruction: Generate impression based on medical findings.

Input: 78 year old female with right upper quadrant pain. Evaluate for gallstones. LIVER: The liver measures 16.7 cm in length. The liver contour is smooth, the parenchyma is normal in echogenicity. No mass is identified.BILIARY TRACT: Small stones are seen within the gallbladder. There is no gall bladder wall thickening or pericholecystic fluid. There is persistent, mild intrahepatic biliary ductal dilatation. The common hepatic duct measures 0.3 cm in diameter, the common bile duct measures 1.1 in diameter. No convincing evidence of choledocholithiasis.PANCREAS: Limited evaluation of the pancreas reveals no significant abnormality.SPLEEN: The spleen measures 9.3 cm in length.KIDNEYS: The right kidney measures 9.1 centimeters in length. The left kidney measures 10.1 cm in length. Bilaterally there is no hydronephrosis or shadowing renal stone, the renal cortex is normal in echogenicity. OTHER: No significant abnormalities noted.

Output: Mild biliary dilatation, similar to prior. No stones are seen within the ducts. As was noted previously, this finding may be age-related rather than secondary to an obstructive process.


Instruction: Generate impression based on medical findings.

Input: 33-year-old female presents with right upper quadrant pain and vomiting. Evaluate for hepatobiliary pathology. LIVER:The liver measures 16.9 cm. The liver parenchyma has a normal echotexture. No focal mass intrahepatic biliary dilation. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder is contracted and the lumen is anechoic. There is no evidence of stone or sludge. The wall measures 2 mm. No pericholecystic fluid. The common bile duct measures 4 mm.PANCREAS: The head appears normal where as the body and tail are obscured by bowel gas.SPLEEN: The spleen measures 9.7 cm without sonographic abnormalities.KIDNEYS: The left kidney measures 10.8 cm. The cortex has normal echogenicity. No shadowing calculi, worrisome mass, or hydronephrosis. The right kidney measures 10.5 cm. The cortex has normal echogenicity. No shadowing calculi, worrisome mass, or hydronephrosis. OTHER: No significant abnormality noted.

Output: 1. Normal ultrasound of the abdomen without gallbladder pathology.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male presents with abdominal distention and generalized abdominal pain. LIVER:Measures 14.9 cm. Increased and coarse echogenicity of the liver parenchyma. Micronodular contour suggestive of early cirrhosis. No focal mass or intrahepatic biliary dilation. Mild ascites.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended with an anechoic lumen. Measures 0.2 cm. No pericholecystic fluid, stones, or sludge. Common duct measures 0.3 cm.PANCREAS: Evaluation is limited due to overlying bowel gas.SPLEEN: Measures 13.4 cm. Calcification in the parenchyma likely represents prior granulomatous disease.KIDNEYS: Right kidney measures 9.6 cm. Left kidney measures 11.0cm. Unremarkable echogenicity. No shadowing calculi, hydronephrosis, or focal mass. Partially imaged right-sided hydroureter. OTHER: Bilateral pleural effusions noted.

Output: 1. Increased and coarse echogenicity and micronodular contour of liver suggestive of chronic liver disease/parenchymal dysfunction and early cirrhosis. Mild ascites.2. Splenomegaly and prior granulomatous disease.3. Partially imaged right-sided hydroureter without hydronephrosis.4. Bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Hyperthyroidism RIGHT LOBE MEASUREMENTS: 6.4 x 2.5 x 1.9 cmLEFT LOBE MEASUREMENTS: 5.9 x 1.9 x 1.2 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: 4 x 1.8 x 2.4 cm predominant solid nodule within the right thyroid gland. Background thyroid parenchyma appears unremarkable.LEFT LOBE: 2.3 x 0.9 x 1.6 cm predominant solid left thyroid nodule. Subcentimeter solid upper pole nodule with renal calcification measuring 0.6 x 0.5 x 0.4 cm. Background thyroid parenchyma appears unremarkable.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Bilateral dominant predominantly solid thyroid nodules. These are amenable to ultrasound-guided percutaneous biopsy as clinically warranted. Background thyroid parenchyma appears unremarkable. No regional adenopathy.


Instruction: Generate impression based on medical findings.

Input: Follow-up bilateral hydronephrosis BLADDER  Wall Thickness: Normal  Contents: Distended and normal. Distal Ureter -- SFU Grade**  Right: 0  Left: 0   Ureteral Jets Right: Observed  Left: Not observedKIDNEYS  Cortical Echogenicity: Normal   Medullary Echogenicity: Normal   Pelvicaliceal System -- SFU Grade*  Right: 1  Left: 1  Length*** Right: 5 cm Left: 5 cm   Mean for age: 4.2 cm  Range for age: 3.8 - 5.8 cmADDITIONAL OBSERVATIONS: None

Output: Bilateral grade 1 pelvicaliceal dilation.*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: History of left inner thigh abscess status post drainage. Targeted grayscale and color Doppler ultrasound evaluation of the left inner thigh demonstrates a 2.2 x 1.0 cm subdermal locule of fluid and surrounding subcutaneous fat edema/induration. Internally there is echogenic material which is presumably iatrogenic gauze/drain.

Output: 2.2 x 1.0 cm inner thigh fluid collection with surrounding soft tissue changes suggestive of cellulitis and/or edema. Internally there is echogenic material which is presumably iatrogenic gauze/drain.


Instruction: Generate impression based on medical findings.

Input: Palpable axillary lesion. Recent normal mammography and MRI. A targeted right ultrasound was performed for the patient’s area of concern. A normal size and morphology lymph node is present at the patient's site of concern. There is no suspicious solid or cystic mass identified.

Output: Normal size and morphology lymph node in the right axillary region at the site of patient's concern.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: 37-year-old male with acute kidney failure. Evaluate for hydronephrosis. Abnormal liver function. LIVER:There is hepatomegaly with the liver measuring at least 20 cm in length. The hepatic parenchyma is echogenic which is nonspecific. No focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: Gallbladder is normal without cholelithiasis, wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: The head is normal. The body and tail are less well seen due to bowel gas.SPLEEN: Splenomegaly with the spleen measuring at least 15 cm in length.KIDNEYS: Right kidney measures 15.7 cm in length and is likely mildly echogenic consistent with parenchymal disease. No hydronephrosis, shadowing calculus or mass. Left kidney measures approximately 15.2 cm in length and is likely mildly echogenic consistent with parenchymal disease. No hydronephrosis, shadowing calculus or mass.ABDOMINAL AORTA: No significant abnormality noted.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No ascites.

Output: Hepatosplenomegaly with echogenic liver.No evidence for hydronephrosis. Kidneys may be mildly echogenic.


Instruction: Generate impression based on medical findings.

Input: Ms. Iannitelli is a 44 year old female with personal history of left lumpectomy in 2008 for invasive ductal carcinoma with nodal involvement, status post radiation and chemotherapy. She presents today for six-month follow-up of a probably benign finding in the right breast 9:00 position. On physical examination, no discrete mass is palpated at the area of interest in the right breast. A targeted right breast ultrasound was performed at the area of concern on the prior ultrasound and also at the patient's palpable concern from 6:00 to 11:00 location in the right breast. -Multiple simple cysts are noted in the outer right breast at the site of patient's palpable concern. The largest cyst measures up to 9 x 4 x 8 mm in the right breast at 10:00 location, 2 cm from the nipple. -Previously identified clustered cyst in the right breast 9:00 location, 2 cm from the nipple has slightly decreased in size and now measures 6 x 3 x 5 mm (previously measures 8 x 4 x 6 mm).

Output: Slightly decrease in size of clustered cyst in the right breast 9:00 location. No sonographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended in 6 months in order to confirm stability of these findings. All results and recommendations were discussed with the patient. BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate cholecystitis History: uptrending LFTs Exam is limited by inability to turn the patient.LIVER: Echogenic hepatic parenchyma, consistent with hepatic parenchymal dysfunction or steatosis.GALLBLADDER, BILIARY TRACT: The gallbladder is borderline distended. There is some evidence of edema around the gallbladder wall. There is a small volume of pericholecystic fluid. There is layering sludge within the dependent aspect of the gallbladder. An echogenic focus in the neck of the gallbladder with posterior acoustic shadowing may represent a stone, but the exam is limited due to the inability to turn the patient. The gallbladder wall measures 3 mm, normal-upper normal.. The common bile duct measures 0.5 cm, normal in size.PANCREAS: Obscured by bowel gas.OTHER: Moderate volume of ascites.

Output: Borderline gallbladder wall thickening, some evidence of gallbladder wall edema, and probable stone in the neck of the gallbladder. These constellation of findings may be seen in acute cholecystitis, however are nonspecific in the setting of ascites and limitations of this exam.


Instruction: Generate impression based on medical findings.

Input: 23-year-old female with abdominal wall mass. Patient relates mass occurred after C-section. In the region of palpable abnormality to the left of midline there is a defect in the peritoneum with protrusion of fat and possibly a small portion of bowel loop consistent with hernia.

Output: Anterior abdominal wall hernia.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female. Follow-up thyroid nodules. RIGHT LOBE MEASUREMENTS: 5.5 x 2.9 x 2 cmLEFT LOBE MEASUREMENTS: 5.7 x 3.2 x 1.8 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: In the inferior pole of the right lobe is a spongiform nodule measuring 0.6 x 1.2 x 1.2 cm without change.LEFT LOBE: In the left lobe, 2 nodules are identified. There is a spongiform nodule in the mid to lower pole of the left lobe measuring 0.6 x 0.9 x 1.1 cm without significant change. In the lower pole there is a small and mildly complex cystic nodule without changeISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable, bilateral thyroid nodules. The appearance is consistent with benign colloid nodules.


Instruction: Generate impression based on medical findings.

Input: Right upper quadrant pain for one month. LIVER: The liver is normal in morphology and size measuring 16 cm in craniocaudal dimension without a focal lesion or biliary ductal dilatation. It is mildly echogenic in echotexture. Normal hepatopedal portal venous blood flow 0.3 m/s.BILIARY TRACT: No biliary ductal dilatation with the common duct measuring 4 mm. Mildly distended gallbladder without wall thickening, pericholecystic fluid, gallstones or focal tenderness.PANCREAS: Evaluation of the pancreas is limited by overlying bowel gas.SPLEEN: The spleen is normal in size measuring 6.5 cm without a focal lesion.RIGHT KIDNEY: The right kidney is normal in size measuring 11.2 cm without hydronephrosis, shadowing nephrolithiasis or focal lesion. OTHER: The left kidney measures 9.2 cm the hydronephrosis, shadowing nephrolithiasis or focal lesion.

Output: No evidence of acute cholecystitis.Non-specific mildly echogenic liver parenchyma may represent fatty infiltration.


Instruction: Generate impression based on medical findings.

Input: 84-year-old female with history of intracystic capillary carcinoma on hormonal therapy. Annual follow-up surveillance. Limited mobility of the patient, ultrasound performed in sitting position.A targeted right ultrasound was performed for the patient’s area of concern. In the 9:00 radian 5 cm from the nipple there is redemonstration of a isoechoic mass. The previously present cystic components have resolved. The mass now measures 1.0 x 0.7 x 1.5 cm, (previously 3.2 x 3.6 x 3.8 cm). There is persistent mild internal vascularity.

Output: Interval decrease in size of right breast mass corresponding to the patient's biopsy-proven intracystic papillary carcinoma. The cystic components are most notably reduced.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: 74-year-old female with thyroid mass and neck adenopathy and prior CT. RIGHT LOBE MEASUREMENTS: 4.1 x 1.8 x 1.6 cmLEFT LOBE MEASUREMENTS: 1.8 x 1.8 x 5.1 cmISTHMUS MEASUREMENTS: 0.2-cmRIGHT LOBE: Heterogeneous in echotexture. Cystic nodule with comet tail artifact consistent with colloid measuring 0.5 x 0.5 x 0.5 cm. Very small, hypoechoic nodules present as well.LEFT LOBE: Heterogeneous in echo architecture. Spongiform appearing lower pole nodule measuring 0.8 x 0.7 x 1 cm likely with comet tail artifact consistent with colloid nodule. Posterior solid nodule with internal dense rim calcification measuring 1.4 x 1.3 x 2.3 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Abnormal lymph nodes identified in the left neck including a round cystic -- appearing level 3 node measuring 0.5 x 0.5 x 0.7 cm a round solid 0. 5 x 0.5 x 0.8 cm level 3 node and a predominantly cystic level floor/supraclavicular cystic node measuring 0.9 x 0.9 x 0.9 cm. OTHER: No significant abnormality noted.

Output: Solid left thyroid nodule with smaller nodules most suggestive of colloid nodules.Necrotic -- appearing left neck lymph nodes.US GUIDED FNA; 3/6/2015 12:46 PMCLINICAL INFORMATION AND PRE-OPERATIVE DIAGNOSIS: Thyroid mass, neck adenopathyPOST-OPERATIVE DIAGNOSIS : SameCOMPARISON: Same-day ultrasound, CT neck from 2/19/15OPERATORS: Doctors paushter; The attending physician, Dr. paushter, performed the procedure. TECHNIQUE: Following a discussion of the procedure with the patient, including its risks, benefits, alternatives and steps to prevent infection, an informed written consent was obtained and documented in the patient's chart. The time-out form was completed to confirm patient identity and side/type of procedure.Localizing US demonstrated large solid left thyroid mass and necrotic -- appearing left supraclavicular lymph node. The skin over the target area was cleansed with chlorhexidine. Transducer was sterilely sheathed. Local anesthesia was obtained using 1% lidocaine, superficially and at depth. Using aseptic technique, and continuous ultrasound guidance, the thyroid lesion was sampled using 25 gauge needles. Two fine needle aspirations were performed. The left supraclavicular lymph node was sampled using 25-gauge needles. Four fine needle aspirations were performed.Cytology was present to confirm specimen adequacy. Specimen was handed to cytology. The patient tolerated the procedure well without immediate complications. Routine post procedure instructions were communicated to the patient.COMPLICATIONS: NoneESTIMATED BLOOD LOSS: Less than 5 cc. An adhesive bandage was placed on the patient’s skin.


Instruction: Generate impression based on medical findings.

Input: 68 years old, Female, Reason: abnormal masses History: thyroid cancer MEASUREMENTS: Patient status post thyroidectomyRIGHT LOBE AREA: No significant abnormality noted. No evidence of local recurrence.LEFT LOBE AREA: No significant abnormality noted. No evidence of local recurrenceISTHMUS AREA: No significant abnormality noted. No evidence of local recurrencePARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing right level 2 lymph node with a fatty hilum is identified measuring 1.5 x 0.4 x 0.8 cm. benign appearing left level 2 lymph node with a fatty hilum is identified measuring 1.7 x 0.3 x 1.0 cm.OTHER: No significant abnormality noted.

Output: No evidence of local recurrence in the thyroidectomy bed or lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Hyperparathyroidism RIGHT LOBE MEASUREMENTS: 4.2 x 1.4 x 1.8 cmLEFT LOBE MEASUREMENTS: 4.8 x 1.6 x 1.7 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Upper pole spongiform nodule measuring 1 x 0.7 x 0.9 cmLEFT LOBE: Multiple spongiform nodules. A representative mid pole nodule measures 1 x 0.8 x 0.9 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: 1.7 x 1.2 x 0.9 cm hypoechoic extrathyroidal focus projecting posterior and inferior to the right thyroid gland. This hypoechoic focus demonstrates what appears to be a fatty hilum.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Bilateral spongiform thyroid nodules; favor benign etiology. Hypoechoic extrathyroidal focus projecting posterior and inferior to the right thyroid gland. While this lesion's morphology favors a lymph node, a parathyroid adenoma cannot be excluded. Would recommend correlation with radionuclide study. No regional adenopathy.


Instruction: Generate impression based on medical findings.

Input: Congestive heart failure with suspected thyrotoxicosis RIGHT LOBE MEASUREMENTS: 2.1 x 5.3 x 2 cm.LEFT LOBE MEASUREMENTS: 2.2 x 5 x 2.9 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Diffusely heterogeneous gland without increased vascularity. 0.6 cm hypoechoic mid gland nodule.LEFT LOBE: Diffusely heterogeneous gland without increased vascularity. Benign subcentimeter colloid nodules. The largest measures 0.7 x 0.4 cm.ISTHMUS: Diffusely heterogeneous gland without increased vascularity.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Diffusely heterogeneous gland without increased vascularity raises the possibility of chronic thyroiditis. Bilateral subcentimeter nodules. No regional adenopathy.


Instruction: Generate impression based on medical findings.

Input: Papillary thyroid carcinoma status post resection with enlarged bilateral level 5 lymph nodes. RIGHT LOBE: Status post thyroidectomy without massLEFT LOBE: Status post thyroidectomy without massISTHMUS: Status post thyroidectomy without massPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Slight interval decrease in size of enlarged bilateral level 5 lymph nodes. The largest on the right now measures 1.9 x 1.3 x 0.6 cm; this is in comparison to 2.5 x 1.6 x 1 cm on 9/30/2015. The enlarged left level 5 lymph node has remained stable measuring 1.5 x 1.2 x 0.6 cm.No new adenopathy.OTHER: No significant abnormality noted.

Output: Stable to slightly decreased in size of enlarged bilateral level 5 lymph nodes; favor benign reactive adenopathy. No new adenopathy or worrisome mass lesion appreciated.


Instruction: Generate impression based on medical findings.

Input: 62-year-old female with history of nephrolithiasis, status post bilateral ureteral stent removal. Evaluate for hydronephrosis. RIGHT KIDNEY: Measures 10.4 cm in length. Extensive nephrolithiasis without hydronephrosis.LEFT KIDNEY: Measures 9.7 cm in length. Extensive nephrolithiasis without hydronephrosis.URINARY BLADDER: Incompletely distended without focal abnormality. OTHER: No significant abnormalities noted.

Output: Nephrolithiasis without hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 27-year-old male with elevated liver function tests. LIVER: Measures 14.5 in length. Increased hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: Collapsed gallbladder with known cholelithiasis, but not clearly demonstrated on this study. No biliary ductal dilation. PANCREAS: The pancreas is incompletely imaged due to bowel gas. The imaged portions of the pancreas appear unremarkable. SPLEEN: Unremarkable in size and echogenicity. KIDNEY: No hydronephrosis, nephrolithiasis, or solid mass. OTHER: Mild-to-moderate pericardial effusion.

Output: 1.Increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease.2.Mild to moderate pericardial effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 87 years old. BPH. Evaluate for hydronephrosis. RIGHT KIDNEY: The right kidney measures 9.7 cm in length, with cortical thinning. A lower pole simple cyst measures 1.1 x 1.1 x 1.4 cm, unchanged. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 9.2 cm in length with cortical thinning. A lower pole simple cyst measures 1.2 x 0.8 x 0.9 cm. No shadowing stones or hydronephrosis.OTHER: The bladder is distended and the prostate is enlarged. Soft tissue projection into the posterior wall of the bladder likely represents the median lobe of the prostate.

Output: Enlarged prostate. No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old. Bladder cancer with recent ureteral stent placement for hydronephrosis. Recurrent AKI Suboptimal exam secondary to overlying bowel gas and portable technique.RIGHT KIDNEY: Right kidney measures 11.9 cm. Increased renal cortical echogenicity. No hydronephrosis. No perinephric free fluid. Unable to delineate stent in kidney.LEFT KIDNEY: Left kidney measures approximately 12.3 cm. Increased renal cortical echogenicity. No hydronephrosis. No perinephric free fluid. Unable to delineate stent in kidney.OTHER: Portions of ureteral stents seen in collapsed bladder, evaluation for bladder wall thickening suboptimal.

Output: No hydronephrosis. Increased renal cortical echogenicity. Portions of ureteral stents seen in collapsed bladder.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: 66 years old, Male, Reason: Periumbilical abd pain History: Please check GB, liver, pancreas LIVER: The liver is mildly enlarged measuring 20 cm in length. Increased parenchymal echogenicity is is suggestive of fatty infiltration. Focal hypoechoic hepatic lesion may represent focal fatty sparing although is indeterminate on this ultrasound examination. Further characterization with MRI is recommended. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.2 m/s.BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. The sonographic Murphy's sign is negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The CBD is mildly enlarged measuring 10 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 9.7 cm in length. RIGHT KIDNEY: Kidney measures 9.1 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 10.2 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.

Output: 1.Focal hypoechoic lesion may represent focal fatty sparing although is indeterminate on this ultrasound examination. Dedicated MRI is recommended for further characterization of this lesion.2.Fatty infiltration of the liver.3.No evidence of cholelithiasis or cholecystitis.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with history of ethanol and heroine use, hepatitis C antibody positive. Assess for cirrhosis. LIVER: Measures 14.4 in length. Unremarkable hepatic morphology and echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: Gallbladder sludge but no evidence of cholelithiasis. No gallbladder wall thickening, pericholecystic fluid, or biliary ductal dilation. PANCREAS: The pancreas is incompletely imaged due to bowel gas. The imaged portions of the pancreas appear unremarkable. SPLEEN: Unremarkable in size and echogenicity. KIDNEY: No hydronephrosis, nephrolithiasis, or solid mass. Increased renal echogenicity. Subcentimeter renal cysts.OTHER: The bladder is collapsed with a Foley catheter in place.

Output: 1. No evidence of hepatic cirrhosis or focal lesion. 2. Increased renal echogenicity consistent with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: 74-year-old female with worsening renal function. RIGHT KIDNEY: Measures 8.9 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. LEFT KIDNEY: Measures 8.1 cm in length. Increased echogenicity without hydronephrosis or nephrolithiasis. 0.7 cm hypoechoic structure in the left mid kidney without definite through transmission. URINARY BLADDER: Incompletely distended without focal abnormality. OTHER: No significant abnormalities noted.

Output: 1. Increased renal echogenicity consistent with medical renal disease. No hydronephrosis or nephrolithiasis. 2. 7 mm hypoechoic structure in the left mid kidney is incompletely characterized. Recommend follow up examination in one year to confirm stability.


Instruction: Generate impression based on medical findings.

Input: Male; 59 years old. Reason: GB or liver or biliary tract abn History: ruq pain LIVER: The liver measures 13 cm in length. Cirrhotic liver morphology with nodular contour and coarsened echotexture. No worrisome hepatic lesions are identified.The main portal vein is patent with hepatic pedal flow and a peak velocity of 0.15 m/sec.There is mild ascites.BILIARY TRACT: The gallbladder is nondistended. The gallbladder wall measures 3 mm in thickness, normal. There is no cholecystic fluid. The patient was not tender when scanning over the gallbladder. The common duct measures 3 mm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The pancreas is not well visualized to overlying bowel gas.SPLEEN: The spleen measures 12 cm in length.RIGHT KIDNEY: The right kidney measures 9.5 cm in length. The renal cortex is normal in echogenicity. There is no hydronephrosis or shadowing stone. No worrisome mass is identified. OTHER: The left kidney measures 9.8 cm in length. The renal cortex is normal in echogenicity. There is no hydronephrosis or shadowing stone. No worrisome mass is identified.

Output: 1.No cholelithiasis, biliary dilatation, or evidence of acute cholecystitis.2.Cirrhotic liver morphology with mild ascites.


Instruction: Generate impression based on medical findings.

Input: Asymptomatic female with dense breasts presents for whole breast ultrasound for dense breast screening. 3-D whole breast ultrasound was performed for both breasts and images were reviewed on an independent workstation. There is new no solid or cystic mass identified. Known right breast fibroadenoma is present. However, due to a technical error, a single column of images located just lateral to the left nipple was not saved. Therefore the patient will need to return for repeat ultrasound. Exam was double read by two attending breast radiologists.

Output: Technical repeat is needed due to missing automated images of the left breast. The patient has been informed of this and is coming in today for the additional images.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: R - Technical Repeat Views.


Instruction: Generate impression based on medical findings.

Input: 25-year-old female for follow-up exam. Evaluate for stability of thyroid gland and resolution of cervical lymphadenopathy. RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 1.6 x 1.1 x 4.4 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 1.6 x 1 x 4.8 cm.ISTHMUS MEASUREMENTS: The thyroid isthmus measures 0.3 cm in thickness.RIGHT LOBE: Mildly heterogenous echotexture. No discrete nodules.LEFT LOBE: Mildly heterogenous echotexture. No discrete nodules.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No suspicious cervical lymphadenopathy.OTHER: No significant abnormality noted.

Output: 1. Mildly heterogenous thyroid gland without evidence of discrete nodules.2. No cervical lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Reason: Rule out adenopathy History: History of thyroid cancer RIGHT LOBE: Status post thyroidectomy without new suspicious nodules in the thyroidectomy bed.LEFT LOBE: Status post thyroidectomy without new suspicious nodules in the thyroidectomy bed.ISTHMUS: Status post thyroidectomy without new suspicious nodules in the thyroidectomy bed.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Multiple prominent to mildly enlarged benign appearing cervical lymph nodes bilaterally:Right level 2 cervical lymph node measures 1.6 x 0.9 x 0.3 cm, previously 1.9 x 0.7 x 0.3 cm.Left level 2 cervical lymph node measures 1.7 x 1.0 x 0.3 cm, previously 1.6 x 0.8 x 0.3 cm.Left level 4 cervical lymph node has an atypical appearance with a prominent echogenic hilum measures 0.6 x 0.7 x 0.7 cm, not measured previously.OTHER: No significant abnormality noted.

Output: 1. Left level 4 cervical lymph node with an atypical appearance should at least be followed by repeat ultrasound in 6 months if not biopsied.2. Status post thyroidectomy without evidence of recurrence in the thyroidectomy bed.These findings were communicated to ordering physician Dr. Ronald Cohen at 1:41 PM on 2/24/16


Instruction: Generate impression based on medical findings.

Input: Multinodular goiter RIGHT LOBE MEASUREMENTS: 6.9 x 3.7 x 3.3 cmLEFT LOBE MEASUREMENTS: 5.8 x 1.4 x 2 cmISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: Interval increase in size of large spongiform nodule occupying much of the lower aspect of the right thyroid gland measuring 4.4 x 3 x 5.1 cm; this is in comparison to 2.2 x 2.7 x 1.5 cm in 2013.LEFT LOBE: No significant change in multiple benign-appearing left thyroid nodules the largest measuring 2.1 x 1 x 1.8 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval increase in size of right spongiform nodule. Left thyroid nodule stable. No regional adenopathy.


Instruction: Generate impression based on medical findings.

Input: Female 61 years old; Reason: eval for signs of cirrhosis, portal HTN History: chronic hep c LIVER: The liver measures 15.6 cm in length. There is coarse increased echogenicity of the liver parenchyma. No focal hepatic lesions. No intrahepatic ductal dilation is seen. The main portal vein is patent with normal hepatopetal flow measured at 18.6 cm/s. No ascites is seen.GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 1.8 mm. No stones are seen. No pericholecystic fluid. The common bile duct measures 2.8 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 9.7 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 9.4 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 9.2 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.

Output: The liver has coarse increased echogenicity compatible with fatty infiltration/hepatocellular dysfunction. No new worrisome masses or ascites are seen.


Instruction: Generate impression based on medical findings.

Input: Hepatitis C LIVER: Stable cirrhotic morphology without worrisome mass. Liver length 15.3 cmGALLBLADDER, BILIARY TRACT: No ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Stable angiomyolipomas. No worrisome mass, stone, or hydronephrosis. Right kidney 10.8 cm in lengthOTHER: Left kidney 10.4 cm in length. Stable left angiomyolipomas. Spleen 12.1 cm in length. No ascites.

Output: Stable cirrhotic morphology without mass or ductal dilatation. No ascites. Stable bilateral renal angiomyolipomas.


Instruction: Generate impression based on medical findings.

Input: Follicular and papillary thyroid carcinoma status post resection. Outside ultrasound suggests worrisome lesion right thyroid bed RIGHT LOBE: Status post thyroidectomy. Vague hyperechoic region and right thyroid bed without increased vascularity unchanged from 11/1/2013.LEFT LOBE: Status post thyroidectomy. Subcentimeter hypoechoic foci within the left thyroid bed. The largest measures 0.8 x 0.3 x 0.7 cm. Given differences in transducer acquisition parameters, it is unclear whether not these foci have significantly changed from the prior studies.ISTHMUS: Status post thyroidectomyPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No regional adenopathy.OTHER: No significant abnormality noted.

Output: Status post thyroidectomy. Echogenic focus within the right thyroid bed unchanged from 2013; favor benign etiology such as scar. Accordingly, no biopsy was performed.Subcentimeter hypoechoic foci within left thyroid bed. Given differences in transducer acquisition parameters, it is unclear whether not these foci have significantly changed from prior studies. While these may represent benign residual thyroid tissue, would recommend follow-up scan in 4 months to document temporal stability.


Instruction: Generate impression based on medical findings.

Input: 52 year old male patient with new onset of renal failure. Pre-renal picture of FE urea concerning for renal artery stenosis or hypovolemia. Evaluate for hydronephrosis, echogenicity, and/or renal artery stenosis. ULTRASOUND KIDNEYSRIGHT KIDNEY: The right kidney measures 10.3 cm in length. Renal cortical echogenicity is within normal limits. No evidence of hydronephrosis.LEFT KIDNEY: The left kidney measures 10.4 cm in length. Renal cortical echogenicity is within normal limits. No evidence of hydronephrosis. Two subcentimeter hyperechoic foci within the left upper pole are noted.OTHER: The bladder is decompressed.

Output: 1. No evidence of hydronephrosis and patent bilateral renal arteries.2. Two subcentimeter hyperechoic foci within the left upper pole; follow up ultrasound is recommended in 6 months to confirm stability.


Instruction: Generate impression based on medical findings.

Input: Reason: nodule on CT History: none RIGHT LOBE MEASUREMENTS: 5.9 x 1.7 x 1.7 cm.LEFT LOBE MEASUREMENTS: 4.9 x 1.9 x 1.5 cm.ISTHMUS MEASUREMENTS: 0.6 cm.RIGHT LOBE: In the inferior pole, there is a predominantly solid well-defined ovoid nodule measuring 0.9 x 0.5 x 0.9 cm, likely benign.LEFT LOBE: In the left lobe, there is a spongiform ovoid nodule measuring 1.2 x 0.8 x 1.0 cm.ISTHMUS: In the isthmus, there is a spongiform ovoid nodule measuring 1.2 x 0.8 x 1.0 cm, likely benign.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.OTHER: No significant abnormality noted.

Output: Three likely benign thyroid nodules.


Instruction: Generate impression based on medical findings.

Input: HBV/HIV. Evaluate for HCC. LIVER: 14 cm in length. Mildly heterogeneous hepatic echotexture. Non-cirrhotic liver morphology. No focal hepatic lesions. Patent portal vein with hepatopetal flow. BILIARY TRACT: No intrahepatic or extrahepatic biliary ductal dilation. Normal sonographic appearance of the gallbladder.PANCREAS: The pancreas is obscured by overlying bowel gas. SPLEEN: 7.4 cm in length. No significant abnormalities noted.RIGHT KIDNEY: 8.6 cm in length. A subcentimeter simple cyst is noted in the superior pole. No significant abnormalities noted. LEFT KIDNEY: 9.1 cm in length. A subcentimeter simple cyst is noted in the superior pole. No significant abnormalities noted. OTHER: No significant abnormalities noted. No ascites visualized.

Output: Mildly heterogeneous hepatic echotexture reflecting hepatic dysfunction, without sonographic evidence of cirrhosis or hepatocellular carcinoma.


Instruction: Generate impression based on medical findings.

Input: Reason: enlarged thyroid RIGHT LOBE MEASUREMENTS: 5.4 x 1.8 x 1.4 cmLEFT LOBE MEASUREMENTS: 5.1 x 1.8 x 1.4 cmISTHMUS MEASUREMENTS: 0.18 cmRIGHT LOBE: Two abutting hypoechoic nodules in the right superior thyroid lobe measure in total 1.4 x 0.8 x 1.0 cm. Hypoechoic, spongiform nodule in the inferior right thyroid lobe measures 0.9 x 0.4 x 0.4 cm. There is no internal vascularity.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Two nodules in the right thyroid lobe. The more inferior nodule is of very low suspicion and the more superior nodule is benign appearing.


Instruction: Generate impression based on medical findings.

Input: Renal insufficiency. Transplant kidney. Ultrasound guidance provided for two percutaneous biopsies of the right iliac fossa renal transplant. No postbiopsy hematoma is evident.

Output: Ultrasound guidance for percutaneous transplant renal biopsy.


Instruction: Generate impression based on medical findings.

Input: 46-year-old female patient with HCV carrier on Gleevec with LAM for suppressive therapy. Evaluate for HCC. LIVER: The liver measures 14.5 cm in length. Hepatic parenchymal echogenicity is increased. There is a 1.7 x 1.6 x 1.5 cm left hepatic cyst, previously 2.0 x 1.8 x 1.5 cm. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: There are no gallstones, gallbladder wall thickening, or pericholecystic fluid. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 2 mm in diameter.PANCREAS: The head and body of the pancreas demonstrate normal echogenicity. The tail is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 10.6 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 11.1 cm in length. No evidence of hydronephrosis.The spleen measures 8.9 cm in length.

Output: Increase hepatic parenchymal echogenicity which can be seen with hepatic steatosis/hepatic parenchymal dysfunction. No suspicious hepatic lesion identified.


Instruction: Generate impression based on medical findings.

Input: Renal stones RIGHT KIDNEY: Unremarkable echogenicity without worrisome mass or hydronephrosis. Multiple subcentimeter nonobstructing echogenic foci again noted. Right kidney 11.4 cm in lengthLEFT KIDNEY: Unremarkable echogenicity without worrisome mass or hydronephrosis. Multiple subcentimeter nonobstructing echogenic foci again noted. Left kidney 12.2 cm in lengthOTHER: Bladder nondistended

Output: Multiple subcentimeter nonobstructing stones bilaterally again noted. No worrisome mass or obstruction.


Instruction: Generate impression based on medical findings.

Input: Male 23 years old Reason: mother with polycystic kidney disease, pt admitted for HTN urgency with elevated Cr eval for renal disease/cysts History: HTN, proteinuria RIGHT KIDNEY: 10.5 cm in length. Diffusely echogenic consistent with chronic medical renal disease. No evidence of hydronephrosis.LEFT KIDNEY: 11.1 cm in length. Echogenic. No hydronephrosis or hydroureter. Echogenic focal area abutting left upper pole of uncertain etiology. Uncertain if this is exophytic off the kidney or accessory spleen. CT may be obtained for the evaluation.Urinary bladder: No significant abnormality.

Output: Echogenic kidneys consistent with chronic medical renal disease. No hydronephrosis. Echogenic focus in or adjacent to left upper pole may be evaluated further with CT.


Instruction: Generate impression based on medical findings.

Input: Palpable right axillary lymph node and palpable left breast mass. The patient had left breast ultrasound-guided core biopsy several months ago which was benign and concordant. She feels the area in her left breast is somewhat increased since biopsy. A targeted bilateral ultrasound was performed for the patient’s areas of concern. In the right axillary region, including at the site of patient concern, several normal morphology axillary lymph nodes are seen. The finding at the site of concern is equivocal for a lymph node, but in any case benign. It measures 6 x 5 mm. In the left breast 9:00 position, a hypoechoic mass with adjacent biopsy clip is noted. The mass measures 8 x 6 mm. As a hydromark clip was placed and is close to the skin surface, it is possible that the biopsy clip is also palpable.

Output: 1. Normal right axillary lymph nodes.2. Biopsy proven benign area in the left breast 9:00 position with adjacent biopsy clip. Given that the clip is close to the skin surface, it too may be palpable.The patient will follow-up with Dr. Jaskowiak today.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: 36-year-old female with a multinodular thyroid. Evaluate nodules. RIGHT LOBE MEASUREMENTS: 5.3 x 1.6 x 1.8 cm.LEFT LOBE MEASUREMENTS: 4.5 x 1.8 x 1.8 cm.ISTHMUS MEASUREMENTS: 0.2 cm.RIGHT LOBE: The right parenchyma is heterogeneous and nodular. There are multiple hypoechoic areas throughout the thyroid. There are associated somewhat linear areas of increased echogenicity which may be seen in thyroiditis. No focal mass. The right thyroid appears less vascular in comparison to the prior study.LEFT LOBE: Left parenchyma is heterogenous and nodular. There are multiple hypoechoic areas throughout the thyroid. There are associated somewhat linear areas of increased echogenicity which may be seen in thyroiditis. No focal mass. The left thyroid appears less vascular in comparison to the prior study.ISTHMUS: The parenchyma of the isthmus is heterogenous and nodular. There are multiple hypoechoic areas throughout the isthmus. No focal mass. The isthmus appears less vascular comparison to prior study.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Parenchyma heterogenous and nodular without focal mass. The appearance is suggestive of thyroiditis. Interval decrease in vascularity in comparison to the prior study dated May 2016.Due to the lack of focal mass, biopsy was not performed. This was discussed with Dr. Peter Angelos.


Instruction: Generate impression based on medical findings.

Input: LIVER: The liver measures 7.2 cm in length, and grossly normal in appearance.The main portal vein is patent, with flow velocity of 23 cm/s.BILIARY TRACT: Mobile sludge is seen within the gallbladder. No biliary dilatation or gallbladder wall thickening.PANCREAS: No significant abnormalities noted.SPLEEN: The spleen is normal in appearance, and measures 5 cm.RIGHT KIDNEY: The right kidney measures 6.2 cm, and demonstrates grade 4 pelvocaliectasis.OTHER: The left kidney measures 5.5 cm, and is grossly normal in appearance.

Output: 1. Gallbladder sludge, without additional significant abnormality of the liver or biliary system.2. Right kidney Grade 4 pelvicaliectasis.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female post resection of mediastinal thyroid and left lobe, with papillary thyroid microcarcinoma. RIGHT LOBE MEASUREMENTS: 4.6 x 1.7 x 1.7 cm. No change in 5 mm cyst.LEFT LOBE MEASUREMENTS: Post thyroidectomy. ISTHMUS MEASUREMENTS: Not measurable on today's examRIGHT LOBE: No change in 5 mm cyst.LEFT LOBE: No massesISTHMUS: Not visible on today's study.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There is again noted an enlarged subclavicular lymph node on the left measuring 1 x 1.4 by 2 cm, not significantly changed.OTHER: No significant abnormality noted.

Output: Stable examination with resolution of thickened isthmus. Stable left subclavicular lymph node.


Instruction: Generate impression based on medical findings.

Input: Female 33 years old . Query anterior abdominal wall hernia? Focused ultrasound performed over the site of patient's clinical concern superior to the umbilical area. An approximately a 1.3-cm defect in the ventral abdominal wall musculature was identified with herniated abdominal content which reduced during the examination.

Output: Reducible ventral wall hernia.


Instruction: Generate impression based on medical findings.

Input: 45 years old, Female, Reason: PBC evaluate for HCC History: PBC LIVER: The liver measures 19.0 cm in length. The liver parenchymal echotexture is normal. No focal hepatic lesion identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.3 m/s.BILIARY TRACT: Small gallbladder polyp is unchanged in size measuring 0.3 cm. There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. The sonographic Murphy's sign is negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures two mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 10.1 cm in length. RIGHT KIDNEY: Kidney measures 10.1 cm in length. No hydronephrosis.LEFT KIDNEY: Kidney measures 10.6 cm in length. No evidence of hydronephrosis. There is a cyst in the left kidney measuring 1.7 x 1.7 x 2.4 cm. There is nonspecific peripheral echogenicity of this cyst which may be related to septation.

Output: 1.Unchanged small gallbladder polyp with no evidence of cholelithiasis or acute cholecystitis.2.The liver parenchymal echotexture is normal. No focal hepatic lesion identified. 3.Unchanged left renal cyst.


Instruction: Generate impression based on medical findings.

Input: 71-year-old female with a history of left mastectomy 20 years ago and biopsy proven right breast cancer presents from surgery clinic with possible right axillary lymph node. A targeted right axillary ultrasound was performed for the palpable area of concern. There is an elongated lymph node in the right axilla measuring 4.1 x 1.2 x 2.8 cm within the eccentrically thickened cortex measuring 8 mm in thickness with eccentric vascularity. A second lymph node with benign morphology was also seen measuring 1.4 x 0.9 x 1.4 cm.

Output: Right axillary lymph node with eccentrically thickened cortex. Ultrasound guided biopsy can be performed if desired.Please submit prior mammograms and ultrasound for comparison.BIRADS: 6 - Known cancer.RECOMMENDATION: B - Surgical Consultation.


Instruction: Generate impression based on medical findings.

Input: 52-year-old male with history of liver transplant and right flank pain. Evaluate for capsular hematoma. LIVER: Perihepatic bland fluid is seen, may represent ascites although this is nonspecific. There is no internal vascularity or mixed echogenicity of the fluid.BILIARY TRACT: No significant abnormalities noted.OTHER: Skin thickening is noted over the incision site, correlate with physical exam to exclude cellulitis.

Output: Bland perihepatic fluid is noted, may represent ascites. No hepatic capsular hematoma is seen.


Instruction: Generate impression based on medical findings.

Input: Right upper quadrant pain with stones on bedside ultrasound and positive Murphy's sign. LIVER: The liver is coarse and echogenic. It measures 21 cm in craniocaudal dimension without a focal suspicious lesion or intrahepatic biliary ductal dilatation. Normal hepatopedal portal venous blood flow at 0.4 m/s.Cholelithiasis with gallstone at the gallbladder neck which did not appear to be mobile. The gallbladder wall is mildly thickened measuring up to 4 mm with pericholecystic fluid. The patient was tender over the gallbladder fossa.BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common duct measuring 6 mm.PANCREAS: The pancreas is mostly obscured by overlying bowel gas.SPLEEN: The spleen is normal in morphology and size measures 11 cm without a focal lesion.RIGHT KIDNEY: The right kidney is normal in size and morphology measuring 11.7 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. OTHER: The left kidney is normal in morphology and size measuring 10.3 cm without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow.

Output: 1. Findings compatible with acute cholecystitis with cholelithiasis, gallbladder wall thickening, pericholecystic fluid and focal tenderness.2. The common bile duct measures up to 6 mm without choledocholithiasis.3. Hepatic steatosis.


Instruction: Generate impression based on medical findings.

Input: Fever pain and elevated creatinine; renal transplant Right iliac fossa renal transplant demonstrates unremarkable parenchymal echogenicity without perinephric collection. No worrisome mass, stone, or hydronephrosis. 13.3 cm in length.Bladder nondistended

Output: Unremarkable right iliac fossa renal transplant without perinephric collection, mass, stone, or hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Elevated LFTs. LIVER: Non-cirrhotic liver morphology. Normal parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Mild gallbladder wall thickening, which is nonspecific in the setting of ascites. Biliary sludge noted. No cholelithiasis or sonographic Murphy's sign.PANCREAS: No sonographic abnormality evident in the visualized pancreatic head and neck. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney is 10.6 cm in length. The left kidney is 11.0 cm in length. The renal parenchymal echogenicity is elevated bilaterally. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 8.1 cm in length, without focal lesions evident.OTHER: Mild to moderate amount ascites.

Output: 1. No cholelithiasis or biliary ductal dilation, per clinical query2. Mild to moderate amount of ascites.3. Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: Reason: history of total thyroidectomy T3N1b thyroid cancer, now with recurrent disease. 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. Within the inferior thyroidectomy bed, there is an irregular shaped hypoechoic region measuring approximately 2.0 x 2.1 x 1.0 cm which is thought to correspond with the area of increased metabolic activity on recent outside PET scan.ISTHMUS: Status post thyroidectomy.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Right level IV 1.1 x 0.4 x 0.9 cm and left level V 1.0 x 0.3 x 0.7 cm lymph nodes, favor benign morphology.OTHER: No significant abnormality noted.

Output: Irregular soft tissue mass within left inferior thyroidectomy bed which appears to correspond to hypermetabolic activity on outside PET, suspicious for recurrent or residual disease and was subsequently biopsied.


Instruction: Generate impression based on medical findings.

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

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


Instruction: Generate impression based on medical findings.

Input: 32 year-old female with history of hyperparathyroidism. RIGHT LOBE MEASUREMENTS: 5.6 x 2.5 x 1.5 cmLEFT LOBE MEASUREMENTS: 4.9 x 1.8 x 1.5 cmISTHMUS MEASUREMENTS: 0.4 cm in thickness. RIGHT LOBE: Mildly heterogenous echotexture without nodules. LEFT LOBE: Mildly heterogenous echotexture without nodules. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Multiple hypoechoic, oval shaped lesions are present compatible with parathyroid adenomas.The first is posterior to the midpole of the right thyroid gland and measures 1.4 x 1.2 x 0.7 cm. The medial edge of this lesion is approximately 2 mm from the trachea.The second is posterior to the inferior pole of the right thyroid gland and measures 1.5 x 0.4 x 0.6 cm. The medial edge of this lesion is approximately 2 mm from the trachea and the inferior edge is approximately 4 mm cephalad to the inferior tip of the thyroid.The third is posterior to the inferior one third of left lobe of the thyroid gland and measures 1.8 x 0.7 x 0.8 cm. The inferior tip of the lesion extends to the inferior tip of the thyroid gland. LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple lesions compatible with parathyroid adenomas as described above.


Instruction: Generate impression based on medical findings.

Input: Hepatitis C LIVER: Mildly coarse liver echotexture noted without mass. Liver length 15.1 cmBILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 9 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 10.8 cm in lengthOTHER: Left kidney 11 cm in length. No ascites

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


Instruction: Generate impression based on medical findings.

Input: Right upper quadrant pain and mild transaminitis. LIVER: The liver measures 16.3 cm in length. The liver is smooth in contour with normal echogenicity. No focal lesions are seen. The portal vein flow is normal in direction and velocity. GALLBLADDER, BILIARY TRACT: There is a 3 mm echogenic focus along the gallbladder wall, which may represent a small polyp or adherent gallstone. No evidence of cholecystitis. No biliary ductal dilation. PANCREAS: No significant abnormalities noted in the visualized pancreatic head and body. The pancreatic tail are obscured by bowel gas.RIGHT KIDNEY: 12.3 cm in length and normal in appearance. OTHER: No significant abnormalities noted.

Output: 1. No specific hepatic abnormality evident.2. 3 mm gallbladder polyp versus adherent stone, without cholecystitis or biliary ductal dilation.


Instruction: Generate impression based on medical findings.

Input: Elevated LFTs. LIVER: The liver is mildly coarse and increased in echogenicity. No focal liver lesion or biliary ductal dilatation. Normal hepatopedal portal venous blood flow of 0.2 mm/s.BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common duct measuring 4 mm. Normally distended gallbladder. The wall thickness is normal measuring 2 mm. No pericholecystic fluid or focal tenderness. Note is made of gallbladder sludge.PANCREAS: The visualized portion of the pancreatic head is unremarkable. Otherwise the pancreas is obscured by overlying bowel gas.SPLEEN: The spleen measures 7 cm in length.RIGHT KIDNEY: The right kidney measures 10.9 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow. OTHER: The left kidney measures 11.2 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow.

Output: 1. Gallbladder sludge without evidence of acute gallbladder inflammation.2. Coarse and mildly echogenic liver parenchyma suggestive of parenchymal dysfunction, including fatty infiltration.


Instruction: Generate impression based on medical findings.

Input: Enlarged thyroid with choking symptoms at night RIGHT LOBE MEASUREMENTS: 2.4 x 1.9 x 6.5 cmLEFT LOBE MEASUREMENTS: 2.4 x 2.4 x 6.5 cmISTHMUS MEASUREMENTS: 0.7 cmRIGHT LOBE: Diffusely heterogeneous gland without mass or increased vascularity.LEFT LOBE: Diffusely heterogenous gland without mass or increased vascularityISTHMUS: Diffusely heterogeneous gland without mass or increased vascularityPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Diffusely heterogeneous gland without mass or increased vascularity. No regional adenopathy.


Instruction: Generate impression based on medical findings.

Input: Patient presents for 6 month follow-up right breast ultrasound to evaluate high probability benign clustered cyst at the 6 o'clock position A targeted right ultrasound was performed for the mammographic area of concern. Clustered cyst identified in the right breast 6:00 position measuring 10 x 5 x 9 mm, previously measured 8 x 4 x 8 mm mostly unchanged from prior study.

Output: Stable clustered cyst right breast 6:00 position. As long as patient's physical examination remains unchanged, bilateral diagnostic mammogram is recommended in 6 months to assess stability.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: 34-year-old female with history of thyroid cancer status post thyroidectomy. Evaluate for recurrence. RIGHT LOBE MEASUREMENTS: Surgically absentLEFT LOBE MEASUREMENTS: Surgically absentISTHMUS MEASUREMENTS: Surgically absentRIGHT LOBE: 0.4 cm hypoechoic focus in the right thyroid bed is unchanged compared to prior studies. No new lesions identified.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Scattered cervical lymph nodes without significant change compared with prior studies. No new lymphadenopathy.OTHER: No significant abnormality noted.

Output: Stable appearance of subcentimeter hypoechoic focus in the right thyroid bed and cervical lymph nodes. No specific evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Elevated LFTs LIVER: No significant abnormalities noted. Liver length 15.1 cmGALLBLADDER, BILIARY TRACT: Status post cholecystectomy. No ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.8 cm in lengthOTHER: Left kidney 10.2 cm in length. Spleen 11.6 cm in length. No ascites.

Output: Negative right upper quadrant ultrasound. Specifically, no evidence for hepatobiliary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: right abdominal pain and firmness; evaluate for hepatic congestion, biliary dilation, and/or RLQ mass LIVER: Echogenic liver parenchyma with coarse echotexture, consistent with hepatic steatosis, parenchymal dysfunction, or chronic liver disease. The liver measures 19.4 cm in length. The portal vein is patent with normal directional hepatopedal portal venous blood flow and peak velocity of 19.9 cm/s. No focal masses.GALLBLADDER, BILIARY TRACT: Several echogenic stones are noted in the dependent portion of the gallbladder body/fundus without evidence of inflammation or cholecystitis. Negative sonographic Murphy's sign. No biliary ductal dilatation. The proximal common bile duct measures 0.4 cm. The gallbladder wall measures 0.2 cm.PANCREAS: Obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 11.6 cm in length. Normal renal parenchymal echogenicity without hydronephrosis, mass, or shadowing calculi.LEFT KIDNEY: The left kidney measures 11.2 cm in length. Normal renal parenchymal echogenicity without hydronephrosis, mass, or shadowing calculi.SPLEEN: The spleen measures 10.1 cm in length.OTHER: No significant abnormalities noted.

Output: 1. Echogenic, coarse liver parenchyma, consistent with hepatic steatosis, parenchymal dysfunction, or chronic liver disease.2. Cholelithiasis without evidence of cholecystitis or biliary ductal dilatation.


Instruction: Generate impression based on medical findings.

Input: Ms. Dupart is a 54 year old female with a personal history of ovarian cancer now status post total abdominal hysterectomy and bilateral salpingooophorectomy who presents for imaging evaluation of a palpable mass in the right breast. Three standard views of both breasts plus an additional left MLO view and spot compression right CC and ML views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty (BiRads Density Category A), unchanged in pattern and distribution. A triangular marker overlies upper inner quadrant of the right breast, indicating the site of the palpable abnormality. There are four contiguous focal asymmetries in the right medial breast, which are better appreciated on the ML spot compression view, which together occupy a region measuring up to 3.7 cm. Scattered benign calcifications are noted bilaterally. A benign intramammary lymph node present in the right upper outer quadrant. ULTRASOUND

Output: 1 indeterminate structure within the right upper inner quadrant, for which ultrasound-guided biopsy is recommended to ensure benignity.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.Findings were discussed with the gynecology resident on call, Kathryn Hawley, on 9/15/2016 at approximately 2:15 PM.


Instruction: Generate impression based on medical findings.

Input: Male 69 years old; Reason: US-guided FNA of new right sided node History: h/o thyroid cancer (adn Schwanomma). now with new right sided node On the prior ultrasound a hyperechoic focus was seen on the right concerning for a lymph node recurrence at level 4. This measured 0.9 cm x 0.6 cm x 0.9 cm. The patient presented today for fine needle aspiration of this lesion. However on today's study, this lesion was not identified in trans or longitudinally. No residual lymph node is seen on the right at level 4.

Output: Right level 4 lymph node seen on prior ultrasound was not visualized on this study. Accordingly, no biopsy was performed. However, would recommend continued surveillance follow-up ultrasound in 6 months with special attention to this region.


Instruction: Generate impression based on medical findings.

Input: Flank pain RIGHT KIDNEY: Multiple nonobstructing right renal stones. The largest stone within the lower pole measures 1 x 0.9 x 0.9 cm. No worrisome mass or hydronephrosis. Right kidney 10.7 cm in length.LEFT KIDNEY: Probable nonobstructing subcentimeter left renal stone. Stable left renal cyst. No worrisome mass or hydronephrosis. Left kidney 10.6 cm in lengthOTHER: Bladder nondistended

Output: Multiple nonobstructing right renal stones. Probable nonobstructing subcentimeter left renal stone. No worrisome mass


Instruction: Generate impression based on medical findings.

Input: RIGHT LOBE MEASUREMENTS: 5.8 x 2.0 x 1.8 cmLEFT LOBE MEASUREMENTS: 6.0 x 2.6 x 4.5 cmISTHMUS MEASUREMENTS: 7 mmRIGHT LOBE: Multiple predominantly subcentimeter nodules are present. Spongiform 7 x 5 x 8 mm interpolar nodule is unchanged. Within the inferior pole in the posterior aspect of the gland is a 1.3 x 1.1 x 0.7 cm solid nodule with small cystic components with a spongiform appearance. No increased vascularity or calcifications. The margins are relatively well defined. LEFT LOBE: The left thyroid lobe is mostly replaced by a 4.8 x 2.3 x 4.1 cm complex predominantly isoechoic solid nodule. No suspicious calcifications or hypervascularity. The nodule margins are relatively well-defined.ISTHMUS: Heterogeneously thickened isthmus.PARATHYROID GLANDS: No parathyroid adenoma candidate was visualized.FINE NEEDLE ASPIRATION REPORT:OPERATORS: Doctors Patel and Trilisky; The attending physician, Dr. Patel, was present for theentire procedure.TECHNIQUE: Following a discussion of the procedure with the patient, including its risks (pain, bleeding, infection, and adequate sample), benefits, alternatives and steps to prevent infection, an informed written consent was obtained and documented in the patient's chart. The time-out form was completed to confirm patient identity and side/type of procedure.Localizing US demonstrated at the target dominant 1.3-cm inferior left pole posteriorly located nodule. The skin over the target area was cleansed with Betadine. Transducer was sterilely sheathed. Local anesthesia was obtained using 1% lidocaine, superficially and at depth. Using aseptic technique, and continuous ultrasound guidance, several attempts were made to aspirate the nodule, however, the patient expressed significant discomfort during the procedure in-spite of additional local anesthetic, the deep location of the nodule made visualization difficult and the medial to lateral approach was complicated by the patient's musculature. The procedure was discontinued with the patient's consent before adequate sampling was obtained. The patient tolerated the procedure well without immediate complications. Routine post procedure instructions were communicated to the patient.COMPLICATIONS: NoneESTIMATED BLOOD LOSS: Less than 1 cc. An adhesive bandage was placed on the patient’s skin.

Output: 1.Multinodular goiter. The dominant left nodule was reportedly previously biopsied and confirmed to be a colloid nodule. The dominant right 1.3 cm nodule has a spongiform appearance and is felt to most likely represent a colloid nodule.2.Attempted ultrasound guided fine needle aspiration of the dominant left 1.3 cm nodule was unsuccessful due to the deep location of the nodule limiting visibility and patient discomfort as described above.


Instruction: Generate impression based on medical findings.

Input: Hematuria, please evaluate Foley catheter noted within the bladder. Enlarged prostate gland is identified which measures 6.3 x 6.5 x 5.4 cm. Calcification noted within the prostate gland. No evidence of ascites.

Output: Enlarged prostate gland noted.Foley catheter within the bladder.


Instruction: Generate impression based on medical findings.

Input: Hepatitis B LIVER: Coarse echogenic liver parenchyma again noted. 1.2 x 1 x 1.5 cm hypoechoic focus within the right lobe again noted and unchanged. Liver length 13.8 cmGALLBLADDER, BILIARY TRACT: Stable subcentimeter gallbladder polyp measuring 0.5 cm in diameter.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.2 cm in length.OTHER: Left kidney 12.5 cm in length. Spleen 12 cm in length. No ascites

Output: Stable coarse echogenic liver parenchyma noted consistent with chronic liver disease. Stable right lobe hypoechoic focus; correlation with prior studies and MR suggests a benign etiology. Stable gallbladder polyp. No ascites.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male with right upper quadrant pain. LIVER: Normal in size, contour and echogenicity. No focal hepatic abnormality.BILIARY TRACT: Biliary tract is normal in caliber. Gallbladder is normal without cholelithiasis, wall thickening or pericholecystic fluid.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: Lobulation involving the midportion left kidney without underlying mass.

Output: Normal gallbladder and biliary tract.


Instruction: Generate impression based on medical findings.

Input: Cardiomyopathy with possible hepatic dysfunction LIVER: Mildly coarse liver echotexture without mass. Liver length 18.2 cm. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: 9.7 cm in lengthOTHER: Left kidney 11.1 cm in length. Spleen 13 cm in length. No ascites

Output: Mild hepatomegaly associated with mildly coarse liver echotexture. Findings suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites.


Instruction: Generate impression based on medical findings.

Input: 65-year-old male patient with positive Murphy sign. Evaluate for cholecystitis. LIVER: The liver measures 13.2 cm in length. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.27 m/sec.GALLBLADDER, BILIARY TRACT: The gallbladder contains stones and sludge. There is gallbladder wall thickening measuring up to 6 mm in certain areas. No significant pericholecystic fluid is identified. Sonographic Murphy's sign is negative, however, the patient is currently medicated. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 4 mm in diameter.PANCREAS: The head and body of the pancreas demonstrate normal echogenicity. The tail is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney is atrophic and echogenic measuring 6 cm in length. No evidence of hydronephrosis. OTHER: The left kidney is not visualized on this examination.The spleen measures 13.1 cm in length.There is a right pleural effusion.

Output: 1. Cholelithiasis with mild gallbladder wall thickening; these findings could represent acute cholecystitis. A HIDA scan can be obtained for further evaluation if clinically warranted. 2. Right pleural effusion.3. Atrophic right kidney.


Instruction: Generate impression based on medical findings.

Input: Reason: RUQ pain, eval for acute cholecystitis History: RUQ pain LIVER: The liver measures 17.3 cm in length. Cirrhotic liver morphology. The portal vein is patent with normal portal venous hepatopedal blood flow, 28.1 cm/s. GALLBLADDER, BILIARY TRACT: The gallbladder is mildly distended without stones or sludge. The gallbladder wall measures 0.4 cm and the common bile duct measures 0.3 cm. No pericholecystic fluid. No intrahepatic or extrahepatic biliary ductal dilatation. PANCREAS: Obscured by bowel gas.OTHER: No significant abnormalities noted.

Output: Cirrhotic liver morphology and distended gallbladder without evidence of cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Enlarged appearing liver during C-section LIVER: No significant abnormalities noted. Liver length 16.7 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.4 cm in lengthOTHER: Left kidney 10.4 cm in length. Spleen 10.6 cm in length. No ascites.

Output: Negative right upper quadrant ultrasound. Specifically, no evidence for hepatobiliary abnormality. Normal size liver.


Instruction: Generate impression based on medical findings.

Input: Hepatitis B LIVER: Coarse echogenic liver echotexture again noted without mass. Liver length 20.8 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Atrophic echogenic right kidney again noted. Right kidney 9.2 cm in length.OTHER: Spleen 9.4 cm in length. Right iliac fossa renal transplant 12.9 cm in length. Left kidney absent. No ascites.

Output: Coarse echogenic liver echotexture again noted consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Moderate hepatomegaly. No ascites.


Instruction: Generate impression based on medical findings.

Input: 74-year-old male with hematuria. RIGHT KIDNEY: The right kidney measures 13.8 cm in length. No hydronephrosis. Numerous cysts are again seen some with minimal internal complexity. No definite solid lesion is identified. No shadowing calculi.LEFT KIDNEY: The left kidney measures 13.1 cm in length. No hydronephrosis. Multiple cysts are again seen, some with minimal internal complexity. No definite solid lesion is identified. No shadowing calculi.URINARY BLADDER: No acute abnormality of the urinary bladder.OTHER: No significant abnormalities noted.

Output: Multiple bilateral renal cysts. No dominant mass is identified. Consider further evaluation with CT or MRI as the multiplicity of nodules makes any single nodule difficult to evaluate.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old. History of hydronephrosis s/p bilateral ureteral stent removal. RIGHT KIDNEY: The right kidney measures 10.0 cm in length, with normal cortical echogenicity. A lower pole nonobstructing stone measures 0.5 x 0.3 x 0.5 cm. No hydronephrosis.LEFT KIDNEY: The left kidney measures 11.1 cm in length with normal cortical echogenicity. A midpole nonobstructing stone measures 0.4 x 0.2 x 0.4 cm. No hydronephrosis.OTHER: The bladder is incompletely distended. Previously seen bilateral ureteral stents are no longer in place.

Output: Bilateral nonobstructing renal stones appear similar to prior. No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: Enlarged right thyroid gland RIGHT LOBE MEASUREMENTS: 6.8 x 2.5 x 1.7 cmLEFT LOBE MEASUREMENTS: 5.2 x 1.2 x 1.2 cmISTHMUS MEASUREMENTS: 0.1 cmRIGHT LOBE: Diffusely heterogeneous gland. Predominantly solid lower pole nodule measuring 4.3 x 2.5 x 3.5 cm.LEFT LOBE: Diffusely heterogeneous gland without massISTHMUS: Diffusely heterogeneous gland without massPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Predominately solid dominant lower pole right thyroid nodule; this nodule is amenable to percutaneous ultrasound-guided biopsy. Diffusely heterogeneous thyroid gland raises the possibility of chronic thyroiditis. No regional adenopathy.


Instruction: Generate impression based on medical findings.

Input: 63-year-old male with history of thyroid nodule. Reevaluate. RIGHT LOBE MEASUREMENTS: 6.3 x 2.3 x 1.7 cm.LEFT LOBE MEASUREMENTS: 6.3 x 2.2 x 2.0 cm.ISTHMUS MEASUREMENTS: 0.5 cm.RIGHT LOBE: Normal homogeneous thyroid echotexture. No focal lesion, calcification, or hypervascularity.LEFT LOBE: Normal homogeneous thyroid echotexture. No focal lesion, calcification, or hypervascularity.ISTHMUS: 0.5 x 0.4 x0.9 cm hypoechoic isthmus nodule is again noted, not significantly changed in size. New punctate shadowing calcific focus. No hypervascularity.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Hypoechoic isthmus nodule not significantly changed in size, but with newly seen calcification. Continued follow-up is recommended.


Instruction: Generate impression based on medical findings.

Input: Low urine output. RIGHT KIDNEY: 11.0 cm in length. Unremarkable renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: 10.3 cm in length. Unremarkable renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.BLADDER: No significant abnormality noted.OTHER: Cirrhotic liver morphology with mild to moderate ascites, partially imaged.

Output: 1. No hydronephrosis. 2. Cirrhosis with ascites.


Instruction: Generate impression based on medical findings.

Input: Reason: Rising bilirubin and jaundice 8 months status post stem cell transplant with Busulfan conditioning. Concern for cholecystitis, cholelithiasis, GVHD, or VOD LIVER: The liver measures 18.0 cm in length. Normal hepatic echogenicity and echotexture. The portal vein is patent with normal directional hepatopedal portal venous blood flow, peak velocity 23.3 cm/s. Peak velocity of the right portal vein is -16.1 cm/s and left portal vein is 10.4 cm/s. Normal hepatic arterial directional blood flow. No focal mass.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted. The gallbladder wall measures 0.1 cm. The common hepatic duct measures 0.3 cm. No biliary ductal dilatation.PANCREAS: Obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 12.8 cm. Small subcentimeter nonobstructing renal stone in the mid portion of the right kidney. No hydronephrosis or masses.LEFT KIDNEY: The left kidney measures 13.3 cm. No hydronephrosis, masses, or stones.SPLEEN: The spleen measures 12.1 cm. Peak splenic vein velocity is 18.4 cm/s. Peak splenic artery velocity is 48.7 cm/s. Abnormal directional venous and arterial flow.OTHER: No ascites.

Output: 1. Subcentimeter nonobstructing right renal stone.2. Unremarkable hepatobiliary system with normal hepatopedal directional portal venous and arterial flow.


Instruction: Generate impression based on medical findings.

Input: 59-year-old female with localized swelling, mass and lump in the neck. Assess right neck swelling. Scans to the right neck show normal vascular structures with normal carotid artery and jugular veins. Homogeneous thyroid is seen with small subcentimeter sonolucent zone. Lateral to the thyroid in the soft tissues of the neck are normal muscle and fascial plane seen without evidence of mass or lymphadenopathy. Scans extended through 5 cervical neck levels without evidence of lymph node or mass.

Output: No mass lesion seen in the soft tissues of the neck as suspected clinically.


Instruction: Generate impression based on medical findings.

Input: 65-year-old male with history of tonsillar carcinoma, now with palpable lymph node. A focused examination was performed in the region of the palpable abnormality just superior to the right clavicle at the base of the neck laterally. In this location there is a rounded, mildly hypoechoic solid lymph node measuring 0.7 x 0.9 x 1 cm. This appears to have abnormal vasculature.

Output: Highly suspicious right supraclavicular lymph node. This would be amenable to fine-needle aspiration.


Instruction: Generate impression based on medical findings.

Input: History of thyroid cancer status post surgery RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: No significant abnormality noted. LEFT LOBE: The hypoechoic focus in the left thyroid bed measures 9 x 4 x 4 mm, previously 8 x 4 x 4 mm when measured similarly and accounting for differences in technique.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not identified.LYMPH NODES: Benign appearing cervical lymph nodes bilaterally.OTHER: No significant abnormality noted.

Output: Unchanged nonspecific subcentimeter hypoechoic focus in left thyroid bed. No specific evidence of disease recurrence.


Instruction: Generate impression based on medical findings.

Input: Weakness Prominent partial fusion is noted at the C2 and C3 vertebrae. There is mild grade 1 subluxation in the C3-C4 level with minimal retrolisthesis at C6-C7. Prominent endplate degenerative irregularities are also present at C6-C7 and to a lesser degree at C5-C6. There is no acute appearing compression deformity.The axial images show prominent disk/spur complex at the C3-C4 level resulting in mild central canal and moderate left-sided foraminal stenosis. Mild stenotic findings are present at C4-C5 and C5-C6 although there is moderate right sided foraminal stenosis. C6-C7 shows mild central canal and bilateral foraminal stenosis. C7-T1 has milder degenerative findings without significant stenosis. Incidental note is made of prominent enlargement with heterogeneous attenuation of the thyroid gland including dystrophic calcification with deviation of the trachea to the right side of midline. This may be further evaluated with ultrasound performed clinically.

Output: Moderate degenerative changes with partial fusion C2-C3 and no acute fracture.Prominent enlargement of heterogeneous appearing thyroid possibly goiter. This would be better evaluated with ultrasound if warranted clinically.


Instruction: Generate impression based on medical findings.

Input: Male; 54 years old. Reason: R lateral shoulder dermal thickening, evaluate for deep mass History: above In the area of the palpable abnormality overlying the right deltoid muscle is a 2.9 x 0.9 x 2.4 cm area of subcutaneous edema. No underlying mass is identified. There is no drainable collection.

Output: Subcutaneous edema but no discrete mass or drainable collection in the area of the patient's reported abnormality. Correlate clinically for signs/symptoms of cellulitis.


Instruction: Generate impression based on medical findings.

Input: Hepatitis C LIVER: Coarse echogenic liver echotexture again noted without mass. Liver length 15.4 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.4 cm in length OTHER: Left kidney 9.9 cm in length. Spleen 8.2 cm in length. No ascites.

Output: Stable coarse echogenic liver parenchyma consistent with chronic liver disease without mass or ductal dilatation. No ascites.


Instruction: Generate impression based on medical findings.

Input: 44-year-old female with recurrent UTI, dysuria. RIGHT KIDNEY: Measures 9.0 cm in length. Normal echogenicity without hydronephrosis, nephrolithiasis, or mass lesion. LEFT KIDNEY: Measures 10.1 cm in length. Normal echogenicity without hydronephrosis, nephrolithiasis, or mass lesion. A left renal stent is in place.URINARY BLADDER: Partially collapsed with distal stent partially imaged. Necrotic lymph node conglomerate abutting the left ureterovesical junction better seen on recent CT examination. OTHER: No significant abnormalities noted.

Output: 1. Left ureteral stent in place without hydronephrosis. 2. Partially collapsed bladder with distal stent partially imaged. Necrotic lymph node conglomerate abutting the left ureterovesical junction better seen on recent CT examination.


Instruction: Generate impression based on medical findings.

Input: Left testicular mass RIGHT TESTIS: 4.6 x 2.3 x 2.7 cm. No intratesticular mass. Bilaterally symmetric Doppler flow characteristicsLEFT TESTIS: 4.5 x 2.2 x 3.4 cm. No intratesticular mass. Bilaterally symmetric Doppler flow characteristics.RIGHT EPIDIDYMIS: Stable epididymal cyst.LEFT EPIDIDYMIS: Stable epididymal cyst.OTHER: Subcentimeter left mobile benign-appearing scrotal pearl again noted

Output: Stable subcentimeter mobile left benign scrotal pearl. No worrisome intratesticular mass. Bilaterally symmetric Doppler flow characteristics. Bilateral epididymal cysts.


Instruction: Generate impression based on medical findings.

Input: 86-year-old male with pain in cheek. Patient states left sided pain. Evaluate for submandibular gland or parotid gland stone. Right parotid gland appears unremarkable. Adjacent, prominent but morphologically normal lymph nodes identified.Left parotid gland with no sialectasis. In or immediately adjacent to the inferior aspect of the left parotid there is dense rim calcification measuring approximately 7 mm in transverse diameter. This obscures underlying tissue.

Output: Rim calcified mass adjacent to inferior left parotid. The appearance is somewhat unusual but has been reported in pleomorphic adenoma. Other parotid masses typically produce only coarse calcifications.This could also be inflammatory or vascular in nature.This could represent a calcified lymph node.


Instruction: Generate impression based on medical findings.

Input: 83 year old male patient with history of right-sided renal mass. Evaluate for changes. RENAL TRANSPLANT: LOCATION: Right iliac fossa.PERITRANSPLANT TISSUES: No perinephric fluid collection is identified.KIDNEY: Renal cortical echogenicity is within normal limits.COLLECTING SYSTEM/URETER: No evidence of hydronephrosis.URINARY BLADDER: No significant abnormality notedVASCULAR DOPPLER DATA: Color Doppler imaging of the transplant kidney is within normal limits.OTHER: There is a 2.1 x 1.9 cm hypoechoic mass within the superior pole of the right native kidney which appears to correlate with previously identified right renal mass. Given differences in modality/technique, the mass appears similar in size to the prior study. An additional subcentimeter hypoechoic lesion is noted.

Output: 1. Similar size of a previously identified mass within the native right kidney given differences in modality/technique when compared to prior CT.2. Unremarkable transplant kidney.


Instruction: Generate impression based on medical findings.

Input: 82-year-old male with unexplained weight loss and transaminitis. LIVER:The liver measures approximately 13.5 cm. Increased echogenicity of the parenchyma. No intrahepatic biliary dilation. Mild ascites is noted. Portal vein is patent with pulsatile hepatopedal flow. There is prominence of the intrahepatic veins and inferior vena cava.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended with an anechoic lumen. There is an approximately 1.9 x 1.7 cm well-defined hyperechoic lesion within the lumen of the gallbladder that cast a shadow, consistent with choledocholithiasis or a sludge ball. Does not appear to be impacted. The gallbladder wall measures 1.3 cm. No pericholecystic fluid. Common duct measures 0.3 centimeters.PANCREAS: Unable to evaluate the pancreas due to overlying bowel gas.SPLEEN: Measures 9.5 cm. No sonographic abnormalities.KIDNEYS: Right kidney measures 10.0 cm. Left kidney measures 12.3 cm. Unremarkable and echogenicity. No shadowing calculi or hydronephrosis.There are three large simple renal cysts around the left kidney, the largest measuring 4.9 x 4.4 x 3.5 cm. OTHER: No significant abnormality noted.

Output: 1. Increased echogenicity of the liver parenchyma consistent with fatty infiltration and chronic liver disease/parenchymal dysfunction.2. Mild ascites. 3. Gallbladder wall thickening which is nonspecific in the context of ascites. No other secondary signs of acute cholecystitis.4. Pulsatile portal vein and prominence of intrahepatic veins and inferior vena cava consistent with a congestive heart failure.5. Multiple left-sided simple renal cyst as described above.


Instruction: Generate impression based on medical findings.

Input: Alcoholism with disorientation LIVER: Coarse echogenic liver parenchyma without mass. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow. Liver length 11.2 cmGALLBLADDER, BILIARY TRACT: Gallbladder sludge without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 8.5 cm in length.OTHER: Left kidney 7.3 cm in length. No ascites

Output: Coarse echogenic liver parenchyma suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites. Gallbladder sludge without acute inflammation.


Instruction: Generate impression based on medical findings.

Input: 86-year-old male with hematuria RIGHT KIDNEY: Measures 10.1 cm in length. Increased renal echogenicity. 4.1 x 5.1 x 4.7 cm right inferior pole renal cyst without septation or solid component, not significantly changed. No hydronephrosis.LEFT KIDNEY: Measures 10.2 cm in length. Increased renal echogenicity without hydronephrosis.URINARY BLADDER: Incompletely distended.OTHER: No significant abnormalities noted.

Output: Increased echogenicity consistent with medical renal disease, without significant change since 2012.


Instruction: Generate impression based on medical findings.

Input: 39-year-old female patient with history of subacute thyroiditis with abnormal imaging, question of nodule. Previous painful, tender nodule on the right in April 2015, pain has resolved. Evaluate for nodules and other characteristics. RIGHT LOBE MEASUREMENTS: 1.2 x 1.2 x 4.4 cm, previously 2.3 x 2.5 x 4.3 cm.LEFT LOBE MEASUREMENTS: 0.9 x 1.1 x 3.9 cm, previously 1.4 x 1.0 x 4.3 cm.ISTHMUS MEASUREMENTS: 3 mm in thickness.RIGHT LOBE: The right thyroid lobe is slightly heterogeneous in echogenicity without focal lesion.LEFT LOBE: The left thyroid lobe is slightly heterogeneous echogenicity without focal lesion.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign morphology lymph nodes are noted bilaterally laterally.OTHER: No significant abnormality noted.

Output: Heterogeneous thyroid gland which can be seen with a history of thyroiditis. No focal thyroid lesion is identified.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with history of microhematuria and 1.4-cm echogenic renal mass ABDOMEN:LUNG BASES: Subcentimeter nonspecific nodule in image number 5, series number 7 in the left lower lobe. Subsegmental atelectasis in the left lower lobe.Small right sided pleural effusion.LIVER, BILIARY TRACT: Multiple cysts throughout the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple stones within the left kidney, predominantly in the lower pole largest measuring 1.1-cm. No hydronephrosis. No stones in the right kidney. No evidence of ureteral stones.1.3-cm enhancing mass in the lower pole of the right kidney. This mass measures 53 HU on the noncontrast and measures 80 HU on the delayed phase images. This is suspicious for a renal cell carcinoma such as papillary variant. Subcentimeter lesion in the midpole of the right kidney, on image number 48, series number 9 measures 8 mm and demonstrates possibly 30 this enhancement.2.2 x 1.2 cm hypodense lesion in the upper pole of the left kidney likely representing a simple cyst. There are multiple other small hypodense lesions which are too small to adequately characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Mildly enlarged prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Left nephrolithiasis.Right lower lobe enhancing lesion suspicious for renal cell carcinoma. Another subcentimeter lesion within the right kidney, too small to accurate characterize but likely demonstrates heterogeneous enhancement.Left renal cyst. Multiple other subcentimeter lesions in both kidneys which are too small to characterize.Multiple hepatic cysts.


Instruction: Generate impression based on medical findings.

Input: Left thyroid nodule detected on outside CT RIGHT LOBE MEASUREMENTS: 4.7 x 1.4 x 1.7 cmLEFT LOBE MEASUREMENTS: 5 x 1.5 x 1.7 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: Diffusely heterogeneous gland without discrete nodule.LEFT LOBE: Diffusely heterogeneous gland. 2.1 x 1.1 x 1.1 cm solid hypoechoic nodule arising from the lower pole of thyroid gland.ISTHMUS: Diffusely heterogeneous gland without discrete nodulePARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Dominant solid hypoechoic nodule arising from the lower pole left thyroid gland. This lesion is amenable to ultrasound guided percutaneous biopsy


Instruction: Generate impression based on medical findings.

Input: 38 year-old female right upper quadrant pain. LIVER: Increased echogenicity of the liver measuring 21.6 cm in length. No focal hepatic lesion. Main portal vein is patent with appropriate directional flow, peak velocity measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: Gallbladder unremarkable. No gallbladder wall thickening. No pericholecystic fluid. Sonographic Murphy's sign negative. Common duct measures 3 mm in caliber. No intra or extrahepatic biliary ductal dilatation.PANCREAS: Distal pancreatic tail is obscured by overlying bowel gas. The visualized pancreas is unremarkable.RIGHT KIDNEY: Normal echogenicity measuring 12.1 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Normal echogenicity of the spleen measuring 10.6 cm in length. Normal echogenicity of the left kidney measuring 11.4 cm in length. No hydronephrosis or shadowing calculi are noted.

Output: Hepatomegaly with increased parenchymal echogenicity suggestive of hepatic steatosis/parenchymal dysfunction.


Instruction: Generate impression based on medical findings.

Input: Female; 41 years old. Reason: evaluate for hydronephrosis History: recent kidney stone diagnosis The exam is somewhat limited due to patient body habitus.RIGHT KIDNEY: The right kidney measures 13.0 cm in length. The renal parenchyma is normal in echogenicity. There is no hydronephrosis or shadowing renal stone identified.LEFT KIDNEY: The left kidney measures 13.7 cm in length. There is normal echogenicity. There is a hydronephrosis or shadowing renal stone identified.URINARY BLADDER: The bladder is nondistended.

Output: No hydronephrosis or shadowing renal stone.


Instruction: Generate impression based on medical findings.

Input: Chronic hepatitis with acute renal insufficiency RIGHT KIDNEY: Echogenic kidney without mass, stone, or hydronephrosis. 6.2 cm in lengthLEFT KIDNEY: Echogenic kidney without mass, stone, or hydronephrosis. 9.2 cm in lengthOTHER: Bladder collapsed. Trace ascites

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


Instruction: Generate impression based on medical findings.

Input: 16-year-old female presents with spell palpated lump in the right breast for two weeks. Family history breast cancer in maternal grandmother. A targeted right ultrasound was performed for the patient’s area of concern. On physical examination, 2-cm mobile nontender soft, palpable mass noted in the right breast 10 o' clock position. Ultrasound demonstrates a possible bilobed or two adjacent smaller hypoechoic parallel oriented, circumscribed masses in the right breast 10 o'clock position, measuring 2.5 x 0.9 x 2 cm, corresponding to a benign fibroadenoma. No suspicious mass noted.

Output: Palpable abnormality right breast 10 o'clock position corresponds to benign fibroadenoma based on imaging. Surgical consultation is recommended. Findings and reformations were discussed with the patient and her mother in detail.BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation.