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Generate impression based on findings. | 75-year-old female with a cholangiocarcinoma presents with gram negative bacteremia and septic shock. Evaluate biliary system. LIVER: Measures 19.3 cm. Coarse heterogenous echotexture of liver noted. Previously noted biliary stent is partially visualized. Area in the left hepatic lobe may have some biliary dilation. No definite ductal dilatation and the common hepatic duct measures approximately 0.5 cm. No mass or ascites. Portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder is absent. The common bile duct is not definitely visualized on this study.PANCREAS: Evaluation the pancreas limited due to overlying bowel gas.SPLEEN: The spleen measures 11.7 cm without sonographic abnormalities.KIDNEYS: The right kidney measures 12.1 cm. Left kidney measures 10.5 cm. The kidneys have normal echogenicity. No hydronephrosis, focal mass, or shadowing calculi. OTHER: No fluid collections are seen. | 1. Coarse heterogenous echotexture of liver consistent with chronic liver disease/parenchymal dysfunction2. No definite ductal dilatation however there is a questionable area in the left hepatic lobe that may have some minimal ductal dilatation related to known cholangiocarcinoma. |
Generate impression based on findings. | Reason: Hyperparathyroidism History: Tertiary hyperparathyroidism a RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 3.8 x 1.4 x 2.0 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 2.0 cm x 3.8 x 1.4 cm.ISTHMUS MEASUREMENTS: 0.5 cm.RIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: There is a round, hypoechoic vascular mass at the inferior aspect of the lower pole of left thyroid lobe measuring 2.0 x 1.8 x 1.9 cm which appears extrathyroidal and is consistent with parathyroid adenoma.LYMPH NODES: Multiple benign appearing borderline to mildly enlarged lymph nodes measuring up to 1.34 cm in the long axis.OTHER: No significant abnormalities. | 2.0 x 1.8 x 1.9 cm probable extrathyroidal mass at the inferior aspect of the left thyroid lobe appears consistent with parathyroid adenoma. |
Generate impression based on findings. | Low TSH RIGHT LOBE MEASUREMENTS: 5.8 x 1.3 x 1.7 cmLEFT LOBE MEASUREMENTS: 5.0 x 1.5 x 1.5 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Multiple benign-appearing spongiform nodules. A representative lower pole right nodule measures 1.2 x 0.8 x 0.8 cmLEFT LOBE: Multiple benign-appearing spongiform nodules. A representative mid pole nodule measures 0.9 x 0.7 x 0.8 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted. | Bilateral spongiform nodules; favor benign etiology. No regional adenopathy. |
Generate impression based on findings. | 57-year-old female with possible history of right breast ADH, need whole breast ultrasound ultrasound due to dense breast A bilateral whole breast ultrasound was performed using Sonocine. 2-3 cystic lesions identified in the right upper-outer quadrant consistent with fat necrosis/oil cyst. There is no solid mass identified. Normal dense glandular tissue identified in the rest of the breast.Study was double read by Dr. Kulkarni and Dr. Sheth. | No sonographic evidence for malignancy.Area of fat necrosis/oil cyst in the right upper-outer quadrant.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Multinodular goiter RIGHT LOBE MEASUREMENTS: 6.9 x 4.2 x 4.0 cmLEFT LOBE MEASUREMENTS: 4.5 x 1.6 x 1.8 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Diffusely heterogeneous gland. 5.1 x 3.7 x 3.7 spongiform nodule.LEFT LOBE: Diffusely heterogeneous gland without discrete noduleISTHMUS: Diffusely heterogeneous gland without discrete nodulePARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted. | Diffusely heterogeneous thyroid gland. Dominant right lobe spongiform nodule; favor benign etiology. |
Generate impression based on findings. | Ms. Rush is a 20 year old female presenting with a physician-detected a "mole" in the right breast. She has a family history of breast cancer in her mother (diagnosed at age of 29). Upon physical examination, a small mole is seen in the right inferior breast. No discrete mass is appreciated underneath this mole.A targeted right ultrasound was performed for the patient’s area of concern. In the right inferior breast, 6 o'clock position, no suspicious cystic or solid mass is identified. Inferior to the skin lesion, there was a simple cyst measuring 2 mm. | No sonographic evidence for malignancy. Patient should follow-up with her primary physician as clinically warranted. In addition, given the strong family history, a consideration into initiating surveillance mammography and MRI starting at the age of 25 should be made. All results and recommendations were relayed to the patient.BIRADS: 1 - Negative.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on findings. | 65-year-old female with elevated creatinine and history of hypertension. ULTRASOUND KIDNEYSRIGHT KIDNEY: The right kidney measures 10.2 cm in length. There is normal echogenicity of the cortex. No hydronephrosis, stones, or worrisome masses are seen within the right kidney.LEFT KIDNEY: The left kidney measures 10.4 cm in length. The echogenicity is normal within the cortex. There is no hydronephrosis, stones, or worrisome masses seen in the left kidney.OTHER: The bladder is visualized but no significant abnormalities are noted. Additionally, uterine fibroids are visualized. | 1. Negative ultrasound of the kidneys bilaterally. No hydronephrosis, stones, or masses are seen.2. Uterine fibroids are visualized. |
Generate impression based on findings. | 65-year-old female presents as a callback from screening mammography for a retroareolar asymmetry in the left breast. No current breast complaints. Three standard views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses(BiRads Density Category C), unchanged in pattern and distribution. A circumscribed asymmetry in the left breast 6:00 position persists with spot compression.ULTRASOUND | Clustered cysts in the left breast correlate with the mammographic asymmetry, and are favored benign. A six-month follow-up ultrasound is recommended to confirm stability.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months). |
Generate impression based on findings. | Female 54 years old Reason: patient with AKI in setting of dissection, want to eval flow to kidneys History: AKI, hematuria RIGHT KIDNEY: 11.0 cm in length. Normal echogenicity. No hydronephrosis or hydroureter.LEFT KIDNEY: 12.4 cm in length.OTHER: Bladder relatively collapsed.Limited color Doppler with a few spectral waveforms shows blood flow to both kidneys. | Blood flow is seen to both kidneys. No hydronephrosis. Normal echogenicity. |
Generate impression based on findings. | 71-year-old female. Evaluate thyroid nodules and parathyroid adenoma. RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 2.3 x 2.1 x 5.9 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 2.7 x 2.4 x 6.1 cm.ISTHMUS MEASUREMENTS: The isthmus measures 0.3 cm in thickness.RIGHT LOBE: The right thyroid lobe has a heterogenous echotexture without discrete nodules.LEFT LOBE: The left thyroid lobe has a heterogenous echotexture. In the left lower pole, there is a 1 x 1.4 x 1 cm spongiform nodule.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Posterior to the left upper thyroid pole is a 1.2 x 1 x 1.8 cm hypoechoic nodule concerning for a parathyroid adenoma candidate.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Posterior to the left upper thyroid pole is a 1.2 x 1 x 1.8 cm hypoechoic nodule concerning for a parathyroid adenoma candidate. Correlation with the same day nuclear medicine parathyroid scan is recommended.2. Spongiform nodule in the left lower pole.3. Enlarged thyroid gland with nonspecific heterogenous echotexture. Clinical correlation is needed for possible thyroiditis. |
Generate impression based on findings. | 31-year-old male with history of acute kidney injury. Evaluate for hydronephrosis. RIGHT KIDNEY: Right kidney measures 10.8 cm. No hydronephrosis or hydroureter. Slightly hyperechoic renal parenchyma, similar to prior.LEFT KIDNEY: Left kidney measures 10.7 cm. No hydronephrosis or hydroureter. Slightly hyperechoic renal parenchyma, similar to prior.URINARY BLADDER: Bladder is distended, within normal limits.OTHER: A small hepatic cyst. | Hyperechoic renal parenchyma, suggestive of medical renal disease/parenchymal dysfunction, without additional abnormality. |
Generate impression based on findings. | Female 69 years old Reason: rule out gallbladder, liver pathology History: right upper shoulder pain with inspiration LIVER: Liver measures 17 cm. No focal lesions. Normal echogenicity.BILIARY TRACT: There are multiple subcentimeter cholesterol polyps within the gallbladder. No evidence of gallstones. No evidence of intra or extrahepatic biliary dilatation.PANCREAS: Not well visualized due to overlying bowel gas.SPLEEN: Spleen measures 8.7 cm, normal in size.RIGHT KIDNEY: No evidence of hydronephrosis in both kidneys. There is a 1.5 cm in diameter simple cyst within the right kidney. Normal echogenicity of the right kidney.Within the left kidney there is a large complex cyst measuring 10 x 9 cm. This cyst contains thick septations and mural irregularity and internal echoes. CT or MRI of the kidneys with contrast is recommended to exclude a renal neoplasm. OTHER: No significant abnormalities noted. | Complex left renal mass. Cystic Renal cell carcinoma cannot be excluded. Contrast-enhanced CT or MRI is recommended for further evaluation.Multiple small cholesterol polyps within the gallbladder.Dr. Blackman was notified and acknowledged about the above findings at the time of the dictation |
Generate impression based on findings. | 47-year-old female with end-stage renal disease, secondary hyperparathyroidism. RIGHT LOBE MEASUREMENTS: 4.4 x 2.6 x 2.0 cmLEFT LOBE MEASUREMENTS: 4.0 x 1.9 x 1.7 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: Two solid hypoechoic nodules in the right thyroid lobe, the larger more superior nodule measuring 0.7 x 0.5 x 0.8 cm, and the smaller more inferior one measuring 0.5 x 0.4 x 0.4 cm with peripheral calcification.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: Hypoechoic peripherally hyperechoic lesion posterior to the inferior right thyroid measures 0.8 x 0.7 x 0.8 cm. Hypoechoic complex lesion posterior to the inferior left thyroid measures 1.7 x 1.5 x 1.3 cm. | 1. Hypoechoic lesions posterior to both inferior thyroid lobes are favored to represent parathyroid hyperplasia given multiplicity and the patient's clinical history. Correlate with results of same day nuclear medicine scan for further characterization. 2. Two small right thyroid nodules as detailed above. |
Generate impression based on findings. | 24-year-old with right breast mass. The patient is unable to describe the area of concern. However, a clinic note shows the area of concern to be in the right upper outer quadrant. A targeted right ultrasound was performed for the clinical area of concern. There is no solid or cystic mass identified. Dense parenchymal tissue is seen, and this could account for a clinically palpable area of concern. | No sonographic evidence for malignancy. Dense parenchymal tissue in the right upper outer quadrant. Clinical correlation with this finding is recommended. The patient will be in touch with Dr. Dade to ensure these benign findings are concordant with her physical exam. If there is any question of discordance, further evaluation could include referral to a breast surgeon.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed. |
Generate impression based on findings. | Rising creatinine RIGHT KIDNEY: Mildly echogenic parenchyma without mass, stone, or hydronephrosis. 12.3 cm in lengthLEFT KIDNEY: Mildly echogenic parenchyma without mass, stone, or hydronephrosis. 13.4 cm in lengthOTHER: Bladder nondistended | Mildly echogenic renal parenchyma raises the possibility of medical renal disease/parenchymal dysfunction without mass, stone, or hydronephrosis. |
Generate impression based on findings. | Renal ATN RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No change in small perinephric fluid collection.KIDNEY: No significant abnormality noted. 11 cm in lengthCOLLECTING SYSTEM/URETER: No significant abnormality notedURINARY BLADDER: No significant abnormality notedVASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels Patent renal vasculature without evidence for inflow or outflow compromise.OTHER: 1.8 x 2.3 cm focal aneurysmal dilatation involving the right iliac artery in the region of the anastomosis. | Patent renal vasculature without evidence for inflow or outflow compromise. Unremarkable collecting system without hydronephrosis.Focal aneurysmal dilatation involving the right iliac artery in the region of anastomosis; while this may be an artifact of vessel tortuosity in the region of anastomosis, a true aneurysm cannot be excluded. |
Generate impression based on findings. | Proteinuria Ultrasound guidance provided for four right renal biopsy passes. A 16 mm collection adjacent to the kidney was noted postprocedure, likely representing a small amount of hemorrhage. | Ultrasound guidance provided for right renal biopsy. |
Generate impression based on findings. | 69-year-old female presents with dysphagia. RIGHT LOBE MEASUREMENTS: The right lobe is absent.LEFT LOBE MEASUREMENTS: 4.1 x 2.2 x 2.2 cm.ISTHMUS MEASUREMENTS: 0.3 cm.RIGHT LOBE: The right lobe is absent.LEFT LOBE: Heterogeneous nodule in the left lobe measuring approximately 2.3 x 2.1 x 1.7 cm, appears stable when compared to the prior study.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No adenopathy.OTHER: No significant abnormality noted. | 1. Stable multinodular left thyroid. Postsurgical changes of a right-sided thyroid lobectomy. No suspicious adenopathy. |
Generate impression based on findings. | The patient submitted outside mammogram dated 7/27/10. Submitted outside study was compared to the current mammogram dated 9/15/15. Two focal asymmetries at upper outer quadrant in the right breast are new, compared to the prior study. Therefore, spot compression views and possible ultrasound study are recommended. | New two focal asymmetries at upper outer quadrant in the right breast. Spot compression views and possible ultrasound study are recommended. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | 57-year-old female with a history of stem cell transplant. Now with transaminitis. LIVER: The liver is minimally coarsened. It measures a 18.8 cm in craniocaudal dimension. No focal hepatic lesion or intrahepatic ductal dilatation is evident. There is normal hepatopetal portal venous blood flow at 30 cm/sec.BILIARY TRACT: There is a normally distended gallbladder with a 4-mm non-shadowing nondependent focus which may represent a small adherent gallstone or polyp. No extrahepatic biliary ductal dilatation with the common bile duct measuring 4 mm at the pancreatic head.PANCREAS: The visualized pancreatic head and body are normal.SPLEEN: Marked splenomegaly, measuring 19 cm in length.RIGHT KIDNEY: The right kidney measures 9.5 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident. Color Doppler demonstrates hilar blood flow. OTHER: The left kidney measures 10.2 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident. | 1. Coarse echogenic liver echotexture suggests chronic liver disease/parenchymal dysfunction without a discrete mass or biliary ductal dilatation.2. Small adherent gallstone versus subcentimeter gallbladder polyp.3. Marked splenomegaly. |
Generate impression based on findings. | 34-year-old male with chronic kidney disease. RIGHT KIDNEY: The right kidney measures 11.3 cm in length. Echotexture is normal. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: The left kidney measures 11.5 cm in length. Echotexture is normal. No hydronephrosis, shadowing calculus or mass.OTHER: Patient voided prior to exam. | Normal renal ultrasound. |
Generate impression based on findings. | Reason: pt with autoimmune hepatitis, screen for hepatocellular carcinoma. LIVER: The liver measures 15.2 cm in length and is smooth in contour. The liver parenchymal echotexture is normal. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.27 m/s.BILIARY TRACT: Cholelithiasis including large gallstone measuring up to 2.4 cm in diameter. No associated gallbladder wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 4 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 10.6 cm in length. RIGHT KIDNEY: Kidney measures 11.3 cm in length. Normal cortical echotexture. No hydronephrosis. Prominent extrarenal pelvis appearing similar to the 12/11/2012 examination.LEFT KIDNEY: Kidney measures 11.7 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No significant abnormalities noted. | 1.No focal hepatic lesions.2.Cholelithiasis without evidence of acute cholecystitis. |
Generate impression based on findings. | Right upper abdominal quadrant pain LIVER: Non-cirrhotic liver morphology. Minimally coarsened parenchymal echogenicity. Benign-appearing cysts noted. No suspicious hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Normal appearance of the gallbladderPANCREAS: The pancreas is obscured by bowel gas.KIDNEYS: The right kidney is 11.6 cm in length, with a simple appearing upper pole cyst. The left kidney is 10.8 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 9.0 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites is noted. | No acute abnormality evident. |
Generate impression based on findings. | 42 year-old female with new onset right upper quadrant pain with history of acute hepatic failure secondary to Tylenol overdose. LIVER: The liver parenchyma is coarse. There is a focal hyperechogenic geographic region measuring 5.7 cm without mass effect, compatible with focal fatty infiltration. The remainder of the liver is coarse. The liver is normal in size, measuring 16.8 cm in the craniocaudal dimension. The liver capsule is smooth. There is normal hepatopetal portal venous blood flow at 20 cm/sec.BILIARY TRACT: No extrahepatic biliary ductal dilatation with common bile duct measuring 4 mm at the level of the pancreatic head. A normally distended gallbladder is present with sludge. There is mild diffuse wall thickening up to 5 mm markedly improved from the prior study. There may be a small amount of pericholecystic fluid, but no focal tenderness.PANCREAS: The visualized pancreatic head and body are normal.SPLEEN: The spleen measures 10.8 cm without a focal abnormality evident.RIGHT KIDNEY: The right kidney measures 14-cm in length with no hydronephrosis, shadowing calculus or discrete lesion evident. Echogenic cortex. OTHER: The left kidney measures 12.7 cm in length without hydronephrosis, shadowing calculus or discrete lesion. Echogenic cortex.There is a trace amount of ascites. Small left pleural effusion. | 1. Gallbladder sludge, moderate yet improved diffuse gallbladder wall thickening without focal tenderness; overall, these findings are not specific for acute cholecystitis. 2. Coarse hepatic parenchyma with suspected focus of focal fatty infiltration is compatible with diffuse parenchymal dysfunction. 3. Trace ascites. Small left pleural effusion. 4. Echogenic renal cortices compatible with medical renal disease. |
Generate impression based on findings. | Abdominal pain. Elevated LFTs. History of renal transplant. LIVER: Non-cirrhotic liver morphology. Minimally echogenic parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Distention of the gallbladder with tumefactive sludge. No gallbladder wall thickening or pericholecystic fluid to suggest cholecystitis.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 9.9 cm in length. The left kidney is 11.1 cm in length. Multiple renal cysts are noted bilaterally. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 16.2 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites identified. | 1. Distended gallbladder with biliary sludge, without evidence of cholecystitis.2. Minimally echogenic liver, compatible with parenchymal dysfunction.3. Splenomegaly. |
Generate impression based on findings. | 47-year-old female who is recalled from screening for right superior, posterior breast lobulated mass. RIGHT BREAST DIGITAL MAMMOGRAPHY: Medial to lateral, exaggerated CC lateral, and 2 spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Again noted is the lobulated asymmetry located within the superior posterior right breast which persists with spot compression.TARGETED RIGHT BREAST ULTRASOUND:Right breast ultrasound demonstrated a lobulated anechoic focus at the 10:00 position measuring approximately 1.1 x 0.4 x 1.1 cm without vascular flow. | Findings consistent with right 10 o'clock position cyst. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | History of renal transplant now with elevated creatinine Ultrasound guidance was provided for biopsy of a transplant kidney in the right iliac fossa by the nephrology service. Two biopsy passes were performed. | Ultrasound guidance provided for transplant renal biopsy. |
Generate impression based on findings. | Volume overload, rule out cirrhosis or evidence of HCC, elevated alkaline phosphatase LIVER: Liver measures 16.9 cm, diffuse coarse heterogenous echotexture. No definite focal lesion noted. Portal vein is patent with normal flow directionality.Calcified granuloma noted in the right lobe of liver. Mild perihepatic fluid noted.BILIARY TRACT: Gallbladder is well-distended without any gallstones. No evidence of gallbladder wall thickening. Pericholecystic fluid is noted.Sonographic Murphy sign is negative.CBD measures 3 mm within normal limits.PANCREAS: Pancreas as visualized appears unremarkable. Tail of pancreas is not visualized due to overlying bowel gas.SPLEEN: No significant abnormalities noted. Spleen measures 11.1 cm.RIGHT KIDNEY: Right kidney measures 11.4 cm left kidney measures 10.7 cm. Normal echotexture of the kidneys. No hydronephrosis or focal lesionsOTHER: No ascites | Diffuse coarse echotexture of the liver consistent with chronic liver disease.Mild ascites. |
Generate impression based on findings. | Evaluate for right neck mass History: swelling, tenderness to right neck with associated anterior and posterior cervical lymphadenopathy Multiple enlarged anterior and posterior right cervical lymph nodes.Right level 2 lymph node: 4.0 x 1.4 x 2.0 cmRight level 3 lymph node: 2.2 x 1.2 x 1.4 cm and 3.0 x 1.3 x 1.7 cmRight level 4 lymph node: 1.9 x 0.6 x 1.3 cmRight level 5 lymph node: 1.8 x 0.9 x 1.2 cm. | Multiple nonspecific enlarged right anterior and posterior cervical lymph nodes, which would be amenable to biopsy; continued follow up suggested. |
Generate impression based on findings. | 57-year-old female with right thyroid nodule. Assess for change in size. RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 4.3 x 1.7 x 1.4 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 4.3 x 1.7 x 1.4 cm.ISTHMUS MEASUREMENTS: The isthmus measures 3.3 mm in thickness.RIGHT LOBE: The hypoechoic/spongiform nodule of the right lower thyroid pole measuring 0.6 x 0.4 x 0.6 cm is stable in size and appearance (prior 0.5 x 0.4 x 0.5 cm).LEFT LOBE: Normal homogeneous echotexture of the left thyroid lobe.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Similar-appearing left level 4 lymph node measuring 1.3 x 0.4 x 0.5 cm. A right level 3 lymph node containing a fatty hilum measures 2.5 x 0.7 x 1.3 cm.OTHER: No significant abnormality noted. | 1. Unchanged subcentimeter right thyroid nodule.2. Stable nondescript left level 4 lymph node. |
Generate impression based on findings. | Reason: ruq pain with nausea and vomiting for 3 weeks History: as above LIVER: The liver measures 14.4 cm in length. Unremarkable hepatic parenchymal echogenicity and echotexture. The portal vein is patent with normal directional hepatopedal flow, peak velocity is 34.3 cm/s. No focal mass.GALLBLADDER, BILIARY TRACT: The gallbladder is decompressed without evidence of shadowing stones or pericholecystic inflammation. The gallbladder wall measures 0.2 cm. The common bile duct measures 0.3 cm. No significant intrahepatic or extrahepatic biliary ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 10.1 cm in length. The left kidney measures 9.4 cm in length. Unremarkable renal parenchymal echogenicity and echotexture. No hydronephrosis. There is a small nonobstructive hyperechoic left mid pole renal calculus measuring up to 5 mm.OTHER: The spleen measures 9.0 cm in length. | 1. Small nonobstructive left renal stone. No hydronephrosis.2. No acute hepatobiliary abnormality. |
Generate impression based on findings. | Ms. Cope is a 66-year-old female who presents for six-month follow-up for focal asymmetry in the right upper inner breast. Three standard views of the right breast and additional right spot compression views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density (BiRads Density Category B), unchanged in pattern and distribution. The focal asymmetry in the right upper inner breast at posterior depth is again seen, questionably increased on ML spot view. Targeted right breast ultrasound was subsequently performed.ULTRASOUND | Focal asymmetry in the right breast at the 2:00 position with a low suspicion correlate hypoechoic lesion on ultrasound, for which ultrasound-guided biopsy is recommended. If a clear ultrasound correlate is not readily identified at the time of biopsy (or if clip placement does not correlate with the mammographic finding), stereotactic biopsy could be undertaken. Results and recommendations were discussed with the patient.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration. |
Generate impression based on findings. | 55-year-old female with known right breast malignancy and bilateral axillary lymphadenopathy currently undergoing neoadjuvant chemotherapy. Evaluate treatment response. Family history of ovarian carcinoma in her sister at age 45 and cervical cancer in her daughter and maternal niece. A targeted right ultrasound was performed for the areas of concern. At the 11 o'clock position of the right breast, 3 cm from the nipple there is an irregular hypoechoic mass measuring 2.1 x 1.2 x 3.2 cm (previously 4.0 x 3.6 x 3.4 cm). Mild peripheral vascularity is appreciated.At the 7 o'clock position of the right breast, 2 cm from the nipple, there is a 2.1 x 1.0 x 2.9 cm irregular hypoechoic mass with mild peripheral vascularity (previously 3.7 x 2.5 x 3.6 cm).Targeted ultrasound of the right axilla was performed, without evidence for adenopathy. The previously identified abnormal lymph nodes are not visualized on today's examination.A targeted left axillary ultrasound was performed for the area of concern. Two prominent lymph nodes are present in the left axilla, both demonstrating a hyperechoic appearance, and decreased in size from prior examination suggesting treatment response. The largest lymph node measures 1.9 x 1.0 x 1.7 cm. The second lymph node measures 1.9 x 0.9 x 0.8 cm. No submitted vascularity is associated with either lymph node. | 1. Decrease in size of two right breast masses, as above. 2. Nonvisualization of previously identified right axillary lymph nodes, suggesting response to therapy.3. Decrease in size of left axillary lymph nodes with treatment response. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on findings. | Ms. Salem is a 15 year old female status post left breast lumpectomy in February 2014 for a borderline Phyllodes tumor. She presents today for a short-term ultrasound follow-up to exclude recurrent disease. Upon physical exam of the left breast, a surgical scar is identified. No palpable masses are appreciated.Targeted left breast ultrasound was performed. Scar tissue and fibrosis is identified without discrete mass. No suspicious sonographic findings seen to suggest residual/recurrent tumor. | No sonographic evidence for residual or recurrent tumor. The patient is scheduled for a follow-up appointment with Dr. Chhablani on 6/11/2015. All results were discussed with the patient and her mother. BIRADS: 1 - Negative.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on findings. | Male 47 years old Reason: hx of kidney cancer, evaluate 2 other renal masses on right RIGHT KIDNEY: Multiple masses are again seen in the right kidney. Solid appearing inferior pole right renal nodule with what appears to be a hypoechoic capsule measures 2.2 x 2.3 x 2.5 cm, increased in size compared to the prior exam when it measured 1.8 x 1.4 x 1.7 cm. This inferior pole lesion was previously documented as enhancing on triple phase abdominal CT, and is concerning for malignancy. Slightly hypoechoic round superior pole nodule measures 2.9 x 2.1 x 3.0 cm. This nodule is likely not significantly changed. Anechoic renal cyst in the right superior pole measures 2.1 x 1.8 x 1.8 cm. Renal cortical echogenicity is within normal limits. No hydronephrosis or shadowing calculus.LEFT KIDNEY: The left kidney is not well visualized on today's exam. Renal cortical echogenicity is within normal limits. No hydronephrosis or shadowing calculus.OTHER: Bladder is distended and unremarkable. | Increase in size of solid appearing inferior pole right renal nodule, which has been previously documented as enhancing on CT. Findings are concerning for malignancy. Recommend dedicated renal CT to further evaluate. |
Generate impression based on findings. | 50-year-old male with hepatitis C Evaluate for hepatocellular carcinoma. LIVER: Liver is normal in size and mildly and coarsely echogenic. No focal hepatic mass is identified. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: Patient has had a cholecystectomy. Biliary tract is normal in caliber.PANCREAS: No significant abnormalities noted.SPLEEN: Poorly visualized but small.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted. | No evidence for hepatic mass. |
Generate impression based on findings. | 67-year-old male with multiple myeloma, renal disease, rising creatinine. RIGHT KIDNEY: Measures 11.7 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. LEFT KIDNEY: Measures 13.6 cm in length. Left renal cysts measuring up to 2.3 cm without discrete septation or solid component. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. URINARY BLADDER: Incompletely distended without focal abnormality. OTHER: No significant abnormalities noted. | 1. Increased renal echogenicity consistent with medical renal disease. 2. No nephrolithiasis, hydronephrosis, or suspicious mass lesion identified. |
Generate impression based on findings. | Hepatitis C. Evaluate for hepatocellular carcinoma. LIVER: Non-cirrhotic liver morphology. 18.3 cm in length. Unremarkable parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Status post cholecystectomy.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 10.0 cm in length. The left kidney is 10.9 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 12.1 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. | No suspicious hepatic lesion identified. |
Generate impression based on findings. | Reason: rule out infection of right arm fistula History: bacteremia, fever, vomiting In the region of the right biceps, there is a tubular structure compatible with patient's known brachial artery to axillary vein dialysis access graft (as seen on 2/9/2016 vascular ultrasound). No flow is seen within the graft. No drainable fluid collections are identified adjacent to the graft. | Thrombosed graft without evidence of adjacent drainable collection. |
Generate impression based on findings. | Reason: RUQ pain, evaluate for cholecystitis LIVER: The liver measures 17.0 cm in length. Normal hepatic parenchymal echogenicity and echotexture. The portal vein is patent with normal directional hepatopedal flow, peak velocity 19.4 cm/s.GALLBLADDER, BILIARY TRACT: The gallbladder is distended, however there are no shadowing stones or intraluminal sludge. No pericholecystic inflammation or fluid. No biliary ductal dilatation. Gallbladder wall measures 0.2 cm and the common bile duct measures 0.2 cm. Negative sonographic Murphy's sign.PANCREAS: No significant abnormalities noted. The pancreatic duct measures 0.13 cm.KIDNEYS: The right kidney measures 8.7 cm in length. The left kidney measures 9.7 cm in length. Echogenic renal parenchyma. No shadowing stones or hydronephrosis.OTHER: No ascites. | 1. Distended gallbladder without evidence of cholelithiasis, sludge, or acute inflammation.2. Echogenic kidneys, consistent with medical renal disease. |
Generate impression based on findings. | Hypothyroidism RIGHT LOBE MEASUREMENTS: 5 x 2.3 x 2.4 cmLEFT LOBE MEASUREMENTS: 5.2 x 2.3 x 1.9 cmISTHMUS MEASUREMENTS: 0.9 cmRIGHT LOBE: Heterogeneous gland. 0.6 x 0.6 x 0.6 cm calcified mid pole nodule.LEFT LOBE: Heterogeneous gland. 0.9 x 0.8 x 1.3 cm mostly cystic nodule lower pole left thyroidISTHMUS: Heterogeneous glandPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted. | Heterogeneous thyroid gland. Subcentimeter calcified right thyroid nodule. Mostly cystic left thyroid nodule as described. No regional adenopathy. |
Generate impression based on findings. | 22-year-old female with fever, elevated AST/ALT, alkaline phosphatase. Evaluate causes of abnormal LFT. LIVER: The liver is enlarged measuring 20.1 cm in length and is normal in echogenicity with no focal hepatic lesions. No intrahepatic biliary ductal dilatation.GALLBLADDER, BILIARY TRACT: Focal echogenic focus along the gallbladder wall with comet tail artifact compatible with focal adenomyoma. No sludge or gallstones. No pericholecystic fluid. Sonographic Murphy's sign is negative. No extrahepatic biliary ductal dilatation. The common duct measures 2 mm in caliber.PANCREAS: The distal body and tail of pancreas are obscured by overlying bowel gas. The remaining visualized pancreas is normal in echogenicity. No pancreatic ductal dilatation.RIGHT KIDNEY: The right kidney measures 11.5 cm in length with no hydronephrosis or nephrolithiasis. OTHER: The left kidney measures 11.9 cm in length with no hydronephrosis or nephrolithiasis. The spleen measures 12.4 cm in length, upper limits of normal. | 1. Hepatomegaly and borderline splenomegaly.2. Focal adenomyoma along the gallbladder wall. |
Generate impression based on findings. | 42 year old female who was recalled from screening mammogram for new left breast masses. No family history of breast cancer. LEFT DIAGNOSTIC MAMMMOGRAM: An ML view and three spot compression views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. There is redemonstration of a new 1.0 cm mass within the posterior upper inner left breast, which persists on spot compression imaging. Additionally, there is redemonstration of a 1.0 cm mass within the outer slightly inferior left breast, which persists on spot compression imaging.LEFT ULTRASOUND: On physical examination, no palpable lesions are identified.At the 10 o'clock position of the left breast, 4 cm from the nipple, there is a well-circumscribed anechoic cyst with posterior acoustic enhancement measuring 0.7 x 0.6 x 0.7 cm. A second simple appearing cyst is noted deep to this measuring 0.9 x 0.7 x 1.1 cm. This lesion likely corresponds to the new mammographic abnormality seen within the upper inner left breast. No significant vascularity associated with these lesions on Doppler imaging.At the 4 o'clock position of the left breast, 6 cm from the nipple, there is a circumscribed nearly anechoic cyst with posterior acoustic enhancement within the deep breast measuring 1.0 x 1.0 x 1.0 cm. This lesion is felt to correspond to the new mammographic mass seen within the outer slightly inferior breast. No significant vascularity is associated with this lesion on Doppler imaging. | Simple left breast cysts, corresponding to the new masses visualized on mammogram.No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Female 37 years old; Reason: New nodules? History: Thyroid cancer s/p surgery The patient is status post total thyroidectomy. No suspicious thyroid bed lesions are identified.LYMPH NODES: No suspicious adenopathy noted. There is a right level 2 lymph node that is slender with a fatty hilum and measures 1.7 cm x 0.5 cm x 1.0 cm. There is left level 2 lymph node with a fatty hilum that measures 1.6 cm x 0.6 cm x 0.9 cm. | Stable exam status-post thyroidectomy without evidence of residual or recurrent disease. No suspicious adenopathy is visualized. |