Professional Documents
Culture Documents
COMPARISON:[]
FINDINGS:GrayscaleandcolormodeimagingofRUQwasperformed.Liverisnormalechotextureandsize([]cminCC
dimension).Gallbladderdemonstratesnormalwallthicknessof[]mmwithoutcholelithiasisorpericholecyscuid.CBDmeasures
[]mmwhichisnormalforage.Hepacveinsarepatentandthereishepatopedalowwithinmainportalvein.Rightkidneymeasures
[]cminlengthwithouthydronephrosis.Pancreacbodyandtailarenotwellvisualizedduetoadjacentbowelgas.Negave
sonographicMurphys.TheleBkidneyandspleenwerenotinterrogatedonthisexam.
IMPRESSION:NormalRUQultrasoundwithoutevidenceforcholelithiasisoracutecholecyss.
ABDOMEN
COMPARISON:[]
FINDINGS:Grayscaleandcolormodeimagingofabdomenwasperformed.Liverisnormalechotextureandsize([]cminCC
dimension).[Nonspecicdiusehomogenouslyincreasedechotextureofliverresulngindecreasedvisualizaonofportaltriads
whichcanbeseeninseUngofdiusehepatocellulardiseasemostcommonlyfayinltraon.]Gallbladderdemonstratesnormalwall
thicknessof[]mmwithoutcholelithiasisorpericholecyscuid.CBDmeasures[]mmwhichisnormalforage.Hepacveinsarepatent
andthereishepatopedalowwithinmainportalvein.Rightkidneymeasures[]cmandleBkidney[]cminlengthwithout
hydronephrosis.Spleeninunremarkable(measuring[]cminlargestdimension).Pancreacbodyandtailarenotwellvisualizeddueto
adjacentbowelgas.NegavesonographicMurphys.
IMPRESSION:Normalabdominalultrasoundwithoutevidenceforcholelithiasisoracutecholecyss.[Fayliver.]
AORTA
COMPARISON:[]
FINDINGS:GrayscaleandcolormodeimagingofabdominalaortaandbilateralCIAwasperformed.APxTransmeasurementsareas
follow:
Proximalabdominalaorta[]x[]cm
Midabdominalaorta[]x[]cm
Distalabdominalaorta[]x[]cm
RightCIA[]cm
LeBCIA[]cm
Thereis[mild/mod]atherosclerocdisease.
IMPRESSION:Noabdominalaorcaneurysm.BilateralCIAappearnormal.[Mild/mod]atherosclerocdisease.
RENAL
COMPARISON:[]
FINDINGS:Grayscaleandcolormodeimagingofkidneysandbladderwasperformed.Rightkidneymeasures[]cmandleBkidney[]cm
inlength.Norenalcorcalthinningorabnormalparenchymalecogenicity.Nohydronephrosisorobviousnephrolithiasis.Pleasenote
thaturetersaregenerallynotassessedonultrasound.Bladderiswelldistendedwithbilateralureteraljetsvisualized.
IMPRESSION:Normalrenalultrasound.Nohydonephrosisorultrasonographicevidenceformedicalrenaldisease.[Mild/mod/severe]
[leB/right]hydronephrosiswithnoobstrucngstonevisualizedonultrasound.
PELVIC
COMPARISON:[]
FINDINGS:Grayscaleandcolor[doppler]imagingofthepelviswasperformedviatransabdominalandendovaginalapproaches.The
uterusisnormalinechotexturemeasuring[]x[]x[]cm([]ccvolume).Nofocalbroid.EMSishomogenousmeasuring[]mmin
thickness.[Nabothiancystsareseenwiththecervix.]Rightovarymeasures[]x[]x[]cm([]ccvolume)andtheleBovarymeasures
[]x[]x[]cm([]ccvolume).[Arterialandvenousowisconrmedwithinbothovariesusingspectralwaveformanalysis.]Noadnexal
mass.Nopelvicfreeuid.
IMPRESSION:Normalpelvicultrasound.
HYSTEROSONOGRAM
COMPARISON:pelvicultrasound[]
FINDINGS:Negavepregnancytestwasconrmedpriortoexam.Endometrialcanalwascannulatedwith[]frcatheterandballoonwas
inated.Underdirectendovaginalultrasoundguidance,[510]ccofNSwasinslledinasterilefashion.Theendometrialcavityis
adequatelydistendedanddemonstrates[].Attheendofexam,catheterballoonwasdeatedandtheloweruterinesegmentwas
interrogatedwhichalsoappearsnormal.
IMPRESSION:Successfulhysterosonogram[].
HERNIA
COMPARISON:[]
FINDINGS:Limitedultrasonographicevaluaonof[regionofinterest]wasperformedusingrealmegrayscaleandcolormodewith
andwithoutvalsalvamaneuvers[insupineanduprightposions].Noevidenceforfocalfascialdefectorherniaon.[Noperistalng
bowelisseenwithinherniasac].Also,nohyperemiaorsolid/cysclesioninregionofinterest.IMPRESSION:Noherniaelicitedduring
realmeexaminaonof[regionofinterest]despitevalsalvamaneuvers.
ASCITES
FINDINGS:Limited4quadrantabdominalultrasonographicevaluaonwasperformedinsupineposionforascitesevaluaon.Intra
abdominalsolidorganswerenotinterrogated.Thereis[minimal/mild/moderate/sig]intraabdominal[anechoic]ascites.LargestAP
dimensionofascicuidwithin4quadrantsareasfollows:RUQ[]cm,LUQ[]cm,RLQ[]cm,andLLQ[]cm.
IMPRESSION:[min/mild/mod/sig]intraabdominalasciteswithlargestpocketidenedinsupineposionwithin[quadrant]measuring
[]cminAPdimensionlocated[]cmdeepfromabdominalskinsurface.[IR/inpaentteam]noed.Ultrasonographicsupportfor
paracentesisavailableuponrequest.
THYROID
COMPARISON:[]
FINDINGS:Grayscaleandcolormodeimagingofthyroidglandwasperformed.Therightthyroidlobemeasures[]x[]x[]cm([]cc
volume)andtheleBthyroidlobe[]x[]x[]cm([]ccvolume).Theisthmusmeasures[]cminAPdimension.Normalthyroidechotexture
withoutfocalnodule.Noglandularhyperemia.
IMPRESSION:Normalthyroidultrasoundwithoutdiscretenodule.
THYROIDWITHNODULES
COMPARISON:[]
FINDINGS:Grayscaleandcolormodeimagingofthyroidglandwasperformed.
Therightthyroidlobemeasures[]x[]x[]cm([]ccvolume)andtheleBthyroidlobe[]x[]x[]cm([]ccvolume).Theisthmusmeasures[]cm
inAPdimension.[Noglandularhyperemia.]
Thyroidglandisdiuselyheterogeneousinechotexturewithmulplebilateralnodules.
Thereare[number]discrete/dominantnoduleswithin[right/leB]lobewhichinclude:
[]x[]x[]cm[locaon][illdened/wellcirc][ecogenicity][composioni.e.predominantlysolid/cyscormixedsolid/cysc]nodulewith
[microcalcicaons][nosignicantorminimalinternalow]
[]x[]x[]cmcysclesionwithincreasedthrutransmissioncontainingecogenicfociwithcomettailarfact(inspissatedcolloid)consistent
withb9colloidcyst
[]x[]x[]cmcyscnodulewithsolidmuralcomponent[withow][withoutow,suggesveofdebris].
Nocervicallymphadenopathyisappreciatedadjacenttothyroidgland.
IMPRESSION:Mulnodulargoiterwithnodulesdemonstrang[equivocalornospecicsuspicious]sonographicfeatures.Consider
followupultrasoundforsurveillancevsFNAofdominantnodulesifclinicalconcern.
[size][locaon]noduledemonstrangsuspiciousfeatures[]forwhichFNAisrecommendedtoexcludemalignancy.
THYROIDFNA
COMPARISON:[]
TECHNIQUE:Risks,benets,andpotenalcomplicaonswerediscussedwiththepaentandawrienconsentwasobtained.Skin
waspreppedanddrapedinausualsterilefashion.Localanesthesiawasobtainedusingsubcutaneous1%Lidocaineinjecon.Under
directultrasoundguidance,using[2225]gneedle,neneedleaspiraonswereperformedof[size][leB/right][sup/mid/inf]thyroid
nodule.[Mulple]sampleswereobtainedandadequacyofsampleswasconrmedbypathologistduringtheprocedure.No
immediatecomplicaon.
IMPRESSION:TechnicallysuccessfulpercutaneousFNAof[].[Paenttofollowupwithorderingprovider][PleaseseeCHCS]fornal
pathologyresults.
TESTICULAR
COMPARISON:[]
FINDINGS:Therighttessmeasures[]x[]x[]cmandtheleBtess[]x[]x[]cm.Bilateraltessarenormalinechotexturewithoutfocal
intratescularmass.Therightepididymalheadmeasures[]x[]cmandleBepididymalmeasures[]x[]cm.Noepididymalheadcystor
spermatocele.Nohydroceleorvaricocele(despitevalsalva)noted.Arterialandvenousowisconrmedwithinbilateraltestesusing
spectralwaveformanalysis.
IMPRESSION:Nointra/extratescularmass.
ANALSPHINCTER
HISTORY:[fecalinconnences/pepisiotomy].
FINDINGS:transversegrayscaleendorectalimagingoftheanalcanalwasperformed.Thereisintacthomogenously
hyperechoicexternalsphinctermeasuring[]mminthickness.Also,intacthomogenouslyhypoechoicinternalanal
sphinctermeasuring[]mminthickness.Nofocaldefect,ssure,ormass.
IMPRESSION:Normalinternalandexternalanalsphincter.
CAROTIDS
COMPARISON:[]
FINDINGS:grayscale,color,andspectraldoppleranalysisofbilateralcommonandinternalcarodarterieswas
performedusinglineartransducer.Peaksystolicvelociesincm/sarereported.
RIGHTCAROTID:
RightCCA[range]
RightproximalICA[],midICA[],distalICA[]
RightICA/CCArao[]
LEFTCAROTID:
LeBCCA[range]
LeBproximalICA[],midICA[],distalICA[]
LeBICA/CCArao[]
[Mild/mod]carodbulbatherosclerocplaque.BilateralECAarepatent.Bilateralvertebralarteriesdemonstrate
antegradeow.
IMPRESSION:
NohemodynamicallysignicantowlimingstenosisofbilateralICA.
[Mild/mod]atherosclerocplaque.
Antegradeowwithinbilateralvertebralarteries.
LOWERDVT
COMPARISON:[]
FINDINGS:Grayscaleandcolordopplerimagingofthe[right/leB]lowerextremitywasperformedfromthecommonfemoralvein
throughpoplitealveinattheconuenceofthedeepveinsofthecalf,withandwithoutcompression.Imagesshowcomplete
compressibilityofthedeepveinsandnoevidenceofthrombus.Spectralwaveformsofcommonfemoralandpoplitealveinsshow
normalrespiratoryvariaon/phasicity,andresponsetoaugmentaon.Otherthanattheirconuencewiththepoplitealvein,thebial
veinsandperonealveinsofthecalfwerenotspecicallyinterrogated.Visualizedporonoftheprofundaveinshowsnoevidenceof
thrombus.
Limitedevaluaonofthecontralateral[leB/right]commonfemoralveinrevealsnormalrespiratoryvariaon/phasicityandresponseto
augmentaon.
IMPRESSION:Noevidenceof[right/leB]lowerextremityDVT.
UPPERDVT
COMPARISON:[]
FINDINGS:Grayscaleandcolordopplerimagingofthe[right/leB]upperextremitywasperformedwithandwithoutcompression.
Imagesshowcompletecompressibilityofthedeepveins(brachial,axillary,andinternaljugular)andsupercialveins(cephalic,basilica)
withnoevidenceofthrombus.Spectralwaveformsofthesubclavianandinternaljugularveinsshownormalrespiratory
variaon/phasicityandcardiacpulsality.BrachiocephalicveinandSVCcannotbeinterrogated.
IMPRESSION:Noevidenceof[right/leB]upperextremityDVT.
VIABILITY
HISTORY:[symptoms].bHCG[level].
FINDINGS:Thereisasingledoubledecidualgestaonalsacwithin[uterinefundus].Yolksacisnormalandmeasures[]mm.
[Embryonicpoleisseenwithintheamnion].Meangestaonsacdiameterof[]mmwhichcorrespondstoesmatedgestaonalage
of[]wks[]days+/[]days.Thecrownrumplengthis[]mm,whichcorrelatestoesmatedgestaonalageof[]wks
[]days+/[]days.[Noembryoniccardiacacvityatthisme].Embryoniccardiacacvityat[]bpm.Noperigestaonalhemorrhageis
seen.Cervixisclosed.
Rightovarymeasures[]x[]x[]cmandtheleBovaryis[]x[]x[]cm.[Normalovarianarterialandvenousowwaveforms.]Noadnexal
massorfreeuid.
IMPRESSION:
[Early]singlelivingintrauterinepregnancyat[]wks[]days+/[]daysby[Gsac/CRL]measurement.
Lackofdetectable[embryo/FCA]atthismeismostlikelydueto[earlypregnancyforwhichshorttermfollowupultrasoundis
recommendedtoestablishviablepregnancy].
Ultrasounddatesare[dis/concordant]withclinicaldatesbasedonLMPwhichpredictsageof[]wks[]days.[PaentisunsureofLMP].
[Size]subchorionichemorrhage.
DATINGu/s
HISTORY:LMP[date]predicng[]wks[]dayswithEDDof[date]
COMPARISON:[]
FINDINGS:Imagesshowsingle,wellformedintrauterinegestaonalsaccontainingaliving[fetus/embryo<9wks].Yolksacmeasures
[]mm.Thecrownrumplengthis[]mm,whichcorrelatestoesmatedgestaonalageof[]wks[]days+/[]days.[Fetal/embryonic]
cardiacacvityat[]bpm.Theplacentaisforming[anteriorly/posteriorly].Noperigestaonalhemorrhageisseen.Cervixis
closed.Rightovarymeasures[]x[]x[]cmandtheleBovaryis[]x[]x[]cm.Noadnexalfreeuid.
IMPRESSION:
Singlelivingintrauterinefetuswithesmatedgestaonalageof[]wks[]days+/[]daysbasedoncrownrumplength.This
is[dis/concordant]withclinicaldatesbasedonLMPwhichpredictsageof[]wks[]days.
Normalbilateralovariesandadnexa.
Ifthereisdiscordance(seechartbelow)andstatetheEDDbasedonCRLoftodaysexamis[].Forredang,ifexpectedGAis(column
one)andtheultrasoundageisoby(column2),thentheyarediscordantandredate
GAREDATEIF
<7weeks>/=5dayso
812weeks>/=7dayso
1218weeks>/=10dayso
1830weeks>/=14dayso
>30weeks>/=21dayso
ANATOMYu/s
HISTORY:(IncludetheEDDandwhatitisbasedon,ifavailableeg.LMP,concordant/discordant1sttrimesterUSetc).
COMPARISON:[1sttrimesteru/s]
FINDINGS:Asinglelivingintrauterinefetusispresentin[]posion.Thecervixis[]cminlengthandclosed.Theplacentais[],and
normalinappearance.Cervixtoplacentadistanceis[].Thereisnoprevia.Fetalcardiacacvityisdocumentedat[]bpm.Amnioc
uidlevelissubjecvelynormal.
BIOMETRY:Biparietaldiameter(BPD)is[]cmwhichcorrespondsto[]w[]d,headcircumferenceis[]cmwhichcorrespondsto[]w[]d,
abdominalcircumferenceis[]cmwhichcorrespondsto[]w[]d,andfemorallengthis[]cmwhichcorrespondsto[]w[]d.Composite
ultrasoundesmatedgestaonalageis[]w[]d+/[]w[]d.[Headtoabdominalcircumferenceraoisnormal.]Esmatedfetalweight
of[]g+/[]gwhichis[]thpercenleperHadlock.
Measurement(cm)Gestaonalage
Headcircumference(HC):[]
Biparietaldiameter(BPD):[]
Abdominalcircumference(AC):[]
Femurlength(FL):[]
RaoNormalrange
HC/AC:[][][]
FL/AC:[][][]
FL/BPD:[][][]
Averageultrasoundage:[]wks[]days+/[]
ExpectedagebasedonLMPof:[]wks[]days
Expectedagebasedondangultrasound:[]wks[]days
Esmatedfetalweight(Hadlock):[]g+/[]g
Esmatedfetalweightpercenle:[]th%ile
ANATOMY:Supratentorialbrain(ventricles,choroid,cavumseptumpellucidum),infratentorialbrain(cerebellum,posteriorfossa),
nuchalskinfoldthickness,noseandlips,heart(fourchamberview,LVOT,RVOT),stomach,kidneys,bladder,3vesselcord,cord
inseron,spineinlongandtransverseplanes,andextremieswereevaluatedandisnormal.
Inadequatevisualizaon/evaluaonoffetal[anatomy]secondarytofetalposion.
IMPRESSION:
Single,liveintrauterinepregnancyin[posion]at[]wks[]daysgestaonalagebasedonEDDof[date],aspreviouslyestablishedby
[LMPorrsttrimesterultrasoundorclinicalhistory].Ultrasoundtodayshows[appropriateinterval]growthwithesmatedultrasound
ageat[]wks[]days+/[]days.Fetalweightat[]thpercenlebyHadlock.
Fetalanatomyisadequatelyvisualizedandisnormal.
Incompletefetalanatomyevaluaondueto[maternalbodyhabitusandfetalposioning].Wewillrecallpaentforaddionalimaging
of[].
ADDITIONALANATOMY
HISTORY:[]
COMPARISON:[anatomyscan]
FINDINGS/IMPRESSION:Supplementalimagingwasperformedasanadjuncttopreviouslyincompletefetalanatomicsurveyonsecond
trimesterultrasounddated[].[anatomy]wasadequatelyvisualizedandisnormal.Inconjunconwithprioranatomyultrasound,this
completes[normal]fetalanatomicsurvey.
GROWTHu/s
HISTORY:[clinicalindicaon].EDDof[date].
COMPARISON:[anatomyscan]
FINDINGS:Asinglelivingintrauterinefetusispresentin[]posion.Thecervixis[]cminlengthandclosed.Theplacentais[],and
normalinappearance.Cervixtoplacentadistanceis[].Thereisnoprevia.Fetalcardiacacvityisdocumentedat[]bpm.Amnioc
uidlevelis[]cmwhichisbetween[][]th%ileforgestaonage.
BIOMETRY:Biparietaldiameter(BPD)is[]cmwhichcorrespondsto[]w[]d,headcircumferenceis[]cmwhichcorrespondsto[]w[]d,
abdominalcircumferenceis[]cmwhichcorrespondsto[]w[]d,andfemorallengthis[]cmwhichcorrespondsto[]w[]d.Composite
ultrasoundesmatedgestaonalageis[]w[]d+/[]w[]d.[Headtoabdominalcircumferenceraoisnormal.]Esmatedfetalweight
of[]g+/[]gwhichis[]thpercenleperHadlock.
Measurement(cm)Gestaonalage
Headcircumference(HC):[]
Biparietaldiameter(BPD):[]
Abdominalcircumference(AC):[]
Femurlength(FL):[]
RaoNormalrange
HC/AC:[][][]
FL/AC:[][][]
FL/BPD:[][][]
Averageultrasoundage:[]wks[]days+/[]
ExpectedagebasedonLMPof:[]wks[]days
Expectedagebasedondangultrasound:[]wks[]days
Esmatedfetalweight(Hadlock):[]g+/[]g
Esmatedfetalweightpercenle:[]th%ile
IMPRESSION:
Single,liveintrauterinepregnancyin[posion]at[]wks[]daysgestaonalagebasedonEDDof[date],aspreviouslyestablishedby
[LMPorrsttrimesterultrasoundorclinicalhistory].Ultrasoundtodayshows[appropriateinterval]growthwithesmatedultrasound
ageat[]wks[]days+/[]days.
Fetalweightat[]thpercenlebyHadlock.
AFIisbetween[][]thpercenleforgestaonage.
Pedsabdomen
FINDINGS:
Pyloricstenosis=Realmeultrasoundimagingofgastricpylorusshows[nofocalstenosisorspasm][abnormalhypertrophyand
resultantstenosisofpyloricchannelwithpyloricchannellength>17mmandpyloricmusclethickness>3mm].[Nopyloricrelaxaonor
peristalsistosuggesttransientpylorospasm].
Intussuscepon=Realmeultrasoundsurveyofabdomendemonstratesnospecicndingsofintussuscepon.Thereisfocaltarget
signappearanceofbowelwithin[quadrant]withconcentricecogenicandhypoechoicringsconsistentwithintussuscepon.
Appendicis=Realmelimitedultrasoundsurveyofrightlowerquadrantinregionofpaentspain[failstodetecttheappendix]
[showsadilatednoncompressibleblindendingtubularstructurewithhyperemiaconsistentwithinamedappendix].Nofocalfree
uidorabscess.IMPRESSION:Appendixnotvisualizedonultrasoundthereforeequivocalforappendicis,considerlowdoseCTscan.
Hipultrasound
FINDINGS:Realmetransverseandcoronaldynamicbilateralhipultrasoundwasperformedin[exed]posion.Thereisgood
coverageofbilateralfemoralheadsbyacetabuli.Alphaangleis[60deg]ontheleBand[60deg]ontheright.Nohipdislocaonor
subluxaondespitestressmaneuvers.[Mildphysiologiclaxity].[Nopulvinarnotedinterposedbetweenfemoralheadand
acetabulum].Nohipeusion.
IMPRESSION:Normalbilateralhipultrasound.
Neonatalheadultrasound
FINDINGS:Neonatalheadultrasoundwasperformedinsagialandcoronalprojeconsviaanteriorfontanelle.Ventriclesandsulciare
unremarkable.Nosubependymal(gradeIIVgerminalmatrixatcaudothalamicgroove),intraventricular,orintracerebral
hemorrhage.Nohydrocephalusorperiventricularleukomalacia(PVL).Echotextureofbrainparenchymaespeciallyperiventricular
whitemaerisnormal.[Prominentsubarchanoidspaces4mmmeasuredincoronalviewatlevelofforamenofMonroe;
interhemisphericssure6mm].Nocongenitalanomalies.
IMPRESSION:Normalneonatalheadultrasound.
Neonatalspineultrasound
FINDINGS:Realmeultrasoundexaminaonofneonatallumbosacralspineinlongitudinalandtransverseplaneswithbabyinprone
posion.Spineisvisualizedfrom[L1]through[sacrum].Distalspinalcordandnerverootsarenormalinappearanceandfreely
mobile.Conusmedullaristerminates[normallyatoraboveL23diskspace]andisnormalinappearancewithoutevidencefor
tethering.Thecalsacterminatesat[S2]withlumterminalemeasuring[<2mminthickness.Noabnormalcyst/mass,meningocele,
lipoma,orsinustract.Visualizedosseousstructuresarenormalwithoutspinaldysraphism.Noabnormalskinlesion(sacrococcygeal
dimple,hairpatch,orhamngioma)isnotedonphysicalexam.
IMPRESSION:Unremarkableexaminaonoflumbosacralspinewithoutevidenceforspinabidaortetheredcord.
LiverTransplant
HISTORY:[]
COMPARISON:[]
FINDINGS:grayscale,color,andspectraldopplerultrasoundexaminaonoftransplantliverwasperformed.
LiverParenchyma
Echogenicity:[normal][increased]
Focallesions:[]
Fluidcollecons:[]
Bileducts:[]
HepacVasculature
Portalveinwaveformsanddireconofow:[]
Portalveinvelocies:main[],right[],leB[]
Hepacveinwaveforms:[normal][dampened]
Hepacveinvelocies:right[],middle[],leB[]
Hepacarteryvelociesandresisveindices:main[],right[],leB[]
Misc
InferiorVenaCava:[patent]
SplenicVeinvelocity:[]
Intraabdominalfreeuid:[]
Other:[]
IMPRESSION:Normalhepactransplantwithoutcomplicaon.
RenalTransplant
HISTORY:[]
COMPARISON:[]
FINDINGS:grayscale,color,andspectraldopplerultrasoundexaminaonof[right/leB]lowerquadranttransplantkidneywas
performed.
FINDINGS:
TransplantKidney
Echogenicity:[]
Focallesions:[]
Hydronephrosis:[present][absent]
Peritransplantuid:[]
Vasculature
Intrarenalarterialwaveforms:[normal]
Resisveindices:[]
Mainrenalandiliacvessels:[patent]
Bladder
[distended][contracted]
Other
[]
IMPRESSION:Normalrenaltransplantwithoutcomplicaon.