RUQ
COMPARISON: []
FINDINGS: Gray scale and color
mode imaging of RUQ was performed.
Liver is normal echotexture and size ([]cm in CC dimension). Gallbladder demonstrates normal wall
thickness of []mm without cholelithiasis or pericholecystic fluid. CBD measures []mm which is normal for age. Hepatic veins are patent and there is
hepatopedal flow within main portal vein.
Right kidney measures []cm in length without hydronephrosis. Pancreatic body and tail are not well
visualized due to adjacent bowel gas.
Negative sonographic Murphy’s.
The left kidney and spleen were not interrogated on this exam.
IMPRESSION: Normal RUQ ultrasound
without evidence for cholelithiasis or acute cholecystitis.
ABDOMEN
COMPARISON: []
FINDINGS: Gray scale and color
mode imaging of abdomen was performed.
Liver is normal echotexture and size ([]cm in CC dimension). [Non-specific diffuse homogenously
increased echotexture of liver resulting in decreased visualization of portal
triads which can be seen in setting of diffuse hepatocellular disease most
commonly fatty infiltration.]
Gallbladder demonstrates normal wall thickness of []mm without cholelithiasis
or pericholecystic fluid. CBD measures
[]mm which is normal for age. Hepatic
veins are patent and there is hepatopedal flow within main portal vein. Right kidney measures []cm and left kidney
[]cm in length without hydronephrosis.
Spleen in unremarkable (measuring []cm in largest dimension). Pancreatic body and tail are not well
visualized due to adjacent bowel gas.
Negative sonographic Murphy’s.
IMPRESSION: Normal abdominal
ultrasound without evidence for cholelithiasis or acute cholecystitis. [Fatty liver.]
AORTA
COMPARISON: []
FINDINGS: Gray scale and color
mode imaging of abdominal aorta and bilateral CIA was performed. AP x Trans measurements are as follow:
Proximal abdominal aorta []x[]cm
Mid abdominal aorta []x[]cm
Distal abdominal aorta []x[]cm
Right CIA
[]cm
Left CIA
[]cm
There is [mild/mod]
atherosclerotic disease.
IMPRESSION: No abdominal aortic
aneurysm. Bilateral CIA appear
normal. [Mild/mod] atherosclerotic
disease.
RENAL
COMPARISON: []
FINDINGS: Gray scale and color
mode imaging of kidneys and bladder was performed. Right kidney measures []cm and left kidney
[]cm in length. No renal cortical
thinning or abnormal parenchymal ecogenicity.
No hydronephrosis or obvious nephrolithiasis. Please note that ureters are generally not
assessed on ultrasound. Bladder is
well distended with bilateral ureteral jets visualized.
IMPRESSION: Normal renal
ultrasound. No hydonephrosis or
ultrasonographic evidence for medical-renal disease. [Mild/mod/severe]
[left/right] hydronephrosis with no obstructing stone visualized on
ultrasound.
PELVIC
COMPARISON: []
FINDINGS: Gray scale and color
[doppler] imaging of the pelvis was performed via transabdominal and
endovaginal approaches. The uterus is
normal in echotexture measuring []x[]x[]cm ([]cc volume). No focal fibroid. EMS is homogenous measuring []mm in
thickness. [Nabothian cysts are seen
with the cervix.] Right ovary measures
[]x[]x[]cm ([]cc volume) and the left ovary measures []x[]x[]cm ([]cc
volume). [Arterial and venous flow is
confirmed within both ovaries using spectral waveform analysis.] No adnexal mass. No pelvic free-fluid.
IMPRESSION: Normal pelvic
ultrasound.
HYSTEROSONOGRAM
COMPARISON: pelvic ultrasound
[]
FINDINGS: Negative pregnancy
test was confirmed prior to exam.
Endometrial canal was cannulated with []fr catheter and balloon was
inflated. Under direct endovaginal
ultrasound guidance, [5-10]cc of NS was instilled in a sterile fashion. The endometrial cavity is adequately
distended and demonstrates []. At the
end of exam, catheter balloon was deflated and the lower uterine segment was
interrogated which also appears normal.
IMPRESSION: Successful
hysterosonogram [].
HERNIA
COMPARISON: []
FINDINGS: Limited ultrasonographic evaluation of [region
of interest] was performed using real-time gray-scale and color mode with and
without valsalva maneuvers [in supine and upright positions]. No evidence for focal fascial defect or
herniation. [No peristalting bowel is
seen within hernia sac]. Also, no
hyperemia or solid/cystic lesion in region of interest.IMPRESSION: No hernia
elicited during real-time examination of [region of interest] despite
valsalva maneuvers.
ASCITES
FINDINGS: Limited 4quadrant
abdominal ultrasonographic evaluation was performed in supine position for
ascites evaluation. Intra-abdominal
solid organs were not interrogated.
There is [minimal/mild/moderate/sig] intra-abdominal [anechoic]
ascites. Largest AP dimension of
ascitic fluid within 4 quadrants are as follows: RUQ []cm, LUQ []cm, RLQ
[]cm, and LLQ []cm.
IMPRESSION: [min/mild/mod/sig]
intra-abdominal ascites with largest pocket identified in supine position
within [quadrant] measuring []cm in AP dimension located []cm deep from
abdominal skin surface. [IR/inpatient
team] notified. Ultrasonographic
support for paracentesis available upon request.
THYROID
COMPARISON: []
FINDINGS: Gray scale and color
mode imaging of thyroid gland was performed.
The right thyroid lobe measures []x[]x[]cm ([]cc volume) and the left
thyroid lobe []x[]x[]cm ([]cc volume).
The isthmus measures []cm in AP dimension. Normal thyroid echotexture without focal
nodule. No glandular hyperemia.
IMPRESSION: Normal thyroid
ultrasound without discrete nodule.
THYROID WITH NODULES
COMPARISON: []
FINDINGS: Gray scale and color
mode imaging of thyroid gland was performed.
The right thyroid lobe measures
[]x[]x[]cm ([]cc volume) and the left thyroid lobe []x[]x[]cm ([]cc
volume). The isthmus measures []cm in
AP dimension. [No glandular hyperemia.]
Thyroid gland is diffusely
heterogeneous in echotexture with multiple bilateral nodules.
There are [number]
discrete/dominant nodules within [right/left] lobe which include:
[]x[]x[]cm [location]
[ill-defined/well-circ] [ecogenicity][composition i.e. predominantly
solid/cystic or mixed solid/cystic] nodule with [microcalcifications][no
significant or minimal internal flow]
[]x[]x[]cm cystic lesion with
increased thru-transmission containing ecogenic foci with comet-tail artifact
(inspissated colloid) consistent with b9 colloid cyst
[]x[]x[]cm cystic nodule with
solid mural component [with flow] [without flow, suggestive of debris].
No cervical lymphadenopathy is
appreciated adjacent to thyroid gland.
IMPRESSION: Multinodular goiter
with nodules demonstrating [equivocal or no specific suspicious] sonographic
features. Consider follow-up
ultrasound for surveillance vs FNA of dominant nodules if clinical concern.
[size] [location] nodule
demonstrating suspicious features [] for which FNA is recommended to exclude
malignancy.
THYROID FNA
COMPARISON: []
TECHNIQUE: Risks, benefits, and potential
complications were discussed with the patient and a written consent was
obtained. Skin was prepped and draped
in a usual sterile fashion. Local
anesthesia was obtained using subcutaneous 1% Lidocaine injection. Under direct ultrasound guidance, using
[22-25]g needle, fine needle aspirations were performed of
[size][left/right][sup/mid/inf] thyroid nodule. [Multiple] samples were obtained
and adequacy of samples was confirmed by pathologist during the
procedure. No immediate complication.
IMPRESSION: Technically
successful percutaneous FNA of [].
[Patient to follow-up with ordering provider][Please see CHCS] for
final pathology results.
TESTICULAR
COMPARISON: []
FINDINGS: The right testis
measures []x[]x[]cm and the left testis []x[]x[]cm. Bilateral testis are normal in echotexture
without focal intra-testicular mass. The right epididymal head measures
[]x[]cm and left epididymal measures []x[]cm.
No epididymal head cyst or spermatocele. No hydrocele or varicocele (despite
valsalva) noted. Arterial and venous
flow is confirmed within bilateral testes using spectral waveform analysis.
IMPRESSION:
No intra/extra-testicular mass.
ANAL SPHINCTER
HISTORY:
[fecal incontinence s/p episiotomy].
FINDINGS: transverse gray scale endorectal imaging of
the anal canal was performed. There is
intact homogenously hyperechoic external sphincter measuring []mm in
thickness. Also, intact homogenously
hypoechoic internal anal sphincter measuring []mm in thickness. No focal defect, fissure, or mass.
IMPRESSION:
Normal internal and external anal sphincter.
CAROTIDS
COMPARISON:
[]
FINDINGS:
gray scale, color, and spectral doppler analysis of bilateral common and
internal carotid arteries was performed using linear transducer. Peak
systolic velocities in cm/s are reported.
RIGHT
CAROTID:
Right
CCA [range]
Right
proximal ICA[], mid ICA [], distal ICA []
Right
ICA /CCA ratio []
LEFT
CAROTID:
Left
CCA [range]
Left
proximal ICA[], mid ICA [], distal ICA []
Left
ICA /CCA ratio []
[Mild/mod]
carotid bulb atherosclerotic plaque.
Bilateral ECA are patent.
Bilateral vertebral arteries demonstrate antegrade flow.
IMPRESSION:
No
hemodynamically significant flow-limiting stenosis of bilateral ICA.
[Mild/mod]
atherosclerotic plaque.
Antegrade
flow within bilateral vertebral arteries.
LOWER DVT
COMPARISON: []
FINDINGS:
Grayscale and color doppler imaging of the [right/left] lower extremity was performed from the common
femoral vein through popliteal vein at the confluence of the deep veins of
the calf, with and without compression. Images show complete compressibility
of the deep veins and no evidence of thrombus. Spectral waveforms of common
femoral and popliteal veins show normal respiratory variation/phasicity, and
response to augmentation. Other than at their confluence with the popliteal
vein, the tibial veins and peroneal veins of the calf were not specifically
interrogated. Visualized portion of the profunda vein shows no evidence of
thrombus.
Limited
evaluation of the contralateral [left/right] common femoral vein reveals
normal respiratory variation/phasicity and response to augmentation.
IMPRESSION: No evidence of [right/left] lower extremity DVT.
UPPER DVT
COMPARISON: []
FINDINGS:
Grayscale and color doppler imaging of the [right/left] upper extremity was performed with and without
compression. Images show complete compressibility of the deep veins
(brachial, axillary, and internal jugular) and superficial veins (cephalic,
basilica) with no evidence of thrombus.
Spectral waveforms of the subclavian and internal jugular veins show
normal respiratory variation/phasicity and cardiac pulsatility.
Brachiocephalic vein and SVC cannot be interrogated.
IMPRESSION: No evidence of [right/left] upper extremity DVT.
VIABILITY
HISTORY: [symptoms].
bHCG [level].
FINDINGS: There is a single double-decidual
gestational sac within [uterine fundus].
Yolk sac is normal and
measures []mm. [Embryonic pole is seen within the amnion]. Mean gestation sac diameter of []mm which
corresponds to estimated
gestational age of []wks []days +/-
[]days. The crown rump length is []mm, which
correlates to estimated
gestational age of []wks []days +/-
[]days. [No embryonic cardiac activity at this time].
Embryonic cardiac activity at []bpm.
No perigestational hemorrhage is seen. Cervix is closed.
Right ovary measures []x[]x[]cm
and the left ovary is []x[]x[]cm.
[Normal ovarian arterial and venous flow waveforms.] No adnexal mass or free fluid.
IMPRESSION:
[Early]
single living intrauterine pregnancy at []wks []days +/- []days by
[G-sac/CRL] measurement .
Lack of
detectable [embryo/FCA] at this time is most likely due to [early pregnancy
for which short-term follow-up ultrasound is recommended to establish viable
pregnancy].
Ultrasound dates are [dis/concordant] with clinical dates
based on LMP which predicts age of []wks []days. [Patient is unsure of LMP].
[Size] subchorionic hemorrhage.
DATING u/s
HISTORY: LMP [date] predicting []wks[]days
with EDD of [date]
COMPARISON:
[]
FINDINGS: Images show single, well formed
intrauterine gestational sac containing a living [fetus/embryo <9wks]. Yolk sac measures []mm. The crown rump length is []mm, which
correlates to estimated
gestational age of []wks []days +/-
[]days. [Fetal/ embryonic] cardiac activity at []bpm.
The placenta is forming [anteriorly/posteriorly].
No perigestational hemorrhage is seen. Cervix is closed. Right ovary measures []x[]x[]cm and the
left ovary is []x[]x[]cm. No
adnexal free fluid.
IMPRESSION:
Single living intrauterine fetus with estimated gestational age of []wks[]days
+/- []days based on crown rump length. This is [dis/concordant] with clinical dates based on LMP which
predicts age of []wks []days.
Normal
bilateral ovaries and adnexa.
If there is discordance (see chart below) and state the
EDD based on CRL of today’s
exam is []. For
redating, if expected GA is (column one) and the ultrasound age is off by
(column 2), then they are discordant and re-date
GA
RE-DATE
IF
<7 weeks
>/=5
days off
8-12 weeks
>/=7
days off
12-18 weeks
>/=10
days off
18-30 weeks
>/=14
days off
>30 weeks
>/=21
days off
ANATOMY u/s
HISTORY:
(Include the EDD and what it is based
on, if available – eg. LMP, concordant/discordant 1st trimester US
etc).
COMPARISON: [1st trimester u/s]
FINDINGS:
A single living intrauterine fetus is present in []
position. The cervix is []cm in length and closed. The placenta is [], and normal in
appearance. Cervix to
placenta distance is []. There is no
previa. Fetal cardiac activity is documented at []bpm.
Amniotic fluid level is subjectively normal .
BIOMETRY: Biparietal diameter (BPD) is []cm which corresponds to []w []d,
head circumference is []cm which corresponds to []w []d, abdominal
circumference is []cm which corresponds to []w []d, and femoral length is
[]cm which corresponds to []w []d.
Composite ultrasound estimated gestational age is []w []d +/- []w
[]d. [Head to abdominal circumference
ratio is normal.] Estimated fetal weight of []g +/- []g which is []th
percentile per Hadlock.
Measurement (cm) Gestational
age
Head circumference (HC):
[]
Bi-parietal diameter (BPD):
[]
Abdominal circumference (AC): []
Femur length (FL):
[]
Ratio
Normal range
HC/AC:
[]
[]-[]
FL/AC:
[] []-[]
FL/BPD: []
[]-[]
Average ultrasound age:
[]
wks []days +/- []
Expected age based on LMP of:
[]
wks []days
Expected age based on dating ultrasound:
[]
wks []days
Estimated fetal weight
(Hadlock): []g +/- []g
Estimated fetal weight percentile: []th %ile
ANATOMY:
Supratentorial brain (ventricles, choroid, cavum septum pellucidum), infratentorial
brain (cerebellum, posterior fossa),
nuchal skin fold thickness, nose and
lips, heart (four chamber view, LVOT, RVOT), stomach, kidneys, bladder, 3
vessel cord, cord insertion, spine in long and transverse planes, and
extremities were evaluated and is normal.
Inadequate
visualization/evaluation of fetal [anatomy] secondary to fetal position.
IMPRESSION:
Single,
live intrauterine pregnancy
in [position] at []wks []days
gestational age based on EDD
of [date], as previously established by [LMP or first
trimester ultrasound or
clinical history]. Ultrasound today shows [appropriate
interval] growth with estimated ultrasound age at
[]wks []days +/- []days. Fetal weight at
[]th percentile by Hadlock.
Fetal anatomy is adequately
visualized and is normal.
Incomplete fetal anatomy
evaluation due to [maternal body habitus and fetal positioning]. We will recall patient for additional
imaging of [].
ADDITIONAL ANATOMY
HISTORY:
[]
COMPARISON:
[anatomy scan]
FINDINGS/IMPRESSION:
Supplemental imaging was performed as an adjunct to previously incomplete
fetal anatomic survey on second trimester ultrasound dated []. [anatomy] was adequately visualized and is
normal. In conjunction with prior
anatomy ultrasound, this completes [normal] fetal anatomic survey.
GROWTH u/s
HISTORY: [clinical indication]. EDD of [date].
COMPARISON: [anatomy scan]
FINDINGS:
A single living intrauterine fetus is present in []
position. The cervix is []cm in length and closed. The placenta is [], and normal in
appearance. Cervix to
placenta distance is []. There is no
previa. Fetal cardiac activity is documented at []bpm.
Amniotic fluid level is []cm which is between []-[]th %ile for
gestation age.
BIOMETRY: Biparietal diameter (BPD) is []cm which corresponds to []w []d,
head circumference is []cm which corresponds to []w []d, abdominal
circumference is []cm which corresponds to []w []d, and femoral length is
[]cm which corresponds to []w []d.
Composite ultrasound estimated gestational age is []w []d +/- []w
[]d. [Head to abdominal circumference
ratio is normal.] Estimated fetal weight of []g +/- []g which is []th
percentile per Hadlock.
Measurement (cm) Gestational
age
Head circumference (HC):
[]
Bi-parietal diameter (BPD):
[]
Abdominal circumference (AC): []
Femur length (FL):
[]
Ratio
Normal range
HC/AC:
[]
[]-[]
FL/AC:
[] []-[]
FL/BPD: []
[]-[]
Average ultrasound age:
[]
wks []days +/- []
Expected age based on LMP of:
[]
wks []days
Expected age based on dating ultrasound:
[]
wks []days
Estimated fetal weight
(Hadlock): []g +/- []g
Estimated fetal weight percentile: []th %ile
IMPRESSION:
Single,
live intrauterine pregnancy
in [position] at []wks []days
gestational age based on EDD
of [date], as previously established by [LMP or first
trimester ultrasound or
clinical history]. Ultrasound today shows [appropriate
interval] growth with estimated ultrasound age at []wks []days +/- []days.
Fetal weight at []th percentile
by Hadlock.
AFI
is between []-[]th percentile for gestation age.
Peds abdomen
FINDINGS:
Pyloric
stenosis=Real time ultrasound imaging of gastric pylorus shows [no focal
stenosis or spasm] [abnormal
hypertrophy and resultant stenosis of pyloric channel with pyloric channel
length >17mm and pyloric muscle thickness >3mm]. [No pyloric relaxation or peristalsis to
suggest transient pylorospasm].
Intussusception=Real
time ultrasound survey of abdomen demonstrates no specific findings of intussusception. There is focal target sign appearance of
bowel within [quadrant] with concentric ecogenic and hypoechoic rings
consistent with intussusception.
Appendicitis=Real
time limited ultrasound survey of right lower quadrant in region of patient’s
pain [fails to detect the appendix] [shows a dilated non-compressible
blind-ending tubular structure with hyperemia consistent with inflamed
appendix]. No focal free fluid or
abscess. IMPRESSION: Appendix not
visualized on ultrasound therefore equivocal for appendicitis, consider low
dose CT scan.
Hip ultrasound
FINDINGS: Real-time
transverse and coronal dynamic bilateral hip ultrasound was performed in
[flexed] position. There is good
coverage of bilateral femoral heads by acetabuli. Alpha angle is [≥60deg] on the left and
[≥60deg] on the right. No hip dislocation or subluxation despite stress
maneuvers. [Mild physiologic
laxity]. [No pulvinar noted interposed
between femoral head and acetabulum].
No hip effusion.
IMPRESSION: Normal
bilateral hip ultrasound.
Neonatal head ultrasound
FINDINGS: Neonatal
head ultrasound was performed in sagittal and coronal projections via
anterior fontanelle. Ventricles and
sulci are unremarkable. No
subependymal (grade I-IV germinal matrix at caudothalamic groove),
intraventricular, or intracerebral hemorrhage. No hydrocephalus or periventricular
leukomalacia (PVL). Echotexture of
brain parenchyma especially periventricular white matter is normal. [Prominent subarchanoid spaces ≤4mm
measured in coronal view at level of foramen of Monroe; interhemispheric
fissure ≤6mm]. No congenital
anomalies.
IMPRESSION: Normal
neonatal head ultrasound.
Neonatal spine ultrasound
FINDINGS: Real time
ultrasound examination of neonatal lumbosacral spine in longitudinal and
transverse planes with baby in prone position. Spine is visualized from [L1] through
[sacrum]. Distal spinal cord and nerve
roots are normal in appearance and freely mobile. Conus medullaris terminates [normally at or
above L2-3 disk space] and is normal in appearance without evidence for tethering. Thecal sac terminates at [S2] with filum
terminale measuring [<2mm in thickness.
No abnormal cyst/mass, meningocele, lipoma, or sinus tract. Visualized osseous structures are normal
without spinal dysraphism. No abnormal
skin lesion (sacrococcygeal dimple, hair patch, or hamngioma) is noted on physical exam.
IMPRESSION:
Unremarkable examination of lumbosacral spine without evidence for spina
bifida or tethered cord.
Liver Transplant
HISTORY: []
COMPARISON: []
FINDINGS: gray
scale, color, and spectral doppler ultrasound examination of transplant liver
was performed.
Liver
Parenchyma
Echogenicity:
[normal][increased]
Focal lesions: []
Fluid
collections: []
Bile ducts: []
Hepatic Vasculature
Portal vein
waveforms and direction of flow: []
Portal vein
velocities: main [], right
[], left []
Hepatic vein
waveforms: [normal] [dampened]
Hepatic vein
velocities: right [], middle[], left[]
Hepatic artery
velocities and resistive indices: main[], right[], left[]
Misc
Inferior Vena
Cava: [patent]
Splenic Vein
velocity: []
Intraabdominal
free fluid: []
Other: []
IMPRESSION:
Normal hepatic transplant without complication.
Renal Transplant
HISTORY: []
COMPARISON: []
FINDINGS: gray
scale, color, and spectral doppler ultrasound examination of [right/left]
lower quadrant transplant kidney was performed.
FINDINGS:
Transplant
Kidney
Echogenicity: []
Focal lesions: []
Hydronephrosis:
[present][absent]
Peritransplant
fluid: []
Vasculature
Intrarenal
arterial waveforms: [normal]
Resistive indices:
[]
Main renal and
iliac vessels: [patent]
Bladder
[distended][contracted]
Other
[]
IMPRESSION: Normal
renal transplant without complication.
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