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chronic elevation right hemidiaphragm is probably responsible for atelectasis of the right lung base, and although there is mild pulmonary vascular congestion, i do not see edema. there is no pneumonia or pleural abnormality. heart size top-normal. no pneumothorax.
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bibasilar atelectasis, limited exam without convincing signs of pneumonia.
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hyperexpanded lungs and flattening of the diaphragms consistent with copd. no evidence of acute cardiopulmonary process.
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comparison to. no relevant change. normal lung volumes. normal size of the cardiac silhouette. mild elongation of the descending aorta. no pneumonia, no pulmonary edema, no pleural effusions.
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leftward deviation of the trachea may be due to goiter or soft tissue mass in the neck. further assessment with ultrasound is recommended on a nonemergent basis. no evidence of acute cardiopulmonary process.
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the tip of the endotracheal tube has been pulled back and is now <num> cm above the carina. tip of the feeding tube is below the ge junction. cardiac silhouette is unchanged and upper limits of normal. punctate densities at the right base may relate to barium aspiration. there is a small right-sided pleural effusion. there is unchanged mild pulmonary edema. there is persistent prominence of the pulmonary hila. no pneumothoraces are seen.
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findings compatible with right middle lobe pneumonia.
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the right picc line is unchanged. there is no pneumothorax or chf. there is obscuration of the left hemidiaphragm suggesting effusion or possibly atelectasis. there is a stent present in the right upper quadrant.
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in comparison with the study of , the left subclavian picc line is difficult to assess, though it does not appear to extend beyond the mid portion of the svc. cardiac silhouette is within normal limits. opacification at the right base is consistent with pleural fluid and atelectasis. opacification in the right mid zone is worrisome for consolidation, especially aspiration in view of the clinical history. dual-channel pacer device has leads in the right atrium and apex of the right ventricle.
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normal radiograph of the chest.
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no acute cardiopulmonary process. mildly engorged pulmonary vasculature and cardiomegaly, similar to prior exam but increased from more remote prior exams.
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bilateral heterogeneous opacification, left greater than right, improved particularly on the right compared to. findings are consistent with resolving severe aspiration pneumonia or pulmonary hemorrhage or reaction to inhaled substances. there is no indication that this is cardiogenic edema. heart is normal size, pulmonary vasculature normal as well. pleural effusions small on the left if any. no pneumothorax. et tube in standard placement. nasogastric tube passes into the stomach and out of view.
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chf. an underlying infectious infiltrate can't be excluded.
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resolved right lower lobe opacity. no evidence of acute cardiopulmonary abnormality.
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there is stable mild pulmonary edema. there is no pneumothorax. there is persistent effusion and/or consolidation in the left base. there is patchy atelectasis in the right base. tracheostomy tube is unchanged.
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no evidence of acute pulmonary process. no displaced rib fracture identified. the right shoulder and neck are not effectively evaluated on this examination.
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no evidence of tuberculosis.
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no acute cardiopulmonary process, specifically no focal consolidation.
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no acute cardiopulmonary abnormality.
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no significant interval change when compared to the prior study.
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right picc tip projecting over the brachiocephalic vein, just above the level of the svc.
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in comparison with the study of , the endotracheal and nasogastric tubes have been removed. there are lower lung volumes with bibasilar atelectatic changes and some indistinctness of pulmonary vessels that could reflect elevated pulmonary venous pressure. there is some dilatation of gas - filled stomach, for which replacement of the nasogastric tube could be considered if clinically needed.
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this repeated radiograph demonstrate normal appearance of the lungs with no evidence of right lower lung opacity, thus previously seen right lower lung abnormality can be attributed to suboptimal inspiration. the lungs are essentially clear. there is no pleural effusion or pneumothorax. mild dextroscoliosis is present.
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no acute findings.
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no significant interval change in right middle lobe airspace opacity which could be compatible with pneumonia in the appropriate clinical setting. stable bibasilar subsegmental atelectasis.
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no acute cardiothoracic process.
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nasogastric tube is seen coursing below the diaphragm with the tip not identified. endotracheal tube and right internal jugular central line are unchanged in position given differences in patient positioning. given the marked patient rotation, assessment of cardiac and mediastinal contours is difficult. there continues to be bilateral layering effusions with associated patchy bibasilar airspace disease likely reflecting atelectasis, although pneumonia cannot be excluded. interval appearance of a patchy opacity in the right mid lung of uncertain significance. this can be further evaluated on followup imaging. stable <num> mm nodular opacity in the left upper lobe unchanged since and therefore consistent with a benign finding. no pneumothorax.
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subtle retrocardiac opacity which could represent an early left lower lobe pneumonia.
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chronic changes of copd. bilateral small pleural effusions. severe stable cardiomegaly.
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heart size and mediastinum are stable. lungs are well aerated and essentially clear. there is no pleural effusion or pneumothorax. no focal consolidations demonstrated as well.
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no definite acute cardiopulmonary process noting low lung volumes.
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no acute cardiopulmonary abnormality.
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no acute cardiopulmonary process.
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mild interstitial pulmonary edema. difficult to exclude a superimposed subtle pneumonia.
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new left lower lobe opacity with morphology more suggestive of atelectasis than pneumonia although infection of lower airways or bronchopneumonia is not excluded.
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left rotation of the patient severely limits the evaluation. unchanged moderate to large left pleural effusion. worsening opacification over the right lower lung is incompletely accounted for by patient's right breast prosthesis and could reflect some combination of right lower lobe atelectasis and at least small pleural effusion. if further evaluation is desired well-positioned frontal and lateral radiographs could be obtained. additionally, the images should be reviewed by the radiologist to determine whether additional lateral decubitus views would be helpful. alternatively, a ct of the chest could be obtained.
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as compared to the previous radiograph of , right internal jugular central venous catheter remains in place, now terminating at the junction of the right brachiocephalic vein and superior vena cava. exam is otherwise remarkable for persistent cardiomegaly, new pulmonary vascular congestion, and worsening left lower lobe atelectasis with adjacent pleural effusion.
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no acute cardiopulmonary process.
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emphysema without superimposed acute process. mild cardiomegaly.
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no acute cardiopulmonary abnormality.
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no evidence of acute cardiopulmonary process. stable moderate cardiomegaly.
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in comparison to study of , the patient has taken a better inspiration. again there is evidence of previous cabg with median sternotomy wires in place. scarring at the right base and costophrenic angle again noted. no evidence of acute focal pneumonia, vascular congestion, or pleural effusion.
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mild pulmonary vascular congestion, patchy opacities in the lung bases, likely atelectasis. possible trace bilateral pleural effusions.
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moderate size hiatal hernia with streaky bibasilar opacities, likely atelectasis.
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no acute cardiopulmonary abnormality.
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decreased moderate right pleural effusion status post pigtail catheter drainage. no other significant interval change.
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no interval change in the left hemothorax and multiple left rib fractures. no pneumothorax visualized.
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comparison to. known parenchymal opacities in the middle lobe and at the left lung bases. these opacities have not substantially changed. known bilateral hilar enlargement. healed old left-sided rib fractures. no new opacities. no pleural effusions.
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no acute cardiopulmonary process; specifically, no evidence of pulmonary edema.
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small bilateral pleural effusions. bibasilar atelectasis. short interval follow-up with a repeat chest radiograph in weeks could be considered to ensure resolution of a more focal opacity at the right base as detailed above.
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slight decrease in left effusions with continued chf. an underlying infectious infiltrate cannot be excluded.
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no acute cardiopulmonary process.
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no evidence of pneumonia.
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subtle prominence of the pulmonary hila may reflect central airways inflammation.
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new elevation of the left hemidiaphragm with substantial gaseous distention of the stomach. clinical correlation with consideration to dedicated abdominal imaging is advised.
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no acute cardiopulmonary process.
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compared to chest radiographs through. consolidation in the right upper lobe continues to clear. severe right lower lobe atelectasis and small bilateral pleural effusions are unchanged. no right pneumothorax. left apical pleural pigtail drainage catheter still in place. left apical pneumothorax tiny if any. heart size normal. right central venous infusion port catheter ends in the low svc.
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the tip of the endotracheal tube is <num> cm above the carina, appropriately sited. there is a left sided central venous line with distal tip in the cavoatrial junction. lungs are grossly clear without focal consolidation, pleural effusions, or pneumothoraces. there is no pulmonary edema. heart size and mediastinal structures are within normal limits. bony structures are intact.
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suggestion of small volume right pleural air. subcutaneous chest wall emphysema. endotracheal tube should be advanced.
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cardiomegaly with small bilateral effusions. possible mild interstitial edema.
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heterogeneous consolidation in the left lower lung zone which worsened between <num> and <num>: yesterday is more pronounced today. the focal distribution suggests pneumonia, perhaps nosocomial bacterial infection. mild interstitial edema elsewhere is stable. the extent of consolidation in the right lower lung attributed to worsening atelectasis is unchanged. heart size is normal. pleural effusions are presumed, but not substantial. et tube in standard position.
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as compared to prior radiograph of <num> day earlier, cardiomediastinal contours are stable in the postoperative. interval improvement in bibasilar atelectasis which remains more substantial on the left than the right. persistent small bilateral pleural effusions, slightly improved on the left.
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allowing for marked leftward patient rotation, there has not been a relevant change in the appearance of the chest since recent study of <num> day earlier.
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diffuse bilateral interstitial opacities concerning for chronic interstitial lung disease. comparison with prior imaging would be helpful to assess whether the more focal opacities in the left upper and lower lobes may reflect areas of superimposed contusion. no acutely displaced fractures identified. recommendation(s): if there is continued concern for an acute rib fracture, consider a dedicated rib series.
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no evidence of acute cardiopulmonary process.
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ng tube sidehole is at the level of the ge junction and ngt should be advanced for position of sidehole in the stomach. endotracheal tube terminates <num> cm above the carina. clear lungs.
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cardiomegaly is unchanged. globular right hilar appearance is unchanged, pleural effusion is minimal, versus pleural thickening. postsurgical changes in the right thorax are similar. no interstitial lung disease a pulmonary edema appreciated. new nodular opacity projecting over the left mid lung might represent atelectasis but giving patient history pulmonary nodule is a possibility and further assessment with chest ct it would be justified.
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no acute intrathoracic abnormalities identified.
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no radiographic evidence of injury.
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comparison to. since the previous examination, the pre-existing parenchymal opacities have minimally increased in extent and severity. this is most obvious in the right lateral parts of the chest. a small left basal pleural effusion with retrocardiac atelectasis is stable. moderate cardiomegaly persists.
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in comparison with the study of , there are lower lung volumes. bilateral pleural effusions with atelectatic changes in are again much more prominent on the right. no evidence of postoperative pneumothorax.
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right upper lobe consolidation compatible with pneumonia in the proper clinical setting. recommend repeat after treatment to document resolution.
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mild pulmonary vascular congestion.
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removal of various support tubes and lines without atelectasis. substantial left base atelectasis with small effusion.
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stable moderate-to-severe cardiomegaly. bibasilar opacifications are similar to prior and likely due to atelectasis. no overt pulmonary edema. no opacification concerning for pneumonia.
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as compared to the previous radiograph, the lingular pneumonia has completely cleared. the pneumonia is not seen on the frontal and the lateral radiograph. no pleural effusions. no pulmonary edema. normal size of the cardiac silhouette.
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as compared to chest radiograph, cardiomegaly pulmonary vascular congestion and interstitial edema are persistent findings. marked enlargement of main and central pulmonary arteries is suggestive of pulmonary arterial hypertension. bilateral small pleural effusions are likely unchanged considering differences in lung volumes.
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in comparison with the study of , there are lower lung volumes. the heart is normal in size and there is no evidence of vascular congestion, pleural effusion, or acute focal pneumonia. some soft tissue prominence in the cardiophrenic angle on the right could reflect a sliding hiatal hernia.
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no pneumonia.
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no acute cardiopulmonary process.
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bibasilar heterogeneous opacities, left greater than right, possibly atelectasis, although infection is not excluded. clinical correlation recommended. findings suggesting mild pulmonary vascular congestion.
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no acute cardiopulmonary process.
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small right apical pneumothorax unchanged from.
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as compared to the previous radiograph, the endotracheal tube has been pulled back. the tip of the tube now projects <num> cm above the carina. the other monitoring and support devices are in unchanged position. unchanged bilateral pleural effusions, right more than left. unchanged bilateral areas of basilar atelectasis. normal size of the cardiac silhouette. no pulmonary edema.
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in comparison with the study of , there is little interval change and no evidence of acute cardiopulmonary disease. mild tortuosity of the descending aorta is again seen, but no vascular congestion, pleural effusion, or acute focal pneumonia. specifically, there is no evidence of pneumothorax.
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enlarged cardiac silhouette. no definite superimposed acute cardiopulmonary process.
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left port-a-cath catheter tip is at the level of lower svc. there is persistent right lower lung opacity potentially representing aspiration or aspiration pneumonia. none aspiration pneumonia is another possibility. heart size and mediastinum are unchanged
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no acute findings.
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mild pulmonary edema has improved. severe cardiomegaly is chronic. combination of pleural effusions and atelectasis is responsible for greater opacification in the lower lungs, no worse today than yesterday. there is no pneumothorax. transvenous right ventricular pacer defibrillator lead is in standard placement. tip of the et tube, less than <num> cm from the carina with the chin flexed is approximately a cm below optimal placement. it should not be advanced.
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no acute cardiopulmonary process.
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as compared to , the bilateral widespread and predominantly nodular parenchymal opacities are unchanged in extent and severity. no new opacities. bilateral areas of atelectasis. moderate cardiomegaly and low lung volumes persist.
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as compared to , no relevant change is seen. normal lung volumes. mild elongation of the descending aorta. no pneumonia, no pulmonary edema, no pleural effusions.
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no evidence of acute cardiopulmonary disease.
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no acute cardiopulmonary abnormality.
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no acute cardiopulmonary process.
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status post aortic valve replacement. no evidence of acute cardiopulmonary disease.
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moderate, slightly asymmetric, pulmonary edema in a perihilar distribution. unchanged enlargement of the cardiac silhouette may reflect cardiomegaly or long standing pericardial effusion. there is no evidence of tamponade. updated results were submitted to the ed qa nurse for communication to the primary care physician by at am,.
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subcutaneous emphysema in the right chest wall extending into the right neck has increased since it first appeared on. very small volume of intrathoracic air outside of the lung is either any stable pneumothorax or extra pleural subcutaneous emphysema. new atelectasis or consolidation has developed at the right lung base. this could be either infectious or bleomycin induced pneumonitis. heart is normal size. right internal jugular infusion port catheter ends in the region of the superior cavoatrial junction. patient has had tavr.
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left basilar patchy and linear opacities may reflect atelectasis and scarring, but appears more pronounced than on the prior exam from and infection cannot be excluded in the correct clinical setting. severe emphysema.
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standard position of support devices. no evidence of acute cardiopulmonary process.