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no pneumonia.
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severely widened mediastinum with rightward deviation of the trachea, a left perihilar mass, and pleural effusion are unchanged from recent ct.
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no evidence of acute intrathoracic injury.
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chronic changes without evidence of acute cardiopulmonary process.
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in comparison with the study , there is little change in the appearance of the cardiomediastinal silhouette. however, there is a increased engorgement and distinctness of pulmonary vessels, consistent with worsening pulmonary edema. the left hemidiaphragm is no longer well seen, consistent with the development of pleural fluid and volume loss at the left base. the tip of the dobhoff tube is in the mid body of the stomach. given the extensive pulmonary changes, in the appropriate clinical setting it would be difficult to exclude superimposed pneumonia, especially in the absence of a lateral view.
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no free air.
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compared to prior chest radiographs, through at. left thoracostomy tube is been removed. there could be a substantial left pleural air collection on the medial side of the postoperative left lung which is substantially atelectatic. mediastinum is persistently shifted to the left hemi thorax. right lung is grossly clear. recommendation(s): conventional chest radiographs to better assess postoperative pleural abnormalities. chest ct scanning may be needed for that determination.
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new bibasilar opacities, left greater than right, are concerning for developing pneumonia, given the patient's clinical history.
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since yesterday, bilateral lower lobe opacities likely from combination of effusion and atelectasis are unchanged.
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no acute cardiopulmonary process.
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low lung volumes without evidence of pneumonia.
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new large amount of subdiaphragmatic free air.
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limited exam with probable interstitial edema.
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very large right pleural effusion is new, accompanied by equivalent right middle and lower lobe atelectasis. if the constellation of findings is due to aspiration, this could be atelectasis or pneumonia and the fluid could be either hepatic hydrothorax or exudate secondary to pneumonia. pneumothorax. left lung grossly clear. heart size normal. feeding tube passes into the stomach and out of view. pic line ends in the upper svc.
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low lung volumes without focal consolidation to suggest pneumonia. grossly unchanged appearance of multiple myeloma lesions in the chest.
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as compared to the previous image, all pre-existing parenchymal opacities have completely resolved. currently, no pathologic opacities are seen. normal size of the cardiac silhouette. no pleural effusions.
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no acute cardiopulmonary process.
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in comparison with the study of , there is little change and no evidence of acute cardiopulmonary disease. no pneumonia, vascular congestion, or pleural effusion. the tip of the port-a-cath the is in the distal svc.
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no focal pneumonia.
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no acute cardiopulmonary abnormality.
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no significant interval change.
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multiple bilateral relatively rounded regions of consolidation in the lungs. these could certainly represent septic emboli in the proper clinical setting. the differential, however is broad and also includes multifocal infection and vasculitis or masses among others. these could be better characterized by ct.
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small left greater than right pleural effusions, with improvement in aeration compared with
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heart size and mediastinum are stable. lungs are clear. there is no appreciable pleural effusion. there is no pneumothorax.
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ap chest compared to at small-to-moderate right pneumothorax is larger than eight hours earlier. subcutaneous emphysema in the right chest wall, however, is decreasing. right apical pleural tube unchanged. small left pleural effusion decreasing. lungs grossly clear. mild cardiomegaly stable. a dual-channel dialysis catheter ends in the svc. right apical pleural tube unchanged in position. feeding tube ends in the stomach. left jugular line ends in the upper svc. no left pneumothorax. paged at , since the findings were recognized.
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mild pulmonary edema without focal consolidation.
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a small right pleural effusion. small hiatal hernia
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left lower lobe opacity, best seen on the lateral view overlying the lower , represent overlying vessels however, cannot rule out pneumonia. these findings were discussed with at on by telephone.
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vascular congestion and bilateral small pleural effusions consistent with heart failure. increasing cardiac silhouette may suggest new cardiomegaly or pericardial effusion given patient's history of end-stage renal disease requiring dialysis. no evidence of pneumonia
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no acute intrathoracic process.
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no acute cardiopulmonary abnormalities
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multifocal pneumonia is most pronounced, and possibly cavitated in, the left lower lobe. recommendation(s): a dedicated chest ct may be performed to confirm possible cavitation.
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in comparison with the study of , there is little overall change in the large, masslike consolidation in the right lower lobe with probable patchy areas of opacification at the left base as well. this is again consistent with multifocal pneumonia, as seen on the recent ct scan. there has been placement of a left ij catheter that extends well into the right atrium.
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the asymmetric perihilar opacities, left greater than right have improved. this likely represents a combination of resolving pulmonary edema and multifocal pneumonia.
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persistent moderate left pleural effusion with adjacent atelectasis and/or infectious consolidation. new patchy and linear right lower lobe opacity suggestive of atelectasis.
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normal chest radiograph. no evidence of pulmonary edema or pneumonia.
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interval removal of the left-sided chest tube. no pneumothorax.
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no acute cardiopulmonary abnormality.
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no definite acute cardiopulmonary process. nodular opacity projecting over the left lung base likely a nipple shadow, but repeat exam with nipple markers in place suggested to confirm.
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constellation of findings compatible with mild interstitial edema.
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there is interval progression of bibasal, in particular left consolidation concerning for infectious process aspiration. mild vascular enlargement is unchanged in cardiomediastinal silhouette is stable. there is no pneumothorax.
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bibasilar atelectasis. no focal consolidation.
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no acute cardiopulmonary process.
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since the prior study there is no substantial change in widespread parenchymal consolidations. the patient has been extubated. ng tube tip is in the stomach.
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status post vats decortication with <num> new left-sided chest tubes present. no discrete pneumothorax identified. interval decrease in extent of the left loculated pleural fluid. new right-sided and persisting left-sided patchy airspace opacities may reflect atelectasis and/or developing consolidation.
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ng tube in the stomach. resolution of prior bibasilar pulmonary opacities.
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two, small rounded opacities projected over the right upper lung may represent areas of focal pneumonia. recommend followup chest radiograph weeks after the completion of treatment. recommendation(s): updated findings emailed to the ed qa nurses at on by dr.
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mild enlargement of the cardiac silhouette. slight blunting of the right costophrenic angle may be due to atelectasis and skinfold; however, a trace pleural effusion is difficult to exclude.
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in comparison to chest radiograph, a nonspecific right lower lobe opacity has partially cleared and a new left retrocardiac opacity has developed. these findings may reflect recurrent aspiration given clinical suspicion for this entity. followup radiographs may be helpful to exclude a developing aspiration pneumonia.
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right pleurx catheter is present in the lower right hemi thorax, with persistent masslike appearance in right mid and lower lung, likely corresponding to known neoplastic mass reported on recent ct with contiguous lymphadenopathy an moderate right pleural effusion. unilateral interstitial lung disease on the right is concerning for lymphangitic carcinomatosis.
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comparison to. the second of <num> subsequent films shows the feeding tube in the stomach, with slight coiling. no complications, notably no pneumothorax.
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no acute intrathoracic process.
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in comparison with study of , there is little change. monitoring and support devices are unchanged. continued moderate cardiomegaly with stable degree of pulmonary edema. retrocardiac opacification again is consistent with volume loss in the left lower lobe and left effusion. the right hemidiaphragm is more sharply seen, which could represent merely a slightly more elevated position of the patient.
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opacities overlying the mid to left lung is concerning for pneumonia. interval increase in the left lower lobe mass compared to the prior exam, as well as new interstitial thickening of the right lung, concerning for lymphangitic spread of disease. a ct is recommended for further evaluation. were d/w dr by dr by phone at <num>:a on.
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no acute radiographic intrathoracic pulmonary disease.
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no acute cardiopulmonary process; specifically, no evidence of pneumonia.
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as compared to the previous radiograph, no relevant change is noted. no evidence of pneumonia, no pulmonary edema. no pleural effusions. minimal atelectasis at the left lung bases, better visualized on the lateral than on the frontal view.
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no evidence of acute cardiopulmonary disease.
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there was limited voluntary inspiratory and expiratory effort, limiting assessment of diaphragmatic excursion. fluoroscopic evaluation would be more sensitive for detecting clinically suspected diaphragmatic palsy. exam is otherwise remarkable for interval apparent removal of right pleural catheter with no visible pneumothorax.
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no acute cardiopulmonary process
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no evidence of rib fractures. stable pulmonary nodules. decreased left pleural effusion. post esophagectomy with gastric pull-through.
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chronic interstitial lung disease with stable small right pleural effusion. no new consolidation identified.
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no acute cardiopulmonary abnormality.
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moderate pulmonary edema. left base opacities potentially asymmetric edema or atelectasis. developing infection is difficult to exclude.
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right internal jugular dual-lumen large bore catheter has its tip in the mid svc. the right subclavian picc line is unchanged position with its tip in the distal svc. there are layering bilateral effusions with increasing prominence of the pulmonary vasculature suggestive of worsening mild pulmonary edema. overall cardiac and mediastinal contours are likely stable. no large pneumothorax is seen, although the sensitivity to detect pneumothorax is diminished given supine technique.
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as compared to , a bilateral combined alveolar and interstitial pattern has worsened,. the distribution is asymmetrical, with increasing confluence in the left mid, left lower, and right upper lung regions. observed findings may be due to asymmetrical pulmonary edema with or without coexisting infectious pneumonia.
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unchanged multifocal opacities likely represent an infectious process rather than heart failure. unchanged position of left picc line.
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mild pulmonary vascular congestion. recommend pa and lateral views after hemodynamic status improves.
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no evidence of pneumonia.
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comparison to. mild bilateral apical overinflation. no evidence of pneumonia. no pleural effusions. no pulmonary edema. normal size of the cardiac silhouette. stable correct position of the right central venous access line.
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re- demonstration of large hiatal hernia with bibasilar atelectasis. trace left pleural effusion. no subdiaphragmatic free air.
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no acute cardiopulmonary abnormality. no free air is seen under the diaphragms.
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normal radiograph of the chest without evidence of pneumonia.
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no acute cardiopulmonary process.
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interval improvement in elevation of the right hemidiaphragm.
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right basilar opacity may represent a combination of cardiac silhouette and atelectasis. left basilar atelectasis. no definite focal consolidation. stable moderate cardiomegaly without evidence of pulmonary edema.
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slight blunting of the posterior left costophrenic angle which may be due to a trace pleural effusion versus pleural thickening. basilar atelectasis with possible involvement of the right middle lobe.
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as compared to the previous radiograph, the patient has received fluid and has now developed moderate pulmonary edema. the edema has both an interstitial and an intravascular component. no pleural effusions. unchanged borderline size of the cardiac silhouette.
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persistent left basilar opacity with subpulmonic left pleural effusion concerning for pneumonia.
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in comparison with the study of , there again are densely calcified lymph nodes bilaterally in the neck with hilar prominence. the nodular opacifications at the left base are again seen, though possibly less marked than on the prior study. specifically, no definite evidence of acute focal pneumonia.
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comparison to. no relevant change. moderate scoliosis. normal size of the cardiac silhouette. no pneumonia, no pulmonary edema, no pleural effusions.
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as compared to previous radiograph of <num> day earlier, widespread bilateral airspace opacities with relative sparing of the extreme lung periphery have progressed. remainder of exam is unchanged.
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low lung volumes without evidence of pneumonia. no free air beneath the right hemidiaphragm.
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comparison to. improved ventilation of the left and right lung. status post right upper lobectomy with subsequent right apical pleural and parenchymal changes. left pectoral port-a-cath is in unchanged position. no pleural effusions. normal size of the cardiac silhouette.
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as compared to the previous radiograph, there is a moderate degree accumulation of a small left pleural effusion. the position of the chest tube has slightly changed but the drain appears to be still correctly positioned in the left pleural space. there is no visible left pneumothorax. unchanged appearance of the cardiac silhouette. better seen than on the previous image is a <num> mm soft tissue density nodule in the right lung apex, projecting just below the anterior portion of the first rib. this lung nodule is documented on multiple previous examinations, notably on the pet-ct from.
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pigtail catheter and chest tube located in the right chest. essentially unchanged chest radiograph from prior imaging.
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interval increase in right pleural effusion, now moderate to large in size, with adjacent atelectasis. it is worth noting that hemorrhage cannot be excluded. enlargement of the cardiac silhouette raising suspicion for a pericardial effusion. a dedicated echo is recommended for further evaluation. known large right midlung mass is again noted. these findings were discussed by dr with dr telephone at am on.
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mild prominence of the hila which may be due to central pulmonary vascular engorgement, underlying lymphadenopathy not entirely excluded. no focal consolidation.
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no pneumothorax. unchanged layering right pleural effusion and increased left basilar atelectasis.
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no acute cardiopulmonary pathology.
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no acute cardiopulmonary abnormality.
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no acute cardiopulmonary process, specifically no evidence of cardiomegaly.
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the feeding tube and right ij central line have been removed. surgical clips are seen within the left axilla. heart size is within normal limits. there is tortuosity of the thoracic aorta. lungs are clear. there are no pneumothoraces. degenerative changes are seen of the right glenohumeral joint.
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since the prior radiograph of , a left pleural catheter is been placed, with decreased left pleural effusion and development of loculated left basilar hydropneumothorax. adjacent left retrocardiac atelectasis or consolidation is noted. known left pleural thickening has been more fully assessed by recent pet-ct.
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an endotracheal tube terminating <num> cm above the carina, left picc terminating at the lower svc, and right port-a-cath terminating at the lower svc are demonstrated. widespread bilateral pulmonary opacities remain unchanged since. there is no superimposed pneumothorax or pleural effusion.
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little interval change compared to the prior study. severe cardiomegaly with small bilateral pleural effusions. redemonstration of herniation of the left lung through an inferolateral left chest wall defect. scattered pulmonary nodules including a spiculated nodule in the left upper lobe are better visualized on prior ct.
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mild cephalization which could reflect mild pulmonary venous congestion.
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no definite signs of acute intrathoracic process.
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mild edema.
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no acute cardiopulmonary abnormality. left-sided calcified pleural plaques, unchanged.