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pa and lateral chest compared to : mild cardiomegaly is chronic. despite very heavily calcified mitral annulus, and coronary artery calcifications, there is no evidence of cardiac decompensation, pulmonary vasculature is normal. mediastinal veins are not dilated and there is no edema or pleural effusion. lungs are clear. previous tracheal displacement by a large thyroid is no longer present.
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multifocal pneumonia
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there may be a small residual left pleural effusion, but lungs are clear. cardiomediastinal and hilar silhouettes and remaining pleural surfaces are normal. left pic line ends in the mid svc. nasogastric tube ends in nondistended stomach.
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chronic changes in the lungs dating back to suggesting underlying interstitial process/fibrosis. no superimposed acute cardiopulmonary process.
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right lower lobe pneumonia.
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no acute intrathoracic process.
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no evidence of acute cardiopulmonary process. a round opacity projecting over the posterior aspect of two mid thoracic vertebrae appears unchanged since but location cannot be accurately assessed. recommend further evaluation with chest ct.
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vague asymmetric opacity in the left lower lobe which may represent an area of early infection.
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left internal jugular central line and left subclavian central lines both have their tips in the proximal svc, unchanged in position. a feeding tube courses below the diaphragm with the tip not identified. lung volumes remain markedly diminished with some crowding of pulmonary vasculature and some patchy opacity at both bases, which likely reflects bibasilar atelectasis. no evidence of pulmonary edema or pneumothorax. stable cardiac and mediastinal contours, given differences in positioning.
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no definite evidence of pneumonia. hazy opacity adjacent to left heart border is not likely to represent pneumonia. though if symptoms develop, a repeat chest radiograph can be obtained for evaluation.
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no reaccumulation of the patient's no pneumothorax. bullous changes along the apex are consistent with paraseptal emphysema.
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ap and lateral chest compared to : heterogeneous opacification right lower lung is probably atelectasis. there are no findings striking enough to call pneumonia. heart size top normal. no pulmonary edema or pleural effusion. thoracic aorta heavily calcified, but not dilated. no pneumothorax.
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focal right lower lobe opacity may represent pneumonia, aspiration, or atelectasis. short interval follow-up cxr may be helpful.
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right upper lobe collapse. endotracheal tube in standard position.
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no acute cardiopulmonary abnormality.
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possible minimal central interstitial edema. stable left mid lung linear atelectasis/scarring.
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no acute cardiopulmonary process.
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resolution of previously noted pulmonary edema. persistent small bilateral effusions and left basilar atelectasis.
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there is an abnormality in the lingula consisting of a small region of consolidation and a more discrete least roughly <num> mm wide pleural-based opacity inseparable from and perhaps thickening the anterior pleural surface. this could all be a small pneumonia, but repeat chest radiographs in <num> weeks time should be obtained even if patient's signs and symptoms clear to make sure that this is not a lung nodule. in addition clinical consideration should be given currently to the possibility of a small pulmonary infarction, particularly since the explanation for requesting the earlier chest radiograph today was acute chest pain, if that characterization was accurate. lungs are mildly hyperinflated but otherwise clear. there is no pleural effusion. cardiomediastinal and hilar silhouettes and pleural surfaces are normal. recommendation(s): repeat conventional chest radiographs in <num> weeks.
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low lung volumes with probable bibasilar atelectasis. consider repeat pa and lateral views with improved inspiratory effort, when the patient is able, for better assessment of the lung bases.
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no radiographic evidence for acute or chronic lung disease.
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lungs are fully expanded and clear. heart is top-normal size. ascending thoracic aorta is mildly dilated or tortuous. hilar contours and pleural surfaces are normal.
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collapse in the left lung. the mediastinal structures have returned to a more normal position.
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ap chest compared to : pulmonary vasculature is still engorged, moderate left pleural effusion is new, and left lower lobe atelectasis worsened. right lower lobe is still collapsed and right pleural effusion may be reaccumulating. large cardiomediastinal silhouette is stable, probably not changing acutely. no pneumothorax.
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ap chest compared to at cardiomediastinal silhouette has not changed in appearance over seven hours. mild edema has developed in the right lung. consolidation in the left lung is much more pronounced accompanied by at least a small if not larger left pleural effusion, but no appreciable pneumothorax. bleeding in the lung and pleural space is likely. multiple displaced left rib fractures, most marked in the lower hemithorax in the proximal few centimeters of at least seven ribs meaning that the patient is at risk for a posterior flail chest although that is less often a problem than an anterior or lateral flail. dr i discussed the findings and their clinical significance by telephone at the time of dictation.
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as compared to chest radiograph, cardiomegaly, pulmonary vascular congestion and interstitial edema are again demonstrated. bibasilar opacities have improved in the interval, particularly in the left retrocardiac region. no other relevant changes.
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interval improvement of the left lung collapse.
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there has been placement of a pacemaker wire from an inferior approach which projects over the right atrium. orogastric and endotracheal tubes are unchanged in position. there is cardiomegaly, stable. there are small bilateral effusions. no focal consolidation is seen.
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there are no prior chest radiographs available for review. mild bronchial cuffing or (see the anterior segmental bronchus, right upper lobe) more likely due to bronchial inflammation, than edema. heterogeneous peribronchial opacification left lower lobe could be atelectasis or recent aspiration, should be followed. remainder the lungs clear. heart size normal. no appreciable pleural effusion.
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linear left basilar opacity, most consistent with atelectasis. likely small right pleural effusion.
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normal chest radiograph
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moderate to severe enlargement of the cardiac silhouette likely due to the presence of a moderate pericardial effusion. pulmonary vascular congestion with small left pleural effusion. bibasilar atelectasis.
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no acute cardiopulmonary process.
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tracheostomy is <num> cm above the carinal. ng tube and up of tube passes below the diaphragm potentially terminating in the stomach. right internal jugular line and right subclavian line tip are at the cavoatrial junction. heart size and mediastinum are unchanged including left retrocardiac atelectasis and left mediastinal shift but there is interval substantial increase in left pleural effusion as well as development of right basal atelectasis and small amount of right pleural effusion.
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there is no pneumothorax or pleural effusion. triangular opacity projecting over the lower pole the right hilus is probably atelectasis. followup with conventional chest radiographs when feasible is recommended. fractures in the left middle ribs and left scapula are healed and incompletely healed in the right upper lateral ribs. there is no pneumothorax or pleural effusion. patient has had median sternotomy. cardiomediastinal silhouette is unremarkable. although no acute fracture or other chest wall lesion is seen, conventional chest radiographs are not sufficient for detection or characterization of such abnormalities. if the demonstration of such a chest cage abnormality is clinically warranted, the location of any referrable focal findings should be clearly marked and imaged with either bone detail views or ct scanning.
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compared to chest radiographs as since , most recently one , read in conjunction with recent chest ct. a masslike lesion at the base of the left lung is concerning for infection. right lower lobe opacification could be atelectasis or, less likely, pneumonia. small pleural effusions are new. heart size is normal. upper lungs are clear. feeding tube passes into the stomach and out of view.
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small bilateral pleural effusions with passive atelectasis. developing bibasilar consolidations are difficult to exclude. redemonstrated densities within the lung parenchyma and neck, possibly secondary to prior granulomatous disease.
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comparison to. the feeding tube on image <num> projects over the middle parts of the stomach with its tip. no complications, notably no pneumothorax.
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compared to chest radiographs since , most recently. new large area of consolidation at the base of the right lung also obscures right heart border suggesting right middle and lower lobe pneumonia. mild pulmonary edema is new. mild cardiomegaly has increased. no appreciable pleural effusion. no pneumothorax. transvenous right ventricular pacer defibrillator lead is continuous from the left pectoral generator.
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no evidence of pneumonia.
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little change in ill-defined bilateral upper lobe opacities compared to one day prior. the chronicity of these remains indeterminate. early pneumonia could be considered in the proper clinical setting, though this could represent chronic scarring. comparison with more remote imaging is recommended. hyperinflation compatible with known copd.
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no acute cardiopulmonary process. specifically, no evidence of pneumonia. results were discussed with dr at on via telephone by dr at the time the findings were discovered.
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comparison to. the patient is rotated to the right. as a consequence, right soft tissues overlying the right lung apex, causing a substantial increase in right apical radiodensity. however, a previously present small right pleural effusion might have slightly increased and the right upper lobe may be partly atelectatic. an effusion an opacities on the left. have substantially improved. however, lung volumes remain low and the cardiac silhouette remains enlarged.
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no relevant change as compared to the previous image. the sternotomy wires are in constant position. severe scoliosis. normal size of the cardiac silhouette. no pneumonia, no pleural effusions. no pulmonary edema.
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as compared to scout image from outside chest ct of , cardiomediastinal contours are stable. right internal jugular vascular sheath terminates in the upper superior vena cava, with no visible pneumothorax. bibasilar linear atelectasis is present as well as mild elevation of the right hemidiaphragm and subcutaneous emphysema in the upper and lower right chest wall.
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mild pulmonary vascular congestion and bibasilar atelectasis. possible trace bilateral pleural effusions.
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in comparison with the study of , there is little overall change. again there is enlargement of the cardiac silhouette with extensive fibrocalcific changes in both apices. prominence of interstitial markings is seen, which could reflect a chronic interstitial abnormality better assessed on the previous ct study. no evidence of acute focal pneumonia.
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no acute cardiopulmonary process.
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endotracheal tube in appropriate position. nasogastric tube side port at ge junction. recommend advancement so that it is well within the stomach. distal tip in the proximal stomach. worsening extensive bilateral left greater than right alveolar opacities. differential diagnoses include pulmonary hemorrhage, infection, ards, underlying component of aspiration not excluded.
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as compared to the previous image, the right pigtail catheter has been removed. the atelectasis at the right lung base has improved. no pneumothorax. minimal retrocardiac atelectasis is unchanged. at overall low lung volumes there is no evidence for pneumonia or pulmonary edema.
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stable exam without acute abnormalities. please note aortic dissection cannot be excluded on radiograph.
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no acute cardiopulmonary process.
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persistent consolidation in lingula, which may be new or recurrent atelectasis or organized pneumonia. severe bronchiectasis and nodular opacities appear stable since , but worse since. given the combination of severe bronchiectasis and emphysema, active suppurative bronchiectasis due to non-tuberculous mycobacterial infection or alpha <num> trypsin deficiency should be considered, if not already investigated. repeat chest ct upon resolution of acute symptoms is recommended for further evaluation of right paraspinal opacity seen on ct from. displaced trachea likely from thyroid nodule seen on prior ct. recommendation(s): repeat chest ct upon resolution of acute symptoms is recommended for further evaluation of right paraspinal opacity seen on ct from.
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no acute cardiopulmonary process.
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left lower lobe pleural effusion and opacification thought likely sequela of atelectasis and/or aspiration, though early infectious process cannot entirely be excluded. enlarged heart with mild congested pulmonary vessels. no overt pulmonary edema.
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mild pulmonary edema with small to moderate size bilateral pleural effusions and bibasilar atelectasis.
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no evidence of acute cardiopulmonary abnormality.
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right basal consolidation has improved. small right pleural effusion is new. severe left lower lobe consolidation unchanged, but lymphovenous congestion in the left upper lobe has improved substantially since. left bronchial stent and left thoracostomy tube still in place. no appreciable pneumothorax. moderate left pleural effusion and pleural thickening persist.
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no acute cardiopulmonary process.
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ap chest compared to through : although the right hemithorax is hyperlucent, i do not see the pleural edge of a pneumothorax and the appearance could be due to emphysema and air trapping. if patient can tolerate an upright view that would be helpful in increasing my level of certainty that there is no pneumothorax. leftward mediastinal shift and elevation of the left hemidiaphragm suggests that the opacification in the left lower lobe has a large component of atelectasis as well as possible pneumonia. et tube in standard placement. nasogastric feeding tube passes into the stomach and out of view. dr was paged.
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no acute cardiopulmonary process.
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no acute cardiopulmonary process.
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no acute cardiopulmonary disease.
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heterogeneous opacification at the right lung base on , partially obscured by external connector, has improved. whether this was pneumonia or atelectasis is difficult to say. borderline cardiomegaly stable. no appreciable pleural effusion.
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possible mild central pulmonary vascular engorgement without overt pulmonary edema. persistent mild cardiomegaly.
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no acute cardiopulmonary process.
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patchy left lower lobe opacity which may reflect an area of developing infection. no rib fracture identified.
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low lung volumes with moderate cardiomegaly and mild bibasilar atelectasis. no new displaced rib fracture.
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low lung volumes without definite acute cardiopulmonary process.
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no acute cardiopulmonary process.
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ascending aortic aneurysm. no evidence of acute pulmonary process. veterbra plana deformity of t<num>, better seen on the mr from the same day.
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elevator right hemidiaphragm unchanged with bibasilar atelectasis and no convincing evidence for pneumonia.
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interval improvement of right lower lobe opacity with no acute cardiopulmonary process.
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tip of the new endotracheal tube is at the upper margin of the clavicles, nearly <num> cm above the carina. it could be advanced <num> cm for more secure positioning. lungs are clear. normal cardiomediastinal and hilar silhouettes and pleural surfaces.
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enlarged cardiac silhouette. no focal consolidation.
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somewhat limited study due to patient rotation. small to moderate size bilateral pleural effusions with bibasilar opacities likely reflecting compressive atelectasis. infection and aspiration at the lung bases however cannot be excluded.
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dilated main pulmonary artery with oligemia of the peripheral pulmonary vasculature ( sign) compatible with known extensive saddle pulmonary embolism.
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mild pulmonary edema and moderate cardiomegaly, unchanged.
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no acute cardiopulmonary process.
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no pneumothorax. the left pleural effusion is decreased.
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in comparison with the study of , there is little overall change. relatively mild enlargement the cardiac silhouette with pulmonary vascular congestion and substantial bilateral layering pleural effusions with compressive basilar atelectasis. monitoring and support devices are unchanged.
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no radiopaque foreign body detected.
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in comparison with the study of , there is again enlargement of the cardiac silhouette with mild to moderate pulmonary vascular congestion and bilateral pleural effusions with compressive atelectasis at the bases. no definite evidence of acute focal pneumonia.
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in comparison with the earlier study of this date, there again is a tracheostomy tube in place with the right subclavian picc line extending to the lower portion of the svc. there is substantial enlargement of the cardiac silhouette with pulmonary edema and bilateral layering effusions, more prominent on the right, with underlying compressive atelectasis at the bases. cervical spine fixation device is again seen.
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possible minimal atelectasis in the left lower lung. otherwise, no acute pulmonary process identified. no findings suggestive of pneumonic infiltrate.
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new left pleural effusion with left basilar atelectasis. pneumonia cannot be excluded in the appropriate clinical setting. slightly improved left chest wall and subcutaneous emphysema.
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possible very minimal pulmonary vascular congestion. otherwise, no acute cardiopulmonary process seen.
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no chest radiograph is available for comparison. the current image shows a platelike area of scarring at the bases of the left lung, previously documented on ct examination from. the diffuse increase in radiodensity of the right hemi thorax is caused by the known breast implant. no other parenchymal changes are noted. no pleural effusions. no pulmonary edema. normal size of the heart.
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status post thoracentesis for right pleural effusion with no evidence of pneumothorax. unchanged left pleural effusion.
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heart size is top-normal. substantial spinal scoliosis is re- demonstrated. lungs are well aerated. nodular opacity projecting over the left lower lung is unchanged since the prior study and represents nipple. no pleural effusion is demonstrated. linear areas of scarring in the right mid lung are re- demonstrated. more focal opacity and potentially increased in size and density in the right upper lung is noted at should be further assessed with cross-sectional imaging.
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moderate cardiomegaly is a stable. retrocardiac atelectasis have increased. vascular congestion has improved. there is no pneumothorax. right lower lobe opacity has increased due to increasing component of pleural effusion and atelectasis.
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stable appearance of right pleural effusion.
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mild silhouetting of the right heart border suggests early right middle lobe pneumonia. recommendation(s): recommend follow-up chest radiograph in weeks to assess resolution.
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no acute cardiopulmonary process.
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no acute cardiopulmonary process.
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compared to chest radiographs through at. aside from mild left lower lobe atelectasis, lungs are grossly clear. pleural effusions are small if any. heart size top-normal. lines and tubes in standard placements. no pneumothorax. healed right rib fractures are numerous.
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marked cardiomegaly. no pleural effusion. mild retrocardiac atelectasis versus scarring.
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in comparison with the study of , the monitoring and support devices are essentially unchanged. hazy opacification of the lower lungs, more prominent on the right, again suggests pleural effusion with compressive atelectasis. cardiac silhouette remains at the upper limits of normal or mildly enlarged. although no definite acute focal pneumonia, this would be difficult to unequivocally exclude, especially in the absence of a lateral view.
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no radiographic evidence of hiatal hernia, however, small one is seen on the ct examination. no acute intrathoracic process.
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no evidence of acute cardiopulmonary process.