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right internal jugular central venous catheter ends in the low svc, status post repositioning. no significant interval change in moderate left pleural effusion or degree of left lower lung compressive atelectasis. decreased mild interstitial pulmonary edema.
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hyperinflated lungs. bibasilar opacities in part due to small effusions. superimposed right basilar opacity, potentially atelectasis with infection not excluded.
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findings concerning for worsening metastatic disease in the chest.
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increased right pleural effusion with loculated pleural fluid at the right lateral lung base loculated fluid and gas at the right apex, unchanged from prior. right basal compressive atelectasis, difficult to exclude pneumonia. followup to resolution advised.
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as compared to the previous radiograph, the tip of the endotracheal tube now projects approximately <num> cm above the carinal. the course of the nasogastric tube is unchanged, the tip is not visualized on the image. there is no evidence of pneumothorax. the right internal jugular vein catheter is constant. unchanged normal appearance of the cardiac silhouette.
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no acute cardiopulmonary process.
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interval insertion of a dobhoff tube into the stomach. no new focal consolidation concerning for pneumonia. previous right lung base interstitial abnormality has improved.
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compared to chest radiographs since , most recently. new, well-demarcated areas of consolidation at both lung bases more likely atelectasis than pneumonia. tiny left pleural effusion may be present. no pneumothorax. no pneumomediastinum. stent has migrated inferiorly approximately <num> cm since.
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no acute cardiopulmonary process.
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compared to chest radiographs through et tube ends at the thoracic inlet and should not be withdrawn further. right subclavian line ends close to the superior cavoatrial junction. feeding tube ends in the upper stomach. compared to mediastinal and pulmonary vessels are more engorged indicating a definite component of volume overload or cardiac decompensation. bibasilar consolidation preceded the relative cardiac decompensation and has subsequently improved. i can't distinguish between concurrent bibasilar pneumonia and dependent atelectasis and edema. no pneumothorax. pleural effusion is presumed but not substantial. no pneumothorax. heart size is normal, but increased since.
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no acute cardiopulmonary process.
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persistent patchy interstitial opacities in both lung bases concerning for ongoing pneumonia, not substantially changed in the interval.
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there no prior chest radiographs available for review. study is read in conjunction with a cta of the chest performed earlier in the day. moderate enlargement of the cardiac silhouette, mostly to the right of midline is due to combination of moderate pericardial effusion and unexplained mild rightward shift of the lower mediastinum. small pleural effusions and moderate size hiatus hernia are more evident on the chest ct. atelectasis at the left lung base is mild.
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right middle lobe collapse.
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no evidence of acute cardiopulmonary process.
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findings consistent with emphysema. retrocardiac opacities may be normal, but is difficult to evaluate on this single projection. if there is clinical concern for pneumonia, a lateral projection may be helpful.
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pulmonary nodules better assessed on prior ct chest. left basal opacity likely atelectasis though cannot exclude pneumonia. possible adjacent small pleural effusion. port-a-cath positioned appropriately.
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heart size and mediastinum are unchanged but there is interval development of vascular enlargement in interstitial opacities consistent with interval development of pulmonary edema. the date re- is mild to moderate, interstitial.
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no signs of pneumonia or other acute intrathoracic process.
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heart size and mediastinum are stable. lungs are clear. there is no pleural effusion or pneumothorax. no evidence of pulmonary edema is currently present. nodule is projecting over the right upper lung, potentially representing calcified granuloma, unchanged at least since does consistent with years of stability.
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comparison to. the monitoring and support devices continue to be in stable position. moderate cardiomegaly. the known left lower lobe parenchymal opacity with air bronchograms is stable. on the right, the opacity has slightly increased in extent and severity and shows a tendency to consolidate. no pleural effusions.
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no acute intrathoracic abnormalities identified.
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right internal jugular line tip is at the level of mid to lower svc. heart size is enlarged. mediastinum is stable. bilateral pleural effusions are moderate. bibasal areas of atelectasis are unchanged. there is no pneumothorax.
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no focal consolidation to suggest pneumonia. slight prominence at the ap window on <num> of the frontal views not seen on the other frontal view may be positional, but underlying mediastinal lymphadenopathy is not excluded.
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no acute cardiopulmonary process.
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no displaced fracture is identified. if there is continued clinical concern, dedicated radiographs of that area could be obtained.
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cardiomegaly without superimposed acute process. right ac joint arthropathy.
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moderate cardiomegaly.
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previous dependent pulmonary edema has cleared. cluster of irregular opacities in the right midlung projecting over the tip of the scapula and anterior fourth rib could be in the lung, such as bronchiectasis, or could be skeletal. conventional radiographs recommended when feasible. normal cardiomediastinal and hilar silhouettes. no bowel abnormality.
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increased size of right middle lobe lung lesion. mild right basilar atelectasis. persistent mild cardiomegaly.
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no relevant change as compared to the previous radiograph. mild elevation of the right hemidiaphragm of the liver surgery. no acute parenchymal process. no pleural effusions. no pneumonia, no pulmonary edema.
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bibasilar opacities have resolved since. no acute cardiopulmonary process.
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ap chest compared to at : guidewire in the right picc line ends in the upper-to-mid svc, but it looks like the catheter extends beyond that to the level of the superior cavoatrial junction. lungs clear. heart size normal. multiple healed rib fractures noted. a thin bore catheter projects over the right neck, paramedian chest and upper abdomen. i presume this is a ventricular shunt, but i cannot tell where it ends. clinical correlation advised.
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lungs are fully expanded and clear. cardiomediastinal and hilar silhouettes and pleural surfaces are normal. mild thoracolumbar scoliosis is chronic.
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right subclavian central venous line ends in the upper right atrium as before. no pleural abnormality. lungs clear. normal cardiomediastinal silhouette.
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in comparison with the study , there is again substantial enlargement of the cardiac silhouette with some elevation of pulmonary venous pressure. the right pleural effusion is either stable or increasing and there is compressive atelectasis at the base. the left lung is essentially clear.
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no acute intrathoracic process.
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no pulmonary edema. reviewed with dr.
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right-sided pleural effusion is unchanged. layering left pleural effusion is likely unchanged compared to prior study. the endotracheal tube is <num> cm above the carina. recommendation(s): the findings were discussed with , by , m. d. on the telephone on at pm, <num> minutes after discovery of the findings.
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no acute cardiopulmonary process.
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no focal consolidation. no displaced fracture identified; however, please note that rib series or chest ct are more sensitive. mild prominence of the ascending aorta may relate to tortuosity; however, mild dilatation is not excluded, which can be further evaluated on chest ct.
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in comparison with the study of , there is little overall change. opacification at the right base persists in this patient with marked hyperexpansion of the lungs consistent with chronic pulmonary disease. no definite pneumothorax at this time.
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unchanged exam compared to <num> day previously with continued moderate left and small right pleural effusions and bibasilar atelectasis.
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pa and lateral chest compared to chest radiographs since , most recently : prior radiographs document chronic right middle lobe atelectasis, and episodes of pneumonia in different areas of the lungs. some of the heterogeneous opacification on was due to pulmonary edema in the setting of severe emphysema, but could have been due also to concurrent pneumonia, particularly in the axillary region of the right mid lung. this area has only partially cleared, and there is progressive heterogeneous opacification at the right apex, which may well represent another focus of pneumonia. triangular region of opacification in the lingula, has shown variable degrees of radiodensity, but has generally grown more coalescent since. given the multiplicity of pulmonary abnormalities, it would be reasonable to perform a chest ct scan to look for evidence of active processes other than simple pneumonia, including malignancy and tuberculosis. small right pleural effusion is new, likely residual of previous heart failure, but conceivably inflammatory. heart size is normal.
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no evidence of acute cardiopulmonary disease.
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findings concerning for small bowel obstruction. small bilateral pleural effusions.
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lower posterior opacity projecting over the spine could be due to rotated position of the patient. recommend repeat lateral radiograph with proper technique to re-assess.
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no evidence of pneumonia. calcified pleural plaques, in keeping with prior asbestos exposure.
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no acute cardiopulmonary process.
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no acute cardiopulmonary process.
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in comparison with the study of , there is increasing opacification at the left base, consistent with worsening pleural effusion and underlying compressive atelectasis. the appearance of rounded atelectasis at the left base reported on the previous examination is not identified, though it could merely be obscured by the pleural effusion. the remainder the study is within normal limits with no evidence of vascular congestion or acute focal pneumonia. of incidental note are apparent free joint bodies involving both shoulders, with substantial degenerative changes.
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left picc line tip terminates at the level of lower svc. heart size and mediastinum are stable. lungs are essentially clear. there is no appreciable pleural effusion. there is no pneumothorax.
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mild left basal atelectasis, otherwise unremarkable exam.
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no acute cardiopulmonary process.
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normal chest radiograph without evidence of pneumonia.
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comparison the. decrease in lung volumes. mild atelectasis at the right lung bases. no pulmonary edema. no pleural effusions. no pneumonia. borderline size of the cardiac silhouette. monitoring and support devices are in unchanged position.
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right picc tip in the mid/low svc. no acute cardiopulmonary process.
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no acute cardiopulmonary process.
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no acute cardiopulmonary process. mildly hyperinflated lungs.
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no previous images. there is mild hyperexpansion of the lungs suggesting chronic pulmonary disease. no acute pneumonia, vascular congestion, or pleural effusion.
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left subclavian picc line remains in place, unchanged with the tip in the mid svc. the patient is status post median sternotomy for cabg with stable cardiac and mediastinal contours. lungs are well inflated without focal airspace consolidation to suggest pneumonia. no evidence of pulmonary edema, pleural effusions or pneumothorax. no acute bony abnormality.
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no acute intrathoracic process.
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there is no air in the upper mediastinum. at the level of the gastric pull-up, the difficult to detect pneumomediastinum and separated from the gastric folds and adjacent atelectasis. there is no pneumothorax or pleural effusion. lungs are clear and the heart is normal size. if symptoms persist and there is clinical concern for perforation, i would recommend ct scanning or fluoroscopically observed contrast swallow.
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interval increase in a now very large right pleural effusion with diffuse metastatic disease.
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no evidence of pneumonia. bronchial wall thickening in the lower lobes, suggestive of bronchitis.
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unchanged stable chest findings with evidence of bilateral pleural effusion and pulmonary congestion, but no evidence of pneumothorax.
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low lung volumes with bibasilar atelectasis and/ consolidation.
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ill-defined patchy left lower lobe opacities concerning for pneumonia. followup radiographs after treatment are recommended to ensure resolution of this finding.
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no radiographic evidence of acute cardiopulmonary process.
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tip of the endotracheal tube is above the upper margin of the clavicles no less than <num> cm from the carina an should be advanced to <num> <num> cm for more secure seating. upper enteric drainage tube has been partially withdrawn and would need to be advanced <num> cm to move all the side ports well into the stomach, which is now moderately distended. supine positioning and very low lung volumes account in part for apparent increase in diameter of the cardiac silhouette, but clinical consideration should be given to the possibility of any developing pericardial fluid collection. there is no venous engorgement in the mediastinum to suggest that pericardial fluid if present is hemodynamically significant. right upper lobe hematoma more readily visible than earlier, but not appreciably larger. there may be an increase in the small right pleural effusion. left lung is clear. subcutaneous emphysema and bullet fragments in the right chest wall are unchanged.
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no acute cardiopulmonary process.
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no pneumothorax identified.
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a dobbhoff tube is advanced into the proximal stomach. the endotracheal tube is unchanged in position. the cardiac and mediastinal contours remain stable. there is slight improvement of central pulmonary vascular congestion.
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et tube tip is <num> cm above the carinal. left chest tube is in place. heart size and mediastinum are stable. bibasal opacities are unchanged. minimal left apical pneumothorax is unchanged there are slightly decreased. the subcutaneous air within the left chest wall is noted, minimal but new
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lungs clear. moderate cardiomegaly increased since , but no pulmonary vascular engorgement or edema. skin fold should not be mistaken for pneumothorax. no pleural abnormality. healed rib fractures noted in the right hemi thorax. conventional chest radiographs, particularly when performed at the bedside, are not sensitive for detection of chest cage trauma. detail views of clearly marked focal findings should be obtained instead
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no acute cardiopulmonary process.
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bibasilar atelectasis and or scarring. possible trace bilateral pleural effusions versus pleural thickening.
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borderline cardiomegaly with suggestion of possible left atrial enlargement, but no evidence of acute disease.
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persistent right upper lobe opacity with volume loss. please follow radiographically as patient's symptoms resolve; if findings do not clear, chest ct should be ordered.
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complete interval resolution of loculated right pleural effusion.
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right upper lobe pneumonia.
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no acute cardiopulmonary process. vague <num>-cm opacities in the mid and lower right lung only seen on the pa view. recommend oblique views for further evaluation.
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low lung volumes with minimal patchy bibasilar opacities, likely atelectasis. no focal consolidation to suggest pneumonia is identified.
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ap chest compared to : small region of consolidation at the right lung base medially is new and small right pleural effusion and even smaller left pleural effusion have increased slightly. the y-stent is barely visible, but appears to be appropriately seated. a large mediastinal mass unchanged. heart size normal. no pneumothorax.
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no acute cardiopulmonary process.
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small right pleural effusion has developed since following removal of the right thoracostomy tube. there is no appreciable pneumothorax. atelectasis persists at the base of the postoperative right lung and the left lung. cardiomegaly is severe, but there is no pulmonary edema.
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no acute cardiopulmonary process or rib fracture.
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diffuse increased interstitial markings bilaterally seen on the prior study; the frontal view appears similar to the prior study, although the lateral view suggests possible mild increase in the markings and thus an acute-on-chronic process may be present.
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pa and lateral chest compared to through : severe hyperinflation is chronic, presumably due to copd. there is no focal pulmonary abnormality. cardiomediastinal and hilar silhouettes and pleural surfaces are normal. atherosclerotic calcification noted in the subclavian, axillary and brachial arteries and at the origin of the aortic arch vessels. heart size is normal.
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right picc terminates in the mid svc.
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severe cardiomegaly with mild pulmonary edema and small bilateral pleural effusions. nonspecific area of focal opacification in the right apex. this could reflect an area of infection, though infarction cannot be completely excluded. if there is high concern for pulmonary embolism, chest cta is recommended. recommendation(s): if there is high concern for pulmonary embolism, chest cta is recommended.
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right lung vague opacity. given lack of definite stability, a non-emergent chest ct is recommended for further evaluation. recommendations sent to the ed qa nurses on at by dr.
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no acute cardiopulmonary process.
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low lung volumes without visualized acute cardiopulmonary process.
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there is a left-sided port-a-cath. heart size is prominent but stable. there has been improvement of the basilar opacities, particularly at the right base. there remains a hazy infiltrate in the right upper lobe.
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no acute cardiopulmonary process.
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no acute cardiopulmonary process.
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bibasilar atelectasis and bilateral effusions. improved, but residual, left lower lobe collapse/consolidation compared with. the right effusion could be very slightly larger. no chf.
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no radiopaque foreign objects visualized.
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increasing opacification/ consolidation in the right upper lung. no new consolidation identified.