0	there are relatively low lung volumes . no definite focal consolidation is seen . mid lung atelectasisscarring is again seen . mild cardiomegaly is again seen . mediastinal contours are unremarkable . no pleural effusion or pneumothorax is seen . no acute cardiopulmonary process .	No Finding	17147859	52077543	b6ce62d8-12124de8-769cb0d0-07e96bef-ca38036d
1	consolidation in the left lung continues to improve . now one can see mild-to-moderate pulmonary edema . moderate right pleural effusion is smaller . heart size is normal, and there is no mediastinal vascular engorgement . feeding tube with the wire stylet in place ends in the upper stomach . a left internal jugular swan-ganz catheter ends in the right pulmonary artery . there is no pneumothorax .	Consolidation&&Edema&&Pleural Effusion&&Support Devices	16334516	59155553	b9835d4b-d30d7c67-ffa9e3ae-98c8543d-e8fc42d8
2	portable frontal chest radiograph there is a subtle ill-defined opacity in the right upper lung which may represent focal aspiration . there is no pleural effusion . no pneumothorax is evident . cardiomediastinal and hilar contours are within normal limits given the ap technique . no subdiaphragmatic free air is identified . retained contrast is seen within the transverse colon .	Lung Opacity	18835687	50547182	423fc237-2b2e1394-e5255f87-97ae0a26-96fd38d9
3	analysis is performed in direct comparison with the next preceding pa and lateral chest examination of . whereas the described changes in the right hemithorax are stable, the left-sided basal pleural density has decreased markedly and the left-sided diaphragmatic contour is now identified both on frontal and lateral view . no evidence of pneumothorax in the apical areas on either side . successful thoracocentesis removing major portion of left-sided pleural effusion . no pneumothorax following thoracocentesis .	Pleural Effusion	13023326	52971492	ccb75760-a2c8e314-d3d63bc2-17217a91-123a376d
4	the dual-chamber transvenous pacemaker leads are in the appropriate position in the right atrium and right ventricle . no pneumothorax, mediastinal widening or evidence of hemothorax . no pleural effusion . mild cardiomegaly stable . left mild basilar atelectasis . no evidence of pneumonia . dual-chamber transvenous pacemaker leads are in appropriate positions . no evidence of pneumothorax, mediastinal widening, or evidence of hemothorax .	No Finding&&Support Devices	19075045	57617376	f15b72a4-0e6020a3-cf98cd7c-c8f430f5-1a7d3aa9
5	the lungs are clear . no right pleural effusion . no large left pleural effusion . no pneumothorax . stable mild cardiomegaly . mediastinal contour and hila are unremarkable . midline sternotomy wires again demonstrate disruption of the second sternotomy . additional sternotomy wires are intact . an enteric feeding tube is seen coursing midline with tip in stomach . a left chest wall pacer device lead tips are in the right atrium and right ventricle . right picc tip is in the mid svc . . stable mild cardiomegaly . . enteric feeding tube tip in stomach, still containing stylet .	Cardiomegaly&&Support Devices	18487334	59763018	e8f94964-26bbd138-d2b7248a-e4fd514a-35beb87c
6	previous edema in the left lung has cleared . there has been no appreciable change in the extent of the large right hydropneumothorax with near collapse of the right lung and moderate leftward shift of the lower portion of the mediastinum and downward displacement of the right hemidiaphragm . findings were discussed by telephone earlier this morning with the house officer caring for this patient, dr . .	Atelectasis&&Enlarged Cardiomediastinum&&Pneumothorax	14387068	56460885	3af2079b-5efadc60-7a5c217f-b733fcbc-346b0893
7	following repositioning, the coiled dobbhoff tube in the mid esophagus has resolved . the distal end is within the stomach . right internal jugular sheath is at upper svc . patient is following median sternotomy for mitral valve replacement and sternal sutures are intact . mild-to-moderate right pleural effusion associated with adjacent lung atelectasis is unchanged since prior radiograph from . no other interval changes in the lung .	Atelectasis&&Pleural Effusion&&Support Devices	18224196	55169735	58d7d80b-3610f757-0e540435-44dbf9dd-12c5b583
8	small bilateral pleural effusions are increased in size compared to most recent prior exam . there is no focal consolidation . the lungs are hyperinflated with emphysematous changes as seen on prior ct . heart size is increased, similar compared to prior . . increased small bilateral pleural effusions . . cardiomegaly . . hyperinflated lungs corresponding with known emphysema . these findings were discussed with dr . by dr . by telephone at am .	Cardiomegaly&&Pleural Effusion	18224196	56094236	eb810218-60a5a044-852328e8-4cdeeaef-1befd540
9	there is little change . again there are low lung volumes that accentuate the transverse diameter of the enlarged heart . bilateral basilar atelectatic changes, more prominent on the right . specifically, the tip of the swan-ganz catheter is in the right pulmonary artery at the mediastinal border .	Atelectasis&&Cardiomegaly&&Support Devices	19075045	52513249	5f626d47-f0333190-ef348062-b306b136-d126da29
10	et tube tip is . cm above the carinal . right internal jugular line tip is at the level of cavoatrial junction . ng tube tip is in the stomach . cardiomegaly is substantial . there is vascular congestion . there are bibasal opacities concerning for infectious process .	Cardiomegaly&&Edema&&Lung Opacity&&Pneumonia&&Support Devices	15131736	52920123	66a9bbd8-4711cfe3-80145c82-d9611044-07ee1359
11	on the hyperinflated . there is no focal consolidation, pleural effusion or pneumothorax . apical pleural thickening bilaterally is stable . the cardiomediastinal silhouette is normal . the imaged upper abdomen is unremarkable . the bones are intact . clips in the left upper quadrant are noted . cervical fusion hardware is noted . no acute cardiopulmonary process .	No Finding	15114531	55107790	39c36e59-7b5c308e-a9153759-84676a45-4cadadf0
12	there is no evidence of left pneumothorax following the recent procedure . left juxtahilar mass is again demonstrated with adjacent parenchymal opacities which likely represent post-obstructive atelectasis and pneumonia . as compared to the recent radiograph, the left upper lobe opacity appears more dense, possibly due to progressive post-obstructive abnormalities, but co-existing hemorrhage or aspiration are certainly possible in the setting of a recent procedure . short-term followup radiograph may be helpful in this regard .	Atelectasis&&Lung Lesion&&Lung Opacity&&Pneumonia	18067737	56427859	805c8f03-c6d068dd-c95f546c-e1dfe872-324866d0
13	there is a marked improvement the lung volumes have increased, reflecting improved ventilation . the signs indicative of fluid overload have overall decreased . a potentially pre-existing small left pleural effusion combined to an area of retrocardiac atelectasis has completely resolved . the size and border of the cardiac silhouette can be better determined than previously . no new opacities . unchanged course and position of the pacemaker leads . the sternal wires are constant .	Atelectasis&&Cardiomegaly&&Lung Opacity&&Support Devices	13896515	51579601	a0515f0c-c19071ab-16f20abd-4732f05d-bbf91504
14	pa and lateral chest views have been obtained with patient in upright position . heart size and mediastinal structures are unchanged . the previously described remaining pleural densities along the upper right lateral chest wall in the shoulder area show diminished thickness of the pleural density surrounding the operative area . postoperative localized apical pneumothorax has diminished further and is now barely cm wide, also showing increasing pleural scar formation . no new abnormalities are seen . the left hemithorax is unchanged, though no evidence of new pulmonary abnormalities . progression of postoperative healing, status post right upper lobectomy accomplished via vats extended to thoracotomy intervention .	No Finding	19991135	50286241	a8c08cbf-15ac0dac-b76a40a0-dab826c7-18015767
15	frontal chest radiograph a nasogastric tube terminates within the stomach . a right-sided hemodialysis catheter terminates at the right atrium . a left-sided picc terminates at the cavoatrial junction . bilateral pleural catheters have been removed . the patient is post median sternotomy and mitral valve repair . an enlarged cardiac contour is unchanged since the prior exam . there is no pneumothorax or focal consolidation . small bilateral pleural effusions are unchanged since the most recent exam .	Pleural Effusion&&Support Devices	15259244	50610932	9ae19357-ed8ab74b-7c794e86-235ab6b4-b0b98b54
16	comparison to prior study of at am . portable ap upright chest film, at is submitted . . interval placement of a nasogastric tube, which is seen coursing below the diaphragm with the tip not identified . persistent marked thoracolumbar scoliosis markedly distorting the thoracic cage . lungs appear grossly clear . the cardiomediastinal contours are difficult to assess given the patient positioning on the current examination superimposed on the scoliosis . no evidence of pulmonary edema, pleural effusions or pneumothorax .	Enlarged Cardiomediastinum&&Support Devices	18110020	56470564	8ec25d32-d8679702-2fb2e638-24c54c84-34d1ee79
17	portable supine chest film at am . is submitted right internal jugular central line has its tip in the proximal superior vena cava . there is a feeding tube coursing below the stomach with the tip not identified . lung volumes remain low, and there is pulmonary vascular congestion likely reflecting a fluid replete state . linear opacity at the left base may represent an area of subsegmental atelectasis . the left costophrenic angle is not entirely included on the study . overall, cardiac and mediastinal contours are likely unchanged given differences in positioning and technique between studies .	Atelectasis&&Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Support Devices	19623993	57032173	0e064bcb-a3b8ea89-90e85aa8-525a773b-7c2718a7
18	the patient has received a pectoral pacemaker . the course of the pacemaker leads is unremarkable, there is no evidence of fracture or displacement . the signs indicative of mild pulmonary edema, present on the previous examination, have decreased . no evidence of pneumothorax . unchanged mild retrocardiac atelectasis and moderate cardiomegaly . status post sternotomy .	Atelectasis&&Cardiomegaly&&Edema&&Support Devices	19759491	50152324	ae135fa3-eb593692-9f19fe95-cdc9b703-28b87ac4
19	right ij catheter tip is in the upper svc . subclavian large catheter tip is in unchanged position, in the lower right atrium towards the ivc junction . moderate left pleural effusion has increased . left lower lobe retrocardiac opacities have increased . small-to-moderate right pleural effusion with adjacent atelectasis are probably unchanged allowing the difference in positioning of the patient . pulmonary edema has markedly improved . widened mediastinum is unchanged . cardiac silhouette is obscured by pleuroparenchymal abnormalities, probably unchanged . there is no evident pneumothorax . findings of enlarging left pleural effusion were discussed with by phone on at pm .	Atelectasis&&Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Support Devices	15259244	59963711	bcb39e0c-aa48bfc8-50a5f824-1f4b73e1-4a1f3235
20	previous mild pulmonary edema has resolved . severe cardiomegaly stable . no appreciable pleural effusion or focal pulmonary abnormality . cardiopulmonary support devices in standard locations unchanged .	Cardiomegaly&&Support Devices	18487334	53333931	0f0038e8-aa61d68a-c46ef78e-4ee08f4b-d4a8e62d
21	single frontal portable view of the chest there is no definite pleural effusion or pneumothorax . the enlarged cardiomediastinal silhouette with diffuse interstitial markings is unchanged from prior . as previously suggested, this may reflect chronic interstitial lung disease with superimposed pulmonary vascular congestion . a right-side central line terminates in the right atrium . although the exam is limited by overlying trauma board, there is no displaced rib fracture .	Edema&&Lung Opacity	13475033	59918608	8fd47aef-a0002ac5-00dd791e-784fc4a3-a7bc5026
22	the lead positions of the dual-chamber pacemaker is unchanged compared to the prior exam . there is moderate cardiomegaly . the lungs demonstrate moderate pulmonary edema but no evidence of pleural effusions or pneumothorax . mild atelectatic changes at the lung bases are unchanged . incidental note is made of chronic stable calcified scarring in the left apex . there are no new parenchymal opacities . there is no evidence of pneumothorax . unchanged lead positions from recently inserted dual-chamber pacemaker .	No Finding&&Support Devices	11893091	55255832	68d1a72f-0552bded-deae306a-343f5d03-ccf9853f
23	persistent pulmonary opacities, vascular engorgement and septal lines refkect mild pulmonary edema . small left pleural effusion cannot be excluded . low lung volumes limit assessment of cardiomediastinal silhouette though the cardiac size appears mildly enlarged . unchanged mild pulmonary edema with likely small left pleural effusion .	Edema&&Pleural Effusion	19159236	55511619	7e424a42-38f2b8c3-7cdac166-95452e5b-2ada132a
24	mild interstitial pulmonary edema has worsened, moderate left pleural effusion has increased . no focal pulmonary abnormalities . heart size is normal . et tube and left internal jugular line are in standard placements . nasogastric tube ends in the upper stomach . esophageal manometer or temperature probe in place at the level of the carina . no pneumothorax .	Edema&&Pleural Effusion&&Support Devices	12433421	57365217	ea76870d-7fdf2c99-bec8634e-1362050a-edc3c8fd
25	a left pectoral pacemaker device with leads through the left transvenous approach end into the right atrium and right ventricle respectively . the patient is status post median sternotomy with intact sternal sutures . heart size, mediastinal and hilar contours are normal . left lung is remarkable for mild left basal atelectasis . right lung is clear . no pneumonia or pulmonary edema . there is no pleural abnormality .	Atelectasis&&Support Devices	17163861	51731956	354f8abd-01f7f413-cb068ad1-1d47c651-7a17c514
26	in comparison to prior study, there is new medial right basilar and left basilar retrocardiac opacity . given the clinical history, this is concerning for aspiration, possibly developing pneumonia . there is no associated effusion, pneumothorax or apparent pneumomediastinum . the upper lungs remain well aerated . hilar and cardiomediastinal contours are unchanged, with marked calcification and tortuosity of the thoracic aorta . degenerative changes are noted in the thoracic spine . no free air is seen in the included upper abdomen .	Lung Opacity&&Pneumonia	12699874	58039469	f27661c7-7cd1d2eb-6116d719-a906e894-7623f8b4
27	ap single view of the chest has been obtained with patient in sitting semi-upright position . comparison is made with the next preceding similar study obtained four hours earlier during the same day . again identified is status post right upper lobectomy with moderately elevated right-sided diaphragm and local chest wall emphysema in the right shoulder area . no pneumothorax has developed since the preceding study, and no new infiltrates are seen . stable chest findings as seen on portable followup examination, status post right upper lobectomy .	No Finding	19991135	54103833	6ce54ac9-077864fe-84217f97-5f43c4e3-f0578456
28	et tube ends . cm above carina . the patient had a recent left lower lobe lobectomy with the chest tube that projects in upper hemithorax without any visible pneumothorax . left pleural effusion is small if any . the lung volumes are low with mild mediastinal and cardiac enlargement . conclusion there is no pneumothorax . the patient had recent left lower lung lobectomy with usual change .	No Finding	12530259	55949339	b76a59ce-cd4c3882-2bf6437f-89cd9378-adc0be20
29	lordotic positioning . there has been interval removal of et and ng tubes . there is cardiomegaly and upper zone redistribution with mild diffuse vascular blurring, suggesting chf with interstitial edema . there is atelectasis at the left base, improved compared with -- the left hemidiaphragm is now visible . minimal blunting of the left costophrenic angle . calcified granulomas of the left upper zone again noted .	Atelectasis&&Cardiomegaly&&Edema	12185775	57648356	07a6c75c-9ee2bcc2-076307a1-e6000602-0ee483bb
30	a left hilar mass is noted, which appears new compared with prior exam of . there is also increased vascular markings in the remaining lung fields as well as a new left-sided pleural effusion . there is mild-to-moderate cardiomegaly which appears to be slightly worsened compared with prior exam . there is no pneumothorax . sternotomy wires are intact . multiple surgical clips are noted in the left hemithorax . . new left hilar mass . a ct is recommended for further assessment . . cardiomegaly associated to increased vascular markings and pleural effusion suggests pulmonary vascular congestion .	Cardiomegaly&&Edema&&Lung Lesion&&Pleural Effusion	11879886	53021526	27a4f085-5eaad330-a1153870-3ec2cd19-20a604cd
31	portable ap radiograph of the chest was compared to . there is interval increase in right pleural effusion, currently large, associated with atelectasisconsolidation . interstitial pulmonary edema has slightly progressed and there are also newprogressing opacities in the left mid and lower lung that might reflect infectious process as well . the left internal jugular line tip is in the persistent left svc, unchanged in appearance . the replaced valves, tricuspid and aortic are redemonstrated .	Atelectasis&&Consolidation&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	19182863	56745275	d59037ae-76814c45-ab38e8da-7b58f204-debaa6b9
32	the heart is normal in size . there is new lobular thickening of the right upper mediastinum and also a nodular appearance to the right hilum . widespread opacity is present in the right middle lobe . elsewhere, the lungs appear clear . there is no pleural effusion or pneumothorax . minimal degenerative changes are noted along the mid thoracic spine . widespread right middle lobe opacity worrisome for pneumonia, but a post-obstructive pneumonitis should be considered, noting abnormal contours of the right upper mediastinum and right hilum . evaluation with chest ct, preferably with intravenous contrast, is recommended to evaluate further to consider the possibly of coinciding malignancy .	Enlarged Cardiomediastinum&&Lung Opacity&&Pneumonia	15204620	57187080	b9d07ae5-876bb931-85ce766f-8dc425d4-5948363d
33	again, there is enlargement of the cardiac silhouette with diffuse prominence of interstitial markings . this could reflect chronic interstitial lung disease, possibly with superimposed elevation of pulmonary venous pressure . central line remains in place .	Cardiomegaly&&Lung Opacity&&Support Devices	13475033	52361758	08c5db2c-71dd02c9-c4a04334-3b52c7a9-afa08832
34	there are diffusely increased interstitial markings throughout the lungs which are hyperinflated . there is no effusion or pneumothorax . cardiac silhouette is enlarged but unchanged . multiple vascular stents are again identified . numerous punctate calcifications in the left upper quadrant are compatible with splenic granulomas . no acute osseous abnormalities identified . increased interstitial markings throughout the lungs bilaterally which can be seen in the setting of atypical infection or interstitial edema, likely superimposed on underlying emphysema .	Edema&&Lung Opacity&&Pneumonia	19061282	51835823	6b316ff1-09afc29c-706a4def-20612025-cb976104
35	the lungs are clear of focal consolidation, effusion or pneumothorax . the heart is enlarged, similar to prior . right upper extremity vascular stent is partially visualized . multiple thoracic compression deformities are again seen . no definite acute cardiopulmonary process .	No Finding	13475033	54655485	69392c89-8fa3a6e8-6c3bc53f-f09b09e2-a33a44e3
36	there is mild pulmonary edema . a moderate right pleural effusion is not significantly changed . a consolidation at right base is not definitive on this examination however is confirmed on the subsequent ct . no pneumothorax is seen . there is moderate cardiomegaly with tortuosity of the aorta . the patient is status post median sternotomy with cabg and valve replacements . mild pulmonary edema with right pleural effusion . consolidation at right base is not definitive on this examination however is confirmed on the subsequent ct .	Consolidation&&Edema&&Pleural Effusion	19182863	57198058	23944c5d-05acde48-c46484e1-0c68641c-e9ad6fd2
37	frontal and lateral radiographs of the chest demonstrate slight interval increase in the opacity in the lingula . there is a new area of atelectasis at the left base . there is slight blunting of the right costophrenic angle, which likely represents atalectasis . the cardiomediastinal and hilar contours are unremarkable . no new or additional foci of consolidation are noted . there is no pneumothorax, pleural effusion, or pulmonary edema . slight interval increase of lingular opacity, and new area of atelectasis at bilateral bases .	Atelectasis&&Lung Opacity	16435402	52353624	b05e2bad-8b5b414e-de701c91-cd96ce95-3dd20d77
38	single ap view of the chest no endotracheal tube is seen . patient is status post right upper lung surgery with unchanged appearance of the right hemithorax and evidence of right sided volume loss . lungs are clear . cardiomediastinal silhouette and hilar contours are unremarkable . no pulmonary edema is present . these results were communicated with dr of the ed by dr at pm via telephone on the date of the study . the wrong requisition was entered . the clinical history is year old women with shortness of breath .	No Finding	19907884	58635342	38c9787f-8f9a7af2-3814ee5a-ebd8ba86-d55e4279
39	pulmonary edema superimposed on background chronic biapical fibrocalcific process . effusion and atelectasis in the right base . the overall appearances are probably little improved from prior study .	Atelectasis&&Edema&&Pleural Effusion	13849733	51332489	6060ae56-99a2e711-2c686d45-24f7adcb-e3ea3454
40	the study is somewhat limited due to motion artifact . the lungs are well expanded . indistinct vasculature and cardiomegaly suggests mild pulmonary edema, although some of the haziness could be due to technique . hazy opacities are seen in the left upper lung and right lung base, which could reflect atelectasis or focal edema, although cannot exclude pneumonia or aspiration in the right clinical setting . there is no pleural effusion or pneumothorax . . mild pulmonary edema . . opacities in the left upper lobe and right lung base, which could reflect atelectasis or focal edema, although cannot exclude pneumonia or aspiration in the right clinical setting . re-assessment after diuresis is recommended . cardiomegaly .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pneumonia	13896515	58127477	106523df-7e5cdd25-a3523b28-f80e71b7-4ed5143c
41	as compared to the prior radiograph performed yesterday morning, there has been slight interval improvement in extent of interstitial pulmonary edema . there are no large pleural effusions . there is no pneumothorax . persistent moderate cardiomegaly . median sternotomy wires are intact . left pectoral pacemaker is unchanged in visualized . slight interval improvement in interstitial pulmonary edema .	Edema	13896515	58373469	f1324f6e-a72d0eb7-dbe2b51f-8da51dcb-822e61dc
42	mild pulmonary edema is present . left lower lung opacity is likely a combination of small atelectasis and probably a small effusion . right small pleural effusion is presumed . heart size is mildly enlarged, and the pulmonary vasculature is minimally congested . a right central line tip ends at lower svc . mild pulmonary edema . left lower lung opacity is likely a combination of atelectasis and effusion and right lung base atelectasis is minimal . there is no evidence of pneumothorax .	Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion	18855147	54353466	71836ad3-c65f5072-d88d098b-00ab4c24-98994b02
43	pa and lateral views of the chest interstitial opacities within the right upper lobe are thought to represent recurrent pneumonia . pneumonia was noted in this area on but had essentially cleared on . the right lower lobe nodule is unchanged in size through . there is no pneumothorax . a small right pleural effusion and right apical scarring persists . the neo esophagus is not distended . the mediastinal silhouette is normal in contour . recurrent right upper lobe pneumonia .	Pneumonia	14295224	58198778	cb2f4f2e-e36e5b5c-fabde40d-22a6a15f-4a4b48ad
44	there is similar moderate-to-severe cardiomegaly . the cardiac, mediastinal and hilar contours appear stable . the pulmonary vasculature is engorged and indistinct including upper zone redistribution . fissures are thickened . a linear opacity in the left mid lung appears unchanged and suggests minor scarring or atelectasis . a left subclavian venous stent is again demonstrated . there has been no significant change . findings suggesting mild pulmonary edema . similar cardiomegaly . stable mediastinal contours .	Cardiomegaly&&Edema&&Enlarged Cardiomediastinum	13473495	51168408	a274e07c-68b358c4-454f3eab-c28f2256-061b00e2
45	interval worsening moderate pulmonary edema . right moderate pleural effusion has also slightly increased . small left effusion persists . left lower lobe parenchymal opacity in the superior segment is now obscured by increasing pulmonary edema . moderate cardiomegaly . no pneumothorax . worsening moderate pulmonary edema as well as right moderate effusion . left lower lobe parenchymal opacity in the superior segment is now obscured by increasing pulmonary edema .	Edema&&Lung Opacity&&Pleural Effusion	14851532	58000887	7d620442-deb05a77-a0f55a7e-f9f1d0e1-99509e35
46	chest pa and lateral radiograph demonstrates decreased size of the left upper lobe opacity possibly due to resolution of hemorrhage, now measuring . in the craniocaudal dimension compared to . cm on prior study . there is persisitent if not increased streaky retrocardiac opacities, possibly related to aspiration . no definitive opacification concerning for pneumonia . minimal left costophrenic angle blunting, likely represents small left pleural effusion . no osseous abnormalities identified . interval decrease in size of left upper lobe opacity, possibly reflecting resolution of prior hemorrhage . likely small left pleural effusion .	Lung Opacity&&Pleural Effusion	19404187	50682888	08da513d-5325ee2d-d57746d8-762cf929-bf1c0fa4
47	upright ap view of the chest the patient is status post median sternotomy and cabg . the cardiac, mediastinal, and hilar contours are normal . the pulmonary vascularity is normal . there are streaky opacities in the lung bases, most likely reflective of atelectasis . no focal consolidation, pleural effusion, or pneumothorax is visualized . there are no acute osseous abnormalities .	Atelectasis&&Lung Opacity	14504940	55011437	93df2443-2b80a0f4-6c12dc92-910966a7-3da34ae3
48	the patient is status first median sternotomy . again, there is fracture of at least the first and second sternal wires, the upper wire was seen to be fractured on the prior study, although the second wire was not clearly fractured at that time . there is left base atelectasis . no definite focal consolidation is seen . there are low lung volumes, which accentuate the bronchovascular markings . there is minimal blunting of the right costophrenic angle, although no definite pleural effusion is seen on the lateral view . there is no pneumothorax . the cardiac and mediastinal silhouettes are stable . . left mid to lower lung atelectasis . low lung volumes . . the patient is status post sternotomy with fracture of at least the first and second sternotomy wires and possibly the lower most sternotomy wire .	Atelectasis&&Fracture	18088200	56018459	f268f466-63237ff9-71f67025-2f256fa0-8f9c0e56
49	there is a new et tube . cm above the carina . there is pulmonary vascular redistribution that is worsened in the interval with alveolar infiltrates bilaterally and dense retrocardiac opacity that could be due to volume lossinfiltrateeffusion . the heart size is moderately enlarged . ng tube tip is in the stomach . there is a small right effusion . . et tube in good location . . increased chf . an underlying infectious infiltrate cannot be excluded .	Cardiomegaly&&Edema&&Lung Opacity&&Pneumonia&&Support Devices	15131736	58833368	e01e8de2-d5095cb4-f851985e-df9c203c-89326fdb
50	comparison is made to previous study from . there is a stent seen within the esophagus which is unchanged in position . there is again seen consolidation at the right lower lobe, stable . right-sided pleural effusion is also unchanged .	Consolidation&&Pleural Effusion	19016834	50657342	7f51e1cc-fc9208cc-470c70a3-9528d87c-9f33be5b
51	ap single view of the chest has been obtained with patient in upright position . the findings on the portable ap single chest view remains the same . thus, bilateral pleural effusions exist and the pulmonary vasculature remains congested similar as it was on all three postoperative and follow up examinations . as on the next previous study, the patient is extubated . right internal jugular approach central venous line remains in unchanged position .	Pleural Effusion&&Support Devices	12952223	54537743	5c03570c-7b4fd4a2-4faf7ff0-ab71c1af-e7dec254
52	cardiomegaly and widened mediastinum are stable . small bilateral pleural effusions have minimally increased . bibasilar atelectasis have increased . mild-to-moderate pulmonary edema is present . patient has known emphysema and bilateral calcified pleural plaques that are better seen in prior ct from . the sternal wires are aligned . patient is status post cabg .	Atelectasis&&Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Pleural Effusion	13078497	58645963	873534d1-56db4ca5-99ce7bc9-e5c568ef-fa59f01b
53	no evidence of pathologic parenchymal opacities on the basis of the technically limited examination . borderline size of the cardiac silhouette, unchanged coiling of the nasogastric tube in the stomach .	Cardiomegaly&&Support Devices	18110020	53957798	474305f3-1346d14f-d554552c-d0606af0-2edf1cb9
54	right internal jugular line tip is at the level of cavoatrial junction . the patients replaced cardiac valves are redemonstrated, unchanged . overall, there is substantial interval improvement in pulmonary edema since the prior study . right basal atelectasis has improved .	Atelectasis&&Edema&&Support Devices	19182863	51214818	181aa53a-d204d3a4-e3e99340-92bb8c76-0f690e54
55	the dobbhoff tube has been pulled back somewhat . the opaque tip is in the mid body of the stomach, pointing laterally . little overall change in the appearance of the heart and lungs .	Cardiomegaly&&Support Devices	14387068	54023727	d395c594-96025cff-7e6af4ad-ca08ac10-032bd500
56	there are lower lung volumes . pacer device is essentially unchanged . continued prominence of the cardiac silhouette with elevation of pulmonary venous pressure . small bilateral pleural effusions with bibasilar atelectasis .	Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices	13921768	58798180	bef80876-2290f20a-fadfeb2b-c23b9250-0c95d76d
57	since the prior exam, there appears to be increased interstitial prominence, although no overt pulmonary edema . stable bronchiectasis and scarring is again noted at the right base . there is no dense consolidation . there is no pleural effusion or pneumothorax . severe cardiomegaly is present . a pacemaker is in place with wires in unchanged position . the patient is status post a cabg . the sternal wires are intact . there are severe degenerative changes of the bilateral shoulders . . mild interval increase in interstitial prominence without definite pulmonary edema . . stable right lower lobe scarring and bronchiectasis .	Lung Opacity	12110863	55875120	c12759af-b70b6882-d6cca08e-8811c264-7caf797c
58	there has been placement of an og feeding tube which is coiled within the stomach with the tip pointing towards the fundus . compared to the most recent prior radiograph, there has been no significant change . moderate loculated right pleural effusion, is unchanged . left mid and lower lung opacities are stable . there is no pneumothorax . cardiac silhouette is enlarged but stable . og tube coiled within the stomach with the tip pointing towards the fundus . otherwise, no significant interval change . these findings were reported to dr . by dr . telephone at pm .	No Finding&&Support Devices	14387068	59638609	f4ed24b7-7ce4f984-cadc1a40-43fde803-53ae7d9b
59	there are fibronodular changes again seen in the upper zones, consistent with the clinical diagnosis of sarcoidosis . no evidence of acute focal pneumonia, vascular congestion, or pleural effusion .	No Finding	14147787	51143208	84bda4d0-5f9d3ab4-fe155b80-2e70766a-60672585
60	frontal lateral views chest performed . a left upper extremity picc has been removed . the cardiac silhouette remains chronically and moderately enlarged . there are small to moderate bilateral pleural effusions which have increased in size from prior . additionally, enlargement of the azygous vein with indistinctness of the pulmonary vasculature is consistent with congestive failure . more focal appearing consolidations are seen in the middle lobe and a lower lobe, probably left . there is no pneumothorax . the imaged upper abdomen is unremarkable . . moderate pulmonary edema with small to moderate bilateral pleural effusions . . opacities within one of the lower lobes, probably the left, and in the middle lobe could represent more focal consolidations . either repeating the study after diuresis or obtaining oblique views would be helpful in clarification . these findings were discussed with dr . by dr . at am on .	Consolidation&&Edema&&Lung Opacity&&Pleural Effusion	16855430	56956118	577e3751-aef1bbf3-e970d911-b1ad5a8e-af1b41d3
61	tiny left apical pneumothorax is stable or slightly improved . the rest of the exam is unchanged with mild pulmonary edema and left middle lung opacity related to recent bal . prior sternotomy was done for aortic, mitral and tricuspid valve repair . moderate cardiomegaly is stable . conclusion left minimal apical pneumothorax is unchanged or slightly improved . the rest of the exam is stable .	Pneumothorax	19182863	52374902	155e0867-6925a927-7f73fa2f-6e5438bb-dc6ae8fc
62	there is still a large right pleural fluid collection, now with a smaller component of air, at the base of the right lung which is severely restricted by severe pleural thickening which has worsened along the costal and particularly along the right mediastinal pleural surface . it would be helpful in our evaluation to know whether the nature of the right pleural effusion was infectious, malignant, are otherwise inflammatory . left lung is well inflated and clear . heart is not enlarged . vascular clips denote prior surgery at the level of the gastroesophageal junction .	Pleural Effusion&&Pleural Other&&Pneumonia	11569093	54749599	4a15096e-ded396cd-2f74c587-afc7d7b0-c226c5cb
63	status post thoracic closure . no evidence of pneumothorax . no pleural effusions . normal size of the cardiac silhouette . unchanged bilateral soft tissue air collections .	No Finding	17770657	59202511	a09b7aaa-77f7ca90-d3e26f5c-782a561e-499254d6
64	since the prior examination there is little change . there is no evidence of pneumothorax . there is a moderate subpulmonic pleural effusion as better demonstrated on the prior lateral radiograph . there is a new small left layering pleural effusion . there are no new focal opacities concerning for pneumonia . cardiomediastinal and hilar contours are stable demonstrating mild tortuosity of the thoracic aorta . heart size is within normal limits . pulmonary vascularity is normal . no evidence of pneumothorax . little change in subpulmonic right pleural effusion as better demonstrated on radiographs from am .	Pleural Effusion	10959054	50128467	ca220440-2b8510e6-fd0298b7-ab4fc422-434e558f
65	portable radiograph obtained for the purpose of dobbhoff tube assessment demonstrates the tip of a dobbhoff tube terminating in the distal stomach .	No Finding&&Support Devices	14841168	51958195	e098de1a-7399b454-7d99f39c-193c0665-82223533
66	there is a large focal consolidation involving the right lower lobe which may also involve the right middle lobe with associated moderate pleural fluid on the right side, all of which are new findings since the prior study . there is increased pulmonary vascular engorgement from the prior study and the cardiac silhouette is enlarged as seen on the prior study but increased in size . no pneumothorax is seen . a right-sided port is unchanged in position with the tip terminating in the low svc . the mediastinal and hilar contours are stable . probable lobar pneumonia involving the right lower lobe and possibly the right middle lobe with associated parapneumonic effusion . findings consistent with heart failure . findings were communicated by dr . by phone at am .	Cardiomegaly&&Edema&&Pleural Effusion&&Pneumonia	16826047	55960520	33ecbdf2-35c3aa31-e848a7b9-a49131b4-0690b4a3
67	in comparison to previous radiograph of day earlier, marked cardiomegaly persists, accompanied by pulmonary vascular congestion and slight improvement in pulmonary edema . interval worsening of right retrocardiac opacity, likely due to atelectasis . persistent small pleural effusions .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion	15131736	59523783	c6e5e02a-e2e30f50-3bb2f2f2-ab3882d4-b94c8610
68	since the earliest postoperative study earlier today on following median sternotomy and dual-valve replacements, there has been no change in the essentially normal postoperative cardiomediastinal silhouette . left lower lobe collapse however has progressed . small left pleural effusion is presumed . right pleural effusion is minimal if any and there is no pneumothorax, basal pleural tube in place . et tube, midline drains are in standard placements . swan-ganz catheter ends in the right descending pulmonary artery and should be withdrawn several centimeters to avoid inadvertent cannulation of the middle lobe or superior segmental lower lobe pulmonary arteries . no pneumothorax .	Atelectasis&&Pleural Effusion&&Support Devices	18224196	57481340	3627c932-73fba01b-b50c256b-fe25f602-a175bb99
69	support lines and tubes are unchanged in position . heart size is enlarged . there has been atelectasiscollapse of the right lower lobe since prior . there is mild to moderate pulmonary edema and subsegmental atelectasis in the left lung . there are no pneumothoraces .	Atelectasis&&Cardiomegaly&&Edema&&Support Devices	14851532	56151362	9aa39b17-1e7fadb7-8b82c0a2-f73018d2-7ac798d1
70	the endotracheal tube, left ij line, and transvenous right atrial biventricular pacer leads are unchanged in position . mild cardiomegaly, mild pulmonary edema, and low lung volumes are stable . no new pneumothorax or pleural effusion . no significant change since the radiograph from the prior day .	No Finding	13896515	53943549	7301509c-ae57fc65-dab3994c-b7d85ab5-8506df82
71	tip of the newly positioned endotracheal tube is in standard placement roughly cm above the carina . overlying apparatus obscures the upper lungs, but pulmonary vascular engorgement in the apices has worsened appreciably, accompanied by increase in moderate cardiomegaly, all suggesting cardiac decompensation, perhaps in the setting of hypotension . there is no florid pulmonary edema, large pleural effusion or any indication of pneumothorax . upper enteric tube passes into the stomach and out of view .	Cardiomegaly&&Support Devices	18906643	50767671	f60e6301-358d7f2f-b52c2c0c-ffea6e75-c35bdbe2
72	in the left perihilar region, there is a hazy opacification consistent with pneumonia . there is no pulmonary edema, pleural effusion, or pneumothorax . the cardiomediastinal silhouette is normal . there is elevation of the left hemidiaphragm, which is stable from the prior exam . left perihilar pneumonia . recommend followup radiographs after treatment to ensure resolution .	Pneumonia	12530259	51770967	dd9cfc23-b05701f2-26215d83-46297578-48e163ea
73	the largely fissural right pleural effusion has increased minimally since . accompanying increase in moderate cardiomegaly and mediastinal vascular caliber suggests a component of early cardiac decompensation may be present . there is no pneumothorax . right subclavian infusion port ends in the mid svc . there is no appreciable left pleural effusion . the right pleural drainage catheter has not migrated since a petct on shows it cannulates the right interlobar fissures from which the loculated pleural effusion should be accessible .	Cardiomegaly&&Pleural Effusion&&Support Devices	16826047	57414582	8db7bace-d0275263-d4c4cdf2-a7b97382-76817caf
74	lateral aspect left lower chest is excluded from the examination . remaining pleural surfaces show no pneumothorax and minimal if any pleural effusion . nasogastric tube passes into the stomach and out of the field of view . swan-ganz catheter tip is partially obscured by cardiac motion, but is probably in the right pulmonary artery in standard placement . right pleural, left pleural, midline drains in place . pulmonary vascular congestion and moderate postoperative widening of the cardiomediastinal silhouette are unchanged . there is more atelectasis in the right lower lobe, left lower lobe atelectasis is mild-to-moderate . there is probably no pulmonary edema .	Atelectasis&&Edema&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	10886362	58072789	22626212-038a564e-86e62d8b-9d61ea9c-daa48afc
75	pa and lateral chest radiographs linear opacities within the left lung base appear unchanged compared to recent prior examination and are consistent with plate-like atelectasis or scarring . flattened hemidiaphragms and hyperexpansion of the lungs suggest underlying obstructive pulmonary disease . no confluent consolidation is identified . there is no vascular congestion or pulmonary edema . a trace left pleural effusion is newly identified . cardiomediastinal and hilar contours are within normal limits . a prosthetic cardiac valve is again noted . there is no pneumothorax . median sternotomy wires appear grossly intact .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Support Devices	13606683	56883120	919158fb-4f0d9b66-46719ab6-5d584449-1a3ad8de
76	swan-ganz catheter has been advanced to the region of the right ventricular outflow tract . other indwelling devices are unchanged in position . cardiac silhouette has slightly decreased in size and pulmonary edema has improved with mild residual interstitial edema remaining as well as a small right effusion . bilateral chest tubes remain in place, with no visible pleural line to suggest pneumothorax . however, slightly deep left costophrenic sulcus associated with lucency in this region could potentially represent a basilar pneumothorax on this supine radiograph .	Cardiomegaly&&Edema&&Pleural Effusion&&Pneumothorax&&Support Devices	13135946	56745473	11deb911-a4fe401f-1955bb16-6adc7f50-673dec83
77	severe cardiomegaly and pulmonary vascular and hilar vascular engorgement are chronic, consistent with global heart failure and pulmonary hypertension . i do not think there is acute pulmonary edema, appreciable pleural effusion or evidence of pneumonia . asbestos-related pleural calcifications noted .	Cardiomegaly&&Edema&&Pleural Effusion&&Pneumonia	17838301	55607397	ee320893-4029e55f-63eb67d9-b7889903-20c23ab3
78	the lungs are clear, the cardiomediastinal silhouette and hila are normal . a gastric pull up is again seen . there is no pleural effusion and no pneumothorax . a bony coalition is seen at the posterior and th ribs, unchanged from the prior study . no acute displaced rib fractures are seen . rib detail views with pain markers might be considered for further workup .	No Finding&&Support Devices	14295224	51954230	d162120b-8bfaf7bf-a5c9e4c5-ab6b8617-14987b73
79	all the monitoring and support devices are unchanged within standard position . patient is after sternotomy for cardiac surgery . lung volume is still low but the left upper lobe opacification is reduced, likely for reabsorption of edema component . also, the left base pleural effusion is reduced . the right basilar opacification is slightly increased for increased pleural effusion . heart is still mildly enlarged . there is no pneumothorax . reduced left upper lobe opacification likely for reduced edema component . reduced left base pleural effusion, but increase in the right base .	Edema&&Lung Opacity&&Pleural Effusion	19075045	52680917	ff4c00a4-74c0b483-307446fe-e534b390-224db689
80	a feeding tube is seen within the stomach . accounting for the positional differences due to patients rotation, there has been no change in the cardiomediastinal silhouette . stable calcification of the aortic knob is noted . since the prior radiograph, there has been a slight increase in size of the left pleural effusion . there is no effusion on the right . the left pulmonary mass is unchanged . there is no new consolidation . stable right lower rib fractures are unchanged . there is no pneumothorax . slight increase in size of small left pleural effusion . no new opacities to suggest aspiration .	Lung Opacity&&Pleural Effusion	15185305	50281752	97766a6d-6ee96b98-90cacba0-3eb50d93-77416ad1
81	supine portable ap view of the chest provided . there is mild opacity obscuring the left heart border which is most likely atelectasis and less likely attributable to pneumonia . no large effusion or pneumothorax . the heart and mediastinal contour is stable . no bony abnormalities .	Atelectasis&&Cardiomegaly&&Enlarged Cardiomediastinum&&Lung Opacity&&Pneumonia	17720924	53687124	41479840-5d9f3cf1-ac29c4be-7007cfb9-37e379f3
82	pa and lateral views of the chest show stability of the moderate right pleural effusion with complete collapse of right middle lobe and lower lobe . right upper lobe and left lung are still clear . median wires are related to sternotomy in patient with history of aortic valve replacement and are unchanged . heart size is stable . there is no pneumothorax . little change .	No Finding	19182863	52415062	47c8159c-71388595-84bf105d-5a7e99e4-077fb801
83	heart size is normal . mediastinum is normal . lungs are essentially clear except for minimal right basal atelectasis . no evidence of pneumomediastinum or pneumothorax is seen within the limitations of the study technique .	No Finding	16848073	55938803	9528bf70-0da47cb5-e9dba3c0-608485c6-9923e87e
84	cardiomediastinal contours are unchanged . the lungs are hyperinflated consistent with emphysema . diffuse bilateral multifocal plate-like atelectases are unchanged . lung nodules describe in prior ct of are below resolution of this radiograph . there is no pneumothorax or pleural effusion . there is no evidence of pneumonia or chf . sternal hardware is again noted and unchanged . patient is status post cabg .	Atelectasis&&Enlarged Cardiomediastinum&&Lung Lesion&&Support Devices	17770657	57198284	783d751b-6d4cbb69-809e26a9-d116cb4e-4f3dee59
85	again, there are low lung volumes . mild blunting of the costophrenic angles may in part relate to low lung volumes with likely trace pleural effusions . additional subtle bibasilar opacities likely represent atelectasis . the patient is rotated to the right . the cardiac and mediastinal silhouettes are similar with the cardiac silhouette possibly slightly less prominent as compared to the prior study . no evidence of pneumothorax is seen . chronic deformity of the right clavicle is again noted .	Atelectasis&&Cardiomegaly&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion	15438386	59891992	b6efc4df-c96de5ed-5551d21b-f99936ca-082ca79e
86	moderate pulmonary edema has worsened, severe cardiomegaly is larger . severe left lower lobe consolidation, either edema or atelectasis is unchanged . small to moderate bilateral pleural effusions are presumed . no pneumothorax . et tube and transesophageal drainage tube in standard placements .	Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Pleural Effusion&&Support Devices	15131736	57446337	6a88bbb2-ff756840-e3f513d9-ff4d1499-f9628163
87	the lungs are hyperinflated with markedly widened ap diameter of the chest which is compatible with emphysema . an area of presumed scarring at the right lung base appears stable from most recent prior exam . there is no new consolidation, effusion, or pneumothorax seen . cardiomediastinal silhouette appears stable . bony structures intact . copd, scarring at the right lung base . no definite signs of pneumonia or chf .	Lung Opacity	19016834	55946640	ed9628e5-62ce1427-67e04f11-6daf5632-424ef2d1
88	the et tube tip is cm above the carina . the right internal jugular line tip is at the level of mid svc . cardiomegaly is unchanged, moderate to severe . the patient continues to be in mild pulmonary edema . right upper lobe opacity appears to be unchanged, representing right upper lobe consolidation, better appreciated on the chest ct obtained on . left basal consolidation is better appreciated on ct and obscured by the cardiomegaly and pleural effusion on the current radiograph .	Cardiomegaly&&Consolidation&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	11022245	56303122	afed4c34-cf95e16b-371ce2be-99427d54-2013960b
89	the et tube tip is . cm above the carina . the right internal jugular line tip is at the level of mid svc . ng tube passes below the diaphragm terminating in the stomach . heart size and mediastinum are unchanged in appearance . interstitial opacities are mild, unchanged . cardiomegaly is unchanged, but there is interval improvement of left lower lung consolidation .	Cardiomegaly&&Consolidation&&Enlarged Cardiomediastinum&&Lung Opacity&&Support Devices	18906643	55518268	04019275-6df0e119-fde98da9-3cc92686-761b70c5
90	the monitoring and support devices are unchanged . there is unchanged evidence of the known massive irritated right lung process . slightly progressive opacifications in the periphery of the left lung . unchanged size of the cardiac silhouette .	Cardiomegaly&&Lung Opacity&&Support Devices	13964474	52073913	0cffed1b-3516a67c-ea383eec-75212689-2620504f
91	the patient has had a prior sternal resection with consequent deformity of the anterior chest wall . the trachea is central . the cardiomediastinal contour is within normal limits . coronary artery bypass graft clips are seen . a spiculated opacity in the right upper lung is less conspicuous than on the prior chest radiograph from a more ill-defined opacity in the left mid lung is similar in appearance . both of these opacities were seen on the prior ct chest . no pneumothorax or pleural effusion seen . the visualized bony structures are demineralized but otherwise unremarkable in appearance . no acute cardiopulmonary process seen . multifocal parenchymal opacities were present on prior imaging and consistent with the patients known multifocal adenocarcinoma .	Lung Lesion&&Lung Opacity	14851532	58644358	cad294ec-5e2a00a5-5080644b-2dcc1bb7-3c743d0a
92	low lung volumes are seen which limit assessment . there is a an opacity, which obscures the right heart border, concerning for an early developing right middle lobe pneumonia . the remainder of the lungs are clear without pleural effusion or pneumothorax . the heart is normal in size . normal cardiomediastinal silhouette . possible early developing right middle lobe pneumonia .	Pneumonia	15659181	59060938	84c1b3da-67a19397-d61bf966-069c630f-75a2038f
93	no focal consolidation is seen . there is minor basilar atelectasis . no pleural effusion or pneumothorax . the cardiac and mediastinal silhouettes are stable . linear radiopaque structure projecting over the left hemidiaphragm may be external to the patient or surgical clips . additional surgical clips are noted in the left mid hemithorax and upper hemithorax . no acute cardiopulmonary process .	No Finding	14794396	54133231	2f40daa6-51dad1b2-e683d1c3-cdf10946-d37ae69f
94	stable cardiomegaly accompanied by pulmonary vascular congestion and interstitial edema . persistent small left pleural effusion with adjacent left basilar atelectasis and or consolidation . questionable small right pleural effusion which could be confirmed or excluded by standard pa and lateral radiographs when the patients condition permits .	Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Pleural Effusion	19759491	54372986	f2566882-96120f55-11c10432-9c3d638d-2b4fc411
95	right ij line and bilateral chest tubes, sternal wires and mediastinal clips are unchanged . a tiny left apical lateral pneumothorax is visualized . the right pneumothorax is probably still present but is very difficult to see . both of these are smaller than on the film from the prior day . continues to be retrocardiac opacity and volume lossinfiltrate in both lower lungs .	Lung Opacity&&Pneumothorax&&Support Devices	16043240	53861171	a0c83599-da2ea7b7-03944f49-45a6b253-31fa3b34
96	single portable chest radiograph demonstrates a large rounded opacity in the left lower lung, correlating with known left lung mass, better visualized on the pet-ct . no focal opacification concerning for pneumonia . bibasilar atelectasis is evident . coarse linear interstitial markings in left upper lobe may reflect emphysematous change . there is no pneumothorax or pleural effusion . prominent pericardial fat pads are evident otherwise, cardiomediastinal contours are normal . no pneumothorax . large left lower lobe mass, better evaluated on prior ct .	Lung Lesion	11378150	55743226	fd480467-a520cdee-c10d86b1-219b21f7-64bb593d
97	a focus of scarring in the right upper lobe is better assessed on the prior ct from . increase in interstitial markings, which could indicate mild interstitial edema or atypical infection . heart size remains stable . no pneumothorax . mild interstitial opacity could represent an atypical pneumonia or edema . otherwise, no change .	Edema&&Lung Opacity&&Pneumonia	13263843	53038880	3c34e348-938dd3fa-3c42bcb9-a7da976b-030bc4b0
98	right lower lung opacities are increased since , concerning for worsening or new pneumonia . the left lung is essentially clear . mild bibasilar atelectasis is noted . the heart size is stable . the right hemodialysis catheter tip is seen in the right atrium . no pneumothorax or pulmonary edema . increased right lower lung pneumonia since , possibly involving the right lower lobe and right middle lobe . .	Pneumonia	16508811	52933806	7d75166a-47342cde-9303b619-7fff892c-486713f7
99	pa and lateral views of the chest moderate enlargement of the cardiac silhouette with a left ventricular predominance is unchanged . the aorta remains tortuous, and the hilar contours are stable . pulmonary vascularity is not engorged . there is minimal atelectasis within the lung bases, but no focal consolidation is present . no pleural effusion or pneumothorax is identified . there are no acute osseous abnormalities .	Atelectasis	17398573	53325824	6a31f7f3-592b6144-a0b7e38c-d11761b4-bd2bf9e3
100	in comparison with the most recent examination, lung volumes slightly lower . the cardiac silhouette is stably enlarged . again noted is a mild indistinctness of the pulmonary vasculature with superimposed opacities bilaterally, more confluent on the left than previously noted, consistent with superimposed pneumonia . possible mild edema with superimposed pneumonia .	Edema&&Pneumonia	16508811	50382515	29a9ca2f-50292418-e78e2999-12755e18-3103a476
101	the monitoring and support devices remain in place . diffuse bilateral pulmonary opacifications are essentially unchanged .	Lung Opacity&&Support Devices	15378103	59287720	ae716843-fde7cd99-a5fb83a1-9d5eb9d9-ffb02e30
102	the right picc line tip is at the level of mid svc . heart size and mediastinum are unremarkable . lungs are essentially clear except for right upper lobe suprahilar opacity, seen on radiograph, but not seen on radiograph . this might potentially represent summation of shadows, but slowly progressing infectious process in this location cannot be excluded . correlation with chest ct might be considered . there is no pleural effusion or pneumothorax . right upper lobe draining catheter is partially imaged .	Pneumonia&&Support Devices	14147380	57782283	73d4997e-feb25b04-950b45f1-533d848a-d9f29409
103	cardiomegaly is substantial, unchanged . enema catheter in pacemaker leads in replaced valve are unchanged . there is interval improvement in interstitial pulmonary edema currently mild . small bilateral pleural effusions are noted . there is no pneumothorax .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	19759491	55578653	6d3bfa82-e23e5cc3-0ffb37e5-cd4bd075-a922da89
104	moderate cardiomegaly has increased in size over the past three days following extubation . greater opacity in the left mid lung laterally could be new pleural effusion or early consolidation, even mild asymmetric edema given severe and extensive lung scarring and pleural thickening and chronic areas of atelectasis which would tend to distribute edema in idiosyncratic fashion . chronic engorgement of the mediastinal veins is also more pronounced today . no pneumothorax or layering pleural effusion is present .	Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Lung Opacity&&Pleural Effusion&&Pleural Other	15809646	52573647	554fad67-08d3ea82-687b0b92-4825e624-b17ef914
105	a frontal and lateral view of the chest demonstrate a diffuse interstitial abnormality . there are no focal areas of consolidation to suggest pneumonia . the cardiomediastinal and hilar contours are normal . there is no pleural effusion or pneumothorax . peristent diffuse interstitial abnormalies . no evidence of pneumonia .	No Finding	12303667	56230969	b8ec370f-450e80d9-25461f27-72d3da41-d6e10bae
106	heart size and mediastinum are stable . lungs are clear . there is no pleural effusion or pneumothorax . bronchiectasis at demonstrated on the prior ct chest are minimal end seen in the left lower lobe with interval resolution of previously demonstrated infectious process .	Cardiomegaly&&Enlarged Cardiomediastinum	15192710	53951719	042b8e55-50d27345-7b393528-2e2d0294-10141795
107	the patient is status post median sternotomy, cabg, and vascular stenting . heart is mildly enlarged but stable . the mediastinal and hilar contours are similar with mild unfolding of thoracic aorta . new consolidative process is noted within the right upper lobe compatible with pneumonia . there is mild pulmonary vascular congestion . small pleural effusion on the right is present . no pneumothorax is identified . degenerative changes involving the left glenohumeral and bilateral acromioclavicular joints are noted . right upper lobe pneumonia . followup radiographs after treatment are recommended to ensure resolution of this finding .	Pneumonia	19150427	53412826	1cbba3f1-9473d496-6a09bade-908af686-5568c136
108	two views of the chest the lungs are extremely low in volume but appear clear . the cardiac silhouette is obscured by an elevated left hemidiaphragm, unchanged . the hilar contours and pleural surfaces appear normal . no definite pleural effusions are present .	No Finding	18338007	57273388	880f55b2-21e9c680-823ecd8e-9ac3a7b2-836baabb
109	there is interval progression in parenchymal opacities bilaterally with complete opacification of both lungs with more ground-glass appearance in the upper and mid lungs and more consolidative appearance in the lower lobes, most likely related to bilateral pleural effusion . there is no pneumothorax . the et tube tip is cm above the carina . the ng tube tip passes below the diaphragm terminating in the stomach .	Consolidation&&Lung Opacity&&Pleural Effusion&&Support Devices	13078497	56504249	d87590d9-95b66369-39f99a0f-0df301b7-61463d4e
110	lower lung volumes seen on the current exam . streaky predominantly right-sided mid and lower lung opacities are seen, most likely due to atelectasis . the lungs are otherwise clear . please note the patients arms are partly obscuring the visualization of the lungs on the lateral view . the cardiomediastinal silhouette is stable . median sternotomy wires again noted . degenerative changes at the right shoulder are identified . no definite acute cardiopulmonary process .	No Finding	17318449	58959180	038426f2-7b990f98-24487e3e-2bd7a156-4761c39a
111	patient is status post left pneumonectomy . there is expected lucent left hemithorax and slight leftward shift of the cardiomediastinal silhouette and right lung hyperinflation . cardiomediastinal silhouette itself is stable, with borderline cardiomegaly . in the right lung, no chf, focal infiltrate, or effusion . left-sided chest tube now present . curvilinear density over the left mid thoracic spine appears to represent a spinal epidural catheter terminating at the level of t for which clinical correlation is requested .	No Finding	12410066	51144460	4076e969-56f5b8aa-66ad39cc-833e7f03-cd0854e9
112	ap upright portable chest radiograph is obtained . overall, there is no significant change from the recent ct performed with innumerable metastatic nodularity involving both lungs and large consolidation occupying the right lower lung with a small to moderate right pleural effusion . there is no new area of atelectasis or new area of confluent opacity to suggest a superimposed pneumonia, though given the extensive underlying lung disease, a subtle acute process would be impossible to exclude . heart size cannot be assessed . mediastinal contour is stable . no pneumothorax is seen . bony structures appear stable . known metastatic lesions involving the inferior scapulae are not clearly visualized as well as the recently diagnosed nondisplaced fracture involving the right posterior eighth rib . overall stable exam with extensive metastatic disease to the lungs with right pleural effusion and right basal consolidation .	Consolidation&&Pleural Effusion	19890786	57664750	ba7962b1-c57c8310-baaa8f93-1ae65fab-edcaa58b
113	the patient is status post median sternotomy and cabg . the heart is mild to moderately enlarged, unchanged . mediastinal and hilar contours are unchanged . mild pulmonary vascular engorgement is present, not significantly changed compared to the prior radiograph . no pleural effusion or pneumothorax is seen . bibasilar airspace opacities are likely reflective of atelectasis . mild pulmonary vascular engorgement .	No Finding	18906643	57135264	742a919c-4e4a6e34-f49de182-4a0dafcf-8b3c101b
114	there is no major change . the monitoring and support devices are in unchanged position . small bilateral pleural effusions with evidence of relatively extensive bilateral probably atelectatic consolidations . mild-to-moderate fluid overload . no newly appeared focal parenchymal opacities . extensive calcifications and tortuosity of the thoracic aorta .	Atelectasis&&Consolidation&&Pleural Effusion&&Support Devices	10975446	55911959	f64708b2-5173902f-9397bc55-1a8502c8-8be61ec4
115	there has been interval intubation, with endotracheal tube tip terminating about cm above the carina . exam is otherwise remarkable for very slight improvement in widespread bilateral alveolar opacities, particularly when compared to the chest radiograph of . bilateral pleural effusions are unchanged .	Lung Opacity&&Pleural Effusion&&Support Devices	13078497	52864337	61767c51-5b13fe95-8ee32eb0-6dc19ea8-be684efc
116	portable ap view of the chest the patient is status post median sternotomy and aortic valve replacement . the heart size is moderately enlarged but unchanged . the aorta is diffusely calcified . there is mild pulmonary edema, new from the prior study . small bilateral pleural effusions are present . there is no pneumothorax . minimal atelectasis is seen at the lung bases . degenerative changes of the right glenohumeral joint are present .	Atelectasis&&Edema&&Pleural Effusion	15419510	52189004	1b6cfbee-901f801d-651c11f8-2c84bb31-91883814
117	endotracheal tube terminates approximately . cm above the carina and is adequately placed . right internal jugular line ends at mid svc . a feeding tube is seen to course below the diaphragm into the stomach however, the distal end is beyond the radiographic view . left lower lung opacities reflecting combination of atelectasis and mild pleural effusion is unchanged since . mildly enlarged heart and mediastinal contours are stable .	Atelectasis&&Cardiomegaly&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Support Devices	15338518	53282269	6fef2911-a06fa6dd-c764a4a5-f0d84931-368a51c4
118	there is little change in the appearance of the heart and lungs . specifically, following esophagoscopy there is no evidence of mediastinal gas or acute pneumonia .	Cardiomegaly	16848073	53447402	11fac305-a3d8a8fe-cd1ad4a0-fc2a287f-0e061474
119	there is right middle lobe consolidation involving the medial segment . otherwise, the lungs are clear . no large pleural effusion or pneumothorax . cardiomediastinal silhouette appears normal . bony structures are intact . no free air below the right hemidiaphragm . pneumonia involving the medial segment of the right middle lobe .	Pneumonia	15857729	56277244	d8b6b619-9e181de2-c46adb2d-08194ead-eefd7108
120	comparison is made with prior study performed the same day earlier in the morning . large right pleural effusion is probably unchanged allowing the difference in positioning of the patient . there has been interval worsening of right lower lobe and right middle lobe atelectasis . there is no evident pneumothorax . left pigtail catheter is in unchanged position at the base . ng tube tip is in the stomach . cardiomediastinal contours are unchanged . nodular lung opacities in the left upper lobe are new , could be superimposition of normal structures or focal areas of atelectasis . attention in followup is recommended . left picc tip is in the mid-to-lower svc .	Atelectasis&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Support Devices	16319601	58175667	801f696c-49628491-d2cfaf1b-3aaa17ff-dbbcfe32
121	right chest wall port-a-cath again noted with catheter tip extending to the upper svc region . midline sternotomy wires are again noted . there is a calcified ovoid structure projecting over the mediastinum likely a calcified lymph node . there is mild basilar atelectasis noted bilaterally . no focal consolidation concerning for pneumonia . no large effusion or pneumothorax is seen . cardiomediastinal silhouette is stable . bony structures are intact . bibasilar atelectasis . no convincing evidence for pneumonia .	Atelectasis&&Pneumonia	11413236	59735304	1a0662d4-8bee75af-c5c452a9-4b43c737-b74d27c1
122	the patient is status post sternotomy . a port-a-cath terminates at the cavoatrial junction . the heart is at the upper limits of normal size . a calcified lymph node is seen along the aortopulmonary window . the cardiac, mediastinal and hilar contours do not appear significantly changed . the lung volumes are low . there is persistent patchy opacification in the left lower lobe, which appears somewhat more dense and compressed, perhaps coinciding with differences in lung volumes rather than a true interval change however . in fact, left basilar opacities are more similar to , where lungs volumes were somewhat lower than on the more recent prior examination . there is no pleural effusion or pneumothorax . bony structures are unremarkable . persistent left basilar opacification, suspected to represent primarily atelectasis . however, the possibility of superimposed pneumonia could be considered in the appropriate clinical setting versus increased atelectasis associated with low lung volumes .	Atelectasis&&Lung Opacity&&Pneumonia	11413236	55108847	a8ad38e3-9a288818-536ed867-e22718fb-0d0833f5
123	the lungs are clear . the cardiomediastinal silhouette is within normal limits . no displaced fractures are identified . no acute cardiopulmonary process .	No Finding	19623993	51014967	afa46108-e06269ce-05deb812-e12dad4d-ef863113
124	there is little overall change in the diffuse bilateral pulmonary opacifications, most prominent in the right mid and lower zones . monitoring and support devices remain in place .	Lung Opacity&&Support Devices	13964474	52177303	cb020c62-235d3656-7939457a-45aec9ae-05c91e36
125	there has been placement of a nasogastric tube with tip in the distal stomach . otherwise, there is little overall change with large right and moderate left pleural effusion with enlargement of the cardiac silhouette and evidence of pulmonary vascular congestion .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	11934114	52625540	fee52ef3-e8e58680-e83b3d50-fa52077b-106381ff
126	the patients overlying chin obscures the medial bilateral upper lobes . the cardiac silhouette remains enlarged . prominence of the pulmonary arteries is partially imaged and again seen . evidence of diaphragmaticpleural plaques is seen bilaterally suggesting prior asbestos exposure . the patients chin overlies the bilateral medial upper lobes, obscuring the view . given this, the cardiac silhouette is persistently enlarged . there is again prominence of the pulmonary arteries . pulmonary vascular congestion appears improved .	Cardiomegaly&&Edema	17838301	57676222	8a1b28a3-0922cd6a-282ceb83-59fd9271-ebf56ff4
127	lung volumes are low . moderate cardiomegaly is re- demonstrated . there is mild pulmonary edema, perhaps minimally worse compared to the previous exam . small bilateral pleural effusions may be present, and bibasilar opacities likely reflect areas of atelectasis . no large pneumothorax is present though assessment of the left apex is slightly obscured due to the patients neck and soft tissues projecting over this region . degenerative changes of the left glenohumeral joint are noted . low lung volumes . mild pulmonary edema and probable small bilateral pleural effusions with bibasilar atelectasis .	Atelectasis&&Edema&&Pleural Effusion	15131736	57865645	f5f335c8-148fbc15-8bb36e82-d7f364d8-066a5b50
128	the lungs are clear of focal consolidation, pleural effusion or pneumothorax . there is no pulmonary edema . lucency of the upper lobes may reflect emphysema . the heart is normal in size . posterior spinal fixation hardware is noted along the lower thoracic spine with re- demonstration of multiple compression deformities . no acute cardiopulmonary process .	No Finding	14353044	57917788	866da04c-e24c3141-42311ab2-6a52b25a-82cf9674
129	there is little overall change . elevation of the right hemidiaphragm is again seen . cardiac silhouette is within normal limits . there is some prominence of the central pulmonary vessels on the right, possibly relating to pulmonary artery hypertension . no evidence of pulmonary vascular congestion or pleural effusion . mild retrocardiac opacification most likely represents atelectasis .	Atelectasis&&Lung Opacity	15161734	54589789	8e47794e-3468eb94-04f479d6-7a76f0c5-05ad69ec
130	multiple calcified granulomas are noted throughout the lungs bilaterally and, unchanged since the prior study . no focal consolidation, pleural effusion, or evidence of pneumothorax is seen . the cardiac and mediastinal silhouettes are stable and unremarkable . degenerative changes are again seen along the spine . no acute cardiopulmonary process .	No Finding	16553329	51229730	d642ad26-82bef23a-5b41c13c-5f34e5e1-f45e10aa
131	the heart is moderately enlarged . the aortic arch is calcified . the mediastinal and hilar contours appear unchanged . the lung volumes are low . calcified pleural plaques are present . there is no definite pleural effusion or pneumothorax . band-like opacity in the left mid lung suggests minor atelectasis or scarring . pulmonary vessels are somewhat engorged centrally suggesting pulmonary venous hypertension if not frank pulmonary edema . there is a confluent right basilar opacity worrisome for pneumonia . . focal right basilar opacity worrisome for pneumonia . . mildly prominent pulmonary vasculature suggesting pulmonary venous hypertension, but not frank pulmonary edema . . moderate cardiomegaly . . calcified pleural plaques .	Cardiomegaly&&Lung Opacity&&Pneumonia	17838301	51266767	474c4fbb-14f486fd-a3c9e647-da14a57d-dcf9e39a
132	a left pectoral pacemaker is unchanged with three leads in the right atrium, right ventricle, and coronary sinus, as before . there has been interval removal of the endotracheal tube from . the cardiac silhouette remains severely enlarged . partial calcification of the aortic knob is redemonstrated . the mediastinal contours are unchanged . there is no pulmonary vascular congestion or interstitial edema . a moderate right pleural effusion is appreciated on the lateral view with mild right basilar atelectasis . there is no left pleural effusion . no pneumothorax is seen . diffuse dense calcification of the abdominal aorta is noted . . no pulmonary edemavascular congestion . . moderate right pleural effusion and mild right basilar atelectasis .	Atelectasis&&Pleural Effusion	12595991	50452688	252da14d-35e528cc-fd8defb9-1ba9e403-6b8cd31c
133	lateral views of the chest were obtained . the lungs appear clear bilaterally . the previously detected opacity in the left lower lung appears to have resolved, though evaluation on a chest radiograph is suboptimal to assess complete resolution . would recommend non-emergent ct of the chest to ensure resolution of the previously detected lingular opacity as well as multiple additional lung nodules described in detail on prior ct chest . cardiomediastinal sillouhette appears normal . bony structures are intact . no acute findings . given findings on ct dated , a nonemergent month fu chest ct is appropriate to ensure complete resolution andor stability of nodules per guidelines .	No Finding&&Support Devices	14213287	56237499	db368d36-8c00c286-fd73c287-46b788dc-3238c890
134	endotracheal tube terminates . cm above the carina . nasogastric tube passes into the stomach . there is a left-sided hemodialysis catheter, which extends to the low svc . lung volumes remain low . there are bilateral pleural effusions, increased . there is diffuse hazy parenchymal opacity, most compatible with pulmonary edema in the setting of central vascular congestion and cardiomegaly . there is no new focal opacity to suggest pneumonia . there is no pneumothorax .	Edema&&Pleural Effusion	14841168	56264253	3ced14b8-2accf862-b2eab013-efdf4f2d-991f75eb
135	there is opacity seen in the region of the lingula, corresponding to the consolidation seen on the prior chest ct . given the patients symptoms and history of a lingular infiltrate, this most likely represents a residual area of cryptogenic organizing pneumonia . no additional foci of consolidation are noted . there is no pleural effusion, pneumothorax, or pulmonary edema . the heart size is normal . mediastinal and hilar contours are stable . lingular opacity likely representing a residual focus of cryptogenic organizing pneumonia . recommend followup chest radiograph in months following treatment to document resolution .	Lung Opacity&&Pneumonia	16435402	58955981	5aa672e1-1a4bfdc1-770847af-e76adb3d-a2d61d6a
136	frontal and lateral views of the chest were slightly limited due to patients body habitus . lung volumes are low, which accentuate bronchovascular markings . mild pulmonary edema is unchanged . there is mild thickening of the minor fissure . bibasilar opacities are noted . there is no pleural effusion . moderate cardiomegaly is stable . hilar and mediastinal silhouettes are unchanged . a dual-chamber dialysis catheter tip projects over proximal right atrium . stable mild pulmonary edema and moderate cardiomegaly . bibasilar opacities may represent atelectasis or infection in the appropriate clinical setting .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pneumonia	13473495	54050506	8aad1160-9cbc4ec4-577f8737-8784924b-ef451f49
137	frontal and lateral views of the chest demonstrate low lung volumes . moderate pulmonary edema is present . costophrenic angles are obscured, suggestive of small pleural effusions . moderate cardiomegaly is noted . hilar and mediastinal silhouettes are unremarkable . aortic arch calcifications are seen with tortuosity of the descending aorta . there is no pneumothorax . moderate pulmonary edema and cardiomegaly, with associated small bilateral pleural effusions .	Cardiomegaly&&Edema&&Pleural Effusion	11512104	56889771	def6f212-4f61456d-60919d0b-c6cddaaf-db3f108a
138	the patient has received a new orogastric tube, which ends into the stomach but its distal end is looped with its tip reaching up to the fundus of the stomach approximately . endotracheal tube tip is cm above the carina and is appropriately positioned . right internal jugular line tip is approximately at the level of the lower svccavoatrial junction . bilateral lung volumes are low . mild diffuse haze in both lungs could be mild pulmonary edema, but given the low lung volumes, its appearance and severity may be exaggerated . prominent hilus and azygos distension suggest increased venous pressure . bi-basal opacity is due to combination of small effusion and accompanying atelectasis . heart size is mild-to-moderately large, unchanged since prior studies . increased retrocardiac density reflecting left lower lung atelectasis has worsened .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	16055653	58996292	84350c37-9b9580be-c60fc9a8-a1221a71-b90ec487
139	frontal and lateral chest radiographs again demonstrate a vascular stent and surgical clips . moderate to severe cardiomegaly is unchanged . there is no definite focal consolidation . pleural and parenchymal scarring have been more fully evaluated by cta of the chest of . a small right pleural effusion is seen . there is no appreciable pneumothorax . the visualized upper abdomen is unremarkable . rightward deviation of the trachea is consistent with left lobe thyroid enlargement . no definite focal consolidation . small right pleural effusion .	Pleural Effusion	14236258	52034094	92c14d77-ecf00fa7-99e8dbe5-0a1591ae-be39eec7
140	the cardiomediastinal silhouette, pulmonary vasculature, and aorta are within normal limits . there is an airspace opacity lateral to the right heart border on frontal projection . right clavicular orthopedic side plate is unchanged . small right lower lobe pneumonia . notification initial interpretation was no acute process, however upon attending review a small right lower lobe opacities suggestive of pneumonia was found . the change in interpretation was emailed to the emergency department qa nurses by dr . on at .	Pneumonia	15881535	58897728	7fae1179-39697856-a9795bb4-19feb4f6-b065f924
141	the lung fields appear clear without evidence of pneumonia . a large hiatus hernia is present . bony lesions are seen in all areas as on the prior occasion . no failure is present . costophrenic angles are sharp . fractured left clavicle again noted .	No Finding	18659631	57233393	1072c678-fa1edea2-a74424cb-595778ce-39f7fe0e
142	a supine portable frontal chest radiograph demonstrates low lung volumes with increased prominence of the cardiac silhouette and bronchovascular crowding . there is been interval placement of a right internal jugular catheter, with the tip likely within the proximal right atrium . there is persistent elevation of the right hemidiaphragm . no definite focal consolidation, pleural effusion, or pneumothorax is identified . the visualized upper abdomen is unremarkable . . low lung volumes . no definite focal consolidation identified . . a right internal jugular catheter terminates within the proximal right atrium . this catheter can be pulled back approximately - cm to place the tip in the distal svc, if desired .	No Finding&&Support Devices	19907884	51612287	32c5499f-c7a8f116-bc3516cf-55127c10-d77b160c
143	diffuse bilateral lung consolidations, larger on the right side, have increased in the left lower lobe consistent with worsening multifocal pneumonia . there is no evident pneumothorax . tracheostomy tube is in standard position . right picc tip is in the mid svc . esophageal stent is in unchanged position . right lower opacity is unchanged, is a combination of a pneumonic consolidation . previously present fluid collection in the right lower lung is difficult to evaluate . cardiomediastinal contours are unchanged .	Consolidation&&Enlarged Cardiomediastinum&&Lung Opacity&&Pneumonia&&Support Devices	13964474	59690708	734482e4-382f7097-45a64d86-648f641c-2179f006
144	generalized chronic interstitial fibrosis and coarse interstitial markings compatible with interstitial lung disease is unchanged . there is no superimposed consolidation suggestive of pneumonia . there is no pleural effusion or pneumothorax . the cardiac and mediastinal silhouettes are stable . there is no free air beneath the right hemidiaphragm .	Lung Opacity	13475033	51842805	70e841c4-5db69600-a5ae730e-bd97e1d0-49246a22
145	compared to the prior film, i doubt significant interval change . again seen is increased retrocardiac density consistent with left lower lobe collapse andor consolidation . no gross left effusion . the left hemidiaphragm may be slightly elevated . an et tube is present, tip approximately . cm above the carina . an ng tube is present, tip extending beneath the diaphragm overlying the fundus . again noted are stents of the right subclavian and left innominate vessels, with the tip of the right ij sheath projecting over the right subclavian mesh stent . incidental note is again made of innumerable calcifications in the spleen thought to represent granulomas and diffusely increased density of the bones .	No Finding	19061282	51715673	2e2e7a5d-da7ea8dc-7b5aae28-24978ba4-346238f9
146	supine ap view of the chest low lung volumes are present . the patient is status post median sternotomy and aortic valve replacement . cardiac silhouette size is mildly enlarged . thoracic aorta remains calcified . there continues to be mild pulmonary vascular congestion . persistent streaky opacities at the lung bases appear slightly improved compared to the prior study, and likely reflect atelectasis . there are adjacent small bilateral pleural effusions, though the size of the effusions appearing slightly improved compared to the most recent prior study . no pneumothorax is identified . there are no acute osseous abnormalities . slight interval improvement in mild pulmonary vascular congestion, small bilateral pleural effusions, and bibasilar airspace opacities likely reflecting atelectasis . please note that infection at the lung bases cannot be completely excluded .	Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia	12952223	54586308	c618f7c6-63bae7bd-d89233fa-c06b5734-3efeed2c
147	cardiac, mediastinal and hilar contours are normal . pulmonary vasculature is normal . no focal consolidation, pleural effusion or pneumothorax is present . there are no acute osseous abnormalities . no acute cardiopulmonary process .	No Finding	11924226	56091680	efd6465a-dbaa29e8-244c7d40-06f432d7-c7150e7d
148	the patient is status post median sternotomy . left-sided pacer device is seen with leads extending to the expected positions of the right atrium and right ventricle . the cardiac silhouette is mildly enlarged . mediastinal contours are unremarkable . there may be minimal central vascular engorgement without overt pulmonary edema . no large pleural effusion is seen . there is no evidence of pneumothorax or focal consolidation . the lungs appear relatively hyperinflated . relatively hyperinflated lungs, suggesting copd . possible minimal central pulmonary vascular engorgement without overt pulmonary edema . no focal consolidation . mild cardiomegaly .	Cardiomegaly	16043637	54280501	bc25fa99-0d3766cc-7704edb7-5c7a4a63-dc65480a
149	portable ap radiograph of the chest is obtained with the patient in the upright position . support and monitoring devices are unchanged . diffuse parenchymal opacities are less dense and lungs are better aerated . cardiomediastinal contours are unchanged . no pleural effusions and no pneumothorax . decreased pulmonary parenchymal opacities and better aeration bilaterally .	Lung Opacity	18855147	52556177	f7bf15c4-c1338417-c196f03f-0fd1e2df-055ce821
150	a bedside ap radiograph of the chest demonstrates surgical sutures and volume loss in the right upper lobe, consistent with the patients prior history of lobectomy . the lungs are hyperinflated, consistent with copd . the lungs, however, are clear . there is no pneumothorax or pleural effusion . the aorta is stably tortuous, and the heart size is normal . pulmonary vascularity is normal, and there is no pulmonary edema . no acute findings to explain patients desaturation event . stable chronic findings as outlined above .	No Finding	16622813	59644344	3960bfee-3d775493-bb08f568-81bff471-ef4dfaa5
151	new pigtail is in right lower hemithorax with significant improvement of subpulmonic effusion . left lower lung pneumonia with small pleural effusion is slightly worse than but improved since . patient had right upper lobe lobectomy and radiation therapy for cancer, this was better assessed in recent ct scan . conclusion there is no pneumothorax after pigtail placement . right subpulmonic pleural effusion has significantly improved .	Pleural Effusion	13263843	51718410	feeef719-f6a236d0-bd85a338-4d4729c9-d91fdf3d
152	diffuse lung opacities, larger on the left side, have worsened on the right . this could be due to trali or ards . cardiomediastinal contours are unchanged with mild cardiomegaly and widened mediastinum . lines and tubes are in unchanged standard position . small bilateral pleural effusions are unchanged . patient has known fibrosis in the right lower lobe . sternal wires are aligned .	Cardiomegaly&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Pleural Other&&Support Devices	15378103	57806038	d45c4a49-a6851be0-0312740e-161eac2e-2badc9f5
153	compared to the prior exam there is no significant interval change . the endotracheal tube is . cm above the carina . severe bilateral alveolar infiltrate is unchanged .	Lung Opacity&&Support Devices	13078497	54325875	0095c967-0422b8fb-9e031c60-f8d09b55-d7fc7d09
154	evidence of previous cabg . the heart remains enlarged . some vascular congestion appears to be present suggesting mild failure . no focal areas of consolidation are seen, but focal pneumonia is not entirely excluded .	Cardiomegaly&&Edema&&Pneumonia	16672854	55024789	d5380e43-b9ca5dee-fb28ec1b-21f2d76b-af26d998
155	a left pectoral pacemaker is noted with a single intact lead . the heart is mildly enlarged . mild central pulmonary vascular congestion is noted . bibasilar airspace opacities likely reflect atelectasis . there is no lobar consolidation, large pleural effusion, or pneumothorax . mild cardiomegaly and central pulmonary vascular congestion .	Cardiomegaly&&Edema	18570152	56605732	a445c04c-f8447b3a-f83c989c-97f7024d-ba4c2370
156	new endotracheal tube is seen appropriately positioned terminating no less than . cm above the carina . there are low lung volumes bilaterally with moderate pulmonary edema . small quantity of bilateral pleural effusion is seen . cardiomediastinal silhouette is somewhat obscured but is stable and within normal limits . appropriately placed et tube . moderate pulmonary edema . these findings were reported to dr . via phone by .	Edema&&Support Devices	12185775	54211038	f2a7f664-bfff0efe-5bb44ad4-469f58a4-0e6b7892
157	single ap view of the chest . postoperative changes again seen in the right thoracic cavity . compared to prior, there appears to be less aerated lung on the right which could be due to enlarging effusion with possible underlying parenchymal abnormality . in addition, there is persistent left basilar opacity not significantly changed given differences in technique . superiorly, the left lung remains clear . right picc and right pleural catheter are again noted . . persistent left basilar opacity, compared to . this could represent atelectasis although infection is not excluded . . less aerated lung on the right when compared to prior, potentially due to collecting pleural fluid although developing parenchymal abnormalities are also possible .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Pneumonia	13263843	53474620	5d12427f-41fd4e5e-6db33536-0d265b21-1b800caf
158	lungs are clear . right lung base is elevated, probably due to a moderate amount of subpulmonic right pleural effusion . lateral view shows a tiny left pleural effusion as well . there is no subpulmonic free air .	Pleural Effusion	11880923	55514554	031f7904-9bf7d478-6ebc3f26-2ddf2209-700c9c83
159	there is a dual lead pacemakericd device whose leads terminate in the right atrium and ventricle, respectively, without significant change . the heart is again moderately enlarged . the mediastinal and hilar contours appear stable . the lungs are clear . there are no pleural effusions or pneumothorax . calcified enthesopathy projects along the greater tuberosity of the left humerus . no evidence of acute disease .	No Finding	18417750	57175390	50da6cea-7757397e-e0e5175b-5dfd32f3-3183a4d4
160	ap upright portable chest radiograph is obtained . a left chest wall pacer device is again seen with lead tips extending into the right atrium and ventricle . abandoned pacing leads are also seen in the right chest wall, extending into the right heart, not significantly changed . the heart is mildly enlarged . the lungs appear clear without definite signs of pneumonia or chf . no large effusion or pneumothorax is seen . the overall cardiomediastinal silhouette is stable . bony structures are intact . no acute findings in the chest . stable mild cardiomegaly . multiple pacer wires are unchanged in position .	Cardiomegaly&&Support Devices	11293517	55525523	4c51a119-6f346625-6da3ca60-c048486b-db7e21e6
161	pulmonary vasculature is more engorged, but there is no pulmonary edema or pleural effusion . moderate cardiomegaly and mediastinal vascular engorgement are chronic . no pneumothorax . no focal pulmonary consolidation .	Cardiomegaly	18906643	59089386	2b3fd304-e1ad171f-32d25706-9ceaaa09-5c2e0711
162	the right picc line tip is at the level of mid svc . heart size and mediastinum are stable, unremarkable . left lower lobe linear opacities and small right lower lobe opacities most likely represent atelectasis but attention to this area to exclude the possibility of developing infection is recommended . in the left suprahilar area, there is more nodular opacity noted than on the prior study . although it might reflect summation of shadows, it should also be followed to exclude the possibility of developing infectious process .	Atelectasis&&Cardiomegaly&&Enlarged Cardiomediastinum&&Lung Lesion&&Lung Opacity&&Pneumonia&&Support Devices	14147380	52177069	84935982-fad67bfc-5d9710eb-129f88db-8f8c8df3
163	there is an increase in extent of the pre-existing bilateral pleural effusions . the signs of moderate pulmonary edema are unchanged . increasing extent of the pre-existing basilar areas of atelectasis . unchanged size of the cardiac silhouette . unchanged monitoring and support devices .	Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	18615099	59417593	62969c3a-e3c22e1f-1e3ca640-6a048fac-c5b86dbe
164	there is a biventricular pacericd with leads terminating in the coronary sinus and right ventricle . the right atrial lead takes an unusual course, directed posteriorly . while this appears unchanged from the prior study on the frontal view, an aberrant location should be considered . there is no evidence of lead fracture or displacement . aortic valve prosthesis is again noted . sternotomy wires and mediastinal clips are present . moderate cardiomegaly is unchanged . there has been further improvement in the mild pulmonary edema . further aeration of the left lung base is consistent with resolving atelectasis and pleural effusions . there is no pneumothorax . lead intended for the right atrium is directed unusually posteriorly . while this lead is likely in the right atrium, correlation with electrophysiology measurements would be helpful . these findings were discussed with dr . by dr . at am on by telephone minutes after discovery .	No Finding	19759491	54010994	bd9e6004-1c524f7f-ef858f02-2076cac1-7e6c370a
165	the right pneumothorax is slightly larger than on . partial right lower lobe collapse and mild pleural effusion on the right are unchanged . also unchanged is the position of the right-sided chest tube and the right port-a-cath . unchanged moderate cardiomegaly without pulmonary edema .	Atelectasis&&Cardiomegaly&&Pleural Effusion&&Pneumothorax&&Support Devices	16826047	57381701	ee027160-ec55fd25-2991f88d-cfc0fb94-bfe15a07
166	frontal and lateral views of the chest are compared to previous exam from . the lungs are clear of confluent consolidation, effusion, or pneumothorax . calcified granuloma again seen in the left mid lung . cardiomediastinal silhouette is stable in configuration . osseous and soft tissue structures are unremarkable . no acute cardiopulmonary process .	No Finding	15612622	51711520	3457e40c-876244f2-a9b678c4-5af63665-49377d02
167	surgical hardware in the lower c-spine noted . clips in the left upper quadrant are present . there is no focal consolidation, effusion, or pneumothorax . the cardiomediastinal silhouette is normal . imaged osseous structures are intact . no free air below the right hemidiaphragm is seen . no acute intrathoracic process .	No Finding	15114531	52114176	076a4be2-5c874ed2-8924ba25-a91078bf-433b46a2
168	since the prior study performed on , lungs are now better aerated . bibasilar opacities persist, although or less consolidated in appearance compared to the prior radiograph . there is no new consolidation . mild pulmonary vascular congestion . no pneumothorax . marked cardiomegaly is stable . improving lung volumes and bibasilar opacities since , may represent resolving infection or atelectasis .	Atelectasis&&Lung Opacity&&Pneumonia	15131736	53749286	a43142f0-504e9beb-f5710f72-fb264e8b-1a8d6b9c
169	the lungs are hypoinflated, accounting for vascular crowding but no evidence of focal opacities . cardiomediastinal and hilar contours are unremarkable . the cardiac size is top normal . there is no pleural effusion or pneumothorax . a right subclavian stent is noted and unchanged from prior examination . no acute intrathoracic process .	No Finding	14744884	54330512	f9dce1d5-9980fc56-0112f0b6-88e9a45f-48e80619
170	right apical parenchymal opacity is unchanged in extent . the right basal parenchymal scarring is also unchanged . minimal left parenchymal scarring . normal size of the cardiac silhouette . no evidence of pulmonary edema, a linear lucency at the left lung apex, mimicking a pneumothorax, is in fact outside of the patient . unchanged course and position of the monitoring and support devices .	Lung Opacity&&Pneumothorax&&Support Devices	17032538	51325572	8a8201f1-257d3a16-561099bb-c8e95167-e3b3b8e1
171	sternotomy wires and mediastinal clips are unchanged as is the prosthetic aortic valve . the heart size is within normal limits . the mediastinal contours appear unremarkable . there continues to be opacity projecting over the heart on the frontal view with air bronchograms which correlates with increased opacity in the retrocardiac space . there is no pneumothorax . left lower lobe pneumonia .	Pneumonia	16773796	58084420	7494cb49-099d351b-0e03726b-10674f3a-b482faaa
172	the endotracheal tube tip sits cm above the carina . a left-sided ij central venous catheter tip sits in the left brachiocephalic vein . the right-sided ij central venous catheter tip sits in the upper svc . the heart size is large but stable . the mediastinal contours are within normal limits . there continue to be bibasilar and perihilar opacities as well as a more rounded confluent opacity in the right upper lung . these findings likely represent increased pulmonary edema as well as right upper and lower lobe consolidations . retrocardiac opacity is also compatible with a left lower lobe consolidation . the costophrenic angles are excluded from the study limiting assessment for subtle pleural effusion . there is no large pneumothorax . . lines and tubes in place . . increased pulmonary edema with right upper lobe and bibasilar consolidations .	Consolidation&&Edema&&Support Devices	11022245	50146341	b418d709-571d80f6-35f680e3-16a938ff-bde93b89
173	mild-to-moderate pulmonary edema with left pleural effusion and subsequent left basal and retrocardiac atelectasis . the pigtail catheter at the bases of the right hemithorax . no evidence of pneumothorax, but areas of right basal atelectasis are present . moderate cardiomegaly . no interval appearance of new parenchymal opacities .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	13755940	59900684	4fe3e961-a3a02576-db1e637e-60077803-2a154636
174	severe cardiomegaly has increased since with right and left atrial enlargement, consistent with right heart decompensation . lung volumes are low with a possibly small left pleural effusion . no focal consolidation or pneumothorax . a left subclavian vascular stent is new since the prior exam . increased cardiomegaly . no focal consolidation .	Cardiomegaly	13473495	56817456	1a48fcb9-1ba60fd5-37d6cc93-9996cbca-e4a827ee
175	heart size and mediastinum are stable . no definitive focal consolidation is demonstrated . there is no pleural effusion or pneumothorax . focal narrowing of the mid trachea is noted and might potentially be related to prior intubation . no definitive evidence of infectious process within the limitations of this study technique . if clinically warranted, correlation with chest ct might be considered .	No Finding	13475033	56721487	9c119cc4-8b633d5b-b1c3b4c6-82ee52b6-ff4477dd
176	in comparison with study of earlier in this date, there is little interval change . substantial opacification of the left hemithorax persists with the right lung being essentially clear . no appreciable pneumothorax . gas within soft tissues is seen in the supraclavicular level on the left . ij catheter is unchanged .	Lung Opacity&&Support Devices	12530259	56383568	f636619c-a5d5b893-e807be46-77d7e8f9-26f324c7
177	moderately severe pulmonary edema has not worsened since earlier in the day, though moderate right and small left pleural effusions have increased . moderate cardiomegaly has remained stable over the past several days, but has progressed substantially since and could be due to cardiomegaly andor pericardial effusion . dual-channel catheter, presumably for hemodialysis ends in the right atrium . no pneumothorax .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	15259244	52824127	8312c3a4-f0043050-3db9e48c-8b180ed0-faf4d335
178	the lungs are clear . the cardiomediastinal silhouette is within normal limits . median sternotomy wires are again noted with fractures of the superior most wires . no acute osseous abnormalities identified . no acute cardiopulmonary process .	No Finding	15518538	53078789	d18abe57-80923646-8d3f05f6-dafedd8b-289ed541
179	comparison is made with prior studies performed earlier the same day . ng tube tip is at the level of the hemidiaphragm and should be advanced for more standard position . this finding was discussed by phone on at pm . with . et tube tip is . cm above the carina . left ij catheter tip is in the lower svc . there is no pneumothorax or pleural effusion . large bibasilar consolidations and opacities in the upper lobes bilaterally are better seen in prior ct performed the same day earlier in the morning .	Consolidation&&Lung Opacity&&Support Devices	10933609	52247073	3391a4a6-64cc1ac6-443cb01a-5a13d4c2-c6b2a84d
180	et tube ends . cm above carina . ng tube is in the stomach, and left jugular line ends in upper svc . there is no pneumothorax, and left chest tube is in unchanged position in upper hemithorax . left upper lobe that was collapsed yesterday is more aerated and left lung pulmonary edema has significantly improved . there is some residual small basilar atelectasis and small pleural effusion, if any . mild subcutaneous air has improved . right lung is unremarkable . mediastinal and cardiac contours are unchanged . conclusion patient with recent left lower lobe lobectomy . aeration and edema of remaining left upper lung has improved .	Edema	12530259	53558787	6f5d182a-b2c3bddf-246d41a2-17fe9e4f-8240e407
181	there is increasing pulmonary edema that is now mild-to-moderate in extent . in addition, atelectatic changes are seen at both lung bases as well as at the bases of the right upper lobe . status post cabg . the lateral radiograph shows mild-to-moderate pleural effusion . no pneumonia .	Atelectasis&&Edema&&Pleural Effusion	19150427	59450064	54035728-03eb01c3-1af39698-5f789e6f-686ca166
182	compared to chest radiographs since , most recently . greater wall thickening in the regions of bilateral upper lobe scarring and traction bronchiectasis with respect to raises possibility of superinfection . lower lungs grossly clear . heart size normal . no pleural effusion . calcifications noted in central lymph nodes, but there is no evidence of increased adenopathy .	Lung Opacity&&Pneumonia	14147787	58168356	a0d2c039-f522ccd9-d97c1582-07999a4b-ffdb3140
183	feeding tube tip is in the stomach . there are no other acute changes from the same day earlier in the morning .	No Finding&&Support Devices	18110020	54704786	ad9e2456-f98c1352-b904fc3d-bc109888-81830f7f
184	comparison is made with multiple prior studies including the most recent one . there is no evident pneumothorax . extensive bilateral subcutaneous emphysema is unchanged . patient has known severe emphysema . multifocal lung opacities, larger in the left upper lobe, right mid and right lower lungs, are stable . there are no new lung abnormalities or pleural effusions . tracheostomy tube is in standard position . right mid thoracic chest tube is in unchanged position . a catheter projecting in the right lower lateral hemithorax is likely outside the patient . left subclavian catheter tip is in the upper svc . cardiomediastinal contours are unchanged .	Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Support Devices	16751749	55021041	c37f2402-7d049ecf-cfaf867c-840f40a1-d8e14aae
185	a left central venous catheter is seen terminating in the lower svc . again seen is elevation of the right hemidiaphragm and small pleural effusion and atelectasis at the base of the right lung . the cardiomediastinal silhouette and hilar contours are grossly unchanged . there is no evidence of pneumothorax . thoracolumbar fusion hardware is seen unchanged in appearance . small pleural effusion and atelectasis at the base of the right lung .	Atelectasis&&Pleural Effusion	14353044	59081164	09c081f1-c1f32700-e71bf5b1-b0dc10ee-1e584a9c
186	single portable view of the chest is compared to previous exam from earlier the same day at pm . interval placement of nasogastric tube is seen, noting that the tube can only be identified to the mid portion of the mediastinum and should be advanced . endotracheal tube tip is approximately cm from the carina . otherwise, there has been no change .	Enlarged Cardiomediastinum&&Support Devices	19159236	58268220	166ed666-3cf27b16-96e71ab7-5c3cb2e9-2f2c90d1
187	there is again evidence of mild pulmonary edema, more prominent on the right . more focal area of opacification at the base medially with poor definition of the right heart border raises the possibility of a middle lobe pneumonia . right pleural thickening or loculated effusion is again seen .	Edema&&Lung Opacity&&Pleural Effusion&&Pleural Other&&Pneumonia	11474065	57848354	d09562d7-3ddb8397-a8101476-43ad0118-5fae5eb9
188	cardiomediastinal contours are normal . the lungs are clear . there is no pneumothorax or pleural effusion . the osseous structures are unremarkable surgical clips project in the left upper quadrant of the abdomen . external device obscures partially the left hilum no acute cardiopulmonary abnormalities .	No Finding	15114531	54918942	2a443c5b-911d577f-f0f52f16-9d2662c4-4c3a0fad
189	the lungs are hyperinflated . there is an increased opacity in the left upper lobe likely atelectasis, attention on follow-up studies needed there is no pneumothorax . cardiac size is mildly enlarged . lines and tubes in standard positions, no change . again seen in the median sternotomy wires . patient status post mvr and avr . increased opacity in the left upper lobe may be atelectasis but attention on follow-up studies is needed .	Atelectasis&&Lung Opacity	18224196	53536595	a30e6be6-cdb72787-3efd0ffc-438f4522-1a95c8da
190	heart size is normal when allowances are made for prominent bilateral pericardial fat pads, shown to better detail on ct abdomen of . mediastinal and hilar contours are within normal limits and without change . lungs are remarkable for upper lobe predominant emphysema, more severe in the right upper lobe than the left . no new focal lung abnormalities were detected, and there are no pleural effusions . mild compression deformity in the mid thoracic spine is unchanged . stable radiographic appearance of the chest with upper lobe predominant emphysema . no evidence of pneumonia . if symptoms persist, consider a chest ct for more complete evaluation if warranted clinically .	No Finding	11213613	52818853	60b7b7e2-29b9d91d-f3fd7cd8-8eca0ccf-2ac86d24
191	median sternotomy wires are intact . moderate cardiomegaly is stable . tortuous aorta with minimal calcifications again noted . no airspace consolidation . mild bilateral pulmonary vascular congestion and interstitial edema . no pleural effusion or pneumothorax . mild pulmonary edema and moderate cardiomegaly .	Cardiomegaly&&Edema	16957952	51725523	4ada6367-cb70c4dd-8f2b5739-ef9da5fa-f1c91813
192	hyperinflation indicates copd . . and , previous pulmonary vascular congestion and mild pulmonary edema have both cleared . lobulation at the apex of the left hemi thorax along the mediastinal border is residual of slowly resolving hematoma . small bilateral pleural effusions are also resolving . heart size normal .	No Finding	14851532	56316578	6a69146c-06c97494-0560bf85-9106a119-4dad5197
193	subcutaneous emphysema in the right chest wall has diminished slightly since removal of the right pleural tube . there is still a small pocket of air and fluid, or clot in the right upper chest alongside the surgical rib fracture . right lung is diffusely edematous, perhaps from hilar lymphatic or venous congestion . left lung is hyperinflated due to emphysema and clear of any focal abnormality . the heart is normal size . fullness in the postoperative right hilus has improved since . lateral view shows persistence of an anterior air and fluid collection, which on the frontal view is at the level of the third anterior interspace .	Edema&&Fracture	19991135	57096024	4998e40c-698af874-8c293856-85757f55-1a4817e4
194	there is no evidence of pneumothorax . continued low lung volumes with substantial mass in the right paratracheal region .	Lung Lesion	10046166	57977208	e2856783-ffa5ec26-043b0303-21aeddc6-b11b2876
195	ap and lateral views of the chest are compared to previous exam from . the lungs are hyperinflated . linear opacity in the left lung base is suggestive of scarring . there is no evidence of consolidation or effusion . cardiac silhouette is enlarged, but stable . median sternotomy wires are again noted . osseous and soft tissue structures are unremarkable . hyperinflation without evidence of acute cardiopulmonary process . no evidence of pulmonary vascular congestion .	No Finding	13606683	51927179	ec2a3c71-3c6943bf-1e4be2be-21077cf2-5f0a9978
196	right ij central venous catheter is seen with its tip in the expected location of the mid svc . there is airspace consolidation in the right lower lung concerning for pneumonia . the left lung is mostly clear . no large effusion is seen . no pneumothorax . cardiomediastinal silhouette is stable . bony structures are intact . . right ij positioned appropriately with tip in the mid svc . . right lower lobe consolidation concerning for pneumonia .	Consolidation&&Pneumonia	15857729	51551684	8dc7bad7-d7cdbfe7-7231abb5-65e3168d-12e734c2
197	prior sternotomy . since yesterdays examination, the swan-ganz catheter has been removed . et tube and ng tube remain and are satisfactory . right chest tube is also unchanged . no pneumothorax identified . no change in appearance of the lung fields .	No Finding&&Support Devices	13896515	55693385	b2661e27-0bced84e-02aa73ae-d1c58697-15ce7b75
198	the monitoring and support devices are unchanged . there is again substantial enlargement of the cardiac silhouette with pulmonary vascular congestion and bilateral pleural effusions, more prominent on the right .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	18460230	53225676	250bb626-f805c9f6-d82488e1-019d8362-ddb9eae6
199	the patient is status post median sternotomy, cabg, and mitral valve replacement . the heart is mildly enlarged . the mediastinal contours are unchanged with calcification of the aortic knob again noted . mild pulmonary edema appears progressed compared to the prior exam with small bilateral pleural effusions, also minimally increased compared to the prior exam . left basilar opacification likely reflects atelectasis . there is no pneumothorax . no acute osseous abnormalities are identified . slight interval worsening of mild pulmonary edema with small bilateral pleural effusions . left basilar opacity likely reflects atelectasis .	Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion	19759491	58459168	8fbf70c6-38be49b6-19536bcd-74b5e494-4ed5093f
200	left pectoral pacemaker with leads overlying the right atrium and right ventricle . right picc line terminates at least at the mid svc and the tip is obscured by overlying pacer leads . there is no pneumothorax . top normal cardiac size . normal hilar and mediastinal structures . no pneumonia, no pulmonary edema . no pleural effusions . right picc line can be traced to the mid svc, beyond that the line is obscured by overlying pacer leads .	No Finding&&Support Devices	16043637	51946836	3084f617-e040a88c-2e4bb84f-d190e19b-fc86d543
201	a single portable frontal upright view of the chest is provided . external pacing wires and electronics partially obscure the view . moderate cardiomegaly is unchanged . lung volumes have slightly increased . mild pulmonary edema persists . there is no focal consolidation, large pleural effusion or pneumothorax . sternotomy wires are noted . moderate cardiomegaly and mild pulmonary edema .	Cardiomegaly&&Edema	12475198	50639335	e4cb9fd1-a291ed0a-a3be1461-78de463c-57194e49
202	frontal and lateral views of the chest are compared to previous exam from . again seen is biapical fibrotic changes . previously seen perihilar and right basilar opacities, have resolved . there is no effusion or new consolidation . the cardiomediastinal silhouette is stable . orthopedic hardware projects over the right glenoid fossa . persistent biapical fibrosis without superimposed acute consolidation .	Pleural Other	10933609	57290683	9d8483b4-460ba2c2-3a8322ea-4d7df3ca-e1789d06
203	minimal edema persists in the left lung . large region of consolidation inferior to the central lungs and pleural scarring has not cleared . heart size is normal . et tube is in standard placement . feeding tube ends in the upper stomach . denser right pleural thickening is chronic, but more pronounced today than in . no pneumothorax .	Consolidation&&Edema&&Pleural Other&&Support Devices	17032538	50829485	b8f743d0-49b92246-83708dd6-caec53a5-fa07d8f5
204	portable supine chest film at is submitted . . left subclavian picc line with its tip in the mid-to-distal svc . endotracheal tube has its tip . cm above the carina . a right internal jugular large-bore catheter has its tip in the right atrium, unchanged . gastric tube is seen coursing below the diaphragm with the tip not identified . . bilateral pleural pigtail catheters are again seen and are unchanged in position . overall, cardiac and mediastinal contours are stable in this postoperative patient status post median sternotomy with mitral valve annuloplasty . increasing opacity at right lung base and the costophrenic angle which could represent accumulating fluid or an area of evolving pneumonia . clinical correlation is advised . no evidence of pulmonary edema . patchy opacities at left base likely reflects atelectasis . no pneumothorax .	Atelectasis&&Enlarged Cardiomediastinum&&Lung Opacity&&Pneumonia&&Support Devices	15259244	56972683	1b4e1f55-4fa1febf-abf7ed18-4531ddc4-2081f4ae
205	moderately severe opacification in the left mid and lower lung zones is probably edema, also affecting the right lower lung and accompanied by a moderate right pleural effusion . emphysema is severe . thickening of the right apical pleural surface is chronic . a large reticulated opacity projecting over the right mid lung could be unusual atelectasis or bronchiectasis or even a pleural calcification present in . inferior to it is scarring in the right mid lung . and i discussed the findings and their clinical significance by telephone at the time of dictation .	Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion	17032538	54097861	744a983f-6e2d9a27-ed516cc1-1ec2dea6-d65f542b
206	there has been placement of a pacer lead extending into the coronary sinus system . there is continued enlargement of the cardiac silhouette with increasing pulmonary vascular congestion . retrocardiac opacification is consistent with volume loss in the left lower lobe and probable small pleural effusion .	Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	13896515	53789660	ebb4833f-b98cb523-ee32fa0a-90c24211-81d147e0
207	portable frontal chest radiographs demonstrate intubated patient, the tip of the endotracheal tube is positioned . cm from the level of the carina . an orogastric tube is in place and is coiled within the fundus of the stomach . there is airspace opacification of the right lung with relative sparing of the apex, as well as basilar left lung opacity . linear atelectasis is seen in the right mid lung . the left lung is relatively clear . a focal nodular opacity is seen in the left upper lung measuring mm . there is linear atelectasis in the left lower lung . there is no definite effusion . there is no pneumothorax . the heart size is enlarged, the mediastinal contours appear grossly unremarkable on this portable film . . bilateral airspace opacity consistent with lobar pneumonia . . nodular opacity in the left lung apex, recommend attention on followup . . moderate cardiomegaly .	Cardiomegaly&&Lung Lesion&&Lung Opacity&&Pneumonia	11022245	50078440	816f21ae-13fa33ff-7a4ea5d9-e246fa18-f09a32ff
208	frontal and lateral views of the chest compared to previous exam from . the lungs are clear of consolidation, effusion or pulmonary vascular congestion . cardiomediastinal silhouette is within normal limits . right-sided vascular stent is again noted . osseous and soft tissue structures are otherwise unremarkable . no acute cardiopulmonary process .	No Finding	14744884	58480173	90e0275c-fdf15b9e-fa00d384-ace49c70-f4727012
209	left-sided pacer device is stable in position . left-sided central venous catheter is also stable in position . enlarged cardiomediastinal silhouette is again seen . patient is status post median sternotomy and cardiac valve replacement . there is mild pulmonary vascular congestioninterstitial edema and a small left pleural effusion . trace right pleural effusion is difficult to exclude . evidence of old left-sided rib fractures is seen . left-sided pacer device is stable in position . left-sided central venous catheter is also stable in position . enlarged cardiomediastinal silhouette is again seen . patient is status post median sternotomy and cardiac valve replacement . there is mild pulmonary vascular congestioninterstitial edema and a small left pleural effusion . trace right pleural effusion is difficult to exclude . evidence of old left-sided rib fractures is seen .	Edema&&Enlarged Cardiomediastinum&&Fracture&&Pleural Effusion&&Support Devices	19759491	58128416	4d570d20-1f80af86-1855ab56-6d99bc9a-cd105562
210	there bilateral regions of consolidation, at the right lung and left mid to lower lung . findings are most concerning for bilateral infection . moderate enlargement of the cardiac silhouette is unchanged . multiple vascular stents are also noted . no acute osseous abnormalities . splenic calcifications are again noted . bilateral parenchymal opacities, right greater than left compatible with pneumonia in the proper clinical setting . recommendations repeat after treatment will be necessary to document resolution .	Lung Opacity&&Pneumonia	19061282	59509358	596ada03-4cd1298c-35965d3c-db44850a-0baa9257
211	the lungs are moderately well inflated . there is a new subtle right lower lobe opacity is noted . no pulmonary edema . no pleural effusion or pneumothorax . the heart is top-normal in size, unchanged since prior examination . mediastinal contour and hila are unremarkable . intact median sternotomy wires and mitral valve prosthesis are noted . a left anterior chest wall pacer device lead tips are in the right atrium and right ventricle . new subtle right lower lobe opacity . differential diagnosis includes atelectasis, early pneumonia or aspiration pneumonia clinical correlation recommended .	Atelectasis&&Lung Opacity&&Pneumonia	16043637	55098650	10b7a5e0-c721996a-b5046563-dd86ee1f-5d1caa58
212	the lung volumes are low . unchanged chronic elevation of right hemidiaphragm . no evidence of focal consolidation . no pulmonary edema . the cardiomediastinal and hilar contours are normal . trace, if any, bilateral pleural effusions . no pneumothoraces . the single lead left icd is intact without any lead terminating in the right ventricle . no acute cardiopulmonary process .	No Finding	14556809	52736852	2dfbf7e0-85ed2f34-4c60e220-a5f1fa98-464b3ce2
213	large cardiomediastinal silhouette has not changed appreciably since at least , early postoperatively . moderate-to-severe cardiomegaly is comparable to the preoperative appearance . small bilateral pleural effusions persist . there is no longer any pulmonary edema . et tube and left internal jugular line are in standard placements and a nasogastric tube passes into the stomach and out of view . no pneumothorax .	Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	10715477	55183572	9197e8a6-688e955b-b870d598-a611016b-66ef0b8e
214	two frontal images of the chest demonstrate well-expanded lungs that are clear . the cardiomediastinal silhouette is unremarkable . there is no pneumothorax or pleural effusion . there is cervical fixation hardware noted along the cervical spine . otherwise, osseous structures are unremarkable . essentially normal chest radiograph with no evidence of pneumonia .	No Finding	15114531	54953521	bd752951-5d4e5b88-c3f34820-c9e7fcd4-1d2b4af7
215	the course of the left internal jugular vein catheter is constant . constant extensive left parenchymal opacity and extensive right apicolateral consolidation . moderate elevation of the right hemidiaphragm with small pleural effusion . unchanged aspect of the left heart border . no pneumothorax, no new opacities .	Consolidation&&Lung Opacity&&Pleural Effusion&&Support Devices	11569093	57204814	0d2a50a2-3711662a-d7838521-4dc58d09-3732a3ad
216	portable chest radiograph at is submitted . left sided single lead pacer unchanged in position . right internal jugular central line with tip in the proximal right atrium . there continue be small stable bilateral pleural effusions with decrease in the amount of loculated fluid on the left . status post median sternotomy with stable cardiac and mediastinal contours . interval appearance of mild interstitial edema . bibasilar patchy opacities likely reflect atelectasis . no obvious pneumothorax .	Atelectasis&&Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Support Devices	19182863	54943123	c97cba0f-be9c81e1-e3b2f294-5af9f1ac-aa4dab80
217	two semi-upright views of the chest are compared to previous exam from . there are hazy bibasilar opacities suggestive of layering effusions . linear opacity in the right mid lung abutting surgical chain sutures are seen, potentially scarring or contribution from fluid within the fissure . linear opacity in the left mid to lower lung is again seen suggestive of scarring or atelectasis . there is cephalization of the vasculature and prominence of the azygos vein . cardiomediastinal silhouette is unchanged . osseous and soft tissue structures are also unchanged . ivc filter is seen within the abdomen . bilateral pleural effusions and pulmonary vascular congestion . post-surgical changes seen in the right lung .	Edema&&Pleural Effusion	16334516	55649635	fa76addb-604afc82-2fed6189-2657d8ca-8464dc84
218	there is little overall change . the two right chest tubes remain in place and there is no evidence of pneumothorax . opacification at the right base with blunting of the costophrenic angle is again seen . the left lung is clear and there is evidence of old healed rib fractures .	Fracture&&Lung Opacity&&Support Devices	13352405	58143212	06dffd2d-fb7ae39b-dc116fd7-677c6133-de43815b
219	midline sternotomy wires noted . stable elevation of the right hemidiaphragm is again seen with chronic right basal atelectasis . subtle retrocardiac linear density may represent focal areas of scarring as this appears unchanged from prior exam . no convincing signs of pneumonia or chf . no large effusion or pneumothorax is seen . cardiomediastinal silhouette is stable . bony structures are intact . no free air below the right hemidiaphragm . no acute findings .	No Finding	17327592	59568059	0edc4350-79bed040-c995383a-424e4573-a701ab07
220	left hilarperihilar opacity corresponds to patients known perihilar mass, better assessed on ct . old-appearing rib deformities on the left may relate to prior fractures, metastatic disease not excluded, although better evaluated on ct . extensive vascular calcification is seen projecting over the upper hemithorax bilaterally . no new focal consolidation, pleural effusion, or evidence of pneumothorax is seen . left perihilar opacity corresponding to known pulmonary mass again seen . otherwise, no acute cardiopulmonary process .	Lung Lesion&&Lung Opacity	19389041	58489635	3dc71595-c47bd185-73aaa5e1-d15818c0-c6096a22
221	the left lung is essentially clear .	No Finding	13263843	54433794	9f64f457-6bee0c2c-6e676bd6-a7ebab4f-3eb5dbbb
222	there is no focal consolidation, effusion, or pneumothorax . the cardiomediastinal silhouette is stable and top-normal in size . imaged osseous structures are intact . no free air below the right hemidiaphragm is seen . no acute intrathoracic process .	No Finding	11052273	59032183	1d1ad085-bc04d368-4062c6ff-8388f25c-c9acb192
223	there is interval extubation of the patient with removal of the ng tube but with swan-ganz catheter still in place with its tip projecting at the level of the right ventricle outflow tract . the patient continues to be with enlarged cardiac silhouette, unchanged since the prior study with bibasal areas of atelectasis . interval development of perihilar vascular engorgement is consistent with fluid overloadmild pulmonary edema . bilateral pleural effusion cannot be excluded, mild . no appreciable pneumothorax is seen .	Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	11212873	51796690	51953a44-cce00b99-06369eea-4bc1bbcd-45ee7fd6
224	moderate cardiomegaly persists . there are new diffuse bilateral hazy opacities suggestive of moderate increase in pulmonary central venous pressure . mid sternotomy wires appear intact . lungs are without focal consolidation . bilateral small pleural effusions may be present . no acute fracture is identified . new bilateral hazy opacities with persistent moderate cardiomegaly . these findings are likely representative of moderate pulmonary edema due to congestive heart failure .	Cardiomegaly&&Edema&&Lung Opacity	16672854	50801992	e75af3b7-a3b4f881-b1f68642-609d0775-916ece62
225	compared with at am, the overall appearance is similar . again seen are et tube, an ng tube and right ij line, all in nominal alignment . the cardiomediastinal silhouette is less prominent, but this is likely related to differences in technique . hazy opacity at both lung bases and increased retrocardiac density are essentially unchanged . upper zone redistribution is again noted .	Enlarged Cardiomediastinum&&Lung Opacity&&Support Devices	13881772	52722388	1d2cf428-cb86995f-d8bd58a7-2811dcec-fadf009b
226	moderate cardiomegaly partially obscures lower lung zones . there are no pulmonary findings to suggest pneumonia . pulmonary vascular congestion is stable, but there is no pulmonary edema . fissural loculation of pleural fluid along the left chest wall laterally has not changed appreciably over several days . no pneumothorax .	Cardiomegaly&&Edema&&Pleural Effusion	18906643	58824000	e3c80a40-fc49e72a-6cd50354-445adf30-3d360387
227	portable ap radiograph of the chest was reviewed in comparison to , obtained at am . the et tube tip is approximately . cm above the carina . the right internal jugular line tip is at the mid low svc . heart size and mediastinum are grossly unchanged in appearance . right pleural effusion is enlarged, unchanged since the most recent prior . small amount of left pleural effusion is most likely present . cardiomediastinal silhouette is stable .	Cardiomegaly&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	12736592	50820057	d0abd39a-1f812f05-b0d99e71-5f3d984a-c46b559f
228	the pre-existing mild interstitial fluid overload has decreased . unchanged are the retrocardiac areas of atelectasis, the large perihilar right-sided opacity as well as the likely presence of bilateral small pleural effusions . the monitoring and support devices are constant . the known rib fractures are better appreciated on the ct examination from . no evidence of pneumothorax .	Atelectasis&&Fracture&&Lung Opacity&&Pleural Effusion&&Support Devices	15185305	50399800	ddf73353-2bd13067-b8238f63-0ee1fa88-b917f360
229	severely enlarged cardiac silhouette is again seen . small left greater than right pleural effusions remain . mediastinal and hilar contours are similar . no displaced fracture is seen . . no displaced fracture, however, if clinical concern for fracture persists of the ribs, suggest dedicated rib series, which is more sensitive . . persistent severe enlargement of the cardiac silhouette and small bilateral pleural effusions .	Cardiomegaly&&Fracture&&Pleural Effusion	13473781	59454336	f39b05b1-f544e51a-cfe317ca-b66a4aa6-1c1dc22d
230	the patient has undergone a right thoracocentesis . the extent of the right pleural effusion has substantially decreased . there is an opacity at the right lung base, likely reflecting reexpansion lung edema . no evidence of pneumothorax . no change in appearance of the left lung and of the cardiac silhouette .	Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion	16826047	58248690	e92d9801-97dad88a-dce9c2c1-ac9d93ac-c7134e12
231	ng tube tip is out of view below the diaphragm passing the stomach . et tube is in standard position . right ij catheter tip is at the confluence of the brachiocephalic vein . left lower lobe opacity has increased consistent with increasing atelectasis and small pleural effusion . right lower lobe atelectasis is unchanged . there is no evident pneumothorax . cardiomegaly is stable, accentuated by the projection . opacities superior to the hila bilaterally, larger on the left side, have minimally increased on the right, but markedly improved from .	Atelectasis&&Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Support Devices	10268877	51779078	db9eeee7-1e5ceadf-dc9a6548-0f43c246-e7c97602
232	the only focal pulmonary abnormality is a band of atelectasis in the right mid lung . there are no findings to suggest active pneumonia . moderate-to-severe cardiomegaly is chronic, but there is no pulmonary vascular engorgement, edema, or pleural effusion . disc degeneration is seen at several levels in the thoracolumbar spine .	Atelectasis&&Cardiomegaly	17147859	59519248	1129d3bb-924babcc-6bcb3caf-4a76b42e-b4b64f89
233	again seen is the bilateral small pleural effusions and left base atelectasis . cardiac silhouette is unchanged . there is no pneumothorax . again noted is the median sternotomy wires, valve replacements, and dobhoff tube in expected positions . changes in the right proximal humerus consistent with previous fracture better seen on shoulder radiographs from . no significant change in appearance of small bilateral pleural effusions and left base atelectasis since .	Atelectasis&&Pleural Effusion	18224196	50780353	90e79548-fcbab121-6100c047-b413fab9-912f13a5
234	note is made that the study was obtained yesterday at pm . and brought to our attention today at am . there is linear vertical lucency running parallel to the right border of the spine, continuing from the level of the carina upwards towards the neck and might potentially reflect air within the mediastinum . alternatively, it can represent air within the neoesophagus but that is less likely . there is interval improvement of the right mid lung consolidation . the bulging contour of the right mid mediastinum most likely reflects dilated neoesophagus . there is new left lower lung opacity that potentially might reflect aspiration . heart size is unremarkable . at am . with the recommendation to repeat chest radiograph to exclude the possibility of pneumomediastinum and discover of the findings was made hour ago and dr . was immediately paged .	Consolidation&&Enlarged Cardiomediastinum&&Lung Opacity	19016834	53651717	2ca44c56-b3b82e54-003fcd78-a48535a0-12e2ed43
235	the extensive right pleural effusion is constant in distribution and extent . also constant are the relatively massive subsequent parenchymal opacities in the right hemithorax . on the left, there is no visible change, the appearance of the left heart border, the left costophrenic sinus and the structure of the lung parenchyma is constant . no pneumothorax . no pleural effusions .	Lung Opacity&&Pleural Effusion	16826047	51795923	25ee6ef1-1e086650-4b388d67-99cae82c-8b65717e
236	comparison radiograph available from . frontal and lateral chest radiographs the heart size is top normal . the hilar and mediastinal contours are within normal limits . there is no pneumothorax, focal consolidation, or pleural effusion .	No Finding	19028690	56321718	73008a4b-9fd383b4-3d289f58-d78bef2a-065b5789
237	persistent largely unchanged left upper lobe, right upper lobe and left lower lobe peribronchial consolidation . there are stable low lung volumes . no pleural effusion or pneumothorax . the cardiomediastinal silhouette is stable within normal limits . the pleural surfaces are unremarkable . persistent bilateral peribronchial consolidations which might represent post-pneumonic fibrosisinflammation, organizing pneumonia, wegeners granulomatosis, or less likely residual infection . followup examination as clinically warranted is recommended .	Consolidation&&Pleural Other&&Pneumonia	10933609	55438657	4a706f94-eae311b0-de845977-dcc52bde-4615615e
238	frontal and lateral chest radiographs demonstrate minimal blunting of the bilateral costophrenic angles . there is no focal consolidation or pneumothorax . the heart size is moderately enlarged, and there are post-surgical changes of median sternotomy and cabg . there is an indistinct appearance of the pulmonary vasculature, consistent with mild-to-moderate pulmonary edema . . mild-to-moderate pulmonary edema, without focal consolidation to suggest pneumonia . there may be small bilateral pleural effusions, with a small degree of bilateral atelectasis . . the heart is moderately enlarged .	Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Pneumonia	13078497	51153042	c8a6b25d-257241cf-19fa30f5-20bedbc5-b371e581
239	cardiomediastinal contours are normal . there are bilateral perihilar plate-like atelectasis . there is no pneumothorax or pleural effusion . moderate degenerative changes are noted in the c-spine .	Atelectasis&&Support Devices	19028690	59630883	3a6ea7f8-a5379f3d-93b5a474-49f4c0e9-a37c0156
240	the picc line tip is at the level of mid svc . pleural effusion is demonstrated on the right, but substantially decreased after placement of the pigtail catheter . left pleural effusion is unchanged . the patient is in mild interstitial pulmonary edema .	Edema&&Pleural Effusion&&Support Devices	13263843	53789417	e78b86cd-f7e154ee-4481e547-c07f5b95-c4b92d03
241	comparison is made to the patients previous study of . a single portable upright chest film, at is submitted . . right internal jugular central line has its tip in the superior vena cava . a right basilar pigtail catheter has been placed and is incompletely visualized on the current examination . . interval decrease in size of a right pleural effusion with residual patchy basilar opacity, which could reflect residual compressive atelectasis, reexpansion pulmonary edema, contusion, and less likely pneumonia . persistent left pleural effusion with retrocardiac opacity, which most likely reflects partial lower lobe compressive atelectasis, although pneumonia cannot be excluded . no evidence of pulmonary edema . no pneumothorax . heart remains enlarged . cervical fusion hardware is seen projecting over the mid cervical spine .	Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	13755940	51099690	e53aee72-582b01ea-a370ca39-62ce5b25-e0eed2b3
242	et tube and right internal jugular line are in unchanged position . heart size and mediastinum are stable . improvement in aeration of the lung bases is demonstrated except for still present minimal left basal atelectasis and most likely present small left pleural effusion .	Atelectasis&&Cardiomegaly&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	17439310	54590636	f98090a5-828d97cc-91675b56-fa42c115-a9cf55cb
243	tracheostomy tube is in standard position . left subclavian line ends at the level of the mid svc . extensive bilateral subcutaneous emphysema is unchanged . given the extent of subcutaneous emphysema, presence of small pneumothorax cannot be certainly identified . the patient has known severe pulmonary emphysema, better evaluated on chest ct dated . multifocal lung opacities are stable . right mid thoracic chest tube is similar in position . heart size and mediastinal contours have similar appearance .	Cardiomegaly&&Enlarged Cardiomediastinum&&Lung Opacity&&Pneumothorax&&Support Devices	16751749	57505283	4ac477ad-67469958-ec8c37e7-547c1f59-9a0137e7
244	the et tube tip is cm above the carina . the esophageal stent is in place, unchanged since the prior study . the right internal jugular line tip is at the level of superior svc . there is redemonstration of pneumoperitoneum, at least mild-to-moderate, grossly unchanged since the prior study . extensive parenchymal consolidations are unchanged as well, predominantly involving the right mid and lower lung and then the left mid lobe .	Consolidation&&Support Devices	13964474	57225010	728ba54e-f806376b-641fb213-f018e8b4-60149648
245	frontal images of the chest demonstrate well-expanded lungs which are clear . there is a left-sided pleural effusion . there is no effusion on the right . there is no pneumothorax . cardiomediastinal silhouette is unremarkable . sternotomy wires and mitral valve ring again noted . visualized osseous structures are unremarkable . left pleural effusion . otherwise, unremarkable chest x-ray .	Pleural Effusion	15259244	52798218	bc28ea67-0dc950d7-d5c81ea4-c8640ac1-e0a88e8d
246	lower lung volumes, likely reflecting a lesser inspiratory effort . moderate cardiomegaly with retrocardiac atelectasis and small bilateral pleural effusions . no newly occurred focal parenchymal opacities . no pulmonary edema .	Atelectasis&&Cardiomegaly&&Pleural Effusion	15758946	57586513	15a43747-b7f52373-15c7623d-8ec7b6f7-c1fd59aa
247	in comparison to chest radiograph, support and monitoring devices are unchanged in position . mild cardiomegaly is accompanied by pulmonary vascular congestion . patchy bibasilar opacities likely reflect atelectasis, but aspiration and developing infectious pneumonia are additional considerations .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pneumonia&&Support Devices	18487334	52779908	501a71e8-c63c6501-4de1111d-c931b2b6-261814fe
248	the patient has taken a much better inspiration . again there and is evidence of multiple old healed rib fractures on the right . calcified hilar and mediastinal lymph nodes again are consistent with known sarcoidosis . no evidence of acute focal pneumonia or vascular congestion or pleural effusion .	Fracture	15776774	50323961	a582694c-9ecb47ce-40948acb-e0ef8797-d08a41a6
249	there is continued diffuse bilateral pulmonary opacifications consistent with worsening effusions, volume loss, and increased pulmonary vascular congestion . possibility of supervening pneumonia must be seriously considered in the appropriate clinical setting, though this is difficult to evaluate in view of the substrate of extensive pulmonary changes .	Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia	15259244	56723838	28674cfd-a09cd562-c2ee2007-8a9a2145-bc7be12c
250	there is again evidence of severe copd with apparent bullous changes in the apices . old healed rib fractures are noted on the right . however, there is no evidence of acute pneumonia or vascular congestion at this time .	Fracture	19991135	56918032	ebe1c050-b5cd68d5-7eb2b544-8906f022-e95300a4
251	continued enlargement of the cardiac silhouette with moderate-to-severe pulmonary edema . opacification at the left base may reflect effusion and atelectasis . hemodialysis catheter again extends to probably the upper portion of the right atrium .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	17340686	54716590	e4f6de95-2089560c-4df114b1-deac3d24-a6bc53f7
252	single ap portable chest radiograph is obtained . tracheostomy tube is present . there is no pneumothorax or pleural effusion . there is a hazy veil-like opacity in the right upper lung zone which may be consolidation, atelectasis or artifact . heart size appears enlarged however, this may be technical due to ap view . bony structures are intact . limited study with hazy opacity in the right upper and mid lungs which may be infectious in etiology, atelectasis or artifact .	Atelectasis&&Lung Opacity&&Pneumonia	10268877	59301985	f2ea048e-52ada468-199a5a64-06f14cb3-76e57312
253	again visualized is a stable right lower lobe opacity consistent with small to moderate right pleural effusion . improved asymmetric edema is noted on the left . there is no evidence of new consolidation or pneumothorax . cardiomediastinal silhouette remains stable . osseous structures remain normal . . stable small to moderal right pleural effusion . . improved asymmetric edema is noted on the left .	Edema&&Pleural Effusion	12185775	53923012	96e29c8f-cbe25758-3c1d7c4e-4f3ed96e-857a1bc7
254	the patient has prior history of gastric pull-through with radiation therapy for esophageal cancer . right upper lobe consolidation in posterior segment has slightly improved . the lungs are hyperinflated . mm right lower lobe nodule is unchanged since . small right pleural effusion is stable since . there is no pneumothorax . mediastinal and cardiac contours are normal . conclusion right upper lobe infiltrate has improved since . there is no new lung consolidation .	Consolidation&&Lung Opacity	14295224	53458437	78a4e7a2-9072e849-a90eb438-518cd14b-3ea197d4
255	the patient is status post median sternotomy and coronary bypass surgery . heart remains enlarged, and is accompanied by pulmonary vascular congestion . interval improved aeration at both lung bases with improving atelectasis and decreasing pleural effusions . no new areas of consolidation within either lung .	Atelectasis&&Consolidation&&Edema&&Pleural Effusion	12952223	52774948	c383b852-eac5f445-af9853bb-aaadded6-9b28a98c
256	right internal jugular catheter ends at svc . orogastric feeding tube is seen to course below the diaphragm into the stomach, however distal end is beyond the view of radiograph . bilateral lung volumes are low . lower lung atelectasis and presumed small left pleural effusion is unchanged . given the low lung volumes, assessment for mild or early pulmonary edema is limited .	Atelectasis&&Edema&&Pleural Effusion&&Support Devices	19623993	59094609	dd1b3904-39c994bb-d70efb14-d51f63a7-7848565c
257	the heart appears borderline in size . the aorta is tortuous with patchy calcification . the cardiac, mediastinal and hilar contours appear stable . the lungs appear clear . there are no pleural effusions or pneumothorax . a mild compression deformity of the t vertebral body appears unchanged . a severe compression deformity of l vertebra plana appears unchanged with stable alignment abnormality . the bones appear demineralized . no evidence of acute disease . stable compression fractures .	Fracture	19454978	54362315	c1835b44-25f4ae1d-7fe2caf9-d07d4f59-ab0150b4
258	analysis is performed in direct comparison with the next preceding similar chest examination . there is status post sternotomy and aortic valve replacement identifying the metallic components of a porcine aortic valve stenosis in place . these findings are rather unchanged . the heart size has increased slightly . no typical new configurational abnormality can be identified . the pulmonary vasculature is not congested, nor is there evidence . marked left atrial enlargement when comparing the posterior cardiac wall in relation to the aortic valve prosthesis on the lateral view . the pulmonary vasculature is not congested . on the other hand, the pulmonary vasculature shows again the previously described marked irregular peripheral distribution that coincides with low positioned and flattened diaphragms . marked increase of chest diameter in depth is noted on the lateral view and related to a markedly increased kyphotic curvature with multiple wedge compressed vertebral bodies in the mid portion of the thoracic spine . as before, one sees multiple peripheral small linear densities and areas of increased translucency rather typical for advanced copd . comparison with the next preceding study does not disclose any new discrete parenchymal infiltrate . also, the lateral and posterior pleural sinuses remain free from any significant fluid accumulation . bilateral apical pleural thickenings are again seen and have not undergone any significant interval change . multiple rib deformities as before indicative of previously sustained local rib fractures . comparison with the next preceding chest examination demonstrates on the frontal view increase of the heart shadow . this coincides also with a more prominent visibility of the azygos vein in the right tracheobronchial angulation . thus, these findings could suggest a volume increase of the right ventricle and thereto related elevated right-sided filling pressure, a suggestion which matches information that the would recommend the performance of an echocardiogram to look for possible right ventricular strain, tricuspid incompetence and elevated right-sided filling pressure . patient has developed new pedal edema . to confirm this suspicion,an echocardiogram could be helpful . no acute new parenchymal infiltrates in these advanced findings of of copdno evidence of pulmonary venous congestion .	Cardiomegaly&&Edema&&Fracture&&Lung Opacity&&Pleural Other&&Support Devices	17392550	53641457	6029ba23-5d73e768-c1fe417b-73eb330f-9c507e77
259	severe cardiomegaly persists and the presence of a left pleural effusion cannot be excluded . in addition to these findings, todays image shows mild pulmonary edema . left retrocardiac atelectasis . no pneumothorax .	Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion	13473781	53148581	790aef7d-e4cf7dd2-82d3a1e4-111fdcc4-3d8cedd7
260	there is again enlargement of the cardiac silhouette with extensive bilateral pleural effusions and compressive atelectasis combined with pulmonary vascular congestion .	Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion	15380734	51191114	1fcd995b-1ec680c3-bba45110-e0430c14-bc44fbde
261	frontal and lateral views of the chest demonstrate normal cardiomediastinal silhouette . the lungs appear hyperexpanded, in keeping with known emphysema . previously seen left lower lobe opacity has resolved on the frontal view but may persist on lateral view obscuring the posterior costophrenic angle, which could represent a component of residual infection andor atelectasis . there is trace basilar atelectasis on the right . there is no large effusion . eventration is seen on the right, unchanged . bibasilar dependent atelectasis . persistent probable left lower lobe posterior opacity which could represent atelectasis or a component of residual infection, to be clinically correlated . followup after treatment recommending to document resolution .	Atelectasis&&Lung Opacity&&Pneumonia	11052935	51137224	c8913af9-734e331d-173b2e64-3bd029ab-fb2771ae
262	the endotracheal tube has been pulled back . the tip of the tube now projects cm above the carina . there is increasing diffuse opacity at the left lung base, likely caused by a small pleural effusion . no other relevant changes . no pneumothorax . unchanged aspect of the cardiac silhouette .	Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Support Devices	13881772	51265927	4d91911d-7ed6ea7f-18ae148c-fb6fdc45-798771a7
263	pacer leads, median sternotomy wires, mediastinal clips unchanged from same day radiograph . cardiac silhouette stably enlarged . mild increased interstitial markings, primarily on the right, compatible with worsening interstitial edema . there are small bilateral pleural effusions, with bibasilar atelectasis .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	13921768	50259315	40e0dc90-fdd63c47-3a4502b4-c7dd49d6-b903b2b9
264	as compared to the previous examination, the patient has been intubated . the tip of the endotracheal tube projects . cm above the carina . the patient also has received a nasogastric tube, the course of the tube is unremarkable, the tip of the tube does not display on the image . the ventriculoperitoneal shunt and the left subclavian access line are unchanged . there is no evidence of complications, notably no pneumothorax . the lung volumes are increased, with subsequent decrease in severity and extent of a pre-existing right basal medial parenchymal opacity . no newly appeared parenchymal opacities, unchanged size of the cardiac silhouette . no pleural effusions .	Cardiomegaly&&Lung Opacity&&Support Devices	11906222	55124994	a7b100cd-08c2be2d-a32c2dac-020c1d75-1bd5b887
265	portable ap supine chest film at is submitted . . right internal jugular dual-lumen catheter remains unchanged in position . the heart remains enlarged and the mediastinal contours are stable . there is coarsening of the interstitium . no evidence of pulmonary edema, focal airspace consolidation to suggest pneumonia . no large pneumothorax . there is deformity of the right lateral rib cage consistent with previous rib fractures . no acute bony abnormality is appreciated .	Cardiomegaly&&Enlarged Cardiomediastinum&&Fracture&&Pneumonia&&Support Devices	18855147	52042427	d8358039-56377194-16d2e4ae-7f54b999-53da73f7
266	very severe subcutaneous emphysema of the entire torso has not improved . the overlying subcutaneous gas makes it difficult to detect pneumothorax but i see no good evidence of any nor is there any appreciable pleural effusion . the hematoma around the pulmonary laceration of the right pleural tube is slightly smaller today than it was on but stable since . a region of hemorrhage in the axillary region in the left mid lung has been stable for the past several days . edema or pneumonia in the right lower lung is stable . emphysema is severe . tracheostomy tube and left subclavian line are in standard placements . the heart is normal size .	Edema&&Pleural Effusion&&Pneumonia&&Pneumothorax&&Support Devices	16751749	59245308	bcf2cc18-3401053b-113ae6db-daa24d50-08934ad9
267	there still diffuse increase in interstitial markings bilaterally consistent with chronic interstitial lung disease . no new focal consolidation is seen . no pleural effusion or pneumothorax is seen . the cardiac and mediastinal silhouettes are grossly stable . no significant interval change . stable diffuse increase in interstitial markings consistent with chronic lung disease .	Lung Opacity	13475033	56055109	f7995b00-70025839-1b735979-92983f8a-5fb639f8
268	there is stable mild pulmonary vascular engorgement . no evidence of pulmonary edema . there are no focal consolidations . no pneumothorax or pleural effusion . heart size is top normal . stable mild pulmonary vascular engorgement . heart size is top normal . no evidence of pneumonia .	No Finding	14177219	52589781	2583e77d-666ff867-9384b210-c059e9e6-31c7da01
269	single frontal view of the chest in semi-erect position demonstrates stable position of a dual-channel central venous catheter with tip terminating in the upper right atrium . the patient is slightly rotated to the left . cardiomediastinal silhouette is within normal limits . multiple clips are seen overlying the right apex . rightward upper tracheal displacement is related to known enlarged left thyroid lobe as seen on ct dated . the lungs are clear with trace, if any, basilar atelectasis . there is no pneumothorax, vascular congestion, or pleural effusion . multiple remote fractures are seen on the left posteriorly, unchanged . no definite evidence to suggest pneumonia or fluid overload .	Pneumonia	14236258	55227594	947b8eee-91990d6d-31a05ac0-0f30e40e-c54fedee
270	a single portable chest film was obtained . a tip of a newly placed ng tube is now seen around the level of the diaphragmatic hiatus . lung volumes are low, accentuating the pulmonary vasculature . replaced ng tube tip near the gastroesophageal junction . it should be advanced further into the stomach and a repeat film taken before use . telephone at on .	No Finding&&Support Devices	13979643	56291217	384cf52b-9692fbc2-b3a9f35b-7afe21a3-e935fdb1
271	moderate cardiomegaly is chronic, and improved since . lungs are low in volume but clear . definition of the airway to the left lower lobe bronchus is poor, as it was on , but a torso ct on showed the bronchus displaced by the large heart, but patent . normal mediastinal and hilar contours and pleural surfaces .	Cardiomegaly	14727722	54416722	2b1a5138-f3160270-992271a6-a4c40f13-eadcb090
272	portable ap chest radiograph right ij line tip projects over the expected region of the upper svc . right-sided picc tip projects over the expected region of the cavoatrial junction . et tube is approximately . cm above the carina . a feeding tube is noted with tip in the expected region of the proximal gastric antrum with side ports within the body of the stomach . severe cardiomegaly is again noted . right-sided pleural effusion is unchanged from the prior examination . the opacification at the left lung base is unchanged from the most recent prior examination may represent pleural effusion with atelectasis, however infectious process such as pneumonia cannot be excluded in the correct clinical setting .	Atelectasis&&Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	11204646	59896422	cc1b3c0f-8e71ad32-d08ab6a1-41e21695-76317bb0
273	moderate cardiomegaly is unchanged . pacer leads are in stable position . hemodialysis catheter terminates in the right atrium, unchanged . the lungs are essentially clear, and the right lung base is partially obscured by the overlying pacemaker generator . prosthetic valves and sternal wires are unchanged . blunting of left costophrenic angle likely indicates a small pleural effusion . . stable moderate cardiomegaly and a likely small left pleural effusion . . hemodialysis catheter terminating in the right atrium .	Cardiomegaly&&Pleural Effusion&&Support Devices	19759491	59146382	8c248d5f-8700e4e5-23cf46b2-e930bffd-cc41a993
274	assessment is slightly limited by patient rotation . the endotracheal tube tip terminates approximately cm from the carina . an enteric tube tip is within the stomach . cardiac silhouette size appears mildly enlarged but unchanged . assessment of the mediastinal and hilar contours is limited . pulmonary vasculature is not engorged . streaky bibasilar airspace opacities may reflect areas of atelectasis . no pleural effusion or pneumothorax is identified . marked degenerative changes are noted involving the right glenohumeral joint . limited examination due to patient rotation . endotracheal and enteric tubes in standard positions . streaky bibasilar opacities, likely atelectasis .	Atelectasis&&Lung Opacity&&Support Devices	16524406	54985612	cae34b8f-cef454bf-250bd88e-8bef265d-9a3f0172
275	comparison is made with prior study performed minutes earlier . et tube is in standard position . ng tube tip is out of view below the diaphragm . right chest tube projected in the right mid lung is in unchanged position . left subclavian catheter tip is in unchanged position with tip in the upper svc . there are no other acute interval changes .	No Finding&&Support Devices	16751749	50833716	a591be11-255de340-3ac24e9b-fd6f9e96-878103e2
276	the lungs are clear of consolidation, effusion, or pneumothorax . left chest wall dual lead pacing device is again seen . moderate cardiomegaly is again noted . upper thoracic dextroscoliosis is seen . no acute fracture identified based on this nondedicated exam . surgical clips seen in the upper abdomen . cardiomegaly without acute cardiopulmonary process .	Cardiomegaly	10754184	56348027	c979aaaa-4bb31072-c9884178-6e3ced8b-edf531fa
277	subcutaneous emphysema is severe in the thoracoabdominal wall and neck . i do not see pneumomediastinum for certain, and no pneumothorax, though i suspect this is not an erect chest radiograph which would be required to exclude that . lung volumes are quite low, exaggerating what is probably mild edema seen best on the right, and mild cardiomegaly . large mediastinal lymph node calcification in the ap window is noted . was paged to recommend repeat examination primarily to exclude pneumothorax .	Cardiomegaly&&Edema	11413236	50855550	a94ddbc2-40a2c88a-c00a1b50-4a09d704-8ebb8115
278	ap and lateral views of the chest are compared to previous exam from . dual-lumen left subclavian line is in stable position . the lungs are clear of consolidation . trace blunting of the left costophrenic angle again seen . there is no right-sided pleural effusion . cardiomediastinal silhouette is stable . surgical clips project over the thoracic inlet bilaterally . osseous structures again notable for bilateral, old posterior healed rib fractures and mild wedging of mid thoracic vertebral bodies, unchanged since . degenerative changes again seen at the shoulders bilaterally including calcification in the region of the right coracoclavicular region . no acute cardiopulmonary process .	No Finding	14236258	55564287	91db5745-87b0042c-4728fa53-e5352d85-501dae1c
279	a right upper lobe consolidation with air bronchograms is similar to . focal tubular lucency within the opacity is new and may reflect cavitation, dilated airways or spared lung parenchyma . opacity in the right lower lobe has progressed since the prior study . there is no effusion or pneumothorax . cardiac and mediastinal contours are normal . there is mild thickening of the left major fissure . non-resolving right upper lobe pneumonia superimposed on bilateral juxtahilar scarring which could be due to prior granulomatous process such as tb or sarcoid . consider ct to further evaluate the right upper lobe and to exclude central necrosis, as well as to further characterize for causes of non-resolving pneumonia .	Lung Opacity&&Pneumonia	10933609	54694185	ff86990a-2b9b1ae4-abec4188-55d0170a-72142dca
280	pa and lateral chest radiographs demonstrate no interval change from . small right pleural effusion, adjacent atelectasis, and scar formation are stable . the cardiomediastinal silhouette is normal . the left hemithorax is unremarkable . stable small right pleural effusion compared to . this study neither suggests nor excludes the diagnosis of pulmonary embolism .	Pleural Effusion	18309149	59608718	c418a7ea-f382ef9c-a8aa6045-d0ecf7cb-87214437
281	semi-upright portable ap view of the chest provided . the heart is massively enlarged . there are trace pleural effusions . increased opacity in the right mid-to-lower lung is concerning for pneumonia . the left lung appears essentially clear . no pneumothorax . the mediastinal contour appears normal . bony structures are intact . massive cardiomegaly with trace bilateral pleural effusions . opacity within the right mid-to-lower lung is concerning for pneumonia .	Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Pneumonia	15857729	55715754	e539ba13-0f60a2b9-c5777304-ac5661fd-236f33a8
282	there continues to be markedly severe s-shaped scoliosis of the thoracolumbar spine . the endogastric tube courses inferiorly into the stomach with its sideport well below the ge junction however, the ng tube does appear kinked in the segment that is just - cm upstream from the sideport . the right picc tip is in the lower svc . within the limits of a severely scoliotic patient, the cardiac and mediastinal contours appear normal . the lungs demonstrate mild retrocardiac atelectasis . there is no large pleural effusion or pneumothorax . . ng tube kinked within the stomach - consider minimal retraction to reposition . . severe scoliosis with mild retrocardiac atelectasis .	Atelectasis&&Support Devices	18110020	54224166	f9939219-9d47f1d2-245483ba-56d3429b-896a3f2e
283	there has been some interval improved aeration in the left upper lobe that now permits visualization of the aortic knob and the previously described appearance of question widened mediastinum is now seen to have represented the left upper lobe infiltrate . there continues to be a dense left upper lobe infiltrate with more hazy opacity of the remainder of the left lung that could be due in part to layering effusion . there are increased patchy areas of infiltrate in the right lung . there is pulmonary vascular re-distribution and ill-defined vasculature consistent with fluid overload . the heart size is mildly enlarged . swan-ganz catheter tip is in the main pulmonary artery . the et tube is cm above the carina . left chest tube and mediastinal drains are unchanged . the dual-lead pacemaker is unchanged .	Cardiomegaly&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Support Devices	19075045	56319561	7f667ba3-a9265ab9-a860e1b3-2fdf36b2-bf3b1ae1
284	portable ap upright view of the chest provided . midline sternotomy wires and mediastinal clips are again noted . there are lower lung opacities which is potential concern for pneumonia . there is no large effusion or pneumothorax . mild central hilar congestion is somewhat improved from prior exam . the heart size is top normal . the mediastinal contour is unchanged . no definite signs of pneumothorax . bony structures appear grossly intact . lower lung opacities which could represent atelectasis versus pneumonia . possible mild congestion .	Atelectasis&&Lung Opacity&&Pneumonia	16672854	57282583	350c270f-70f4a764-33a53729-ec529c84-cd886aa9
285	the lungs are hyperinflated but clear of consolidation . linear opacity in the right mid to upper lung is compatible with scarring as well as changes of the posterior right ribs which are chronic . blunting of the right lateral posterior costophrenic angle is chronic, potentially due to scarring or trace effusion . blunting of the left posterior costophrenic angle suggests small pleural effusion . cardiomediastinal silhouette is within normal limits . prominent retrocardiac opacity on the right is compatible with a neo esophagus . no acute osseous abnormalities . new trace left pleural effusion . otherwise, no significant interval change .	Pleural Effusion	14295224	56185390	2434d6b8-4828302e-7923908c-d6ea3b85-b4cfc271
286	there has been interval placement of a dobbhoff tube, which is coiled within the pharynx . there is a left-sided picc line with tip terminating at the cavoatrial junction . there is interval removal of the right-sided central venous sheath . no pneumothorax evident . there is stable small right pleural effusion . right lower lung opacification likely represents combination of atelectasis and layering pleural effusion . stable calcified granuloma projects over right mid lung . a nodular opacity projecting over left upper lung corresponds with nipple evident on the , chest ct . . dobbhoff tube coiled in esophagus with tip in pharynx . recommend withdrawal . . no evidence of pneumothorax . . stable right pleural effusion and basilar atelectasis . communicated these findings to dr at on via telephone .	Atelectasis&&Pleural Effusion&&Support Devices	16319601	50891752	e3462cbd-2ad9049e-4bc04cbf-4f3005ab-3c4c0678
287	patient is status post median sternotomy and cardiac valve replacement . dual lead left-sided pacemaker stable in position . a right port-a-cath terminates in the low svc without evidence of pneumothorax . no focal consolidation or pleural effusion is seen . there is minimal lateral right basilar atelectasisscarring . no pulmonary edema is seen . the cardiac and mediastinal silhouettes are stable . no acute cardiopulmonary process .	No Finding	16043637	54793306	c9696dea-5c1429f6-f7f379f6-a8b0af2c-8d29d931
288	previous mild pulmonary edema has improved, small bilateral pleural effusions have decreased, but left lower lobe atelectasis has worsened . heart size top normal . no pneumothorax .	Atelectasis&&Edema&&Pleural Effusion	12433421	59409427	7f267ae9-96a871a2-d6201f05-95d76d1d-0e0ce72b
289	the lung volumes have improved . cardiomegaly is severe, pulmonary vasculature is engorged, and left infrahilar consolidation is likely . pleural effusions are presumed, but not large . no pneumothorax . right internal jugular introducer ends at the origin of the svc . et tube in standard placement . esophageal drainage tube passes into the stomach and out of view .	Cardiomegaly&&Consolidation&&Pleural Effusion&&Support Devices	15131736	51479309	879a6090-bc908584-faa34013-2ab152cc-c80f9feb
290	cardiac silhouette is enlarged and accompanied by widened vascular pedicle, pulmonary vascular congestion and moderate pulmonary edema . a more confluent area of opacity in the left retrocardiac region could reflect atelectasis or clinically suspected aspiration . followup radiographs after diuresis may be helpful to ensure clearing of edema and to exclude underlying aspiration or infectious pneumonia . small pleural effusions are also demonstrated .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia	15393401	52299108	4bb046fd-97a72e50-21955713-67e2c1c0-ee97bbc4
291	comparison is to at . a portable ap chest film dated at am . . right internal jugular introducer catheter has its tip in the cavoatrial junction . endotracheal tube has its tip approximately cm above the carina . nasogastric tube is seen coursing below the diaphragm with the tip not identified . a right subclavian picc line has its tip at least to level of the mid superior vena cava, unchanged . . bilateral diffuse airspace process appears unchanged with the exception of loculated fluid within the horizontal fissure . these findings may reflect moderate-to-severe pulmonary edema, though bilateral infectious process cannot be entirely excluded . the right costophrenic angle is not entirely included on the current examination . overall, cardiac and mediastinal contours are stable . no pneumothorax .	Edema&&Enlarged Cardiomediastinum&&Pneumonia&&Support Devices	19757720	54364406	c655764b-a45dc3cd-b0352fcf-f496ec60-32cdb429
292	single ap upright image of the chest was obtained . there is a left basilar opacity . no right sided pleural effusion . no pulmonary edema . unchanged markedly dilated cardiac silhouette . no pneumothorax . no bony abnormality . no free air below the hemidiaphragm . left basilar opacity possibly due to pneumonia, effusion, atelectasis or a combination of the above . stable severe cardiomegaly .	Atelectasis&&Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Pneumonia	13473781	50453286	ae4c4185-418ae838-935a5921-92daeeca-f8194630
293	there is moderate pulmonary edema, but no pleural effusion or pneumothorax . heart size is top-normal, stable . mediastinal contours are within normal limits . osseous structures are intact . . moderate pulmonary edema without pleural effusions . . top-normal heart size .	Cardiomegaly&&Edema	12810135	59870920	9e0fc31a-ce25b7bc-30362279-d96a0c0c-f6d54e86
294	prior right picc is no longer visualized . lower lung volumes are seen on the current exam . the lungs remain clear of besides mild retrocardiac opacity . the cardiomediastinal silhouette is stable . degenerative changes are seen at the shoulders . retrocardiac opacity, potentially atelectasis, infection is not excluded . consider repeat with pa and lateral .	Atelectasis&&Lung Opacity&&Pneumonia	19454978	50297024	674352c6-0c0645c1-b23ec675-6af58553-7af149b1
295	there is a right ij central venous line with distal lead tip at the cavoatrial junction, stable . there are extensive large pleural effusions, right side worse than left . atelectasis at the left lung base and poor inspiratory effort is again visualized . no pneumothoraces are seen . there is mild underlying pulmonary edema .	Atelectasis&&Edema&&Pleural Effusion&&Support Devices	12952223	57273961	c8502a35-a270d52b-bd1e0d87-6a535418-3c742175
296	the monitoring and support devices remain in place . there may be mild increased aeration in the left upper zone . retrocardiac opacification is consistent with volume loss in the left lower lobe . hazy opacification bilaterally is consistent with pleural effusions, and there is some increase in pulmonary venous pressure .	Lung Opacity&&Pleural Effusion&&Support Devices	19075045	56483572	c148002c-a0674884-d784b291-762232a4-a10fa5aa
297	chest portable comparison is made to prior examination of . the et tube has been removed . a small right apical pneumothorax is identified . there is a small amount of subcutaneous emphysema in the right supraclavicular region in the neck, which is not significantly changed . again noted are hazy opacities in the right hemithorax and these are stable . by dr . by telephone on at am, time of discovery am .	Pneumothorax	17112432	57935403	f05b9731-d6bf3b29-6197f242-4cc974a3-fe0f5b56
298	one portable supine view of the chest . the endotracheal tube ends in the right internal jugular line and is in unchanged position . no ng tube is seen . the lung findings are unchanged compared to minutes earlier .	No Finding&&Support Devices	16409152	57976054	eae82e15-d009faf9-ea670371-7404ef86-edfc3065
299	no focal consolidation, pleural effusion, or pneumothorax is seen . linear retrocardiac densities were seen previously and may represent atelectasis . lung volumes are low, exaggerating pulmonary vasculature and hila . heart and mediastinal contours appear similar compared to prior . there is no evidence for free intraperitoneal air below the diaphragms . low lung volumes without radiographic evidence for acute process . bibasilar atelectasis . no evidence of free air beneath the diaphragms .	Atelectasis	13120957	55681597	d53ea806-f9b5f637-2a0ee3e9-a8409e3d-56e8cf0f
300	status post cabg, right internal jugular vein catheter . small left pleural effusion with left retrocardiac atelectasis . no pneumonia . no pulmonary edema .	Atelectasis&&Pleural Effusion&&Support Devices	15272972	55355224	f4c84687-90ca8c27-94ff047f-739ca07b-e7f169d4
301	single portable view of the chest is compared to previous exam from . when compared to prior, there has been significant interval enlargement of bilateral pleural effusions which are now moderate in size . underlying airspace disease is also possible . superiorly, however, the lungs are grossly clear . cardiac silhouette is difficult to assess given the size of effusions . osseous and soft tissue structures are unchanged . significant interval increase in the bilateral pleural effusions since prior exam with possible underlying airspace disease not excluded .	Lung Opacity&&Pleural Effusion	10410641	56839020	5644c5de-1ae5b48c-edb63079-e8230bfa-79dfbf13
302	right subclavian line has been withdrawn from the low to the mid svc . right basal atelectasis has improved . lungs are clear, though pulmonary vasculature is now mildly engorged . moderate cardiomegaly is chronic . indentation of the cervical trachea is mild and unchanged . no pneumothorax .	Atelectasis&&Cardiomegaly&&Support Devices	11474065	54030442	bcd7e653-bdbda5eb-c1e8c446-d66776b2-7e86ed00
303	portable semi-upright radiograph of the chest demonstrates low lung volumes with resulting bronchovascular crowding . an area of increased opacification of the left base may represent artifact from patient positioning or atelectasis, however superimposed infection cannot be excluded . there is a probable small left-sided pleural effusion . there is no pneumothorax . the cardiomediastinal contours are unchanged . increased opacification of the left base may represent artifact from patient positioning or atelectasis, however superimposed infection cannot be excluded .	Atelectasis&&Lung Opacity&&Pneumonia	14841168	54393658	7c70e574-d72b406a-b5eddc73-e53c3242-c9c99c9b
304	the lung volumes have increased, likely reflecting improved ventilation . the transparency of the lung parenchyma on the right has increased more than on the left . on the left, there are unchanged areas of left basal atelectasis and a moderate left pleural effusion . borderline size of the cardiac silhouette . no newly appeared parenchymal opacities .	Atelectasis&&Cardiomegaly&&Pleural Effusion	12074041	57679936	467d9162-e7cce16e-70dfaa79-1867728f-1db6394e
305	there are parenchymal opacities in the right middle lobe . there are also - opacities in the region of the lingula . dual-chamber pacer in the left upper chest terminates in the right atrium and ventricle, stable . mild cardiomegaly and tortuous aorta is unchanged . there is no pleural effusion or pneumothorax . hyperexpansion and flattened hemidiphragms suggest copd . right middle lobe and lingular pneumonia .	Pneumonia	13762730	58807210	e3555bac-cb4ffa77-657be5f9-38bcdc9b-0b46292b
306	the heart size is enlarged . the mediastinal contours demonstrate engorgement of the central venous vasculature . additionally small bilateral pleural effusions are present with basilar atelectasis . there does not appear to be appreciable interstitial edema . there is no pneumothorax . cardiomegaly and small bilateral pleural effusions but no evidence of chf .	Cardiomegaly&&Pleural Effusion	11204646	50533006	d6fbe6a9-57f6ae9d-07f24e69-1c032794-76d80d8f
307	heart size is borderline enlarged with a left ventricular predominance . the aorta is unfolded . mediastinal and hilar contours are unchanged . calcified nodule in the left mid lung field is similar, compatible with a granuloma . lungs are clear without focal consolidation . pulmonary vasculature is normal . no pleural effusion or pneumothorax is seen . there are multilevel moderate degenerative changes in the thoracic spine . no acute cardiopulmonary abnormality .	No Finding	15612622	58857549	5c2bf1b4-d3738135-b0f5cea4-bfa67dda-166feb65
308	comparison is made to the prior study of . portable ap upright chest film, at is submitted . . interval placement of a right internal jugular dialysis catheter, which has its tip in the right atrium and is in similar position to that on prior study dated . . the previously seen left effusion has decreased in size . there is a diffuse bilateral interstitial process, which likely reflects a component of mild pulmonary edema . the heart remains borderline enlarged . mediastinal contours are unchanged . no pneumothorax . no focal airspace consolidation to suggest pneumonia .	Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Pleural Effusion&&Pneumonia&&Support Devices	15259244	54251102	c9f72311-636e3e48-e91cc14d-ba98d9ce-c823252f
309	compared to prior chest radiographs, through . right lung is low in volume but clear, although the pulmonary vessels are engorged . severe cardiomegaly and mediastinal venous distension are stable . hilar enlargement reflects pulmonary arterial hypertension . most of the left lower lung is obscured by the large part but there is at least atelectasis . left pleural effusion is small . no pneumothorax . et tube is in standard placement, feeding tube passes below the diaphragm and out of view . right pic line ends in the mid svc .	Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices	14841168	51715383	3e8684a6-648033ea-79431638-c694d922-dadb2370
310	there has been interval development of diffuse, mild to moderate interstitial pulmonary edema . a focal opacity seen in the right middle lobe may represent an early pnemonia in the appropriate clinical setting . redemonstrated is stable moderate cardiomegaly with small bilateral pleural effusions . mediastinal and hilar contours are stable . the patient is status post cabg with median sternotomy wires aligned and intact . a transvenous pacemaker is seen with leads terminating in right atrium and right ventricle . . probable right middle lobe pneumonia . recommend palateral chest radiographs to confirm and further characterize the opacity . . mild to moderate, diffuse interstitial pulmonary edema . . stable moderate cardiomegaly with small bilateral pleural effusions .	Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia	19075045	58669896	e8fe1d63-cd1aba2f-a7c06ed9-9add34f1-736fa06f
311	the et tube is now cm above the carina . there continues to be pulmonary vascular redistribution and areas of alveolar infiltrate consistent with fluid overload . swan-ganz catheter tip is in the pulmonary outflow tract . cardiac pacemaker is unchanged . the left ij line tip is in the svc .	Lung Opacity&&Support Devices	10886362	51423353	9192ac1a-8d64bbf3-4b035831-96f59abc-903b2aaa
312	the cardiomediastinal and hilar contours are stable, with moderate cardiomegaly . multiple intact sternotomy wires, mediastinal surgical clips, and prosthetic aortic valve are noted . there is minimal improvement in a chronic moderate-sized left pleural effusion . no pneumothorax is seen . faint opacity right base laterally appears to represent residua from xray . bibasal opacities, left greater than right, likely represents atelectasis . ppossible background chronic lung disease . faint opacity over left upper quadrant of abdomen may represent residual contrast in te stomach . no free air seen beneath the diaphragm . no obvious displaced rib fractures are seen . if there is a high clinical concern for a nondisplaced rib fracture, dedicated rib series scan be performed with a marker placed at the site of maximum tenderness .	Atelectasis&&Cardiomegaly&&Pleural Effusion	15259244	50282926	ede252ee-83066d8a-376961c0-b07de3b1-0dfeb1e0
313	moderate pulmonary edema has progressed since yesterday . bibasilar atelectasis is unchanged . mild cardimegally is similar . median sternotomy wires are intact and mediastinal clips are in expected positions . progression of moderate pulmonary edema .	Edema	12952223	54128066	88fa75e4-2f2e9c03-71433ae3-1d8780f4-1e2eae3c
314	there is little change in the appearance of heart and lungs . nasogastric tube coils within the fundus of the stomach with the tip in the upper to mid body of this organ .	No Finding&&Support Devices	18110020	50243114	cde578b4-835fd6d8-52f31743-1cefcefc-0fa3157d
315	the endotracheal tube and nasogastric tubes have been removed . there is no significant change in the pulmonary edema . there are no new areas of consolidation with some persistent density in the right lung base . there is no pneumothorax .	Consolidation&&Edema	15131736	58698919	4b3c3806-311dc11c-5c89f911-3f5b98e5-e5291eb6
316	the lungs are well expanded and show a new right and left lower lobe opacity . the cardiac silhouette is enlarged, unchanged . the mediastinal silhouette and hilar contours are unremarkable . no pleural effusion or pneumothorax is present . multiple right ventricular and right atrium leads are noted, unchanged . a left-sided pacer is also unchanged in position . new bibasilar opacities could represent atelectasis, sequelae of aspiration or pneumonia .	Atelectasis&&Lung Opacity&&Pneumonia	11293517	57001251	bba7f682-33b9288a-712a4870-190d5eb1-2045568c
317	moderately severe pulmonary edema has changed in distribution but not in overall severity since . a small concurrent pneumonia would not be appreciated . small bilateral pleural effusions are presumed . moderate cardiomegaly and mediastinal vascular engorgement are unchanged, and recurrent .	Cardiomegaly&&Edema&&Pleural Effusion&&Pneumonia	17340686	50365719	46501b98-e0a88786-27dbb719-b9a7468c-376d9f6a
318	there is moderate cardiomegaly, but no pulmonary edema . there is no pleural effusion and no pneumothorax . there is a plate-like lingular atelectasis . moderate cardiomegaly, but no pulmonary edema . no pneumonia .	Cardiomegaly	18512911	59232798	8f3afa87-cb2c2fec-210903d7-8faa6559-a7b6bf8e
319	there has been placement of a long intestinal tube that appears to extend well into the body of the stomach, then curl back on itself into the fundus with the tip pointed distally . persistent opacification at the left base consistent with atelectasis and effusion . engorgement of the pulmonary vessels is consistent with elevated pulmonary venous pressure . left central catheter again extends to the lower portion of the svc .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Support Devices	13979643	56225769	be6da065-d1ae7d5e-8c62d864-d943a731-d9a38c86
320	the dobhoff tube can be seen only to the level of the distal esophagus, were crosses the lower margin of the image, to evaluate the tip, a view of the upper abdomen must be obtained using abdominal technique . the area of increased opacification at the right base seen previously is not appreciated at this time .	Lung Opacity&&Support Devices	18487334	53404392	6814b280-d33103fb-57bac34d-4b2fe11e-850ad502
321	severe cardiomegaly is chronic and mediastinal veins are generally dilated . moderate right pleural effusion increased in compared to , moderate in size and subsequently unchanged . left lung is grossly clear . et tube in standard placement . nasogastric tube passes below the diaphragm and out of view . a right subclavian picc line can be traced into the right atrium, but the tip is quite indistinct . no pneumothorax .	Cardiomegaly&&Pleural Effusion&&Support Devices	11204646	51807337	53f16e4e-347b6971-9312cbfa-d05f1ca8-6046ec2f
322	lungs are hyperinflated, consistent with copd . there is cardiomegaly . the patient is status post sternotomy, with prosthetic valve . there is upper zone redistribution and diffuse vascular blurring, consistent with chf . there is a moderate to moderately large left effusion layering along the left chest wall and left apex, with underlying collapse andor consolidation . minimal blunting of the right costophrenic angle is present . there is atelectasis at the right base . there is straightening of the ap window on the left and prominence of the right hilum . this could reflect pulmonary hypertension . a dual lumen right-sided catheter is present, distal tip overlying the right atrium . a slightly displaced left posterolateral third rib fracture again noted, unchanged . this was present on a chest x-ray dated . . continued chf, probably slightly worse compared with . . left pleural fluidthickening, left lower lobe collapse andor consolidation, overall similar .	Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Pleural Effusion	15259244	58869711	995e2d81-54b60cfa-a52c5f7a-4d97f982-645e4731
323	no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is seen . heart and mediastinal contours are within normal limits . posterior right seventh rib fracture is incompletely evaluated due to overlying anterior rib . no radiographic evidence for acute cardiopulmonary process . old right posterior seventh rib fracture . findings discussed with by by telephone at pm . on at the time of discovery of these findings .	Fracture	13866940	52775752	91aa37d1-c2d7d819-bea91a37-602f27c2-ab6984ae
324	et tube in standard placement . nasogastric tube passes into the stomach and out of view . no pneumothorax . leftward mediastinal shift suggests a new opacification at the base of the left lung is atelectasis . the right lung is clear . left jugular line ends at the origin of the svc .	Atelectasis&&Lung Opacity&&Support Devices	10268877	53368667	aebc8b32-83f9db36-e7859808-602b3b39-66bb2765
325	there is a very large hydropneumothorax on the right side . there is compression of the lung parenchyma . there is also some mediastinal shift to the left side . the left lung appears well aerated without focal consolidation, pleural effusions or pneumothoraces . the right base has increased in the size with pleural effusion, however, this may be secondary to patient positioning . there is a pleural-based catheter at the right base .	Pleural Effusion&&Pneumothorax&&Support Devices	14387068	51227270	2001d733-0290af9c-11d2f658-a475b597-45f1095a
326	a frontal semi-upright view of the chest was obtained portably . the endotracheal tube ends at the level of the inferior clavicular heads and is no less than cm above the carina . the nasogastric tube follows the expected course, although the tip is not visualized . low lung volumes result in bronchovascular crowding . new opacification of both lower lobes despite no change in lung volumes compared to the prior study is concerning for pneuomonia . the upper lung zones are clear . there is no large pleural effusion or pneumothorax, although the left lung apex is obscured by the chin . the azygous vein is bigger than before with increased caliber of the left upper lobe vessels . the right hilus is chronically enlarged . cardiac silhouette is stable . flattening of the right humeral head may be due to avascular necrosis . degenerative change is seen in the left shoulder girdle . . endotracheal tube is no less than cm above the carina . given that the patients chin is down on the radiograph, the ett could be advanced -cm for better seating . . bilateral lower lobe opacification, concerning for pneumonia . . mild congestive heart failure .	Cardiomegaly&&Edema&&Lung Opacity&&Pneumonia&&Support Devices	15161734	57523636	6620c86d-6be6ba2b-c1c0beb1-2b89f89b-a0a59da4
327	a portable erect frontal chest radiograph again demonstrates multiple sternal wires, which are intact . heart size remains mildly enlarged . the lungs are fairly well-aerated, without focal consolidation, pleural effusion, or pneumothorax . the visualized upper abdomen is unremarkable . no acute cardiopulmonary process .	No Finding	16957952	50482541	9370636b-c15ba900-6d4fa453-e8725bf7-124cf815
328	pa and lateral views of the chest mild cardiomegaly is unchanged compared to the prior study . aortic knob calcifications are again noted . the mediastinal and hilar contours are stable . previously noted pattern of mild pulmonary vascular congestion has essentially resolved . streaky opacity in the right lung base likely reflects atelectasis . no pleural effusion, focal consolidation or pneumothorax is identified . no acute osseous abnormality is seen . no definite evidence for congestive heart failure . patchy streaky opacity in the right lung base likely reflects atelectasis though infection is difficult to exclude .	Atelectasis&&Lung Opacity	11052273	53537165	f9f7d4af-2d90cb81-2541b729-6aab0e3f-06acb455
329	the heart is normal in size . the aortic arch is calcified . the mediastinal and hilar contours appear unchanged . there is no pleural effusion or pneumothorax . there is a nodular focus projecting over the right lower lung, probably a nipple shadow, although not visualized on prior radiographs . otherwise the lung fields appear clear . . no evidence of acute disease . . newly apparent nodular focus projecting along the right lower lung, probably a nipple shadow, although a pulmonary nodule should be considered . when clinically appropriate, repeat pa view with nipple markers is recommended .	Lung Lesion&&Support Devices	15182529	56993533	c3827619-5b104baa-e1895045-007f9978-837ef55e
330	portable ap upright chest film, at is submitted . . right internal jugular dialysis catheter again having its tip within the right atrium in similar position as compared to multiple prior studies . there is increasing bibasilar and perihilar airspace opacities, which likely reflect worsening moderate pulmonary edema . there are likely layering effusions, left greater than right . diffuse pneumonia would be less likely given the rapidity of interval change . no pneumothorax is seen . overall, cardiac and mediastinal contours are unchanged, with the heart being stably enlarged .	Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	15259244	59671026	87694c3c-e07ea01b-0ee35fd8-55a7defd-8e318d65
331	a right tunneled hemodialysis catheter is unchanged in position with its tip in the right atrium . the heart remains severely enlarged . the lungs are well expanded and clear . there is no pleural effusion, or pneumothorax . the mediastinal contours are normal . severe cardiomegaly is unchanged, there is no edema or acute chest abnormality .	Cardiomegaly	12963531	57210258	5f17fe93-aaa0c148-72ccdc7f-ad2268b1-56572a09
332	lines and tubes right ij line terminates in the svc . lungs well inflated with unchanged bilateral lower zone linear and hazy opacities . pleura small left pleural effusion . no pneumothorax . mediastinum stable cardiomegaly and prominence of hilar vasculature . bony thorax no interval change persistent, unchanged pulmonary edema .	Edema	16508811	53845981	0762369f-af8531f3-09fc45b2-f00d90c9-88e6ff7d
333	new endotracheal tube ends less than cm above the carina and should be withdrawn . cm for optimal placement . moderate cardiomegaly is stable . lung volumes are lower and greater opacification in the left lower lobe is attributable to new atelectasis . no pneumothorax or appreciable pleural effusion . right internal jugular line ends just below the superior cavoatrial junction, as before .	Atelectasis&&Cardiomegaly&&Lung Opacity&&Support Devices	19454978	50916783	a83a9a0b-f3f4d97f-3a796f51-aca87088-8244d6b5
334	there is a swan-ganz catheter whose distal lead tip is in the main pulmonary outflow tract . the cardiac silhouette is enlarged . there is again seen moderate right-sized pleural effusion which is stable . there is some improvement in the pulmonary vascular edema . there are no pneumothoraces identified .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	13135946	56680924	3433048d-a6c5dc75-1a99a0b6-1f89a734-ef0b39b8
335	there is no change or evidence of acute cardiopulmonary disease . no pneumonia, vascular congestion, or pleural effusion .	No Finding	11673948	57018476	9fbe751e-040f98f7-66f9047b-8c7b8554-28250c9c
336	a right internal jugular catheter is in stable position . the heart is enlarged but stable in size . pulmonary vascular congestion mild edema is minimally improved from the prior examination but persists . there is no focal consolidation or pleural effusion identified . mild pulmonary edema, improving from the prior examination on . bibasilar opacities are most consistent with edema however underlying infection should be considered in the appropriate setting .	Edema&&Lung Opacity&&Pneumonia	16508811	59258574	524967a5-136b039a-0f60c1fe-2450be2a-a34378a7
337	previous pulmonary edema has cleared . severe cardiomegaly and dilatation of the hilar and peripheral pulmonary vasculature have improved . pleural effusions are small if any . no pneumothorax . right pic line ends at the origin of the svc .	Cardiomegaly&&Pleural Effusion&&Support Devices	15131736	51943302	312fff58-774c36da-dcef46b3-9256ea6d-7f4495b3
338	there is persistent opacification projecting in the lateral aspect of the right upper lobe demonstrated along the fissure on the lateral view that is mildly improved since . there is associated overlying pleural abnormality relating to healing rib fractures . there are no new areas of focal opacification . there are no pleural effusions or pneumothorax . the cardiomediastinal and hilar contours are stable demonstrating moderate cardiomegaly and tortuosity of thoracic aorta . a large hiatal hernia is unchanged . pulmonary vascularity is not increased . there are extensive rib fractures of varying ages . in addition there is lytic destruction of several right-sided lower thoracic ribs . there is an old left clavicular fracture . there are multiple wedge compression deformities of the thoracolumbar spine grossly stable since . . persistent right upper lobe opacification has only mildly improved since . . multiple rib fractures of varying age and an old left clavicular fracture with lytic destruction of the several right lower thoracic ribs more apparent since .	Fracture&&Lung Opacity	18659631	59284918	af8f292e-eecbb702-9aeef1d2-46861e97-709d3307
339	there has been interval progression of consolidation in the right lung, consistent with worsening of right lung multifocal pneumonia . patient has known collapse of the right middle lobe . multiple spiculated lung nodules in the left lung are better seen in prior ct . opacities in the left lower lobe have minimally increased . small left pleural effusion has increased . right large pleural effusion is probably unchanged, though difficult to evaluate . cardiomediastinal contours are obscured by pleuroparenchymal abnormalities on the right . right picc tip is in the mid svc . there is no evident pneumothorax .	Atelectasis&&Consolidation&&Enlarged Cardiomediastinum&&Lung Lesion&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	13263843	54800318	79fdd45e-7af2a61f-364d419f-be8d7b7e-ddce9027
340	there is unchanged evidence of bilateral pleural effusions . mild interstitial lung edema . moderate cardiomegaly with bilateral areas of atelectasis . no newly occurred focal parenchymal opacity suggesting pneumonia .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia	15109122	58611036	be8079bf-2ab5656d-d2cf6c18-8b9c6ea9-072acfe8
341	comparison is made with prior study performed two hours earlier . pulmonary edema has almost completely resolved . widened mediastinum has improved . et tube tip is . cm above the carina . swan-ganz catheter tip is in the main pulmonary artery . ng tube tip is in the stomach . mediastinal and bilateral chest tubes are in place . there is no pneumothorax or pleural effusion . the fifth sternal wire has slightly changed position, and attention in this area should be paid in followup studies . the other sternal wires are aligned .	Enlarged Cardiomediastinum&&Support Devices	13135946	55409720	3b24f327-81d52457-be771314-08a42897-5e8c9dd8
342	frontal and lateral views of the chest are compared to previous exam from . the lungs remain clear of consolidation or effusion . cardiomediastinal silhouette is unchanged and notable for median sternotomy wires and mediastinal clips . osseous and soft tissue structures are notable for mild height loss at the lower thoracic vertebral body level, unchanged from prior . no acute cardiopulmonary process .	No Finding	16957952	55095340	7958accd-21d0f8fa-0a0f1a50-fbb2ce69-5128a4a4
343	there is little change and no evidence of acute cardiopulmonary disease . the heart is normal in size, and there is no acute pneumonia, vascular congestion, or pleural effusion . the right picc line has been removed and the cervical fusion is again seen .	No Finding&&Support Devices	15114531	59999832	0636d0c0-a771097e-ac0c52a9-9124a5d0-95b0bc51
344	lungs are normally expanded . there is no focal airspace opacity to suggest pneumonia . the heart is mildly enlarged, but unchanged . the mediastinal and hilar contours are stable with tortuosity of the aorta and mild prominence of the pulmonary artery, better seen on prior ct of the chest . small bilateral pleural effusions persist . there is no pneumothorax . compression deformity of t is unchanged . stable small bilateral pleural effusions and mildly enlarged cardiac silhouette similar to prior .	Cardiomegaly&&Pleural Effusion	19454978	59760473	92ed1b87-016202fb-06cb6d9b-524f6193-a2cafa9c
345	previous moderately severe pulmonary edema has improved . severe cardiomegaly and pulmonary artery dilatation are chronic . poor aeration at the base of the left lung is persistent, either atelectasis or pneumonia . pleural effusion is presumed, but not large .	Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Pneumonia	15131736	50494700	36147048-4907c6d9-99ef69b7-c4b50592-a5f2a9cd
346	heterogeneous pulmonary opacification has worsened in both lungs . this is largely pulmonary edema, but more focal abnormalities in the axillary portion of the left lung and at the right lung base could be concurrent pneumonia . in addition, chest radiographs from suggest concurrent substantial interstitial lung disease . mild-to-moderate cardiomegaly is stable . endotracheal tube is no less than cm from the carina, with the chin in neutral position . care must be taken that it not advance inadvertently . a left subclavian infusion port ends in the right atrium . was paged at the time of dictation .	Cardiomegaly&&Edema&&Lung Opacity&&Pneumonia&&Support Devices	10439781	53479699	86d7a0e2-a6e5e874-ed2fed4c-1c2ffbf1-4f1621e3
347	there is substantial decrease in the right pleural effusion . although no clinical evidence is presented, this could be a reflection of interval thoracentesis . no evidence of pneumothorax . the remainder of the study is essentially unchanged .	Pleural Effusion	13263843	51947296	92d470e7-32490114-834a55ac-2baa551a-40bfb365
348	pa and lateral views of the chest the cardiac silhouette size is normal . the mediastinal and hilar contours are unremarkable . hyperinflation of lungs with emphysematous changes , most pronounced within the lung apices is again demonstrated . ill-defined patchy opacity within the right lower lobe appears slightly improved when compared to the prior study, but persists . additionally, continued patchy ill-defined opacity within the left lower lobe is not significantly changed in the interval . no pleural effusion or pneumothorax is identified . there is no pulmonary vascular engorgement . scarring within the left upper lobe is stable . there is no pneumothorax . multilevel degenerative changes of the thoracic spine are redemonstrated . slight interval improvement in ill-defined patchy opacity within the right lower lobe likely representing pneumonia . patchy opacity in the left lower lobe may be reflective of atelectasis, though infection in this region also cannot be excluded, but appears relatively unchanged compared to the prior study .	Atelectasis&&Lung Opacity&&Pneumonia	11052935	53884408	50ca584b-f859bda7-fd523d01-28a67cc1-ac2b5c55
349	comparison is made with the next preceding similar study obtained four hours earlier during the same day . the previously described right-sided chest tube remains in unchanged position . no pneumothorax has developed and there is no evidence of significantly increased pleural densities during this interval . the right-sided chest wall emphysema described earlier has regressed . no new abnormalities are seen . left-sided hemithorax is unremarkable .	Support Devices	19991135	59381316	d122eb74-bc404dd2-45a05cd3-18505b72-5058fbdd
350	lung volumes are low . linear horizontal scarring in the right middle lobe is unchanged since . mild cardiomegaly is unchanged . no new consolidation, effusion or pneumothorax is present . no acute cardiopulmonary process . discussed with dr phone at .	No Finding	17147859	55301691	d8f6df8b-a89ccea2-63bada22-1566fcf0-126ceeb7
351	comparison is made to the prior study from . there are chest tubes with the distal tips at the right base and right apex . the previously seen pigtail catheter at the right base has been removed . there is a persistent moderate-sized right pleural effusion . no pneumothoraces are seen . there are low lung volumes . cardiac silhouette is within normal limits .	Pleural Effusion&&Support Devices	13352405	59616378	ad2bd086-921f17c8-b1dd649c-09b63b13-1c0ae6e7
352	in comparison with the study of earlier in this date, there is little change in the diffuse bilateral pulmonary opacities with prominent right and probably small left effusion . the endotracheal tube remains in position .	Lung Opacity&&Pleural Effusion&&Support Devices	13964474	56999137	171e85cb-282b0f3f-e2cb30e8-b7aaa1ca-3e4422d5
353	there are small-to-moderate bilateral pleural effusions with overlying atelectasis . mild-to-moderate interstitial edema is also seen . no evidence of pneumothorax is seen . there is minimal biapical pleural thickening . accurate assessment of the cardiac silhouette size is difficult due to the bilateral pleural effusions . small-to-moderate bilateral pleural effusions with overlying atelectasis along with interstitial edema consistent with fluid overload .	Atelectasis&&Edema&&Pleural Effusion	13881772	56217980	430828eb-7dec0d0c-7b255eae-3baecf25-4a61cddb
354	bilateral interstitial opacities likely represent interstitial edema . there is no new focal consolidation, pleural effusion, or pneumothorax . cardiomegaly persists . the mediastinal and hilar contours are unchanged . leftward scoliosis of the thoracic size stable . cardiomegaly and interstitial opacities, likely due to interstitial edema . if the diagnosis is in doubt clinically, followup radiographs after diuresis may be helpful to exclude the possibility of an atypical interstitial pneumonia .	Cardiomegaly&&Edema&&Lung Opacity&&Pneumonia	13475033	59862902	02ed59f0-43d0aa6f-4bf3340b-c891b4b8-42ea5f9b
355	cardiomediastinal contours appear unchanged from . patient is status post right upper thoracoplasty with rib resections . left lung shows no focal consolidation . pulmonary edema is improved since the prior exam . improved pulmonary edema .	Edema	13263843	59488278	2490c254-7417637a-6aa79f1e-ce072f64-173c1e05
356	the patient is status post median sternotomy and aortic valve replacement . a right internal jugular central venous catheter is unchanged in position with the tip terminating in the low svc . a small caliber left ij line is also noted . the lung volumes are slightly decreased . there is slight elevation of the left hemidiaphragm compared to the right . the cardiac silhouette remains enlarged but stable . the mediastinal contours are prominent postoperatively . there is mild calcification of the aortic knob . mild to moderate pulmonary edema is increased from the most recent prior study . there is increased streaky opacification at the right lung base compared to the most recent prior study . in the absence of aspiration, this most likely reflects atelectasis . mild opacification of the left lung base is unchanged and compatible with mild atelectasis . no significant pleural effusion or pneumothorax is detected . . mild to moderate pulmonary edema, increased from . . small right pleural effusion and bibasilar atelectasis on the right greater than the left .	Atelectasis&&Edema&&Pleural Effusion	19182863	58365706	eec556a6-1c46381e-1b9492b9-f747e8ec-048b888a
357	there is mild cardiomegaly and moderate pulmonary edema as well as small right greater than left pleural effusions . no pneumothorax . severe degenerative changes at the right glenohumeral joint . moderate pulmonary edema .	Edema	19715857	50848970	c8cfc832-b771f3f4-0862618d-c5b40b2a-86706006
358	pa and lateral views of the chest are obtained . there is mild atelectasis at the left lung base . the previously seen endotracheal tube and nasogastric tube are no longer present on this study . there is no evidence of pneumonia, pleural effusion or pulmonary edema . the cardiomediastinal silhouette is unremarkable . conclusion no acute cardiopulmonary disease . mild atelectasis of the left lung base .	Atelectasis	13700088	58916510	6f76af94-e325cbe7-266c1d35-9c931f0e-e0a1a2b5
359	current study demonstrates enlarged heart, replaced aortic valve and substantial mitral annulus calcifications, unchanged since the prior study . cardiomegaly is unchanged . there is diffuse interstitial opacities as well as engorgement of azygos vein as well as bilateral small pleural effusions, findings most likely consistent with interstitial pulmonary edema . an additional left lower lobe pneumonia is a possibility and potentially other areas of infection are present obscured by the interstitial pulmonary edema .	Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	19759491	51878257	c91e9a5a-31b9ea3e-ec8615ca-48493c7e-d9e9b82e
360	a right internal jugular hemodialysis catheter ends in the low svc . sternotomy wires and mediastinal clips are seen . bilateral layering pleural effusions are unchanged . no pneumothorax . moderate cardiomegaly is stable . bibasilar atelectasis . there is decreased interstitial edema and pulmonary vascular congestion . . stable bilateral layering pleural effusions . decreased pulmonary edema . . no evidence for pneumonia or active or nonactive tuberculosis .	Edema&&Pleural Effusion	16360107	57166957	9e0b006b-70cbcb07-0aaf5bd7-5faf6256-c93f4008
361	transvenous right atrial and right ventricular pacer leads appear in standard placement . cardiomediastinal silhouette remains mildly enlarged but stable . the aorta appears somewhat tortuous with atherosclerotic calcifications . the lungs are clear with no evidence of consolidation, effusion, or pneumothorax . median sternotomy wires appear aligned and intact . no acute fractures are identified . mild bilateral acromio-clavicular degenerative changes are noted . no acute cardiopulmonary process . stable mild cardiomegaly .	Cardiomegaly	15144601	55421522	d918062a-d0a7bedc-45270789-08ad2dec-e2c2ca87
362	single portable ap view of the chest is compared to previous exam from . the lungs are clear of focal consolidation . there is, however, persistent blunting of the right costophrenic angle, potentially due to pleural thickening especially in the setting of multiple prior healed right rib fractures . cardiomediastinal silhouette is stable . no visualized free air below the diaphragm . no acute cardiopulmonary process . no visualized free air .	No Finding	12136799	50323020	234b22c4-55fb91a9-44f7a42f-b764d462-018d3bb9
363	cardiac silhouette is markedly enlarged, but stable in size, with indwelling right atrial and right ventricular pacing leads unchanged in position . the lungs are well expanded and grossly clear except for a small calcified granuloma at the left lung apex . there are no pleural effusions or acute skeletal findings . stable marked cardiomegaly without evidence of pulmonary edema .	Cardiomegaly	13762730	54472974	0ff0bb39-4a3b9b22-0150d88d-040cd9e6-c1d6078b
364	patient status post coronary artery bypass graft . median sternotomy wires are intact . numerous surgical clips project over the mediastinum and around the heart . the heart is not enlarged . mediastinal hilar contours are normal . calcification and tortuosity of the thoracic aorta is re- demonstrated . there is no pleural effusion or pneumothorax . there is no pulmonary edema . the lungs are hyperexpanded with flattening of the hemidiaphragms as before . . left basilar opacity is resolved . . copd .	Lung Opacity	17962324	50935375	41df0913-e1804610-248fbdd1-6c00cbe1-01bebf5e
365	one portable ap upright view of the chest . low lung volumes . mild left basilar atelectasis . right lung is clear . no vascular congestion or pulmonary edema . no pneumothorax . moderate cardiomegaly . no evidence of pneumonia . no pleural effusion . . mild left basilar atelectasis . . moderate cardiomegaly . no vascular congestion or pulmonary edema .	Atelectasis&&Cardiomegaly	17533771	56679657	135f75db-12a94b0c-6c6aab28-36eee09d-648f5827
366	there relatively low lung volumes . there is increased opacity projecting over the right hemi thorax likely due to increased right pleural effusion with overlying atelectasis, underlying infectious process not excluded . possible trace left pleural effusion . the cardiac silhouette is top-normal to mildly enlarged . mediastinal contours are unremarkable . no pneumothorax is seen . increased opacity projecting over the right hemi thorax likely due to increased right pleural effusion with overlying atelectasis, underlying infectious process not excluded .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Pneumonia	10959054	53881360	32ec8188-8c334483-81cb6b13-428e8019-c0db3517
367	right hilar and perihilar opacification appears unchanged and suggests a site of treated malignancy . the cardiac, mediastinal and hilar contours appear unchanged . the lungs appear otherwise clear . there are no pleural effusions or pneumothorax . stable appearance of the chest no evidence of a superimposed acute process .	No Finding	12433541	50247294	7e530d0e-05f64408-24c921b8-1929b8f8-29ec99fd
368	there has been interval increase in the pulmonary edema, greater on the right than on the left . there are bilateral small pleural effusions with compressive atelectasis . there is stable widening of the mediastinum . a right chest tube is seen and unchanged from the prior exams . there are multiple overlying wires . the cardiomediastinal silhouette is unchanged . . worsening of the patients pulmonary edema, more severe on the right than on the left . . bibasilar pleural effusions with compressive atelectasis .	Atelectasis&&Edema&&Pleural Effusion	16848073	51339993	3d99ed96-dc2263d9-e1073168-b827579b-63b897ec
369	streaky linear opacities are again seen in the mid-to-upper lungs in an unchanged pattern suggestive of scarringfibrosis . no new consolidation, effusion, pneumothorax . cardiomediastinal silhouette appears normal . bony structures are intact . no free air below the right hemidiaphragm . no acute findings . stable scarring in the bilateral mid-to-upper lungs .	Lung Opacity	14147787	57886251	eca4fc13-1e4006db-4372cf2e-ed001e18-a7050d3e
370	there has been slight clearing of the aspiration pneumonia since the prior chest x-ray of . no new foci are present .	No Finding	10933609	53512860	3e25d193-509147d7-b305908a-51e0da17-7cb23fda
371	compared to chest radiographs . subsegmental atelectasis in the right middle lobe is new and could be due to bronchial narrowing from bronchitis . severe cardiomegaly is chronic, but there is no pulmonary or mediastinal vascular congestion and no pleural effusion .	Atelectasis&&Cardiomegaly	17147859	52321096	e8a8bd48-feafd477-16f9cfa0-575478d2-bc2c5cbb
372	low lung volumes are present which accentuate the size of the cardiac silhouette which is mildly enlarged . the mediastinal and hilar contours are unremarkable . ill-defined somewhat nodular opacities are noted within the upper lobes bilaterally, more pronounced on the left, similar to that seen on the prior ct . known smaller nodules within the lower lobes bilaterally are better assessed on prior ct . minimal atelectasis is seen at the left lung base . no pleural effusion, focal consolidation or pneumothorax is identified . multiple clips are noted within the left upper abdomen compatible with prior nephrectomy . no acute osseous abnormalities demonstrated . ill-defined nodular opacities within the upper lobes, more pronounced on the left, are similar compared to the prior ct, and again may reflect a drug related pneumonitis . no focal consolidation identified . minimal atelectasis in the left lung base .	Atelectasis&&Lung Lesion&&Lung Opacity	14794396	58369249	4fe5756d-bd504c0e-ec57e8bd-d9d21f15-a2cd65f3
373	previous mild but asymmetric pulmonary edema continues to improve . the residual opacification in the right upper lobe raises concern for pneumonia . heart size is normal . there is no pleural effusion .	Edema&&Lung Opacity&&Pneumonia	10933609	56267214	dc460b17-20bafc45-b91e6c92-311eb0ad-7ea1a883
374	comparison to prior study dated at . . persistent consolidation in the right middle lobe which likely reflects post-obstructive pneumonia . more patchy opacity at the left base represents patchy atelectasis, although aspiration or pneumonia in this vicinity should also be considered . no evidence of pulmonary edema . a right hilar and right paratracheal soft tissue opacity represents lymphadenopathy when correlated with ct images of . no pneumothorax . no acute bony abnormality appreciated . overall cardiac size is likely stable .	Atelectasis&&Cardiomegaly&&Consolidation&&Lung Opacity&&Pneumonia	15204620	56397547	e4ecf4d9-5ce7b0e1-e325db2b-85ecca33-c69c8031
375	there is redemonstration of a right pleural catheter, with its tip projecting over the posterior pleural space . a moderate loculated right pleural effusion is slightly increased in size compared to the most recent radiograph from . heterogeneous opacities in the right mid to lower lung are slightly increased, possibly partially due to overlying pleural fluid, although atelectasis or infection in this region is certainly possible . there is borderline pulmonary edema . mild cardiomegaly is not significantly changed . there is no definite left pleural effusion . no pneumothorax is seen . there is evidence of central adenopathy, increased compared to prior radiographs from . . increased moderate right loculated pleural effusion . unchanged positioning of a right pleural catheter . . slight increase in right mid to lower lung heterogeneous opacities, likely partially due to increased pleural fluid, although atelectasis or infection in this region is certainly possible . . borderline pulmonary edema . . unchanged mild cardiomegaly . . increased central adenopathy compared to prior radiographs from . further evaluation could be performed with ct, if clinically indicated . findings and recommendations were discussed with dr . by dr . via telephone on the day of the study .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	16826047	57424140	2d93fd96-9b0fecad-1fdab811-37caf33a-3874a948
376	on the current exam, there is no evidence of confluent consolidation . linear opacities at the left lung base most suggestive of scarring . icreased interstitial markings are seen compatible chronic underlying lung disease, not significantly changed since . trace bilateral effusions . cardiac silhouette is enlarged and also notable for a prosthetic aortic valve . no acute osseous abnormality detected . chronic lung disease without definite superimposed acute process .	No Finding	13606683	58568223	a3a06d4a-738a23e2-049e6887-d1e5cc2f-c1573666
377	there are relatively low lung volumes . mild elevation of the right hemidiaphragm is unchanged . there has been interval removal of endotracheal and nasogastric tubes . there is pulmonary vascular congestion . no large pleural effusions are seen, although a trace effusion on the left would be difficult to exclude . no pneumothorax is seen . the cardiac silhouette remains enlarged . pulmonary vascular congestion with persistent enlargement of the cardiac silhouette . no large pleural effusion is seen, although a small left pleural effusion would be difficult to exclude .	Cardiomegaly&&Edema	15131736	51229977	4ffa9df0-24b7231c-3f67bde1-d9698406-f27658a3
378	left-sided dual-chamber pacemaker device is noted with leads terminating in the right atrium and right ventricle, unchanged . mild enlargement of the cardiac silhouette is similar . the aorta remains tortuous and diffusely calcified . pulmonary vasculature is not engorged, and hilar contours are unchanged . lungs are hyperinflated with emphysematous changes again noted in the upper lobes . scarring in the lung apices is similar . no focal consolidation, pleural effusion or pneumothorax is detected . clips are seen in the right upper quadrant of the abdomen . there are no acute osseous abnormalities . emphysema . no acute cardiopulmonary abnormality .	No Finding	18929056	54328164	f562ddad-3fb08dd0-f299d5c8-61447a92-3111dfa5
379	the lung volumes are low and there is chronic lung disease, which is relatively unchanged since . no new focal opacities are seen compared to the chest radiograph however, right upper lobe consolidation is unchanged and may represent old pneumonia . there is no pleural effusion or pneumothorax . the heart and mediastinal contours are normal . no new focal opacities are seen . right upper lobe consolidation was present on and could represent an old pneumonia or chronic changes . the lung volumes remain low . comment discussed with .	Consolidation&&Lung Opacity&&Pneumonia	10933609	59243134	bb067a71-304abf94-bb1611d4-e8ac9115-189005f3
380	left sided dual lumen catheter tip terminates within the proximal right atrium, unchanged . mild to moderate cardiomegaly is similar . the aorta remains tortuous and diffusely calcified . mild pulmonary edema is unchanged compared to the prior study . there is likely a small right pleural effusion, without evidence for pneumothorax . no acute osseous abnormalities detected . mild pulmonary edema, not significantly changed from the prior exam with trace right pleural effusion .	Edema&&Pleural Effusion	17340686	54477721	56b0777b-ec731ed4-e7b2af82-7cedbe31-65605bf9
381	portable ap chest radiograph cardiac, mediastinal and hilar contours are unchanged from . bilateral low lung volumes are noted with mild crowding of bronchovascular markings . indistinct pulmonary vascular markings suggestive of mild fluid overload pattern are again noted . trace left pleural effusion cannot be completely excluded . cardiac silhouette is enlarged but stable .	Edema&&Pleural Effusion	16855430	53405597	1b6de453-c29f3bea-062b74e0-18018703-0456f192
382	moderate cardiomegaly is stable . mild-to-moderate pulmonary edema has improved . right lower lobe aeration has improved . left lower lobe opacities have minimally improved, consistent with atelectasis, edema and pleural effusion . enlargement of the pulmonary arteries is again noted . et tube is in standard position . ng tube tip is out of view below the diaphragm . left ij catheter tip is in the upper-to-mid svc .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	10268877	51051449	c32a83d9-d6134d67-b859a63c-c8d7c7a5-588358e3
383	tip of intra-aortic balloon pump terminates about cm below the superior aspect of the aortic knob, and a swan-ganz catheter continues to terminate in the region of the distal right interlobar pulmonary artery . other indwelling devices are in standard and unchanged position . persistent cardiomegaly accompanied by pulmonary vascular congestion and improving asymmetrical pulmonary edema . bilateral pleural effusions have also decreased in size . apparent moderate elevation of left hemidiaphragm could potentially represent a subpulmonic component of left pleural effusion . consider a left lateral decubitus radiograph if warranted clinically .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	13606683	51871239	b9ebeb06-2f7bc1bd-93527eb7-36325430-6bd74fce
384	an endotracheal tube is in appropriate position with the tip terminating mm above the carina . a left-sided picc line is unchanged in position with the tip projecting over the cavoatrial junction . a right internal jugular large-bore central catheter is unchanged in position with the tip terminating in the right atrium . an og tube is in appropriate position . bilateral pleural pigtail catheters are unchanged in position in the lower lobes . increased opacification in the left lower lobe could be a combination of left-sided pleural effusion with associated atelectasis or in the appropriate clinical setting, focal consolidation . a small right-sided pleural effusion is stable with persistent opacity in the peripheral right lower lobe most likely atelectasis . the patient is status post median sternotomy with an atrial valve prosthesis consistent with bentall procedure . the mediastinal contours are stable . the cardiac silhouette is severely enlarged with an apparent gradual increase in size from prior studies which is concerning for pericardial effusion . increased opacification of the left lower lobe is most likely a small left-sided pleural effusion with associated atelectasis in this postoperative patient . stable small right-sided pleural effusion with associated atelectasis . increased size of enlarged cardiac silhouette over multiple priors and when compared to baseline raises the possibility of pericardial effusion . findings were communicated by dr . to of cardiac surgery by phone at pm on .	Atelectasis&&Cardiomegaly&&Lung Opacity&&Pleural Effusion	15259244	58966181	438f1b70-14b9e3c9-bd4e7c92-e6463ffc-e5aec56d
385	there is continued enlargement of the cardiac silhouette with vascular congestion and large pleural effusions, more prominent on the left with underlying substantial compressive atelectasis . dual-channel dialysis catheter remains in place . there has been insertion of a left subclavian catheter . the tip of this is difficult to evaluate because it is superimposed on the dialysis catheter . it definitely extends at least to the lower portion of the svc . to more precisely demonstrate the tip of this catheter, oblique views would be necessary .	Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	15259244	54865295	2f01c6ef-54b9b5f8-0f452502-c6cd3871-48a2c872
386	post-sternotomy wires are unchanged including two upper broken sternal wires . left mediastinal shift is persistent, expected . surgical fracture of the left sixth rib related to lobectomy is redemonstrated . lung is well aerated . there is no pleural effusion or pneumothorax . right lung is unremarkable . satisfactory appearance after surgery .	No Finding	11378150	54147285	28905df6-b5221808-9da88146-e62944a2-7fb81888
387	a dobbhoff tube ends into the stomach however, coiled in the mid esophagus . right internal jugular sheath tip is at upper svc . there is evidence of prior median sternotomy for mitral valve replacement and tricuspid valvuloplasty . allowing for differences in technique, mild-to-moderate right pleural effusion has minimally increased, while moderate left pleural effusion with complaining left lower lung atelectasis is unchanged over last hours . very mild pulmonary vascular congestion is unchanged . post-operative cardiomediastinal silhouette has an expected post-op appearance and stable . there is no pneumothorax . the findings regarding dobbhoff tube was already communicated by dr . with by phone at pm .	Atelectasis&&Edema&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	18224196	58314226	4fbab26c-0355ac52-0e5488f4-490701fc-88f483cf
388	the right dialysis catheter has been removed . the left ij line with tip in the svc is unchanged . ng tube has been removed . there continues to be moderate cardiomegaly and opacity projecting over the left mid lung that could represent loculated effusion . there is a small left effusion seen obscuring the left cp angle that is increased compared to prior and there is bibasilar volume loss .	Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Support Devices	18906643	52874765	2e8c5b5c-9271aa86-6e8f8585-b9dde222-7db00264
389	there is continued substantial pulmonary edema with bilateral effusions and compressive atelectasis in a patient with previous cabg and dual-channel pacemaker device in place .	Atelectasis&&Edema&&Pleural Effusion&&Support Devices	18615099	54992879	b74e11fc-805d197f-bbcb7e01-986abcbe-6152c60b
390	there are changes related to emphysema . there is superimposed mild interstitial pulmonary edema and small bilateral effusions with bibasilar atelectasis . there are no new focally occurring opacities concerning for pneumonia . there is no pneumothorax . the cardiomediastinal and hilar contours are stable demonstrating marked cardiomegaly . there is tortuosity of the thoracic aorta, which contains atherosclerotic calcification . mild interstitial pulmonary edema .	Edema	15186992	59749696	4ce9e5bc-91147696-d0c4b6cd-fc5ffa18-c485b700
391	new endotracheal tube is in standard placement . feeding tube passes into the stomach and out of view as before . right pic line ends in the mid-to-low svc . bibasilar atelectasis moderate-to-severe on the left, mild on the right, unchanged . previous mild pulmonary edema has resolved over the past three hours, but there has been an increase in the small-to-moderate left pleural effusion . heart size is normal . mediastinal vasculature is not dilated .	Atelectasis&&Pleural Effusion&&Support Devices	13031876	50510286	ff2efa2a-247e7e02-2a1deddd-82479afe-136446a9
392	there is severe extremely irregular opacifications of both lungs, more severe on the right, has improved since at , . the nodular appearance of the lungs is probably due to severe peribronchial infiltration in the setting of emphysema . the interval improvement is more likely due to resolution of a component of pulmonary edema . small left pleural effusion is presumed, but not significant . there is no pneumothorax . heart is partially obscured and its size is indeterminate . transvenous right atrial and ventricular pacer defibrillator leads follow their expected courses . no pneumothorax .	Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	12475198	53378145	ba5b5b5f-13d50976-7e931ab9-b5cae769-76a2d17e
393	the ng tube tip passes below the diaphragm, terminating in the stomach . the heart size and mediastinum are grossly unchanged . note is made that the head is obscuring upper chest . minimal left basal opacity is unchanged as well .	Cardiomegaly&&Enlarged Cardiomediastinum&&Lung Opacity&&Support Devices	15438386	55060674	5f7fabe4-ef89e705-401654db-7da95115-a824cf01
394	portable ap radiograph of the chest was reviewed in comparison to prior study obtained the same day earlier . the dobbhoff tube passes below the diaphragm with its tip being at least at the distal stomach . right upper abdomen drain is in place . the right internal jugular line tip is at the level of superior svc . the left internal jugular line crosses the midline with its tip continuing towards the right brachiocephalic vein and should be repositioned .	No Finding&&Support Devices	19623993	52709220	6105c9cd-e224ad35-761201b7-d737ed68-59c229d9
395	the heart is of normal size with normal cardiomediastinal contours . left perihilar opacity is again seen, compatible with known mass and parenchymal scarring as seen on ct . a small left pleural effusion is present . no pneumothorax . leads of a left chest wall pacer terminate in the right atrium and right ventricle . the osseous structures are unremarkable . no appreciable change since , allowing for difference in modality . left perihilar opacity, compatible with known mass and scarring . small left pleural effusion .	Lung Lesion&&Lung Opacity&&Pleural Effusion	18067737	58327706	b973beee-a64f055b-a96181c0-05105bc5-25dcc796
396	enteric tube is seen coursing below the level of the diaphragm, coiling in the stomach . there has been interval placement of an endotracheal tube, terminating approximately cm above the level of the carina . a left-sided internal jugular central venous catheter has also been placed in the interval, terminating in the proximal svc . there has been interval development of left lower lobe atelectasis with possible effusion . there is also increase in perihilar opacity suggesting pulmonary edema . scattered areas of linear opacity again seen due to scarringatelectasis . the cardiac and mediastinal silhouettes are grossly stable . again, the patient is status post median sternotomy and cabg . . endotracheal and enteric tubes in appropriate position . . interval placement of a left-sided ij central venous catheter terminating in the proximal svc without evidence of pneumothorax . . interval development of left base opacity, likely combination of left lower lobe collapse and pleural effusion . increased perihilar opacities suggest pulmonary edema .	Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	16334516	53653168	c9028d9d-b5be82c7-94f4e115-fcd0cbb2-bdc86018
397	mild cardiomegaly is new, but there is no pulmonary edema or pleural effusion . aside from mild left infrahilar atelectasis, lungs are clear and there is no pleural effusion or pneumothorax . left upper quadrant drain in place .	Cardiomegaly&&Support Devices	17962324	58141612	b5f871d3-8702f640-44c08eed-e1b45081-74211f61
398	single frontal portable view of the chest . endotracheal tube terminates . cm above the carina . the side port of a nasogastric tube is below the diaphragm . pulmonary vasculature is ill-defined, compatible with severe pulmonary edema . hazy opacity overlying both lungs and blunting of the costophrenic angles are compatible with bilateral pleural effusions . no lobar consolidation or pneumothorax . mild cardiomegaly is similar to prior . leads of a left chest wall pacer terminates in the right atrium and ventricle . median sternotomy wires and numerous mediastinal clips are intact . severe pulmonary edema with bilateral pleural effusions .	Edema&&Pleural Effusion	18615099	56961814	61ae8e67-88ced0e9-c454f0c6-1cb71dd6-26e77a9e
399	this examination was centered in the thoracoabdominal region . the ng tube tip is in the stomach . when compared to prior study , small bilateral effusions larger on the left side have decreased . pulmonary edema has resolved . bibasilar atelectases, larger on the right side, have improved on the left . cardiomediastinal contours are unchanged . left picc tip is in the svc . of note, the apices of the lungs were not included in this examination .	Atelectasis&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	13979643	57130836	2c418fdf-dbd4bdb4-f0a46833-6fd3f24f-a1fb71de
400	there are substantially lower lung volumes . the tip of the nasogastric tube is in the upper stomach with the side hole probably just above the gastroesophageal junction . the tube could easily be pushed forward about cm . low lung volumes may account for much of the prominence of the transverse diameter of the heart and fullness of pulmonary vessels, though some elevation of pulmonary venous pressure could well be present . some atelectatic changes are seen in the retrocardiac region . no change in the appearance of the cervical fusion . metallic anchors are seen about the right shoulder .	Atelectasis&&Cardiomegaly&&Support Devices	13031876	51631521	e16a3994-29f6fa7c-062b1eb7-a8c902f3-83a49faa
401	multilevel degenerative changes in the thoracic spine . interval fracture of the right humeral surgical neck, with an overriding fracture fragment . this appears subacute, with partially corticated margins .	Cardiomegaly&&Fracture&&Pleural Other	12110863	59358922	fba838cc-fa4eb8b6-b3e8de64-e89c00ab-1bb9216a
402	since the prior exam, there is increased opacity at the right lung base which could represent a combination of atelectasis and effusion, though underlying pneumonia is difficult to exclude in the correct clinical setting . lung volumes and evaluation for mild pulmonary edema is limited . there is no overt edema . no pneumothorax is seen . bony structures appear intact . increased opacity at the right lung base, likely a combination of effusion and atelectasis, though underlying pneumonia difficult to exclude .	Atelectasis&&Lung Opacity&&Pleural Effusion	19844485	53504804	5b433593-d02544b5-225e12eb-2d963391-108a1692
403	patient rotation slightly limits assessment . endotracheal tube tip terminates approximately cm from the carina . enteric tube is seen coursing through the stomach with side port in the stomach, and tip off the inferior borders of the film . the patient is status post median sternotomy and cabg . left-sided aicd lead terminates in the right ventricle . there is moderate enlargement of cardiac silhouette . mild pulmonary vascular congestion is present . no focal consolidation, pleural effusion or pneumothorax is present . . endotracheal tube and enteric tubes in standard positions . . mild pulmonary vascular congestion .	Edema&&Support Devices	11540283	51114398	ff4180bc-fa800289-1e6a39c6-4c38b356-ad513e6a
404	right ij line extends into the mid svc . median sternotomy wires are in unchanged alignment . there are small bilateral pleural effusions, greater on the left, which are little changed . however, vascular congestion and pulmonary edema has decreased . hilar and cardiomediastinal contours are unchanged . no pneumothorax or new opacity to suggest pneumonia .	Edema&&Pleural Effusion	15272972	52062769	78de0f59-b436260e-9d46d449-56c7de3b-ff3655cd
405	the patient is intubated . the tip of the endotracheal tube projects approximately cm above the carina . the patient also has a nasogastric tube, the tube could be slightly advanced, given that the sidehole is at the level of the gastroesophageal junction . no evidence of complications, notably no pneumothorax . as compared to the previous image, the size of the cardiac silhouette remains moderately enlarged and signs of mild-to-moderate pulmonary edema are seen . a right and left pleural effusion with subsequent areas of atelectasis has newly developed . no other parenchymal changes .	Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Pneumothorax&&Support Devices	15393401	52258598	b50c5a50-2713d6bf-b6a084a7-d2b96375-54cc29d2
406	compared to chest radiographs since , most recently . lungs are well expanded and clear . cardiomediastinal and hilar silhouettes and pleural surfaces are normal . stabilization hardware projects over the lower cervical spine, along with vascular clips .	No Finding&&Support Devices	15114531	51865597	ea89b622-63cd1a03-7338ee75-9ccef395-57d58bdc
407	portable semi-erect frontal chest radiograph lung volumes are low resulting in bronchovascular crowding . there is mild pulmonary vascular congestion, though no overt interstitial edema . no confluent consolidation is identified . there is no pneumothorax . cardiomediastinal and hilar contours are within normal limits . mild cardiomegaly is unchanged from prior . median sternotomy wires from prior cabg appear grossly intact on this frontal chest radiograph . . mild pulmonary vascular congestion, though no overt interstitial edema . unchanged mild cardiomegal .	Cardiomegaly&&Edema	17318449	54808796	a13f355f-dafd65c3-ab50b75f-03d32b03-0a659e44
408	there are bilateral pigtail catheters at the bases . there has been a substantial decrease in effusion on the right with reexpansion of the lung . on the left, there has been no decrease in effusion with increased amount of opacification along the left lateral chest wall . some of this may represent loculated rather than free effusions . monitoring and support devices remain in place, and there is again evidence of vascular congestion and cardiomegaly .	Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	15259244	58685714	ecc315d7-39f7e590-405c1a1f-5a8f026d-560ba339
409	a bedside ap radiograph of the chest demonstrates interval clearance of the large right pleural effusion with diffuse opacification of the right middle and lower lobes, likely secondary to re-expansion atelectasis . there is now a new small left pleural effusion which was not present four days ago . there is no pneumothorax . cardiomegaly is stable . interval widening of the upper mediastinal silhouette secondary to central venous engorgement is suggestive of hypervolemia . there is no pulmonary edema . a right chest wall central venous catheter is appropriately positioned in the lower svc . the right chest tube is also appropriately positioned, in the right lower pleural space, including the side port . . the chest tube is appropriately positioned and there is no pneumothorax . . interval clearance of large right pleural effusion with re-expansion atelectasis of the right middle and lower lobes . . new small left pleural effusion not present on the prior study . . findings suggestive of mild hypervolemia .	Atelectasis&&Pleural Effusion&&Support Devices	16826047	51777321	8b71881c-c896b1ec-9e6c08d8-6f61075a-c98e7454
410	the heart remains enlarged . the aorta is markedly tortuous . increased interstitial markings are seen throughout the lungs, similar to prior, and most compatible with edema . no pneumothorax or consolidation or pleural effusion . there is diffuse demineralization . incidental note is made of a right cervical rib . sternotomy sutures project over the mediastinum . ekg leads overlie the chest wall . . mild pulmonary edema . . no pneumonia .	Edema	16957952	59684377	cc94c95e-0ab572e9-4530d0e6-f22f983e-4b10755a
411	new right-sided port-a-cath terminates near the cavoatrial junction . left pectoral pacemaker with dual leads seen extending into in the region of the right atrium and right ventricle . median sternotomy wires and prosthetic cardiac valve are noted . there is no focal consolidation, effusion, or pneumothorax . the cardiomediastinal silhouette is top normal . no acute cardiopulmonary process .	No Finding	16043637	58576963	37281a6b-d40f025d-51681f11-e078aa8f-3c6452d2
412	as compared to the previous examination, the left central venous access line has been removed . there is a marked increase in interstitial markings and increase in vascular diameters . increasing retrocardiac atelectasis and likely new left pleural effusion . overall, moderate predominantly interstitial pulmonary edema is present . no other relevant changes . at the time of dictation, pm, the referring physician, . was notified by telephone and the findings were discussed on .	Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion	16772702	52474242	8d88d859-5ae2eefd-3af51dce-25f4fd2d-15e047c7
413	mild pulmonary edema has improved since . atelectasis in the left mid and lower lung zones is severe and unchanged . pleural effusions are small if any . the heart is top normal size . mediastinal veins are mildly dilated . feeding tube and nasogastric tube passes into the stomach and out of view . left internal jugular line ends at the junction of brachiocephalic veins, but is pointed upward towards the right brachiocephalic vein, crossing the right internal jugular line which ends in the upper svc . no pneumothorax .	Atelectasis&&Edema&&Pleural Effusion&&Support Devices	19623993	57199757	50c4c252-0054801a-aa949595-362953d3-23b18e2e
414	the ett is cm above the carina . there is a right ij swan-ganz catheter with tip in the right main pulmonary artery . the ng tube tip is in the stomach . there are bilateral pleural effusions and bilateral lower lobe volume loss there is a dense left upper lobe infiltrate . heart size is moderately enlarged . there is pulmonary vascular redistribution with ill-defined vascularity .	Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Support Devices	14851532	53391606	cb0066e2-7af933a5-97947108-f34228af-7b0bf717
415	no focal consolidation, pleural effusion, or pneumothorax is seen . heart size is top normal . pacing leads appear to be similarly positioned compared to prior . there is no evidence for pulmonary edema . multiple prior right rib fractures are seen the th rib fracture demonstrates persist linear lucency, raising the possibility of incomplete healing . sternal wires appear intact . . no radiographic evidence for acute cardiopulmonary process . . possible delayed healing of the right th rib fracture . correlation for pain at this location is recommended . discussed with dr . by dr . by phone at am .	Fracture	18487334	53377112	1d5931ea-ae06916c-5082d79e-ce203e51-6581ddc9
416	pulmonary vascular congestion is mild, but persistent . relative enlargement of the cardiac silhouette compared to suggests some increase in moderate cardiomegaly andor pericardial effusion . if there is pericardial effusion it is probably not hemodynamically significant but that determination would require echocardiography . small right pleural effusion which increased between and is stable . a left pleural abnormality could be due to a combination of pleural thickening and small effusion, is unchanged since . transvenous right ventricular pacer lead is unchanged in position, tip projecting over the floor of the right ventricle close to the anticipated location of the apex . no pneumothorax .	Cardiomegaly&&Edema&&Pleural Effusion&&Pleural Other&&Support Devices	11607628	52246418	c154b276-3e9ecb31-b2fe9540-94554c09-d541d5fa
417	following left chest tube placement, left tension pneumothorax has substantially resolved . small residual pneumothorax persists, but no evidence of tension . small amount of pneumopericardium is likely related to recent surgery . minimal atelectasis is present in the left lung base . there is no pleural effusion . patient is status post median sternotomy, and sternal sutures are intact . postoperative mediastinal widening and mildly enlarged heart size are stable . endotracheal tube ends approximately . cm above the carina . consider retracting the et tube by cm for appropriate seating . orogastric tube ends into the stomach, and a swan-ganz catheter through the right internal jugular approach terminates approximately in the right main pulmonary artery . following left chest tube placement, a left pneumothorax has markedly decreased in size with small residual basilar pneumothorax .	Pneumothorax&&Support Devices	16875792	58068113	f6eee07f-b610f72b-a8832d42-b5472b4d-7cc97271
418	a small to moderate right pleural effusion is new compared to most recent study . a right lower lobe opacity has persisted since may represent pneumonia . left lung is clear . there is no left pleural effusion . aortic and mitral valve replacement and tricuspid annuloplasty are seen . sternotomy wires are in place . no pneumothorax . moderate cardiomegaly is unchanged . the mediastinal and hilar contours are normal . . increased right pleural effusion, now small to moderate . . right lower lobe opacity may represent pneumonia . the other opacities in the right lung have resolved .	Lung Opacity&&Pleural Effusion&&Pneumonia	19182863	56775180	b9fa87e8-60fe2f5e-ead3ccb6-7ad496d8-8233efbd
419	moderate cardiomegaly is stable . note is made of aortic and coronary artery calcifications, notably in the lad . generalized chronic interstitial abnormalities remain unchanged . no focal pulmonary abnormality is identified to suggest pneumonia . there is no large pleural effusion or pneumothorax . unchanged chronic interstitial abnormalities with no acute cardiopulmonary process .	No Finding	13475033	58757097	87839031-cf5f44d0-580a18ad-b86bcca4-c95455c5
420	support lines and tubes are unchanged in position . heart size is enlarged but unchanged . there has been worsening of the opacities at the lung bases, right worse than left . there remains mild prominence of the pulmonary interstitial markings suggestive of mild fluid overload, stable . no pneumothoraces are seen .	Cardiomegaly&&Lung Opacity&&Support Devices	16508811	55453302	fbe2b85e-495d3c4a-efdfbec7-0fd71f4d-058b81ff
421	the endotracheal tube, the nasogastric tube, and the left internal jugular vein catheter are unchanged . the right hemodialysis catheter has been removed . the signs of moderate to massive fluid overload, combined to a rounded opacity at the right lung base, are unchanged in extent and severity . no larger pleural effusions . no new parenchymal opacities .	Lung Opacity&&Support Devices	17340686	55232811	b1e23843-fd96303d-eaefd4f1-7b0a4357-08877685
422	an et tube is present, in satisfactory position approximately . cm above the carina . an ng tube is present, extending beneath diaphragm, off film . a dual-lumen catheter is present, with tips over the mid and distal svc . clips noted overlying the right hilum . allowing for lordotic positioning, no pneumothorax is detected . there is probable background copd . there is cardiomegaly with a calcified aorta . there is upper zone redistribution and diffuse vascular blurring, consistent with chf . there is tenting andor fluid tracking at the right lung base . no gross effusion is identified . compared with one day earlier, , at am, the overall appearance is similar . there has been possible slight improvement in the chf findings and in basilar aeration . the cardiomediastinal silhouette may also be slightly improved .	Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Support Devices	18855147	59697114	1d27a19c-ea617441-d83e08b5-cfc02f93-4e212162
423	right picc can be follow to the upper-to-mid svc, the tip is not clearly visualized . cardiomediastinal contours are normal . the lungs are clear . there is no pneumothorax or pleural effusion .	No Finding&&Support Devices	15114531	55783830	55f894b1-3ca82dcd-410935e9-581ee95c-1273b576
424	there is slightly rotated positioning . an et tube is present, tip in satisfactory position approximately a . cm above the carina . a right ij line is present, tip over distal svc . multiple lines and tubing overlie the chest . again seen is marked cardiomegaly . in this setting, the presence of a pericardial effusion cannot be excluded . there is upper zone redistribution and diffuse vascular blurring, consistent with chf and interstitial edema . probable moderate right and small-to-moderate left effusions, with underlying collapse andor consolidation . compared with at am . and allowing for differences in positioning, i doubt significant interval change .	Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Pleural Effusion&&Support Devices	11204646	57013017	70c5d38c-8e98476f-411c89a0-7a50a63c-df1c40fb
425	comparison is made to the prior study from . the feeding tube, left ij catheter and endotracheal tube are unchanged in position . there is persistent cardiomegaly . there is unchanged left retrocardiac opacity . there are no signs for overt pulmonary edema . there is a small right-sided pleural effusion as well . overall, these findings are stable .	Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	11607628	57673768	b83e699f-f3106ae1-2e81b3c2-289d9017-3ddb459c
426	endotracheal tube has been repositioned, now terminating about . cm above the carina . heart remains enlarged . rapid improvement in pulmonary edema, which is nearly resolved . more confluent opacity in right upper lobe is also improving, but difficult to fully assess due to patient rotation . calcified pleural plaques are present, indicative of prior asbestos exposure .	Edema&&Lung Opacity&&Support Devices	17838301	56581318	8663aaa6-c83d78b8-ff43e08f-5ea79d11-e7cca33e
427	one portable ap view of the chest . compared to prior study on , there is increased pulmonary edema . there is borderline cardiomegaly . no pneumothorax or focal consolidation . no pleural effusion . increased pulmonary edema compared to . these findings were discussed with dr . on by telephone .	Edema	13896515	50183767	c85e209c-a1fec74b-431277e7-6032eb3a-95fe7881
428	there has been interval improved appearance of the lungs with more well- defined vasculature and decreased left effusion . however, there continues to be a dense left upper lobe infiltrate . it is unclear how much of this is due to volume lossretained secretions or if there could be an underlying infectious infiltrate . there continue to be patchy areas of alveolar edema however, the overall appearance of the lungs is markedly improved compared to the study from the prior day . the supporting devices, lines and tubes appear similar compared to prior .	Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	19075045	52129079	cbb5ad98-f607de54-6bb0cb49-b19365ae-791d9d25
429	a single ap radiograph of the chest was acquired . there is redemonstration of a right tunneled internal jugular central venous catheter, ending in the mid-to-low svc . there is a small quantity of fluid within the minor fissure . there is minimal linear left mid lung atelectasis . there is also subsegmental bilateral lower lung atelectasis . the heart is moderately enlarged, as seen on the prior radiograph from . there are no definite pleural effusions . no pneumothorax is seen . . minimal left mid and bibasilar atelectasis . no focal consolidation . . moderate cardiomegaly, as seen on the prior chest radiograph from .	Atelectasis&&Cardiomegaly	13473495	53131726	1b09adcd-7bd70867-f05e7f34-ad26a085-cf236edb
430	single lead left-sided pacemaker is stable in position . cardiac silhouette size is top-normal . mediastinal contours are stable and unremarkable . no focal consolidation is seen . there is no pleural effusion or pneumothorax . degenerative changes are partially imaged along the spine . no acute cardiopulmonary process .	No Finding	18893199	53527484	711f27df-b3aacd5a-c3fb842d-dcadab6d-36569853
431	portable ap radiograph of the chest w as compared to , there is interval development of pleural effusion as well as substantial progression of right basal consolidations . the findings have been already demonstrated on , chest ct . overall, as compared to ct there is no substantial change demonstrated on the current chest radiograph .	Consolidation&&Pleural Effusion	16662264	50991057	73c41d4f-3d37dadd-90729029-8999920d-77f956eb
432	blunting of the right costophrenic angle is unchanged and might be consistent with thickening of the pleura since no appreciable pleural effusion is demonstrated . heart size and mediastinum are stable . lungs are clear with improved aeration as compared to the prior study . there is no pneumothorax .	Cardiomegaly&&Enlarged Cardiomediastinum	16848073	54293117	aac36650-9ed388fe-1dea8afb-ba02389c-5a62c2cc
433	as far as i can tell, given the severe anatomic distortion of the chest cage and its contents, lungs were clear on . small region of opacification may have been developing lateral to the left hilus on , and today there is a suggestion of some new opacification at the base of the lung, but these observations are far from certain . i am not even confident that conventional radiographs, should the patient be able to cooperate for them, would clarify the issue . ct scanning, if feasible, would certainly confirm if the lungs are clear, but in the absence of a baseline study it might be difficult to distinguish atelectasis from pneumonia . pleural effusion is minimal if any . heart is probably not enlarged . nasogastric tube is looped in the stomach . right pic line ends in the mid svc . no pneumothorax .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	18110020	57554917	6235b1fc-c21d03f8-be2bbeff-8fe43d75-2e28779b
434	there is continued opacification of the right base . it is not significantly worsened since the prior exam . this may be due to a combination of pleural effusion, atelectasis, and aspiration . in the proper clinical setting, pneumonia cannot be excluded . there is a stable moderate right pleural effusion . there is a small left pleural effusion . no new consolidation is identified . there is no pulmonary edema or pneumothorax . the cardiomediastinal silhouette is normal . an esophageal stent is unchanged in position . a drain is present overlying the mid abdomen . . unchanged opacification at the right base . this may be due to atelectasis or aspiration . in the proper clinical setting, pneumonia cannot be excluded . . stable moderate right and small left pleural effusions .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Pneumonia	19016834	54233043	914b17d9-ffa084b2-cf81dd9b-6a125b63-3a69dd01
435	there is no significant interval change since the prior radiograph performed yesterday evening . a biventricular pacer defibrillator is visualized . the hemodialysis catheter is unchanged in position and terminates in the right atrium . there is persistent mild pulmonary vascular congestion accompanied by interstitial pulmonary edema . no new areas of focal consolidation are identified . left lung base opacity is probably due to a combination of a small pleural effusion and adjacent atelectasis . a small right pleural effusion is also noted . stable cardiomegaly . . stable pulmonary vascular congestion and interstitial edema . . left lung base opacity is probably due to a combination of small left pleural effusion and adjacent atelectasis .	Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion	19759491	51323886	856ccba6-265c59c6-d6f7dcf6-78eea3ea-b33762d5
436	portable view of the chest is compared to previous exam from . dual-lead pacing device again seen . faint bibasilar opacities are seen, particularly in the retrocardiac region which are nonspecific and given low lung volumes could represent atelectasis . there is no definite large pleural effusion . cardiac silhouette is stable as are the osseous and soft tissue structures . no definite acute cardiopulmonary process however, pa and lateral may offer additional detail if desired .	No Finding	18615099	59612133	a0ff876f-331fe46d-c522fdea-c26a2300-676e3cfa
437	as compared to the previous examination from , the rounded pleural opacity should not be mistaken for a mass on the right, caused by encapsulated pleural effusion, has almost completely resolved . the right pleural effusion has decreased in extent . however, there is elevation of the hemidiaphragm, a small basal pleural effusion and subsequent areas of atelectasis . on the left, the lung parenchyma now appears normal . healed left rib fractures are visible . normal size of the cardiac silhouette . mild tortuosity of the thoracic aorta .	Atelectasis&&Fracture&&Lung Lesion&&Pleural Effusion	13352405	59873070	3c333c52-c86e232a-705001ae-b328c40c-41096f34
438	the lungs are clear . there is no left effusion or pulmonary vascular congestion . cardiac silhouette is enlarged but stable in configuration . no acute osseous abnormality detected . cardiomegaly without acute cardiopulmonary process .	Cardiomegaly	19454978	56426309	5432fbd3-085280d8-b2452bf4-52defb60-99f287db
439	status post spinal stabilization, left subclavian access line . borderline size of the cardiac silhouette, elevation of the right hemidiaphragm with subsequent areas of atelectasis seen on both the frontal and the lateral radiograph . no newly appeared parenchymal opacities . no larger pleural effusions .	Atelectasis&&Cardiomegaly	14353044	53138800	b9850dc4-c0036cbc-c577eb21-c259db2c-2d9368a6
440	right pectoral infusion port terminates in upper svc . sternotomy wires are intact . lung volume is low . mild bibasilar opacities likely reflect atelectasis . calcification at the ap window likely reflect calcified lymph nodes in a unchanged from before . there is no large pleural effusion or pneumothorax . mild cardiomegaly is similar to before . no convincing radiographic evidence for pneumonia is identified . mild bibasilar opacities are likely atelectasis .	Atelectasis&&Lung Opacity	11413236	53994053	bf7c2bb6-a8ce931b-a0037382-88c9ab10-ef166969
441	there are continued areas of increased opacification bilaterally consistent with some combination of aspiration and volume loss . increasing prominence of pulmonary vessels is consistent with overhydration or worsening cardiac function . monitoring and support devices are in unchanged position, with the right picc line again at the cavoatrial junction or in the right atrium .	Lung Opacity&&Support Devices	16313531	58147681	8d361e7d-f4f46fc7-956ef2b6-bc506025-0df660c3
442	the tracheostomy tube midline and unchanged . the right subclavian and brachiocephalic vein stent appears similar to prior . the left brachiocephalic stent is unchanged . the vascular catheter coursing through the ivc terminates in svc . the diffuse bilateral lung opacities have increased slightly . this is concerning for multifocal pneumonia . the opacities in the left lung appears or nodule and discrete . with known history of squamous cell carcinoma of the tongue, nodular metastases is on the differential . bilateral lower lobe atelectasis is stable . the mild to moderate right pleural effusion is stable . minimal pleural effusion in the left lung . no pneumothorax . mediastinal silhouette is unchanged . splenic ossification is again seen and unchanged . the visualized vertebrae appear more sclerotic which could represent osseous metastases . . increased diffuse opacification is concerning for multifocal pneumonia . . the left lung discrete nodular opacities are also worrisome for nodular metastases . . the sclerotic vertebrae are concerning for osseous metastases .	Lung Lesion&&Lung Opacity&&Pneumonia	19061282	59190819	24b1563d-4e7efd6d-c06b429d-2ea5af54-95e60968
443	the et tube tip is approximately cm above the carina . the ng tube tip is in the stomach . heart size and mediastinum appear to be unchanged since . vascular engorgement and bibasal consolidations are unchanged as well . right picc line tip is at the cavoatrial junction .	Cardiomegaly&&Consolidation&&Enlarged Cardiomediastinum&&Support Devices	15131736	56028927	b6b79d26-76a917b5-08130023-1a42cc2e-2eeb048c
444	pa and lateral chest radiographs air-fluid levels are identified within the previously visualized retrocardiac opacity, findings consistent with a stable moderate hiatal hernia . the lungs are clear . there is no focal consolidation or pneumothorax . there is no vascular congestion or pleural effusions . cardiomediastinal and hilar contours are within normal limits .	No Finding	14608347	54135185	59f7b1a5-e3b803cc-ec6d1131-1e8caefd-eed8e970
445	overall cardiac and mediastinal contours are likely stable given patient rotation . calcified hilar nodes are consistent with known sarcoidosis . there continues to be deformity of the right upper chest wall with some right lateral pleural thickening and scarring with volume loss at the right medial lung base . however, there has been interval obscuration of the lateral aspect of the left hemidiaphragm which when correlated with the recent ct may reflect an early pneumonia or aspiration . clinical correlation is recommended . no pneumothorax . no pulmonary edema . no obvious pleural effusions .	Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Other&&Pneumonia	11474065	56570382	da99191c-5176d7bc-b809d55a-4429a7cd-ae8b21e9
446	frontal radiograph of the chest demonstrates stable mild enlargement of the cardiac silhouette . normal mediastinal and hilar contours . compared to the prior study of the bilateral pleural effusions have resolved . no focal consolidation or pneumothorax present . no pulmonary edema . the lungs remain hyperinflated .	Cardiomegaly	13881772	52661101	693bd533-69dbe685-2d5a9d4a-dfb5e67b-2b70b394
447	low lung volumes are present . this accentuates the size of the cardiac silhouette which is likely mildly enlarged . mediastinal and hilar contours are likely within normal limits . a right brachiocephalic venous stent is re- demonstrated . there is crowding of the bronchovascular structures with probable mild pulmonary vascular congestion . no pleural effusion or pneumothorax is identified . low lung volumes with mild pulmonary vascular congestion .	Edema	14744884	57996680	49e45fba-5b48f519-adb35266-68939cbb-dfda8e0f
448	comparison is made to previous study from . central venous catheter with distal lead tip in the mid svc is again seen . heart size is within normal limits . there is mild improved aeration of pulmonary edema . there remains blunting of bilateral cp angles, right side worse than left consistent with small pleural effusions . there is improved aeration at the left base as well .	Edema&&Pleural Effusion&&Support Devices	18855147	59030328	baafe7cb-474127df-e3251e9e-6341cd2a-e650e8da
449	comparison is made with prior studies . large hydropneumothorax is present with increase in the component of the pleural component . collapse of the right lung is grossly unchanged . the cardiomediastinum is shifted towards the left side . mild vascular congestion of the left lung is unchanged . cardiac size is normal . et tube is in unchanged position . ng tube tip is out of view below the diaphragm . right basal pigtail catheter is in place . findings were discussed with dr by phone on at pm .	Atelectasis&&Edema&&Enlarged Cardiomediastinum&&Pneumothorax&&Support Devices	14387068	57868625	49d23b84-4594fc1d-966aab33-6f25d4ab-0af232fe
450	there are low lung volumes . the lungs are clear . there is no pleural effusion or pneumothorax . the cardiomediastinal silhouette is unremarkable . left central line terminates in the right atrium . median sternotomy wires and mediastinal clips are noted . a calcified lymph node is noted in the ap window . no acute cardiopulmonary process .	No Finding	11413236	51503417	86f89f10-d6932134-162d3d5b-689149a3-81dd2b70
451	and no focal opacity to suggest pneumonia is seen . there is bibasilar atelectasis and small bilateral pleural effusions . no pneumothorax is present . the heart size is top normal . there are remote right sided rib fractures .	Atelectasis&&Fracture&&Pleural Effusion	17439310	54772630	5ffe4561-fd5efe80-1fb3d78d-8d867983-fd9561af
452	continued enlargement of the cardiac silhouette in a patient with intact midline sternal wires after cabg . no evidence of vascular congestion . the overall discordancy raises possibility of cardiomyopathy . calcification is again seen in coronary vessels . no evidence of acute focal pneumonia .	Cardiomegaly	18828251	56632211	81045bbb-0ff47e0f-e6832f53-a8620841-66e813f0
453	the patient is status post median sternotomy and cabg . left-sided pacemaker device is noted with single lead terminating in the right ventricle, unchanged . the aortic knob is calcified and aorta remains mildly tortuous . there is new mild pulmonary vascular congestion . hyperinflation of the lungs is re- demonstrated . new consolidative opacity within the right upper lobe is concerning for pneumonia . and ill-defined nodular opacity within the right upper lung field measuring up to mm is also new, and likely infectious in etiology . no large pleural effusion or pneumothorax is present . no acute osseous abnormality is seen . there are multilevel degenerative changes in the thoracic spine . new right upper lobe pneumonia . mild pulmonary vascular congestion .	Edema&&Pneumonia	13291370	56991236	cf080221-83e85abe-e7849064-2dae1076-601c8319
454	the nasogastric tube is at the level of the pylorus . nasoenteric tube is in place, the tip is out of the image but appears to be post-pyloric . the endotracheal tube has been removed . a new left central venous access line projects over the confluence of the brachiocephalic veins . minimal loss in lung transparency, potentially caused by fluid overload . no evidence of pneumothorax .	No Finding&&Support Devices	19623993	50438261	d4d5dc4c-6021744f-fa9497e5-157fa69b-f68ddb75
455	cardiomediastinal contours are unchanged . tracheostomy tube is in standard position . right subclavian catheter tip is in the lower svc . there is no pneumothorax or pleural effusion . bibasilar opacities are unchanged, larger on the right side . this could be atelectasis but superimposed infection cannot be excluded . small bilateral pleural effusions previously seen are less conspicuous in this examination . there are no new lung abnormalities . there is mild vascular congestion . ng tube tip is out of view below the diaphragm .	Atelectasis&&Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	13135946	55451827	58578d45-f79852d7-bbc291c6-3ecd360f-65584281
456	following the procedure, there is no evidence of pneumothorax . there are lower lung volumes with evidence of bilateral pleural effusions, more prominent on the right with compressive atelectasis at the bases . retrocardiac opacification is again consistent with volume loss in the left lower lobe .	Atelectasis&&Lung Opacity&&Pleural Effusion	12847817	56524359	aff4536f-731bfbe8-e4a91fc5-06868b90-fbdb4737
457	as compared to the previous image, the patient has received an external pacemaker . the tip of the pacemaker is in expected correct position, as documented on the previous fluoroscopy . unchanged position of the other monitoring and support devices . moderate cardiomegaly with signs of mild pulmonary edema . no pleural effusions . no pneumothorax . left apical pleural calcification . mild atelectasis at the left lung bases . no evidence of pneumonia .	Atelectasis&&Cardiomegaly&&Edema&&Support Devices	11893091	50901361	1d2eae56-aca1446e-78e09b18-02818224-5f58634a
458	sternotomy wires and mediastinal clips are unchanged . the cardiomediastinal contours are unchanged . there is increased consolidation of the left lower lung as well as in the upper lung . there is no large pleural effusion or pneumothorax . the right lung is clear . left lung consolidation, compatible with pneumonia .	Consolidation&&Pneumonia	16773796	50535279	8ecf5181-09dec4e6-27b43fca-3b8999bf-6d25f591
459	severe infiltrative pulmonary abnormality, stable on the left, more coalescent on the right . this is probably diffuse pneumonia or pulmonary hemorrhage in a patient with emphysema . heart size is large but indeterminate because heart borders are obscured by lung abnormality . transvenous right atrial and right ventricular pacer defibrillator leads follow their expected courses . small if not moderate bilateral pleural effusion is presumed . there is no pneumothorax .	Cardiomegaly&&Pleural Effusion&&Pneumonia&&Support Devices	12475198	54377872	c10a5364-1d030517-1045826d-0914fda6-b9c30acc
460	frontal and lateral radiographs of the chest . there is no obvious lobar airspace consolidation . increased perihilar opacities and interstitial markings are consistent with mild pulmonary edema . the heart size is minimally enlarged . there is no pneumothorax or pleural effusion . although the patient is somewhat rotated, rightward deviation of the trachea is likely secondary to tortuous aorta . marked kyphosis of the spine is unchanged . there is a stable moderate-large hiatal hernia . mild decompensated congestive heart failure .	Cardiomegaly&&Edema	15896572	58423258	f11d267a-fb7c10b3-abbbef5e-66e9412c-99b8c90d
461	there is chronic blunting of the left lateral costophrenic angle potentially due to atelectasis or small effusion . there may be mild vascular congestion but without overt edema . linear left basilar opacity is likely atelectasis . cardiomediastinal silhouette is stable . no acute osseous abnormalities . peg tube projects over the abdomen . vascular congestion without overt edema .	Edema	16853729	56958096	ea644819-f1117ff7-4f06774f-336c60f0-51a50fd0
462	single portable ap radiograph was provided . there is increased opacity at the right base which may be due to infectious process or aspiration . rounded density projecting over the right ninth posterior rib is likely a nipple shadow and can be followed on subsequent radiographs . a chronic moderate-sized left pleural effusion is similar in appearance to the prior study . overlying opacities are likely atelectasis . cardiomediastinal silhouette is unchanged . median sternotomy wires are intact . new opacity at the right base may represent infection or aspiration . stable moderate left pleural effusion with overlying atelectasis .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Pneumonia	12538508	58740782	d423cd88-d0739c64-5212e268-96f30c3b-7bd9f6ae
463	the monitoring and support devices remain in place . there is again substantial enlargement of the cardiac silhouette with congestive failure . mild blunting of the left costophrenic angle .	Cardiomegaly&&Support Devices	13896515	59666373	97d5dca2-592bf7a2-9513cf15-b692dc63-7e494cd2
464	right lung is entirely airless, function of worsening pleural effusion and atelectasis . severe opacification of the left lung has a distinctly nodular quality which could be due to collections of fluid in bullae, or multiple septic emboli . heart is enlarged but hard to assess because the right border is obscured by pleural and parenchymal abnormalities in the right chest . right jugular line ends over the region of the low svc . no pneumothorax . findings were discussed by telephone with the house officer caring for this patient at the time of dictation .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Support Devices	14471276	51837713	7fcfad8c-62cf43c4-53d85ee1-2c8bb890-c7773830
465	the study is somewhat limited due to patient rotation . the heart remains moderate to severely enlarged . mediastinal widening is unchanged compared to the prior studies . the pulmonary vascularity is normal . small right pleural effusion has decreased in the interval . left lung is clear . there is minimal atelectasis in the right lung . no pneumothorax is present . no acute osseous abnormality is seen . interval decrease in size of small right pleural effusion with mild right basilar atelectasis .	Atelectasis&&Pleural Effusion	11204646	55611611	a4849658-ce9b054b-b59e436d-df3b5ab8-80025982
466	since , bilateral small pleural effusions and bibasilar atelectasis are unchanged . no new focal consolidation is identified . no pneumothorax . unchanged mild cardiomegaly . tip of the endotracheal to is seen . cm above the carina . right double-lumen central line terminates in the right atrium . a feeding tube is seen in the stomach . left pectoral pacemaker is seen with transvenous leads in the right ventricle . left chest tube positioning has been adjusted . median sternotomy wires are intact and well aligned . . unchanged bilateral pleural effusions and bibasilar atelectasis since . . all support devices are in appropriate position .	Atelectasis&&Pleural Effusion&&Support Devices	19182863	56666007	0f55eb03-9eb3edde-1c46e2fb-60625b8b-86fdba40
467	rounded bilateral mid lung opacities are again seen, grossly unchanged and likely reflect consolidative infectious process given history of septic emboli . there is unchanged bibasilar opacification, which is likely atelectasis with left greater than right effusions . cardiac silhouette is markedly enlarged, similar to the most recent prior . left picc terminates in the cavoatrial junction . median sternotomy wires are intact . . unchanged bilateral mid lung opacities likely reflect infectious process given history of septic emboli . . unchanged or slightly increased left greater than right pleural effusion and associated atelectasis .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Pneumonia	11022245	58274962	f7ba6691-53545537-20c8b2dc-79dbd392-36f05d15
468	the patient is status post mitral valve replacement and probably coronary artery bypass graft surgery . the heart is mildly enlarged . there is patchy basilar opacification suggesting a combination of atelectasis and pleural effusion . streaky left upper lobe opacity suggests minor atelectasis or scarring which is unchanged . there is no pneumothorax . no free air is demonstrated . patchy left basilar opacity, highly suggestive of atelectasis in association with a small-to-moderate suspected pleural effusion, although opacification is not entirely specific as the etiology .	Atelectasis&&Lung Opacity&&Pleural Effusion	15259244	51877138	bbfadd26-26a1370d-69d5f8f9-5b210fd9-a89a0589
469	ap upright and lateral views of the chest were provided . a vascular stent is again noted in the region of the svc, left brachiocephalic vein . there is blunting of the right cp angle which could indicate a small effusion . no overt signs of edema or pneumonia . the cardiomediastinal silhouette is stable . bony structures are intact . degenerative changes again noted at the left glenohumeral joint . small right pleural effusion . otherwise unremarkable .	Pleural Effusion	14236258	52998742	8ee276bc-f8413bb2-79639432-b58d2a14-2d9f78c0
470	cardiomegaly is substantial . right basal consolidation is new and concerning for infectious process . no pleural effusion or pneumothorax is seen .	Cardiomegaly&&Consolidation&&Pneumonia	18767957	52987117	33aac685-1abdf680-75cd5689-530f4138-195db35f
471	pa and lateral views of the chest there are low lung volumes . the heart size is within normal limits . peribronchial opacities bilaterally are similar when compared to the prior study . previously noted left lower lobe opacity appears improved when compared to the prior exam, suggestive of resolving pneumonia . no new focal consolidation, pleural effusion, or pneumothorax is seen . there are no acute osseous abnormalities . radiopaque densities projecting over the right shoulder joint are unchanged as is a surgical clip within the left upper quadrant of the abdomen .	Pneumonia	10933609	52402828	e19a6258-3792982e-db47dccd-c9961bb6-e0aeba69
472	compared to prior chest radiographs is since , most recently at . the tip of the new et tube is above the clavicles no less than . cm from the carina with the chin elevated . this is probably acceptable . moderate bilateral pleural effusions, stable on the right, decreased on the left . no pneumothorax . moderate enlargement of cardiac silhouette . transvenous pacemaker lead traverses the persistent left-sided svc, termination not unchanged . esophageal drainage tube ends in nondistended stomach .	Cardiomegaly&&Pleural Effusion&&Support Devices	19182863	58250250	05a2438b-6777cb93-a97597e4-6b1ba817-01bbe697
473	comparison is made to the patients prior study of . portable ap upright chest film, at is submitted . . the patient is status post median sternotomy with a mitral valve replacement . the cardiac and mediastinal contours are stable in this postoperative patient . a dobbhoff feeding tube is seen coursing below the diaphragm with the tip not completely identified on this study . a right internal jugular sheath remains in place, unchanged . there are bilateral effusions, left much greater than right, with associated airspace disease, which most likely reflects compressive atelectasis, although pneumonia cannot be entirely excluded . the interstitium appears somewhat coarsened, but no overt pulmonary edema is seen . no pneumothorax . overall, there has been no significant interval change .	Atelectasis&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	18224196	54459875	ae60e1b1-f9d562ba-0ac12b85-a554cdd0-beebdc8f
474	there is a new dense right central opacity approximately cm x cm on frontal view . given the rapid onset of this finding, the differential is limited to airspace consolidation atelectasis . given previous radiographic evidence of slow neo-esophagealgastric emptying, it is possible that patient had aspirated contrast material . this would also explain the dense opacity seen on lateral projection . however, other radiopaque fluid, such as fluid, pus, , be filling the airspace in this region . adjacent to this dense opacity are ill-defined peripheral opacities which is not matched on the contralateral side . the left lung is unremarkable . there is no pleural effusion pneumothorax . there is pronounced flattening of the hemidiaphragms . the cardiomediastinal silhouette is unchanged and within normal limits . the pleural surfaces are unremarkable . large dense right central opacity which represent collapse airspace consolidation with adjacent area of asymmetric pulmonary edema . given history of lymphadenopathy, collapse could be secondary to nodal compression of an airway . alternatively, given recent history of oral contrast and poor gastric emptying, opacity represent aspirated contrast material . consolidation also be secondary to a fistula between the neo-esophagus and the right lung . if this finding represent consolidation, the radiopaque material cannot be identified definitely and represent , fluid pus . ct imaging is highly recommended for further evaluation of this finding . these findings were discussed with dr . via phone by .	Atelectasis&&Consolidation&&Edema&&Lung Opacity	19016834	50975397	6ba63140-f35853ba-1c3f30d6-79e8a6d9-972b8b3a
475	the heart size and mediastinal contours are prominent but similar to prior studies . the lungs are clear . there is no pleural effusion or pneumothorax . no acute cardiopulmonary process .	No Finding	14727722	55687833	b6a6935d-4971116a-88062d67-ad36e7ac-0fc76bdf
476	right internal jugular line ends at lower svccavoatrial junction . patient is status post median sternotomy for cabg with borderline-sized heart and sternal sutures are intact . since , left lower lung atelectasis, mild-to-moderate pleural effusion and mild right pleural effusion have improved . mediastinal and hilar contours are in normal limits . since , bilateral lower lung atelectasis, mild-to-moderate left and mild right pleural effusions have improved .	Atelectasis&&Pleural Effusion	11565803	59027235	0f1b4789-8c43bc5c-ec9ef921-5cd7c4a7-5acfae4d
477	ap portable semi upright view of the chest . midline sternotomy wires, left chest wall pacer with leads extending to the region of the right atrium and right ventricle and prosthetic cardiac valve are again seen . the lungs are clear . no focal consolidation, large effusion or pneumothorax is seen . the cardiomediastinal silhouette appears grossly unchanged allowing for differences in technique . bony structures are intact . no free air below the right hemidiaphragm . no acute findings .	No Finding	16043637	59826830	d531af35-5e195d3a-0756d7c2-7e3aff86-d6c94461
478	semi-upright ap view of the chest cardiac silhouette size remains top normal . the mediastinal and hilar contours are unchanged, with calcification of the aortic knob . there continues to be minimal patchy opacities in the lung bases which may reflect atelectasis . no pulmonary vascular engorgement is definitively noted . small bilateral pleural effusions may be present, but no pneumothorax is identified .	Atelectasis&&Pleural Effusion	19159236	52514701	1fa07d59-1b6609db-c7feef15-3888f71e-17d91291
479	the generalized increase in interstitial structures is unchanged as compared to the previous image, there is a history of known interstitial lung disease . the lung volumes are low . moderate cardiomegaly with elongation of the descending aorta . no pleural effusions . no pneumonia . no overt pulmonary edema .	Cardiomegaly&&Lung Opacity	13475033	52994496	6facf396-7379189e-2e080917-b29d6209-25eb040b
480	pa and lateral views of the chest provided demonstrate no focal consolidation, effusion or pneumothorax . the cardiomediastinal silhouette is normal . bony structures are intact . there is no free air below the right hemidiaphragm . mild degenerative change in the mid thoracic spine noted on the lateral projection . no signs of pneumonia .	No Finding	11924226	56051681	417162c9-a460e98a-56bf6ab3-b6c591a2-86230b6d
481	comparison is made with prior study performed minutes earlier . there has been reposition of right chest tube, now is less kinked . left chest tube is also less kinked . the side port is just at the entrance of the pleural cavity . there is extensive bilateral subcutaneous emphysema . cardiac size is normal . patient has severe emphysema . multifocal lung opacities in the left upper lobe, right upper lobe and in the right lower lobe have increased in the right lower lobe, consistent with multifocal pneumonia andor hemorrage as seen in ct performed two hours after this study . there is no pneumothorax or large pleural effusion . et tube is in standard position . left subclavian catheter tip is in the mid svc . ng tube tip is in the stomach . cardiomediastinum is midline .	Enlarged Cardiomediastinum&&Lung Opacity&&Pneumonia&&Support Devices	16751749	53325992	4133d13c-b7509603-e76013d9-06a54774-fb044ffb
482	moderate cardiomegaly is comparable, but pulmonary vascular congestion and upper lobe redistribution of blood flow have developed . there is no pulmonary edema or appreciable pleural effusion . no pneumothorax . no focal consolidation to suggest pneumonia .	Cardiomegaly&&Edema&&Pneumonia	11052273	58377417	97cfb5fb-f151949c-ec5357b7-3b5b1046-5ef2a77c
483	portable ap chest radiograph . the et tube is in appropriate position . ng tube courses below the diaphragm and terminates outside the field of view . note is made of a right subclavian vein stent . there are low lung volumes and mild pulmonary edema . there is no pleural effusion or pneumothorax . . et tube and ng tube are in appropriate position . . mild pulmonary edema .	Edema&&Support Devices	14744884	54052607	a7086ff1-0170e249-78abab05-8879d1bc-4bf53b97
484	portable ap upright chest radiograph is obtained . evaluation is somewhat limited given the underpenetrated technique . there is stable prominence of the right hilar structures with slight upward retraction of the right hila again noted . a small right effusion is again noted . mild congestion is difficult to exclude . the heart is top normal in size . bony structures appear intact . stable prominence and upward retraction of the right pulmonary hilum in this patient with known lung cancer . right pleural effusion and probable mild interstitial edema .	Edema&&Pleural Effusion	19720782	58510466	4d50716a-ce9e59d8-2bccee5f-9fd75a55-f12cd66a
485	bronchial wall thickening or peribronchial infiltration in the lower lungs where most pronounced bronchiectasis is have worsened since consistent either with a flare of bronchiectasis or development of peribronchial pneumonia . heart size is normal . there is no pleural effusion, no pneumothorax . feeding tube ends in the upper stomach .	Lung Opacity&&Pneumonia&&Support Devices	10402372	52241282	917859c3-e459ee3b-965451a4-1d4a3e3b-cdbac544
486	a portable frontal chest radiograph demonstrates an endotracheal tube terminating in the mid thoracic trachea, intact sternal wires, a left chest wall pacer device with the lead projecting over the right ventricle, right central catheter terminating in the upper right atrium, enteric tube terminating in the stomach, and interval placement of a left chest tube which projects over the left lung base . there is no appreciable pneumothorax . bilateral small pleural effusions and bibasilar atelectasis is unchanged compared to the most recent chest radiograph on . no new focal consolidation is identified . the visualized upper abdomen is unremarkable . interval placement of a left chest tube, without appreciable pneumothorax . bilateral small pleural effusions and bibasilar atelectasis are unchanged compared to .	Atelectasis&&Pleural Effusion&&Support Devices	19182863	55023208	121a82e4-e8fcc625-76d8bd71-defee5fe-3f48af2b
487	the patient has taken a somewhat better inspiration . nevertheless, lines are still low . there is enlargement of the cardiac silhouette with vascular congestion and bilateral effusions with compressive atelectasis . nasogastric tube extends to the distal stomach .	Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	18079481	56374996	7e35b00e-b26953b2-8748806e-5162f99f-feffc6b2
488	frontal and lateral chest radiographs a left lower lobe opacity demonstrating multiple air bronchograms is concerning for consolidation . there is no pneumothorax . there is a small left pleural effusion . the heart is moderately enlarged, as seen on the examination .	Cardiomegaly&&Pneumonia	16855430	53939178	97dce762-0f106b37-190de5f9-33071881-9d9e0b6d
489	the entire upper part of the chest missing on the current image . the basal parts of the right and left hemithorax are unchanged . there is bullous disease at the lung bases . the tip of the dobbhoff catheter projects over the middle parts of the stomach . the size of the cardiac silhouette is within the upper range of normal . no evidence of pleural effusions .	Cardiomegaly&&Support Devices	17032538	59715122	a9c449db-9cd2fe30-50cd41c6-aa9508ea-806361eb
490	the patient is status post coronary artery bypass graft surgery . a dual-lead pacemakericd device appears unchanged . the mediastinal and hilar contours appear unchanged . the heart appears mildly enlarged . a widespread interstitial abnormality suggests mild vascular congestion . although there is increased relative opacification of the left mid lung compared to the right, an asymmetric pattern of pulmonary edema has been seen on prior radiographs such as . findings most suggestive of mild-to-moderate interstitial pulmonary edema .	Edema	18615099	57276121	dd3bb5f4-72efaaca-854cacfc-e1b8f92d-745973bd
491	there is a newly appeared small retrocardiac atelectasis . small bilateral pleural effusions might also have newly occurred . no overt pulmonary edema . unchanged appearance of the cardiac silhouette and the mediastinum .	Atelectasis&&Cardiomegaly&&Enlarged Cardiomediastinum&&Pleural Effusion	14641474	56168637	fd15e7bf-1621a059-9416c9b7-f74f9113-61918f0f
492	pa and lateral views of the chest swan-ganz catheter has been removed, and a right-sided port-a-cath is noted with tip in the lower svc . consolidative opacity within the right lower lobe is concerning for pneumonia . there is elevation of the right hemidiaphragm with lateralization of the diaphragmatic peak suggesting a subpulmonic effusion . the cardiac silhouette size is top normal . there is mild prominence of the pulmonary vascular markings . no left-sided pleural effusion is seen, and there is no pneumothorax . there are no acute osseous abnormalities .	Pleural Effusion&&Pneumonia	16826047	50453673	76c350ea-1a3f5c17-77dc0d18-f3ac57a7-27bd14f8
493	there are again bilateral pleural effusions, which may be increasing on the right . continued enlargement of the cardiac silhouette, possibly with mild elevation of pulmonary venous pressure .	Cardiomegaly&&Pleural Effusion	12847817	51265355	98799e4e-1081c047-ad705716-d7734aa8-600d7924
494	the monitoring and support devices are constant . no evidence of pneumothorax . no other acute interval changes .	No Finding&&Support Devices	11204646	59171234	016991da-a5224d79-0a00be4e-485841d2-f9e917e8
495	two views of the chest the lungs are well expanded and clear . the cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal . no pleural effusion or pneumothorax is present . sternal wires are intact .	No Finding	10274145	58307391	638f2c7f-1ddfe2c3-062f8057-b3e8a5aa-17b03955
496	a generalized increase in opacification of the lower lungs accompanied by persistence of previous acute enlargement of the heart suggests much of the interval change over the past four days is due to worsening pulmonary edema and pleural effusions, moderate on both sides . given those findings, early pneumonia would be difficult to detect, but does not have to be invoked to explain the changes we see . patient has had right upper thoracoplasty with rib resections, in association with the described lobectomy .	Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia	13263843	55748723	f8cdc217-0b1f1e62-649813f5-30f60097-a04abd77
497	a dual lead pacemakericd device with two leads appears unchanged . the patient is status post endovascular aortic valve replacement . mitral annular calcifications are present . the heart is moderately enlarged . the mediastinal and hilar contours appear unchanged . a mild new interstitial abnormality suggests vascular congestion, but no focal opacities are identified . there is no pleural effusion or pneumothorax . the patient is again status post vertebroplasty of the t vertebral body which demonstrates a fragmented moderate compression deformity with slight retropulsion of the dominant posterior fragment, but not significantly changed . prior posterior fusion involving t and t also appears unchanged . a moderate biconcave l compression deformity appears unchanged . findings suggesting mild pulmonary vascular congestion .	Edema	18417750	50640370	e8f40dc1-eb1d35c9-581a0b09-a78294c8-1a9ab9f1
498	the tip of a right-sided picc line is difficult to visualize but is probably unchanged . the lung volumes remain low . there is an extensive consolidation in the right lower lung, probably in the right lower lobe . the appearance is fairly similar to the more recent prior radiographs allowing for differences in technique although pulmonary vasculature is somewhat less prominent . it is difficult to exclude small pleural effusions but no definite pleural effusion is seen . the cardiac, mediastinal and hilar contours appear unchanged, including cardiac enlargement . . persistent consolidation in the right lower lung worrisome for pneumonia . follow-up radiographs are recommended to show resolution within eight weeks . . findings suggesting mild vascular congestion but seemingly improved .	Consolidation&&Edema&&Pneumonia	16055653	54823444	e2706168-aad7b524-06ccdf55-031e9a4f-5c0bdcb8
499	frontal and lateral chest radiographs the patient is status post median sternotomy and prosthetic valve placement . the heart is mildly enlarged . the central pulmonary vessels are engorged and congested . patchy bibasilar opacities are present, and there are multiple kerley b lines, representing moderate interstitial edema . a tiny left pleural effusion is present . there is no pneumothorax .	Edema	16672854	52891865	e51c0403-d316954a-0ea8f97b-063b0ac1-c4fb078e
500	the increased opacification at the left base has substantially cleared . the suspected area of opacification at the right base laterally is barely perceptible at this time . substantial hyperexpansion of the lungs with upper lobe predominant emphysema is again noted and there is little change in the appearance of the cardiomediastinal silhouette .	Enlarged Cardiomediastinum&&Lung Opacity	11052935	56673612	ab104077-b39a8fcb-8c1d8fd5-5a8badb0-be5353a1
501	lung volumes are slightly low, as before, with persistent mild pulmonary vascular congestion and mild cardiomegaly . no focal consolidation concerning for pneumonia is identified . there is no pneumothorax . a metallic right subclavian vein stent is unchanged . stable mild pulmonary vascular congestion and mild cardiomegaly .	Cardiomegaly&&Edema	14744884	57120452	b7013a8b-6c5dab19-f07b823e-d65d3507-a7548d2f
502	the heart is normal in size . the aorta is tortuous . allowing for differences in technique, mediastinal and hilar contours are unremarkable . there is volume loss in the right hemithorax with scarring at the right apex that is presumably post-surgical . mild chronic-appearing compression deformities are poorly visualized along the upper thoracic spine although unlikely to represent acute fractures, there may be some increase in the degree of attenuated body heights at one or more levels since the prior ct from several years ago . mild mid thoracic vertebral compression fractures, similar to slightly increased since the prior ct from although not fully characterized, probably chronic . if symptoms refer to the thoracic spine, further imaging assessment could be given consideration .	Fracture	16622813	53002522	f54d71e9-cb078a0e-41326b2e-d8a5e132-77b9f33a
503	the bilateral pleural effusions are unchanged in extent and distribution . also unchanged is the moderate cardiomegaly as well as the signs indicative of mild fluid overload . no focal parenchymal opacities have newly occurred in the lung parenchyma . the old healed left rib fractures are unchanged . the nasogastric tube has been removed in the interval . the right picc line is in unchanged position .	Cardiomegaly&&Fracture&&Pleural Effusion&&Support Devices	11934114	51139077	4fc6f280-2eae00ca-b8720682-3d0a8eee-b2dbb3c6
504	endotracheal tube terminates approximately . cm above the carina and is adequately positioned . feeding tube is seen to course below the diaphragm into the stomach however, distal end is out of the radiographic view . right mid and lower lung and left lower lung opacities concerning for multifocal pneumonia have worsened since . an coexisting component pulmonary edema is possible . no other interval changes . scarring in the right lower lungs and right apical dense pleural thickening are unchanged . small bilateral pleural effusions are similar . no pneumothorax .	Edema&&Lung Opacity&&Pleural Effusion&&Pleural Other&&Pneumonia&&Support Devices	17032538	58641137	6ec78bca-9eb86302-16367715-1a68dd88-f70084c0
505	lung volumes are low with secondary crowding of the bronchovascular markings . there is however superimposed pulmonary edema which may have progressed since prior although changes could in part be to lower lung volumes . enlargement of the cardiac silhouette is also noted, again not significantly changed . more dense left basilar opacity, particularly on the frontal view could be combination of atelectasis noting that infection is difficult to exclude . . cardiomegaly and pulmonary edema which may have progressed since prior although some changes may be accounted for by lower lung volumes on the current exam . left basilar opacity, potentially atelectasis noting that infection would also be possible .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pneumonia	15131736	51468636	73d09a2f-e8077206-2a03b426-badcd185-81f46a4f
506	monitoring and support devices remain in place . continued prominence of the cardiac silhouette with evidence of some elevated pulmonary venous pressure . retrocardiac opacification persists, as does some mild atelectatic changes on the right .	Atelectasis&&Cardiomegaly&&Lung Opacity&&Support Devices	15338518	50989504	a3b5f140-09ecc379-5729bd0f-98abe246-f9eea2ed
507	compare to prior chest radiographs since , most recently . et tube in standard placement . right pic line ends in the upper right atrium . feeding tube passes into the stomach and out of view . moderate enlargement cardiomediastinal silhouette is stable . left hilar enlargement is probably due to chronic pulmonary arterial dilatation but pulmonary vascular engorgement has improved since and there is no edema . left lower lobe atelectasis is mild . pleural effusions are small if any . no pneumothorax .	Atelectasis&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	14841168	53426458	93cda90a-dff91783-8c5eaa57-5242ceca-f2ba281a
508	the patient is status post median sternotomy as well as cabg . chronic interstitial changes are noted in the lungs, which have somewhat increased, which may be related to interstitial edema . however, this is not accompanied by any pleural effusion or evidence of pneumonia . there is no pneumothorax . multiple veterbral compression deformities are present at the thoracolumbar junction . diffuse increased interstitial markings related to chronic lung disease, slightly increased, likely related to superimposed edema .	Edema&&Lung Opacity	16957952	56986984	b3068b62-93af079c-28037ceb-5f8b41e3-8d9c5e81
509	the dobbhoff tube was pulled back . the course of the tube is now unremarkable . the tip of the tube projects over the middle parts of the stomach . there is no evidence of complications, notably no pneumothorax . in the interval, the pre-existing picc line malpositioned in the right axillary vein is still unchanged the signs indicative of fluid overload have minimally decreased, no newly appeared focal parenchymal opacities .	No Finding&&Support Devices	13031876	51083465	50ce474f-a6c1b7fd-18d97f9e-98effe01-c29ad3be
510	homogeneous opacification of the right lower hemithorax medially could be due to either consolidation in the right lower lobe or posteriorly layering pleural effusion, best evaluated with an upright chest radiograph when feasible . left lung is clear . heart size is normal . mediastinal and hilar silhouettes are normal, and the costopleural surfaces are unremarkable . no evidence of pneumothorax . et tube is in standard placement, and a nasogastric tube passes into the stomach and out of view . intraaortic balloon pump ends midway between the upper margin of the left main bronchus and the apex of the aortic knob, approximately . cm from the latter .	Consolidation&&Lung Opacity&&Pleural Effusion&&Support Devices	17288844	52302794	e12f3c50-f3483123-b58a8f99-6e949bb7-98729b1a
511	there is a somewhat heterogeneous but generally diffuse mild interstitial abnormality suggesting slight pulmonary congestion . one of two views shows a slightly more confluent right upper lobe opacity of uncertain significance, quite vague, and there is also focal left infrahilar opacity . there is no definite pleural effusion or pneumothorax . findings suggesting mild vascular congestion . more focal patchy right upper lobe and left infrahilar opacities of uncertain significance but possibly due to coinciding atelectasis or scarring . if developing infection is a clinical consideration then short-term followup radiographs could be considered .	Atelectasis&&Edema&&Lung Opacity&&Pneumonia	10975446	59969148	66cab843-95809cae-6a67db82-36faecab-8a75c30e
512	the patient is status post median sternotomy and cabg . dual-lead left-sided pacemaker is again seen with leads extending to the expected positions of the right atrium and likely right ventricle . there is blunting of the left costophrenic angle most consistent with a small left pleural effusion . left base opacity may be due to combination of pleural effusion and atelectasis, although consolidation is not excluded . there is mild central pulmonary vascular congestion . the cardiac silhouette is mildly enlarged . mediastinal contours are similar compared to . there is diffuse osteopenia . left pleural effusion with overlying atelectasis . left base opacity may be due to combination of pleural effusion and atelectasis, although consolidation is not excluded . mild pulmonary vascular congestion .	Atelectasis&&Consolidation&&Edema&&Lung Opacity&&Pleural Effusion	18615099	59480739	04d8b146-8f27fd48-e07afc43-464529fc-57350e1b
513	the lungs appear clear . a pacemaker is seen projecting over the left chest with a wire appropriately placed in the right atrium . the cardiomediastinal silhouette, hilar contours, and pleural structures are normal . no pneumothorax or pleural effusion . other than the pacemaker, no radio-opaque metallic foreign object is identified in chest radiograph . . pacemaker seen projecting over the left chest with a wire appropriately placed in the right atrium . other than the pacemaker, no radiopaque metallic foreign object is identified . . no acute cardiopulmonary process .	No Finding&&Support Devices	18893199	53091268	0d8631a3-76f811f9-2cdcf377-22f2f8eb-4d5a97e4
514	a small region of new opacification has developed at the lateral aspect of the right middle lobe . this could be early pneumonia . lung volumes remain severely low, particularly the right lung above the elevated right hemidiaphragm which obscures a substantially consolidated right lower lobe, suffering from collapse or pneumonia p the condition of the left lower lobe is similar and . all of the basal pulmonary abnormalities have developed since . moderate cardiomegaly is stable . pleural effusions are presumed, but not substantial . right internal jugular line ends close to the inferior cavoatrial junction . transvenous atrial biventricular pacer defibrillator leads are continuous from the left pectoral generator, and unchanged . there is no pneumothorax .	Atelectasis&&Cardiomegaly&&Consolidation&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	12595991	52170957	4d837b55-e381fd19-f31d9007-733a21e2-276bf002
515	the lungs are hypoinflated with crowding of vasculature . there is progression of severe vascular engorgement with peribronchial cuffing as well as bilateral perihilar opacities with interval increase in small left pleural effusion . no right pleural effusion . no pneumothorax . moderate cardiomegaly is stable . a right picc tip is seen at least up to the low svc . . moderate pulmonary edema with stable moderate cardiomegaly and increased small left pleural effusion . . in order to exclude pneumonia a repeat pa and lateral chest radiograph once the edema has resolved should be considered as current underlying parenchymal disease limits evaluation . . a right picc tip is seen at least up to the low svc .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	15131736	58318333	947ce661-ea81059f-7da8d1e6-033e612e-ba93f7fd
516	there is unchanged evidence of a small right pleural effusion . in addition, an area of parenchymal opacity at the right lung base has newly appeared . this opacity is likely caused by a basal atelectasis . known status post valvular replacement . normal alignment of sternal wires . unchanged left lateral aspect of the second rib . no evidence of pneumothorax . no other acute lung changes .	Atelectasis&&Lung Opacity&&Pleural Effusion	19182863	56282491	f08f01b8-22e9d374-4b8af575-e8a913dd-c93812ec
517	recurrence of left suprahilar consolidation could be due to return of atelectasis or development of pneumonia in the region of prior aspiration . right lower lobe atelectasis has been present for several days, not improved . there is no pulmonary edema . mild cardiac enlargement has increased, but pulmonary vasculature is not engorged and there is no appreciable pleural effusion . no pneumothorax . right jugular line ends close to the superior cavoatrial junction . findings were discussed by telephone with at am .	Atelectasis&&Cardiomegaly&&Consolidation&&Pneumonia&&Support Devices	14851532	58345071	552535b0-f25af20e-f0731a45-c3c4dec8-3f85e93b
518	pa and lateral chest radiograph demonstrate a right chest port, its tip which projects within the upper superior vena cava, unchanged in position relative to prior study . median sternotomy wires appear intact . cardiomediastinal silhouette appears stable relative to prior examination . heart size is mildly enlarged . there is no evidence of pulmonary edema . nodular opacities within the in right infrahilar region likely reflect vascular shadows . lung volumes are low . bibasilar atelectasis is moderate . there is no focal opacity convincing for infectious process . calcification on the ap window could be due to calcified nodes . no large pleural effusion or pneumothorax is identified . overall stable appearance of the chest with low lung volumes and basilar atelectasis .	Atelectasis	11413236	57361873	7634db9d-273d50e3-b619164d-90d11c3f-2a46ab37
519	moderate cardiomegaly and pulmonary vascular engorgement are chronic . there is no pulmonary edema, consolidation, or pleural effusion .	Cardiomegaly	14177219	55111273	a8175445-d55b2d93-a5a3a22c-7662cb0a-6519b608
520	portable frontal chest radiograph an opacity projecting over the right hilum is unchanged from prior examination is consistent with paramediastinal radiation changes . there is a persistent loculated right pleural effusion, unchanged in size from prior . the left lung remains clear . no pneumothorax is evident . there is pulmonary vascular congestion, though no overt pulmonary edema . cardiac size is within normal limits and unchanged .	Lung Lesion	19720782	55515719	b378a3b5-08a7504a-631c758a-059fd7ba-eea6caf2
521	right-sided chest tube remains in place, with a small right apicolateral pneumothorax which has minimally decreased in size since the recent study . multifocal pulmonary opacities in the right lung appear unchanged allowing for differences in lung volumes, and multiple right rib fractures are again demonstrated . within the left lung, an area of patchy opacity in the retrocardiac region has slightly worsened . . slight decrease in small right apical pneumothorax with chest tube in place . . multifocal right-sided pulmonary opacities consistent with contusion in the setting of recent rib fractures . coexisting laceration injury seen to better detail on recent ct .	Fracture&&Lung Opacity&&Pneumothorax&&Support Devices	17112432	59522601	efe3cdc5-c0ced06a-212a5901-9c1ee7c7-bbbe0e6b
522	there are new heterogenous parenchymal opacities involving the right upper lobe and right lower lobe, compatible with patients recent history of aspiration . opacity along the medial aspect of the right apex likely represents post-radiation changes, and was noted as far back as the ct torso . small right pleural effusion is not significantly changed from prior . the left lung is essentially clear . no pneumothorax . the mediastinum, hila and heart are within normal limits . . new heterogenous parenchymal opacities in the rul and rll, compatible with aspiration pneumonia . . stable post-radiation changes in right paramediastinal lung . notification findings telephoned to dr . by dr . on at pm, time of discovery .	Lung Opacity&&Pneumonia	14295224	54581813	b019f6c5-62bfcfe4-13976b55-788794c1-c400accb
523	ap and lateral supine views of the chest were reviewed and compared to prior . in the mid portion fo the left lung, a focus of ill-defined linear opacities likely represents scarring from prior left lower lobe abscess . otherwise, the lungs are clear bilaterally without vascular congestion, pleural effusion, or pneumothorax . there is no concerning bone or soft tissue lesions .	No Finding	19748558	53711569	e340b826-77b272b0-563eb16a-9d61d7c8-debd50bf
524	there is hilar congestion and diffuse bilateral ground glass opacities, most predominant at the bases, slightly improved from prior exam, and most consistent with pulmonary edema . an underlying pneumonia cannot be fully excluded . there are trace bilateral pleural effusions . there is no pneumothorax . the cardiac silhouette is moderately enlarged and unchanged from the prior exam . the mediastinal contours are normal . bilateral ground glass opacities and small bilateral pleural effusions are consistent with moderate pulmonary edema . in the proper clinical setting, a pneumonia cannot be excluded . can consider a repeat chest radiograph after diuresis .	Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia	17189198	54225810	a02fc8d7-4d89d7b2-2bcaaf26-ebd72059-2e9d5341
525	final addendum addendum right subclavian picc line extends to the mid portion of the svc on the study .	Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices	16508811	50936626	a25b5ac3-3b72b7c3-74275421-5dc344b8-b3a2cd7c
526	in the background of severe interstitial lung disease, which is predominantly reflected in fine reticulation of the lung periphery on each side, there are patchy superimposed opacities in the right upper lung as well as the left mid and lower lung worrisome for superimposed pneumonia . there is no pleural effusion or pneumothorax . the lung volume are again low . the cardiac, mediastinal and hilar contours appear unchanged, allowing for differences in technique . multifocal opacities worrisome for pneumonia superimposed on severe underlying interstitial lung disease although recent prior radiographs are not available for comparison and progression of chronic lung disease could be considered as an alternative, acute superimposed pneumonia seems most likely .	Lung Opacity&&Pneumonia	10867202	59071382	da5580a4-d85e8eac-795ffec6-41e6d24b-273b3747
527	in comparison with the study of earlier in this date, the endotracheal tube has been removed, as has the nasogastric tube . continued enlargement of the cardiac silhouette with some element of elevated pulmonary venous pressure . opacification at the right base is consistent with collapse in the right middle and lower lobe with possible pleural effusion . less prominent left basilar opacification is consistent with some volume loss in the left lower lobe and probable small effusion .	Atelectasis&&Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Support Devices	14851532	59956491	721e19bf-893cd83c-ea610180-ee56a931-b0b7c146
528	there is unchanged evidence of moderate cardiomegaly and a right pleural effusion . the signs indicative of fluid overload have increased in extent, best visible in the left upper lung . there is minimal blunting of the left costophrenic sinus, potentially indicative of the presence of a small pleural effusion . no evidence of pneumonia .	Cardiomegaly&&Pleural Effusion	11204646	59345943	9f6c9e7b-4ccd8468-517c7976-e5deee18-02e95e8a
529	when compared to prior study, , small-to-moderate right pleural effusion has markedly decreased in size . small left pleural effusion has also decreased in size . cardiomegaly is unchanged . mediastinal contours are stable . there are no new lung abnormalities . patient has known emphysema .	Cardiomegaly&&Enlarged Cardiomediastinum&&Pleural Effusion	18224196	52946760	c2bb8990-9789045a-070071f0-a817d725-cfb2472c
530	in comparison to the recent radiograph of day earlier, subcutaneous emphysema has slightly decreased in extent, and pneumomediastinum also appears improved . heterogeneous opacities in the right lung have slightly worsened in the right upper lobe and slightly improved at the right lung base . left basilar opacities have nearly resolved, and a small left pleural effusion has decreased in size .	Lung Opacity&&Pleural Effusion	11474065	52511628	d77fc718-e1eacd2f-2fa45ea8-a06418df-85ae6300
531	since the prior study the pseudotumor fluid in the major fissure on the right has resolved . post treatment changes including elevation of the right hilus and coarse interstitial changes indicative of radiation fibrosis are again noted, a chronic finding . obscuration of the right hemidiaphragm is likely a function of atelectasis and a small pleural effusion . the left lung is largely clear . heart size and mediastinal contours are stable . heavily calcified aortic arch is again noted . . resolution of fluid in the right major fissure . . small right pleural effusion and right basilar atelectasis . . chronic treatment-related changes in the right lung .	Atelectasis&&Pleural Effusion	19720782	51067581	0bfb85a2-fe62f571-fb0c092b-b592a4d6-60a8b4ff
532	in comparison with the study of from an outside institution, there is little change . cardiac silhouette is within normal limits and there is no evidence of acute pneumonia, vascular congestion or pleural effusion . probable dense calcification of the mitral annulus .	No Finding	16553329	53049033	4765eb14-526b941e-eca533c4-4036ca47-964e3982
533	chest frontal and lateral radiographs demonstrate unremarkable cardiomediastinal and hilar contours . lungs are clear . no pleural effusion or pneumothorax evident . minimal degenerative change at right acromioclavicular joint . no osseous abnormality is identified . no acute intrathoracic process . no overt evidence of pcp .	No Finding	18835687	59203230	38e5d885-855b370d-ff1f67a4-ece45a25-cc36e325
534	right upper lobe pneumonia continues to clear . tiny right pleural effusion is smaller . hyperinflation indicates copd . heart size normal . right apical pleural scarring unchanged .	Pleural Effusion&&Pleural Other	14295224	52321575	655fe8bc-af25268c-f206b4d3-5d5ed0cb-8d545266
535	ap and lateral views of the chest show no consolidation, pulmonary edema, or pneumothorax . there is a possible trace left pleural effusion . a small nodule in the left mid lung zone is stable measuring mm and likely due to prior granulomatous disease, as also seen on chest ct from . cardiac size is at the upper limits of normal . the mediastinal contours are normal . . no evidence of pneumonia . . possible trace left pleural effusion . . stable left mid lung nodule is likely prior granulomatous disease .	Lung Lesion&&Pleural Effusion	16855430	50718199	a77d2e8f-c6ecaa1e-c2b76bec-23469463-3e9de1f1
536	compared to prior chest radiographs through . small to moderate bilateral pleural effusions are unchanged, following removal of the left pigtail pleural drainage catheter . there is no pneumothorax . moderate cardiomegaly increased slightly with persistent pulmonary vascular congestion . no definite pulmonary edema . transvenous pacer lead traverses a left svc to the right ventricular apex . patient has had median sternotomy and probable tricuspid valve repair . healed chronic left upper rib fractures noted .	Cardiomegaly&&Edema&&Fracture&&Pleural Effusion&&Support Devices	19182863	57618911	73ee1dc8-28fc5f5b-76e543d9-70afa724-b6dc8113
537	pa and lateral chest radiograph sternotomy wires are midline and intact . bilateral interstitial edema has decreased since the most recent prior examination . cardiomegaly is stable . surgical clips in the mediastinum, unchanged . opacification at the left lung base is resolved . minimal opacification right lung base concerning likely related to infection or edema is improved compared to the prior examination .	Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pneumonia	11879886	51551069	58fedcf0-3247be4c-33428852-1d9d9fed-c613aa80
538	single portable view of the chest is compared to previous exam from . tracheostomy tube and postoperative changes of left upper lobectomy are again seen . right basilar opacity silhouettes the right hemidiaphragm . superiorly, the right lung is clear and appearance of the left lung is stable . cardiomediastinal silhouette remains stable as do the osseous and soft tissue structures . right basilar opacity silhouetting the hemidiaphragm, possibly due to any combination of effusion, atelectasis or consolidation . clinical correlation recommended . two-view chest x-ray may also offer additional detail .	Atelectasis&&Consolidation&&Lung Opacity&&Pleural Effusion	10885696	59532499	33cbca42-cc8136d7-714fe7b7-c6fd6342-7bfbd4f1
539	there is some decrease in the opacification at the right base . chest tubes remain in place, and there is no evidence of pneumothorax . some residual atelectasis and effusion are noted . the possibility of supervening pneumonia at the right base could not be excluded . the left lung is essentially clear with mild atelectatic changes at the base . subcutaneous emphysema persists along the right lateral upper abdominal wall .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	18309149	54224807	21e742f7-ee50e64f-508ad946-db407641-972bfa79
540	single portable view of the chest at pm . is compared to previous exam from earlier the same day at pm . left-sided chest tube is seen with tip projecting over the left lung apex . although there is increased lucency in the left hemithorax, no discrete pleural line is identified based on this supine film . there is left chest wall subcutaneous gas seen . otherwise, there has been no change . left-sided chest tube now seen with tip overlying the left lung apex .	No Finding&&Support Devices	12736592	50957430	3056f052-ff3c284f-0d46f60a-7d4ee6af-498142fb
541	pulmonary edema is mild and new since . increased opacity at left lung base is either atelectasis andor combination of atelectasis and edema . left pleural effusion is presumed and small and is also new since . heart size is normal . cardiomediastinal silhouette is unremarkable . mild-to-moderate atherosclerotic calcification is present in the aortic arch . mild pulmonary edema and presumed small left pleural effusion, new since .	Edema&&Pleural Effusion	10650001	55609649	6bad4c60-b2e3becf-a99801f7-aac3757c-2b669f35
542	there is a new moderate left and small right pleural effusion . right lower lobe atelectasis has slightly worsened . there is an indistinct haziness over the right lower lung field which may represent layering effusion . there is stable bilateral apical pneumothoraces . ij catheter is seen in unchanged position terminating within the upper right atrium . the cardiomediastinal silhouette is stable and demonstrates a mildly enlarged heart . stable cardiomediastinum with no evidence of failure . worsening bilateral pleural effusion and atelectasis .	Atelectasis&&Enlarged Cardiomediastinum&&Pleural Effusion	16043240	55694501	9cb7472a-803c242b-a9526718-19d7b53c-e332df01
543	the tip of the swan-ganz catheter is now projected over the mediastinal border of the right pulmonary artery . the patient has taken a slightly better inspiration with little overall change in the appearance of the heart and lungs . prosthetic device in the right shoulder is again seen .	Cardiomegaly&&Support Devices	19075045	55710466	a1cd58cf-bef24282-3f8dd017-ac556cfc-92537bf4
544	there is continued opacification of most of the left hemithorax . right lung remains essentially clear . left ij catheter again extends to the brachiocephalic vein close to the junction with the superior vena cava . the supraclavicular gas on the left is decreasing .	Lung Opacity&&Support Devices	12530259	52715750	968192ec-09ed8f86-65cb3129-91dbad60-4710e7fb
545	comparison is made to the prior study performed two hours earlier . interval placement of a nasogastric tube, whose distal tip and sideport are below the gastroesophageal junction . endotracheal tube and right ij central line are in unchanged position . there is persistent cardiomegaly . there is a left retrocardiac opacity . there is prominence of the pulmonary vascular markings, consistent with mild pulmonary edema . there is some atelectasis at the left lung base .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Support Devices	10268877	58267855	95efb462-e05c1ac9-3c5319d6-bafdcede-df6db042
546	moderate cardiomegaly is stable . pacer leads are in unchanged position . hd catheter is in standard position . there is no pneumothorax . mild vascular congestion has minimally improved . retrocardiac opacities are a combination of small effusion and adjacent atelectasis, stable . sternal wires and valve replacement are again note .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	19759491	52929450	c5ba12eb-19b106cb-51fb3665-486c18e6-65a1a778
547	there is cardiomegaly . there are diffusely increased interstitial markings present throughout the lung parenchyma, not significantly changed from prior study . unchanged gentle dorsal kyphosis and wedge fractures are also noted . the appearances are consistent with pulmonary edema . an old left clavicular fracture is observed . moderate pulmonary edema is suggested .	Edema	13475033	51347202	893e71a8-87c6c1ff-1e2204e9-40f4c0c5-973e72c1
548	the lungs are clear of focal consolidation, effusion, or pulmonary vascular congestion . cardiac silhouette is mildly enlarged, similar to priors . hypertrophic changes noted in the spine . median sternotomy wires are again noted . no acute cardiopulmonary process .	No Finding	17318449	57272372	3e95e1d8-dfda84b0-7eded0f8-e83090e4-12e3ff68
549	a dual lumen left subclavian central venous catheter terminates in the right atrium unchanged from prior exam . the heart size is stably enlarged . vascular calcifications are seen along the aortic arch . there is perihilar and basilar prominence of the pulmonary vasculature compatible with fluid overload . mild interstitial abnormalities are unchanged from prior exam . there is blunting of the bilateral posterior costovertebral angles likely representing a very small effusions . patchy consolidations in the right middle lobe may represent pneumonia in the right clinical circumstances . . right middle lobe patchy consolidation which could reflect infectious process . . perihilar and basilar vascular prominence compatible with fluid overload .	Consolidation&&Edema&&Pneumonia	17340686	51203739	e023c3e4-39101fc9-0c1d4cb4-1566e997-0080096e
550	pa and lateral views of the chest are obtained . since the prior exam, there has been removal of the left and right picc lines . linear subsegmental right lower lung atelectasis is noted . there is no evidence of pneumonia or chf . no pleural effusion or pneumothorax . cardiomediastinal silhouette is stable with mild cardiomegaly redemonstrated . degenerative changes at the right shoulder are moderate . an l compression fracture is stable from a ct from . there is increased vertebral body loss of height involving a compression fracture at t compared with a prior radiograph . this compression though is new compared with the ct dated . subsegmental right lung base atelectasis . increasing loss of vertebral body height at t . stable l compression fracture . right shoulder humeral djd . interval removal of picc lines .	Atelectasis&&Fracture&&Support Devices	18512911	53933599	81662f3f-0c97fb86-66099abe-260ad401-e1d61e16
551	the right internal jugular central venous catheter is malpositioned, coursing cephalad within the right internal jugular vein, tip off of the superior borders of the film . remainder of the exam is unchanged . malposition right internal jugular central venous catheter coursing cephalad within the neck .	No Finding&&Support Devices	14851532	54675277	33e89953-a3344800-0b12cc28-ae13c39f-f350e654
552	the extensive bilateral parenchymal opacities, bilateral pleural effusions, cardiomegaly, and basal atelectasis are unchanged . no new opacities . unchanged monitoring and support devices .	Atelectasis&&Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Support Devices	10975446	56122911	71472bea-4861bb4b-57725cca-447baed5-d7d18080
553	there are increased diffuse bilateral interstitial opacities, consistent with edema . additionally, small bilateral pleural effusions are present . no pneumothorax is seen . the heart size is mildly enlarged . there are calcifications of the aortic arch . a left subclavian vascular stent is seen, new from the prior examination . a stent in the left arm is inchanged . pulmonary edema . small bilateral pleural effusions .	Edema&&Pleural Effusion	16772702	57167682	8e9b736c-1abf5111-086c325e-36cc49cf-82791ceb
554	the picc ends in the upper svc . the cardiomediastinal silhouette is normal, although evaluation is somewhat limited by patients rotation . there is a moderate right pleural effusion, similar in size from the previous study on . no left pleural effusion is present . there is no consolidation or pneumothorax . tip ends in the upper svc . results were communicated with the iv team at am . on via telephone by dr . .	No Finding	11204646	57940242	cdd198d4-7b34ff26-cdf455d8-f2c979c2-93535229
555	the lungs are clear of focal consolidation, effusion, or pulmonary edema . the cardiomediastinal silhouette is stable . median sternotomy wires again noted . hypertrophic changes seen in the spine . no acute cardiopulmonary process .	No Finding	17318449	53591854	fd6e4f88-f10a601f-5ab99df7-15c792e7-3edf3e2c
556	comparison is made with prior study performed hours earlier . there is minimal decrease in still large amount of air in the pleural cavity in the right upper hemithorax . two right chest tubes are in unchanged positions . right subcutaneous emphysema is new . cardiac size is normal . cardiomediastinal silhouette is midline . widened mediastinum, a post-op change, is stable . et tube is in standard position . right lower lobe has better aeration . there is persistent opacity in the right middle lobe . mild interstitial edema has improved . the patient has known emphysema .	Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Support Devices	19991135	51478737	e9fed58f-81080573-29e7c963-c3bae1ff-a15dab90
557	the cardiac silhouette is less prominent and the pulmonary vascularity is substantially improved . mild atelectatic changes are seen at the bases .	Atelectasis&&Cardiomegaly	15032623	52225063	ee2fe22f-087ea688-eacd294b-68409208-45f2430d
558	et tube tip is cm above the carina . ng tube tip is in the stomach . heart size and mediastinal contours are stable . bilateral pleural effusions are noted as well as most likely present mild pulmonary edema . no pneumothorax is seen .	Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	12952223	52630381	81e8871e-6dcf3fbb-f5b0f14f-bc932fbe-4ea03e27
559	frontal and lateral chest radiographs heterogeneous consolidation within the mid-to-upper left lung corresponds with opacity of concern on prior chest ct, suspicious for reccurrence of malignancy . additional concerning nodules seen on prior ct are not well characterized on this radiographic examination . linear opacities in the lung bases and right mid lung likely reflect areas of subsegmental atelectasis . prominence of the interstitium is likely related to technique . no overt pulmonary edema is evident blunting of the bilateral costophrenic angles may be due to small bilateral pleural effusions . cardiomediastinal and hilar contours are within normal limits . . heterogeneous opacity in the left mid lung, concerning for primary lung malignancy, better characterized on recent prior ct . . possible small bilateral pleural effusions . no overt pulmonary edema .	Lung Opacity&&Pleural Effusion	14851532	57001723	5828d9a8-9cf90a1a-c0941ded-b106d21c-4625544a
560	moderate cardiomegaly, mediastinal venous engorgement and mild interstitial edema have all worsened indicative of cardiac decompensation . no focal pulmonary abnormality is present to suggest pneumonia, nor is there is substantial pleural effusion or any indication of pneumothorax .	Cardiomegaly&&Edema&&Pleural Effusion&&Pneumonia&&Pneumothorax	13475033	53018485	25fd1806-d10b52d5-9a3103c0-66e21a5f-36fb5086
561	bilateral lung volumes are low . since , mild pulmonary vascular congestion and pulmonary edema has worsened . small bilateral pleural effusions are unchanged . mildly enlarged heart size and some mediastinal widening is worse than before . status post median sternotomy with intact sternal sutures . mild pulmonary edema, mild pulmonary edema and mild-to-moderate cardiomegaly with some mediastinal widening is worsened since .	Cardiomegaly&&Edema	16672854	50841626	e8ee2b4d-8ea54f5a-fbbd13ae-b0322e55-8d89e12b
562	the lungs are hyperinflated, consistent with copd . the patient is status post sternotomy . heart size is at the upper limits of normal or slightly enlarged . the pulmonary hila are slightly prominent with a tapered configuration, which could reflect pulmonary hypertension . there is biapical fibronodular scarring, probably with retraction of the hila . no chf, focal consolidation or effusion is identified .	Lung Opacity	17392550	57779343	04df00d4-612ef140-93265d75-e89c65e2-d6451eb9
563	comparison is made to the prior study from . there is a right basilar chest tube . there remains a moderate to large right-sided pleural effusion which is stable in size . there is a right-sided port-a-cath with distal lead tip in distal svc . there is stable cardiomegaly . the left lung is clear . overall, there is no appreciable change . no pneumothoraces are seen .	Cardiomegaly&&Pleural Effusion&&Support Devices	16826047	54140146	d2f3ca46-8acb3e22-648cbc5d-db7450d3-d3a634a6
564	cervical fusion hardware is noted . lungs are hyperinflated . there is no focal consolidation, effusion, or pneumothorax . the cardiomediastinal silhouette is normal . imaged osseous structures are intact . no free air below the right hemidiaphragm is seen . tiny clips seen in the left upper quadrant . no acute intrathoracic process .	No Finding	15114531	53909940	3a00ab90-4563967d-ad46d969-ae884a78-c7f2dd2b
565	pa and lateral chest radiographs demonstrate low lung volumes and distended bowel as described on concurrent ct abdomenpelvis . there are patchy opacities suggesting minor dependent bibasilar atelectasis . there is persistent cardiomegaly . there is no pneumothorax or pleural effusion . suggestion of pulmonary venous hypertension is unchanged from prior radiograph .	Atelectasis&&Cardiomegaly&&Lung Opacity	10532326	53897449	0df9bbe7-ea299297-6717c3a6-4faece0e-15ca4a73
566	a permanent pacer is again noted with leads terminating in the right atrium and right ventricle in satisfactory position . the metallic portion of an aortic valve prosthesis is again visualized . sternotomy wires are also present . heart size remains normal . the mediastinal and hilar contours are normal . there is no pleural effusion or pneumothorax . the lungs are clear . . expected normal position of permanent pacer electrodes . . stable chest radiograph, no pneumothorax .	No Finding&&Support Devices	16043637	57929429	4121b513-0b19d16a-eae78b94-9ad9e2c6-d0f50262
567	there has been substantial improvement in the degree of pulmonary edema with only mild residual elevation of pulmonary venous pressure . persistent opacification at the bases is consistent with pleural effusion and volume loss, especially in the retrocardiac region .	Edema&&Lung Opacity&&Pleural Effusion	13586204	50270173	8dbd2003-7d7887eb-6d6e4bad-7b02ceed-acdeda24
568	ap and lateral views of the chest were provided . the lungs appear clear . eventration of the right hemidiaphragm noted . cardiomediastinal silhouette is normal . bony structures are intact . old left clavicular shaft deformity noted . prior study is dated .	No Finding	13475033	59116034	748c4a64-47da4847-4a87a967-a4bec5ab-352fc0c9
569	frontal and lateral chest radiographs a right-sided hemodialysis catheter terminates at the right atrium . again seen are reticular interstitial opacities distributed evenly across both lungs, stable over multiple prior radiographs, previously attributed to chronic hypersensitivity pneumonitis on the chest ct from . the cardiac and mediastinal silhouettes are unchanged . the central pulmonary vessels appear more prominent since the study . superimposed mild edema cannot be excluded . there is no focal consolidation, pleural effusion, or pneumothorax . again seen reticular interstitial opacities distributed evenly across both lungs, stable over multiple prior radiographs, previously attributed to chronic hypersensitivity pneumonitis . mild superimposed fluid overload cannot be excluded no focal consolidation .	Consolidation&&Lung Opacity	13475033	59787158	b0a3c7f8-26d03d87-2b85a969-b02fab24-22c44433
570	lung volumes are somewhat low, which accentuates bronchovascular markings but the lungs appear clear . the cardiomediastinal and hilar contours are within normal limits . there is no focal consolidation, pleural effusion or pneumothorax identified . no osseous abnormalities are identified . low lung volumes . no acute cardiopulmonary abnormality .	No Finding	19748558	56664513	f6996351-b7330fe0-c77b11b0-628b7301-475c940f
571	an esophageal stent, right picc line and tracheostomy tube are in standard position . necrotizing pneumonia in right lower lung is unchanged . a pigtail catheter is present in the right lower chest . as compared to the prior radiograph from , the coiled tip of this catheter is more medially placed . diffuse airspace opacities in the right upper lung are unchanged, whereas in the left lung, the airspace opacities and ill-defined mid lung consolidations have minimally decreased over last hourscardiomediastinal silhouette is stable .	Consolidation&&Enlarged Cardiomediastinum&&Lung Opacity&&Pneumonia&&Support Devices	13964474	53353191	67f96700-fa7ae0b7-52f52249-55e93d91-53fcc6c8
572	there has been removal of pleural fluid from the left hemithorax . no evidence of pneumothorax . coalescent areas in the left upper and lower zones could well reflect regions of consolidation . the right lung is essentially clear . right ij central catheter extends to the lower portion of the svc .	Consolidation&&Support Devices	19404187	58274681	2105a3d5-135b0241-ad3232b4-24f593cc-3d0862a6
573	compared to the study from the prior day, there has been some interval increase in the left-sided effusion . there continues to be volume loss at both bases . right-sided picc line tip is in the distal svc .	Pleural Effusion&&Support Devices	16313531	59994014	605a5651-5fb67eb8-b56ccc7e-8fce40db-0924c841
574	diffuse increase in interstitial markings as well as pulmonary vessel engorgement are suggestive of moderate to severe pulmonary edema . cardiac silhouette is moderately enlarged . there is no pleural effusion or pneumothorax . moderate to severe pulmonary edema .	Edema	13475033	52240207	c5f6b48e-5ca7ae46-4fab692c-24718944-688b465f
575	the patient has undergone a right thoracotomy and decortication . three right chest tubes are in situ . there is a minimal right basal pneumothorax at the site of chest tube insertion . no evidence of tension . mild right basal postoperative atelectasis . in the interval, the patient has been intubated, the tip of the tube projects . cm above the carina . moderate cardiomegaly, unremarkable and unchanged left lung .	Atelectasis&&Pneumothorax&&Support Devices	13352405	50344973	ce1985cc-a6c42ebf-5ff6ebaa-52ca117e-11ae0c1c
576	a right picc ends in the low svc . heart size is mildly enlarged . there is no overt pulmonary edema . there is no focal lung consolidation . there is no pneumothorax or pleural effusion . no focal consolidation to suggest pneumonia . stable mild cardiomegaly .	Cardiomegaly&&Pneumonia	16508811	56646773	e54056af-0e47378b-d4809463-9d218a22-17591156
577	subtle linear density in the left mid to lower lung is most compatible with platelike atelectasis . no convincing evidence for pneumonia or edema . no large effusion or pneumothorax . the cardiomediastinal silhouette is normal . imaged osseous structures are intact . no free air below the right hemidiaphragm is seen . no acute intrathoracic process .	No Finding	19623993	50373067	66607c54-01766ee9-0296b1fd-b642145d-24ea1577
578	as a consequence, the structures at the lung bases appear denser than on the previous image . however, there are no new parenchymal opacities or abnormalities noted . moderate cardiomegaly persists . the right chest tube has been removed .	Cardiomegaly&&Lung Opacity	14851532	55077014	ff9478db-4ce6ed74-e3b6d8f2-320694e0-e8a21817
579	lung volumes are decreased compared to the prior exam . heart size remains within normal limits . mediastinal contour is unchanged . within the right upper lobe and perihilar region, there is chronic opacification compatible with radiation fibrosis . mild pulmonary edema is demonstrated with perhaps slight enlargement of a moderate size right pleural effusion which is partially loculated superiorly and medially . right basilar opacification may reflect atelectasis but infection is not excluded . no pneumothorax is seen . mild pulmonary edema with moderate right pleural effusion, perhaps slightly increased compared to the prior study . chronic opacity within the right upper lobe and perihilar region is compatible with radiation fibrosis . right basilar opacity may reflect atelectasis but infection is not completely excluded .	Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion&&Pleural Other&&Pneumonia	19720782	57890092	38d03b04-0d7ed79f-2cf5f34d-96d831d3-227a44aa
580	there is mild cardiomegaly . no chf or definite focal infiltrate . minimal crowding of vessels in the right cardiophrenic angle likely reflects atelectasis . no effusion . compared with and allowing for technical differences, i doubt significant interval change .	Atelectasis&&Cardiomegaly	19623993	59732891	1b2918e7-7299bc31-009a6db9-9ac44163-479cf007
581	since the prior study, there is little change in opacification of the right lung base, likely combination of atelectasis and effusion, moderate cardiomegaly, and location of pacemaker leads and prosthetic aortic and tricuspid valves . infection at the right lung base cannot be excluded . there is mild pulmonary vascular congestion . unchanged mild cardiomegaly, mild pulmonary vascular congestion, and small right pleural effusion with adjacent right basilar opacification, likely atelectasis but infection cannot be excluded .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia	19182863	55563866	1b28921d-4ff1da35-9168d4d3-3ae39a1f-15dedb6c
582	frontal and lateral views of the chest demonstrate new pulmonary and mediastinal vascular congestion, perihilar haziness and chronic moderate cardiomegaly . new right infrahilar consolidation could be regional edema or concurrent pneumonia . the leads of an atriobiventricular icd are unchanged in position, as are two additional right sided right ventricular leads which cross the chest wall from right to the left pectoral pacemaker . there is no pleural effusion, or pneumothorax . . acute exacerbation of recurrent chf . possible right lower lobe pneumonia in the .	Cardiomegaly&&Edema&&Pneumonia	11293517	56805129	d8e53bde-7150419c-176ca653-637955cb-4fed0efd
583	portable frontal view of the chest demonstrates low lung volumes . there is no pneumothorax . the left costophrenic angle is obscured, suggestive of a small pleural effusion . retrocardiac opacity is noted, more conspicuous from prior exam . there is no right pleural effusion . there is apparent thickening of the minor fissure . calcified lymph nodes within the ap window are again noted . the hilar and mediastinal silhouettes are unchanged . the heart size is top normal . there is no pulmonary edema . port-a-cath tip projects over cavoatrial junction . partially imaged upper abdomen is unremarkable . retrocardiac opacity is more conspicuous from exam, which likely represents atelectasis or infection in the appropriate clinical setting . possible small left pleural effusion .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Pneumonia	11413236	59798652	09b5b0a8-2cb137c2-240ac597-66295226-2b2af51c
584	multifocal consolidations, larger on the right lung are unchanged as well as complex right lower lobe fluid collection . cardiomediastinal contours are unchanged . there is no evident pneumothorax . lines, tubes, and esophageal stent are in unchanged standard position .	Consolidation&&Enlarged Cardiomediastinum&&Support Devices	13964474	51994168	6417dbb4-5d20a66b-bc8a091b-85f4b83f-4543f0a8
585	normal heart lungs hila and pleural surfaces . distention of the azygos vein is a long-standing finding in this patient, probably of no clinical significance .	No Finding	19623993	56454351	cb8d35f1-a0181bde-a8292078-9c949b30-f3ba3ace
586	has compared to the prior study there is no substantial change in multifocal opacities with minimal improvement at the level of the left mid lung . heart size and mediastinum are unchanged . no interval development or increase in pleural effusion demonstrate .	Cardiomegaly&&Enlarged Cardiomediastinum&&Lung Opacity	13921768	56900002	d025d08b-868642d3-1968cca6-f44c2f1d-4c1dd9c7
587	borderline size of the cardiac silhouette without evidence of pulmonary edema or pleural effusions . small pericardial fat pad on the left . known and healed left rib fracture . no evidence of pneumonia . mild tortuosity of the thoracic aorta .	Cardiomegaly&&Fracture	19565388	54621108	a9510716-02da91b0-61532c26-a65b2efc-c9dfa6f1
588	pa and lateral views of the chest are compared to previous chest x ray from and chest ct from . there is a large right lower lung opacity, compatible with pleural effusion . given relatively mild mediastinal shift to the left, there must be components of atelectasis in the right lower and right middle lobes with possible superimposed consolidation . the right upper lobe is grossly clear . small left pleural effusion is also seen however, the left lung remains grossly clear . there is a rounded density projecting in the retrosternal clear space on the lateral . cardiomediastinal silhouette is difficult to assess, however, is slightly shifted towards the left . osseous and soft tissue structures are unremarkable . new large right-sided pleural effusion with underlying atelectasis and possible consolidation in the middle and lower lobes . ct scan may offer additional detail of underlying parenchymal abnormalities . small left-sided pleural effusion .	Atelectasis&&Consolidation&&Pleural Effusion	10410641	53850317	20f54ecb-20a32ed8-5f27bfe6-e9d07de1-ce76357e
589	there is still an area of increased density in the left upper lobe projecting over the anterior aspect of the second rib measuring approximately . cm, improved from . the cardiomediastinal silhouette is normal . there is no pleural effusion or pneumothorax . improving left upper lung zone consolidation compared to .	Consolidation	19404187	57780214	480f169c-15ef13a4-4ca3b85d-181a240e-edc79169
590	the lung volumes are low, accentuating the heart size, which is persistently mildly enlarged . there is mild pulmonary vascular congestion . the right subclavian vein stent is in place . there is no pleural effusion, pneumothorax, or focal consolidation worrisome for pneumonia . no evidence of subdiaphragmatic free air . mild pulmonary vascular congestion and stable mild cardiomegaly . no subdiaphragmatic free air .	Cardiomegaly&&Edema	14744884	57238617	2dbc33d8-a5b00a49-a6bfeea2-cff69532-91a4aac1
591	relatively wide mediastinum, caused by mediastinal lipomatosis documented on a pet-ct examination from . borderline size of the cardiac silhouette . no evidence of pleural effusion, pulmonary edema, or pneumonia . no pneumothorax .	Cardiomegaly&&Enlarged Cardiomediastinum	17257913	52072042	e872e235-dee5ac10-dfd4a5e4-e40a9a02-73e5ee8a
592	ap portable view of the chest moderate left pleural effusion, essentially unchanged since prior exam . left lung base consolidation is present . no large right pleural effusion is seen . peripheral right lung base opacity is more conspicuous since prior exam . moderate cardiomegaly persists and mild interstitial pulmonary edema is relatively similar . hilar and mediastinal silhouettes are unchanged . aortic valve calcifications are seen . multiple surgical clips project over cardiac silhouette compatible with prior cabg . sternotomy wires appear intact . the mitral valve prosthesis is in place . there is no pneumothorax . . in comparison to exam, moderate left pleural effusion, mild interstitial pulmonary edema, and cardiomegaly is unchanged . . left lung base consolidation, likely collapse or superimposed infection . . right lung base peripheral opacity more conspicuous since prior exam and may represent infection, infarction or organizing pneumonia .	Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia	15259244	55259608	6973b010-49ac25bb-d2e035bc-667938df-855b7f4c
593	the lungs are clear . there is no consolidation, effusion, or edema . the cardiomediastinal silhouette is within normal limits . multiple fractured median sternotomy wires are again noted . no acute osseous abnormalities, old healed left anterior rib fractures are noted . surgical clips in the right upper quadrant suggest prior cholecystectomy . no acute cardiopulmonary process .	No Finding	19499595	57390903	8f866521-2083f0bb-a12df756-24346ecd-5e484e40
594	ap upright and lateral views of the chest provided . vascular stent is seen in the region of the right brachiocephalic vein . the heart is moderately enlarged . there is mild interstitial pulmonary edema . previously noted et and ng tubes have been removed . no large pleural effusion . mediastinal contour is stable . bony structures are sclerotic which could reflect renal osteodystrophy . mild cardiomegaly with mild interstitial pulmonary edema .	Cardiomegaly&&Edema	14744884	50952862	2343dc55-38e48c6b-7156e38e-160821ce-be18c5a3
595	the monitoring and support devices remain in place . continued substantial enlargement of the cardiac silhouette with bilateral pleural effusions, compressive basilar atelectasis, and moderate pulmonary edema .	Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	12189285	54523680	f2b4864c-c60e842d-258889c6-61e08bca-a7990195
596	the dobbhoff tube tip is in the proximal stomach . note is made that the lung apices were excluded from the field of view . the known chronic changes in the right lung and in the left lung base are redemonstrated . heart size and mediastinal silhouette appear unchanged . the patients et tube is not clearly seen, extubated .	Cardiomegaly&&Enlarged Cardiomediastinum&&Support Devices	17032538	55502536	5653278e-a63fbb15-f2942f21-627563af-20b8e76e
597	right picc line ends at mid svc . left-sided pacer defibrillator with leads through the left transvenous approach is seen to end in the right atrium, right ventricle, and coronary sinus . minimal right basal atelectasis is unchanged . there are no other lung opacities of concern . top normal heart size, mediastinal and hilar contours are stable . right picc line ends at mid svc . small bibasilar atelectasis is unchanged .	Atelectasis&&Support Devices	12475198	56545860	c54b631c-b7726bc9-2bb21f6f-25f9eee0-57a0d6a6
598	heart size is normal . the aorta is tortuous . unchanged widening of the mediastinum attributable to mediastinal lipomatosis is re- demonstrated . hilar contours are unremarkable . pulmonary vasculature is not engorged . lungs are clear . no pleural effusion, focal consolidation or pneumothorax is demonstrated . there are no acute osseous abnormalities . no acute cardiopulmonary abnormality .	No Finding	17337033	56541072	66fece2b-2fccf418-d23f1eda-9dde45e2-d85df8da
599	compared to the prior study there is no significant interval change . no change .	No Finding	15131736	56589755	5561133e-55a2fb38-51a45d25-98a90295-40203962
600	enlarged left effusion is minimally increased, allowing for difference in positing of the patient . lines and tubes are in unchanged standard position . there are low lung volumes . cardiomegaly is stable . widened mediastinum has minimally increased . right lower lobe atelectasis has markedly improved . there is no pneumothorax . right shoulder arthroplasty is again noted . left upper lobe opacity is unchanged . mild vascular congestion is stable .	Atelectasis&&Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Support Devices	19075045	53059312	7b21ad7a-37b07365-275b2da4-a938c9e4-5342d9d8
601	cardiac silhouette remains enlarged, accompanied by pulmonary vascular congestion . interstitial edema has improved in the interval . bibasilar atelectasis is again demonstrated, with improvement on the left . bilateral small pleural effusions are also evident as well as multiple calcified granulomas in the left lung .	Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion	12185775	51682896	996aed23-e2ca70b1-ece8d46f-47a6d9f9-dbb95bfe
602	portable frontal chest radiograph previously identified linear opacities in the left lung base have improved compared to recent prior examination from . however, a new confluent opacity in the right lung base is concerning for recurrent pneumonia, likely due to aspiration . the upper lungs are clear . there is no pneumothorax . there is no vascular congestion or large pleural effusion . cardiomediastinal and hilar contours are within normal limits .	Consolidation&&Pneumonia	19565653	51006959	b5599aff-71fe317d-6e792fbc-d586d408-3b18b394
603	moderate cardiomegaly is unchanged . pulmonary vascular redistribution is mild, and there is no pulmonary edema or pleural effusion . transvenous right atrial and right ventricular pacer leads are in standard placement . spinal stabilization hardware in place in the low thoracic spine, with transpedicle screws in a fractured vertebral body, just below moderately wedged vertebral body, comparable in appearance to .	Cardiomegaly&&Fracture&&Support Devices	18417750	56026588	db56756a-36970d83-92b338a6-23a982c5-fe090973
604	comparison is made with prior study, ct, . tracheostomy tube is in a standard position . esophageal stent is noted . there has been interval worsening of diffuse multifocal consolidation, the largest in the right lower lobe . there is no evident pneumothorax or enlarging pleural effusions . cardiac size is normal . the mediastinum is unchanged .	Consolidation	13964474	50634232	509fd9e1-43b8892b-e1fc8e15-f4cb2ac1-b2e65974
605	right central venous catheter terminates in the right atrium . left pectoral pacemaker and its leads are in unchanged position . sternotomy wires are intact . mild bibasilar opacities are likely atelectasis in setting of low lung volumes . enlarged pulmonary vessels are slightly larger compared to . mildly enlarged cardiac silhouette is similar to before . trachea is mildly deviated to the left with luminal narrowing, similar to . . slightly increased pulmonary vascular congestion compared to . . trachea is mildly deviated to the left with luminal narrowing, similar to but increased compared to . possible etiologies may include enlarged thyroid or other mass . notification the impression . was discussed with , md .	Edema&&Lung Lesion	19075045	55300369	f3d507c2-a374ec9a-30b7c848-c991828c-333297ff
606	mild cardiomegaly and mediastinal contours are unchanged . the patient is status post cabg . multiple bilateral lung nodules are unchanged . there are no new lung abnormalities, pneumothorax, or pleural effusion . mediastinal wires are aligned .	Cardiomegaly&&Enlarged Cardiomediastinum&&Lung Lesion&&Pleural Effusion&&Pneumothorax	16773796	50173735	af678ce2-4efcb795-3e500be1-4aab8bb8-a811632d
607	no central venous line visualized . no pneumothorax identified . otherwise, stable examination with unchanged left base retrocardiac opacification likely representing a combination of atelectasis and effusion . cardiomediastinal and hilar contours are unchanged . unchanged exam . no pneumothorax .	No Finding	15259244	56680584	ef97e724-84de20c9-3e73a8b5-65a01e95-2f82137a
608	a cluster of heterogeneous opacities in the right lower lung has has continued to grow since . otherwise, the lungs are clear . moderate cardiomegaly, including severe left atrial enlargement is chronic there is no pulmonary vascular congestion or edema . the thoracic aorta is heavily calcified . there may be a new small, right pleural effusions or pneumothorax . slowly progressive chronic right pneumonia, could be exogenous lipoid pneumonia, but tuberculosis is in the differential . ct scanning recommended . nurse and i discussed the findings and their clinical significance by telephone at the time of dictation .	Pneumonia&&Support Devices	18874374	58085167	4d9de708-0d2bc7fe-d09123f4-cddd314f-81bceaad
609	pa and lateral views of the chest are compared to previous exam from . compared to prior, there has been no significant interval change . there is no evidence of focal consolidation . increased interstitial markings on one of the lateral views resolves on the second lateral view, likely due to improved inspiratory effort . cardiomediastinal silhouette is unchanged, as are the osseous and soft tissue structures . calcific densities projecting over the neck and left upper quadrant are unchanged, as are the vascular stents . no evidence of acute cardiopulmonary process .	No Finding	19061282	50010466	144f46e1-630ba5e3-82d84674-9f0575c5-6017bdd1
610	there is persistent elevation of the right hemidiaphragm with a superimposed right basilar opacity suggestive of an effusion, similar in size when compared to prior . there is also pulmonary vascular congestion, increased compared to prior . there is no definite focal consolidation . cardiomediastinal silhouette is unchanged . elevation of the right hilum with increased density in the right paratracheal region compatible with prior post-treatment changes, better characterized on prior ct . persistent right-sided effusion and pulmonary vascular congestion .	Edema&&Pleural Effusion	19720782	55652987	8f27588d-1bdebd8f-27072fe7-d51a60d5-c6968fcf
611	temporary pacemaker wire appears in appropriate position . sternotomy wires and mediastinal clips are stable . the mild-to-moderate cardiomegaly is unchanged . no focal consolidation, pleural effusion or pneumothorax . no acute cardiopulmonary process . temporary pacemaker appears in appropriate position . mild cardiomegaly .	Cardiomegaly&&Support Devices	12475198	58466988	20ac90a4-87044528-f3284c7b-e22cd4ff-feeeb0df
612	ap upright and lateral chest radiographs were obtained . known interstitial lung disease contributes to a bilateral perihilar interstitial abnormality . in addition to the chronic findings there is bilateral ground-glass opacity and interstitial thickening, predominantly radiating from the hila . cardiomegaly remains moderate . aortic arch calcifications are unchanged . a right-sided picc line terminates in the low svc . a left chest port-a-cath terminates in the right atrium . vertebroplasty changes are stable . new pulmonary parenchymal abnormalities on top of chronic pulmonary fibrosis most likely represents pulmonary edema . infection is less likely .	Edema&&Pleural Other&&Pneumonia	10439781	50501762	58c735ba-cc7d2492-f290f622-154bc6f2-5fdc853c
613	ap upright portable radiograph was obtained . nasogastric tube, left internal jugular central venous catheter, and endotracheal tube which terminates cm above the carina are in unchanged position . left basilar consolidation is decreased with mild pulmonary edema . the heart and mediastinum are unremarkable with calcification of the aortic knob . moderate-to-severe degenerative change is seen in the shoulders . enlarged left pulmonary arterial contour could reflect pulmonary arterial hypertension .	Consolidation&&Edema	10268877	53021891	046bbbe6-823f11ab-c43a868b-b3342241-8cf3254b
614	cervical spinal hardware again noted . clips noted in the upper abdomen . there is no focal consolidation, effusion, or pneumothorax . the cardiomediastinal silhouette is normal . imaged osseous structures are intact . no free air below the right hemidiaphragm is seen . no acute intrathoracic process .	No Finding	15114531	52731689	b91c97ed-5177ed0b-fa1759b1-28b3e6ac-e518d525
615	as seen on multiple prior exams, there is generalized chronic interstitial fibrosis manifested by coarsened interstitial markings which is compatible with provided clinical history of ild . there is no superimposed consolidation to suggest pneumonia . no pleural effusion or pneumothorax . the cardiomediastinal silhouette is stable . no free air below the right hemidiaphragm . an old left mid shaft clavicle deformity is again noted . no acute bony abnormalities . no superimposed pneumonia in this patient with known ild .	No Finding	13475033	51820068	10a3cd75-c86d7f2a-f350e7bc-b872fc06-79271f33
616	the heart size is normal . the hilar and mediastinal contours are unremarkable . the lungs are well expanded and clear . the patient is status post median sternotomy with aortic valve repair . there is a pacer with the leads terminating appropriately in the right atrium and right ventricle . there is an aortic valve prosthesis . there is no pleural effusion or pneumothorax . there are no focal consolidations . no acute abnormalities identified to explain patients cough and asthma flare .	No Finding	16043637	59440363	368f87de-9f5ace1d-685ab2ab-845aa8b8-5fd1e2ed
617	portable ap radiograph of the chest was reviewed in comparison to fluoroscopic spot views . current ap radiograph of the chest demonstrates no evidence of pneumothorax . right basal opacities are demonstrated most likely representing a combination of known nodular process, consolidation and post-procedure atelectasis . no interval development of pleural effusion is demonstrated .	Atelectasis&&Consolidation&&Lung Opacity	11474065	58468356	a92c319b-35630ca5-b7bea7b5-225b1bce-39e89eca
618	there is a a mild increase in extent and severity of the pre-existing parenchymal opacities . most likely, the opacities reflect a combination of pulmonary edema and pneumonia . unchanged moderate cardiomegaly and normal alignment of the sternal wires as well as normal course of the pacemaker wires . there is unchanged blunting of the left costophrenic sinus, potentially resulting from a small left pleural effusion .	Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	12475198	57980363	b28c193b-b49d6d0c-3105d352-5dc8e17f-3d0e39cd
619	chest radiographs there is a new consolidation in the retrocardiac left lung base, concerning for pneumonia or aspiration . no pleural effusion or pneumothorax is seen . there is mild pulmonary vascular congestion . the mediastinal silhouette is unchanged . multiple intact mediastinal wires relate to prior sternotomy .	Consolidation&&Pneumonia	17318449	55484286	e9683fa3-283e5f0c-c05c217c-b320d070-4a8e9fc0
620	lung volumes are mildly decreased . blunting of the bilateral costophrenic angles has not changed since at least . cardiac and mediastinal contours are normal . there is no evidence of pneumothorax or pneumomediastinum . no acute cardiopulmonary process, pneumothorax, or pneumomediastinum .	Pneumothorax	16848073	50416709	33afaafe-a1605f54-f33616de-424605bf-7c961442
621	pa and lateral chest radiograph is compared to prior study dated . there has been little interval change with no focal consolidation concerning for pneumonia identified . lungs are hyperinflated . patient is status post radiation therapy to the right lung . previously seen right lower lung sub cm nodular opacity is not definitely visualized . cardiomediastinal contours are stable . there is no pleural effusion or pneumothorax . visualized osseous structures demonstrates no acute abnormality . no acute intrathoracic abnormality . hyperinflated lungs with chronic radiation changes .	No Finding	14295224	58409548	84ee4f3c-27c6c5ff-e84f61b7-1ab68ce3-99820e85
622	pacemaker leads terminate in right atrium and ventricle . right picc line tip is at the level of mid svc . heart size and mediastinum are unchanged . no interval progression of minimal left basal opacity demonstrated . there is no pleural effusion . there is no pneumothorax .	Cardiomegaly&&Enlarged Cardiomediastinum&&Support Devices	18487334	50016413	edf64680-6038da78-f6693f72-535ac2bb-feee4c8b
623	heart size is enlarged but stable . there are chronic coarsened interstitial markings . the opacity in the left suprahilar region is partially attributed to postsurgical scarring as well as the previously seen consolidation, however is not well evaluated on this single frontal projection . right pleural effusion is increased, now small to moderate . . increased right pleural effusion since the prior radiographs . . moderate cardiomegaly, stable . . left suprahilar opacity is attributed to postsurgical scarring and a previously seen consolidation, however is less well evaluated on the current radiograph . frontal and lateral projections can be obtained for further evaluation as needed .	Cardiomegaly&&Consolidation&&Lung Opacity&&Pleural Effusion	14851532	57086484	f9af4910-694f5e1f-75e4a512-0bd1c6dc-e4616d88
624	et tube is in standard position . the tip is . cm above the carina . large right hydropneumothorax and collapse of the right lung is unchanged . there is mild vascular congestion seen in the left lung . the cardiomediastinum is midline . right basal pigtail catheter is in place .	Atelectasis&&Edema&&Enlarged Cardiomediastinum&&Pneumothorax&&Support Devices	14387068	53200737	904ed560-196507e7-79c10549-789f9b1e-f0ee6cf7
625	pa and lateral chest radiographs again seen are two cavitary lesions in the right lung, with the largest in the right perihilar region, now measuring at least cm in craniocaudal . this lesion is slightly larger since the prior study where it measured cm . an airfluid level is seen in this lesion . the smaller cavitary lesion in the right upper lobe is stable . no new cavitary lesion is seen . multiple areas of ground glass opacities, with more confluent consolidation in the left upper lobe are similar to the prior ct . no pleural effusions or pneumothorax is seen . . cavitary lesions in the right lung, consistent with known aspergillosis, with interval increase in the size of the largest lesion since . . stable multifocal ground glass opacities, with more confluent consolidation in the left upper lobe .	Consolidation&&Lung Lesion&&Lung Opacity	17270742	50255843	a14d938c-b4edf238-b00dca2d-348b1732-ab6959a5
626	portable ap chest radiograph demonstrates stable positioning of the left picc . pulmonary edema has cleared significantly since . however, there still is a moderate pleural effusion and opacification of the on the left lower lung . mild cardiomegaly is stable . there is no pneumothorax . significant improvement of pulmonary edema from . persistence of left lower lung opacification and pleural effusion makes infection most likely, given this patients history .	Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia	16855430	55801123	6de51358-d77c44f7-19d5cd49-0d32b6fa-15f71ae5
627	frontal and lateral chest radiograph there are diffuse interstitial opacities which are new since the prior examination . though likely due to interstitial pulmonary edema given evidence of prior cardiac surgery, there is no evidence of central venous engorgement, cardiomegaly or pleural effusions . an alternative possibility would be atypical infection in the appropriate clinical circumstance . no confluent consolidation is identified . there is no pneumothorax . mediastinal and hilar contours are within normal limits and unchanged from prior . mild cardiomegaly is stable . post-surgical changes from prior cabg are unchanged . median sternotomy wires appear grossly intact .	Edema&&Lung Opacity&&Pneumonia	11879886	54357764	94795c9f-9f6f801d-ed57d02c-5e9e02be-b35bf9a1
628	moderate bilateral pleural effusion, left-greater-than-right, increased since . pulmonary vascular congestion borderline pulmonary edema and mild to moderate cardiac enlargement are unchanged .	Cardiomegaly&&Edema&&Pleural Effusion	13881772	56214455	aaae2ccb-5195b34a-97d13c9d-2f9ad735-44a7d31a
629	there is little change . again there is enlargement of the cardiac silhouette in a patient with previous aortic valve replacement and dual-channel pacer device with leads in the appropriate position . there may be mild elevation of pulmonary venous pressure . no evidence of acute focal pneumonia .	Cardiomegaly&&Support Devices	16043637	50775862	0396bbb8-89af3082-08140a7c-6f9e487e-44400561
630	the right venous introduction sheath has been removed and a left picc line has been inserted . the course of the line is unremarkable, the tip of the line projects over the mid svc . there is no evidence of complications, notably no pneumothorax . the pre-existing bilateral parenchymal opacities, mostly caused by pleural effusions and subsequent atelectasis, have decreased in extent .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Support Devices	11022245	56258422	848b0d7f-e95a86d4-0c40c933-7b2dc937-ac3d74c6
631	frontal and lateral chest radiographs the heart size is top normal . the hilar and mediastinal contours are within normal limits . there is no pneumothorax, focal consolidation, or pleural effusion . a round well-circumscribed left retrocardiac opacity corresponds to a known large hiatal hernia .	No Finding	14608347	59114520	3f0f5cbb-59b29982-c936c70b-36a6c86d-23da1915
632	there are slightly increased hazy opacities at the right lung base . the cardiomediastinal silhouette and hilar contours are unchanged . there is no pleural effusion or pneumothorax . median sternotomy wires, left chest pacemaker, as well as cardiac valve replacement are unchanged . slight increased hazy opacities at the right lung base which may reflect developing consolidation in the appropriate clinical setting .	Consolidation&&Lung Opacity	16043637	50848467	d4e70647-9bed282e-fd4e5b2f-d659e2f5-2b751fc4
633	cardiomediastinal contours are stable in appearance with persistent very large hiatal hernia . linear areas of atelectasis are present in both mid lung regions, and atelectasis is also identified in the lower lungs adjacent to the large hiatal hernia . no areas of consolidation are evident . small pleural effusions are present bilaterally . bones are diffusely demineralized, and multilevel compression deformities are present, most marked at the thoracolumbar junction and upper lumbar region, with similar appearance in the thoracic spine to recent ct of . the patient is status post vertebroplasty procedures in the upper lumbar spine . large hiatal hernia . multifocal atelectasis and small pleural effusions .	Atelectasis&&Pleural Effusion	15541869	55266015	176e0588-2fc59c9a-096765cc-a04685eb-e860762a
634	low lung volumes are seen compatible with patients history of fibrosis . diffusely increased interstitial markings are seen throughout the lungs, but these appear overall slightly worse when compared to prior . cardiomediastinal silhouette is grossly unchanged . no acute osseous abnormality is detected . findings compatible with pulmonary fibrosis with likely superimposed edema . please note that infection cannot be excluded and clinical correlation is necessary .	Edema&&Pleural Other&&Pneumonia	10867202	51707133	bb795051-0e639ffa-dbded494-287ec2f7-1a213bd1
635	there is no new consolidation . right lower lobe pneumonia that was present in prior exams has significantly improved . esophageal stent is in unchanged position . there is no pneumomediastinum or pneumothorax . there is no pleural effusion . mediastinal and cardiac contours are stable . conclusion there is no radiologic evidence of new pneumonia .	Pneumonia	19016834	55157144	405581ff-6e5fc337-04c3cddc-f4b5bffe-992dd6f7
636	frontal chest radiograph again seen is marked elevation of the left hemidiaphragm, with adjacent compressive atelectasis . gas is seen within the splenic flexure . there is mild central pulmonary vascular congestion with mild interstitial edema, new since . there is no pneumothorax or pleural effusion . the heart size is normal .	Edema	18338007	58103596	aa9371dd-52fdb59b-0cafade1-142e3fc3-116591ab
637	portable ap radiograph of the chest was reviewed in comparison to prior study obtained the same day earlier . the dobbhoff tube tip is currently in the stomach . the heart size and mediastinum is stable, but there is substantial interval improvement in pulmonary edema .	Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Support Devices	13031876	52130325	aa2e2a96-6ab4170e-539eb20c-0b4b2fc8-ee2502ad
638	the heart is normal in size . the mediastinal contours appear stable . again seen is a rounded opacity superimposed along the right cardiac border that appears similar to decreased and was previously shown to correspond to fluid and consolidation on the recent prior chest ct . there is a small persistent left-sided pleural effusion, but substantially decreased . a moderate right-sided pleural effusion has also decreased in size and is now small to moderate . there is a vague nodular opacity projecting over the right upper lung that is similar to better defined compared to the recent prior chest radiographs and may correspond to nodular focus along the right minor fissure seen on the ct study . patchy basilar opacities are nonspecific, but could be seen with a resolving infection or atelectasis associated with effusions . decreased pleural effusions . better defined nodule projecting over the right upper lung, of recent onset and potentially infectious or inflammatory in etiology . attention on followup radiographs is recommended to show resolution .	Lung Lesion&&Pleural Effusion&&Pneumonia	16662264	54325260	8e24f563-9ef7ca91-17190c86-0d7d6406-35d94599
639	the patient has a history of chronic interstitial lung disease with waxing and waning pulmonary edema and infection . today it is largely unchanged with diffuse infiltrative and interstitial opacities stable since . bilateral pleural effusion is essentially the same . cardiomediastinal silhouette is stable and demonstrates mild cardiomegaly . there is no pneumothorax . enteric tube is seen once again, entering the stomach and then out of field of view . right-sided picc terminates within the mid svc . an endotracheal tube terminates no less than cm from the carina . study is essentially unchanged from priors with unchanged diffuse infiltrative and interstitial opacities .	Lung Opacity	13078497	55575670	b93327f5-228e6c2c-3dde8c34-4ed1cae0-997d5fc4
640	single portable semi upright ap image of the chest . the lungs are well expanded and clear . there is no pleural effusion or pneumothorax . the cardiomediastinal silhouette is unchanged from prior exam with prominence of the right pulmonary artery again noted . the apparent enlargement of the aorta is due to adjacent atelectasis, as seen on recent ct . no acute cardiopulmonary process .	No Finding	19454978	59371821	603b6fc2-24054d99-32b7b09a-fd1fec08-ca0b306f
641	few opacifications have been present on numerous previous films . there is an increased density around the right chest tube which was not present on the chest x-ray of though was present on the prior chest x-ray of am . this is thought to probably represent atelectasis but could represent an area of infection .	No Finding	16751749	58084217	4161612b-04b736ab-f5965aae-1028ae0b-6bf634ae
642	the patient is status of previous radiation therapy in the right lung, with associated geographically marginated radiation fibrosis in the right paramediastinal and hilar regions with associated volume loss in the right lung . pleural thickening at the right apex and right costophrenic angle also appear stable . heterogeneous lung opacities in the right lung on the radiograph have resolved . no new areas of consolidation are identified . a sub cm nodular opacity is seen in the periphery of the right lower lung and appears unchanged from radiograph, corresponding to a subpleural nodule on ct of . . resolution of pneumonia since radiograph . no evidence of recurrence pneumonia .	No Finding	14295224	57142346	12f2d9bf-89dc902e-a9cd6aaa-22c63b63-c5abd408
643	a persistent patchy opacification in the left mid and lower lung fields, unchanged from the prior exam . the right lower lung aeration has improved from the prior exam with resolution of the previously seen opacity . multiple small nodules are seen bilaterally, consistent with the patients known history of metastatic renal cell carcinoma . no new opacifications are present . there is no pleural effusion or pneumothorax . the cardiomediastinal silhouette is normal . . improvement in right lower lobe aeration with resolution of previously seen opacity . . persistent left mid and lower lung opacification . . multiple pulmonary nodules, consistent with known history of metastatic renal cell carcinoma .	Lung Lesion&&Lung Opacity	12702423	59289980	6a3ffb5c-a406d8c7-ed1414d0-d1521e7f-48b48a9a
644	the patient is status post right thoracotomy . apparent decrease in postoperative right pleural effusion and slight improvement in right basilar atelectasis . otherwise, no relevant changes since recent study .	Atelectasis&&Pleural Effusion	11474065	52736624	e81bcf8f-2499df37-89d72ab3-6180b4ca-88ade891
645	the monitoring and support devices are in unchanged position . there are improved lung volumes, notably on the left, potentially reflecting increased ventilatory pressure . currently, there is no overt pulmonary edema . atelectatic changes are seen at both lung bases, right more than left, no new parenchymal opacities, unchanged moderate cardiomegaly with tortuosity of the thoracic aorta .	Atelectasis&&Cardiomegaly&&Lung Opacity&&Support Devices	15809646	52030252	bdbdde19-6dd4e8f3-1636aed1-04e54b76-0009a601
646	a frontal upright view of the chest was obtained portably . since , miild interstitial edema persists, but has improved . there is no focal consolidation, pleural effusion, or pneumothorax . heart size is stable . aortic tortuosity is unchanged . the left humeral head appears inferiorly subluxed with respect to the glenoid however is not visualized adequately on this film and may partially be positional . no pneumonia . improved but persistent mild interstitial edema . possible subluxationdislocation of left glenohumeral joint for which dedicated shoulder films can futher characterize .	Edema	13475033	56081681	0325340c-c95a8b30-4a454b66-d20de6cb-d5353596
647	no previous images . the nasogastric tube is not coiled, however it extends only to the distal esophagus . this information has been conveyed to dr . , who is covering for dr . , by telephone at on . the heart is normal in size and there is no evidence of pneumonia, vascular congestion, or pleural effusion .	No Finding&&Support Devices	14213287	57975962	b7bd32a8-4cf22df1-81612a8c-d36d71b4-2787c2b5
648	there is no pneumothorax or appreciable right pleural effusion . however, consolidation in the right middle lobe and more heterogeneous opacification in the right lower lobe may have increased since the previous study . extensive adenopathy in the right hilus and particularly in the paratracheal mediastinum suggests two diagnostic possibilities, obstructing malignancy or primary tuberculosis . left lung is grossly clear and the heart size is normal .	Consolidation&&Enlarged Cardiomediastinum&&Lung Opacity&&Support Devices	15204620	57426287	a18c7507-2e69a04b-701ddbf9-526439aa-c754e39b
649	the new right basal pneumothorax, located at the site of the tube insertions, is no longer visible . the pleural space appears to be filled with a small amount of fluid . the position of the three right chest tubes is constant . markedly increasing is the cervical and right pleural soft tissue air collection . unchanged appearance of the left lung and of the cardiac silhouette .	Cardiomegaly&&Pneumothorax&&Support Devices	13352405	59156265	41ee9261-0756cf99-574bf302-f275f3e5-a8e33f13
650	ap and lateral views of the chest were obtained . the lateral view is suboptimal due to overlying soft tissues due to patients inability to move right arm, secondary to chronic right humeral head deformity and severe osteoarthritis of the right glenohumeral joint . a left port-a-cath is again seen, terminating at the cavoatrial junction . the heart is moderately enlarged, as before . the lung volumes are low, and there is mild fluid overload with small bilateral pleural effusions . there is no pneumothorax or focal consolidation concerning for pneumonia . bibasilar atelectasis is present . . moderate cardiomegaly with mild fluid overload and small bilateral pleural effusions . no definite evidence of pneumonia . . chronic deformity of the right humeral head with severe osteoarthritis of the right glenohumeral joint .	Cardiomegaly&&Pleural Effusion	17340686	58908940	39ca48e7-53f0eca0-ce297a4a-84fa12a4-cb30308f
651	single portable view of the chest demonstrates normal lung volumes . costophrenic angles are minimally blunted, suggestive of trace pleural effusions . bibasilar opacities obscure hemidiaphragms . right lung base opacity is more conspicuous on todays exam . moderate pulmonary edema . hilar and mediastinal silhouettes are unremarkable . heart is mildly enlarged . moderate pulmonary edema with mild cardiomegaly and possible trace pleural effusions, progressed from exam .	Cardiomegaly&&Edema&&Pleural Effusion	11893091	55430447	2773b5c2-bd9e0357-064af3b4-ddc4997e-61ff380f
652	stent catheters in both brachiocephalic veins, joining at the origin of the svc, have not narrowed or migrated since . severe hyperinflation reflects emphysema . heart size is top-normal, improved since . there is no focal pulmonary abnormality . previous left lower lobe atelectasis has resolved and there is no pleural effusion . severe renal osteodystrophy is responsible for the appearance of the thoracic spine .	Cardiomegaly&&Support Devices	19061282	54735623	e87655af-053bad7e-3bd0b4e8-0ca44de9-652ca403
653	the right internal jugular vein catheter has been pulled back . the tip of the catheter now projects above the clavicle . the catheter should be repositioned to ensure a correct position in the mid svc . therefore, advancement of the catheter by approximately cm would be required .	No Finding&&Support Devices	19454978	56894057	f7078882-7927ae24-2cb5194e-a4ea0c05-99f8ea08
654	comparison is . overall, cardiac and mediastinal contours are stable . interval appearance of patchy opacity at the left base could represent early pneumonia, although aspiration or patchy atelectasis would also be in the differential . clinical correlation is advised . no evidence of pulmonary edema, pneumothorax or pleural effusions . no acute bony abnormality .	Atelectasis&&Enlarged Cardiomediastinum&&Lung Opacity&&Pneumonia	11052273	53407845	e8da4f53-f62c1459-cc4b5add-8a21431c-c2395de1
655	the monitoring and support devices remain in place . no definite pneumothorax, though this could be difficult to detect in view of the extremely large amount of subcutaneous gas .	No Finding&&Support Devices	16751749	54136532	cb1f8e7a-37c1dd98-3ded7ccb-0f29a540-71ff7d2d
656	heart size and mediastinum are grossly stable . bibasal consolidations are unchanged . there is interval progression of vascular congestion but no overt worsening of consolidations concerning for pneumonia demonstrated .	Cardiomegaly&&Consolidation&&Edema&&Enlarged Cardiomediastinum&&Pneumonia	19454978	50082220	9ea9d7ed-af25b8f5-d58509f4-3b363917-c3e443af
657	ap and lateral views of the chest are compared to previous exam from . previously identified left picc line is no longer seen . lower lung volumes seen on the current exam . there are indistinct pulmonary vascular markings suggestive of fluid overload . there are also possible small bilateral pleural effusions noting that lateral view is limited secondary to patients arms obscuring visualization . cardiac silhouette is enlarged but stable . degenerative changes noted at the acromioclavicular joints bilaterally . finding suggestive of pulmonary vascular congestion with possible small bilateral pleural effusions .	Edema&&Pleural Effusion	16855430	58581234	3c172ae3-82504f6a-6de0bc7a-28294cec-278aa9d6
658	comparison is made to prior study of . portable ap chest film of at hours is submitted . . status post median sternotomy for cabg with stable cardiac enlargement and calcification of the aorta consistent with atherosclerosis . relatively lower lung volumes with no focal airspace consolidation appreciated . crowding of the pulmonary vasculature with possible minimal perihilar edema, but no overt pulmonary edema . no pleural effusions or pneumothoraces .	Cardiomegaly&&Edema	10183775	52835225	7f6d7289-9941e757-2663be13-0dde50f8-5d2670aa
659	there has been placement of a nasogastric tube with its tip in the body of the esophagus . the side hole is in the region of the gastroesophageal junction and the tube should be advanced several centimeters . pulmonary vessels are less well defined than on the previous study, consistent with some mild increase in pulmonary venous pressure .	No Finding&&Support Devices	18855147	58301804	bb31f02a-26cfe8cb-d6444793-d24a3c7a-3ba6afb6
660	the lung volumes continue to be low . moderate atelectasis at both the left and the right lung bases . moderate cardiomegaly, unchanged as compared to the previous image . currently no evidence is seen of pneumonia or pulmonary edema . the patient has received the nasogastric tube . the course of the tube is unremarkable, the tip of the tube projects over the proximal parts of the stomach . the pacemaker is in unchanged position . gastric overinflation, seen on the previous image, has substantially decreased .	Atelectasis&&Cardiomegaly&&Edema&&Pneumonia&&Support Devices	12595991	56983444	99417741-ca740461-763a545e-baf5aa74-65bf4e43
661	the patient is status post median sternotomy and aortic valve replacement . the heart size is normal . the aorta is diffusely calcified . the mediastinal and hilar contours are normal . the lungs are hyperinflated with relative lucency within the lung apices, compatible with emphysema . previously described nodular opacities on ct are not well demonstrated on the current radiograph . no focal consolidation, pleural effusion or pneumothorax is detected . multiple compression deformities of the thoracic spine are unchanged as well as old bilateral rib deformities . no focal consolidation to suggest pneumonia . emphysema . previously noted nodular opacities seen on ct not clearly visualized on the current radiograph .	Lung Lesion&&Lung Opacity&&Pneumonia	17392550	51791247	9adf1edf-b9cd0878-60c0cc62-6a5125d2-d77223ee
662	pa and lateral chest radiographs again seen is a large pleural effusion, with likely a loculated component on the right, with compressive atelectasis of major portions of the right lower and middle lobes . there is no pneumothorax . the left lung is well expanded and clear . the cardiac size is within normal limits . the hilar and mediastinal contours are normal . large right pleural effusion again seen, stable to slightly increased, likely loculated, with compressive atelectasis of major portions of the right middle and lower lobes . if the cause of the pleural effusion has not been established, recommended a ct of the chest with contrast, after thoracentesis to rule out an underlying mass .	Atelectasis&&Pleural Effusion	12699874	51280998	f46ebce4-270dbbd9-24602b65-695b054c-bcd8093c
663	pa and lateral chest radiographs the cardiac, mediastinal, and hilar contours are unremarkable . both lungs are clear with no focal consolidation, pleural effusion, or pneumothorax . mild hyperinflated lungs are noted with flattening of the hemidiaphragms .	No Finding	19389547	53982700	b2ad1391-f9791757-01f3acb5-d501ad40-abc9a837
664	comparison study of , there is again extensive opacification involving much of the right hemithorax . this is consistent with a previous study showing substantial loculation of right pleural fluid collection with underlying extensive volume loss . prominence of markings on the left most likely represents redistribution of blood flow to non-aerated regions on the right .	Lung Opacity&&Pleural Effusion	13263843	57887570	9b916224-1f793e77-0cc55cc4-1f3c9fe5-7eab98cb
665	esophageal stent has not migrated from earlier position, starting at the level of the sternal notch . it is intact as to caliber . et tube and right internal jugular line are in standard placements . very large pneumoperitoneum is essentially unchanged . large scale aspiration to the axillary region of the left lung has improved, but mild pulmonary edema is probably present . heart size is normal . as before, the right lower hemithorax is entirely replaced by a large cavitary pneumonia, inseparable from the pleural space containing residual contrast agent, presumably employed to define the pulmonary or esophagopleural fistula . no pneumothorax .	Edema&&Pneumonia&&Support Devices	13964474	57204056	f46e8d2c-be685657-0321ae36-1093f777-379d385b
666	there are even lower lung volumes . the head of the patient somewhat obscures the upper mediastinum . nasogastric tube remains in place, though the endotracheal tube appears to have been removed . there is evidence of pulmonary vascular congestion with blunted costophrenic angles that could reflect atelectasis and effusion . on this study, it is impossible to exclude a supervening pneumonia .	Atelectasis&&Edema&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	18079481	54683624	32f086b1-c463fbe9-679d7bcb-50ac810a-fc5cab93
667	in comparison to radiograph, there has been decrease in the severity of the pulmonary edema with residual mild edema remaining . moderate left pleural effusion and adjacent left retrocardiac atelectasis and or consolidation have slightly worsened . no other relevant change .	Atelectasis&&Consolidation&&Edema&&Pleural Effusion	13896515	53679398	4f32b256-67629057-efe5e52b-06323e27-46eeb15b
668	since most recent chest radiograph, there has been interval placement of a right ij central venous catheter which terminates projecting over the right atrium . there is no pneumothorax . lungs are clear . persistent elevation the right hemidiaphragm is noted . radiopaque lucencies overlie the right upper mediastinum . right ij central venous catheter terminates projecting over the right atrium . no pneumothorax .	No Finding&&Support Devices	19907884	53905237	d9e22f16-a5b260d1-2a5aee7a-4cd66d44-b590afb8
669	the patient is status post median sternotomy . the previously seen left lower lobe focus of consolidation is no longer seen . there is mild right base atelectasis . no pleural effusion or pneumothorax is seen . the cardiac and mediastinal silhouettes are stable the cardiac silhouette is not enlarged . the aorta remains calcified and tortuous . evidence of dish is seen along the spine . no acute cardiopulmonary process .	No Finding	17318449	56456060	eb015667-db827ca3-eadd5d39-1e4f2e30-bf09f5b6
670	there is increased opacity in the right lung, particularly projecting over the base . right lung base nodule is less well seen on the current exam, potentially projectional, and adequate comparison for interval change is not possible on this exam . post-radiation changes are again seen in the right paratracheal region . there is also subtle opacity at the left lung base in the retrocardiac region . cardiomediastinal silhouette is stable . no acute osseous abnormalities identified . bridging of the posterior right and th ribs are again seen . bibasilar right greater than left opacities, new since prior, which could represent infection or potentially aspiration . no other change since prior .	Lung Opacity&&Pneumonia	14295224	59790228	dadf469d-f8a75d8f-24e452d6-a7394bb7-ace0708c
671	comparison is made to the prior study . mild-to-severe cardiomegaly is partially obscured by the bilateral mild pleural effusions and atelectasis . there is mild-to-moderate pulmonary edema . transvenous pacemaker leads terminate in standard position in the right ventricle .	Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	12074041	56121920	d834b686-fc38fc45-187ea122-4e655952-20a720bd
672	well expanded and clear lungs . no pleural effusion or pneumothorax . heart size, mediastinal contour, and hila are within normal limits . visualized upper abdomen is unremarkable . normal chest radiograph . no pleural effusion or pneumonia .	No Finding	11924226	50241018	c2af2ab3-6a11cbae-d9fa4d64-21ab221e-cf6f2146
673	portable semi-erect frontal chest radiograph a left port-a-cath terminates in the right atrium, unchanged from prior . lung volumes are extremely low resulting in bronchovascular crowding and limited evaluation of the lung bases . diffuse interstitial opacities have increased, and despite the low lung volumes, findings are consistent with superimposed pulmonary edema on a background of pulmonary fibrosis . no large pleural effusion is evident . there is no pneumothorax . cardiomediastinal and hilar contours are within normal limits . high density material within multiple mid thoracic vertebral bodies is likely related to prior kyphoplasty, unchanged from prior .	Consolidation&&Edema&&Pleural Other	10439781	51129150	1d74ca1d-12ac2785-bd84a322-376f04bc-b9fdaa99
674	heart size is normal . mediastinal and hilar contours are unremarkable . pulmonary vascularity is normal . nodular area of opacification in the left mid lung field was not clearly demonstrated on the prior radiograph . no other areas of focal consolidation, pleural effusion or pneumothorax are demonstrated . healed fracture of the left th rib is seen, superior to the left nipple shadow . numerous radiopaque circular ovoid structures are seen within the upper abdomen, likely reflecting ingested pills within the bowel . clips are noted in the upper abdomen related to prior cholecystectomy . rounded opacity in the left mid lung field, possibly reflecting an area of infection .	Lung Opacity&&Pneumonia	16435402	51293673	4b64a5b1-add48a29-703a757c-e888cd6b-4684205e
675	there is mild enlargement of cardiac silhouette . the mediastinal contours are unchanged . there is mild pulmonary vascular engorgement and small bilateral pleural effusions which have decreased in size compared to the previous exam . patchy bibasilar airspace opacities likely reflect atelectasis, but infection is not fully excluded . no pneumothorax is demonstrated . multilevel degenerative changes are noted in the thoracic spine . small bilateral pleural effusions, mild pulmonary vascular engorgement, and bibasilar atelectasis . infection, however, within the lung bases cannot be completely excluded .	Atelectasis&&Pleural Effusion&&Pneumonia	16553329	51580913	5033a612-cecd8c09-fda1ffcf-89bbc30e-147ecb44
676	the patient has received an endotracheal tube . the tube projects . cm above the carina . the lung volumes are low . the right internal jugular vein catheter is unchanged . the pre-existing parenchymal opacities at the lung bases are minimally improved . no new opacities . no evidence of complications, notably no pneumothorax .	Lung Opacity&&Pneumothorax&&Support Devices	16055653	57513742	636c3d85-735bc7ab-f85f38f5-8b782e04-3f94239f
677	postoperative widening of the cardiomediastinal silhouette continues to improve . lungs low in volume but clear . pleural effusion is small if any on the left . no pneumothorax . transvenous right atrial and right ventricular pacer leads in standard placements . a right subclavian line passes into the right atrium, but the tip is indistinct . no pneumothorax .	Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	15144601	55341919	b10086a9-a4ddd90e-8d225a77-9c7b3e0b-261c474f
678	 .	Enlarged Cardiomediastinum&&Lung Opacity&&Support Devices	13078497	50736883	7818c621-96de3398-2d9b9d86-9c6dd223-0513fab7
679	there is mild pulmonary edema . there is atelectasis at the left lung which is stable . the heart size is enlarged but unchanged . there is also a more focal opacity at the right base which may represent atelectasis or developing infiltrate . the sternotomy wires and the spinal hardware is grossly intact .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Support Devices	14434800	52682048	0d9ee316-000a9e0c-be78c74d-62923605-0315f8e4
680	lung volumes are low . no focal consolidation is identified . the cardiomediastinal silhouette and hilar contours are stable . there is a calcified prevascular lymph node . there is no pleural effusion or pneumothorax . a left chest port-a-cath terminates at the level of the upper svc, as before . patient is status post median sternotomy . no evidence of acute cardiopulmonary process .	No Finding	11413236	55420069	6eb1afd3-d7b2eea4-6367e332-aa78e2dd-387ee425
681	the heart and mediastinum are normal . the lung fields are clear . no areas of pneumonia are identified . a picc line is present with the tip in the upper svc . there is no pneumothorax .	No Finding	15857729	56895158	c855dbbc-7d247e08-21f25260-20ed7254-73ac858a
682	as compared to previous studies there is no change in the cardiomediastinal silhouette including mild cardiomegaly . mild interstitial pulmonary edema is unchanged . compression fracture of the lower thoracic vertebral body is present . aorta is extremely tortuous .	Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Fracture	16957952	52307593	f44cd0b1-41c1556c-8cb1b4db-632a0833-ed413255
683	the left-sided chest tube has been removed . no pneumothorax is visualized . lung volumes are low and there is continuedincreased infiltrate in the left upper lung . there continues to be retrocardiac opacity and a layering left effusion . vascular plethora and patchy areas of alveolar edema are also seen on the right . the et tube is . cm above the carina . the ng tube is in the stomach . markedly worsened appearance of the left upper lung .	No Finding	19075045	57544155	b6243df3-d51d165a-8d436de1-245fac16-bbd54062
684	widespread ground-glass pulmonary opacification, probably edema, has recurred after earlier improvement between . though the most likely explanation is cardiac, conceivably transfusion of blood products or new medication could be responsible . the greater opacification in the left lower lobe is most readily explained by atelectasis in the setting of a very large left heart, but pneumonia due to aspiration would be radiographically indistinguishable . small left pleural effusion is stable . there is no pneumothorax . transvenous right ventricular pacer defibrillator lead, left ventricular lead, and the posteriorly positioned right atrial lead are all unchanged in their respective positions as far as one can tell from a solitary frontal radiograph . no pneumothorax .	Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	19759491	59644580	d2ff69b9-d6534a05-a33ca72e-8d998fcf-78a65663
685	there has been placement of a left ij catheter that extends to the upper portion of the svc . no evidence of pneumothorax . otherwise, little change .	No Finding&&Support Devices	10715477	59089311	0cdeff10-c7e75e12-5c067cb6-eab4e635-50d1144c
686	the right hemothorax that pre-existed has slightly decreased in extent but is still visible . the pneumothorax is limited to the apicolateral parts of the right hemithorax . there is no evidence of tension . unchanged moderate cardiomegaly with bilateral pleural effusions and areas of atelectasis . mild fluid overload . status post cabg .	Atelectasis&&Cardiomegaly&&Pleural Effusion&&Pneumothorax	12952223	51183783	8753dd62-80681aa9-11dcf353-7d254056-7c7675c7
687	a left pleural effusion with overlying atelectasis remains present . left base retrocardiac opacity likely represents combination of atelectasis and effusion, although underlying consolidation is difficult to exclude . patient is status post median sternotomy and cabg . no definite focal consolidation is seen in the right lung . the patient is status post median sternotomy and cardiac valve replacement . cardiac and mediastinal silhouettes are stable . left pleural effusion with overlying atelectasis, underlying consolidation is difficult to exclude .	Atelectasis&&Consolidation	15259244	54434271	e8149721-c9e4afbc-7a9dde4a-3c9f7362-fec663a4
688	upright ap and lateral views of the chest left-sided dual-chamber pacemaker device is noted with leads terminating in the right atrium and right ventricle . the heart size is normal . the aorta remains tortuous and calcified . again demonstrated are fibrotic changes within the right lung base which appear similar when compared to the prior radiograph . there is likely minimal atelectasis in the left lung base . no pulmonary edema, focal consolidation, pleural effusion, or pneumothorax is identified . there are no acute osseous abnormalities .	No Finding	15378103	55675760	aa615bc7-e32c0c72-a1f0ee3f-0a7f4a52-5e7078c2
689	a dual-lead left pectoral pacemaker device has its leads terminating at expected locations in the right atrium and right ventricle . no pneumothorax . bilateral pleural effusions and bibasal atelectases are mild . bilateral lungs are remarkable for mild vascular and interstitial prominence, likely congestion . normal heart size, mediastinal and hilar contours are unchanged in appearance since .	Atelectasis&&Pleural Effusion&&Support Devices	13762730	55828202	428c4099-c29bb97d-e06be8f3-614d3b6e-d343eee7
690	there is little overall change . again there is increased opacification in the left mid and lower lung zones . although this could merely represent extensive atelectasis, in the appropriate clinical setting superimposed pneumonia would have to be seriously considered . continued low lung volumes with enlargement of the cardiac silhouette and mild pulmonary vascular congestion .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pneumonia	14841168	56921440	d47b1887-47d16d76-fc1df56f-5a5cd514-a9f91c9e
691	there is a minimal decrease in extent of a pre-existing small right pleural effusion . interstitial markings, on the other hand, are slightly increased, potentially reflecting increased interstitial fluid contents . unchanged of the cardiac silhouette . unchanged basal areas of atelectasis, unchanged right venous introduction sheath . also unchanged are left lung calcified granulomas . overall, the findings indicate a mild increase in pulmonary edema .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion	12185775	56614076	45e31ec5-029d54e9-1acec167-663a1397-bccb2493
692	no significant change compared to the prior exam . the lungs are well-expanded and clear . no focal consolidation, pleural effusion, pulmonary edema, or pneumothorax . the cardiomediastinal silhouette, hila, and pleura are within normal limits . no acute osseous abnormality . no acute cardiopulmonary process, including no focal consolidation to suggest pneumonia .	No Finding	14855790	52432749	b2187498-bd6044fd-89eafb88-63b96bdd-2794d412
693	the tip of an endotracheal tube is . cm from the carina . there is stable moderate enlargement of the cardiac silhouette . the mediastinum is normal . a small left pleural effusion is unchanged . an adjacent persistent hazy opacification at the left base likely represents atelectasis . the right lung is clear . there is no pneumothorax . persistent left basilar atelectasis and small left pleural effusion .	Atelectasis&&Pleural Effusion	13031876	53831546	8e011dfc-c2e23780-6e926bd4-fdef5895-a403ee8f
694	perihilar opacification in the left lung which developed between and has improved, probably resolving pneumonia . lung volumes remain quite low, but discrete atelectasis in the left lower lobe is not as pronounced today as it was on . heart is moderately enlarged and the thoracic aorta is generally dilated and heavily calcified, but not acutely changed . et tube and right internal jugular line are in standard placements and transvenous right atrial and right ventricular pacer leads are unchanged in their positions following their expected courses . nasogastric tube ends in the distal stomach . no pneumothorax .	Atelectasis&&Lung Opacity&&Pneumonia&&Support Devices	13649937	56825873	537f8439-9fc144bc-2e4220b4-1fb7bc02-5cb4bcc9
695	lungs are clear without focal consolidation, effusion, or edema . mild cardiomegaly is similar compared to prior . coronary artery stents and median sternotomy wires are noted . no acute osseous abnormalities . no acute cardiopulmonary process .	No Finding	19150427	51511674	bf73d8b0-3e093d0f-dd91f13c-0d6e276b-53136b54
696	monitoring and support devices remain in place . widespread airspace opacities, more prominent on the right, are consistent with diffuse pneumonia . the known abscess in the right lower lobe is better seen in detail on recent ct scan . pigtail catheter is again seen at the base of the lung on the right, presumably within the abscess cavity . little change in the moderate pleural effusion . little change .	No Finding	13964474	55485079	7299f098-d62bc751-9fe83648-b69333fb-38bddb75
697	portable upright ap view of the chest study is limited as the left costophrenic angle is excluded from the field-of-view . left-sided dual-chamber pacemaker with leads terminating in the right atrium and right ventricle is unchanged . again noted is a left upper lobe paramediastinal mass . opacification in the left lung base likely reflects a combination of a moderate-to-large pleural effusion and adjacent atelectasis . the right lung is grossly clear . there is no pulmonary vascular congestion . no significant interval change from the prior exam . no evidence of congestive heart failure . persistent left pleural effusion and left basilar opacity likely reflective of atelectasis . left upper lobe paramediastinal mass compatible with known malignancy .	Atelectasis&&Lung Lesion&&Lung Opacity&&Pleural Effusion	18067737	53583954	0efbdb11-4a6e04cf-2acc8b02-8b0ee7b6-36a1e507
698	the lungs well expanded . coarse reticular interstitial opacities are again noted bilaterally, consistent with chronic interstitial lung disease . no evidence acute pulmonary edema . there is no pleural effusion or pneumothorax . the cardiomediastinal silhouette is top-normal in size . unchanged tortuous aorta chronic interstitial lung disease . no evidence of acute pulmonary edema .	Lung Opacity	13475033	58198532	94420d61-059622c4-a869e720-aa8d1a7b-6910f91c
699	pa and lateral views of the chest are compared to previous exam from . the lungs are now clear without focal consolidation or effusion . cardiomediastinal silhouette is normal . osseous and soft tissue structures are unremarkable . no acute cardiopulmonary process .	No Finding	19800337	51584806	b800c916-3b94102e-b30f93af-af52c677-167e5233
700	pa and lateral views of the chest are compared to previous exam from . the lungs are clear of focal consolidation . cardiomediastinal silhouette is normal . note is made of a vascular stent in the right subclavian area . osseous and soft tissue structures are unremarkable . no free air is seen below the diaphragm . no acute cardiopulmonary process .	No Finding	14744884	51696222	5d9cf85d-134469a1-4ea8049e-fd8251d2-d8281018
701	mild interstitial pulmonary edema is new . exacerbation at the base of the right lung may be due to asymmetric deposition of edema due to the persistent elevation of the right lung base and poor aeration in the lower lobes . the elevation of the right lung base is primarily due to a large chronic right pleural effusion . the elevated and enlarged right hilus, adjacent radiation fibrosis and apical pleural thickening are chronic . a second region of more focal edema in the right upper lobe sitting on the minor fissure is probably due to disturbed lymphatic drainage from the radiated lung . moderate cardiomegaly is stable . small size of nodules in the left lung on chest cta yesterday, i am surprised at the prominence of such nodules today in the mid lung . it would be prudent to repeat this chest radiograph later in the day to exclude the development of nodular infection . was paged at am . when the findings were realized .	Cardiomegaly&&Edema&&Lung Lesion&&Pleural Effusion&&Pleural Other&&Pneumonia	19720782	54254493	244ae491-3e0f01f5-8506784c-32d65ab2-f96e30b6
702	a vascular stent is again noted in the left brachiocephalic vein and svc, stable in position . the cardiac and mediastinal silhouettes are stable . prominence of the right hilum is grossly stable . subtle prominence of perihilar vasculature may be due to mild vascular congestion . the right basilar opacity is stable as compared to the prior study from . right basilar opacity is stable as compared to the prior study from . no large pleural effusion . possible mild vascular congestion .	Edema&&Lung Opacity	14236258	55400628	5d37e278-47fa9e3a-5fa3bbcf-a9b2cfae-74ed3559
703	portable ap radiograph of the chest was reviewed in comparison to prior study obtained the day before . the right internal jugular line tip is at the level of cavoatrial junction . heart size and mediastinum are unchanged . mild interstitial edema is re-demonstrated associated with bilateral pleural effusions and left more than right basal opacities . infection is a possibility, although atelectasis would be another alternative .	Atelectasis&&Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	17669276	52198118	cefdaf4b-0a87c4c2-7ab7899a-6c885be5-80d5be19
704	there is moderate cardiomegaly . left lower lobe consolidation has increased, worrisome for worsening pneumonia . there is also increase of loss of volume in the left lower lobe . right picc tip is in the mid-to-lower svc . et tube is in a standard position . ng tube tip is out of view below the diaphragm . there is no pneumothorax or pleural effusion . right lower lobe medial opacities are likely atelectasis .	Atelectasis&&Cardiomegaly&&Consolidation&&Lung Opacity&&Pneumonia&&Support Devices	10268877	55809473	9dedb45c-ce21220f-3df796c5-b8039ee0-6a854155
705	the already improved post-operative widening of the cardiomediastinal silhouette is stable . moderate right pleural effusion and moderately severe right basal atelectasis are unchanged, but previous left lower lobe atelectasis and left pleural effusion are improved . there is no pulmonary edema or pneumothorax .	Atelectasis&&Enlarged Cardiomediastinum&&Pleural Effusion	16875792	50022945	4331c9eb-f6e0c046-8c50bffc-6f363a16-02f0f87f
706	the swan-ganz catheter, left-sided pacemaker, endotracheal tube, feeding tube and mediastinal wires are all unchanged in position . there is a confluent area of opacity in the left upper lobe which is stable . there is an increase in opacity at the right base, which may be due to developing infiltrate or atelectasis . there is an unchanged left retrocardiac area which may represent underlying infiltrate andor pleural effusion . there is a left ventricular prominence . no pneumothoraces are present .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Support Devices	19075045	52020406	7ab74669-cc831f4c-a2b5b2bd-b7212ec9-7b926c3d
707	ap upright and lateral views of the chest provided . there is top-normal heart size with tiny left pleural effusion . calcified nodular structures in the left upper lung and right mid to lower lung likely represent calcified granulomas . there is no evidence of pneumonia or chf . mediastinal contour stable . bony structures intact . top normal heart size, tiny left effusion .	Pleural Effusion	16553329	57667161	9cc3281f-64ff9f26-d2f759b1-ee26296f-50d416d4
708	the appearance of the lungs is stable . there is diffuse increase in interstitial markings bilaterally, similar to prior, consistent with chronic lung disease . no focal consolidation is seen . no pleural effusion or pneumothorax is seen . the cardiac and mediastinal silhouettes are stable . no significant interval change .	No Finding	13475033	56231194	e919ccde-cbde9eef-ec83c6fe-361b22e6-fea7aa96
709	the previously seen chest tube has been removed without evidence of pneumothorax . the right loculated pleural effusion remains . the right hemithorax appears less opacified due to improved position of the patient, but mild residual diffuse opacification remains . the cardiac silhouette remains enlarged . no pneumothorax after chest tube removal .	No Finding&&Support Devices	11474065	53907259	c9f4d430-e4b86819-292b0c15-3b043b8f-eda461f1
710	following thoracocentesis and pigtail catheter placement positioned at the right lung base, a large right pleural effusion has decreased but still at least moderate amount of right pleural fluid accompanying complete collapse of the right lower lobe and possibly at least partial collapse of the right upper lobe is persisting . an ill-defined opacity in the left suprahilar region which was new on radiograph is likely an aspiration pneumonia . left lower lung is clear . mild mediastinal shift to the left side owing to the right pleural effusion still persists, but better since yesterday . there is no demonstrable pneumothorax . following thoracocentesis and right pigtail catheter placement, large right pleural effusion has decreased, but still at least moderate pleural effusion persists and accompanies complete collapse of the right lower lobe and possibly a partial collapse of the right upper lobe . ill-defined left suprahilar opacity which was new on is likely aspiration pneumonia .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	14387068	51265253	7f2e0501-621b2ad0-0969b247-d16c6c18-12077b6d
711	semi-upright ap view of the chest the heart size appears moderately enlarged . the mediastinum demonstrates tortuosity of the thoracic aorta . there is perihilar haziness with vascular indistinctness, compatible with mild pulmonary edema . hazy opacities in both lung bases likely reflect small layering bilateral pleural effusions with associated bibasilar atelectasis . no large pneumothorax is identified . there are no acute osseous abnormalities .	Atelectasis&&Edema&&Pleural Effusion	13700088	59542064	44265749-00dd7405-287e7f77-b68607f3-663cc2f7
712	portable ap radiograph of the chest was reviewed in comparison to obtained am . there has been interval decrease in the right pleural effusion that could be potentially related to thoracocentesis post-sternotomy wires are stable as well as cardiomediastinal silhouette and replaced tricuspid valve . small amount of left pleural effusion is most likely present . minimal opacity in the left lower lung is noted, might potentially be part of the overall vascular congestion, attention after diuresis is recommended .	Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Support Devices	19182863	58170172	47bb3903-f0ad177e-b50a04af-583fbb5e-379aec00
713	the patient is rotated to the right . the patent esophageal stent has migrated in position with the superior portion now projecting over the right lung apex . also, since the prior study, there has been development of significant opacity projecting over the right hemithorax which may be due to a combination of pleural effusion and consolidation . the left lung is clear . the cardiac silhouette is not enlarged . ed aware at the time of the dictation .	Consolidation&&Lung Opacity&&Pleural Effusion	19016834	56647535	f49301d7-6e0b977b-e4fe5357-229f8407-66ff773c
714	portable ap upright chest radiograph was obtained . compared to the scout radiograph from a torso ct from , there is increased opacity in the left lower lung, concerning for worsening effusion and consolidation . extensive nodularity in the lungs is compatible with known metastatic disease . heart size cannot be assessed . bony structures appear unchanged . increasing opacity in the left lower lung, concerning for worsening consolidation and effusion . extensive metastatic disease within the chest . refer to subsequent ct for further details .	Consolidation&&Lung Opacity&&Pleural Effusion	12702423	51244261	bceb45d9-799ac7a7-effd7ba0-71a61a33-92e4f08a
715	there are bilateral pleural effusions, new from prior exam with subjacent consolidation which could represent compressive atelectasis . the possibility of pneumonia is not excluded . there is no pneumothorax . the heart is top-normal in size . a vascular stent is again noted in the left brachiocephalic vein . the imaged osseous structures are intact . no free air is seen below the right hemidiaphragm . bilateral pleural effusions with adjacent consolidation new from prior exam raises concern for fluid overload . correlate with renal function .	Consolidation&&Pleural Effusion	12847817	53234157	a235e413-ace39b4e-97962e04-aed60fc7-c71c87ed
716	the patient is status post coronary artery bypass graft surgery . the heart is at the upper limits of normal size . the aortic arch is partly calcified . the pulmonary vasculature is minimally prominent suggesting pulmonary venous hypertension or slight congestion without frank congestive heart failure . there is also a patchy right infrahilar opacity, suspected to represent minor streaky atelectasis . a linear opacity seen posteriorly on the lateral view probably is due to stable scarring in the left lower lobe . there are no pleural effusions or pneumothorax . thin anterior flowing syndesmophytes are present along the lateral and anterior aspects of the visualized thoracic spine, which could be seen with idiopathic skeletal hyperostosis . . findings suggesting minimal congestion or pulmonary venous hypertension, new on this study . . patchy right basilar opacity suspected to represent minor atelectasis .	Atelectasis&&Lung Opacity	17318449	51654271	0e02f05c-dfa11803-7fd610f9-7011086c-eeeeb1fb
717	a right internal jugular central venous catheter tip terminates in the mid svc . no pneumothorax is identified . moderate to severe cardiomegaly persists . mediastinal and hilar contours are unchanged . a septal closure device is noted again . there is a small right pleural effusion with atelectatic changes in the right lung base . left lung remains clear .	Atelectasis&&Cardiomegaly&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	11204646	53737003	fc346a9c-a6343b2b-98bdb36b-5a813740-aa659cba
718	the right lung is clear . there is new diffuse patchy opacities throughout the left upper lobe and lingula . the left hemidiaphragm is slightly elevated . there is a more dense opacity compared to the prior study and is concerning for either a mass or more confluent consolidation . prior radiation changes are also seen within the left lung . there is a small pleural effusion on the left . the mediastinal and cardiac contours on the left are blurred by superimposed lung opacification . the right mediastinal and hilar and cardiac contours are normal . pacemaker is in place with biventricular leads in the appropriate position . left upper lobe opacification with mild volume loss concerning for pneumonic consolidation and possibly post-obstructive pneumonitis associated with a new central mass, radiation stricture, or mucus plug . more central denser opacity may represent mass or particularly dense area of consolidation . ct is recommended to better assess if needed clinically, preferably with intravenous contrast if no contraindications exist . these findings were discussed with dr . on by telephone .	Consolidation&&Lung Lesion&&Lung Opacity	18067737	58001075	8faff40c-536b8347-b1b760e0-182dc706-77835a8e
719	there are persistent bilateral small to moderate pleural effusions . there is marked cardiomegaly with mild to moderate pulmonary vascular congestion . no focal consolidation or pneumothorax is seen . suture line in the right lower lobe and left-sided vascular stent are unchanged . no bony abnormality is identified . . persistent bilateral pleural effusions . . marked cardiomegaly and pulmonary vascular congestion .	Cardiomegaly&&Edema&&Pleural Effusion	12847817	53469163	fb3ef8ae-36255356-cb0d2269-7e268b4a-a253c3bf
720	ap portable frontal chest radiograph there is a new large confluent consolidation within the right upper lung, findings concerning for pneumonia given the clinical history in immunocompromised state of the patient . the exact lobar distribution is difficult to assess on this single frontal view only . the remainder of the lungs is clear . there is no pneumothorax, vascular congestion, or pleural effusions . mediastinal and hilar contours are within normal limits . mild cardiomegaly is unchanged from prior .	Consolidation&&Pneumonia	18835687	53924742	04b94a16-2f255dc1-135c9cbd-82107f89-2d706167
721	pa and lateral radiographs of the chest demonstrate that the right pleural effusion, which had been drained on the radiograph, has returned to the size it was on . in addition, there is right middle and lower lobe collapse . there is no shift of mediastinal structures . the visible lung fields are clear . there is no pneumothorax or left-sided effusion . moderate cardiomegaly is unchanged . pulmonary vascularity is normal . there is a right-sided chest wall port with the catheter terminating in the low svc . reaccumulation of moderate right pleural effusion . note findings were communicated to dr . by dr . telephone on at am .	Pleural Effusion	16826047	53010349	299e5b56-5569fb81-d1129251-b7cb6071-ab3dc20b
722	there is no substantial change in the position of the pigtail catheter . no evidence of pneumothorax is present on the current image . moderate overinflation, normal size of the cardiac silhouette, unchanged course and position of the left-sided picc line .	No Finding&&Support Devices	17770657	52284173	f99f8714-5e5a416e-ab4d7b84-1c4f38b2-32864a70
723	orogastric tube is seen to course below the diaphragm into the stomach and is appropriate . right picc line ends at cavoatrial junction . mild-to-moderate right pleural effusion with associated lung atelectasis is unchanged since prior radiograph from , acquired two to three hours apart . mild to moderately enlarged heart size, mediastinal and hilar contours are unchanged . pleural effusion if any is minimal on the left side . left lower lung atelectasis is unchanged .	Atelectasis&&Cardiomegaly&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	11934114	58725099	f1a86b6c-1907b6f9-4893b125-c7f89eee-604fbd73
724	there is a subtle but new opacity at the right lung base, in the medial aspect of the lung . the opacities located in an area of bronchiectasis . given the clinical presentation, pneumonia must be suspected . the referring physician, . was paged for notification at the time of dictation, pm . on and the findings were discussed over the telephone . otherwise, the radiograph is unchanged, extensive overinflation with bronchiectasis but no pleural effusions or other parenchymal changes . normal size of the cardiac silhouette . unchanged position of the nasogastric tube .	Lung Opacity&&Pneumonia&&Support Devices	10402372	50879902	09bcae55-47d8afaa-5cd21ca4-2cc83c46-d432bd6d
725	there is a large right hydropneumothorax with a moderate amount of fluid . it is difficult to compare size however, copared to the prior ct chest, it appears mostly unchanged . there is no evidence of tension as is supported by the fact that the trachea, the aortic knob, and the left heart border appear in similar position as radiograph prior to the pneumothorax on . hazy opacities are seen involving the right middle and lower lobes . the localized nature of this process more likely represents hemorrhage or infectious process rather than reexpansion edema . the left lung is clear . the cardiomediastinal silhouette is stable . there are no acute bony abnormalities . . large right hydropneumothorax, most likely unchanged in size from recent ct . no evidence of tension . . hazy opacities involving the right middle and lower lobes most likely represents hemorrhage or infectious process . these findings were discussed with dr . by dr . telephone at am .	Lung Opacity&&Pneumonia&&Pneumothorax	12699874	55849664	ced7abec-82b5f4e3-6be372fb-d6226a24-9e91b7ba
726	there is little change and no evidence of acute cardiopulmonary disease . no pneumonia, vascular congestion, or pleural effusion . the cardiac silhouette is at the upper limits of normal in size or slightly enlarged .	Cardiomegaly	14727722	59022336	f3f953d7-e6a719c7-2e5e731b-3181955e-30e32f42
727	the multiple areas of increased opacification in the right hemithorax are again seen, with the apparent loculated pleural collection in the upper zone laterally appearing somewhat more prominent . the left lung remains clear .	Lung Opacity	16826047	50043446	2155d1bd-3cd88831-6b690bee-e3ac34ae-4b25fa8a
728	lungs are clear bilaterally . no effusion or pneumothorax is seen . cardiomediastinal silhouette is stable . bony structures are intact . no acute findings .	No Finding	13881772	53598647	0ac370ca-d14e45b3-07c05241-b3a551b3-4cde1652
729	comparison is made to previous study from . there is an endotracheal tube whose distal tip is cm above the carina, appropriately sited . there is a left ij line with distal lead tip in the mid svc slightly oblique to the svc wall . there is a right-sided subclavian catheter with the distal lead tip in the distal svc . the heart size is within normal limits . there are bilateral pleural effusions and a left retrocardiac opacity . there is no overt pulmonary edema or pneumothoraces .	Lung Opacity&&Pleural Effusion&&Support Devices	11880923	53737059	839c423e-0ad4e63c-cb7783d9-5a24793c-930b2b72
730	a left-sided chest tube is present . there is subcutaneous emphysema along the left chest wall . left mediastinal surgical clips again noted . there is probable small pneumothorax at left lung apex . there is retrocardiac density with obscuration of the left hemidiaphragm, increased compared with the prior stidy . this likely represents a combination of elevated left hemidiaphragm, left lower lobe collapseconsolidation, and a small left effusion . the right lung is grossly clear, without pneumothorax, frank consolidation or gross effusion . minimal linear atelectasis in the right mid zone is noted . there s possible minimal upper zone redistribution, but i doubt overt chf . compared with at pm, the et tube has been removed . the tiny left pneumothorax is new or better seen . the opacification at the left base is new . findnigs were discussed with dr . at approximately pm on the day of the exam , phone .	Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumothorax&&Support Devices	12530259	51917429	617522b0-48f733b6-4112032c-69d6ff78-b2d433e8
731	portable upright chest radiograph demonstrates a known left hilar mass . there is no effusion, or definite pneumothorax . the cardiac silhouette and mediastinal contours are otherwise unremarkable . no pneumothorax status post biopsy of known left hilar mass .	Lung Lesion	12530259	56218099	20d18a78-8f7cd753-628b5cf4-7d43c522-c3e8f53e
732	pa and lateral views of the chest were reviewed . the cardiomediastinal and hilar contours are unremarkable . rca stent is noted . there is no pleural effusion or pneumothorax . flattened hemidiaphragms with widened ap diameter are consistent with emphysematous changes . extensive parenchymal opacities with distortion in both apices and chain sutures in the right upper lobe are reflective of known malignancy and post treatment changes . there is no focal consolidation concerning for pneumonia . there is no pulmonary edema . no acute process in a patient with known non-small cell lung cancer with extensive post treatment changes and emphysema .	No Finding	14851532	51210610	9428e731-163d993c-618d497c-871a84b1-39a4138e
733	atrio-biventricular icd leads are in standard placements . there is no pneumothorax, mediastinal widening or attendant pleural effusion . small left pleural effusion, moderate cardiomegaly and vascular congestion in the lower lungs are all unchanged .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	13606683	52305481	39c0aa47-d1bbe85e-ce60e6c7-48015716-b4e39643
734	analysis performed in direct comparison with the next preceding portable chest examination of , ie . hours earlier during the same day . the patient has now been intubated and ett seen in the trachea to terminate some cm above the level of the carina . no pneumothorax has developed . identified is also an intra-aortic balloon pump device in the aorta with the metallic tip reaching just to the lower contour of the aortic arch . thus, the position is appropriate . no pneumothorax has developed in comparison with the previous study . remarkable finding is a diffuse haze over the right hemithorax, more marked than on the left side . this may be explained by a shift of the interstitial edema pattern seen already on previous examination as faintly detectable interstitial edema . an explanation could be that the patient during the latest examination interval was mostly located on the right side explaining gravitational forces . there is no evidence of overall deterioration of the pulmonary congestion nor is there evidence of any new parenchymal infiltrate . an og tube passes well through the esophagus and reaches into the stomach .	Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Support Devices	17288844	53298293	c6b71b77-d56881b6-ee8c63bc-6ee0be88-89856367
735	since the examination from , right basilar nodular opacification is improved . there is a persistence of a moderate layering pulmonary effusion on the right . in addition, there is increased opacification in the right lower lobe, improved since . there are no new focal opacities concerning for pneumonia . there is no pneumothorax . the cardiomediastinal and hilar contours are stable, with mild cardiomegaly . pulmonary vascularity is not increased . moderate layering right subpulmonic pleural effusion . otherwise, mild improvement in right basilar atelectasis .	Atelectasis&&Pleural Effusion	10959054	59281953	47aa8fda-9852d351-ef7343e7-38ee20f2-b982b15d
736	a new feeding tube ends in the stomach . left pic line ends in the svc . lungs are low in volume . previous mild pulmonary edema has resolved . heart size normal . no pneumothorax . pleural effusion is small if any .	Pleural Effusion&&Support Devices	13979643	55324135	4fe2791a-5a6ddb9b-d73fb7f6-bdb8d5ad-01ab723d
737	moderate-to-severe cardiomegaly is unchanged . in the lateral view there is increased opacity of the posterior segment of one of the lower lobes likely the right, consistent with pneumonia . atelectasis in the left mid lung have increased . mediastinum is unchanged . there is no pneumothorax or pleural effusion . several wedge-shaped deformities in lower thoracic vertebral bodies and upper lumbar vertebral body are again noted .	Pneumonia	18512911	59995405	16fd3cf3-d29c1429-19334155-3ffd9fd5-a25b09bf
738	comparison is made with prior studies including chest ct, and chest , . cardiomediastinum is shifted towards the right, as before . left picc tip is in the mid-to-lower svc . there has been interval increase in air component in the right basal hydropneumothoraxempyema . adjacent consolidation is unchanged . diffuse lung opacities have worsened, consistent with worsening pulmonary edema superimposed on multifocal pneumonia . ng tube tip is in the duodenum . cardiac size is normal . mediastinal lymphadenopathy is better seen in prior ct . right basal pigtail catheter is unchanged .	Consolidation&&Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pneumonia&&Pneumothorax&&Support Devices	14387068	58601585	027ed427-b023757e-7391ee80-7a5da2fb-b3ae0b4e
739	the patient is intubated, the ett terminating in the trachea cm above the level of the carina . no pneumothorax has developed . an ng tube has been placed, seen to reach well below the diaphragm including its side port . there is mild elevation of the left-sided hemidiaphragm, but no evidence of acute pulmonary infiltrates or major atelectasis is identified . the pulmonary vasculature is not congested . there exists no prior chest examination or records available for comparison . intubated, ng tube in place, no acute pulmonary infiltrates or chf .	Cardiomegaly&&Edema&&Support Devices	16015751	54842270	7536f4a6-1fbe0f20-f19b428c-ed5f66a2-68198980
740	an et tube is present, approximately cm above the carina . an ng tube is present, tip extending beneath diaphragm off film . left mediastinal drain and left-sided chest tubes are present . a right ij central line tip overlies the mid svc . no pneumothorax detected . the cardiomediastinal silhouette is prominen,t but unchanged . there is upper zone re-distribution, diffuse vascular blurring, interstitial and minimal alveolar edema, consistent with chf . there is dense retrocardiac density, consistent with left lower lobe collapse andor consolidation . small joint effusions . multiple mediastinal clips and right-sided vertical density noted .	Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	17770657	59339513	81283cfb-7bfa242e-22317b9e-f2979399-2788b211
741	single upright ap image of the chest . the lungs are well expanded . there is opacity in the right lung base which could represent patchy atelectasis, early pneumonia or aspiration . clinical correlation is advised . there is no pleural effusion or pneumothorax . the cardiomediastinal silhouette is mildly enlarged, similar prior exams . status post median sternotomy . opacity at right lung base which could represent patchy atelectasis, pneumonia or aspiration . clinical correlation is advised .	Atelectasis&&Lung Opacity&&Pneumonia	19150427	59375093	6698971c-6ec76761-85ca680f-24dfc39f-790eb123
742	a dual-lead pacemakericd appears unchanged with leads terminating in the right atrium and ventricle, respectively . the heart is normal in size . there is increase in right infrahilar opacity probably correlating with focal right lower lobe opacity . this is superimposed on a probably more chronic interstitial abnormality at the lung bases, which is greater on the right than left . there is no definite pleural effusion or pneumothorax . right lower lobe opacity suggesting pneumonia or aspiration . suspected moderate interstitial disease at the lung bases . follow-up radiographs are recommended .	Lung Opacity&&Pneumonia	16848073	50943671	9c4e6c30-f517fbdf-d045185b-4f7d3c4b-5cb54b42
743	there is no pneumothorax . if any, there is a small right pleural effusion . et tube is in standard position . ng tube tip is in stomach . swan-ganz catheter tip is in the right main pulmonary artery . a left chest tube removed in place . left lower lobe retrocardiac atelectasis is unchanged . left upper lobe opacity is new consistent with atelectasis . cardiomediastinal contours are unchanged .	Atelectasis&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Support Devices	13135946	55603183	fb0f6c35-db1388f9-9fe71fcd-def5b9cc-d088eb40
744	comparison to prior study dated at . portable ap upright chest film, at is submitted . . interval extubation, removal of the nasogastric tube, removal of mediastinal drains and removal of left basilar chest tube . right internal jugular central line has its tip in the distal superior vena cava, unchanged . . persistent low lung volumes with patchy bibasilar opacities and a probable layering left effusion . these findings likely reflect compressive atelectasis . no pneumothorax is seen . status post median sternotomy with stable postoperative cardiac and mediastinal contours .	Atelectasis&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Support Devices	12810135	50049540	e973d1f1-67f0309d-c6f961a4-02eda522-e311557e
745	ap and lateral chest radiographs there is mild pulmonary vascular congestion . a subtle ill-defined opacity in the right upper lung may reflect overlapping shadows, though an underlying parenchymal process may be present . follow-up radiographs are recommended to assess for interval change . linear scarring within the right mid lung is unchanged from prior . linear opacities within the bilateral lung bases likely reflect areas of subsegmental atelectasis . there is stable mild elevation of the left hemidiaphragm, unchanged from prior . the thoracic aorta is tortuous . cardiomediastinal and hilar contours are within normal limits . mild pulmonary vascular congestion . subtle opacity in the right upper lung, possibly representing a confluence of shadows, but follow-up radiographs are recommended to assess for interval change .	Edema&&Lung Opacity	13979643	54753684	2ff152b9-2b4549f1-9fc64fbd-baf8d8e4-cafcdbee
746	the cardiomediastinal and hilar contours are stable . there is no pleural effusion or pneumothorax . the lungs are well expanded and clear . pulmonary vasculature is within normal limits . no acute cardiopulmonary process .	No Finding	18767957	59375123	ee7e973e-09b18407-53d2a8d5-becd082f-6debca86
747	frontal and lateral views of the chest demonstrate low lung volumes, which accentuate bronchovascular markings . there is no focal consolidation, pleural effusion or pneumothorax . the hilar and mediastinal silhouettes are unremarkable . heart size is top normal . partially imaged upper abdomen demonstrates prominent air-filled large bowel loops . no evidence of acute cardiopulmonary process .	No Finding	13202100	50109176	89b0ebca-d32862e8-5268f3d8-5b946fe8-a2876759
748	new heterogeneous opacification in the right lower lung at least some of which is in the middle lobe, obscuring the right heart border, the remainder at the base, is all new since , considered pneumonia until proved otherwise . new anterior chest wall drains are noted . heart is normal size . the hyperinflation and vascular deficiency of emphysema are longstanding . a ring shadow in the left upper lung at the level of the aortic arch is more prominent today than it has been since an abnormality in this region was demonstrated on chest ct scanning in . there may be a second similar region in the right lower lung at the level of the sixth anterior rib . these findings are suggestive of active bronchiectasis, which can be seen with mycobacterial infection, either tuberculosis or atypical species . there is no appreciable pleural effusion . , was paged at am, one minute following recognition of the findings . findings were discussed ten minutes later with the np caring for the patient .	Lung Opacity&&Pneumonia&&Support Devices	17770657	54721212	51150936-2cf82a04-6fa1a638-e1577644-0ba4c3a3
749	the heart is again mild-to-moderately enlarged . the mediastinal and hilar contours appear unremarkable . there is patchy opacity in the right infrahilar region suggestive of minor atelectasisscarring, but widespread opacities and pleural effusions have resolved . no pneumothorax is demonstrated . no evidence for acute disease .	No Finding	11569042	54093116	44d21fe9-7d185d5f-00927b0f-11bf3dce-45b85640
750	the heart continues to be enlarged, and there are chronic interstitial markings . no focal consolidation, pleural effusion or overt pulmonary edema is seen . there is leftward scoliosis of the thoracic spine . cardiomegaly .	Cardiomegaly	13475033	53354417	3851190a-af79fb41-4c2b3b1e-b4269325-f8a2fb78
751	ap upright and lateral views of the chest were obtained . subtle patchy right base opacity is seen, which could be due to infection or aspiration . no consolidation is seen on the left . there is no pleural effusion or pneumothorax . the cardiac and mediastinal silhouettes are stable .	Enlarged Cardiomediastinum&&Lung Opacity&&Pneumonia	16050730	57637607	9b148afe-84b1cee1-f5157098-7afc39cf-7d78784c
752	single portable view of the chest is compared to previous exam from . dual-lumen right subclavian central line is again seen with tip at the ra-svc junction . increased interstitial markings seen throughout the lungs are again noted and suggestive of chronic interstitial disease . right mid lung opacity has resolved . the cardiomediastinal silhouette is stable as are the osseous and soft tissue structures . no acute cardiopulmonary process . persistent increased interstitial markings in the lungs compatible with chronic interstitial disease . interval resolution of the right mid lung opacity since prior .	Lung Opacity	13475033	58495524	5e8e548c-59b6fa70-d71716fa-d03c9e0b-2dc443eb
753	the bilateral upper lobe scarring including traction bronchiectasis is more evident today than it was on , consistent with and progression of pulmonary sarcoidosis . there is no evidence of central adenopathy or any pleural abnormalit .	Lung Opacity	14147787	55391430	7a52e00c-0cd9dc20-34963936-2a8e2811-cdd867d0
754	in comparison to prior radiograph of day earlier, there has been little change in the appearance of the chest except for interval improvement in the previously noted atelectasis in the right upper and left lower lobes .	Atelectasis	14841168	54292875	db7deae0-c131f372-8a041d5f-81013233-74ccf3f3
755	severe cardiomegaly is probably stable, but mild pulmonary edema, more pronounced in the right lung is new, accompanied by at least small bilateral pleural effusion . dual-channel right supraclavicular dialysis catheter set ends in the right atrium . trans-subclavian atrial biventricular pacer defibrillator leads are continuous from the right axillary power pack . no pneumothorax .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	19759491	53350789	3480ade8-6825b33b-dc07898d-97d83f8a-c743b07b
756	portable semi-upright radiograph of the chest demonstrates low lung volumes with resultant bronchovascular crowding . clearing of the right base is consistent with decrease in size of the pleural effusion and improved aeration . persistent retrocardiac opacity corresponds to atelectasis and probable left pleural effusion . there is moderate pulmonary edema . cardiomediastinal and hilar contours are unchanged . monitoring and support devices are in the appropriate position . . moderate pulmonary edema . . stable retrocardiac opacity, consistent with small pleural effusion and atelectasis .	Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion	12595991	55463602	bf9f8403-f941bbb9-13c134ff-ac80d6b9-e8442bdf
757	ap upright and lateral views of the chest were provided . left chest wall pacer pack is again seen with leads extending into the right heart . abandoned pacing leads are also noted in the right chest wall extending into the right heart . the heart remains moderately enlarged . lung volumes are low, with equivocal ground-glass opacity on the frontal view, which appears less conspicuous on the lateral view most likely attributable to underpenetrated technique . no gross evidence for pneumonia or pulmonary edema . no large effusions are seen . there is no pneumothorax . bony structures are intact . limited study demonstrating moderate cardiomegaly and no overt edema or pneumonia .	Cardiomegaly&&Edema&&Pneumonia	11293517	50845269	f24dcfb8-8d336748-8d0d5686-a52f7cc9-2aefd3a6
758	the heart size is enlarged similar to prior study . its rounded shape raises a question of cardiomyopathy and less likely pericardial effusion . sternotomy wi .	Cardiomegaly	18828251	59257021	f608cced-6b58fb15-27c96aec-bee65e84-0155c300
759	pa and lateral views of the chest are compared to multiple prior exams including ct torso from with most recent x-ray from . when compared to most recent exam, there has been near complete resolution of the right upper lung opacity . there is evidence of scarring at the upper lobes bilaterally with retraction of the hila and some nodular densities, particularly in the left upper lung . these have been seen on multiple prior exams . minimal blunting of the left posterior costophrenic angle may represent trace effusion . there is no large confluent consolidation . cardiomediastinal silhouette is stable as are the osseous structures, noting multiple orthopedic screws projecting over the right glenoid . essentially complete resolution of the right upper lobe opacity seen on prior . findings suggestive of underlying chronic upper lobe scarring, although superimposed acute infectious process, particularly on the left, is not completely excluded .	Lung Opacity&&Pneumonia	10933609	58929044	dda9463c-13653db6-03e65f74-74ef0b98-4cceb8c9
760	there is continued extensive bilateral pulmonary opacification, worse on the right . the findings could reflect some combination of widespread pneumonia, severe pulmonary edema, an even ards . monitoring and support devices remain in place .	Edema&&Lung Opacity&&Pneumonia&&Support Devices	19757720	56399963	fa3c5d61-58bb9992-05e07467-d6f5340b-7253e398
761	ap upright portable chest radiograph obtained . there is a new right ij central venous catheter with its tip residing in the high svc . bibasilar opacities are unchanged . no pneumothorax .	Lung Opacity&&Support Devices	15370732	54694272	e13035e9-35e026e1-d7d54018-e342a349-93752c81
762	there is again enlargement of the cardiac silhouette with a pacer device in place . no definite vascular congestion, raising the possibility of underlying cardiomyopathy or pericardial effusion . no acute focal pneumonia . the right picc line has been removed .	Cardiomegaly&&Support Devices	11293517	53430284	ac50a7e7-7e116074-b42ad5c9-c2a852c3-3c61019d
763	the right internal jugular line has been inserted with its tip being at the cavoatrial junction . the ng tube tip passes below the diaphragm terminating in the stomach . the et tube tip is approximately cm above the carina . bibasal opacities appear unchanged . mild pulmonary edema is still present . no pleural effusion or pneumothorax is seen .	Edema&&Lung Opacity&&Support Devices	15161734	57529728	752f7b9f-81a342bd-682bae18-572716d6-eada830a
764	dual lead left-sided pacemaker is stable in position with leads extending to the expected positions of the right atrium and right ventricle . the patient is status post median sternotomy . there is minimal left base atelectasis . no focal consolidation, pleural effusion, or evidence of pneumothorax is seen . the cardiac and mediastinal silhouettes are stable . no displaced fracture is seen . no acute cardiopulmonary process .	No Finding	17163861	56013519	0f513599-eb6bddc9-4306d15d-46c7c0c2-a3c6c854
765	moderately severe pulmonary edema has worsened . small right pleural effusion is probably new . heart size is normal . a focal consolidation would not be appreciated . nasogastric tube passes below the diaphragm and out of view .	Consolidation&&Edema&&Pleural Effusion&&Support Devices	13031876	59018724	58d3a7e8-1cc861cc-3428518f-8b578623-d3be6ba1
766	clinical indication -year-old with respiratory distress, status post endotracheal tube placement and orogastric tube placement . comparison is made to the patients previous study dated at am . portable semi-erect chest from at is submitted . . interval placement of an endotracheal tube, which has its tip approximately to cm above the carina but appears to be in satisfactory position . there is a nasogastric tube coursing below the diaphragm, which appears to be coiled within the proximal stomach . lungs again are hyperinflated suggesting underlying emphysema, and there are stable postoperative changes on the right side . both pulmonary arteries remain prominent, consistent with underlying pulmonary artery hypertension . heart remains within normal limits in size . the aorta appears somewhat dilated and unfolded on the current examination, likely related to marked patient rotation to the right . no evidence of pneumothorax .	Support Devices	16622813	55353288	a249c5ba-c1c92f36-682ef4b1-98f3bd56-7d2f6932
767	frontal chest radiograph a new endotracheal tube terminates . cm above the carina . there is a new orogastric tube terminating within the stomach . again seen is a confluent right mid lower zone opacity with a central rounded lucency, which may reflect cavitary lesion or abscess . no underlying consolidations are present . there is no pneumothorax . . et tube terminating . cm above the carina . orogastric tube terminating within the stomach . . unchanged appearance of middle and lower lobe opacities with central lucency suggestive of cavitation or abscess .	Lung Opacity&&Support Devices	13964474	51648837	4460b78c-d6c33b0d-eb6264df-74386a2b-371f79ec
768	comparison is made with prior studies including ct , chest x-ray , and . there are persistent low lung volumes . moderate cardiomegaly is stable . widened mediastinum due to tortuous aorta is stable . left lower lobe opacities are consistent with atelectasis . there are left perihilar and right lower atelectasis . rib fractures on the right side in the seventh and eighth ribs are more conspicuous than before . there is no pneumothorax . there is no evidence of acute or chronic tb .	Atelectasis&&Cardiomegaly&&Enlarged Cardiomediastinum&&Fracture&&Lung Opacity	16853729	50336040	be9ef580-3556eb15-d35c2bfb-f8249147-9fa04f25
769	lungs are grossly clear . there are no new lung opacities which are of concern . there is no evidence to suggest pleural effusion or pneumothorax . severe scoliosis is noted . cardiomediastinal silhouette is unchanged . the nasogastric tube tip is in the stomach and right picc line is approximately at the mid svc .	Enlarged Cardiomediastinum&&Lung Opacity&&Support Devices	18110020	59044985	2d45a143-1df013b8-730bd381-c219de78-7ad22f77
770	tip of the endotracheal tube is at the upper margin of the clavicles, cm from the carina . it could be advanced cm for more secured seating . severe cardiomegaly is worse . mild interstitial edema persists . severe opacification of the left lower lung could be atelectasis and pleural effusion but raises concern for pneumonia . pleural effusion, at least moderate on the right, is unchanged . no pneumothorax . swan-ganz catheter ends in the right pulmonary artery and a nasogastric tube passes below the diaphragm and out of view . no pneumothorax .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	12185775	57463116	552b9cdb-02b1e116-417a8a56-d2f54f1e-865a2a0c
771	the lung volumes are normal . mild bilateral apical scarring . borderline size of the cardiac silhouette without pulmonary edema . no overt pneumonia . small basal lung nodule projecting over the right costophrenic sinus, unchanged as compared to the previous examination . no inflammatory or edematous change in the lung parenchyma . normal appearance of the mediastinum .	Cardiomegaly&&Lung Lesion&&Lung Opacity	19549821	56573421	bc763820-6af428a2-67311ece-8d067825-f6282dba
772	frontal and lateral views of the chest demonstrate a transsubclavian right atrial and ventricular pacer defibrillator leads in standard position with no pneumothorax, pleural effusion, or mediastinal widening . lung volumes remain low . the heart is stably enlarged . icd leads end in the right atrium and right ventricle . no evidence of bleeding or pneumothorax .	No Finding&&Support Devices	12475198	59735543	92b3ce9d-9a7bb494-1dec6d0b-93cf4386-82995e53
773	portable ap radiograph of the chest was reviewed in comparison to prior study from and several prior studies dating back to . the et tube tip is . cm above the carina . the right internal jugular line tip is at the level of superior mid svc . the picc line tip is not clearly seen, most likely at the level of mid low svc . the ng tube passes below the diaphragm terminating in the stomach most likely . there is no change in extensive opacification of the right lung ,left lung and in particular, left lower lobe consolidation . no interval development of pneumothorax or interval increase in pleural effusion can be documented .	Consolidation&&Lung Opacity&&Pleural Effusion&&Support Devices	19757720	54045154	d5cabbb7-94d369a5-63b100a0-ee367e8e-e320832b
774	the lungs are hyperinflated . there is no focal consolidation, pleural effusion or pneumothorax . small focal opacity projects over the lateral right lower hemithorax, may represent overlapping structures, but further evaluation is recommended with shallow obliques to assess for possible pulmonary nodule . heart size is normal . mediastinal silhouette and hilar contours are normal . . no acute intrathoracic process . . small focal opacity projects over the lateral right lower hemithorax . shallow obliques off the frontal view are recommended for further evaluation . findings and recommendations discussed with dr . covering for dr . , by phone at pm .	Lung Opacity	11052935	55372843	d4800b11-08ea5ece-04ba7667-a463e711-378c3893
775	post-operative changes are again seen in the left hemithorax with shift of the mediastinum to this side . chest tube remains in place and there is no evidence of pneumothorax . the right lung is essentially clear except for some residual atelectatic change at the base . the gas along the upper chest border on the left and subcutaneous tissues is decreasing . there appears to be some increase in the extensive opacification in the left hemithorax . this could reflect additional pleural fluid, though in the appropriate clinical setting, the possibility of supervening pneumonia would have to be considered .	Atelectasis&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	11378150	50979785	7d987f2a-f684bbcb-c1e27bf0-0cb90406-cf56be90
776	there are low lung volumes and bronchovascular crowding . there is prominence of the hila suggesting pulmonary vascular engorgement with possible mild pulmonary vascular congestion . no pleural effusion or pneumothorax is seen . left infrahilar and left basilar opacity may relate to vascular crowding, although infectious process cannot be excluded in the appropriate clinical setting . there are right paramediastinal surgical clips . cardiac and mediastinal silhouettes are stable .	Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pneumonia	19907884	52269494	be142141-0e637201-65d2ff88-43edd072-198d4dc7
777	there has been interval decrease in ground-glass opacity bilaterally compared to prior study of at pm, which represents decrease in pulmonary edema . there has been interval decrease in observed cardiomegaly . there is bilateral small amount of pleural effusion . there are no areas of focal consolidations and no pneumothorax . the pleural surfaces are unremarkable . the endotracheal tube is no less than . cm from the carina, could be advanced cm for optimal placement . interval reduction in pulmonary edema and cardiomegaly . et tube can be advanced cm for optimal placement .	Cardiomegaly&&Edema&&Support Devices	13078497	58895837	aed9fe49-bb7468b2-ba4f60dd-25410316-df9b9d8c
778	since the prior radiograph two days prior, there has been worsening mild pulmonary edema . there is no consolidation, pleural effusion, or pneumothorax . the cardiomediastinal silhouette is unchanged with a normal postoperative appearance . sternal wires and the prosthetic cardiac valve are unchanged in appearance . . worsening mild pulmonary edema . . no pneumothorax . results were discussed with dr . at on via telephone by dr . minutes after the findings were discovered .	Edema	19182863	51621424	d85667b8-c62dec2e-998b6abd-7f553ce3-75954004
779	right basilar opacity without any corresponding opacity seen on the lateral view likely represents atelectasis . there is no pleural effusion or pneumothorax . the cardiac and mediastinal silhouette is within normal limits . no acute cardiopulmonary process .	No Finding	15659181	50701107	08b3a2f5-6a4527a8-cea348a9-b559b9e1-42a62261
780	comparison is made to the patients previous study of . portable ap upright chest film, at is submitted . there are persistent and slightly worsening opacities in the left upper and mid lung and right lower lung which would be concerning either for worsening edema or pneumonia . chain sutures are again identified abutting the minor fissure consistent with prior surgery . bilateral effusions, left greater than right, are again seen . persistent retrocardiac opacity may reflect compressive atelectasis, although infection in this region cannot be excluded . the patient is status post median sternotomy for cabg, but assessment of cardiac and mediastinal contours is difficult due to the patients marked rotation on the current examination . left internal jugular central line continues to have its tip in the mid svc . linear calcifications in the left upper hemithorax are felt to likely be pleural in etiology . a portion of the inferior vena caval filter is imaged at the edge of the study .	Atelectasis&&Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	16334516	52224512	8a2e287f-a1d2adab-ab39ac3c-c8e1077c-c3811102
781	upright ap and lateral views of the chest the patient is status post median sternotomy and cabg . left-sided dual-chamber pacemaker is noted with leads terminating in the right atrium and right ventricle . there is mild enlargement of the cardiac silhouette which is stable . the aorta remains tortuous . there is mild pulmonary edema and a small right pleural effusion . previously noted left pleural effusion is not clearly seen on the current study . patchy ill-defined opacity in the right base persists and is likely due to atelectasis, though infection cannot be excluded . there is no pneumothorax . no acute osseous abnormalities are present . mild pulmonary edema with small right pleural effusion and right basilar opacification, possibly reflecting atelectasis, though infection is not excluded . previously noted small left pleural effusion appears resolved .	Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia	15378103	51347031	4a04164c-bf7a47b2-39273bf3-6f841e34-278431eb
782	the degree of pulmonary vascular congestion may have slightly decreased in this patient with continued substantial enlargement of the cardiac silhouette . the possibility of supervening interstitial lung disease is difficult to assess on plain radiograph, but was apparent on the ct study of . no acute focal pneumonia . central catheter remains in place . some improvement in still prominent pulmonary vascular congestion .	Edema	10439781	55725911	2e5ac89a-e2d5d8c6-8cbf02bc-ec6e4725-9339a9cc
783	portable ap radiograph of the chest was reviewed in comparison to , obtained at am . current study demonstrates interval redevelopment of interstitial pulmonary edema seen in perihilar areas and lower lobes . it obscures currently the appearance of the left upper lobe consolidation, but no interval worsening of the left upper lobe consolidation demonstrated . small amount of pleural effusion cannot be excluded . pacemaker defibrillator leads are in unchanged position .	Consolidation&&Edema&&Pleural Effusion&&Support Devices	13606683	54400622	fad8bdac-78afc435-8cab7288-0938d17b-0d2be00b
784	portable semi-upright radiograph of the chest demonstrates a stable cardiomediastinal silhouette as seen on prior examinations, with mediastinal widening . an elevated right hemidiaphragm is again seen . the left lung base is not visualized . no focal consolidation is identified in the visualized lung fields . given supine technique, it is difficult assess for pleural effusion or pneumothorax . no significant change since recent prior .	No Finding	14841168	59947539	b90427be-b8e2a5b2-d96a239f-5b791587-230e2fe5
785	the cardiac, mediastinal, and hilar contours appear unchanged . multifocal opacities which persist in the upper lungs with volume loss suggest chronic scarring without definite superimposed disease . blunting of the left posterior costophrenic sulcus is unchanged, suggesting either trace pleural effusion or pleural thickening . bony structures are unremarkable . stable appearance of the chest .	No Finding	10933609	54300688	21f6f51a-c6b2fab8-8c228bb8-1a8f8c46-d568b413
786	unchanged monitoring and support devices . unchanged moderate cardiomegaly with signs of mild fluid overload . left and right basal atelectasis . potential small-to-moderate right pleural effusion . no left pleural effusion . no interval appearance of new parenchymal opacities .	Atelectasis&&Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Support Devices	14841168	52365850	ffd311aa-b1ad24f7-29b178ef-4423264a-d0298e46
787	since the prior study, the previously described right upper lobe nodularity has improved, with residual left upper lobe opacities, possibly repesenting postinflammatory scarring . there is no large pleural effusion, focal pneumonia, or pneumothorax . left apical clips are unchanged in position . the cardiomediastinal silhouette is stable . postsurgical changes in the upper abdomen are related to prior left nephrectomy . . no acute cardiopulmonary process . . improved biapical opacities as compared to prior radiograph in early . small pulmonary nodules are better assessed on prior chest ct from .	Lung Lesion&&Lung Opacity	14794396	51199892	2e11d19f-7fd45c8b-fd747233-8ee0a18d-191447d3
788	portable ap chest radiograph demonstrates a dobbhoff tube in the lower thorax . the radiopaque tip is terminating above the diaphragm . left basilar atelectasis and pleural effusion is unchanged from . the cardiomediastinal silhouette is stable . there is no pneumothorax . dobbhoff tube terminates in the distal esophagus . by phone at pm .	No Finding&&Support Devices	18079481	56238840	45dc8b2b-703d5d88-d0e05f85-35cc43ba-84b1f4be
789	endotracheal tube, nasogastric tube, right hemodialysis catheter and right-sided surgical drain are in unchanged position with interval removal of left-sided swan with sheath still within the left internal jugular vein . asymmetric right greater than left pulmonary edema and moderate pleural effusion are unchanged with progressive right sided volume loss and rightward shift of the mediastinum over the past films . the heart size is top normal in size with normal cardiomediastinal contours . progressive right sided volume loss since intubation could be due to mucous plugging iwith unchanged right effusion and vascular congestion . by dr . at on by phone .	Edema&&Pleural Effusion	11880923	50969842	4db2b802-44d922f7-c712342d-b8af15be-7ac7a0ed
790	there are low lung volumes . there is elevation of the left hemidiaphragm . there is a large area of atelectasis in the periphery of the left lower lobe . there is a right chest tube . there is no pneumothorax . if any, there is a small right pleural effusion . there is mild atelectasis in the right lower lobe . the mediastinum is slightly widened . cardiac size is stable .	Atelectasis&&Cardiomegaly&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	19389547	59607772	6aa507c8-091eb714-e018466d-28671eeb-4bb67070
791	frontal chest radiograph an endotracheal tube terminates . cm above the carina . again seen is a markedly elevated right hemidiaphragm . there is mild central pulmonary vascular congestion with interstitial edema . small bilateral pleural effusions are present, larger on the right . an orogastric tube extends into the stomach . since the prior examination, there has been worsening of mild-to-moderate interstitial edema and pulmonary vascular congestion . there is no pneumothorax . the cardiac and mediastinal silhouette is unchanged . . et tube terminating . cm above the carina . orogastric tube terminating within the stomach . . interval worsening of mild-to-moderate pulmonary edema . . unchanged marked right hemidiaphragm elevation .	Edema&&Support Devices	11569093	59234239	382dbe73-cac300e6-08430cac-cec951a4-86e9e1e1
792	compared with with pm . and allowing for technical differences, i doubt significant interval change .	No Finding	16848073	57686985	760376cf-c8d2ce52-f0bcb949-d108c9d1-49df600a
793	interstitial prominence has increased compared to prior, suggestive of mild edema . no focal consolidation or pneumothorax is detected . tiny right pleural effusion appears new compared to prior . heart and mediastinal contours appear stable with mild cardiomegaly . new mild interstitial edema and tiny right pleural effusion .	Edema&&Pleural Effusion	13475033	55316579	f067c77a-54a4358e-ff4a3ce6-75df62e9-a3be270f
794	when compared with multiple prior studies, there is bilateral upper lung scarring with slight retraction of the bronchovasculature . there is no definite sign of new consolidation with relative opacity at the right heart border on the frontal view, not convincing for pneumonia . lung volumes are low . heart and mediastinal contours appear stable . no effusion or pneumothorax . stable chest radiograph with upper lung scarring . subtle opacity in the right lower lung, likely crowding of bronchovasculature .	Lung Opacity	10933609	54870311	7acf30bd-0ed39a38-bb6159dd-2ed09689-dd05ba98
795	the patient is status post right thoracotomy with a worsening loculated right pleural effusion along the lateral and anterior pleura . there is diffusely increased hazy opacification of the right hemithorax, mainly due to the oblique positioning of the patient . lung volumes are low with secondary widening of the cardiomediastinal silhouette . there is only mild vascular congestion . there is no pneumothorax . unchanged chest tube . . since yesterday morning, only minimal worsening of the right pleural effusion and atelectasis . . diffusely increased hazy opacification of the right hemithorax, is mainly due to the oblique positioning of the patient .	Atelectasis&&Lung Opacity&&Pleural Effusion	11474065	54696391	f292b1a8-2e6fdb2c-a2e020b7-ae3b0cc9-9e3866d1
796	the right and left pleural effusions are virtually unchanged . they are mild-to-moderate in extent . the effusions are at the source of bilateral areas of compression atelectasis . unchanged borderline size of the cardiac silhouette . no evidence of pneumonia . unchanged right internal jugular vein catheter and left pectoral pacemaker . no pneumothorax .	Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices	15378103	57681546	1f7d224a-19e6cfa7-5627f007-83212a22-be1faf67
797	the patient is status post median sternotomy and aortic valve replacement . right-sided pacemakeraicd device is again noted with leads terminating in the right atrium, right ventricle, and the region of the coronary sinus, unchanged . enlargement of the cardiac silhouette is moderate, and similar compared to the previous study . the mediastinal and hilar contours are normal . there continues to be upper zone vascular redistribution, similar when compared to the previous study compatible with mild pulmonary vascular engorgement . lungs remain hyperinflated compatible with copd . linear opacities in the lung bases are compatible with scarring . small bilateral pleural effusions are relatively unchanged . there is no pneumothorax . mild pulmonary vascular congestion, similar compared to the previous study with small bilateral pleural effusions . scarring within the lung bases .	Edema&&Lung Opacity&&Pleural Effusion	13606683	55832727	64f99800-8450e0a6-9bcd9fa5-3fe8ad9f-9c164aa4
798	the endotracheal tube is in unchanged position . the nasogastric tube and the right central venous access line are also unchanged . there are bilaterally increasing pleural effusions with subsequent increasing areas of basal atelectasis . the overall lung volumes remain low . moderate cardiomegaly is unchanged . known pulmonary metastatic disease .	Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices	16409152	57478725	df2afec3-bcff5990-a6f64c83-6bb93795-d38a1ec8
799	the patient has received a new dobbhoff tube . the tip of the tube projects over the middle parts of the stomach . the course of the tube is unremarkable . there is no evidence of complications, notably no pneumothorax . otherwise, the radiographic appearance of the thoracic organs is similar to the previous examination .	No Finding&&Support Devices	14841168	54146597	d89f6431-69df909d-747f1354-8a38a37f-5835e7aa
800	heart size is upper limits of normal . there has been improvement of the pulmonary edema . there remains vague opacities at the lung bases . this may be due to resolving pulmonary edema versus atelectasis versus residual infiltrate . there are no pneumothoraces .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity	18767957	51612379	1f39a0e5-eb257452-7629c4fc-d3d059e7-17bf34f5
801	no definite focal consolidation is seen . there is no pleural effusion or pneumothorax . the patient is status post median sternotomy with multiple fractured sternal wires including the third superior most and additional more inferior as also seen previously . cardiac silhouette is mildly enlarged . there may be slight prominence of the main pulmonary artery, which may be in part related to patient positioning, however, underlying pulmonary hypertension is not excluded .	Cardiomegaly&&Fracture	19499595	57088454	faafd86d-6a1d4047-0cf76260-da7b281c-eba9d436
802	increased interstitial markings seen throughout the lungs, not significantly changed since prior . there is no focal consolidation nor effusion . there is moderate cardiac enlargement and tortuosity of the descending thoracic aorta . compression deformity of several upper lumbar vertebral bodies are again noted . no acute osseous abnormalities . cardiomegaly with pulmonary vascular congestion but no overt edema .	Cardiomegaly	16957952	58025986	ac61125d-0a43dbdc-3c290b21-1ded59a4-0131570a
803	moderate pulmonary edema with moderate cardiomegaly but without pleural effusions . overall low lung volumes . retrocardiac atelectasis .	Atelectasis&&Cardiomegaly&&Edema	15131736	53904896	2482c720-f75763bb-00774ba9-894119a7-24bd15a6
804	the parenchymal consolidation surrounding the right hilus has moderately decreased in extent and severity . the changed likely reflect resolving pneumonia . moderate cardiomegaly persists . no other pathologic parenchymal process . the radiograph also continues to show multiple cervical soft tissue calcifications as well as punctate splenic calcifications and at diffusely increased bone density, suggesting renal osteodystrophy .	Cardiomegaly&&Consolidation&&Pneumonia	19061282	54993114	7cbc9371-93ae74a8-4d6234b9-a496d3e4-8812a350
805	ap and lateral chest radiographs were obtained . the lungs are well expanded and the central pulmonary vasculature is more indistinct . cephalization of the upper lobe pulmonary vasculature has progressed since . small bilateral pleural effusions are new . moderate cardiomegaly is unchanged . sternotomy wires and vascular clips are in unchanged positions . indistinct pulmonary vasculature and small pleural effusions are consistent with worsening of mild chf since .	Cardiomegaly&&Edema&&Pleural Effusion	18828251	53348686	35deb322-043ec12f-b33e7567-530c7a88-8b213991
806	moderate atelectasis in the retrocardiac lung regions . no new parenchymal opacities . unchanged position of the endotracheal tube and nasogastric tube .	Atelectasis&&Lung Opacity&&Support Devices	15131736	54626336	9b42f01f-2bbe3c2e-1348a6c8-33031532-1a82c013
807	there are lower lung volumes with secondary mild widening of cardiomediastinal silhouette . there is no pleural effusion, pneumothorax or focal lung consolidation . there are bibasilar opacities which are better seen on the subsequent ct abd, may represent aspiration or atelectasis .	Atelectasis&&Enlarged Cardiomediastinum&&Lung Opacity	10975446	56820999	28a61df7-4fa64f79-11a7bc9c-789dd22b-171b52b3
808	a mild diffuse interstitial abnormality persists, possibly reflecting known airways abnormalities previously imaged by ct . there are no new focal opacities . no effusion and no pneumothorax . the hilar and cardiomediastinal contours are unchanged . there is no pulmonary vascular congestion or pulmonary edema . chronic deformity of the distal right clavicle is unchanged from prior studies . there is mild compression deformity of two mid-thoracic vertebral bodies, similarly stable . no new fractures are identified . little change in diffuse interstitial prominence, without new focal parenchymal opacity . chronic osseous changes involving the distal right clavicle and mid-thoracic vertebral bodies are again noted .	Lung Opacity	19765968	52279876	c5b9a963-19ad5c79-7e658aef-87d2cec2-8d00ddc7
809	dense consolidation in all the basal segments of the left lower lobe has progressed since . this could be either chronic collapse, or less likely chronic collapse with a component of pneumonia . right lung is clear . left pleural effusion, small if any, is a function of the persistent basal atelectasis . heart size is normal .	Atelectasis&&Consolidation&&Pleural Effusion&&Pneumonia	15114531	50027153	4347b81b-2a702858-6a330ca4-e115c0ac-f1017427
810	study is essentially unchanged from immediately prior study dated . middle lobe and lingular infiltrate are once again observed and essentially unchanged . there has been a slight interval decrease of bilateral pleural effusions . no new areas of consolidation are appreciated . no pneumothorax . the cardiomediastinal silhouette is stable and within normal limits . unchanged bilateral pneumonia with decreased pleural effusions .	Pleural Effusion&&Pneumonia	16662264	57833493	21dd100a-bf76f673-4ee97c34-87797534-1ff8583e
811	an area of scarring in the right lower lung appears unchanged . remainder both lungs appear relatively clear . cardiomediastinal silhouette is stably prominent . no pneumothorax . chronic right upper rib cage deformity and chronic changes related to vertebroplasty in the lower t-spine . no convincing evidence for pneumonia or edema .	Edema&&Pneumonia	11474065	59083645	7bcd081b-869f44f4-57a93477-646a8796-ee97546c
812	there may be slightly less fluid in an air and fluid collection at the base of the right hemithorax lying just superior to a pigtail drain . with conventional radiographs, much less a single frontal view, it is impossible to say how the position of the tube relates to pleural collections . right middle lobe is probably still collapsed . left lung shows mild pulmonary vascular congestion as before, and a small left pleural effusion is stable . heart size is normal . right pic line ends low in the svc .	Atelectasis&&Edema&&Pleural Effusion&&Support Devices	14387068	50084331	5d8d15d2-dc99cbe5-5c910973-385d5e29-82320f37
813	dobhoff tube has been repositioned and now passes below the diaphragm and crosses the midline, likely within the second portion of the duodenum . the wire is still in place . exam is otherwise unchanged . dobbhoff tube below the diaphragm and likely post-pyloric .	No Finding&&Support Devices	17770657	50170341	0e3f8459-2b944097-bffb91c8-6578b8ac-e143b9a2
814	the lungs are clear without focal consolidation . there is a prominent right mediastinal fat pad . no pleural effusion or pneumothorax is seen . cardiomegaly is stable . no acute cardiopulmonary process .	No Finding	17398573	51522722	4a102c0d-0f7d000d-98e8aac0-7509e4c8-b9d60545
815	coronary stent projects over the heart . a stent projects over the right upper arm . there is again noted to be coarsened prominent interstitial markings throughout both lungs which could reflect underlying fibrosis versus interstitial pulmonary edema . no large effusion or pneumothorax . no convincing evidence for pneumonia . cardiomediastinal silhouette is stable . bony structures are intact . a chronic left clavicular midshaft deformity is noted . prominent bilateral interstitial opacities could reflect interstitial lung disease versus interstitial edema . please correlate clinically .	Edema&&Lung Opacity	13475033	51351077	c8d8a6ba-39f605e7-31f65aff-3edf85bf-f9e26e9b
816	the patient has received a new right internal jugular vein catheter . the course of the catheter is unremarkable, the tip of the catheter projects over the lower svc . there is no evidence of complications, notably no pneumothorax . otherwise unchanged radiographic appearance .	No Finding&&Support Devices	19454978	53537107	854781b3-f371e22e-df201d6f-78f736e1-07330978
817	and on initial radiograph, a line near the right apex is seen . this was further evaluated by repositioning and repeat radiograph demonstrating the absence of this line which most likely represented a skin fold . no pneumothorax is identified . the examination overall is unchanged with known severe emphysema and multifocal opacities . extensive subcutaneous emphysema is also not significantly changed . right-sided chest tube, right-sided central venous line and tracheostomy tube are unchanged .	Lung Opacity&&Support Devices	16751749	51987558	eafdbeaa-59012e3f-a57953ad-06e738fb-b38b3f1d
818	frontal and lateral chest radiographs demonstrate moderate interstitial pulmonary edema . the heart size is moderately enlarged, there are moderate bilateral pleural effusion . there is no lobar consolidation . the aortic contour is mildly tortuous . embolic coiling material is seen in the mid abdomen on the lateral view . moderate pulmonary edema, cardiac silhouette enlargement, and pleural effusions suggest chf . no evidence of lobar pneumonia .	Cardiomegaly&&Edema&&Pleural Effusion	17189198	55198163	84ffb901-893b00a7-7f2090be-d5cf6a4e-c34ab763
819	lung volumes remain low, accentuating the cardiac silhouette and bronchovascular structures . with this limitation in mind, cardiomediastinal contours are stable in appearance . persistent elevation of left hemidiaphragm with adjacent atelectasis at the left lower lobe . right retrocardiac atelectasis is also similar to the prior study .	Atelectasis&&Cardiomegaly&&Enlarged Cardiomediastinum	18338007	51909516	f0de6eac-d8d4cc43-59d26e49-46200472-34fa5de1
820	the right picc line has been pulled back . the tip appears to project over the right subclavian vein, the does not reach the superior vena cava . placement of a is required . no other relevant changes . no pneumothorax . mild cardiomegaly, left pleural effusion and moderate pulmonary edema .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	13896515	56302138	54140bf8-0a93e22f-fcdfa610-39ed40a3-a0e0136d
821	the pre-existing and pre-described right lower lobe pneumonia has substantially increased in extent and severity . there now is a large area of parenchymal consolidation at the right lung bases, potentially associated with a small right pleural effusion . the size of the cardiac silhouette is minimally enlarged . the retrocardiac atelectasis has newly occurred . unchanged tortuosity of the thoracic aorta . no pneumothorax .	Atelectasis&&Cardiomegaly&&Consolidation&&Pleural Effusion&&Pneumonia	14295224	51689739	0096fc1d-7c100751-e1c8cb03-c461efb4-1c6b0f8e
822	the cardiomediastinal silhouettes are grossly stable . no definite focal consolidation is seen . there is no pleural effusion or pneumothorax . the bilateral rib deformities are due to prior fractures . compression deformities along the thoracic spine are grossly stable compared to .	Enlarged Cardiomediastinum&&Fracture	18079481	56876464	a82741ea-8169b7a6-82642ef9-7c78cbbe-95583ecb
823	cardiomediastinal contours are unchanged in position with persistent widening of right mediastinal contour, a change in appearance from a standard pa and lateral chest radiograph of but similar to the radiograph . this could potentially be due to accentuation of tortuous vascular structures by low lung volumes and portable semi-erect technique, but attention to this area on repeat study with improved inspiratory volume would be helpful to exclude a mediastinal mass or hemorrhage . slight improvement in bibasilar atelectasis . no new areas of lung opacification . persistent small bilateral pleural effusions, seen to better detail on recent abdominal ct of the same date . multiple bilateral healed rib fractures .	Atelectasis&&Enlarged Cardiomediastinum&&Fracture&&Lung Opacity&&Pleural Effusion	18079481	56171502	7314ab8f-787ccb0b-f465183a-18649a4d-0d37cc0e
824	right internal jugular central venous catheter tip terminates in the midlow svc . assessment of the left hemithorax is obscured due to the patients hand projecting over this region . no pneumothorax is identified on this supine exam . lung volumes are low . heart size remains mildly enlarged . no large pleural effusion is seen . again demonstrated are streaky opacities in the right lung base . no acute osseous abnormalities seen . limited exam . right internal jugular central venous catheter tip in the midlower svc . no large pneumothorax seen on this supine exam .	No Finding&&Support Devices	16050730	59066796	6d5d81f0-24db4698-0b10ede2-80628bfa-6c5de5f8
825	small right pleural effusion is stable to slightly increased compared to prior and tracks into the fissures . opacity in the right mid to lower lung field is new compared to . retrocardiac linear opacities likely represent basilar atelectasis . small right upper lobe perihilar opacity appears stable . heart and mediastinal contours are stable . no pneumothorax is detected . new right lower lung opacity compared to , concerning for pneumonia, with stable to slightly increased small right pleural effusion . by by telephone at pm . on at the time of initial review of the study .	Lung Opacity&&Pleural Effusion&&Pneumonia	11880923	57292244	9bb86127-fb575908-ca75aaee-e4e15b0b-b804e9d3
826	there are low lung volumes . et tube is in the standard position . ng tube tip is out of view below the diaphragm . a right picc tip is in the right atrium, unchanged . cardiomegaly is stable . mild pulmonary edema and bibasilar consolidations, larger on the left side, are grossly unchanged . if any, there is a small left pleural effusion .	Cardiomegaly&&Consolidation&&Edema&&Pleural Effusion&&Support Devices	10268877	54571214	6b65d2d1-52308eab-5ad5e512-81319db7-b4855e54
827	there is a new left subclavian line with tip at the cavoatrial junction . lung volumes are low . the right lower lobe opacities unchanged . there continues to be cardiomegaly, pulmonary vascular redistribution, ill-defined vascularity, and retrocardiac opacity compatible with chf . the ng tube and large bore right ij line are unchanged . the et tube is cm above the carina . there is no pneumothorax . new left central line . no pneumothorax .	No Finding	17340686	54614605	e38221a2-36d9eedb-5a9af804-2eba7cb0-ea8d7ffd
828	right-sided port-a-cath tip terminates at the junction of the svc and right atrium . patient is status post median sternotomy and aortic valve replacement . lung volumes are low with mild enlargement of the cardiac silhouette, unchanged . mediastinal and hilar contours are similar . there is mild pulmonary edema, slightly improved in the interval . patchy opacities in the lung bases may reflect areas of atelectasis, but infection particularly in the left lung base cannot be completely excluded . no pleural effusion or pneumothorax is demonstrated . elevation of the left hemidiaphragm is again noted . no acute osseous abnormality is visualized . slight improvement in mild pulmonary edema . patchy opacities in the lung bases may reflect atelectasis, but infection particularly in the left lung base cannot be completely excluded .	Atelectasis&&Edema&&Lung Opacity&&Pneumonia	11022245	50126222	0ae07ada-41d03c2a-ec74ae48-d0c17cec-343ae6fa
829	bibasilar opacities with blunting of the costophrenic angles which could be due to effusions . there are indistinct pulmonary vascular markings . relatively lentiform-shaped opacity over the right mid lung is suggestive of fluid within the fissure . the cardiac silhouette is enlarged, similar to prior . atherosclerotic calcifications are noted . pulmonary vascular congestion, small effusions with probable fluid in the right fissure .	Edema&&Pleural Effusion	11052273	54389393	d7395617-98bb6ef8-6f0187e5-2c3df909-6f3a57c4
830	the patient is now intubated . the tip of the endotracheal tube projects approximately . cm above the carinal . the lung volumes have increased . nonetheless, the severity in extent of the bilateral parenchymal opacities, predominating in the perihilar areas, is unchanged . moderate cardiomegaly with retrocardiac atelectasis . no pleural effusions . no pneumothorax .	Atelectasis&&Cardiomegaly&&Lung Opacity&&Support Devices	15857729	59652151	9fe1d7c8-517e71cd-ac942a65-345092b2-8bbb82c0
831	vague opacity projecting over the right midlower lung the which is new since prior . elsewhere, the lungs are clear . there is no layering effusion . cardiac silhouette is enlarged but similar in configuration . multiple vascular stents are again noted projecting over the svc, left brachiocephalic vein and left upper extremity . surgical clips project over the lower neck . no acute osseous abnormalities . vague right midlower opacity, nonspecific the could represent infection in the proper clinical setting .	Lung Opacity&&Pneumonia	14236258	58255867	0f33dea2-1c4e6245-7b21b568-ef0299e9-03c0863a
832	review of frontal and lateral views were remarkable for bilateral lower lung bronchiectasis with peribronchial opacities . in the right lower and medial lung, peribronchial opacities have improved since . there are no new opacities . lungs are mildly hyperinflated . heart size, mediastinal and hilar contours are normal . no pleural effusion . bilateral lower lobe bronchiectasis with improved right lower medial lung peribronchial consolidation .	Consolidation	10402372	56446284	510e2767-2a04a9c8-afb492f8-57d38e8e-75d5d488
833	posterior fixation hardware in the thoracic spine is several years old . elevation of the right lung base has been increasing slowly over the past years . small right pleural effusion is comparable to , slightly larger than on . left subclavian line ends in the distal svc . heart size is normal . cardiomediastinal and hilar contours are normal . right basilar linear atelectasis is unchanged . no consolidation or pulmonary edema is present . no evidence of cardiac decompensation . chronic unexplained elevation, right lung base and chronic, small to moderate right pleural effusion .	Pleural Effusion	14353044	53086061	8c4ad17a-c6ec16dc-137e714a-10dc9541-499191a1
834	on the current film, the et tube extends to the origin of the right main stem bronchus and should be retracted approximately - cm . an ng tube is present, sideport in the region of the ge junction or immediately distal to it and tip overlying the stomach . again seen are diffuse bilateral somewhat patchy alveolar infiltrates throughout the entire right lung and through most of the left lung, with relative sparing of the left upper zone . possible slight interval improvement in the appearance of the infiltrates, as the previously seen right middle lobe bronchograms are less apparent . no gross effusion . . et tube at origin of right main stem bronchus . findings called to the ordering clinician, dr , at the time of discovery at pm . on the day of the exam and discussed with her shortly thereafter , phone . ng tube tip overlying stomach, but sideport is at or immediately distal to the ge junction .	No Finding&&Support Devices	16662264	50752207	3fee0682-231a4968-00593ef2-652c36ae-98495700
835	cardiomegaly is moderate and unchanged . mediastinal silhouette is unchanged including mild mediastinal widening potentially reflecting known mediastinal lipomatosis . left lung opacities are slightly more conspicuous as compared to the previous study and are concerning for infectious process . there is mild vascular enlargement but no overt pulmonary edema . followup of the patient after antibiotic therapy is recommended for documentation of resolution .	Cardiomegaly&&Enlarged Cardiomediastinum&&Lung Opacity&&Pneumonia	14841168	53733833	d50e8844-70b979c1-018fdf07-8a21dee8-bea92072
836	both lungs are well expanded . very ill-defined opacity is seen on the lateral view only in the posteroinferior lung overlying the lower thoracic spine which is concerning for pneumonia . otherwise, lungs are clear . heart size is top normal . mediastinal and hilar contours are normal . there are no interstitial abnormalities . there is no pleural effusion . very faint and ill-defined opacity evident only on the lateral view in the posterior-inferior lung overlying the lower thoracic spine is concerning for pneumonia . these findings were discussed with dr . on at pm .	Lung Opacity&&Pneumonia	16826047	59712299	cfba203e-fe166598-71452568-2adea590-f7158b8f
837	enlargement of the cardiac silhouette persists with chronic interstitial prominence as seen on recent ct . the possibility of some element of elevated pulmonary venous pressure must be considered . no focal consolidation .	Cardiomegaly	13475033	57951979	fd6509f0-c39f57c5-744a9382-37db12e6-fa9b1784
838	a spiculated and cavitary nodule in the left mid lung at the level of the third left anterior rib measuring . cm in diameter appears slightly larger than on the prior radiograph and corresponds to a known left upper lobe lesion on prior ct of . it is morphologically concerning for a primary lung cancer and less likely an indolent granulomatous infection . lungs are otherwise clear, with no new focal areas of consolidation to suggest the presence of an acute pneumonia . lungs are otherwise remarkable for linear scar versus atelectasis in the mid lung regions . sclerosis of medial left clavicle, likely due to prior trauma, is unchanged .	Atelectasis&&Consolidation&&Lung Lesion&&Lung Opacity&&Pneumonia	13450581	57882993	f39a0cd8-fb45cb6e-63f5fa30-21668913-0ac228d3
839	patient is rotated slightly to the right . the patient is status post median sternotomy . enlargement of the cardiomediastinal silhouette is grossly stable as compared to the prior study . there are small bilateral pleural effusions . interstitial prominence suggests interstitial edema . left retrocardiac opacity is seen which may be due to combination of pleural effusion and atelectasis, although focal consolidation is not excluded .	Atelectasis&&Consolidation&&Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion	17669276	52930189	00f1a123-51de83f7-4d563a12-f705f4f0-4683b4eb
840	in comparison with study of earlier in this date, the tip of the endotracheal tube measures approximately . cm above the carina . nasogastric tube extends into the stomach, with the tip crossing the lower margin of the image . increased opacification is seen at the right base medially . it is unclear whether this represents crowding of pulmonary vessels, atelectasis, or, in the appropriate clinical setting, a developing consolidation .	Atelectasis&&Consolidation&&Lung Opacity&&Support Devices	18517718	56047116	26cd4845-5c52d871-e5d996d0-a2113787-630c0309
841	the questionned retrocardiac abnormality is a large part of the stomach passing through a hiatus hernia, as seen on the chest radiograph, . evaluating possible mass in the stomach would require ct scanning . lungs are clear of pneumonia . expanded right anterior rib ends should not be mistaken for lung nodules . heart size is normal . azygous distention is new, suggesting increased intravascular volume, but there is no pulmonary edema or pleural effusion .	Lung Lesion	14608347	55317494	748c169c-828f1222-57447816-e11e5338-53a98735
842	mild pulmonary edema is new . left lower lobe retrocardiac opacities have increased, consistent with increasing atelectasis . cardiomediastinum is unchanged . there is no pneumothorax . if any, there is a small right pleural effusion . ng tube tip is in the stomach .	Atelectasis&&Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Support Devices	18517718	52043785	cb101618-fcbfd3af-8a1c1df2-ed58ac80-04fe691d
843	tracheostomy tube, esophageal stent and picc remain in place . cardiomediastinal contours are unchanged . widespread airspace opacities affecting the right lung to greater degree than the left are again demonstrated, and are concerning for widespread infection . known abscess in right lower lobe is seen to better detail on recent ct . pigtail pleural catheter is present in the lower right hemithorax, presumably within the abscess . moderate right pleural effusion is unchanged .	Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	13964474	56134201	57a0381a-0454897e-b498f4de-dc3d8b24-a305b687
844	diffuse predominantly reticular opacities, diffusely distributed through the lung, without evidence of other focal parenchymal abnormality . no evidence of pneumonia . no pleural effusions . borderline size of the cardiac silhouette . mild tortuosity of the thoracic aorta .	Cardiomegaly&&Lung Opacity	12303667	56901171	8be5e566-84d421c6-72d46c14-79091c67-73751f9f
845	the lung volumes are stable . a new right lower lung opacification . the cardio mediastinal and hilar borders are stable . the pleural surfaces are stable . the left pacemaker is intact with leads in appropriate positions . again seen, is destruction in the second sternotomy wire . the og tube appears to be malpositioned proximally lying in the proximal fundus of the stomach . the right picc line terminates in the mid svc . the osseous structures are stable . . new right lower lung opacity may represent aspiration, less likely atelectasis . . malpositioning of the og tube . recommend advancement of the tube . recommendations advancement of the og tube . notification attempts were made to contact the referring physician, however been successful . therefore, the impression above was entered by dr . on at into the department of radiology critical communications system for direct communication to the referring provider .	Atelectasis&&Lung Opacity&&Support Devices	18487334	57881979	ff8b2af5-e8c313a0-9caec8e9-f6a90929-3b53792a
846	the cardiomediastinal contours are within normal limits and without change . interval decrease in size of right pleural effusion with residual small effusion remaining . adjacent atelectasis in the right mid and lower lung has improved with residual linear atelectasis remaining . minimal linear atelectasis is also present in the left lower lobe . no focal areas of consolidation are identified to suggest the presence of pneumonia .	Atelectasis&&Pleural Effusion&&Pneumonia	14353044	50273882	ae80e1b1-1e1e539f-5e6839cf-76c7451a-19b7e2a2
847	cardiac, mediastinal and hilar contours are normal . pulmonary vasculature is normal . lungs appear clear . the previously noted patchy opacity within the right lower lobe seen on ct is not well visualized on the current exam . no pleural effusion or pneumothorax is present . cervical spinal fusion hardware is partially imaged . several clips are noted within the left upper quadrant of the abdomen . no acute cardiopulmonary abnormality . of note, the patchy opacity within the right lower lobe seen on prior ct is not visualized on the current radiograph .	Lung Opacity	15114531	53595850	5d38b235-8992ecec-2b630078-d290f396-00fdf5db
848	single ap view of the chest provided . a right atrioventricular pacemaker appears unchanged . the right lung is hypoinflated in relation to the left lung . there is mild vascular congestion consistent with fluid overload . no pneumothorax . small, bilateral pleural effusions are seen with associated bibasilar atelectasis . hilar contours are normal . the aorta is tortuous . severe s-shaped is unchanged . . there is mild vascular congestion consistent with mild fluid overload . . opacification of the right upper lung could be due to asymmetric pulmonary edema, scapula projecting over the lung or in the appropriate clinical setting pneumonia . . small, bilateral pleural effusions and associated bibasilar atelectasis .	Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia	13921768	50966773	794214ee-e57ac38e-8e01e79b-648f4673-7b7f3e7c
849	two portable upright view of the chest are compared to previous exam from . there is new right lung base opacity compatible with at least some component of pleural effusion with probable underlying airspace disease . the left lung remains essentially clear, noting mild scarring versus atelectasis at the lung base . left subclavian central line is seen with tip at the cavoatrial junction . cardiomediastinal silhouette is stable . posterior spinal fixation hardware is partially visualized . right basilar opacity in part due to pleural effusion with possible underlying airspace disease .	Lung Opacity&&Pleural Effusion	14353044	56193921	930d1abf-e069b3d3-a6503794-fe52c8f6-d8c0f1e1
850	mild pulmonary edema has worsened . left lower lobe remains densely consolidated or collapsed . moderate to severe cardiomegaly unchanged . indwelling et tube, right internal jugular line, and nasogastric tube are in standard placements . no pneumothorax . pleural effusion is likely, but not substantial in size .	Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Pleural Effusion&&Support Devices	15131736	57776801	668168bb-d505142b-df37a7a6-f4d12e0f-ba63c1f6
851	pa and lateral views of the chest the heart is moderately enlarged . the aortic knob is calcified . the mediastinal and hilar contours are relatively unchanged, though there is mild pulmonary vascular congestion, which is worse compared to the prior study . no large effusion or pneumothorax is seen . there is minimal patchy opacity in the retrocardiac region likely reflecting atelectasis . no acute osseous abnormalities are seen .	Edema	15131736	59654928	4db0b107-b92cf8bd-4725e810-1ceb5f96-fcbd4d2a
852	the et tube tip is cm above the carina . cardiomediastinal silhouette is unchanged including the areas of atelectasis, bilateral pleural effusions, and mild vascular engorgement . no pneumothorax is seen .	Atelectasis&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	14841168	51273136	184a9e7a-6c077522-edb3c396-b40dbd57-ffb02b71
853	ap and lateral views of the chest are compared to previous exam from . there is engorgement of the central pulmonary vasculature with indistinct pulmonary vascular markings seen peripherally . there is no large confluent consolidation or effusion . cardiac silhouette is enlarged but stable . osseous and soft tissue structures are unchanged . findings suggestive of pulmonary vascular congestion .	Edema	15131736	50036264	4ef84da8-ff83a551-31f0aa42-d17ba6a2-c6561835
854	left transvenous pacemaker leads are in standard position . top normal heart size, mediastinal and hilar contours are unchanged . new left internal jugular line ends at the mid svc . core- valve prosthesis is unchanged in position . mild bibasilar atelectasis is unchanged . there are no new lung opacities which are concerning for pneumonia .	Atelectasis&&Lung Opacity&&Pneumonia&&Support Devices	13221453	52022822	b9f6d23e-fa8de1ca-1144b6a0-d8b4fe4b-9c13592e
855	despite the right pleurx catheter in place, there is still a substantial layering pleural effusion with compressive atelectasis at the right base . the left lung is essentially clear at this time . continued enlargement of the cardiac silhouette with minimal if any vascular congestion . no acute focal pneumonia on the left .	Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	16826047	51435164	c8b95c4e-1ab26289-9107ecb6-6e70a749-ec02c584
856	portable ap chest radiograph demonstrates severe cardiomegaly, both interstitial and alveolar edema as well as small bilateral pleural effusions . a more confluent opacity is seen in the right middle lobe . there is no pneumothorax . atherosclerotic calcifications are noted in the aortic arch . marked pulmonary edema . follow up cxr after diuresis may be helpful to exclude underlying pneumonia in right middle lobe .	Edema	11893091	53774431	79eee504-b1b60ab8-5e8dd843-b6ed87aa-670747b1
857	right lower lobe opacity is worrisome for consolidation, possibly due to pneumonia . along the superior aspect of the right lower lung consolidation, there is a -cm nodular opacity, projecting between the posterior right sixth and seventh ribs, which could relate to consolidation or an underlying pulmonary nodule is not excluded . recommend followup chest radiograph after appropriate therapy and if finding remains, chest ct . there is also a left suprahilar opacity, which could be a second site of infection or relate to mild volume overload . there is central pulmonary vascular engorgement . no large pleural effusion or pneumothorax is seen . single-lead left-sided pacemaker is seen with leads in the expected position of the right ventricle . the cardiac silhouette is enlarged . right lower lobe and left infrahilar opacities, right greater than left, in the appropriate clinical setting, raises concern for pneumonia . recommend followup to resolution . possible . cm nodular opacity along the superior aspect of the right lower lung opacity, could relate to consolidation, but pulmonary nodule not excluded . recommend followup chest radiographs after appropriate therapy and if finding remains, chest ct . left suprahilar opacity, which could be a second site of infection or relate to mild volume overload . pulmonary vascular engorgement . enlarged cardiac silhouette .	Cardiomegaly&&Consolidation&&Lung Lesion&&Lung Opacity&&Pneumonia	18570152	59698565	615687f6-9c68c0c3-ea00fb31-0987abc8-6d4be9c7
858	the ij catheter has been removed and replaced with a right subclavian catheter that extends to the lower portion of the svc . continued enlargement of the cardiac silhouette with pacer-defibrillator in place . mild indistinctness of pulmonary vessels could reflect some elevated pulmonary venous pressure . the retrocardiac area is not optimally seen, though there is only mild atelectasis . bilateral chest tubes are in place and there is no evidence of pneumothorax .	Atelectasis&&Cardiomegaly&&Edema&&Support Devices	15144601	55001785	b0b2d70b-d96be717-6c1cbd4c-fcf2bcd9-e8d42293
859	the heart is markedly enlarged, as seen on prior radiographs from . there is haziness of the hila with diffuse, but predominantly mid and lower lung heterogeneous opacities, consistent with moderate pulmonary edema, likely with both interstitial and alveolar components . the descending thoracic aorta is slightly tortuous, as before . there may be small bilateral pleural effusions . no pneumothorax . moderate pulmonary edema, likely cardiogenic in nature given marked enlargement of the heart .	Cardiomegaly&&Edema	13762730	50664785	db39cf32-d22fb990-e46ba7c8-c73f9b0b-c77db2a1
860	left-sided central venous line is again seen similar in position, terminating in the low svc . again seen is elevation of the right hemidiaphragm and blunting of the right costophrenic angle which could be due to a trace right pleural effusion . there is overlying right basilar atelectasis . minor left basilar atelectasis is also seen . no new focal consolidation is seen . the cardiac and mediastinal silhouettes are stable . the aortic knob is calcified . spinal surgical hardware is noted . no significant interval change .	No Finding	14353044	57988469	cd77c46e-224eaafc-a386ab71-e1f0d17d-b743688b
861	left-sided port-a-cath is again seen, terminating at the distal svccavoatrial junction . persistent blunting of the right costophrenic angle is seen . chain sutures are again noted in the right mid lung . no new focal consolidation, large pleural effusion, or evidence of pneumothorax is seen . cardiac and mediastinal silhouettes are stable, as are hilar contours . old right rib deformity is again seen involving posterior right eighth rib . known lesion in the right scapula is better assessed on ct . no acute cardiopulmonary process .	No Finding	15758946	50020371	a767b7c0-6bdaee42-8ca0cd60-7b89ffb1-3bbbba27
862	a right internal jugular central line ends in the upper svc . the swan-ganz catheter has been removed . a new consolidation at the right base is concerning for possible pneumonia, aspiration, or less likely infarction . small bilateral pleural effusions are stable . calcified granulomas in the left mid lung zone are unchanged . . new right basilar consolidation is most concerning for pneumonia or aspiration . less likely, it may be infarction . . stable small bilateral pleural effusions . . mild enlargement of the cardiac silhouette is unchanged . results were discussed with at on via telephone by dr . .	Cardiomegaly&&Consolidation&&Pleural Effusion&&Pneumonia	12185775	53930112	b738cf47-6ae04cdf-25d11841-ddcb8d78-fe7feceb
863	feeding tube with a wire stylet in place ends in the lower esophagus and would need to be advanced at least cm to move all the side ports into the stomach . was paged as requested . moderate bilateral pleural effusions and left lower lobe atelectasis have worsened . upper lungs are clear . heart size normal . no pneumothorax . probe is unchanged in position at the gastroesophageal junction and a nasogastric drainage tube still ends in the upper esophagus . right internal jugular line tip is low in the svc . et tube in standard placement . no pneumothorax .	Atelectasis&&Pleural Effusion&&Support Devices	13881772	55058518	48d78c08-a2ca4095-efd2e551-da6b1010-e90a62ef
864	an endotracheal tube, ng tube, and right upper extremity picc with its tip at the cavoatrial junction are unchanged . there is no change in left lower lobe opacity . there is no large pleural effusion, or pneumothorax . the cardiac silhouette remains moderately enlarged, mediastinal contours are notable for calcification of the aortic arch . mild residual retrocardiac opacification remains, pneumonia vs . atelectasis .	Atelectasis&&Lung Opacity&&Pneumonia	10268877	57976739	d6010cbd-efa41b72-2fbc0daf-8fa1dc40-bdd4fe35
865	the right basal opacity appears to be still present, although improved since the prior study and might reflect interval decrease in size of infectious process . repeated evaluation in four weeks is recommended . the finding is still persistent, assessment with chest ct would be required to exclude the possibility of post-obstructive pneumonia .	Lung Opacity&&Pneumonia	19800337	53142730	181d43c2-cde3b96e-33411986-ba61fdd2-46dc6d41
866	portable ap view of the chest demonstrates low lung volumes . a moderate-to-large loculated right pleural effusion is longstanding, but appears increased in size from prior exam . moderate loculated left pleural effusion is unchanged from prior . bibasilar opacities are noted . there is prominence of the right mediastinum, suggestive of vascular congestion . aortic arch calcifications are noted . heart size is top normal . mild pulmonary edema is present . sternotomy wires are noted . multiple surgical clips project over left cardiac border . moderate-to-large loculated right pleural effusion appears increased in size from prior exam . moderate left pleural effusion is unchanged . bibasilar opacities likely represent atelectasis or infection in the appropriate clinical setting . mild pulmonary edema .	Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia	16360107	58395298	a797fb72-ac31496e-fb500d8f-daa52795-1800ca2e
867	supine ap view of the chest right internal jugular central venous catheter tip terminates in the svc . no pneumothorax is present . patient is status post median sternotomy, cabg, and mitral valve repair . there is continued opacification of the left lung base . small bilateral pleural effusions, left greater than right are again noted . there is mild pulmonary edema . subacute left posterior third rib fracture is present . streaky opacity in the right lung base may reflect atelectasis . right internal jugular central venous catheter tip in the svc . no interval change in mild pulmonary edema with continued left basilar consolidation possibly reflecting atelectasis or infection, with small bilateral pleural effusions .	Atelectasis&&Consolidation&&Edema&&Pleural Effusion&&Pneumonia&&Support Devices	15259244	54770541	b267e44d-493a0dca-420b4fd5-a91a1026-c3386cac
868	chest pa and lateral radiograph demonstrates unremarkable mediastinal and hilar contours . stable mild cardiomegaly evident . increased opacity overlying the right diaphragm on background of right lower lung atelectasis, may indicate pneumonia . no pleural effusion or pneumothorax evident . stable l and t compression fractures . stable degenerative changes of the right shoulder . increased opacity of right lower lung may reflect worsening atelectasis, though in proper clinical setting, pneumonia is a possibility . no pleural effusion evident .	Atelectasis&&Lung Opacity&&Pneumonia	18512911	56917340	c4b67dd3-d40261f4-896ca5c9-acc7cde5-d93ec993
869	portable ap radiograph of the chest was reviewed in comparison to obtained at pm . the et tube tip is . cm above the carina . heart size and mediastinum are unchanged in position . the new esophageal stent is unchanged . there is interval increase in left pleural effusion, small-to-moderate currently, although it might be reflecting different position of the patient . right lung opacification is unchanged . the right internal jugular line tip is at the level of mid svc .	Cardiomegaly&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Support Devices	19016834	51427581	3f1c5c54-e3cae103-4b1e822d-3b6c863b-9191faaa
870	since the prior exam, there is a new thin linear density along the left apex, which may represent a pneumothorax . alternatively, it could be a skinfold . additionally, there are worsening basilar opacities, right more than left, likely due to pulmonary edema from re-expansion after the right thoracentesis . patchy bilateral opacities are otherwise not significantly changed . there is stable small left effusion . the right costophrenic angle is somewhat obscured by overlying monitoring lines, though there is likely a small right effusion . there is no right pneumothorax . the cardiomediastinal silhouette is normal . . linear opacity along the left apex extending down laterally may represent a new pneumothorax . alternatively, it could represent a skinfold . recommend a repeat chest radiograph for further clarification . . increasing basilar opacities, likely from worsening re-expansion edema . there is a stable small left pleural effusion and likely a small residual right pleural effusion . scattered bilateral opacities are otherwise unchanged, likely reflective of the known multifocal pneumonia . results were discussed with dr . resident at pm . on via telephone by dr . at the time the findings were discovered .	Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Pneumothorax	16662264	53233378	dcdd32f6-e80f7f1f-0c2448f5-0816540b-3b890ebf
871	compared to most recent prior exam, there has been interval improvement in bilateral pleural effusions small pleural effusions remaining . there has been interval improvement in interstitial edema with mild residual vascular engorgement and very mild bibasilar interstitial edema . heart size continues to be enlarged . no pneumothorax is detected . previously noted abdominal stent is incompletely imaged . interval improvement in interstitial edema and bilateral pleural effusions with mild interstitial edemavascular engorgement and small bilateraly pleural effusions remaining .	Edema&&Pleural Effusion	17189198	57397512	7d2e3c50-e0ca79fb-74b46922-68f9cb02-e05269e5
872	right-sided port-a-cath tip terminates in the svc . large right pleural effusion which is loculated appears slightly increased compared to the prior study . right basilar opacification could reflect compressive atelectasis though infection is not excluded . chest tube is again noted with tip projecting over the right lung base . there is mild leftward shift of mediastinal structures, slightly increased compared to the prior study . cardiac and mediastinal contours otherwise are unchanged . streaky left basilar opacity likely reflects atelectasis . no pneumothorax is identified, and no pulmonary edema is seen . no acute osseous abnormalities detected . large right loculated pleural effusion, slightly increased in size with increasing right basilar opacification suggestive of atelectasis though infection is not excluded .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Pneumonia	16826047	57080795	196c8e5f-ab6084a7-145ac6ef-54b05747-9768ba0f
873	heart size is normal . lung fields are clear . the superior mediastinum appears slightly widened, but this may be projectional . patient is mildly rotated . followup films in four to six weeks time are recommended to keep this area under observation . because of varying degrees of rotation, comparison to the previous examination of is difficult .	Enlarged Cardiomediastinum	11924226	56990167	dc00203a-4168ce8c-d79d47d2-eef8780b-d3fe037a
874	the patient is status post sternotomy . the heart is moderately enlarged . layering pleural effusions are present . these are difficult to directly compare to the prior study, because of suspected differences in positioning, but the appearance is probably fairly similar . coinciding compressive atelectasis is likely . mild interstitial opacification suggests mild vascular congestion, new since the prior study . prior vertebroplasties have been performed . findings suggesting mild interstitial pulmonary edema and persistent bilateral pleural effusions, probably at least moderate in size .	Edema&&Pleural Effusion	17669276	56894803	2e82b549-d2fb6a33-4747e742-d21b905f-813ff996
875	the monitoring and support devices are unchanged . at low lung volumes there is moderate cardiomegaly and mild fluid overload but no overt pulmonary edema . no pleural effusions . no visible pneumothorax .	No Finding&&Support Devices	12475198	59310626	b92a4a75-b5345ec3-917fc5be-e7953fb5-d91be228
876	consolidative opacities involving the left upper lobe and right middle lobe are suspicious for multifocal pneumonia . small left effusion may also be present . there is no pulmonary edema . the heart is top normal in size with normal cardiomediastinal silhouette . right shoulder does not appear well seated in the glenoid and correlation with exam findings and dedicated shoulder radiographs is recommended . large hiatal hernia is unchanged . these findings were discussed with dr . by dr . by phone at on .	Consolidation&&Lung Opacity&&Pleural Effusion&&Pneumonia	16360985	55698800	88633d62-dc511693-f8ff40bf-fbf31a2e-2760a8e3
877	portable ap radiograph of the chest was reviewed in comparison to obtained at am . the patient continues to be in pulmonary edema, moderate . port-a-cath catheter is unchanged in position . heart size and mediastinum are unchanged as well . no substantial interval increase in pleural effusion is demonstrated .	Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	10439781	56653253	7bc78455-41c1debf-80eb11b0-d8ff58b8-e4e2496d
878	slight hyperinflation, chest cta prior to surgery did not show emphysema . it did show mild to moderately severe bronchiectasis, particularly in the left lower lobe . postoperatively, left lower lobe consolidation is probably due to atelectasis, stable since . there is new peribronchial opacification on the right, conceivably aspiration . exacerbation of bronchiectasis is another possibility . there is no pulmonary edema, and the upper lungs are clear . tiny left pleural effusion is of no clinical significance . heart size is normal .	Atelectasis&&Consolidation&&Lung Opacity&&Pleural Effusion	10402372	58117612	34fcf711-355f24f3-53a8dbc6-97730735-1d046d5a
879	comparison is made to the prior study performed at am . there is a right-sided catheter with the distal lead tip at the cavoatrial junction . there is a left ij central venous line with the distal lead tip in the mid svc . the endotracheal tube tip is . cm above the carina . the feeding tube whose distal tip is below the ge junction . these tubes are all unchanged in position . there is stable cardiomegaly . there is mild improved aeration at the lung bases . there remain bilateral pleural effusions . there are no signs for overt pulmonary edema or pneumothoraces .	Cardiomegaly&&Edema&&Pleural Effusion&&Pneumothorax&&Support Devices	11880923	59196954	e3ba16c1-e0005eef-0c0e37cd-1ad23c91-beac16e8
880	mild pulmonary edema on the right and moderate pulmonary edema on the left have worsened since , both slightly less severe than on when there was also asymmetry . heart size is normal . small right and moderate left pleural effusions are stable . left internal jugular line ends in the mid svc . no pneumothorax .	Edema&&Pleural Effusion&&Support Devices	16334516	56389775	70cc5d8f-bbf4b758-e95c371a-f0e2a6b1-09a32c70
881	no relevant change as compared to the previous examination, the postoperative changes in the left upper lung and the scarring in the perihilar portions of the right lung are constant in distribution and appearance . there currently is no evidence of pleural effusions on the lateral and frontal radiograph . status post cabg . moderate elongation of the descending aorta . no pneumonia .	No Finding	14851532	58584546	2c699f50-503e7098-01ecae7c-d395875a-02612502
882	frontal and lateral chest the lungs are well expanded . lingular opacity and right basilar linear atelectasis are unchanged from . no new opacity is seen . there is no pleural effusion or pneumothorax . heart size is normal . mediastinal silhouette and hilar contours are normal . requested wet read provided to dr . by phone .	Lung Opacity	16435402	57153483	1497c1a7-0f52e042-8b3ffade-b8b71145-17eae73d
883	this study was not made available for my interpretation until today, . increased opacity at the right lung base is likely due to overlapping vascular structures . there is no focal consolidation, pleural effusion or pneumothorax . heart size is top normal . mediastinal silhouette and hilar contours are normal . no acute intrathoracic process . ct is more sensitive for detection of mass lesions .	Lung Lesion	18767957	56290236	ecd3a847-44218ca9-e9039305-57d97776-45c6a231
884	low lung volumes are again noted . chronic changes compatible with patients pulmonary fibrosis are noted . more severely affected areas seen at the bases, left greater than right . cardiomediastinal silhouette is stable . no acute osseous abnormalities identified . findings again compatible with patients known pulmonary fibrosis without definite superimposed acute process, noting that subtle change would be difficult to detect based on a portable film .	Pleural Other	10867202	59535316	38ea1228-340e5c29-16578c7c-9c80eaed-1bb35307
885	ap upright and lateral views of the chest providedthere is diffuse pulmonary edema which is moderate in extent . compare to prior, appearance is more compatible with pulmonary edema then a pneumonia . cardiomediastinal silhouette is stably prominent . hila remain congested . trace pleural fluid outlines the fissures . moderate pulmonary edema, stable cardiomegaly, trace pleural fluid .	Cardiomegaly&&Edema&&Pleural Effusion	16508811	52110166	3c683456-9107fcf5-4722c784-358a526d-54f47984
886	indwelling support and monitoring devices remain in standard position . cardiac silhouette remains enlarged, and is accompanied by pulmonary vascular congestion and mild edema . improving opacities at both lung bases may reflect improving atelectasis in the setting of interval decrease in size of adjacent pleural effusions .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	18906643	56188866	197dd856-31ef9250-0c7a8773-b83b65ef-167e2eea
887	the right internal jugular dialysis catheter terminates within the right atrium . there is no pneumothorax or pleural effusion . the cardiac silhouette is severely enlarged, but unchanged . the hilar structures are unremarkable . there is no pleural effusion . there is a chronic subclincal pulmonary edema appearance to the pulmonary vascularity without evidence for acute volume overload . satisfactory right internal jugular dialysis catheter position without pneumothorax . unchanged severe cardiomegaly .	Cardiomegaly&&Support Devices	12963531	54527138	eb52937f-7fa55b40-86540246-ca98fc35-a5a9b68a
888	no focal consolidation, pneumothorax, or pulmonary edema is seen . heart and mediastinal contours are stable . there has been interval resolution of the previously seen pulmonary edema . a right subclavian hemodialysis catheter is seen with tip projecting over the expected location of the right atrium . there is a small right pleural effusion . small right pleural effusion with interval resolution of pulmonary edema since .	No Finding	15259244	53532692	bb03b651-512952bc-0ea27cd3-c61b8255-0b80bbb5
889	heart is upper limits of normal size given ap technique . mediastinal contours are stable . there are scattered radiopaque nodular opacities within both lungs suggestive of prior granulomatous infection . the perihilar vasculature is somewhat prominent . small layering bilateral effusions suggestive of mild vascular congestion . no overt pulmonary edema . no pleural effusions or pneumothorax . no evidence of focal pneumonia . degenerative changes in the thoracic spine with no acute bony abnormality identified .	Edema&&Enlarged Cardiomediastinum&&Lung Lesion&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Pneumothorax	16553329	50643762	d021c1f9-134fd8f8-e73a3e87-387d59f4-ea4ea7a6
890	the reduced volume of the right hemithorax with areas of lateral pleural thickening . the areas of pleural thickening are constant, size and morphology . unchanged perihilar areas of fibrosis . unchanged size and aspect of the cardiac silhouette, no pathologic changes in the left lung .	Cardiomegaly&&Pleural Other	19389547	59044011	daf22278-c7ef9cb8-31e6569f-0e1541a4-153d1977
891	cardiac size is normal . multiple bilateral lung nodules are again noted . patient is status post cabg . no esophageal stent is noted . either one stent is seen in the stomach that is coiled or two stents are present in the stomach . this is difficult to evaluate, given the technique .	Lung Lesion&&Support Devices	16773796	52436523	96cda79d-ce622999-1de435f1-addeda4d-cdc26979
892	the presence of extensive subcutaneous emphysema reduces the sensitivity of chest radiography for detecting pneumothoraces . with this limitation in mind, no pneumothorax is identified . left chest tube has been removed since the prior study, and right chest tube is unchanged in position . endotracheal tube remains in standard position, but cuff appears slightly overdistended . heart size is normal . worsening heterogeneous airspace opacities in right lower lobe are concerning for aspiration or evolving infectious pneumonia . numerous air-fluid levels are again demonstrated in the left upper lobe lateral to the left hilum, and may reflect hemorrhage or infection within a bullae . an adjacent area of consolidation is present in this region as well . as compared to the recent study of , the degree of subcutaneous emphysema has worsened, and is particularly more marked in the neck, axilla and lateral chest wall as compared to the prior studies . . no evidence of pneumothorax following removal of left-sided chest tube, but extensive subcutaneous emphysema reduces the sensitivity of radiography for detecting pneumothoraces . . worsening right lower lobe airspace opacity, concerning for developing pneumonia in the appropriate clinical setting . . progressive diffuse subcutaneous emphysema . . severe emphysema .	Lung Opacity&&Pneumonia&&Pneumothorax	16751749	57862102	4a5bbca6-64ed6abf-84645068-6a7688bd-9a9910d4
893	chest pa and lateral radiograph demonstrates a markedly elevated right hemidiaphragm with adjacent compressive atelectasis or consolidation . minimal blunting of the posterior costophrenic angle may indicate a small right pleural effusion . left lung is clear . cardiomediastinal borders are unremarkable . right hemidiaphragm elevation with opacification posteriorly suggesting extensive adjacent lung atelectasis, though cannot exclude developing infectious process . possible right pleural effusion as well . if findings do not resolve on subsequent radiography, evaluation with chest ct could be considered, preferably with intravenous contrast if possible .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Pneumonia	11569093	51983905	ab1e1361-80eb18db-60ce9d49-0c7e8e71-477b3559
894	opacity over the right mid-to-lower lateral lung appears similar, likely corresponding to known loculated pleural effusion catheter within the effusion appears similarly positioned . right port-a-cath terminates in the low svc, similar to prior . no new consolidation, left effusion, pneumothorax, or pulmonary edema is detected . heart size is persistently enlarged, likely exaggerated by low lung volumes . stable-appearing loculated right pleural effusion with corresponding catheter .	Pleural Effusion&&Support Devices	16826047	57308128	5d60432d-9a9f7b91-2a3f88ee-8f0c574e-de8f7187
895	the patient had left lower lobe lobectomy in . expected stable surgical changes are seen in the left lung with volume loss and mild pleural thickening . there is no pneumothorax . the right lung is unremarkable . mediastinal and cardiac contours are not enlarged . conclusion the exam is stable since with expected changes after left lower lobe lobectomy .	No Finding	12530259	53225437	ed9e09e7-e22ee204-4a73ca03-dc121d89-5ca5a446
896	there has been a substantial increase in the degree of right pleural effusion, which extends upward on the frontal view to almost the level of the carina . there may be mild shift of the mediastinum to the left, though there is probably substantial volume loss in the right lower lung . the left lung is essentially clear . otherwise, little change .	Enlarged Cardiomediastinum&&Pleural Effusion	19182863	55667092	357764ae-3c98ec1b-8c94907d-641d3d01-5bae8280
897	semi-upright portable ap view of the chest was provided . please note, due to marked scoliosis, evaluation is limited . there is a severe rotatory dextroscoliosis of the lower thoraciclumbar spine . the lungs appear grossly clear bilaterally without large consolidation, effusion, or definite signs of pneumothorax . heart size cannot be assessed . no definite signs of fracture . severe scoliotic deformity without definite signs of aspiration or fracture .	Fracture	18110020	51285349	d9e22dc4-c2df3c29-6bbda3ee-d5d33e26-c93e5f4e
898	heart size and mediastinum are stable . no change in mild cardiomegaly and prominence of the main pulmonary arteries present . mild vascular congestion is present but there is no overt pulmonary edema . no appreciable pleural effusion or pneumothorax .	Cardiomegaly&&Edema&&Enlarged Cardiomediastinum	11052273	57433211	f0f60c0b-52abfabd-2b92739a-f825fa77-74c719e9
899	the monitoring and support devices, including the esophageal stent are in constant position . constant right pigtail catheter . the bilateral severe parenchymal opacities are unchanged .	Lung Opacity&&Support Devices	13964474	55513654	634557d1-cf60366d-474c0152-9a7b5559-72f0bc1e
900	comparison is made with prior studies performed a day earlier . allowing the difference in positioning of the patient, large right pleural effusion is either stable or minimally increased . there is no evidence of pneumothorax . cardiomegaly cannot be assessed . mild pulmonary edema is new . port-a-cath and right pleural catheter are in place .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	16826047	51426470	f277a782-19eae246-7886e1cf-23cb06bd-7b9d64ff
901	the heart size is enlarged but similar to prior exam . the mediastinal and hilar contours are within normal limits . the lung volumes are low with bibasilar atelectasis, more pronounced on the left than the right and there is no large pleural effusion or pneumothorax . there is no evidence of pulmonary edema or thickened septal lines . multiple compression fractures of the lower thoracic spine have not changed since prior ct . cardiomegaly and low lung volumes with bibasilar atelectasis .	Atelectasis&&Cardiomegaly	18512911	56663989	74539665-467d0bc8-6f5c9920-f9b6e911-a6f92f44
902	in comparison with the study , there has been placement of an endotracheal tube with its tip approximately . cm above the carina . nasogastric tube extends to the lower body of the stomach . continued low lung volumes . there is increase in the size and indistinctness of pulmonary vessels, consistent with elevated pulmonary venous pressure possibly related to over-hydration . the -channel pacer device remains in place . the left ij catheter again crosses the midline to extend to the right subclavian or internal jugular system .	Edema&&Support Devices	12595991	59402852	39fd5a3b-600c7c44-8426c20e-dafdd287-f5b59fca
903	ap and lateral chest radiographs are provided . there is no focal consolidation, pleural effusion, or pneumothorax . the cardiomediastinal silhouette is unremarkable . median sternotomy wires are intact . surgical clips are seen along the left heart border . there are degenerative changes throughout the thoracic spine and at the right acromioclavicular joint . no acute cardiopulmonary process .	No Finding	15032623	52019812	c1ca2269-888c6d31-99903c19-c02256b7-390f38a1
904	the lung volumes are normal . mild cardiomegaly with tortuosity of the thoracic aorta . no current pulmonary edema . minimal atelectasis at the right lung base but no evidence of pneumonia . no pleural effusions . normal aspect of the mediastinal structures .	Atelectasis&&Cardiomegaly	12810135	50981777	14d22854-f75c9939-e36fa170-315d2ccb-2fc011e3
905	cardiomediastinal contours are stable . patchy and linear opacity has developed at the left lung base, and may reflect atelectasis although coexisting aspiration or infectious pneumonia is possible . band-like linear atelectasis at the right base has worsened in the interval . otherwise, no short-interval change since recent study .	Atelectasis&&Enlarged Cardiomediastinum&&Lung Opacity&&Pneumonia	19061282	56963912	c9d87d11-a862527b-17c66e14-b5598f4f-2f5d28c5
906	a right subclavian central line is present, tip at svcra junction overlying the uppermost ra . status post sternotomy . mild-to-moderate cardiomegaly . small to moderate left effusion with underlying collapse andor consolidation . upper zone re-distribution and mild diffuse vascular blurring . small right effusion . prosthetic valve and additional mediastinal or upper abdominal clips noted . compraed with , overall appearances are similar, but chf findings may be slightly worse and the left effusion is probably slightly larger .	Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Pleural Effusion&&Support Devices	13135946	51657622	cbac2f9e-cc7b29cb-4abb137c-1d89c1ea-a6c56689
907	tracheostomy tube is in standard position . left subclavian line ends at mid svc . small lucency near the left lung apex could conceivably be a small pneumothorax, however, given the extent of bilateral severe subcutaneous emphysema, this may represent skin fold and moreover detection of small pneumothorax in this sitting is difficult . otherwise, the overall extent of bilateral subcutaneous emphysema is unchanged . multifocal lung opacities are similar . cardiomediastinal silhouette is stable .	Enlarged Cardiomediastinum&&Lung Opacity&&Pneumothorax&&Support Devices	16751749	50795677	aaf8a24a-aa94d1ac-0c8bf9e2-7a786f52-61f413f3
908	since consolidation has largely cleared from the right lung base since , this was presumably either dependent edema alone or dependent edema and atelectasis . minimal interstitial edema remains, but the left lower lobe is much better aerated today . the heart is mildly to moderately enlarged . no pneumothorax . dual-channel dialysis line ends in the right atrium .	No Finding	15259244	59654440	981f5956-9dbb9f69-8b7bbf12-b872f7a3-16f09cf4
909	compared to the most recent prior radiograph, there has been no significant change . there is no evidence of pneumothorax . again seen is minimal bibasilar atelectasis . there is no pleural effusion or focal consolidation . the cardiac silhouette is stable, and there is mild tortuosity of the aorta . median sternotomy wires and clips are unchanged . subcutaneous air in the left soft tissues is again seen . no significant interval change .	No Finding	12736592	54548144	ddace369-8c8f0353-59316221-492cdda4-f6bfe724
910	there continues to be elevation of the left hemidiaphragm with left effusion and an alveolar infiltrate in the left mid lung . however, overall the aeration on the left is much improved . the right lung is clear .	Lung Opacity&&Pleural Effusion	12530259	52210830	da3efe68-9a328a1b-4d20e7f8-0152154a-e945badd
911	moderate cardiomegaly is stable . mild generalized interstitial pulmonary abnormality is longstanding, probably not edema or infection . there is no appreciable pleural effusion . atherosclerotic calcification of the aortic arch and proximal head and neck vessels is heavy . several longstanding fractures of left middle ribs posteriorly are non-united . there is also the suggestion of lytic lesions in several left ribs, particularly the eight . clinical correlation advised . findings posted to the online record of critical results reporting for notification of the referring physician .	Cardiomegaly&&Edema&&Fracture&&Pneumonia	17206933	56118817	0a48d5b4-3f3aff93-e685c884-b13d2c6c-2c2ab46b
912	comparison to . no relevant change . lung volumes are low . the monitoring and support devices are in stable correct position . moderate cardiomegaly with mild fluid overload but no overt pulmonary edema . minimal pleural fluid along the minor fissure on the right . no evidence of pneumonia .	Cardiomegaly&&Pleural Effusion&&Support Devices	14841168	56506968	431a17b6-190ff348-b3f07795-8b75e49c-9c2e5030
913	comparison is performed with the next preceding similar study of . heart size and mediastinal structures unchanged . on the right base, the previously described two pleural chest tubes remain in unaltered position . the degree of pleural densities blunting the lateral and posterior pleural sinus has regressed mildly . no new pulmonary abnormalities are present . no pneumothorax has developed . left-sided hemithorax is unremarkable as before . mild regression of pleural densities right base in a patient with known empyema, still with chest two draining and tubes . no pneumothorax .	No Finding&&Support Devices	13352405	55629622	982578b4-18516c2a-5faf15d7-e4641de2-eca3ad55
914	basilar opacity seen on the lateral view best corresponds to a retrocardiac opacity suspicious for developing left lower lobe pneumonia or aspiration event in the setting of altered mental status . chronic peribronchiolar opacities seen bilaterally are similar in distribution and slightly more apparent due to lower lung volumes and ap technique . there is no pleural effusion or pneumothorax . the heart size is normal with normal cardiomediastinal silhouette . left lower lobe opacity likely reflects pneumonia or aspiration .	Lung Opacity&&Pneumonia	10933609	56058164	67106e2c-168fd4e2-52fbcc7d-4c4b2f27-5499c157
915	triple lead pacing device along the right chest wall is again noted with leads in unchanged position . mitral valvular replacement again noted . prominence of the interstitial markings are again seen without evidence of focal consolidation or overt pulmonary edema . there is no large pleural effusion noting persistent probable fluid within the major fissure on the lateral . degree of cardiomegaly has not changed . no acute osseous abnormalities detected . findings is compatible with mild interstitial edema .	Edema	19759491	58191597	73f1035a-9d57466e-92c2b0b1-5ee3d31c-78ad1ad4
916	compared with prior radiographs on , there is slight increase in opacity in the left lower lung adjacent to the left heart border, with improved right basilar opacity . there is a small right pleural effusion, slightly decreased from prior . no pneumothorax . there is no overt pulmonary edema . the cardiac and mediastinal silhouettes are unchanged . slightly increased opacity at the left lower lung adjacent to the left heart border, with decrease in right basilar opacity compared with prior . slight decrease in small right pleural effusion .	Lung Opacity&&Pleural Effusion	14851532	54545268	078b8107-6b122d1a-325d9a89-33038b55-a20ebabc
917	bedside upright ap radiograph of the chest demonstrates little interval change when compared to prior study performed hours ago . there is minimal, stable enlargement of the cardiomediastinal contours consistent with mild chronic heart failure . persistent obscuration of the pulmonary vascular markings in the right lung base is consistent with trace pulmonary edema . bibasilar atelectasis is still present . the lungs are otherwise clear . there is no pneumothorax or pleural effusion . a left internal jugular central venous catheter, an endotracheal tube, and an orogastric tube are unchanged and appropriately positioned . the chronic findings of atherosclerotic calcification of the aortic arch and bilateral glenohumeral joint degenerative changes are once again noted . . mild chronic congestive heart failure with stable trace pulmonary edema at the right lung base . . stable bibasilar atelectasis .	Atelectasis&&Cardiomegaly&&Edema	10268877	54103072	46258faf-c930aa13-1b09c523-4972126b-47bba114
918	portable upright view of the chest demonstrates low lung volumes, which accentuate bronchovascular markings . there is near-complete resolution of bilateral pleural effusions seen on exam . there is no pneumothorax or focal consolidation . streaky opacity in the left juxtahilar region along with mild prominence of the pulmonary vascularity likely reflects mild interstitial edema, which is improved compared to the prior study . heart is mildly enlarged . mediastinal contour is slightly widened, which is most likely due to low lung volumes and patient positioning . post-surgical changes related to median sternotomy and cabg are again noted . . low lung volumes . mild interstitial pulmonary edema, improved from the previous exam . . near-complete interval resolution of bilateral pleural effusions since . . prominent mediastinal silhouette is most likely due to low lung volumes and patients positioning . a repeat conventional pa and lateral radiographs will be helpful, when tolerated .	Edema&&Enlarged Cardiomediastinum	18615099	53424979	469c319a-57c55551-e71b3f83-73849157-a180b0ee
919	previously identified left-sided picc line remains in unchanged position . an ng tube is seen to be curled up in the epipharynx area and the tip of the line reaches just in the upper portion of the esophagus, terminating to cm above the level of the carina . adjustment of ng tube is required . ref . physician was paged at pm . case was discussed and tube had been withdrawn completely .	No Finding&&Support Devices	13979643	54505002	dc4cccd3-1c855845-e52e1419-7da6cc73-c40f3f5b
920	a longstanding left upper lobe oval nodule has been present since at least and has not changed since at least when a chest ct report termed it benign . sclerosis at the right first costochondral junction as well as post-surgical changes from a wedge resection in the right upper lobe are all stable since . the cardiomediastinal silhouette and hila are normal . there is no pleural effusion and no pneumothorax . mild pulmonary vascular congestion is chronic or recurrent . no acute cardiothoracic process including no evidence of pneumonia .	No Finding	16334516	59804376	ab08af63-948a2416-3f9f6080-5d16badd-02c43b45
921	single portable chest radiograph demonstrates a vague opacification projecting over the lingula in the region of the previously noted mass . finding is likely a combination of residual mass and a small, not unexpected hemorrhage . no pneumothorax identified . cardiomediastinal and hilar contours are unremarkable . minimal atelectatic changes are noted in the right lung base . no osseous abnormality evident . no pneumothorax . faint opacification over lingula is combination of residual mass and small amount of unexpected postoperative hemorrhage .	Lung Lesion&&Lung Opacity	16435402	57635079	16b32195-cb3e0995-d4cf9ac1-4af71b24-8d42365f
922	cardiac and mediastinal silhouettes are stable with the cardiac silhouette mild-to-moderately enlarged . there is mild pulmonary vascular congestion . no pleural effusion or pneumothorax is seen . degenerative changes are seen along the spine . mild pulmonary vascular congestion . cardiomegaly . pulmonary nodules documented on ct from are better appreciated on that study .	Cardiomegaly&&Edema&&Lung Lesion	19844485	53788698	e9f8beb8-4ee1436c-72c497d0-1bc5a42c-e9cfb483
923	compared with the earlier study, a new endotracheal tube terminates . cm above the carina . lobe lung volumes are re- demonstrated, with cardiomegaly, mild to moderate pulmonary edema, and persistent hilar congestion . no large pleural effusions or pneumothorax on this limited scan . a presumed enteric tube courses be low the left hemidiaphragm another view . et tube tip positioned cm above the carina . ng tube extends inferiorly, tip not seen . persistent pulmonary edema .	Edema&&Support Devices	15131736	58145542	b031566e-064ee571-7c0e1804-9509e4ce-e8c2fd74
924	upright ap and lateral views of the chest the patient is status post median sternotomy, cabg, vascular stenting . the heart size is mildly enlarged, but stable . the mediastinal and hilar contours are unremarkable . the pulmonary vascularity is not engorged . the lungs are clear without focal consolidation . no pleural effusion or pneumothorax is visualized . no acute osseous abnormality is seen .	No Finding	19150427	56901180	27be8e47-777aa20b-bdfc0d00-edfb3263-1cebe4df
925	the dobbhoff tube tip passes below the diaphragm, terminating at the distal duodenumproximal jejunum . right central venous line tip is at the cavoatrial junction . heart size and mediastinum are unchanged . left internal jugular line tip is at the junction of left brachiocephalic vein and svc . there is interval increase in the right lower lung atelectasis as well as slight increase in bilateral pleural effusions . no pneumothorax is seen . pulmonary edema is present, moderate .	Atelectasis&&Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	11880923	50889423	5fe74fb9-978c6718-4181ec01-234b0987-85e6ce3b
926	there is obscuration of the left heart border, likely scarring from prior infection . there is no pleural effusion or pneumothorax . the heart size is normal . the mediastinal and hilar structures are unremarkable .	Lung Opacity	16662264	59191421	39a0863f-9a6a4e94-41b1b286-8536e7dc-75252ad8
927	unchanged appearance of the left postoperative lung with decrease in size of the hemithorax . unchanged opacities at the right lung base, potentially caused by atelectasis or, possibly, aspiration . short-term further radiographic followup should be performed . no larger pleural effusions .	Atelectasis&&Lung Opacity	10885696	52654095	eee70ea1-a4bb5ad0-eb92e7e6-ac788ab6-922f880b
928	again seen are stable bilateral linear opacities in the upper lungs with suggestion of local fibrosis . there is no evidence of fibrosis in other lung zones or progression of disease . there is no hilar adenopathy, focal consolidation, pleural effusion, or pneumothorax . no newly appeared micronodules . the cardiomediastinal silhouette is normal . stable bilateral upper lung opacities, most likely local fibrosis . no evidence of disease progression .	Lung Opacity&&Pleural Other	14147787	59631450	5b73306f-64ed83f7-dc6e0957-f8d1a9b2-bdd393f3
929	pa and lateral views of the chest demonstrate interval increase in size of right pleural effusion, along with complete atelectasis of the right middle and lower lobes, raising concern for bronchial obstruction . the right upper lobe and left lung are grossly clear . the heart size is unchanged . median sternotomy wires and post-surgical changes associated with aortic valve replacement are unchanged . interval increase in right pleural effusion with complete atelectasis of the right middle and lower lobes, raising concern for bronchial obstruction . the above findings were communicated to dr . by dr . telephone at pm, min after discovery .	Atelectasis&&Pleural Effusion	19182863	52356800	7d705bf2-0c6a9344-d86b9381-311c9eb2-e4b1ab6c
930	the patient is status post median sternotomy and cabg . left-sided dual-chamber pacemaker is noted with leads terminating in right atrium and right ventricle, unchanged . cardiomegaly is similar . there is continued mild to moderate pulmonary edema, slightly improved compared to the prior exam . small layering bilateral pleural effusions also may be slightly decreased in the interval . bibasilar airspace opacities likely reflect atelectasis . there is no pneumothorax . no acute osseous abnormalities are visualized . . mild to moderate congestive heart failure, slightly improved in the interval, with layering small bilateral pleural effusions . . bibasilar airspace opacities likely reflect compressive atelectasis . infection cannot be excluded .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia	18615099	55695509	2d13a8b7-f90c5932-218e4fdf-056b5c2f-550c0a09
931	single frontal view of the chest demonstrates a left pectoral cardiac pacer with leads terminating in the right atrium and right ventricle . the heart is top normal in size . the mediastinal and hilar contours are within normal limits . there are increased perihilar streaky opacities, which suggests pulmonary edema . right suprahilar pulmonary mass is redemonstrated, better correlated on cross-sectional imaging . there is dense retrocardiac probable atelectasis and small left pleural effusion . mild pulmonary edema . small left effusion .	Edema&&Pleural Effusion	13067703	59557085	35526265-ad9db1b3-08d311e6-d1193a33-473315c3
932	the right-sided chest tube is in unchanged position . unchanged massive soft tissue air collection . an intrathoracic pneumothorax cannot be detected . unchanged opacity at the right lung base and in the left lung apex . unchanged size of the cardiac silhouette .	Cardiomegaly&&Lung Opacity&&Pneumothorax&&Support Devices	16751749	54355730	15f11dc8-bf0efa42-bfe3db80-e0bf6c95-1ae84951
933	there has been complete clearing of the areas of consolidation bilaterally . no evidence of vascular congestion, pleural effusion, or acute focal pneumonia .	No Finding	19800337	50788655	0a5e513b-7a7ee423-b8c4a49e-66eb48ce-2ad0011a
934	right picc terminates at in mid svc . there is no consolidation, pleural effusion, or pneumothorax . cardiomediastinal and hilar silhouettes are normal size . cervical spine hardware is partially included . no radiographic evidence of pneumonia .	No Finding	15114531	59942551	4e536fbd-1d3c1f99-c3494ba6-918a4177-3e3b72ff
935	severely enlarged heart is stable . bilateral small pleural effusions, left side more than right, and mild bibasal atelectasis is present . no evidence of pneumonia . mediastinal and hilar contours are stable .	Atelectasis&&Cardiomegaly&&Enlarged Cardiomediastinum&&Pleural Effusion	13473781	57035793	c4d46e0f-fba1a258-b4b5722e-5aec1b56-de6931be
936	mild right pleural effusion . substantial cardiomegaly with tortuosity of the thoracic aorta . mild fluid overload . no pneumonia . minimal areas of atelectasis at both the right and the left bases .	Atelectasis&&Cardiomegaly&&Pleural Effusion	19454978	57439770	52b231f0-b5da5c5b-5a030c08-1b4c1c46-99c6b79e
937	the et tube tip is . cm above the carina . ng tube tip is in the stomach . there is left retrocardiac opacity, unchanged since the prior study . minimal interstitial pulmonary edema is unchanged . no interval development of pleural effusion or pneumothorax is seen .	Edema&&Lung Opacity&&Support Devices	10268877	50214117	0ae61039-a3a12c67-9f740931-e24e8c00-776d83f0
938	there is slight interval decrease in pleural effusion, in particular on the right where the subpulmonic component is most likely substantial . the mediastinal contour is unremarkable, consistent with neoesophagus . lungs are essentially clear . small amount of left pleural effusion still present .	Pleural Effusion	16848073	57816818	4ef6ed7d-7e5c2651-ceb2b69c-d9738889-3c732c77
939	ap semi-erect and lateral chest radiograph evaluation is limited due to significant patient rotation to the right . median sternotomy wires appear intact . moderately severe enlargement of the cardiac silhouette appears grossly unchanged . evaluation of the mediastinum is limited due to the significant patient rotation . there is mild interstitial pulmonary edema . the appearance is similar to recent portable radiograph from . blunting of the bilateral costophrenic angles is chronic and are compatible with persistent small pleural effusions . no confluent consolidation or pneumothorax is present . evidence of prior vertebroplasty in the mid thoracic spine is unchanged from prior . . limited examination due to poor patient positioning . . mild interstitial pulmonary edema is similar to recent prior examination with small bilateral pleural effusions . . stable moderately severe cardiomegaly . . no confluent consolidation or pneumothorax .	Cardiomegaly&&Edema&&Pleural Effusion	17669276	53398424	8011d9cb-8f3ea017-86ad36bd-5e7380ff-32005f00
940	except for minimal bibasilar atelectasis, the lungs are clear . mild cardiac congestionis stable . cardiac contour is normal . the upper mediastinum appears widened due to the lordotic view . chest ct in only showed mediastinal fat in this region . conclusion there is no evidence of pneumonia .	No Finding	17720924	57474951	d958a1d3-977c9fd6-0296ff8d-bf5c5aa9-8894c621
941	there is mild blunting of the right cp angle which could reflect a tiny effusion or pleural thickening . the lungs are otherwise clear . the cardiomediastinal silhouette is normal . imaged osseous structures are intact . no free air below the right hemidiaphragm is seen . tiny right pleural effusion versus pleural thickening .	Pleural Effusion&&Pleural Other	14295224	55167612	a55b384b-7dd7a06c-b48b46f4-b7522c74-c7f156b3
942	the cardiac, mediastinal and hilar contours appear unchanged including mild cardiomegaly . there is similar elevation of the left hemidiaphragm with persistent unchanged vague left mid to lower lung opacity which may indicate some degree of chronic atelectasis and, particularly given lack of change, isnot suspicious for an acute superimposed process . the lungs appear otherwise clear . old left-sided rib fractures are also unchanged . there has been no significant change . no evidence of acute cardiopulmonary disease .	No Finding	15446959	52616494	647c3bd0-6e8ea0e4-e367edee-d6eefb00-174fcf42
943	cardiomediastinal contours are normal . the lungs are hyperinflated . patient has known bronchiectasis in the lower lobes bilaterally . bronchial wall thickening has worsened in the lower lobes bilaterally . faint patchy peribronchial opacities in the lower lobes, right greater than left, have also minimally increased . this is consistent with worsening inflammatory or infectious process . there is no pneumothorax or pleural effusion .	Lung Opacity&&Pneumonia	10402372	53941324	fac91686-0b3af505-de09585a-0b7529e2-2d4defc6
944	comparison is made to prior study performed a day earlier . lines and tubes are in unchanged standard position . multifocal consolidations in the right upper and lower lobes bilaterally left greater than right are unchanged . severe cardiomegaly is stable . there are no new lung abnormalities . probably small right pleural effusion is unchanged .	Cardiomegaly&&Consolidation&&Pleural Effusion&&Support Devices	11022245	55512076	d5d3964c-238d57c2-52e7bc5c-5233980d-1f0a2e2a
945	the pacer unit leads are unchanged in position . the endotracheal tube tip sits cm above the carina . the endogastric tube side port sits just below the ge junction . a prosthetic mitral valve is noted . the heart size is stable . there has been minimal improvement in the diffuse ground-glass opacities . blunting of both costophrenic angles suggests small pleural effusions along with predominantly retrocardiac atelectasis . there is no pneumothorax . slightly improved pulmonary opacities compatible with moderate pulmonary edema versus pulmonary hemorrhage .	Edema&&Lung Opacity	18322589	51044625	0d930f0a-46f813a9-db3b137b-05142eef-eca3c5a7
946	no significant change in comparison to . no pulmonary edema . mild retrocardiac opacity unchanged, likely atelectasis . stable severe cardiomegaly . there is no pneumothorax or pleural effusion . ett measures . cm above the carina . right atrial and right ventricular pacer leads in standard positions and contiguous with the left pectoral generator . ng tube tip terminates in the stomach . right ij catheter tip in the mid svc . no significant interval change compared to chest radiograph from .	No Finding	18487334	50701063	8421105f-75a36b56-fb945313-e4f6d3a0-e2876c01
947	comparison . no relevant change . minimal right and moderate left pleural effusion, the left pleural effusion is slightly increasing . moderate cardiomegaly . signs of mild pulmonary edema . no new focal parenchymal opacities . unchanged alignment of the sternal wires, unchanged . left pectoral pacemaker .	Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	19182863	55740020	7576b31f-3445c62b-0b2c892b-4ec42aea-61ada0c6
948	ap upright portable radiograph of the chest demonstrates a mildly enlarged heart with mild pulmonary edema and mild bibasilar atelectasis . there is no pneumothorax or pleural effusion . there is a cardiac pacemaker in place, unchanged in position . there are numerous mediastinal surgical clips as well as sternal cerclage wires in place . mild pulmonary edema, mild cardiomegaly, mild bibasilar atelectasis .	Atelectasis&&Cardiomegaly&&Edema	18615099	59152117	01c5daed-cf6a5552-a23ad3f6-5850acca-d9619ea2
949	pa and lateral chest radiographs again demonstrate compression fractures involving the t and t vertebral bodies . of note, the t vertebral has worsened compared to . the lung volumes are low with probable bibasilar atelectasis, particularly along the right heart border, where there is some increase in conjunction with reduced lung volumes . there is no focal consolidation or pleural effusion . the heart size is normal . . no definite pneumonia suspected atelectasis in the right infrahilar region, perhaps somewhat increased in association with reduced lung volumes . . worsening t compression fracture compared to .	Atelectasis&&Fracture	13978244	56696460	a86906cf-710c164d-b996484a-ac9ade58-dbcff302
950	heart size is enlarged but stable . there remains moderate pulmonary edema which is unchanged . there is an unchanged left retrocardiac opacity . there are likely small bilateral effusions . there are no pneumothoraces .	Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion	15131736	56644987	498f05dc-57343a1b-c611226d-832d85bd-a088cd1e
951	frontal and lateral views of chest were obtained . dual-lead left-sided pacemaker is again seen with leads extending to the expected positions of the right atrium and right ventricle . left perihilar opacity is again seen, grossly similar in appearance, consistent with known mass and parenchymal scarring . there is persistent blunting of the left costophrenic angle which appears slightly increased since the prior study . left retrocardiac opacity may relate to combination of effusion and atelectasis, however underlying consolidation cannot be excluded . the right lung is clear . . left pleural effusion which appears increased since the prior study . left retrocardiac opacity may relate to combination of effusion and atelectasis, however underlying consolidation cannot be excluded . . left perihilar opacity consistent with known mass and parenchymal scarring . grossly stable appearance of the left perihilar region .	Atelectasis&&Consolidation&&Lung Lesion&&Lung Opacity&&Pleural Effusion	18067737	58056585	ce6c73a2-bfbdbdf8-f7f014a2-bfffc5e3-232d2d80
952	ap portable upright chest radiograph was provided . loculated right pleural effusion is again seen, with compressive lower lobe atelectasis unchanged . there is right perihilar opacity which likely reflects known fibrosis as seen on prior ct . new consolidation is seen . no pneumothorax . overall, cardiomediastinal silhouette is stable . bony structures are intact . unchanged appearance of the chest with findings of right pleural effusion, loculated and lower lobe atelectasis as well as right perihilar fibrosis is unchanged . please refer to subsequent cta chest for further details .	Atelectasis&&Pleural Effusion&&Pleural Other	19720782	53035658	5932603f-64abd8a2-713ef8b9-907f95b0-106004c5
953	there has been interval placement of left-sided picc, which terminates in the low svc . previously seen right-sided picc which is curled in the right axilla is no longer seen . there is also interval removal of previously seen right-sided internal jugular central venous catheter . the patient is status post median sternotomy . the cardiac silhouette remains moderately enlarged . mediastinal contours are stable, with the aorta tortuous and unfolded . there appears to have been slight interval increase in bilateral pleural effusions which may in part relate to differences in patient position . there are increased perihilar opacities suggesting pulmonary edema . left base retrocardiac opacity may be due to combination of pleural effusion and atelectasis however, underlying consolidation is not excluded . no pneumothorax is seen . persistent moderate enlargement of the cardiac silhouette . bilateral pleural effusions, likely slightly increased . increased perihilar opacities most likely related to pulmonary edema however, an atypical infection is not entirely excluded in appropriate clinical setting . left basilar opacity may represent combination of pleural effusion and atelectasis however, underlying consolidation is not excluded .	Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia	17669276	58950601	44af3e4a-0cc1e98d-377c1626-46bc8189-2c995eb3
954	right internal jugular line tip is at the level of cavoatrial junction . post-sternotomy wires are unremarkable . the patient is still in volume overload but it has improved since the prior study . bilateral pleural effusions are large associated with bibasilar atelectasis . no pneumothorax is demonstrated . since the prior study, there has been interval decrease in the right pleural effusion consistent with reported history of thoracocentesis, although effusion is still at least moderate .	Atelectasis&&Pleural Effusion&&Support Devices	12952223	57927198	d7539f3d-8434d8d9-45deaba6-7524faea-7412f5dc
955	moderate cardiomegaly is a stable . small bilateral effusions are decreased on the right and stable on the left . bibasilar adjacent atelectasis have improved on the right . pulmonary edema has almost completely resolved . there is no pneumothorax . multiple bilateral ill-defined nodular opacities and a larger opacity in the left mid lung were better evaluated on ct . continued followup is recommended . patient has known emphysema .	Atelectasis&&Cardiomegaly&&Lung Lesion&&Lung Opacity&&Pleural Effusion	14851532	58144042	c973cc75-e43e939d-63395fb7-0e75eeb1-8abb0081
956	diffuse interstitial opacities have progressed since . the hila are indistinct . there is a new small left pleural effusion . moderate cardiomegaly is similar . aortic arch calcifications are similar . there is a stable convex left thoracic scoliosis . thoracic vertebral compression fractures and old left clavicle fracture are unchanged . moderate to severe interstitial pulmonary edema is worse compared with .	Edema	13475033	52606958	55339975-113cd016-3378dc51-976067bf-8b4e471f
957	the lungs remain hyperinflated . again seen is biapical scarring and evidence of bullous disease . there is increased opacity at the lateral right lung base which could relate to underlying scarring and is likely similar in appearance to ct from scout view . however, underlying infectious process cannot be entirely excluded in the appropriate clinical setting . cardiac and mediastinal silhouettes are stable as compared to .	Enlarged Cardiomediastinum&&Lung Opacity&&Pneumonia	16751749	53647250	fccc3e79-097ee8e0-2e6dd2f2-272cc880-9a0ef87b
958	pa and lateral chest compared to chest radiographs since , most recently at pm, and ct scanning of the chest on pm . on , for ct-guided transthoracic needle aspiration . small bilateral pleural effusions were present prior to needle aspiration, and are not complications of the procedure . there is no pneumothorax . large area of consolidation with a mass-like quality in the lingula has grown appreciably since , most of which was hemorrhage associated with transbronchial biopsy on . reviewing the series of chest radiographs and chest ct scans since , the findings suggest granulomatous infection not malignancy, particularly fungal pathogens, such as coccidioidomycosis or cryptococcosis, alternatively mycobacterial infection, actinomycosis, or nocardia .	Consolidation&&Lung Lesion&&Pleural Effusion&&Pneumonia	16435402	55968926	09a1e64f-23ae347f-cda48fff-8cd6e499-65b4bed0
959	aeration in the previously atelectatic or consolidated left upper lobe has improved, improvement in the left lung base is less pronounced . both are presumably due to atelectasis but radiographically one could not exclude clearing pneumonia . moderate left pleural effusion is still present . moderate enlargement of the heart is unchanged . right lung shows milder atelectasis but is otherwise clear . there is no pulmonary edema or pneumothorax . transvenous right atrioventricular pacer leads are in standard placements .	Atelectasis&&Cardiomegaly&&Consolidation&&Pleural Effusion&&Pneumonia&&Support Devices	19075045	52124955	f2623666-d215e0db-d9e21905-b5e17801-8f754dd9
960	portable ap chest radiograph moderate-to-severe chronic cardiomegaly is unchanged . the lung volumes are extremely low resulting in crowding of the bronchovascular markings . mild pulmonary vascular congestion is present, with improvement in the previously seen pulmonary edema . no consolidation, pleural effusion or pneumothorax is seen in this study .	Edema	15131736	54359651	a8398d17-610399a9-7f2059be-9b8fe9f8-b05f3290
961	a dialysis catheter terminates in the right atrium . there is a vascular stent projecting over the left chest apex which probably corresponds to a left subclavian venous stent . the heart is again moderately enlarged . the lung volumes are low . there is no pleural effusion or pneumothorax . the lungs appear clear . no evidence of acute disease .	No Finding	13473495	57447816	23fdc685-8851eb9b-b5ee438b-0f486c37-4677e1ed
962	the left lung is relatively well aerated and clear . the right hemithorax is markedly opacified with volume loss, circumferential pleural thickening and pleural fluid with near complete opacification of the right lung with right basal pleural catheter noted . hydropneumothorax previously seen is not as well evaluated on this not fully upright film . cardiac contours are somewhat obscured but unremarkable .	Lung Opacity&&Pleural Effusion&&Pleural Other&&Pneumothorax&&Support Devices	11569093	59433529	3d9581e4-1ca59a74-f2f5dfee-2599dad8-491fc6a0
963	there has been development of diffuse bilateral pulmonary opacifications with widening of the vascular pedicle . in view of the injury to the manubrium, this most likely represents congestive failure, possibly exacerbated by large amounts of fluid replacement . bilateral pleural effusions are seen with compressive atelectasis at the bases . in view of the multiple traumas, the possibility of fat embolism syndrome would have to be considered if diuretic therapy is insufficient to cause clearing of the radiographic findings .	Atelectasis&&Lung Opacity&&Pleural Effusion	13586204	51189125	7394806d-330706a4-f0e6ba1f-7d857d57-2492e480
964	widespread bilateral parenchymal opacities, combined to an enlarged cardiac silhouette . the monitoring and support devices are in constant position .	Cardiomegaly&&Lung Opacity&&Support Devices	13078497	55557117	8a429357-0b188f6b-54307015-8a57c7cd-31b1ed38
965	the patient is status post left pneumonectomy procedure . there is expected leftward shift of the cardiomediastinal contours . slight increase in amount of fluid in the lower left hemithorax, but majority of the pneumonectomy space remains gas-filled . right lung is overexpanded, and note is made of linear atelectasis at the right base . subcutaneous emphysema persists in the left chest wall .	Atelectasis&&Enlarged Cardiomediastinum	12410066	51727838	9d674775-c0b3be98-7ed72cdd-47852026-4ca978b4
966	in comparison with earlier study of this date, the nasogastric tube extends well into the stomach with the tip beyond the lower limit of the image . the dobbhoff tube has been removed .	No Finding&&Support Devices	15338518	59291942	035b3c94-500ee35c-10e923c5-3a5a2324-348b48c2
967	ap and lateral views of the chest the cardiac, mediastinal, and hilar contours are normal . pulmonary vascularity is normal, and the lungs are clear . no pleural effusion or pneumothorax is present . there are no acute osseous abnormalities . clips are noted within the upper abdomen compatible with prior cholecystectomy .	No Finding	16435402	51143879	4a11826b-f6d01af0-18890057-960c5a8c-f24fc5f0
968	et tube and right internal jugular line are in standard placements . mild pulmonary edema has improved since . moderate bilateral pleural effusion and moderate cardiomegaly are stable . no pneumothorax .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	10975446	56616764	f76c2a78-65248647-1c1b4bdf-9896fb2b-f5c2ab8d
969	upright ap view of the chest an endotracheal tube and right internal jugular central venous catheter have been removed . a left internal jugular catheter follows a normal course terminating at the confluence of the left brachiocephalic and svc . surgical clips and mediastinal drains are noted in situ . lungs are hyperexpanded . there is no new consolidation . right mid lung triangular opacity persists and probably represents fissural fluid . subtle right basilar opacity is similar to the prior exam, probably fluid . left effusion and atelectasis have improved . there is no pneumothorax . cardiomediastinal silhouette is stable .	Atelectasis&&Consolidation&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Support Devices	17770657	50844481	608b0d80-17eff322-aea174f9-714f31a8-41683ee7
970	moderate cardiomegaly is stable . pacer lead is in a standard position in the right ventricle . ng tube tip is out of view below the diaphragm . et tube tip is in standard position . there is no pneumothorax or large effusion . patient is status post cabg . mild vascular congestion has minimally improved . increasing opacities in the lower lobes, left greater than right are consistent with worsening atelectasis, aspiration cannot be totally excluded .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Support Devices	11540283	56385625	17d85861-7a43410c-8f9b5b54-4629da0d-5647276d
971	single portable view of the chest is compared to previous exam from . as on prior, low lung volumes are seen . within this limitation, the lungs are grossly clear . linear opacity at the right lung base is suggestive of subsegmental atelectasis . cardiomediastinal silhouette is stable . dual-lead pacing device is again seen . degenerative changes seen at the right glenohumeral joint . surgical clips seen in the right upper quadrant . no acute cardiopulmonary process based on this limited, portable examination .	No Finding	12369221	50178679	861f9946-68cebd2f-e11dbfba-aaad1909-7ccc759e
972	ap portable semi upright view of the chest . endotracheal tube is been placed with its tip located approximately . cm above the carina . an ng tube courses into the left upper abdomen . the lungs appear clear . cardiomediastinal silhouette is unchanged . bony structures are intact . ett tip positioned . cm above the carina . ng tube positioned with tip in the stomach .	No Finding&&Support Devices	18224196	56373683	02c9f4f3-ce818858-04a867b4-0c5c1823-e247eb67
973	a left pectoral pacemaker is noted with a single intact lead . mild pulmonary edema is improved from chest x-ray . there is a small right pleural effusion . there is no lobar consolidation or pneumothorax . the heart is mildly enlarged . the mediastinal borders and hilar structures are normal . mild pulmonary edema and small right pleural effusion which is improved as compared to chest x-ray .	Edema&&Pleural Effusion	18570152	54399607	68e2da8e-4b0cc570-5f6dac62-dd096bf8-ce452663
974	endotracheal tube and other support and monitoring devices are in standard position . status post removal of sternal wires . mass-like opacity at left lung apex appears similar to previous studies and has been more fully evaluated by ct of . pulmonary vascular congestion is again demonstrated as well as mild interstitial edema . moderate right and small left pleural effusions are similar with adjacent basilar lung opacities .	Edema&&Lung Lesion&&Lung Opacity&&Pleural Effusion&&Support Devices	14851532	55969579	94afdd5f-dc06961f-690e6029-5a69f579-0be3a0a9
975	the et tube is . cm above the carina . the ng tube tip is off the film, at least in the stomach . right ij cordis tip is in the proximal svc . the heart size is moderately enlarged . there is ill-defined vasculature and alveolar infiltrate, right greater than left . this is markedly increased compared to the film from two hours prior and likely represents fluid overload .	Cardiomegaly&&Lung Opacity&&Support Devices	10268877	50042142	4c3c1335-0fce9b11-027c582b-a0ed8d89-ca614d90
976	there has been improvement in mild-to-moderate pulmonary edema with decreased interstitial markings compared to most recent prior study . small bilateral pleural effusions have resolved . there is no focal consolidation or pneumothorax . heart size is moderately enlarged and stable . a left chest wall port-a-cath terminates in the ra . the patient is status post multiple vertebroplasties . improved but not resolved mild-to-moderate pulmonary edema .	Edema	10439781	56140154	fd8df0f3-08320e37-c337efdf-505d4348-76e89a9e
977	there is again enlargement of the cardiac silhouette . however, the pulmonary edema has substantially improved . blunting of the costophrenic angles process . there is an area of increased opacification in the right perihilar region, which could represent a new region of consolidation .	Cardiomegaly&&Consolidation&&Edema&&Lung Opacity	13975291	58304701	772a5436-29f7b5fa-5ad23833-0939fd67-e58a599f
978	right chest wall triple lead pacing device is again seen as well as a dual lumen right-sided central venous catheter . prosthetic mitral valve is noted . degree of cardiomegaly is unchanged . persistent mild pulmonary edema is again noted . retrocardiac opacity may be accentuated by portable technique, grossly unchanged from prior . there is no large effusion . old healed left lateral rib fractures identified . persistent mild pulmonary edema . more confluent retrocardiac opacity potentially due to atelectasis accentuated by portable technique . consider pa and lateral if patient is amenable to further characterize .	Atelectasis&&Edema&&Lung Opacity	19759491	58917922	7fab0be6-9ffd373a-a2ef5222-4aaf90ed-c4afea69
979	the patient was extubated with removal of the supporting devices . mediastinal and cardiac contours are unchanged, but enlarged . bilateral pleural effusion is most likely present and small . minimal vascular congestion is noted, but no overt edema is seen .	Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	12733339	59488681	33c926ca-af4fc716-ced32c6c-5734ba7a-2d690062
980	a pacerdefibrillator unit projects over the left chest with a lead terminating in the right ventricle . the heart size is mildly enlarged, although this may be exaggerated by ap technique . the mediastinal contours demonstrate calcified atherosclerotic disease of the aortic knob . the hilar contours demonstrate mild vascular engorgement . the lungs also demonstrate widespread hazy opacity, compatible with pulmonary edema . there is no large pleural effusion or pneumothorax . degenerative changes are present in the bilateral glenohumeral joints . pulmonary edema .	Edema	12074041	52969052	b4a1b5bb-c12e1164-ded8460a-ccc5b283-abc72a43
981	unchanged extent of moderate bilateral pleural effusions and moderate pulmonary edema . unchanged monitoring and support devices . unchanged size of the cardiac silhouette . no pneumothorax .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	12433421	54607940	d714d837-b94d4724-3105ec18-ec20dde4-57c58bf4
982	overlying ekg leads are present . cardiomegaly is again noted with interval development of hilar congestion and mild interstitial pulmonary edema . asymmetric opacity in the right lung is concerning for a superimposed pneumonia . no large effusion is seen . no pneumothorax . bony structures appear intact . mild cardiomegaly, hilar congestion, probable mild interstitial pulmonary edema . right-sided pulmonary opacities concerning for pneumonia .	Cardiomegaly&&Edema&&Lung Opacity&&Pneumonia	16508811	54970692	983faa39-85b84785-39cbeb3d-01519146-5be82c3b
983	there is a right upper extremity picc with the tip of which is in the mid svc . the lungs are notable for slight increased left lower lobe opacity with air bronchograms seen on the lateral view . the pulmonary vasculature is normal . the cardiac silhouette is mildly enlarged . . slight increase in prominence of airspace opacity in left lower lobe might represent developing or resolving infection . . mild enlargement of the cardiac silhouette . interval placement of picc, the tip of which is in the mid svc . at am .	Cardiomegaly&&Lung Opacity&&Pneumonia&&Support Devices	16508811	59206877	d69cce11-46d26bdd-72a95d03-473ab83c-553c9c91
984	a left ij swan-ganz catheter is present . as before, the tip lies relatively distal in the right pulmonary artery . clinical correlation to assess for possible retraction is requested . a mesh-like stent extends along the expected course of the left subclavian and brachiocephalic vessels . compared with the earlier film, there may have been slight interval improvement in the upper zone redistribution and vascular engorgement . otherwise, no gross interval change is detected . again seen is mild vascular prominence and opacity at the right base which is likely a combination of pleural fluid, possible elevated hemidiaphragm, and underlying collapse andor consolidation . there is also increased retrocardiac density, consistent with left lower lobe collapse andor consolidation and a small left effusion . the left effusion is slightly more apparent on the current exam . no pneumothorax is detected .	Atelectasis&&Consolidation&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	12847817	59739662	33ccb602-aba645d8-4359cbd7-39568ada-b906f1d4
985	single ap view of the chest is provided . there has been interval placement of a right internal jugular line with tip residing in the distal svc . there is no pneumothorax . again seen are irregularly marginated opacities in the left and right lung zones . chronic pleural thickening is unchanged from prior . again seen is mild cardiomegaly . there is no pleural effusion . interval placement of right internal jugular line with tip in the distal svc . no pneumothorax . unchanged appearance of the lungs .	No Finding&&Support Devices	15809646	57611237	a231b16b-dd2f002a-f99f05d9-20a0f431-bbeee698
986	in comparison with the study , there is little change . the inner low lung volumes with enlargement of the cardiac silhouette and tortuosity of the aorta . no vascular congestion or acute focal pneumonia . multiple old healed rib fractures are again seen bilaterally .	Cardiomegaly&&Fracture	18079481	54655227	a38b4a62-5deaca1f-e0321ec0-146245c7-e41f6981
987	there are low lung volumes . bibasilar atelectasis have minimally improved . mild vascular congestion has minimally improved . there are no new lung abnormalities or pneumothorax . bilateral pleural effusions are small . right picc tip is at the cavoatrial junction .	Atelectasis&&Edema&&Pleural Effusion&&Pneumothorax&&Support Devices	14147380	54232769	57fce1b0-808d43b3-38a72d47-a9e8bb62-3237e1a6
988	there has been interval placement of a nasogastric tube with its side port below the ge junction . the left-sided picc tip terminates at the mid to upper svc . otherwise, the heart size is unchanged, and there is bibasilar atelectasis . no large pleural effusion or pneumothorax is present . appropriate positioning of endogastric tube .	No Finding&&Support Devices	13979643	52325695	9bb9ac9f-5c0710a7-9ff3aaa6-12658f5a-ddbe2f3b
989	pulmonary vascular engorgement has improved . there is no mediastinal widening . the heart is unchanged in size, probably mildly enlarged, but obscured by mediastinal fat deposition . the postoperative appearance of the left hemithorax including bulbous left hilus is also longstanding . large scale atelectasis in the right lower lobe has also been a feature since mid , probably progressed to complete collapse . tracheostomy tube in standard placement .	Atelectasis&&Cardiomegaly&&Support Devices	10885696	56441444	f50a6967-0c476fd1-f6b7ff3a-5cdaaa5f-c072b628
990	endotracheal tube tip terminates approximately . cm from the carina . orogastric tube is seen coursing below the diaphragm, with the tip not well visualized . the heart remains severely enlarged . there is mild pulmonary edema which has progressed compared to the previous study with a probable layering left pleural effusion . persistent bibasilar airspace opacities again may reflect atelectasis, aspiration or infection . there is no large pneumothorax on this supine study . low lying endotracheal tube with tip terminating approximately . cm above the carina . orogastric tube courses below the diaphragm . worsening mild pulmonary edema with layering left pleural effusion .	Edema&&Pleural Effusion&&Support Devices	13473495	54861751	b53f680b-da2b71cb-81533dc8-2bfa0ee3-f1450be5
991	single portable view of the chest is compared to previous exam from . lower lung volumes are seen on the current exam . there is, however, suggestion of diffuse increased interstitial markings with more confluent opacities at the lung bases . while these could be due to impart atelectasis, underlying edema or infection is also suspected . cardiac silhouette is unchanged, as are the osseous and soft tissue structures . bilateral parenchymal opacities, worse at the bases, left greater than right, suggestive of underlying edema or bilateral infection superimposed on atelectasis . pa and lateral with better inspiratory effort may help further characterize .	Atelectasis&&Edema&&Lung Opacity&&Pneumonia	19159236	53822449	85e6c011-1020a8b3-3145216e-1aed7acb-abe82459
992	cardiomediastinal silhouette is unchanged including prominence of the main pulmonary artery consistent with pulmonary hypertension and overall cardiomegaly . bilateral, right more than left pleural effusions are unchanged, larger on the right and moderate-to-large on the left . there is no evidence of pneumothorax . there is bilateral vascular engorgement seen in the perihilar areas with interstitial prominence, consistent with mild interstitial pulmonary edema, most likely chronic findingas compared to , the degree of interstitial edema has improved slightly . unchanged appearance of the stent in the left brachiocephalic artery is noted .	Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Pleural Effusion	12847817	55528877	c45f4a37-92c5b7e4-84967783-d67f3d31-c1be91c5
993	dobbhoff tube courses into the proximal duodenum and out of view . left picc terminates in the mid-to-distal svc . a combination of opacity and lucency at the right base is compatible with known empyema and associated atelectasis . confluent opacification in the left lung is increased from the previous examination and likely reflects a combination of progressed new pneumonia as well as edema in the setting of increased right-sided opacities, prominent interstitial lines, and fullness of the pulmonary vessels . the heart size is also slightly increased from the previous examination . no pneumothorax is identified . . increased opacity of both lungs compatible with mild to moderate pulmonary edema superimposed on existing, perhaps slightly worsened, left sided pneumonia . . unchanged appearance to right basal empyema and accompanying atelectasis .	Atelectasis&&Edema&&Lung Opacity&&Pneumonia	14387068	59024525	855b1f9b-cacca17f-ff431f6d-3e9c2ba3-65382faf
994	comparison to . the patient has received a left chest tube, the left pleural effusion has minimally decreased but is still present . subsequent atelectasis on the left is unchanged . moderate pulmonary edema persist in almost unchanged manner . stable borderline size of the cardiac silhouette .	Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	13896515	50433627	9ffd35db-e8513d0b-320dab7d-17429141-c3c6f7d3
995	portable chest radiograph demonstrates interval placement of endotracheal tube with tip cm above the carina . nasogastric tube seen coursing into the stomach and out of view . no pneumothorax identified . otherwise, unchanged exam with hyperinflation of lungs and severe bullous emphysematous changes identified in the upper lungs, particularly on the left . increased opacity at the lateral right lung base thought to represent scarring versus infectious process on prior study is better evaluated on current study and appears to be consistent with scarring, unchanged from . no pleural effusions evident . status post intubation with tip cm above carina . no pneumothorax . relative opacity at lateral right lung base thought to represent scarring versus infectious process on prior study is better evaluated on current study and appears to be consistent with scarring, unchanged from .	Lung Opacity&&Pneumonia	16751749	57955448	14047a00-16ef4559-fd349a7f-fc7d9ef5-2667ceaf
996	right-sided port-a-cath terminates in the mid svc as before . heart is top-normal in size . mediastinal and hilar contours are within normal limits . lung volumes are low over the lungs are clear without focal consolidation, effusion or pneumothorax . no acute cardiopulmonary abnormality .	No Finding	11413236	53410264	01162a03-2f26a872-9c7a120b-f5ce80a2-46b2577b
997	the right basilar opacity has cleared . no evidence of acute pneumonia, vascular congestion, or pleural effusion .	No Finding	19800337	54891883	398b9c15-85897d9b-b04d11e2-25092267-47db634a
998	single ap portable erect view of the chest was obtained . relatively increase in opacity projecting over the right lung base is seen, which raises concern for underlying consolidation . dedicated pa and lateral views of the chest would be helpful for further evaluation . left lung is clear . slight blunting of the right costophrenic angle likely relates to overlying soft tissue . no overt pulmonary edema is seen . the cardiac and mediastinal silhouettes are stable and unremarkable . right-sided vascular stent is unchanged in position . no evidence of free air is seen beneath the hemidiaphragms . right base opacity could be due to consolidation from pneumonia . pa and lateral views of the chest would be helpful for further evaluation . no evidence of free air beneath the diaphragms .	Consolidation&&Lung Opacity&&Pneumonia	14744884	53924935	99aeda2e-665dd4de-645bda53-e43dbd3e-e3b45e9f
999	no focal consolidation, pleural effusion, or pneumothorax is seen . heart and mediastinal contours are within normal limits . lungs are again noted to be hyperinflated . stable chest radiographs without acute change .	No Finding	10402372	58736291	c4713b43-d31ad200-30f7309b-ba7d87e3-b69db479
1000	there is unchanged opacity in the left mid lung which likely represents residual scarring in this patient with prior pneumonia in this region . nipple shadows are noted bilaterally . no definite signs of acute consolidation, effusion or pneumothorax . no signs of pulmonary edema . the heart size and mediastinal contour are unremarkable . the bony structures are intact . vague opacity residua in the left mid to lower lung likely represents scarring in this patient with history of pneumonia in this region . no acute findings .	Lung Opacity	16435402	57334765	1f37fa7f-bbfdda2f-9ae5bac4-0027124f-f462fe0b
1001	the nasogastric tube is in adequate position and there is a resolution of the gastric distention . there is still mild bibasilar atelectasis . there are no pneumothorax no pleural effusion . the cardiac and mediastinal contour are unchanged . conclusion the nasogastric tube is in adequate position and there is resolution of the gastric distention .	No Finding&&Support Devices	10532326	51742525	ef191125-3db31590-77881dc9-a6302910-7a35821f
1002	pulmonary edema had improved substantially between and , but there is substantially worse consolidation in the right lower and left upper lobes today than on . whether this is recurrence of pulmonary edema or concurrent pneumonia is radiographically indeterminate . at least small bilateral pleural effusion is presumed . moderate-to-severe cardiomegaly is longstanding . left pic line ends in the upper svc . findings were discussed by telephone with dr .	Cardiomegaly&&Consolidation&&Edema&&Pleural Effusion&&Pneumonia&&Support Devices	16855430	58154356	c4d33fe5-ac2ec3d5-49786015-e5ea7a4d-04c82de3
1003	single frontal image of the chest was obtained . again seen is a partially collapsed right lung with increased density at the inferior border of the lung, consistent with pleural effusion versus pleural thickening . below the inferior border of the right lung is again seen a hydropneumothorax with an air-fluid level . there again appear to be some small opacities within the partially collapsed right lung . the left lung is seen again to be clear . cardiomediastinal silhouette is unchanged . unchanged chest radiograph from previous imaging .	No Finding	11569093	59413372	fef81fa7-75d8ca91-07651606-538e5b40-bb00dbff
1004	there appears to be further increase in the substantial right pleural effusion . there is evidence of compressive atelectasis at the base . some opacification just above the level of the effusion on the frontal view could possibly be a manifestation of consolidation in the appropriate clinical setting . remainder of this study is unchanged .	Atelectasis&&Consolidation&&Lung Opacity&&Pleural Effusion	13849733	59249240	87ab8784-89bb34a7-0cd83f89-8208e8d6-8ceaaf76
1005	vague nodular opacity projecting over the right lower lung represents atelectasis, less likely pneumonia . no large effusion or pneumothorax is seen . the cardiomediastinal silhouette is stable . imaged osseous structures appear intact . no free air is seen below the right hemidiaphragm . vague nodular opacity projecting over the right lower lung is most likely secondary to atelectasis . consider repeat radiograph with more optimal inspiratory effort to further assess .	Atelectasis&&Lung Lesion&&Lung Opacity	19800337	53459280	be1ddefb-9327567f-aef38bd8-e918043d-91c40219
1006	pa and lateral views of the chest provided demonstrate an aicd projecting over the left chest wall with leads extending into the region of the right atrium, right ventricle, and coronary sinus . cardiomegaly is moderate . the lungs are clear . no pleural effusion or pneumothorax . atherosclerotic calcification at the aortic knob . bony structures intact . no free air below the right hemidiaphragm . moderate cardiomegaly with aicd in unchanged position . no evidence of congestive heart failure or pneumonia .	Cardiomegaly&&Support Devices	12595991	50291999	09a7bc78-861b7d8a-bf31a633-67e32681-cec68e43
1007	frontal and lateral chest radiographs a left-sided pacemaker projects leads into the right atrium and ventricle . multiple intact sternal wires denote prior history of median sternotomy . the heart size is top normal . the hilar and mediastinal contours are within normal limits . the lungs were slightly underinflated, however there is no pneumothorax, focal consolidation, or pleural effusion . a large gastric air bubble is seen, with mild elevation of the left hemidiaphragm . no free air is present . there is mild leftward deviation of the upper trachea, which appears new . . no acute intrathoracic process . . no free intraabdominal air . . mild leftward deviation of the trachea . please correlate with physical examination .	No Finding	17163861	55133499	bd8fc3e9-687db5d6-574cb5a6-b78d18b2-2f5fb4de
1008	portable upright chest radiograph demonstrates an interval increase in size of a now moderate left pleural effusion with left basilar atelectasis . there is a smaller right pleural effusion with associated right basilar atelectasis . pulmonary edema is improved . moderate to severe cardiomegaly is unchanged, the mediastinal contours are normal . a right ij catheter tip is unchanged projecting over the lower svc . median sternotomy wires, and mitral valve prosthesis are unchanged . increasing left greater than right pleural effusions, represent residua of improved congestive heart failure .	Cardiomegaly&&Edema&&Pleural Effusion	15259244	54223010	fd10e506-04541266-88f11cc7-b24b4822-8cf8bc4b
1009	exam is limited by patient positioning as well as the patients chin and neck obscuring the lung apices . low lung volumes are present . heart size is moderately enlarged . atherosclerotic calcifications are noted at the aortic knob . mediastinal contours are unremarkable . crowding of bronchovascular structures is present with possible mild pulmonary vascular congestion . small left pleural effusion is likely present . patchy bibasilar opacities may reflect atelectasis . no large pneumothorax is present . there are hypertrophic changes noted in the thoracic spine . low lung volumes with probable bibasilar atelectasis . infection at the lung bases cannot be excluded in the correct clinical setting . mild pulmonary vascular congestion and trace left pleural effusion .	Atelectasis&&Edema&&Pleural Effusion&&Pneumonia	15131736	52937624	d9cc9107-872f0471-6fba0396-edc86cf6-6e1a2a4e
1010	there has been interval placement of a large-bore dual-lumen right central venous catheter, distal aspect not well seen, but likely terminating at the cavoatrial junctionproximal right atrium . the cardiac silhouette is mildly enlarged . there is a left base opacity, likely represents combination of pleural effusion and atelectasis . there is a moderate pulmonary vascular congestion . no pneumothorax seen . left base opacity likely represents combination of pleural effusion and atelectasis although underlying consolidation cannot be entirely excluded in the appropriate clinical setting . the above findings with mild enlargement of the cardiac silhouette and pulmonary vascular congestion suggest fluid overloadchf .	Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Lung Opacity&&Pleural Effusion	15840907	56097707	3de6e01e-157ea365-d2474e3c-ab60b297-9e6bcadc
1011	heart size is normal . mediastinal and hilar contours are unremarkable . the pulmonary vascularity is normal . streaky bibasilar airspace opacities likely reflect atelectasis . no pleural effusion or pneumothorax is seen . multiple old right-sided rib fractures are re- visualized . bibasilar airspace opacities likely reflect atelectasis .	Atelectasis&&Lung Opacity	17720924	58847709	99afae49-8d95e258-a1717ce5-74e8f9fa-715ae11a
1012	the lung volumes have slightly decreased . the multiple pre-existing parenchymal opacities, notably at the right lung base and in the left perihilar areas, are constant in extent and severity . moderate cardiomegaly . mild elongation of the descending aorta . no overt pulmonary edema . no pleural effusions . the right internal jugular vein catheter continues to be in correct position .	Cardiomegaly&&Lung Opacity&&Support Devices	14851532	57089146	aaaa9831-9d16cbd6-73e400af-8f17ddaf-44968eda
1013	there is a dominant area of patchy opacity in the right upper zone . this is slightly more pronounced than on the prior film, though much of this may be accounted for by differences in film technique . there is minimal increased interstitial marking in the left suprahilar and right infrahilar regions, which is similar to the prior film . no new area of opacity or confluent consolidation is identified . no effusion . again seen are low inspiratory volumes . the lateral view, however, suggests anterior hyperinflation . incidental note made of a surgical anchor over the right glenoid . equivocal slight worsening of the opacity in the right upper zone . otherwise, no interval change identified . compared to a radiograph from , the opacity in the right upper zone has improved, as have changes at the right cardiophrenic region .	Lung Opacity	10933609	54537700	406539e1-fd9fe3f2-6192f2a5-e24d2d07-5ff88d1d
1014	a left-sided picc line passes through a left brachiocephalic stent and terminates at the distal superior vena cava . the cardiac, mediastinal and hilar contours are stable . a moderate-sized pleural effusion on the right freely layers . there is also a small left-sided layering pleural effusion . substantial coinciding right basilar atelectasis seems to involve collapse of all or much of the right middle lobe and substantial elements of the right lower lobe . there is no shift of mediastinal structures .	Atelectasis&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	12847817	53606038	399fb314-aac34ecd-b7b71a40-3b2ac5e3-9dcdaa7a
1015	there has been interval removal of a right internal jugular central venous catheter . cardiac and mediastinal silhouettes are grossly stable given differences in patient position . mild prominence of the hila suggest central pulmonary vascular engorgement with mild peribronchial cuffing . no definite focal consolidation is seen . no large pleural effusion or pneumothorax is seen . central pulmonary vascular engorgement without overt pulmonary edema . no focal consolidation to suggest pneumonia .	Pneumonia	16050730	50776901	b57f6693-0b6cfcff-9a77d958-c0a4c1f5-fab766d2
1016	low lung volumes . the lungs are clear . mild enlargement of the cardiac silhouette . the hila are normal . there is no pleural effusion and no pneumothorax . no acute cardiothoracic process .	No Finding	18767957	53273257	55249a04-13ab44b1-04c4b5e6-803f6e35-0c091a7d
1017	pa and lateral views of the chest demonstrate no focal consolidation, pleural effusion, or pneumothorax . the cardiomediastinal silhouette is normal in size . the pulmonary vascular markings are within normal limits . no acute cardiopulmonary process .	No Finding	18893199	56948056	ee1b7363-7791f3b8-05250aa7-b16ae53b-f1d3e209
1018	diffusely enlarged cardiomediastinal silhouette is stable and chronic dating back to . compared with most recent prior radiograph, bibasilar opacities have resolved . no focal consolidation, pleural effusion or pneumothorax is present . there is no evidence of pulmonary vascular congestion . no acute intrathoracic process . stable chronic severely enlarged cardiac silhouette .	Cardiomegaly	13473781	59379638	93b163fa-7f80655a-ef8a0aa1-a7f79efd-6feebd5f
1019	the pre-existing right lower lobe pneumonia has substantially increased in extent and severity . the opacity now extends up to the level of the right hilus . in addition, a left upper lobe predominant similar opacity has developed, showing air bronchograms and an alveolar pattern of radiodensity . finally, there is evidence of left retrocardiac atelectasis . moderate cardiomegaly persists . unchanged course and position of the right internal jugular vein catheter . at the time of dictation and observation, , on the , the referring physician .	Atelectasis&&Cardiomegaly&&Lung Opacity&&Pneumonia&&Support Devices	15857729	50947201	e05c237c-fb8a0000-33d30826-2a3cf122-3e58c1f4
1020	mild left base atelectasisscarring is seen . no definite focal consolidation is seen . there is no pleural effusion or pneumothorax . there may be mild pulmonary vascular congestion . mitral annulus calcification is re- demonstrated . the cardiac silhouette remains top-normal in size . mediastinal contours are unremarkable . possible mild vascular congestion . no definite focal consolidation .	Edema	16508811	51162875	cd5bb1b2-3fb23145-b033324b-a7cb4c43-c1641cc9
1021	cardiomediastinal contours are stable in appearance . lungs remain hyperinflated . a subtle area of increased opacity has developed at the left lung base and could reflect acute aspiration, developing pneumonia, or atelectasis . other findings including postoperative appearance of the right hemithorax and enlarged hilar structures due to a combination of enlarged pulmonary arteries and right hilar lymphadenopathy appear unchanged since the recent chest radiograph .	Atelectasis&&Enlarged Cardiomediastinum&&Lung Opacity&&Pneumonia	16622813	59142109	9cc2f017-fb143b0b-85dffa52-fbe2bdfe-eb8ed83c
1022	ap upright and lateral views of the chest were provided . midline sternotomy wires are again noted . patient is rotated somewhat limiting the evaluation of the cardiomediastinal silhouette, though cardiomediastinal silhouette appears grossly stable . there are small layering bilateral effusions with mild interstitial edema . overall, there has been no significant change from prior study . bony structures are intact . mild interstitial edema, stable cardiomegaly with small bilateral effusions .	Cardiomegaly&&Edema&&Pleural Effusion	17669276	52841174	4eab5702-5e51a961-a59e4e84-b5aa758f-4e367b89
1023	frontal chest radiograph the heart is moderately enlarged . the aorta is mildly calcified and tortuous . the central pulmonary vessels are engorged and hazy, accompanied by patchy interstitial opacities, most dense at the left base . an et tube terminates . cm above the carina . an orogastric tube terminates within the stomach . there is no pneumothorax or large effusion . . extensive bilateral patchy pulmonary opacities . in the setting of central vascular congestion, this is most likely severe pulmonary edema, but pneumonia cannot be excluded, particularly at the left base . . et tube terminating . cm above the carina . orogastric tube within the stomach .	Edema&&Lung Opacity&&Pneumonia&&Support Devices	12185775	55494760	e6b4a152-bc73f001-84e7b150-4191779a-754f8459
1024	extensive emphysematous lung parenchymal destruction in both upper lobes, right more than left . subsequent distortion of vascular and airway structures at the lung bases . no pulmonary edema . no pneumonia . borderline size of the cardiac silhouette .	Cardiomegaly	15186992	59053386	d17e21ba-cf76b4d5-e90b2776-43be3667-dacf2f6f
1025	the patient is status post median sternotomy and mitral valve replacement . the cardiac silhouette remains enlarged . aortic knob is calcified . there is blunting of the left costophrenic angle again seen, consistent with pleural effusion . there is slight increase in markings in the right lung base, this may be artifactual, although underlying consolidation is not excluded . . left pleural effusion again seen . . slight increased opacity in the right lung base may be artifactual, although an early consolidation is not excluded in the appropriate clinical setting .	Consolidation&&Lung Opacity&&Pleural Effusion	15259244	54437537	6f3ad43a-df5c6fdb-9ca593fc-13d161a4-8869dd8f
1026	since most recent prior radiograph a swan-ganz catheter, feeding tube, right ij central line have been removed and et tube hav been removed . lung volumes are low . there are now new bilateral large bibasilar opacities consistent with atelectasis . there are unchanged bilateral pleural effusions . there is new mild pulmonary edema . a right chest tube is in place . there are median sternotomy wires and stable moderate cardiomegaly . . removal of multiple monitoring and support devices . . new mild pulmonary edema .	Edema&&Support Devices	12952223	51455625	77f8b16c-dc92cae8-c7cbef7d-dd25244a-9176e253
1027	heart size is normal . mediastinal and hilar contours are unremarkable . pulmonary vascularity is normal . the lungs are hyperinflated with severe emphysema . punctate calcified granulomas are seen within the lung bases . linear opacities in the lung bases likely reflect scarring or subsegmental atelectasis . residual patchy opacity within the left upper lobe likely reflects scarring, as seen on the prior chest ct . no new consolidation, pleural effusion or pneumothorax is identified . scarring within the lung apices is again noted . there is diffuse demineralization of the osseous structures . no acute cardiopulmonary abnormality . severe emphysema . residual left upper lobe opacity likely reflects scarring, as seen on the prior chest ct, with bibasilar linear opacities either reflecting subsegmental atelectasis or scarring .	Atelectasis&&Lung Opacity	11052935	57502393	2f142040-3d2b5cf2-a37622c9-4909cb67-92fad10f
1028	the nasogastric tube has been advanced . the tip of the tube, however, is directed towards the gastroesophageal junction . no evidence of complications, no other relevant changes .	No Finding&&Support Devices	13979643	57345846	98a6b1be-37d7c0d7-9de7d63b-c95bf9a0-17713dcd
1029	the heart is at the upper limits of normal size . the mediastinal and hilar contours appear unchanged, including calcification and unfolding along the aorta . there is similar moderate relative elevation of the right hemidiaphragm compared to the left . the mediastinal and hilar contours appear unchanged . there is again a coarse reticular abnormality favoring the bases and peripheral aspects of the lung, most consistent with pulmonary fibrosis . parenchymal findings appear stable allowing for small differences in technique . there is no pleural effusion or pneumothorax . the lateral view depicts air-fluid level in the mediastinum suggesting esophageal fluid which could be seen with esophageal dysmotility that may accompany crest syndrome . in addition, there is a cluster of small densities, possibly pill fragments, three altogether projecting near the expected site of the gastroesophageal junction . the bones appear demineralized . . stable findings of chronic interstitial lung disease without definite evidence for superimposed process . . air-fluid level in the esophagus which could be seen with known crest syndrome . in addition, there is a cluster of small densities, possibly pill fragments, three altogether, projecting near the expected site of the gastroesophageal junction . clinical correlation regarding any potential aspiration risk is recommended .	Lung Opacity	19640059	51233560	fcf2656a-1407b4d0-e029e995-c324e158-e2b9ce15
1030	the lungs are clear of focal consolidation or large effusion, noting that the right costophrenic angle is excluded from the field of view on the lateral view . no overt pulmonary edema . cardiomediastinal silhouette is enlarged but stable . median sternotomy wires are again noted . hypertrophic changes seen in the spine . no acute cardiopulmonary process .	No Finding	17318449	55782701	9e39cc45-a2ff14d4-3339ec28-dae4711c-f856e2b8
1031	by , the patient has largely cleared the extensive consolidation affecting all of the left lung and the right upper lung at the beginning of . residual peribronchial opacification in the upper lungs was probably scarring, and persists . there may be a very slight increase in the pleural perfusion of abnormality in the left upper lung, but not enough to call pneumonia, and the lower lungs are essentially clear . heart size is normal . mediastinal and hilar silhouettes are unremarkable and no pleural abnormality . feeding tube follows the same course through either a medially displaced stomach or postoperative gastric remnant . no pleural abnormality .	Lung Opacity&&Support Devices	10933609	57053258	7f53537b-fa6d85dc-ba21f7bb-f4c04a3c-177aeed6
1032	tip of the endotracheal tube is just at the thoracic inlet with the chin flexed, no less than cm from the carina . to avoid inadvertent extubation with extension of the neck it should be advanced to cm for more secured seating . enteric tube passes into the stomach and out of view . right jugular line ends in the mid svc . no pneumothorax . right lower lobe is now completely collapsed . there may be developing consolidation at the left lung base . followup recommended for possible pneumonia . at least a small right pleural effusion is presumed . lucency outlining the left mediastinal contour from the aortic knob to the hilus has been present since chest radiographs , presumably represents paraseptal emphysema .	Atelectasis&&Consolidation&&Enlarged Cardiomediastinum&&Pleural Effusion&&Pneumonia&&Support Devices	15161734	53462360	aada2247-29840013-b9823ba1-08f3f7f8-795716fd
1033	pa and lateral chest radiographs demonstrate no focal consolidation, pleural effusion, or pneumothorax . the cardiomediastinal silhouette is normal . the aorta is mildly tortuous, unchanged . no acute cardiopulmonary process .	No Finding	18835687	50822353	42cb7646-ac2acc5b-504f6247-07366b48-3d2bd573
1034	cardiac, mediastinal and hilar contours are unchanged, with the heart size within normal limits . a rounded consolidative opacity within the lingula is mildly smaller compared to the prior study, measuring approximately . cm, previously . no pulmonary vascular congestion is present . there is a small left pleural effusion, slightly increased compared to the prior study . no pneumothorax is identified . cholecystectomy clips are noted in the right upper quadrant . there are no acute osseous abnormalities . slight interval decrease in size of lingular consolidative opacity with interval increase in size of a small left pleural effusion .	Consolidation&&Lung Opacity&&Pleural Effusion	16435402	57661470	8a783cbe-d52d08bc-f2c3bbf8-9b3be898-4872449b
1035	there is little overall change in the appearance of the heart and lungs . continued hyperexpansion without evidence of acute focal pneumonia, though there are atelectatic changes at the left base . there is subcutaneous gas along the chest walls bilaterally that was not appreciated on the prior study . this information was telephoned to the nurse in the icu taking care of the patient on at upon noticing the abnormality .	Atelectasis&&Cardiomegaly	17770657	53115889	13a5d3b6-8cf4d79a-807319e4-1292cd55-39f57349
1036	ap single view of the chest has been obtained with patient in supine position . the patient is now intubated, the ett terminating in the trachea some cm above the level of the carina . a right internal jugular approach sheath has been placed carrying a swan-ganz catheter, tip of which reaches the central portion of the pulmonary artery . an ng tube reaches well into the stomach . mediastinal drainage tubes from below are seen . there is a left-sided pneumothorax measuring up to cm in width in the apical area but extending along the chest lateral wall as well . when comparison is made with the next preceding pa and lateral chest examination of , considerable degree of mediastinal shift towards the right is identified . also noted is that the sternotomy wires have a somewhat different appearance indicating that the patient has since then undergone new cardiac operation and new sternotomy wire placement . the presently described findings show an acute pneumothorax with tension component . a telephone call was placed to extension . contact with the responsible cardiac surgeon was established . the described findings were communicated verbally and the surgeon assured that the situation would be attended immediately . telephone call was given at pm . of .	Pneumothorax&&Support Devices	16875792	50476602	b00146a8-daf7d7b9-b5b42300-46be81dc-b7c723c0
1037	portable ap radiograph of the chest was reviewed in comparison to prior study obtained the same day earlier . the et tube tip is cm above the carina . the right subclavian line tip is at the level of cavoatrial junction . the dobbhoff tube tip is in the stomach . heart size and mediastinum are stable . there is substantial interval improvement of pulmonary edema . left lower lobe opacity and bilateral pleural effusions are noted .	Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Support Devices	13135946	54379083	e98b0a69-33b404ea-93dbba08-08c5acd7-3f06fe8e
1038	the patient has received a nasogastric tube . the tip projects over the middle parts of the stomach . no complications, notably no pneumothorax . the apical lung regions are not included on the image .	Pneumothorax&&Support Devices	17163861	51599732	c2d5f938-8ac36872-dfac1b06-126c490e-6f63e582
1039	the lung volumes have decreased . the relatively extensive bilateral parenchymal opacities, mainly caused by pulmonary edema, are slightly progressive . moderate cardiomegaly and retrocardiac atelectasis persists . the monitoring and support devices continue to be correctly positioned .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Support Devices	15131736	50383259	7dea99ce-f65ab6a2-cd11e9ee-34a5071f-c8877a75
1040	comparison is made with prior study performed seven hours earlier . cardiomegaly and widened mediastinum are stable . there is new total collapse of the left lower lobe . there is no pneumothorax . bilateral pleural effusions are unchanged . mild pulmonary edema is stable . multiple calcified lung nodules in the left upper lobe are again noted findings discussed with dr by phone, at p .	Atelectasis&&Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Lung Lesion&&Pleural Effusion	12185775	59303778	c56f8951-02281b89-f74c14f3-806db927-c57c3c7a
1041	comparison is made to the previous study from . there is a right-sided picc line with distal lead tip in the mid svc . dobbhoff tube is seen . there is again seen hydropneumothorax in the right base . there is loculated fluid along the right apex as well as well as right-sided volume loss . a small left-sided pleural effusion is seen .	Pleural Effusion&&Pneumothorax&&Support Devices	14387068	53051445	c78782df-1b7c8dd3-106b9075-7374ae77-130d785a
1042	there is little overall change . again there is enlargement of the cardiac silhouette with pulmonary vascular congestion and hazy opacification of the right hemithorax suggesting layering pleural effusion . right ij catheter again extends to the mid-to-lower portion of the svc . mild atelectatic changes are seen at the bases .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	19182863	53597008	0fbc52f8-e1f7ad4b-73a2039c-cb06f96e-e187e1f7
1043	there is a newly appeared right pleural effusion, as suspected . the left costophrenic sinus is also mildly blunted, so that the presence of a small pleural effusion is likely . the size of the cardiac silhouette as well as the multifocal bilateral right predominant parenchymal opacities are unchanged in extent and severity .	Cardiomegaly&&Lung Opacity&&Pleural Effusion	16662264	56404316	ce1f47b6-0118a2a3-259807fd-a6713c05-84e92c9f
1044	compared with the radiograph of , the lungs are more clear, without focal consolidation, effusion, or pneumothorax . lungs are slightly hyperexpanded . left-sided pacemaker with lead projecting of the right ventricle is unchanged in position . cardiomediastinal silhouette is normal . no focal consolidation concerning for pneumonia . notification the above findings were communicated via telephone by dr . at on , min after discovery .	Pneumonia	18570152	57576479	bdc767d8-f9566903-2dda971f-c7110e57-164c5277
1045	there lungs are low in volume but without focal consolidation . diffuse opacities likely reflect mild pulmonary edema . there is no pleural effusion or pneumothorax . the cardiac size and cardiac silhouette are obscured by low lung volumes . the mediastinal and hilar contours appear unremarkable . mild pulmonary edema . repeat imaging after diuresis is recommended to evaluate for concomitant pneumonia .	Edema&&Pneumonia	19159236	54259835	88723780-1ba2f066-c81f8785-f1b6c689-360af444
1046	new mild pulmonary arteries cephalization with increased interstitial markings are compatible with mild interstitial edema . mild cardiac enlargement is stable . there are bibasilar opacities that could be explained in part by small bilateral pleural effusion and atelectasis however, pneumonia or aspiration cannot be excluded . there is no pneumothorax . conclusion . new mild interstitial edema with stable mild cardiomegaly . . bibasilar opacities could be in part explained by small pleural effusion and atelectasis . however, aspiration or pneumonia cannot be excluded . this has been verbally discussed with referring physician .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia	12074041	56502688	765fd687-06776030-fe337975-2739eab4-decbb9c2
1047	the lungs are clear . the hilar and cardiomediastinal contours are normal . there is no pneumothorax . there is no pleural effusion . pulmonary vascularity is normal . no acute cardiopulmonary process .	No Finding	14855790	53565184	886b46d2-5577e6fc-fe1bb0e6-08228079-9b623407
1048	left picc enters a left-sided superior vena cava and subsequently courses vertically to terminate in the lower left hemithorax, just above the level of the diaphragm . withdrawal by approximately cm could be performed to ensure positioning within the lower left superior vena cava . cardiac silhouette remains enlarged . opacities involving the right middle and right lower lobe appear slightly improved and may reflect atelectasis andor infectious consolidation . moderate right pleural effusion with subpulmonic and intrafissural components is unchanged as well as a small left pleural effusion .	Atelectasis&&Cardiomegaly&&Consolidation&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	19182863	55177624	b4d823ad-b9f7d3f3-47e57646-bd49ea72-8e3c5bd0
1049	comparison is also made with outside ct from . cardiomegaly cannot be assesed . mediastinal lymphadenopathy is better seen in prior ct . sternal wires are aligned . pacer leads are in standard position . diffuse bilateral lung consolidations are new from , unchanged from consistent with multifocal pneumonia . there is no pneumothorax . left effusion is small .	Cardiomegaly&&Consolidation&&Pleural Effusion&&Pneumonia&&Support Devices	12475198	52368505	add53357-1e2c3208-14598e99-b52076d5-4f606b89
1050	cardiomediastinal contours are normal . the lungs are grossly clear . there is no evidence of pneumonia, chf, pneumothorax or pleural effusion . the mitral annulus is calcified .	No Finding	16508811	58582715	a7c2113c-b5445d48-45d2238f-d7cfa15c-6fd2383a
1051	pa and lateral chest views have been obtained with patient in upright position . comparison is made with the next preceding portable ap single chest view of . right-sided chest tube remains in place terminating somewhat lower than on the preceding study in the apical area . the second lower right chest tube remains in unchanged position . small amount of right-sided pleural effusion persists blunting the lateral and posterior pleural sinus . no new parenchymal infiltrates are seen, and no significant pneumothorax has developed in the apical area . the left-sided hemithorax remains unchanged with no new infiltrates . as before, there are local rib deformities apparently related to previous old trauma as already observed on previous chest ct . stable appearance of right-sided postoperative small apical pneumothorax and pleural effusion .	Pleural Effusion&&Pneumothorax	13352405	59589248	60781ae0-7016f7ed-54a825ab-7509c1b0-9b9b2725
1052	as compared to prior chest radiograph from earlier today, there has been interval placement of an endotracheal tube, terminating . cm above the carina . the cardiac silhouette is enlarged . as before, there is mild pulmonary edema . lungs are otherwise clear . there is no focal consolidation, pneumothorax or pleural effusion . . endotracheal tube terminates . cm above the carina . . unchanged mild pulmonary edema . findings discussed with by via telephone on at am .	Edema&&Support Devices	15857729	53656059	f3627f06-7f8dc376-299731cc-3607780e-44c820e4
1053	ap and lateral views of the chest provided . there is no focal consolidation or pneumothorax . trace right pleural effusion and bibasilar atelectasis are again seen . the cardiomediastinal silhouette is normal . no free air below the right hemidiaphragm is seen . elevation of the right hemidiaphragm and aortic knob calcification are not significantly changed . diffuse osteopenia, spinal fusion hardware, and multiple compression deformities are re- demonstrated . trace right pleural effusion and bibasilar atelectasis are again seen . no acute intrathoracic process .	Atelectasis&&Pleural Effusion	14353044	55615214	5e56226b-f483939b-5c83520e-f030d297-124a879a
1054	the patient has received an esophageal stent . the stent is in correct position according to radiographic criteria . the patient, however, developed free intra-abdominal air . the monitoring and support devices are unchanged, with the exception of the nasogastric tube, this has been removed . the parenchymal opacities seen in both lungs, right more than left, have not substantially changed . the observation of free intra-abdominal air was made at am, , at the time of dictation . at this same time point, the referring physician, . , covered by dr . , was paged for notification and the findings were subsequently discussed over the telephone .	Lung Opacity&&Support Devices	13964474	58308524	4c6b5299-3ebba16c-f51ce5aa-b087e79c-2ac29f2d
1055	newly placed endotracheal tube terminates approximately . cm above the carina, and a nasogastric tube courses below the diaphragm . a -cm diameter rounded lucency is identified lateral to the endotracheal tube and nasogastric tube to the left of midline . although potentially representing an over-distended endotracheal tube cuff, the position is more lateral than expected for this condition . alternative possibilities include an air-filled diverticulum arising from the trachea or esophagus . findings were communicated by telephone with dr . on at pm . at the time of discovery . exam is otherwise remarkable for persistent cardiomegaly and worsening congestive heart failure with increasing perihilar edema and persistent small right pleural effusion .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	11893091	57330158	07ec545e-2a913153-c28cae67-2c38c3b4-c1d7e30a
1056	comparison is made with prior study, ct . mild cardiomegaly is stable . large right supraclavicular catheter tip is in the cavoatrial junction . there is no evidence of pneumothorax or pleural effusion . new right mid lung opacity could be due to small area of hemorrhage . diffuse peripheral interstitial, right greater than left abnormality consistent with interstitial lung disease is unchanged .	Cardiomegaly&&Lung Opacity&&Support Devices	13475033	56556080	4cf1a7d7-deccbdb0-b66e87d3-5a2dee67-bea0829f
1057	comparison is made to the prior study from . there are two right-sided chest tubes with distal tips at the apex and at the base . these are unchanged in position . no pneumothoraces are seen on either side . there is elevation of the right hemidiaphragm and volume loss on the right side . no signs for overt pulmonary edema is seen . there is some atelectasis at the lung bases .	Atelectasis&&Edema&&Support Devices	13352405	55492069	40b2ad97-b8cd3c49-7a1658b6-79be29bb-676d3481
1058	the patient is status post cabg with intact sternotomy wires . the hilar and mediastinal contours appear to be stable with evidence of a tortuous aorta . there is stable mild cardiomegaly . there is no pleural effusion or pneumothorax . there appears to be a subtle increase in opacification in the retrocardiac region, superimposed on a stable mild background of interstitial abnormality, best seen on the lateral view . stable diffuse increased interstitial markings with an interval increase in opacification in the retrocardiac region, best seen on the lateral view, which could be secondary to overlap of structures, however an acute infectious process is not excluded .	Lung Opacity&&Pneumonia	16957952	59962443	93e655d4-f85397d7-f5a5bd25-3ff6da79-c4342fc6
1059	comparison is made with prior study performed hours earlier . ng tube has been advanced, now the tip is out of view below the diaphragm . there are persistent low lung volumes . et tube is in standard position . the pacer lead tip is in the right ventricle . there is no pneumothorax . left pleural effusion is small associated with stable retrocardiac opacities consistent with atelectasis . mild vascular congestion is stable .	Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	19565388	57394992	369d8e0f-25c12a70-b223ef0d-3098e3cd-92006477
1060	there are relatively low lung volumes . mild elevation of the right hemidiaphragm persists . there is persistent right base atelectasis . no new focal consolidation is seen . there is no pleural effusion or pneumothorax . the cardiac and mediastinal silhouettes are unremarkable . no significant interval change .	No Finding	14312560	52078894	cfc2ef1b-a194024a-6147d0d3-6d42379a-575c395f
1061	there is no focal consolidation, effusion, or pneumothorax . the cardiomediastinal silhouette is normal . imaged osseous structures are intact . no free air below the right hemidiaphragm is seen . no acute intrathoracic process .	No Finding	18343726	55741690	2a5046e4-c023b60a-61a89d1b-464d705c-e2b1eae7
1062	cardiac size is top normal . right lower lobe opacity could be due to atelectasis or pneumonia in the appropriate clinical setting . there is no pneumothorax or large pleural effusions .	Atelectasis&&Lung Opacity&&Pneumonia	15857729	52244948	2e3227a1-0011c4de-8fd10de2-ea626fd3-2dc6c2c1
1063	lung volumes remain low, accentuating the cardiac silhouette and bronchovascular structures . there is persistent elevation of the left hemidiaphragm . adjacent atelectasis of the left lower lobe has slightly improved . right retrocardiac atelectasis remains unchanged . there are small bilateral pleural effusions . . slight improvement of left basal atelectasis . . small bilateral pleural effusions .	Atelectasis&&Pleural Effusion	18338007	52162827	459cfba0-0e5fabcb-a6cd2ff8-887d8f8c-59a166aa
1064	compared to prior radiograph, there is widened appearance of the mediastinum which may be technical in nature . lung volumes are low and there is bilateral atelectasis at the bases . there is no pleural effusion or definite focal consolidation . there may be some mild pulmonary congestion . post-traumatic changes are seen at the distal right clavicle . . widened appearance of the mediastinum . recommend repeat upright pa radiograph when patient is more stable . . atelectasis at the bases and low lung volumes . possible mild pulmonary congestion . these findings were discussed with by dr . telephone at pm .	Atelectasis&&Edema&&Enlarged Cardiomediastinum	17439310	55803590	42f9b759-e6e7ad97-975fc45e-f1a03ce4-1f252352
1065	ap and lateral views of the chest were reviewed . the heart size is top normal . the mediastinal and hilar contours are unremarkable . there is no pleural effusion or pneumothorax . there is no focal consolidation concerning for pneumonia . mild prominence of the pulmonary vasculature is consistent with mild pulmonary edema . mild pulmonary edema .	Edema	16050730	57265603	38708899-5132e206-88cb58cf-d55a7065-6cbc983d
1066	the heart is mild-to-moderately enlarged . upper mediastinal contours are stable . lung volumes are low and there is bibasilar atelectasis, but no focal consolidation, pleural effusion, or pneumothorax . compression deformity in the mid thoracic spine is similar to prior . pneumobilia in the right upper quadrant is incidentally noted . stable cardiomegaly . low lung volumes with bibasilar atelectasis .	Atelectasis&&Cardiomegaly	19454978	53305461	bfa3c5fe-e3616a0b-f2cede25-46b58e40-679b44d1
1067	portable ap chest radiograph small bilateral pleural effusions improved on the right and increased on the left since the most recent prior examination of . increased opacification at the left lung base may represent underlying infection . moderate-to-severe enlargement of the cardiac silhouette is chronic and unchanged . bilateral low lung volumes are noted with crowding of bronchovascular markings . a supraclavicular dialysis catheter ends in the right atrium . in the interim since the most recent prior examination, there has been removal of the left-sided picc tip . sternotomy wires are midline and intact . patient is status post left mitral valve repair . . bilateral pleural effusions, improved on the right compared to the prior examination, but worsened on the left . increased opacification at the left lung base may represent underlying infection . . low lung volumes with crowding of bronchovascular markings and minimal increased pulmonary vascular engorgement .	Lung Opacity&&Pleural Effusion&&Pneumonia	15259244	54517823	515703bc-4c8240a5-4b5d0a83-1f8c8dda-289ce799
1068	two leads of a three-lead right pectoral icd pacemaker can be traced to the standard positions in the right atrium and right ventricle, the third lead, intended left ventricular lead, passes into the coronary sinus, but its tip is not visible . conventional chest radiographs should be able with show it . there is no pneumothorax or attributable pleural effusion or mediastinal widening . mild cardiomegaly is chronic . hyperinflation indicates copd . small left pleural effusion or pleural thickening is unchanged since prior studies .	Cardiomegaly&&Pleural Effusion&&Pleural Other&&Support Devices	13606683	56497798	9d32e96f-dcc52f72-a7262f7a-298b9e97-39fc55bb
1069	 . stable right pleural effusion and right basilar opacity, without convincing evidence of new pneumonia . . stable cardiomegaly . . stable compression deformity of mid thoracic vertebral body .	Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Pneumonia	18460230	55751115	839692be-04ae989a-2d56b63c-541abfe9-f8be40ec
1070	the degree of pulmonary congestion is similar or slightly more pronounced . continued enlargement of the cardiac silhouette with bilateral effusions and bibasilar atelectasis .	Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion	18079481	56778521	2598d2a4-fec32ad4-e6bb68b9-b6c86b6e-ec0a7008
1071	the lungs are relatively hyperinflated . there is no focal consolidation concerning for pneumonia . no pleural effusion or pneumothorax is detected . the pulmonary vasculature is not engorged and there is no overt pulmonary edema . the cardiac silhouette is top normal in size, as before . a left pectoral pacemaker is in place with dual leads terminating in the right atrium and right ventricle . the mediastinal and hilar contours are within normal limits . no focal consolidation concerning for pneumonia .	Pneumonia	11893091	53024166	8854ac17-02cbb55b-6797803e-0247f114-8e114394
1072	comparison is made to the patients previous study dated . . dobbhoff feeding tube is seen coursing below the diaphragm with the tip not completely identified but positioned within the stomach proximally . it does not appear to be significantly changed . bilateral lower lobe bronchiectasis is stable . no focal airspace consolidation is seen to suggest an acute pneumonia . no pleural effusions or pneumothoraces . overall, cardiac and mediastinal contours are unchanged . lungs remain hyperinflated .	Enlarged Cardiomediastinum&&Support Devices	10402372	52824884	1bfd4f62-e1254bfb-54b0a6ac-29453546-2c0e7100
1073	there has been placement of a right basilar chest tube with clearing of almost all of the pleural effusion . no evidence of pneumothorax . the remainder of the study is essentially unchanged .	Pleural Effusion&&Support Devices	12952223	59762556	c9479a79-1b877264-b3222893-a2b4e2b9-8eba1e3f
1074	portable ap radiograph of the chest was reviewed in comparison to at am . the left internal jugular line, right central hemodialysis catheter are unchanged in appearance and position . cardiomegaly, moderate-to-severe is unchanged . bilateral pleural effusions are unchanged . mild interstitial pulmonary edema cannot be excluded but overall no substantial change radiographically from the prior examination has been seen .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	12189285	52939782	42c2c190-38498880-cb567499-34810fb4-46a63137
1075	ap single view of the chest has been obtained with patient in upright position . there is no evidence of pneumothorax in the apical area on either left or right side . in comparison with the next preceding chest examination of , at that time described pulmonary abnormalities including a left lower lobe mass persists . no evidence of pneumothorax following transbronchial biopsy intervention .	No Finding	19389041	51467319	7701efe6-56cfaf62-917ec157-bf142818-4a6993ee
1076	frontal and lateral chest radiographs demonstrate mediastinal and hilar contours are unremarkable . stable mild cardiomegaly identified . mild interstitial edema noted no pleural effusion or pneumothorax . no osseous abnormality identified . stable positioning of atrioventricular icd leads . abandoned leads again noted in the right chest wall . surgical clips project over the upper mediastinum . mild cardiomegaly with mild interstitial pulmonary edema .	Cardiomegaly&&Edema	11293517	55831566	40994464-b17516cf-be885c02-984e9fa1-79da2ac8
1077	there is now a tracheal stent with its lower border at the mid clavicular level . there is better inspiration with continued enlargement of the cardiac silhouette . right basilar opacification persists, consistent with a combination of known nodular process, consolidation, and post-procedure atelectasis . there is mild fullness of the pulmonary vessels, consistent with mild elevation of pulmonary venous pressure .	Atelectasis&&Cardiomegaly&&Consolidation&&Lung Opacity	11474065	59691021	c9355375-ab810bbd-434a7359-567930d2-984ba8aa
1078	new alveolar consolidation is seen around left upper lobe cavitary lesion compatible with important bleeding after biopsy . right lung is unremarkable . there is no pneumothorax or pleural effusion . mediastinal and cardiac contour are within normal limits . conclusion new consolidation is seen around left upper lobe cavitary lesion compatible with important hemorrhage post-biopsy . was contacted at pm . with the results . time of the exam am .	Consolidation&&Lung Lesion	13450581	59529409	8ab13ae3-2d580227-ac6e610c-f2e5c694-60d57d41
1079	pa and lateral views of the chest are compared to previous exam from . dual-lead pacing device is again seen with lead tips in stable position . right upper lobesuprahilar opacity with fiducial marker is again seen, not significantly changed from exam from two weeks prior . left side pleural effusion which is seen with loculation posteriorly . there is mild pulmonary vascular congestion without frank pulmonary edema . free air seen below the right hemidiaphragm is compatible with daily peritoneal dialysis . osseous and soft tissue structures are unremarkable . mild pulmonary vascular congestion without evidence of overt pulmonary edema . at least partially loculated left-sided pleural effusion with possible adjacent atelectasis . free air below the diaphragm compatible with peritoneal dialysis . right suprahilar mass as above .	Atelectasis&&Edema&&Lung Lesion&&Pleural Effusion	13067703	58611846	320c382c-ac349a5d-0bd44e5e-5e5cd679-682ea75e
1080	a left-sided dual-lead pacemaker is present, with lead tips over the right atrium and right ventricle . the patient is status post sternotomy, with mediastinal clips . the cardiomediastinal silhouette is prominent, but probably unchanged . again seen is patchy opacity in the left upper zone left lower lobe collapse andor consolidation and probable small left effusion . there is minimal atelectasis at the right lung base . portion of a right shoulder prosthesis incidentally noted . overall similar to the most recent prior film . pleural fluid at the left lung base may be slightly increased .	Pleural Effusion	19075045	56350217	14200531-39fee1a8-8d9a8e5b-6371c2b4-a4440c1e
1081	the right port-a-cath reservoir projects over the right chest and is currently accessed the catheter tip ends in the lower svc . there has been interval placement of sternotomy wires, which are intact . the heart size is within normal limits and the mediastinal hilar contours do not appear widened . calcified ap window node again seen . the lungs demonstrate left bailar opacity which is more linear in configuration on the lateral view . there is no pleural effusion or pneumothorax . left costophrenic angle opacity, somewhat linear on the lateral view, more suggestive of atelectasis or scarring, less likely small focus of consolidation . no pleural effusion .	Atelectasis&&Consolidation&&Lung Opacity	11413236	51161513	2e0c4b42-d1ef618d-2b25304c-1b6ef8a5-29e7671d
1082	upright ap and lateral chest radiographs were obtained . the lungs are low in volume, which obscure the right lower lung calcified granuloma . no focal consolidation is seen . there is no pleural effusion or pneumothorax . the heart is normal in size with post-surgical changes including intact mediastinal wires .	No Finding	10046166	51738740	3a8a17fc-3cd357d9-83466363-91dc5a06-a401e5ed
1083	upright ap and lateral views of the chest right-sided port-a-cath tip terminates within the svc . calcified prevascular lymph node is redemonstrated . a moderate-to-large right pleural effusion appears similar when compared to the prior reference chest radiograph, and has increased when compared to the prior chest radiograph of . previously noted right upper lobe consolidation persists, and may be slightly improved when compared to the prior study . no pneumothorax is demonstrated . left basilar atelectatic changes are present . the mediastinal contours appear unchanged, and assessment of the cardiac silhouette size is difficult given the presence of the moderate-to-large right pleural effusion . no acute osseous abnormality is seen .	Pleural Effusion	14969719	51427095	95e57a26-a6de4499-4dddba72-f21f0627-c864e681
1084	comparison is made to previous study from . there is unchanged cardiomegaly . there has been some improvement of aeration at the right lung base . there remain bilateral pleural effusions and a left retrocardiac opacity . no pneumothoraces are present .	Cardiomegaly&&Lung Opacity&&Pleural Effusion	12847817	55410068	34a9c77c-75d0076f-b1afc9bf-6a0be3b9-0bf021d1
1085	there is a rounded opacity in the right upper lobe, approximately cm . there is no effusion or pneumothorax . the pulmonary vasculature is within normal limits . there is partial visualization of anterior fusion hardware of the cervical spine . the heart size is magnified by portable technique, the mediastinal contours are unremarkable . right apical rounded opacity concerning for infection or malignancy . recommend repeat dedicated ap and lateral chest radiograph, or ct for further evaluation . these recommendations were discussed with dr . the micu at am by phone .	Lung Opacity&&Pneumonia	13031876	50882034	cbd0493a-45581768-2a4a0cdc-ed7b4ccf-20000354
1086	the three chest tubes are now on waterseal . the appearance of the right hemithorax, including the clips and soft tissue collection of air is unchanged as compared to the previous examination . there is increased gas filling of colon interposed between the chest wall and the liver . no current evidence of pneumothorax . unchanged normal appearance of the cardiac silhouette and of the left lung . no other changes .	No Finding&&Support Devices	13352405	55680047	22582d1c-114af91c-83312668-0af5831e-ceacf04b
1087	cardiac size is top normal . new opacities in the lower lobes bilaterally and worsening consolidations in the perihilar regions right greater than left and right upper lobe are consistent with aspiration . there is some component of basilar atelectasis . et tube is in a standard position . cm above the carina . there is no pneumothorax or pleural effusion .	Atelectasis&&Consolidation&&Lung Opacity&&Support Devices	10933609	54853227	c3994ff3-e8774cd2-b7a4c40c-959819fa-d8d942b6
1088	previous mild pulmonary edema has cleared from the right lung, improving on the left . small left pleural effusion has increased . no appreciable right pleural effusion . moderate cardiomegaly has improved . tip of the endotracheal tube is no less than . cm above the carina, in standard placement . swan-ganz catheter ends in the right descending pulmonary artery and care should be taken that it not advance any further when it is not in the wedge position . nasogastric tube passes into the distal stomach and out of view . no pneumothorax .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	12185775	57164346	135f90e3-562abed8-10d18797-fc0fc641-ea889ffb
1089	linear opacities in the upper lungs are noted with associated retraction of the hila likely reflecting scarring in this patient with prior pneumonia . subtle opacity in the left lower lobe retrocardiac region is of unclear etiology . no large effusion or pneumothorax . old left lower rib fractures are noted . areas of scarring in the upper lungs . subtle opacity in left lower lobe . please correlate with ct chest performed earlier same day for further details .	Lung Opacity	10933609	55447530	92fe0d65-6cd5e4b6-22dbcaec-949cb8bd-1c28d956
1090	again seen is a large right hydropneumothorax without evidence of tension, mostly unchanged from the prior radiograph . there is slightly improved aeration of the right middle and lower lobes . the cardiomediastinal silhouette is normal . the left lung is clear . . stable large right hydropneumothorax without tension . . improving aeration in the right middle and lower lobes .	Pneumothorax	12699874	57974904	6d9766ff-d338bb04-cdbfb5a8-a6aefc8e-d28602a0
1091	chest portable comparison is made to prior examination of . the lung volumes are low . the heart size is therefore likely adequate . there is some widening of the mediastinum although again this is likely due to poor inspiratory effort . there is hazy opacity and vascular haziness in both lungs consistent with interstitial edema . an et tube is identified . cm from the carina in correct position . a pacemaker lead in the right ventricle and a second lead in the right atrium . there is a subclavian line with its tip in the distal svc . an ng tube is noted coursing through the esophagus into the stomach . the tip of the ng tube is not identified on this film . . tubes and lines in adequate position as described above . . pulmonary edema involving both lungs . . widening of the mediastinum and possible cardiomegaly are likely due to low lung volumes .	Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Support Devices	13067703	51140369	a9fa9dcf-791d8328-1f38b677-e6d7a2aa-56b111e5
1092	the lung volumes have increased, likely reflecting improved ventilation . no focal parenchymal opacities suggesting pneumonia . normal size of the cardiac silhouette . normal appearance of the hilar and mediastinal structures . no lung nodules or masses . dating back to previous exams from , the left hilus has always been slightly rounder and denser than on the right . however, no pathologic contours are seen and the appearance of the hilus is unchanged with respect to size .	Pneumonia	19800337	51102831	19254d2e-12f84a8a-3d9be406-77b33fc9-ff7ed852
1093	previous right pleural thickening is improving, following tracheobronchoplasty via right thoracotomy . posterior rib osteotomy, unchanged in relative position . normal postoperative cardiomediastinal silhouette, including borderline cardiomegaly predating surgery . lungs grossly clear . lateral view shows prior cementoplasty, vertebral bodies thoracolumbar spine .	Cardiomegaly&&Pleural Other	11474065	57723670	965cab94-dee35b99-bf9616fc-1707a75d-e2368901
1094	in comparison with the previous study, the tip of the endotracheal tube lies approximately cm above the carina . little change in the appearance of heart and lungs .	No Finding&&Support Devices	18855147	52163179	e556173d-1f21a53c-e214118c-39d134bc-23638059
1095	lung volumes are low which accentuates bronchovascular markings and the transverse diameter of the heart . given that, the heart is top-normal to minimally enlarged . the pulmonary vasculature is mildly engorged and there is mild edema . a right basal opacity suggests atelectasis however infection should be considered . no pleural effusion is identified . the left lung is clear . markedly low lung volumes . thank basal opacity suggests atelectasis and mild edema . infection or aspiration should be considered in the appropriate setting .	Atelectasis&&Edema&&Lung Opacity&&Pneumonia	18309149	58786693	8a31b2b4-ae7e2d63-755cd377-936102cb-9bb02fac
1096	frontal chest radiograph endotracheal tube is . cm above the carina . the enteric tube is within the esophagus but appears to terminate at the gastroesophageal junction . exact position could be determined with an abdominal radiograph if necessary . extensive carotid calcifications are noted . multifocal opacities within the lungs, predominantly in the left upper lobe, are consistent with pneumonia . sutures and scarring are seen in the left upper lung, likely from prior surgery . the heart is mildly enlarged and there is mild pulmonary edema . there are small to moderate bilateral pleural effusions . there is no pneumothorax .	Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	14851532	57432047	17c17bf4-5c86a90d-dd7f7b90-cfa93c69-b37cdca4
1097	a right-sided tunneled dialysis catheter terminates in the right atrium . the cardiac silhouette is enlarged . there is redemonstration of peribronchial cuffing and increased interstitial markings, likely secondary to pulmonary edema . increased bilateral lung opacities refelct growing nodules . there is a new region of consolidation above the minor fissure which could refelct an early infectious process . . right-sided tunnel dialysis catheter terminates in the right atrium . . increased bilateral lung opacities reflect growing nodules . . new region of consolidation above the minor fissure is concerning for an acute infectious process . short interval followup recommended .	Consolidation&&Lung Lesion&&Lung Opacity&&Pneumonia&&Support Devices	17340686	56598807	9b4f1964-734c3d45-d58e0850-71a0baee-535ae2c8
1098	comparison is made with prior study performed hours before . there are new kinked bilateral chest tubes . cardiomediastinal is unchanged and midline . increasing opacity in the right upper and lower lobes is consistent with infection . there is no pneumothorax or pleural effusion . new left upper lobe opacity could represent infection or hemorrage . ng tube tip is out of view, below the diaphragm . subcutaneous emphysema is new . severe emphysema with multiple bullae is better seen in ct . et tube is in standard position, the cuff seems overinfalted . left subclavian catheter is unchange .	Lung Opacity&&Pneumonia&&Support Devices	16751749	51100533	76a5e5ee-2113aefe-e8d472a9-dff5f008-b1263281
1099	comparison is made with the next preceding similar examination of . the previously identified residual local pleural thickenings and scar formations as well as mild elevation of the right-sided diaphragm again noted following the previously performed decortication procedure . comparison between the two examinations demonstrates further marked reduction of the postoperative scar formations . mild blunting of the lateral and posterior pleural sinus on the right side persists, but there is no evidence of any remaining free fluid . no new abnormalities are seen . left-sided hemithorax is unremarkable . further postoperative improvement . followup at somewhat greater time interval may show final resolution .	No Finding	18309149	50546279	89fbc7f3-542fde0d-c914db57-f46e285f-22e70ae1
1100	heart size and mediastinum are stable in appearance including left mediastinal shift, expected . no evidence of pneumothorax or interval increase of pleural effusion is demonstrated . post-sternotomy wires appear unchanged including two upper broken wires . the chronic interstitial changes are unchanged as well .	Cardiomegaly&&Enlarged Cardiomediastinum	11378150	53538021	f57fb82c-9e2e5835-423ff895-f31965f4-9a066b95
1101	cardiomegaly is accompanied by improving pulmonary vascular congestion and decreasing pulmonary edema . left retrocardiac opacity has substantially improved, likely a combination of atelectasis and effusion . a more confluent opacity at the right lung base persists, and could be due to asymmetrically resolving edema, but pneumonia should be considered in the appropriate clinical setting . small right pleural effusion is likely unchanged, with pigtail pleural catheter remaining in place and no visible pneumothorax .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	14851532	59364971	39922ca1-cb122a2e-5f5f5b94-65973906-45a1b814
1102	linear opacities of the lung bases bilaterally likely reflect atelectasis . hyperlucency of the upper zones is reflective of emphysema . no focal consolidation, pleural effusion, or pneumothorax . heart size and mediastinal contours are normal . osseous structures are demineralized diffusely with a compression deformity in the mid thoracic spine which is unchanged from . emphysema and bibasilar atelectasis . no evidence of pneumonia .	Atelectasis	11213613	55481818	229975a2-d2e6a791-a66a597a-9b370606-8323c2cd
1103	the cardiac silhouette is within normal limits and there is no vascular congestion, pleural effusion, or acute focal pneumonia . the vague opacification in the left lower zone is unchanged and probably represents pleural plaquing .	Lung Opacity	16435402	50515450	221d35b8-df2b99dc-be23b128-b7f8e7e7-4e76e5ae
1104	the lungs are clear without focal consolidation . no pleural effusion or pneumothorax is seen . the cardiac and mediastinal silhouettes are stable, with the cardiac silhouette mildly enlarged . . the right subclavian brachiocephalic stent appears grossly unchanged . the bones are noted to be somewhat sclerotic on prior imaging, thought to be related to renal osteodystrophy . no acute cardiopulmonary process .	No Finding	14744884	52667466	fe314fbf-50e95159-d593c5dd-390f58f6-7a7cb04b
1105	comparison is made to prior study from at am . there is a dobhoff tube whose distal tip is below the gastroesophageal junction . there is endotracheal tube whose tip is cm above the carina . there is a right-sided central venous catheter with the distal lead tip in the mid svc . there are bilateral pleural effusions and left retrocardiac opacity, which is stable . there is also some pulmonary vascular congestion which is unchanged .	Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	12952223	51080537	352d3cd6-62973415-eb038984-1a3b871f-3d226e60
1106	there again are low lung volumes that accentuate the transverse diameter of the heart . there again are probably atelectatic changes at the bases . no definite acute focal pneumonia .	Atelectasis&&Cardiomegaly	13978244	52706130	0aca2329-7932adb6-984bd8e0-a597477e-92276d94
1107	the heart is of normal size with stable cardiomediastinal contours . prominence of the superior mediastinum is compatible with mediastinal lipomatosis seen on chest ct . lungs are clear . no focal consolidation, pleural effusion, or pneumothorax . no displaced rib fracture is visualized . no radiopaque foreign body . no evidence for acute cardiopulmonary process .	No Finding	17337033	51074951	5b3a073e-8c070064-383e87bc-900d5646-a15c9576
1108	there is little change in the appearance of the heart and lungs and the pacer device .	Cardiomegaly&&Support Devices	13921768	53004850	c836e7ff-0f43d4ff-f91fabcf-b1522150-030daf2c
1109	large right pleural effusion has progressed slowly since . also, increased his moderate enlargement of the cardiac silhouette and a smaller left pleural effusion . pulmonary vascular congestion is present, but i would not say there is pulmonary edema . consolidation in the left lower lobe could be atelectasis or pneumonia . it developed between and . right pic line ends in the mid svc . no pneumothorax .	Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Pleural Effusion&&Pneumonia&&Support Devices	11934114	58600769	60fa6a80-205ed57c-835e6296-1969c8b7-58eeaacf
1110	there again there is evidence of upper low fibrosis and traction bronchiectasis consistent with the clinical diagnosis of sarcoidosis . however, no evidence of acute focal pneumonia or vascular congestion .	Pleural Other	14147787	56678203	a418be70-ef72fa03-c22364d3-1ff688ee-a54559ec
1111	moderate elevation of right-sided hemidiaphragm as before . two chest tubes entered from the lower lateral chest wall terminate in unchanged position, draining the area of the previous empyema . the lowermost of the two tubes is in unchanged position, whereas the higher ending tube has been withdrawn by a few centimeters, but still remains in place . the size of the pleural density that forms a triangular thickening of the right lateral and posterior pleural space has decreased slightly in comparison with the next previous study . there is no evidence of any new cavitation, loculated pneumothorax or other new parenchymal abnormalities . the left-sided hemithorax remains completely unchanged and within normal limits . mild regression of pleural thickenings, no new abnormalities, no pneumothorax .	Pleural Other	13352405	51233388	c95ac9a4-70c1c602-421eacbd-bb29c3f1-7ab0862c
1112	heart size remains mildly enlarged . aortic knob is calcified . mediastinal and hilar contours are unchanged . previously noted left upper lobe mass appears more vague with surrounding ill-defined opacity, possibly related to infection . there is a lingular opacity which is new compared to the prior study, and could reflect an area of infection . the right lung is grossly clear . no pleural effusion or pneumothorax is seen . there are no acute osseous abnormalities . . lingular opacity is concerning for infection in the correct clinical setting . . previously seen left upper lobe mass appears more vague with adjacent ill-defined opacity which could reflect post-treatment changes .	Lung Lesion&&Lung Opacity&&Pneumonia	13450581	51153135	842c80c2-40a8d117-9d30e18e-4548b4b6-99f871ed
1113	severe cardiomegaly is chronic, as is a large hiatus hernia, generally to the right of midline . there is no radiographic evidence of pulmonary edema or pneumonia and no appreciable pleural effusion is present . thoracic aorta is heavily calcified and tortuous but not focally aneurysmal .	Cardiomegaly	15896572	51237274	2cdb2a27-7c2b2d98-f15e16f6-14f179ab-c34735ea
1114	right picc terminates near the right subclavian and internal jugular vein confluence with its tip pointing slightly superiorly in the direction of internal jugular vein . left pectoral pacemaker has its leads terminating in right atrium and the right ventricles . there is no consolidation, pleural effusion, or pneumothorax . cardiomediastinal silhouette is normal size . right picc terminates near the right subclavian and internal jugular vein confluence with its tip pointing slightly superiorly in the direction of internal jugular vein .	No Finding&&Support Devices	16043637	57440750	27e83fc9-b156bdac-0ec31eb2-21403864-d2def4c7
1115	the right picc line is in unchanged position . unchanged evidence of mild fluid overload and retrocardiac atelectasis . no overt pulmonary edema . no pneumonia . moderate cardiomegaly .	Atelectasis&&Cardiomegaly&&Support Devices	15131736	56993005	32fc392a-9a450d85-3d0a2229-e89958e6-49584ed9
1116	compared with the study of , there has been placement of a hemodialysis catheter that extends into the right atrium . the other monitoring and support devices are essentially unchanged . continued enlargement of the cardiac silhouette with some elevation of pulmonary venous pressure . probable bilateral pleural effusions .	Cardiomegaly&&Pleural Effusion&&Support Devices	18906643	56201710	58742345-8a241152-4b4d44c2-4b3196da-324efa44
1117	no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is seen . heart size is normal . there is persistent aortic tortuosity . no rib fracture is detected, although sensitivity is low on routine chest radiography . no acute findings .	No Finding	19623993	58679736	03c9f091-1ac40a2e-362d8a50-c5e3a9c0-eaea0cd2
1118	single portable view of the chest is compared to previous exam from . as on prior, the lungs are hyperinflated with parenchymal changes suggestive of emphysema, particularly at the left lung apex . increased interstitial markings are identified at the left lung base . elsewhere, the lungs are grossly clear . cardiomediastinal silhouette is within normal limits . osseous and soft tissue structures are unremarkable . linear patchy at the right lung base is compatible with atelectasis versus scarring . increased interstitial markings at the left lung base, potentially due to chronic changes however, in the proper clinical setting, component of infection is also possible . two views of the chest may help further characterize .	Lung Opacity&&Pneumonia	11052935	59503672	146e8390-fd657795-492c6a0b-7aaa1bef-06c08c00
1119	mild pulmonary edema and mediastinal venous engorgement are new . heart size is normal but increased, and moderate left pleural effusion is larger while small right pleural effusion is stable . et tube is in standard placement . nasogastric tube ends in the stomach . right jugular line ends at the junction of brachiocephalic veins . left central venous infusion port ends in the region of the superior cavoatrial junction . no pneumothorax .	Edema&&Pleural Effusion&&Support Devices	15758946	52981971	b2f5bef1-dc067a8c-521f6348-16787841-eb270634
1120	the lungs are hypoinflated . the cardiac silhouette is enlarged . there is pulmonary vascular congestion and mild pulmonary edema . a left retrocardiac opacity likely reflects pleural effusion with adjacent atelectasis . an underlying left basilar consolidation cannot be excluded . calcifications are noted along the aortic arch . . congestive heart failure with cardiomegaly and mild pulmonary edema . . probable left pleural effusion with adjacent atelectasis, though an underlying consolidation cannot be excluded .	Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Pleural Effusion	15131736	57642788	97365c4c-68d2ec4d-fbc504dc-02498793-2914b5de
1121	there has been interval removal of the ett and dobhoff . there is an orogastric tube seen with the tip and side hole below the diaphragm . there is a right-sided picc line, which is unchanged in positioning . there are ill-defined opacities at the left base, which likely represent atelectasis, but an underlying lower lobe pneumonia cannot be excluded . the cardiomediastinal silhouette is enlarged but stable . the left hilum is prominent, likely reflecting pulmonary hypertension . the pulmonary vasculature is normal . no pleural effusion or pneumothorax is seen . . appropriately positioned orogastric tube and picc line . . ill-defined left basilar opacities, which likely represent atelectasis, but an underlying left lower lobe pneumonia cannot be excluded . . stable enlargement of the cardiomediastinal silhouette and left hilum .	Atelectasis&&Enlarged Cardiomediastinum&&Lung Opacity&&Pneumonia&&Support Devices	14841168	59941702	df381e4e-bf31f79a-d78a3d63-8b19d21e-bf14cc6d
1122	sclerotic bones, splenic granulomas, vascular stents, and moderate cardiomegaly are again visualized . there is dense retrocardiac opacification compatible with volume loss infiltrateeffusion . there is also an infiltrate of right lower lobe partially obscuring the right hemidiaphragm . other patchy alveolar infiltrates are seen in the right upper lobe and left mid lung . overall the appearance is worsened compared to prior new bilateral lower lobe volume lossinfiltrate . infection is of concern .	Lung Opacity&&Pneumonia	19061282	51030152	9bb1fe4e-c234466a-72525367-a54b28d3-b91d05fe
1123	the heart size and mediastinum are stable . right pleural effusion has increased in the interim, moderate . replaced what appear to be tricuspid and aortic valves are redemonstrated . there is no evidence of pneumothorax . the left internal jugular line most likely continues into the left svc given its position . fracture of the second rib on the left is noted, seen on the multiple previous studies .	Cardiomegaly&&Enlarged Cardiomediastinum&&Fracture&&Pleural Effusion&&Support Devices	19182863	56361895	8df48300-1f93b8ff-42f9e66d-0678758d-fe0aa039
1124	mild pulmonary edema which developed between and accompanied by increasing moderate cardiomegaly has partially cleared, but there has been increase in moderate right pleural effusion . new partial consolidation in the right lower lobe consistent with acute pneumonia . the region of chronic bronchiectasis in the left supra hilar lung, with an appearance strongly suggestive radiation fibrosis, is unchanged from . there is no evidence of active infection in that location .	Cardiomegaly&&Consolidation&&Pleural Effusion&&Pleural Other&&Pneumonia	14851532	54171810	8eb4a26d-a860ddfd-44a66c3f-49fcc3f5-9e3142a2
1125	the patient has had a prior left lower lobectomy . since the prior exam, nodular pleural thickening encasing the left lung has increased at the expense of aeration of the left lung with stable elevation of the left hemidiaphragm . central adenopathy in the left hilus and adjacent mediastinum has also progressed . the right lung is clear . cardiomediastinal silhouette is unchanged . progression of left pleural and nodal metastases .	No Finding	12530259	57147904	ef905e68-392ffa59-22123661-7afd32ae-30f983d5
1126	right internal jugular line ends at lower svc whereas the dialysis catheter through the left subclavian approach ends at mid svc . moderate right pleural effusion and bilateral lower lung atelectasis are unchanged . mild pulmonary vascular congestion is stable . enlarged heart size, mediastinal and hilar contours are unchanged . no pneumothorax .	Atelectasis&&Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	11204646	52842984	799b532b-5d5f4a41-fe352b84-83e78fa1-73e7b283
1127	right internal jugular line tip terminates at the level of cavoatrial junction . ng tube tip is in the stomach . cardiomediastinal silhouette is unchanged . right pleural effusion is unchanged . mild vascular congestion is present . no focal consolidations to suggest pneumonia .	Edema&&Enlarged Cardiomediastinum&&Pleural Effusion&&Pneumonia&&Support Devices	14851532	58585627	42c22f15-803b9ea1-709d9163-e1ec1da8-df4d6d86
1128	left pectoral pacemaker with dual leads seen extending into in the region of the right atrium and right ventricle . a right-sided picc line is noted to terminate in the right subclavian vein . median sternotomy wires and prosthetic cardiac valve are noted . there is no focal consolidation, effusion, or pneumothorax . the cardiomediastinal silhouette is normal . a chronic compression deformity in the upper lumbar spine appears stable from . no free air below the right hemidiaphragm is seen . no acute intrathoracic process .	No Finding	16043637	57880955	1b969967-88c2b36b-65da30a7-644c09d3-96356c51
1129	enteric tube tip is in the mid stomach, new since prior . improved bilateral perihilar, bibasilar opacities . sternotomy, valve replacement . bilateral shoulder arthroplasties . cardiac pacemaker . right ij central line tip near cavoatrial junction . postoperative changes in the spine, with hardware in place . degenerative changes spine . enteric tube tip in the mid stomach . improved pulmonary opacities .	Lung Opacity&&Support Devices	19075045	58577683	2d0d0cce-dd111287-ec34ac38-90e1c536-17d3bdd9
1130	there is again evidence of previous median sternotomy and cabg with post-surgical changes on the right with blunting of the costophrenic angle . no evidence of acute pneumonia, vascular congestion, or pleural effusion .	No Finding	15272972	55987882	3c2ceb4b-9a71f26f-29f23ca1-471edb79-e24b6136
1131	frontal and lateral radiographs of the chest were acquired . scattered parenchymal opacities within both lungs are not significantly changed compared to the most recent chest radiograph from , correlating to areas of post-treatment change and known neoplastic disease . there is no focal consolidation . the heart size is normal . the mediastinal contours are normal . there are no definite pleural effusions . no pneumothorax is seen . left-sided rib deformities are redemonstrated . suture chain is seen within the left upper lung, as before . no acute cardiac or pulmonary findings .	No Finding	14851532	51895071	4c8cfdf2-2ceef04b-440ed4a3-a43a738c-f031c582
1132	a left-sided hickman catheter terminates over the expected location of the cavoatrial junction . the distal tip is not well visualized, therefore function of the catheter should be assessed clinically . thoracolumbar hardware appears in standard unchanged position, though is incompletely evaluated on this single frontal view . compared to the prior examination, the aeration of the lungs has significantly improved . there is no focal consolidation or pneumothorax . there is no vascular congestion or pleural effusions . cardiomediastinal and hilar contours are within normal limits .	No Finding	14353044	50620677	0b9184ba-a570a2c0-10adfa1b-8c804f0a-280b0de1
1133	there is chronic blunting of the right lateral costophrenic angle potentially due to scarring . the lungs are clear without consolidation or effusion . the cardiomediastinal silhouette is within normal limits . median sternotomy wires and mediastinal clips are noted . atherosclerotic calcifications noted within the tortuous thoracic aorta . no acute osseous abnormalities identified . no acute cardiopulmonary process .	No Finding	15032623	56426120	d62b71ce-51a1757d-79a7f8cd-a73c6266-19484978
1134	subtle linear opacity in the right upper lobe likely represents atelectasis . the lungs are otherwise clear . the hilar and cardiomediastinal contours are normal . there is no pneumothorax or pleural effusion . pulmonary vascularity is normal . no evidence of pneumonia . clear lungs .	No Finding	15857729	55746776	ae4c91eb-797ef162-94445cf7-b657d732-2344c20d
1135	one portable upright ap view of the chest . the right picc line has been pulled back and now ends proximal to the junction of the right subclavian and right internal jugular vein . mild-to-moderate cardiomegaly is stable . mild pulmonary venous engorgement and mediastinal widening is stable . there is no pulmonary edema or pneumonia . pleural effusions are small if any . . no evidence of pneumonia . . right picc line has been pulled back now and now ends just proximal to the junction of the right subclavian and right internal jugular vein . . mild pulmonary venous engorgement and mild mediastinal widening are stable .	No Finding&&Support Devices	14841168	58204843	7b714b4a-a32cd9a3-99984154-eacb273a-b64ec97a
1136	interval intubation with tip of endotracheal tube terminating cm above the carinal appear cardiomegaly is accompanied by pulmonary vascular engorgement and development of severe diffuse airspace disease throughout the right lung and patchy multifocal airspace opacities in the left lung . differential diagnosis includes multifocal pneumonia, widespread aspiration, pulmonary hemorrhage, and or pulmonary edema . small right pleural effusion is present . there is no visible pneumothorax .	Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	13473495	53797803	edbccca2-c4fb443b-76458df4-ebb5c146-da6f90f7
1137	the heart shows stable cardiomegaly . the mediastinal and hilar contours are unremarkable . the previously described left mid upper lung opacity has improved in appearance . the left lower lobe consolidation appears similar . subtle blunting of the left costophrenic angle may also indicate a trace amount of pleural fluid in that locale . there is no pneumothorax . improving right upper lobe consolidation stable appearance of the left lower lobe consolidation with probable trace pleural effusion on the left .	Consolidation&&Pleural Effusion	15792940	58501970	6a53a787-2e1025f2-59359f42-140f8938-45899305
1138	frontal and lateral views of the chest were provided . midline sternotomy wires are again noted . the heart is poorly assessed, though remains enlarged . there are at least small bilateral pleural effusions . there may be mild interstitial edema . no pneumothorax . bony structures are demineralized with kyphotic angulation in the lower t-spine again noted . limited exam with small bilateral effusions, cardiomegaly, and possible mild interstitial edema .	Cardiomegaly&&Edema&&Pleural Effusion	17669276	52816124	a044ddbb-f45fc0ce-2f0a6955-8242603e-184c26b0
1139	heart size and mediastinum are stable . right basal consolidation is even more conspicuous than on the prior study . left basal consolidation has progressed . findings are concerning for development of bibasal infection . no pulmonary edema is currently seen . postsurgical changes in the right hemi thorax are overall stable including subcutaneous air in the right upper chest wall and associated hematoma .	Cardiomegaly&&Consolidation&&Enlarged Cardiomediastinum&&Pneumonia	11474065	55570024	aa483dd9-3aa43e2a-f7cfb7e5-7205952e-ddfc95fd
1140	patient has been intubated . the tip of the endotracheal tube ends cm above the carina . the nasogastric tube ends in the stomach . right subclavian vein line tip projects over the mid-to-low svc . moderate-to-severe right pleural effusion . atelectatic right basal lung . moderate cardiomegaly and mild fluid overload . the left pectoral pacemaker is constant .	Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices	18417750	52622865	fe10d1ed-22968c1c-23c84bf4-ddc23640-bc64a3ed
1141	frontal and lateral views of the chest are compared to previous exam from . when compared to prior, there has been interval improvement in the appearance of the pulmonary edema . indistinct pulmonary vascular markings persist as well as small right and moderate left pleural effusions . cardiac silhouette is enlarged but stable in configuration . osseous and soft tissue structures are unchanged . interval improvement of the findings compatible with congestive failure when compared to previous exam from with persistent bilateral left greater than right pleural effusions and pulmonary vascular congestion .	Edema&&Pleural Effusion	16772702	58773373	ba4bbaf8-52c6f0c8-d6922907-95d9b63b-f10069d0
1142	the patient is status post sternotomy . a port-a-cath terminates in the right atrium . the heart is mildly enlarged . calcified mediastinal lymph nodes are unchanged . the lung volumes are low . streaky basilar opacities suggest minor atelectasis . there is no pleural effusion or pneumothorax . cholecystectomy clips project over the right upper quadrant . low lung volumes and streaky basilar opacities, most suggestive of minor atelectasis . no definite evidence of acute cardiopulmonary disease .	Atelectasis&&Lung Opacity	11413236	53836642	5a57f9ad-cca470ce-4338e8a1-bd61ba63-c40ce753
1143	portable semi-upright chest radiograph the cardiomediastinal and hilar contours are stable, with stable severe cardiomegaly . no pulmonary consolidation, edema or pneumothorax is seen . a small left pleural effusion is present .	Cardiomegaly&&Pleural Effusion	13473781	57373953	b201c59c-783b3811-27abc766-9831d333-e648e28e
1144	the left-sided picc line tip the is not visualized due to overlap of the pacer wires . dual lead pacemaker is in similar position . the patient has had prior sternotomy and aortic valve repair . the lungs are clear, no interstitial edema or consolidation . the cardiomediastinal silhouette is not enlarged . no pleural effusions or pneumothorax . no radiographic evidence of acute intrathoracic disease .	No Finding	16043637	58144724	cd986c7a-427ddb9f-9727cd08-4715c210-8b6ffc50
1145	one portable supine ap view of the chest . right internal jugular catheter ends near the cavoatrial junction . ng tube is seen in the stomach with last side port below the ge junction . the lung findings are unchanged compared to study done two hours prior .	No Finding&&Support Devices	16409152	51031461	20106d63-2c479e81-0d61595c-25ef9723-cba07432
1146	lung volumes are low . no focal opacity to suggest pneumonia is seen . no pleural effusion, overt pulmonary edema or pneumothorax is present . the heart size is at the upper limits of normal, unchanged . a right-sided vascular stent is seen within the brachiocephalic vein . no evidence of acute intrathoracic process .	No Finding	14744884	57048625	a23f7cc0-2cc8da91-5f864f5b-6672534c-98f63cd8
1147	comparison is made to the patients previous study of selected images from a ct study dated . a portable ap upright chest film dated at is submitted . . interval removal of the sternal wires with placement of new sternal closure devices, mediastinal and tubes . lungs are well inflated with linear streaky opacities seen at the left base likely representing scarring andor subsegmental atelectasis . no evidence of pulmonary edema, pneumothorax, pleural effusions or focal airspace consolidation to suggest pneumonia . slight lucency at the left apex is felt to be related to underlying emphysema rather than representing a pneumothorax .	Atelectasis&&Lung Opacity&&Pneumonia&&Pneumothorax&&Support Devices	17770657	57661627	0acd838c-5dafe19b-8d9fbbe4-3367ef1b-c28e2b42
1148	mild asymmetric pulmonary edema has improved slightly since . there may be a region of consolidation at the right base which has developed over the past hr . conventional radiographs would be helpful to see if there is right lower lobe pneumonia . region of chronic abnormality in the left upper lobe is highlighted by the edema . mild cardiomegaly stable . pleural effusions small if any . right jugular line ends in the mid svc . no pneumothorax .	Cardiomegaly&&Consolidation&&Edema&&Pleural Effusion&&Pneumonia&&Support Devices	14851532	51818744	60b550de-e91988cd-eb265e25-8c98e078-fc12db16
1149	lung volumes are lower than on the prior study with volume loss in both lower lobes and bilateral pleural effusions, right greater than left . underlying infectious infiltrate in the lower lobes cannot be excluded . compared to the prior study, the pulmonary appearance in the lower lobes is worsened . right-sided picc line tip is in the svc . there is no pneumothorax .	Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	12952223	51592807	d7e9f055-751c8d65-66226fcf-da86917c-6f5082a5
1150	mild cardiomegaly is similar to prior . there is mild pulmonary congestion without overt pulmonary edema . no focal pulmonary consolidation, pleural effusion, or pneumothorax is seen . the osseous structures are unremarkable . the leads of an atriobiventricular icd are in similar position to prior . mild pulmonary congestion .	Edema	11293517	55101140	eae9552c-edf076af-61e6ad23-f29e7eb7-2dc91ede
1151	there is a diffuse reticular nodular pattern throughout both lungs which indicate mild pulmonary edema, though some component of underlying interstitial lung disease is not excluded . no large effusion or pneumothorax . a focal eventration of the right hemidiaphragm is noted medially . the overall cardiomediastinal silhouette is stable . bony structures are intact . old left clavicular midshaft deformity noted . diffuse reticular nodular pattern of the lungs suggests interstitial edema, though underlying chronic lung disease not excluded .	Edema	13475033	57429813	2518c7ca-5bc35dd2-e35d9b4f-c44f6549-ee3b0443
1152	since the prior study, an endotracheal tube has been placed . its tip is . cm from the carina . a picc ends in the mid svc . a feeding tube overlies the stomach with the tip out of view . a pleural effusion on the left is small . a persistent consolidation at the left base is unchanged and likely reflects chronic atelectasis . there are no new opacities . there is no pneumothorax . cervical hardware and right humeral soft tissue anchors are unchanged . . endotracheal tube . cm from the carina . . persistent left pleural effusion and atelectasis .	Atelectasis&&Pleural Effusion&&Support Devices	13031876	54922650	17c72825-5e526be7-2960df0b-bf160fda-b97951bf
1153	monitoring and supporting devices are in standard positions . bilateral, confluent, airspace opacities, right side more than left are unchanged since . as mentioned previously, these opacities are likely from combination of pulmonary edema, hemorrhage or pleural effusion . enlarged heart size, mediastinal and hilar contours have similar appearance . increased retrocardiac density reflecting left lower lung atelectasis is similar .	Atelectasis&&Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Support Devices	19757720	57361288	c72bf2bc-e22e489c-44cc5b8c-04c75d9e-5533e141
1154	comparison is made with prior study performed three hours earlier and ct performed two hours earlier . severe emphysema is better seen in prior ct . left upper lobe, right upper and right lower lobe consolidations are unchanged . there is no pneumothorax or pleural effusion . cardiac size is normal . lines and tubes are in unchanged standard positions . extensive bilateral subcutaneous emphysema is unchanged .	Consolidation&&Support Devices	16751749	53880759	bf6b9ef8-5d5b0363-9ff18917-5b4c91ff-849a090d
1155	unchanged alignment of the pacemaker wires . unchanged moderate cardiomegaly without pulmonary edema or acute parenchymal changes . known scars and mild chronic parenchymal alterations, better documented on the ct examination from . the right pectoral pacemaker and its leads are in unchanged position . no pneumothorax .	Cardiomegaly&&Lung Opacity&&Support Devices	13606683	53940581	c49e5abd-d37fecd3-1fd78a6d-9249f8ad-e8eec581
1156	an endotracheal tube approximately cm from the carina and at the level of the clavicular head is in proper position . a feeding tube is seen within the stomach with the tip out of the field of view . a left chest tube is present . mediastinal drains are in place . sternal wires with a stabilizing device are present . a swan-ganz catheter is seen within the right atrium, but the distal tip cannot be traced further due to the overlying structures . the cardiomediastinal silhouette has the normal postoperative appearance . there is mild bibasilar atelectasis and right upper lobe atelectasis . there are no pleural effusions or pulmonary edema . the previously seen pulmonary edema has resolved . there is no pneumothorax . . bibasilar and right upper lobe atelectasis . . endotracheal tube, chest tube, mediastinal drains and swan-ganz catheter appear to be in the proper positions .	Atelectasis&&Support Devices	11212873	59983953	3470d736-53ab4170-ab83b760-57a5b839-c7302405
1157	cardiomegaly is stable . there are low lung volumes . left lower lobe collapse is unchanged . right perihilar opacities have improved . right upper lobe opacities also improved . mild-to-moderate right pleural effusion is probably unchanged allowing for the differences in positioning of the patient . ng tube tip is out of view below the diaphragm . et tube tip in a standard position . the tip is . cm above the carina . there is no pneumothorax .	Atelectasis&&Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Support Devices	16313531	57570449	56a7703d-e485b8f2-cedb0b12-8138943c-86df9465
1158	mild cardiomegaly and mediastinal contours are stable . perihilar vascular congestion appears similar in severity compared to the prior exam . chronic loculated bilateral pleural effusions are long-standing with persistent bibasilar opacities likely representing atelectasis and scarring . no new focal consolidation or pneumothorax . fragmented and misaligned sternotomy wires are unchanged, as are mediastinal clips . stable appearance of the chest with mild congestion, cardiomegaly, chronic loculated pleural effusions, and persistent bibasilar opacities .	Cardiomegaly&&Lung Opacity&&Pleural Effusion	16360107	53942185	b900fc21-dda79088-8dc65796-63160053-790a5628
1159	a right pleural effusion has increased since and is now large . the left lung is clear . no left effusion or pneumothorax is present . a right-sided port-a-cath tip remains in the mid svc . cardiomegaly is unchanged . significant progression of a large right pleural effusion . discussed with dr phone at .	Pleural Effusion	16826047	57361130	92e316b6-8facf11c-bce58686-26309d9a-afc8bed3
1160	pa and lateral chest radiograph a feeding tube is noted with the tip not clearly visualized in the field of view provided . a right picc tip projects over the level of the low svc . hyperexpanded lungs with decreased vascularity appear consistent with chronic obstructive pulmonary disease . opacification within the right middle lobe appears consistent with loculated fissural effusion evident on the prior ct, slightly more prominent on todays study compared to the prior examination . minimal opacification at bilateral lung bases is stable to slightly improved compared to the prior radiograph of obtained at .	Lung Opacity&&Pleural Effusion&&Support Devices	17770657	58760728	dc130e93-8226ed32-f9924895-6be11d35-3d395b3c
1161	there is no change in position of the monitoring and support devices . the tip of the endotracheal tube is quite high and would benefit from advancement by to cm . moderate cardiomegaly persists . there is unchanged evidence of mild pulmonary edema . there also is retrocardiac atelectasis and the presence of a small right pleural effusion cannot be excluded . no new parenchymal opacities . no pneumothorax . unchanged normal alignment of the sternal wires .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	18906643	56289226	4853dd84-ab86c09a-c204f25e-0a6f5d96-c03fc2f9
1162	there are small bilateral pleural effusions with fluid extending into the major and minor fissures bilaterally . there is no focal consolidation . rounded densities projecting over the peripheral right upper lung zone on the ap view may represent pulmonary nodules . there is mild pulmonary vascular congestioninterstitial edema . the cardiac silhouette is mild-to-moderately enlarged, but stable . the mediastinal and hilar contours are within normal limits . partial calcification of the aortic knob is noted . . small bilateral pleural effusions . . mild pulmonary vascular congestioninterstitial edema . . right upper lobe densities, for which followup chest ct could be considered on a non-urgent basis .	Edema&&Pleural Effusion	15393401	53386512	efea65d1-1ef297f0-129ff6e4-c843bd43-2db0b71d
1163	heart size and mediastinum are unremarkable . lungs are essentially clear . no pleural effusion or pneumothorax is demonstrated . hyperinflation of the upper lungs most likely reflects emphysema . no nodular opacity along the right lower lung is currently demonstrated, most likely reflecting nipple shadow on the prior examination .	No Finding	15182529	57527174	e337d4c3-16ff3087-0094492f-365edc12-31b45f47
1164	the cardiac, mediastinal and hilar contours appear unremarkable . the large right perihilar consolidation, likely representing infection, has improved since the most recent prior examination of . minimal air-fluid level is noted within the neoesophagus on the lateral view .	Consolidation&&Pneumonia	19016834	56012267	daf6cf16-a484b5dd-18011dd3-da52fe5d-68986a14
1165	there is little overall change in the appearance of the cardiomediastinal silhouette . mild atelectatic changes are seen especially at the right base . little change in the degree of pleural fluid . central catheter has been removed .	Atelectasis&&Enlarged Cardiomediastinum&&Pleural Effusion	19182863	56593920	c5faee40-351cd77d-cb9145ad-278c11ed-e7f9b874
1166	et tube is in standard position . right ij catheter tip is in the upper svc . there is no pneumothorax . cardiomediastinal contours are unchanged . esophageal stent is unchanged . multifocal consolidations consistent with pneumonia that are diffuse, larger in the right perihilar and right lower lobe regions are unchanged . pneumoperitoneum is again noted .	Consolidation&&Enlarged Cardiomediastinum&&Pneumonia&&Support Devices	13964474	53373086	3c4b1fb7-4341bbc7-88b0ddcd-b5d45344-8288e24b
1167	the cardiomediastinal and hilar contours are normal . subtle linear horizontally oriented opacities in the left costophrenic angle appear improved compared to prior exams and likely reflect the sequelae of resolving atelectasis . there is no pneumothorax . a small left pleural effusion is seen . small left pleural effusion and improving atelectasis, but no pneumothorax .	Atelectasis&&Pleural Effusion	15192710	58836461	dc93422b-fd5ec685-19eb4eba-fb31f8d0-b60d8b47
1168	ap view of the chest a vascular stent is again noted in the left brachiocephalic vein and svc, in unchanged position . compared to the most recent prior study of , the lung volumes have decreased . there is no new opacity concerning for pneumonia . linear scarring or atelectasis in the right mid lung field is similar . there is no pleural effusion or pneumothorax . the cardiac and mediastinal contours are stable . there are degenerative changes within the left glenohumeral joint . old healed right rib fractures are again noted .	Lung Opacity&&Pneumonia	14236258	51115148	8a8519a4-3254cb1a-775d799a-d0d1bd38-8b776ba6
1169	there is continued elevation of the left hemidiaphragm with left pleural abnormality, unchanged since the prior exam . there is no evidence of pneumonia, pneumothorax or pulmonary edema . the heart is top normal in size . conclusion no acute cardiopulmonary disease . elevation of the left hemidiaphragm and left pleural abnormality which may represent either a loculated effusion or pleural thickening, is unchanged since prior exam .	Pleural Effusion&&Pleural Other	12530259	51979149	19c665a6-5b2ac8ce-afabbb92-17bfdb7d-3db41a78
1170	comparison to prior study at . a single portable upright chest film on at is submitted . . postoperative appearance to left hemithorax is stable . there is a patchy opacity at the right base which could reflect a combination of a layering effusion with atelectasis, although an acute infectious process cannot be excluded . overall, however, there is not significant interval change since . no pneumothorax . cardiac and mediastinal contours is difficult to assess due to the postoperative state of the patient as well as patient positioning on the current examination . no evidence of pulmonary edema .	Atelectasis&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Pneumonia	10885696	52894975	91612855-728b71c5-52138016-9cb33506-c5fc594e
1171	the monitoring and support devices are in unchanged position . there is a slight increase in extent of a right pleural effusion that is now moderate . the left retrocardiac atelectasis is unchanged . no other relevant changes . no pneumonia .	Atelectasis&&Pleural Effusion&&Support Devices	17770657	54392557	f0f0f362-66be2ab0-3210b813-23d16481-c7a59206
1172	new nasogastric tube ends in the upper stomach . severe cardiomegaly and hilar and pulmonary vascular engorgement persists but mild interstitial edema is improving . note is made of asbestos-related pleural calcifications, particularly along with diaphragmatic surfaces . right jugular line ends low in the svc . pleural effusions are small if any . lung apices excluded from this examination . the other pleural surfaces show no pleural air .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	17838301	56219969	4311ab39-fdf14b78-f7e1cb44-06f554ac-a50702b8
1173	there is little change in the appearance of the moderate right and small left pleural effusions with compressive atelectasis in this patient with radiographic evidence of chronic pulmonary disease as well as previous cabg procedure . no evidence of acute focal pneumonia or vascular congestion .	Atelectasis&&Pleural Effusion	12658295	58521232	a6a6000b-26fecffe-b90ded19-73b8a48f-6e3f7557
1174	there is a left pacemaker with appropriately positioned right atrial and right ventricular leads . the heart is moderately enlarged, increased in size compared to . there is pulmonary venous congestion with cephalization and predominantly perihilar heterogeneous opacities, consistent with mild interstitial pulmonary edema . no pleural effusions or pneumothorax . possible slight loss of height of a upper mid thoracic vertebral body would be unchanged compared to . mild interstitial pulmonary edema thought to be cardiogenic in etiology given increased moderate cardiomegaly .	Cardiomegaly&&Edema	11928692	54164323	5475bdcc-37f6b853-142a043b-3e6572f9-5b71d475
1175	left subclavian catheter tip is at the confluence of the brachiocephalic vein . there is no pneumothorax . cardiomediastinal contours are normal . there is mild vascular congestion . right upper lobe opacity is grossly unchanged . residual contrast in the bowel loops, partially imaged in the upper abdomen .	Edema&&Lung Opacity&&Support Devices	18835687	50256977	00de6142-4e8c886c-86883a2b-ead5cc20-23399659
1176	there has been previous median sternotomy and aortic valve replacement . icd pacing device remains in place, with unchanged position of leads in the right atrium, right ventricle and an additional lead for biventricular pacing . moderate cardiomegaly is stable in appearance, is accompanied by upper zone vascular redistribution and mild interstitial edema . the latter superimposed upon chronic pleural and parenchymal scarring within the mid and lower lungs bilaterally . lung volumes are increased, in keeping with history of copd . there are questionable small bilateral pleural effusions present . congestive heart failure with interstitial edema superimposed upon chronic changes of emphysema and pleural-parenchymal scarring .	Cardiomegaly&&Edema&&Lung Opacity	13606683	57242265	af6c2c8b-de4ab155-e59a3a03-1f473d61-d357be8d
1177	the patient has a left-sided picc line . the tip of the line is at the level of the mid svc . a nasogastric tube is new, the tip is not visible on the image but the sidehole projects - cm below the gastroesophageal junction . mild fluid overload with small left pleural effusion . mild cardiomegaly .	Cardiomegaly&&Pleural Effusion&&Support Devices	13979643	57818938	a5d9f091-f420153d-6e818031-8ca6c1c0-1694ca63
1178	upright ap and lateral views of the chest right-sided dual-lumen hemodialysis catheter is noted with tip terminating at the junction of the svc and right atrium . the patient is status post median sternotomy and cabg, with multiple broken median sternotomy wires redemonstrated . heart size is top normal . there are low lung volumes, with crowding of the bronchovascular structures and likely mild pulmonary vascular congestion . bilateral pleural effusions are again noted, which appear loculated laterally and are similar in size when compared to the prior study . patchy opacities at the lung bases most likely reflect atelectasis . no pneumothorax is identified . there are no acute osseous abnormalities . the mediastinal contour is unchanged with aortic knob calcifications again noted .	Atelectasis&&Edema&&Pleural Effusion	16360107	55999205	9b3b2ac9-c7621799-9c520077-028dc771-d93cf2d7
1179	there is a diffuse mild interstitial abnormality, unchanged from prior chest radiographs, and likely chronic . there is no evidence of consolidation or edema . there is no pleural effusion or pneumothorax . there is evidence of stable pulmonary hypertension and vascular engorgement . the aorta is calcified and tortuous . the mediastinal contours are otherwise normal . the heart is moderately enlarged . a left port-a-cath is present with the tip in the right atrium . . no acute cardiopulmonary process . . stable diffuse interstitial abnormality, moderate cardiomegaly, vascular engorgement and secondary signs of pulmonary hypertension .	Cardiomegaly	17340686	52578479	53f32ceb-f05afd4e-d67f0e46-129e6b89-26b170b5
1180	patient is status post median sternotomy and cardiac valve replacement . dual lead left-sided pacemaker is seen with leads extending to the expected position of the right atrium and right ventricle . there may be minimal basilar atelectasis . no focal consolidation is seen . there is no pleural effusion or pneumothorax . the cardiac and mediastinal silhouettes are stable and unremarkable . no acute cardiopulmonary process .	No Finding	16043637	56104633	378d7d48-0cfa19a3-361e40d3-6bd71394-bca64527
1181	a right internal jugular hemodialysis catheter ends in the right atrium . the size of the cardiac silhouette is at the upper limits of normal . sternal wires are intact . a moderate right pleural effusion is slightly bigger . there has been slight increase in the pulmonary edema . opacification at the right base persists and may be a pneumonia . there is no pneumothorax . . increasing pulmonary edema and enlargement of the moderate right pleural effusion . . possible right lower lobe pneumonia is unchanged .	Edema&&Pleural Effusion&&Pneumonia	15094735	57678258	cff0405e-7c684aeb-122051b9-dec202c9-1dfbb41e
1182	following removal of a right-sided chest tube, there is no visible pneumothorax . remaining indwelling devices are unchanged in position, and there is stable cardiomegaly . pulmonary vascular congestion has worsened in the interval with increasing predominantly interstitial edema . bibasilar patchy atelectasis is also noted . . no pneumothorax following tube removal . . worsening pulmonary edema .	Edema&&Support Devices	13896515	56199247	56941204-63c3a811-c32c65ee-fd5dc81e-ef6dc8e0
1183	portable upright chest radiograph demonstrates interval increase in bibasilar opacity, without large pleural effusion or pneumothorax . the cardiac silhouette remains mildly enlarged, the mediastinal contours are normal . the pulmonary vasculature is mildly engorged . there is no edema . bibasilar opacities, likely atelectases, and mild pulmonary vascular engorgement . if there is clinical concern for infection, recommend repeat dedicated ap and lateral views in the department .	Atelectasis&&Lung Opacity&&Pneumonia	18512911	55001746	86d4ab20-e9abbc54-b65af50f-128d2b48-d9884715
1184	the pre-existing opacity in the right lung apex has completely resolved . however, opacities at both lung bases are still present . the opacities appear less dense than on the previous image . currently, no evidence of pulmonary edema is present . the size of the cardiac silhouette is at the upper range of normal . there is no evidence of pleural effusions on the frontal and lateral images .	Cardiomegaly&&Lung Opacity	16508811	50598243	2e619f64-89aad18a-fa15db10-86ed910e-e1d9fb82
1185	compared to prior examination there is interval development of multifocal opacities, in particular in the left mid and lower lung as well as at the right mid and infrahilar area, findings highly worrisome for interval development of multifocal infection . bilateral pleural effusion, bibasilar atelectasis are suspected as well . dobbhoff tube tip is in the stomach . cervical spine fixation device is redemonstrated .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	13031876	50629857	3c58546c-0dbf3603-a97cbc6f-c4f6379f-46f0775b
1186	cardiomegaly is stable . pacer leads are in standard position . mild vascular congestion is stable, asymmetric worse on the right . small bilateral effusions are unchanged . sternal wires are aligned . patient is status post cab .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	13921768	50877377	bc930c3b-03f10f77-32ff77d5-13f5f708-5a1ce695
1187	a picc line has been removed . the heart is mildly enlarged . the mediastinal and hilar contours appear unchanged . there is no pleural effusion or pneumothorax . the lungs appear clear . no evidence of acute disease .	No Finding	16508811	54723356	cf48760b-bc0b549d-17be5069-3e7b5248-e5f62e37
1188	as compared to the previous examination, the lung volumes have increased, potentially reflecting improved ventilation . there are still signs indicative of mild pulmonary edema . in addition, there is a small right medial basal atelectasis . moderate cardiomegaly . no evidence of pleural effusions .	Atelectasis&&Cardiomegaly&&Edema	13978244	52400635	b4099aa9-794a51a6-50ff7979-a10ba3fb-0747eb19
1189	semi-upright portable ap view of the chest was obtained . mild elevation of the right hemidiaphragm is unchanged . the heart is grossly within normal limits and stable in size . there is no definite pleural effusion or focal consolidation . mediastinal contour is stable . no pneumothorax . bony structures appear intact . grossly stable exam with no acute intrathoracic process .	No Finding	13978244	55980966	f1a28150-66237dd6-699fd87a-ac1c6ec6-61f0f104
1190	there is asymmetry and volume loss of the right hemithorax and mediastinal shift to the right and diffusely increased opacification of the right hemithorax, which might represent early infection along with volume loss . there is no pneumothorax .	Lung Opacity&&Pneumonia	13263843	52063347	9aaaaf2a-75b77833-5da35513-6c289824-edd9e84c
1191	position of the endotracheal tube is unchanged . the exact position of the nasogastric tube cannot be determined on current chest x-ray but appears to be in a satisfactory position on the recently obtained chest ct . tip of the endotracheal tube currently lies . cm from the carinal angle . the lung fields remain clear .	No Finding&&Support Devices	13700088	57798512	7502e61e-9548ae94-78e53cb0-47f06975-6a4a0cd6
1192	moderate cardiomegaly is stable . transvenous pacemaker leads are in unchanged standard position . et tube tip is . cm above the carina . ng tube tip is in the stomach . left lower lobe opacity has worsened, consistent with worsening atelectasis and small left pleural effusion . right lower lobe opacity has increased consistent with increasing right lower lobe atelectasis . if any, there is a small right pleural effusion . moderate pulmonary edema is stable .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	18322589	56081926	75f9f886-f3756d63-abb8d1f9-11e61578-a1c734a4
1193	the cardiac, hilar, and mediastinal contours are normal . the pulmonary vascularity is normal . mild elevation of the right hemidiaphragm is unchanged with mild tenting of the diaphragm suggestive of mild volume loss . no focal consolidation, pleural effusion or pneumothorax is present . there are no acute osseous abnormalities . no acute cardiopulmonary abnormality .	No Finding	19907884	59741915	484ad440-175df0f1-5dfa85f0-c66c85d9-8b671d66
1194	the monitoring and support devices are constant . there is unchanged evidence of extensive bilateral parenchymal opacities . the extent and the severity of these opacities have not changed . unchanged appearance of the cardiac silhouette .	Cardiomegaly&&Lung Opacity&&Support Devices	15378103	53117169	5ecd8878-ac3a84b5-6b82b286-c4e20569-9b9f5df3
1195	large-bore right-sided central venous catheter is stable in position, terminating and the proximal right atrium . the cardiac and mediastinal silhouettes are stable . there is moderate pulmonary vascular congestion . bibasilar opacities are felt to more likely relate to vascular congestion rather than consolidation, however in the appropriate clinical setting, underlying pneumonia is difficult to exclude . no pleural effusion or pneumothorax is seen . moderate pulmonary vascular congestion . bibasilar opacities are felt to more likely relate to vascular congestion rather than consolidation, however in the appropriate clinical setting, underlying pneumonia is difficult to exclude .	Edema&&Lung Opacity	16508811	50706776	77ab84c4-ba890f3a-4d161cb1-8516d2ff-ba5e1842
1196	heart size and mediastinum are stable . previously demonstrated multifocal consolidations have resolved . small amount of pleural effusion is present . right lower lung pulmonary nodule appears to be slightly increased as compared to the prior study and might potentially be further assessed with a chest ct . no appreciable pleural effusion is demonstrated . no pneumothorax is seen . scarring in the right upper lobe is noted .	Cardiomegaly&&Enlarged Cardiomediastinum&&Lung Lesion&&Lung Opacity&&Pleural Effusion	14295224	57630991	fdce2841-ba70c298-a83fb5a1-71e58044-dd1115a4
1197	there are new bibasilar opacities compatible with right middle lobe and lingular pneumonia . elsewhere, the lungs are clear and there is no effusion . cardiomediastinal silhouette is within normal limits . no acute osseous abnormality . right middle lobe and lingular pneumonia . recommend repeat after treatment to document resolution .	Pneumonia	16662264	56661236	a10dea57-90f876f4-c66af250-6fb45322-6ef88ddc
1198	a pacemakericd device with two leads appears unchanged . the cardiac, mediastinal and hilar contours appear unchanged . the pacer device overlaps persistent opacification of the left costophrenic angle that is probably unchanged, however, likely reflecting a combination of atelectasis and a small loculated pleural effusion . there is persistent thickening of the minor fissure with possible fluid and atelectasis with a small right-sided pleural effusion . nodular suprahilar opacification on the right is associated with treated malignancy with an associated fiducial seed and appears stable . there is no pneumothorax . free air is no longer apparent on this study . findings suggesting mild fluid overload including pleural effusions, but no definite superimposed process .	Pleural Effusion	13067703	55049183	c826ff67-cd70843b-c8ce2e1a-49f768a6-5738d4cc
1199	the heart is moderately enlarged . the mediastinal and hilar contours appear unchanged, allowing for differences in technique . a band-like opacity projecting over the left mid lung suggests minor atelectasis or scarring . more generally, there is mild increased opacification with indistinct pulmonary vascularity suggesting mild pulmonary vascular congestion without definite focal opacities . calcified pleural plaques are suspected . findings consistent with mild pulmonary edema .	Edema	17838301	58936592	b9d3a2a8-efad6e43-fd5c9461-389ea619-4454f98c
1200	endotracheal tube and nasogastric tube remain in standard position . swan-ganz catheter has been slightly withdrawn, with tip terminating in the central right hilar region . left sided catheter has been removed, with no visible pneumothorax . cardiac silhouette remains mildly enlarged, but previously reported mild edema has nearly resolved . bibasilar retrocardiac atelectasis is present with some improvement on the left, and small left pleural effusion is unchanged .	Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices	12185775	58095298	90eaadd7-6de5ffd4-601d0a6b-6495e636-4f893187
1201	severe cardiomegaly and mediastinal vascular engorgement are stable . pulmonary edema is mild, but small bilateral pleural effusions have increased . no pneumothorax . et tube is in standard placement . right central venous line ends just proximal to the origin of the svc . no pneumothorax .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	14841168	55583412	94baae89-465cf7b4-d12f450e-b149838d-67c2edb4
1202	the patient has been extubated since the last exam . the right central line and left jugular line are in the same position . there is a feeding tube . the surgical catheter in the upper right abdomen has been also removed . stability of the left mild pleural effusion with atelectasis, but worsening of the mild pleural effusion and atelectasis on the right . the mediastinal and cardiac contours are stable and normal . there is no pneumothorax . conclusion the patient has been extubated since the previous exam . slight deterioration of a mild pleural effusion and atelectasis on the right side .	Atelectasis&&Pleural Effusion	11880923	55238105	3bc5aaef-73a4b1b2-8a55d3ee-28d357d6-6c94acb0
1203	the lungs are clear . the hilar and cardiomediastinal contours are normal . there is no pneumothorax or pleural effusion . pulmonary vascularity is normal . a dual-lead pacemaker is present . no acute cardiopulmonary process .	No Finding	17163861	52169517	dd7f3873-773c451c-3500ff51-f62851f4-3a6116a9
1204	there is a new left ij catheter with tip in the mid-svc . there is no pneumothorax . moderate-to-severe cardiomegaly is stable . moderate-to-large bilateral pleural effusions have increased with increasing bibasilar atelectasis, larger on the right side . mild-to-moderate pulmonary edema has worsened . right central catheter tip is in the right atrium . the appearance of the sternal wires is unchanged . patient is status post cabg .	Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	12189285	56010471	37c4fc49-424cf73f-548972b1-dab98549-2ae26c18
1205	a single portable frontal upright view of the chest was obtained . the right internal jugular central venous catheter has been pulled back now terminating in the mid svc . otherwise there is no substantial change over this short-interval followup . right internal jugular central venous catheter has been pulled back, now terminating in the mid svc .	No Finding&&Support Devices	12595991	59048499	372f588f-f2061650-9cc50694-12a70654-dd425821
1206	interval improvement in the severity of severe interstitial lung abnormality, at least in the left lung, is due to recent decrease in the component of reversible pulmonary edema, aside from severe pulmonary fibrosis . right lung has not appreciably improved . pleural effusions small if any . moderate-to-severe cardiomegaly stable . no pneumothorax .	Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Pleural Other	10867202	59191972	bea5fb24-e1d13af2-d70b5be5-fb32e7b8-15828f56
1207	overlying ekg leads are present . minimal platelike left basal atelectasis is noted . otherwise lungs are clear without focal consolidation, effusion or pneumothorax . no signs of congestion or edema . the cardiomediastinal silhouette is normal . imaged osseous structures are intact . no acute intrathoracic process .	No Finding	11673948	53339862	c375e421-68a1e118-133cd727-71b1be6f-8d62fa58
1208	cardiomediastinal contours are stable in appearance . enlargement of hila is consistent with a combination of enlarged pulmonary arteries and right hilar lymph node enlargement as demonstrated on recent ct . lungs are overinflated, but demonstrate no focal areas of consolidation . postoperative changes in right hemithorax related to previous lobectomy are stable . no evidence of pneumonia .	No Finding	16622813	57243655	e71e1f01-11b4f60d-139fce5f-3eed20e2-1b61e149
1209	the monitoring and support devices are unchanged . there is again prominence of the cardiac silhouette with some indistinctness and pulmonary vessels consistent with elevated pulmonary venous pressure . calcified granulomas are again noted in the left mid lung .	Cardiomegaly&&Edema&&Support Devices	12185775	58100629	8d36f63d-6e725615-3f005c82-5e0213ba-13cc3761
1210	cardiomegaly is substantial, unchanged since the prior study, but there is interval improvement in interstitial pulmonary edema . still present right basal opacity might reflect the residua as well as a combination of pleural effusion with atelectasis . no pneumothorax is seen .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion	15393401	57869215	ae1cb3e4-7807870b-ebd61015-6285477f-253c9637
1211	the lungs are normally expanded except for mild atelectasis at the lung bases . opacities project over the spine on the lateral radiograph . the heart is slightly smaller since the study of , however there is still moderate cardiomegaly . there is no pleural effusion or pneumothorax . there is no pulmonary edema . mild rightward deviation of the trachea is likely secondary to known enlargement of the thyroid, left greater than right . moderate cardiomegaly smaller since the prior study . opacity projecting over the spine on the lateral radiograph may reflect pneumonia .	Cardiomegaly&&Lung Opacity&&Pneumonia	15857729	56216565	de9e7463-d51a6b2a-2601990d-3ca399d2-0f7a8df4
1212	the lungs are free of focal consolidations, pleural effusions or pneumothorax . cardiomediastinal silhouette is within normal limits . median sternotomy wires are intact . no evidence of pneumonia .	No Finding	15032623	54572206	3358b4e8-14a2bc35-f84f23f1-d2e9e486-dd707de1
1213	there is again extensive post-surgical changes in the right hemithorax with elevation of the hemidiaphragm with tenting as well as displacement of the trachea to the right . the degree of right effusion has decreased . the left lung is essentially clear, though there is again prominence of interstitial markings consistent with some elevation of pulmonary venous pressure . central line remains in place .	Lung Opacity&&Pleural Effusion&&Support Devices	13263843	57439643	c365e493-6ff6870f-caa75db4-c926e87a-f62d82d8
1214	the lungs are moderately well inflated with no pulmonary edema or lobar consolidation . newly placed ng tube terminates in the proximal stomach and could be advanced by approximately - cm . cardiomediastinal silhouette is unchanged compared to the prior radiograph . lines and tubes also remain unchanged compared to the prior radiograph . old healed fractures involving the right posterior lower ribs noted . . newly placed ng tube terminates in the proximal stomach and could be advanced by approximately - cm . . well inflated lungs with no pulmonary edema or lobar consolidation . recommendations advancement of the newly placed ng tube by approximately - cm .	No Finding&&Support Devices	18487334	59001506	37d75746-aa6bbc7a-bbbf7bd9-3bb0f97b-3bd37684
1215	comparison multiple chest radiographs from to a pre-operative study from . semi-upright portable radiograph of the chest there has been interval widening of the mediastinum due to vascular engorgement . in addition, there is new bilateral interstitial edema . a possible left pleural effusion and atelectasis obscure the left cardiac and hemidiaphragmatic contours more than the prior day . the small right pleural effusion and basilar atelectasis is unchanged . there is no pneumothorax . the support and indwelling lines are unchanged and in their expected locations . mild acute congestive heart failure .	Cardiomegaly&&Edema	10715477	59170987	74501968-2251dd66-a1905203-8ff7c470-9c45dcb6
1216	heart size and mediastinum appears stable . there is no definitive evidence of pneumomediastinum or pneumothorax . lungs are essentially clear . blunting of the right costophrenic angle is unchanged .	Cardiomegaly&&Enlarged Cardiomediastinum	16848073	50996108	f67d7028-171364e2-05112546-2528cbd1-52c791fe
1217	interstitial pulmonary edema is noted, moderate, minimally worse than on the prior study . cardiomediastinal silhouette and pacemaker leads are unchanged . right picc line tip is at the level of the cavoatrial junction .	Edema&&Enlarged Cardiomediastinum&&Support Devices	13896515	51691897	d901a9f6-27dda78a-1ff8e05e-69f9de4f-38ccb2a1
1218	cardiac silhouette is mildly enlarged, and accompanied by pulmonary vascular congestion and mild interstitial edema . patchy opacities persist at the bases, and likely reflect atelectasis . followup radiographs may be helpful to exclude pneumonia in the appropriate clinical setting .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity	10975446	50572011	d25f054a-e8199cdc-c669cb2e-ebcfb082-54c205b7
1219	severe cardiomegaly and very large pulmonary arteries are chronic . lungs are grossly clear . no appreciable pleural effusion . right pic line ends in the low svc . esophageal drainage tube passes into the stomach and out of view .	Cardiomegaly&&Support Devices	15131736	54730459	725b3b1f-cc1d9a66-0292de54-7bea58ed-5b724b75
1220	lung volumes are relatively low with bibasilar atelectasis . superiorly, lungs are clear . there is no overt edema nor effusion . the cardiomediastinal silhouette is stable . prosthetic aortic valve and left chest wall dual lead pacing device are unchanged . there is a new dual lumen right-sided central venous catheter with distal tip in the right atrium . bilateral shoulder arthroplasties are noted as well as lumbar fixation hardware . . low lung volumes without definite acute cardiopulmonary process .	No Finding	19075045	57932391	2c34a6e4-968a506c-a8b39537-c46c370e-184792f4
1221	redemonstrated is a reticular interstitial pattern consistent with known . lung volumes are low . there is no focal consolidation, pleural effusion, or pneumothorax . hardware is seen in the lumbar spine . no acute process . chronic interstitial changes cw .	No Finding	12303667	53999109	ba5d48f0-3105c3a1-1e049eec-c72ac120-415942b0
1222	status post spinal reconstruction with according postoperative devices in situ . right internal jugular vein catheter in correct position . cutaneous clips . the lung volumes are low . there is atelectasis in the retrocardiac lung region . borderline size of the cardiac silhouette without evidence of pulmonary edema or pleural effusions . no focal parenchymal opacities indicating pneumonia .	Atelectasis&&Cardiomegaly&&Pneumonia&&Support Devices	13914812	57142742	19685c5a-8abf83ed-143d0e05-53e3ce3c-d35eec35
1223	there is interval progression in upper lobe opacities, bilateral, with is similar areas of distribution but involving more substantial amount of lung parenchyma . heart size and mediastinum are unchanged . the differential diagnosis might include cryptogenic organizing pneumonia as previously suggested as well as potentially sarcoidosis . correlation with tissue diagnosis is recommended .	Cardiomegaly&&Enlarged Cardiomediastinum&&Lung Opacity&&Pneumonia	14794396	59249979	7356a3c4-b08d7964-33f10497-0dc8f50e-4c20aa7f
1224	cardiac silhouette remains enlarged, and is accompanied by pulmonary vascular congestion and a mild interstitial edema . left retrocardiac opacity has slightly improved, could reflect improving atelectasis or a resolving pneumonia in the appropriate clinical setting . adjacent small left pleural effusion is also slightly smaller . no visible pneumothorax .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia	19759491	50269116	d21a9727-19732ca3-04b1e396-f706bb33-063c90b8
1225	ap upright and lateral views of the chest providedleft chest wall pacer device is again noted with leads extending into the region of the right atrium and right ventricle . cardiomediastinal silhouette is unchanged with atherosclerotic calcifications along the aortic knob and unfolded thoracic aorta again noted . the lungs appear clear . no focal consolidation, large effusion or pneumothorax . no signs of congestion or edema . chronic left ribcage deformities again noted . stable mild cardiomegaly . no signs of pneumonia or edema .	Cardiomegaly	18929056	59886749	a31cf547-a85da812-785f9396-ec422967-38d69e1c
1226	since most recent prior radiograph, there has been resolution of opacity in the right mid lung . again seen are chronic pleural changes on the right and thickening of the minor fissure . the cardiomediastinal silhouette is normal . left hemithorax is unremarkable . . stable chronic pleural changes on the right . . resolved opacity in the right mid lung zone .	Lung Opacity	18309149	53423060	74e72ac6-d04d2e9a-135b0911-cce87e45-cdf6d625
1227	post-treatment asymmetric appearance of the right hemithorax is unchanged with upper right rib resection and volume loss with rightward mediastinal shift and right hemidiaphragm elevation . suture chains project over the right hemithorax . the opacification at the right lung has decreased from . the left lung is clear . no pleural effusion or pneumothorax is present . the cardiac silhouette is normal in size . the thoracic aorta is slightly unfolded . degenerative changes are again seen in the thoracic spine . . no acute cardiopulmonary process . . stable post-treatment appearance of the right hemithorax with slightly decreased opacification of the right lung from .	Lung Opacity	13263843	55312260	22ebe993-418ddc79-44f5af39-3e2d7039-df6bd5fc
1228	the heart size is within normal limits . mediastinal and hilar contours are normal . the previously described resolving right upper lobe pneumonia has improved . there is increasing density over most of the left lung with a small left-sided pleural effusion . there is no pneumothorax . anchors are present within the right glenoid . improving right upper lobe pneumonia and increasing left lung opacity concerning for worsening or new pneumonia .	Lung Opacity&&Pneumonia	10933609	57695180	c11514bb-319a3161-c0c85326-68094c62-0220f4f4
1229	left-sided dual lumen subclavian central venous catheter tip terminates within the proximal right atrium, coursing through a vascular stent within the left brachiocephalic vein and superior vena cava . cardiac silhouette size is normal . mild rightward deviation of the trachea with left superior mediastinal mass compatible with a known thyroid goiter is unchanged . hilar contours are unchanged . pulmonary vasculature is not engorged . subsegmental atelectasis is noted in the lung bases without focal consolidation . no pleural effusion or pneumothorax is demonstrated . marked degenerative changes of the left glenohumeral joints and remote right posterior rib are re- demonstrated . no pulmonary edema or pneumonia .	No Finding	14236258	50717913	3cc05f00-8fba02b7-e911f543-5d48de64-b69bda76
1230	there is prominence of the right paratracheal stripe consistent with known enlarged lymph node . heart size and mediastinum are otherwise unchanged in the short interim . calcified granuloma in the right lower lobe is redemonstrated . no new abnormalities within the lungs seen .	Cardiomegaly&&Enlarged Cardiomediastinum	10046166	56173345	da33ac9f-b047f007-dd9e0ac7-81b4a35e-bb2b6b5b
1231	cardiac silhouette is upper limits of normal in size, similar to recent chest radiograph of , but slightly increased from the earlier radiograph of . on the lateral chest radiograph, there are apparent small bilateral pleural effusions, new since . minimal adjacent basilar lung opacities are present . the remainder of the lungs are clear except for unchanged relatively symmetrical bi-apical scarring . small bilateral pleural effusions with minimal adjacent basilar lung opacities, which likely reflect atelectasis . no definite pneumonia, but followup radiographs may be helpful if symptoms persist in order to exclude a subtle basilar pneumonia .	Atelectasis&&Lung Opacity&&Pleural Effusion	19549821	54696287	9a4ccf98-58c3f0da-81d2cd90-38c242fb-cc48af1b
1232	the endotracheal tube tip sits cm above the carina . a right-sided central venous catheter tip sits at the cavoatrial junction . an endogastric tube courses inferiorly below the ge junction . a pacer defibrillator unit projects over the left chest with leads in the right atrium, right ventricle, and coronary sinus . sternotomy wires, prosthetic valve, and cabg material are unchanged . the heart size is at the upper limits of normal . the mediastinal contours are within normal limits . the lungs demonstrate stable appearance of interstitial edema, and small bilateral pleural effusions with associated atelectasis are present . there is no pneumothorax . stable mild interstitial edema with small bilateral pleural effusions with associated atelectasis .	Atelectasis&&Edema&&Pleural Effusion	18322589	58137643	9b9cce32-6e61e5c8-31b59b5f-9aa235c9-7fc98cb1
1233	ap portable semi upright view of the chest . lung volumes are low limiting assessment . there is increased bibasilar atelectasis and bronchovascular crowding . overall cardiomediastinal silhouette is unchanged . the right upper extremity access picc line appears in unchanged position extending to the level of the cavoatrial junction . mild congestion is difficult to exclude in the correct clinical setting . no overt signs of edema . increasing bibasilar atelectasis . possible mild pulmonary vascular congestion .	Atelectasis&&Edema	11022245	58402174	8d3d599d-c63f3e85-fcd2ddbe-2e931945-482b1161
1234	no current evidence of pneumothorax . unchanged aspect of the cardiac silhouette . unchanged mild bilateral air inclusion in the soft tissues .	Cardiomegaly	17770657	52978683	79d6fa76-8cc30af0-1dba3386-66e2a784-e134a348
1235	single portable view of the chest compared to previous exam from . right subclavian line is seen with catheter tip in the lower svc . there is no visualized pneumothorax . previously seen right picc and left subclavian lines are no longer seen . cardiomediastinal silhouette is within normal limits . osseous and soft tissue structures are unremarkable . new right subclavian line with tip in the lower svc . no pneumothorax .	No Finding&&Support Devices	18835687	55728799	aa546728-20bdd90f-5ff37933-03763e88-8460fa7e
1236	ap single view of the chest has been obtained with patient in sitting semi-upright position . analysis is performed in direct comparison with the next preceding similar study dated . a right-sided picc line is again identified . it is now seen to terminate overlying the right-sided mediastinal structures at the level of the carina . thus, it has been withdrawn by approximately cm in comparison with the preceding examination and is now in good position in the mid portion of the svc provided good venous flow has been established . no pneumothorax or any other placement-related complications identified . cardiomegaly and pulmonary vascular congestive pattern with some pleural densities in left base as before .	Cardiomegaly&&Support Devices	12185775	55200248	35405ddd-e3962eab-c0815341-608847ce-234f9d06
1237	 . interval placement of a right internal jugular swan-ganz catheter which has its tip in the right interlobar artery . there has been interval placement of a nasogastric tube which courses below the diaphragm with the tip not identified . interval placement of an endotracheal tube, which has its tip approximately cm above the carina . heart remains enlarged, which most likely reflects cardiomegaly, although pericardial effusion cannot be excluded . the mediastinum appears widened but this is likely related to patient rotation . there are bilateral layering effusions with retrocardiac consolidation likely reflecting partial lower lobe atelectasis . in addition, there has been interval appearance of moderate pulmonary and interstitial edema . no large pneumothorax is seen . the patient is status post median sternotomy with an aortic valve replacement . a right-sided pacer remains in place . right internal jugular central line also is unchanged in position .	Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	13606683	57077344	a158a187-8bc54174-4245141b-7afe393b-40c6e701
1238	the endotracheal tube sits cm above the carina . the endogastric tube tip sits within the stomach, although a portion of the weighted tip sits above the ge junction . the heart size is within normal limits . the mediastinal and hilar contours appear unremarkable . the lungs continue to demonstrate heterogeneous opacity in the right mid and lower portion, which may represent an area of scarring . additionally, more scattered punctate densities throughout the right and left lung are compatible with calcified pleural plaques as confirmed by the visualized chest portion of the abdominal and pelvic ct from . trace bilateral pleural effusions . there is no pneumothorax . . lines and tubes as described above . . right mid and lower lung scarring and trace bilateral pleural effusions .	Lung Opacity&&Pleural Effusion&&Support Devices	17032538	53570653	39af0cd9-82745eb4-2fe05152-1dfd448e-8725c801
1239	cardiomegaly is mild, similar to prior . prominent interstitial lung markings are compatible with known lung fibrosis . indistinct pulmonary vascular markings are similar to prior and compatible with mild pulmonary edema . no focal consolidation, pleural effusion, or pneumothorax . the catheter of the left chest wall port terminates in the right atrium . multiple vertebroplasties are similar to prior . no displaced rib fracture is identified . mild pulmonary edema superimposed on known lung fibrosis . severe chronic cardiomegaly and pulmonary hypertension . no displaced rib fracture . multiple vertebroplasties, similar to prior .	Cardiomegaly&&Edema&&Pleural Other	10439781	56498272	cbf70dce-197f82f4-7b8613a7-c0b0b099-d1de4726
1240	again identified is a left juxta-hilar mass adjacent to a fiducial seed and a right hilar mass . multiple other nodules are also identified but better delineated on recent ct . otherwise, the lungs are without a focal consolidation or pneumothorax . a small right pleural effusion is noted . an overlying left subclavian central line is visualized in place . there is stable elevation of the left hemidiaphragm . no free air is noted in the abdomen . findings consistent with known intrathoracic malignancy . no evidence of infection or other acute process .	No Finding	12145137	54833205	61b4d5e0-66a2bcaf-6c4d6c19-6b735e59-b1390cb2
1241	there is continued substantial enlargement of the cardiac silhouette with elevated pulmonary venous pressure . probable bilateral layering pleural effusions with compressive atelectasis at the bases . in the appropriate clinical setting, supervening pneumonia would have to be seriously considered .	Atelectasis&&Cardiomegaly&&Pleural Effusion&&Pneumonia	13473495	53000263	021e1de7-890774b9-f2aa1f31-53b8b7b8-eb9c4fd2
1242	comparison to prior study of . portable ap upright chest film of at hours is submitted . . relatively low lung volumes with scattered linear opacities at the bases and in the left mid lung, likely reflecting subsegmental atelectasis . crowding of the pulmonary vasculature with no evidence of overt pulmonary edema . no pneumothorax . no pleural effusions . . interval removal of the right internal jugular central line . spinal hardware overlies the lower cervical spine .	Atelectasis&&Lung Opacity&&Support Devices	15321868	54552753	67ba33ad-ec43cf26-e563d64a-3069ed2e-c5844c0c
1243	one portable ap upright view of the chest . in the left mid and lower lung, there is an opacity concerning for pneumonia . the right lung appears clear . there is no pleural effusion on the right . there is no evidence of pneumothorax in either lung . the left hemidiaphragm is not well seen and a small left pleural effusion cannot be ruled out . left mid and lower lung opacities concerning for pneumonia . probable small left pleural effusion .	Lung Opacity&&Pleural Effusion&&Pneumonia	16313531	57149976	9899772e-b051b74d-f68faa87-f45ebf9b-3fcd4d7b
1244	again, the bones are diffusely sclerotic . the somewhat limits assessment for underlying focal consolidation, however, previously seen multifocal consolidations bilaterally on have significantly decreased in the interval . no definite new focal consolidation is seen . there is no pleural effusion or pneumothorax . the cardiac silhouette is moderately enlarged . mediastinal contours are stable . several vascular stents are re- demonstrated . osseous sclerosis limits assessment for underlying focal consolidation . interval decrease in pulmonary consolidations compared to . no definite new focal consolidation . moderate cardiomegaly .	Cardiomegaly&&Consolidation	19061282	55403688	407f8ab5-8827f7ad-75133d25-50cf5e18-f830a187
1245	single ap portable frontal view of the chest was obtained . again seen is asymmetry and volume loss and opacification of the right hemithorax . postoperative changes of the right hemithorax are noted . right hemithorax opacification again likely represents combination of radiation changes and volume loss . given differences in patient position, there appears to be slight decrease in the opacification of the right lung . the left lung is clear aside from mild left base atelectasis . cardiac silhouette is not enlarged . mediastinal contours are similar to slightly less prominent as compared to the prior study . hilar contours are similar in appearance .	Enlarged Cardiomediastinum&&Lung Opacity	13263843	52974031	d73fc335-ef582778-b33761ad-1003aef6-8129d67d
1246	comparison is made to previous study from . there is an endotracheal tube whose tip is low, cm above the carina . this could be pulled back to cm for more optimal placement . there is a nasogastric tube whose distal tip is poorly seen due to technique but is at least to the level of the ge junction . there is a left-sided central venous catheter with distal lead tip at the cavoatrial junction, unchanged . there is unchanged cardiomegaly . there is again seen pulmonary vascular congestion which is stable . . low et tube . this could be pulled back cm for more optimal placement . . nasogastric tube tip is not well seen due to technique but is at least to the level of ge junction . recommend repeat cxr or abdominal films for further evaluation of the distal tip . . unchanged persistent pulmonary edema . . stable cardiomegaly .	Cardiomegaly&&Edema&&Support Devices	14841168	51131705	7ab14399-04914a4f-ecbeb632-86169815-b8874a50
1247	previous mild-to-moderate pulmonary edema has substantially cleared . the residual opacification in the left lung base is a candidate for possible pneumonia, and should be followed . pleural effusions are small and unchanged . moderate cardiomegaly is stable . mediastinal vascular engorgement has improved slightly . no pneumothorax .	Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Pneumonia	19715857	58400851	e1eb5589-20b5223f-dfff33dd-0d4ed3f6-19b045fd
1248	there is no pneumothorax . small bilateral pleural effusions are larger today than on when the patient was and mild pulmonary edema . the irregular left perihilar opacity conforming to persistent consolidation the superior segment left lower lobe is more prominent today than before . it needs to be evaluated as it possible indolent infection or even malignancy . there is no pulmonary edema today . borderline cardiomegaly is chronic . right pic line ends in the lower svc . evaluation of the retro sternal fluid collection would require repeat chest ct scanning, since the conventional radiographs have consistently under estimated the size of that abnormality .	Cardiomegaly&&Consolidation&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	14851532	55268779	3b728ba8-286ccc7c-03fe6ea5-cd414e08-a5ee38c1
1249	there is some improved inspiration . continued enlargement of cardiac silhouette with tortuosity of the a or a . mild elevation of pulmonary venous pressure with small bilateral pleural effusions and bibasilar atelectasis . pacer leads are in good position and there again are surgical clips in the left axillary region .	Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices	13921768	59679445	6e061299-d827a367-715485b9-dc146072-974eb92a
1250	patient is status post median sternotomy and cardiac valve replacementthe lungs are clear without focal consolidation . no pleural effusion or pneumothorax is seen . cardiac silhouette is mild to moderately enlarged . no pulmonary edema is seen . mediastinal contours are unremarkable . cardiomegaly . no pulmonary edema .	Cardiomegaly	19499595	52825626	00dbc849-560058de-e051c029-8cd120fe-9a4f3202
1251	the heart size and mediastinum are stable . the right upper lobe consolidation appears to be progressed, concerning for developing infectious process such as right upper lobe pneumonia, and potentially there is also a focus of infection in the right lower lobe .	Cardiomegaly&&Consolidation&&Enlarged Cardiomediastinum&&Pneumonia	10933609	51826402	1ccba7cb-19cab96d-3af214af-04c55ded-7842012a
1252	the three chest tubes remain stable in position compared to the prior study . the appearance of the right hemithorax including the clips is unchanged as compared to the previous examination however, it appears that the soft tissue collection of air has increased in size . there is increased gas filling of colon interposed between the chest wall and the liver, and continued elevation of the right hemidiaphragm . unchanged normal appearance of the cardiac silhouette and the left lung . no current evidence of pneumothorax . findings remain stable compared to the previous study with the exception of increased air with the soft tissues of the right lateral chest wall .	No Finding	13352405	56801982	dedc8034-9860140a-df88abb0-b9b2fab5-3265641f
1253	there is a new focal parenchymal opacity in the right upper lobe . in the appropriate clinical setting, this opacity represents a pneumonia . borderline size of the cardiac silhouette . status post sternotomy . pacemaker wires in situ . no larger pleural effusions . status post valvular repair . at the time of dictation and observation, , on the , the referring physician . min later, the findings were discussed with over the telephone .	Cardiomegaly&&Lung Opacity&&Pneumonia&&Support Devices	16043637	55161126	1944fc3b-e15f09ec-eafd2e68-fa2452be-6505ea41
1254	single ap supine portable view of the chest was obtained . a large bore left-sided central venous catheter is seen extending to the right atrium . there is moderate pulmonary edema with possible trace bilateral pleural effusions . relative more confluent opacity in the right lung base is again seen, worrisome for consolidation which has been present over multiple prior radiographs and could relate to the pulmonary edema . the cardiac and mediastinal silhouettes are stable . surgical clips seen in the upper abdomen .	Consolidation&&Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Support Devices	17340686	59566680	c19b01bf-e57e7aee-f251430e-9a1d156e-acbf7677
1255	comparison is made with prior study performed nine hours earlier . there is no evident pneumothorax . there has been improved atelectasis in the left lower lobe and improved subcutaneous emphysema in the left chest wall, otherwise there are no acute interval changes .	Atelectasis	12736592	56294295	d732824a-2a53ee39-1a60037a-d31d8e45-54dd3a99
1256	there is again biapical thickening and adjacent pulmonary parenchymal scarring with tortuosity of the aorta . mild elevation of the right hemidiaphragm is again seen . no evidence of pulmonary vascular congestion or acute focal pneumonia .	Lung Opacity	19914761	52697084	a4a72137-eea8a09f-a1ac8c72-4c948dd3-57236f6e
1257	compared with the prior film, i doubt significant interval change . again seen is some patchy opacity at the left lung base and cardiophrenic regions . there is upper zone redistribution, without other evidence of chf . again seen is cardiomegaly, with stable cardiomediastinal silhouette . left-sided pacemaker-type device and additional abandoned leads are unchanged . no pneumothorax is detected .	Cardiomegaly&&Enlarged Cardiomediastinum&&Lung Opacity&&Support Devices	11293517	54700382	fe378922-7456a91f-d442d29f-89e17975-2360f005
1258	the patient is status post right upper chest wall resection, right upper lobectomy with right apical scarring and upward traction of the right hilum from radiation fibrosis, all unchanged . there is no pleural effusion or pneumothorax . the left lung is clear . heart size is normal . interval resolution of right pleural effusion .	No Finding	13263843	56749558	f6a45850-afbc320a-ab118fd9-85e788d6-d88d5060
1259	the bilateral parenchymal opacities have decreased in extent and severity . no new opacities . the lung volumes remain low . borderline size of the cardiac silhouette . no larger pleural effusions .	Cardiomegaly&&Lung Opacity	12475198	56329592	2807416a-1e2f3ee5-da0d8c38-d898df41-666df4df
1260	indwelling support and monitoring devices are unchanged in position, and cardiomediastinal contours are stable allowing for positional differences . left retrocardiac atelectasis has improved, but an area of confluent increased opacity in the right infrahilar region is new . the latter may reflect atelectasis, aspiration, or developing infection .	Atelectasis&&Enlarged Cardiomediastinum&&Lung Opacity&&Pneumonia&&Support Devices	10268877	52199665	f1b12ac7-37699f77-a605ccbb-0eee65fd-e2f0351d
1261	there has been interval decrease in size of the left pleural effusion, which is now moderate in severity . small right pleural effusion is present . bilateral consolidations, more dense on the left, persist . no pneumothorax is seen . extensive nodularity is consistent with known metastatic disease . interval decrease in size of left pleural effusion, which is still moderate in severity .	Pleural Effusion	12702423	53795595	def3b450-db2f7c7f-a082b686-800a5de0-6b74e997
1262	right-sided chest tube remains in place, with slight increase in size of a small right pleural effusion, but no visible pneumothorax . bibasilar linear atelectasis has slightly worsened, and there is a persistent small left pleural effusion .	Atelectasis&&Pleural Effusion&&Support Devices	19389547	57356552	85817777-b9158c6e-b0d376b5-d21f2744-f3a04234
1263	there are diffuse bilateral interstitial markings, overall unchanged since . this is consistent with chronic lung disease . no new areas of focal consolidation or pleural effusions . no pneumothorax . heart size is top normal, stable from prior . atherosclerotic calcifications are seen in the coronary arteries, better appreciated on the lateral view . . no acute intrathoracic process . stable bilateral interstitial markings, likely chronic lung disease . . coronary artery calcifications .	Lung Opacity	13475033	55339618	5037ce6f-1b5a2beb-cefbe169-b7e53cbf-427eaf91
1264	there is again some enlargement of the cardiac silhouette without definite vascular congestion, pleural effusion, or acute focal pneumonia .	Cardiomegaly	11052273	52056685	833353ab-ca676eba-dc9127a5-675bc9a1-79e5737d
1265	endotracheal tube has been removed . there remains a left ij central venous line with the distal lead tip at the cavoatrial junction . cardiac silhouette is enlarged . there are diffuse airspace opacities bilaterally, more confluent within the right lung . findings are consistent with pulmonary edema, although multifocal pneumonia should also be considered .	Cardiomegaly&&Edema&&Lung Opacity&&Pneumonia&&Support Devices	10933609	59018975	ca5edfd1-791faa24-0e6c7747-b17088d0-d90a8fc2
1266	single portable frontal view of the chest lung volumes are low resulting in vascular crowding . however, despite this, there is evidence of mild to moderate pulmonary vascular congestion . cardiac silhouette is enlarged despite the portable technique . probable small bilateral pleural effusions . no focal consolidation is seen to suggest pneumonia . no pneumothorax is evident although the lung apices are obscured by overlying soft tissue .	Edema	15131736	57531802	308bf948-d05f2a1d-2c32a818-2df09584-d17283f6
1267	compared to there is increased opacification within the right lower lobe with silhouetting of the right hemidiaphragm . this may represent right lower lobe atelectasis, however infectious process or asymmetric edema cannot be excluded . additional areas of opacification in the right upper lung may represent asymmetric pulmonary edema . cardiac silhouette is enlarged likely representing volume overload . a pa and lateral chest radiograph may be obtained to help localize area of consolidation . a chest ct with contrast should be obtained once the patient is more stable to rule out presence of underlying mass . is at on via telephone .	Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Lung Lesion&&Lung Opacity&&Pneumonia	15840907	57339166	38b3b47d-6984aed6-acb1ea60-2c93049b-1ccdfc91
1268	et tube is in standard position . right ij catheter tip is in the mid svc . ng tube tip is out of view below the diaphragm . of note, the lower aspects of the hemidiaphragms were not included on the film . cardiomegaly is obscured by lung abnormalities . diffuse bilateral pulmonary consolidations, severe on the right and moderate on the left, are unchanged . as mentioned in prior studies, these findings are a combination of pulmonary edema, pulmonary hemorrhage and pleural effusions . there are no new lung abnormalities . the main pulmonary artery is enlarged . cardiac silhouette is obscured by lung abnormalities .	No Finding	19757720	51034858	3e2089f9-a5133cb9-a2ccafcd-956a95d1-c2af1f26
1269	in comparison to the recent radiograph of day earlier, the position of the dobhoff tube in the stomach is not appreciably changed . heart size remains normal, and lungs are clear .	No Finding&&Support Devices	15114531	56753331	3fc3893f-6a756dad-3cfcb050-5d1e7080-9ef06032
1270	there is little overall change . substantial cardiomegaly with bilateral opacifications most likely reflecting pulmonary edema . the possibility of supervening pneumonia would have to be raised in the appropriate clinical setting . central catheter remains in place . slight impression on the lower cervical trachea on the right could possibly represent a small thyroid mass .	Cardiomegaly&&Edema&&Lung Lesion&&Lung Opacity&&Pneumonia&&Support Devices	10439781	51441976	3d0754cf-6b313d54-5c41bc32-9f042b6f-4f2f7051
1271	compared to the previous radiograph, there is no relevant change . the left internal jugular vein catheter has been removed, the nasogastric tube remains in place . unchanged borderline size of the cardiac silhouette with minimal fluid overload . an area of atelectasis at the left lung bases is constant . there is no evidence of interval appearance of pneumonia . no pneumothorax .	Atelectasis&&Cardiomegaly&&Support Devices	19623993	58826933	3cdc8349-0fc6e527-5c2ba552-1ec32b7b-0e53822f
1272	status post gastrectomy, postoperative widening of the right upper mediastinum with creation of a double contour . unchanged small right pleural effusion with subsequent areas of atelectasis . no recent or acute changes, no edema, no pneumonia . constant size of the cardiac silhouette .	Atelectasis&&Cardiomegaly&&Enlarged Cardiomediastinum&&Pleural Effusion	16848073	59336512	8e086f17-1ab22133-89a28c98-fdd1bab2-fb852083
1273	a right internal jugular venous catheter tip projects within the mid svc . an enteric feeding tube tip is demonstrated in the region of the pylorus . since the prior examination there has been interval worsening of now moderate interstitial pulmonary edema . there are small bilateral pleural effusions . there is left retrocardiac atelectasis . there is no evidence of pneumothorax . the cardiomediastinal and hilar contours are stable, demonstrating moderate cardiomegaly . . interval worsening of now moderate interstitial pulmonary edema . . dobbhoff tube tip is demonstrated in the region of the pylorus and a post-pyloric position cannot be confirmed .	Edema&&Support Devices	19623993	51406657	8213e26d-d00f0c0f-5125e457-8602815c-1ccc2765
1274	ap upright and lateral views of the chest are obtained . midline sternotomy wires, mediastinal clips, and aicd device are unchanged . there is pulmonary vascular congestion and mild pulmonary edema . small bilateral pleural effusions are also noted, new . cardiomediastinal silhouette is stable . no pneumothorax . bony structures are intact . findings compatible with congestive heart failure .	Cardiomegaly&&Edema	15207316	52767831	425d59af-b3a07390-48699ce4-edd9cf7d-3b4faafe
1275	one portable ap semi-erect view of the chest . severe pulmonary edema is unchanged . bilateral pleural effusions are unchanged . moderate cardiomegaly is stable . there is no evidence of pneumothorax . sternotomy wires and mitral valve hardware are in appropriate position . right atrial transvenous pacer lead still passes posteriorly in the right atrium ending at the inferior cavoatrial junction, a nonstandard position . the right ventricular lead is in appropriate position . . unchanged severe pulmonary edema . bilateral pleural effusions are unchanged . . right atrial lead still ends at the inferior cavoatrial junction .	Edema&&Pleural Effusion	18322589	57120453	5cc8a35c-430e95e2-0ece986e-69a22503-cc4bf39e
1276	previous moderate pulmonary edema has nearly resolved, but small bilateral pleural effusions remain . heart is normal size . there is no pneumothorax . patient has had right upper chest wall resection, and presumed radiation accounting for elevation of the right hilus and scarring at the lung apex .	Lung Opacity&&Pleural Effusion	13263843	57452809	2a18ff9e-bcc1e679-a9be811c-4cd490dc-fa3faf63
1277	the patient is rotated with his neck turned to the right . the tip of the tracheostomy tube appears appropriately positioned and unchanged . the configuration of the right subclavian vein and brachiocephalic vein stent appears similar to the prior chest ct with kinking of the stent at the level of the clavicle . the configuration of the left brachiocephalic vein stent is also similar to the prior ct . bilateral right worse than left parenchymal opacities have progressed from the prior radiograph as well as ct, again concerning for multifocal infection andor metastases . a right pleural effusion may be trace . the left pleural effusion may have resolved in the interim . no pneumothorax . the heart is normal in size . mild prominence of the right mediastinum may correspond to the known mild ascending thoracic aortic aneurysm on prior ct . the size of the mediastinum is similar to the prior exam . calcified right mediastinal lymph node is unchanged . catheter projecting over the lower portion of the svc is unchanged . coils projecting over the left upper abdomen are also unchanged . coarse calcifications projecting over the left upper abdomen are unchanged from the prior radiograph in correspond to splenic calcifications on the prior ct . coarse calcifications in the soft tissue of the neck are unchanged from prior ct neck . . interval progression of bilateral, right worse than left parenchymal opacities again concerning for multifocal infection andor metastases . . similar appearance of the mediastinum . . probable small right pleural effusion, new from the prior exam . . position of vascular stents with kinking of the right brachiocephalicaxillary vein stent is similar to the prior chest ct .	Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Pneumonia	19061282	51863042	1c038d27-c6193e6a-d4588595-a78608bd-565e11fa
1278	single frontal portable view of the chest left chest tube has been removed . there is no pneumothorax . right cvl is unchanged . lung findings are stable from the study performed one hour prior .	No Finding	16875792	58566283	f7bbdf2d-8612cba0-b5619cfe-072a43c1-6438f2be
1279	the cardiac, mediastinal and hilar contours appear unchanged . the heart appears mildly enlarged . there is slight unfolding of the thoracic aorta . the lungs appear clear . there are no pleural effusions or pneumothorax . mild relative elevation of the right hemidiaphragm is similar . although this study does not include a dedicated rib series, no fracture is identified . no definite evidence of injury .	No Finding	19623993	57448721	5b9d3fcb-ec593910-a4df74dc-05deda2c-9719c9ea
1280	the right costophrenic angle is not included on the images . again seen is a large area of right mid-to-lower lung opacity which is better assessed on prior ct from . there is a moderate right pleural effusion with overlying atelectasis, an underlying consolidation cannot be excluded . streaky and fibrotic opacities are seen in the right lung involving the upper, mid and lower lung fields, most noted in the left mid lung field, also seen on the prior study . left apical pleural thickening and calcifications are again seen, consistent with chronic change . no large left pleural effusion is seen . there is no pneumothorax . the cardiac and mediastinal silhouettes are stable . multiple old right-sided rib deformitiesfractures are again seen . a left sided vascular stent is again partially imaged . . right costophrenic angle not fully included on the images . given this, large area of right mid-to-lower lung opacity is again seen, likely representing combination of pleural effusion, atelectasis and possible underlying consolidation . increased right perihilar opacity . areas of patchy and fibrotic opacities in the left lung again seen, may be chronic .	Atelectasis&&Consolidation&&Lung Opacity&&Pleural Effusion	13849733	58936335	9db9d5b2-ca959890-19e93b7b-dd184ea9-9bdabe28
1281	the heart is of top normal size with stable cardiomediastinal contours . the lungs are hyperinflated with flattened diaphragms . streaky left lung base opacity is similar to prior and compatible with atelectasis . a trace right pleural effusion is similar to prior . no pneumothorax . sternotomy wires, mediastinal clips, and two valvular prostheses are similar to prior . trace right pleural effusion and left base atelectasis, similar to .	Atelectasis&&Pleural Effusion	18224196	50633646	23a461cb-eb3f1804-b272899e-c6e30098-39682b9c
1282	the patient is status post median sternotomy and cabg . no focal consolidation, pleural effusion, or evidence of pneumothorax is seen . cardiac and mediastinal silhouettes are stable and unremarkable . degenerative changes are seen along the spine . no acute cardiopulmonary process . no evidence of pneumonia . the mediastinum is not widened .	Enlarged Cardiomediastinum	14504940	58521372	4e5ddaa7-63711567-067f2a36-70ca8cbf-3684164e
1283	no definite focal consolidation is seen . there is no pleural effusion or pneumothorax . cardiac and mediastinal silhouettes are grossly stable given differences in technique and inspiration . pulmonary vascular congestion is seen . slight prominence of the left hilum has been seen over several prior studies in likely relates to vascular structures . no definite focal consolidation to suggest pneumonia . pulmonary vascular congestion .	Edema&&Pneumonia	14841168	53366281	3ed3bb4b-239e165f-32a0305f-6e40b696-afdec18d
1284	the monitoring and support devices, including the nasogastric tube, the left internal jugular vein catheter and the right double-lumen catheter, are unchanged . borderline size of the cardiac silhouette . extensive right lower lung opacities, combined to a right pleural effusion . left retrocardiac atelectatic changes, accompanied by a small left pleural effusion . no newly appeared parenchymal opacities . no pneumothorax .	Atelectasis&&Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Support Devices	11880923	58862282	cd611c14-18a02010-13493fd2-e8f3a50a-fc345827
1285	there is improvement of ventilation, as reflected by decrease in extent of the parenchymal opacities . at the lung bases, the opacities, however, are still evident . moderate cardiomegaly, mild fluid overload, no pneumothorax .	Cardiomegaly&&Lung Opacity	12952223	57259586	c23b378d-83c12bd1-41434eef-579d522e-0862b804
1286	an extensive right hilar lung mass is associated with radiation fibrosis, better delineated on ct . an additional component of postobstructive pneumonia may be present . retrocardiac opacity, left pleural effusion, and left plueral thickening are also new . no pneumothorax is present . . large right hilar lung mass and radiation fibrosis . additional post-obstructive pneumonia in the right upper and lower lobes is possible but hard to delineate . . new left retrocardiac opacity, small left effusion, and pleural thickening . findings were discussed with , rn, via telephone at and again with dr at .	Lung Lesion&&Lung Opacity&&Pleural Effusion&&Pleural Other&&Pneumonia	12433541	54729238	7e1f323f-a2ad8df6-c4803950-58e8a9d6-7058b48e
1287	the cardiac size is normal . new density in the retrosternal clear space suggests the presence of an anterior mediastinal lesion, of note in prior ct there were enlarge lymph nodes in this location . the pulmonary vasculature is normal . the lungs are clear . there is no pleural effusion or pneumothorax . basilar atelectasis is noted . several wedge shaped compression fractures are long standing no acute cardiopulmonary abnormality . density in the retrosternal space suggests the presence of an anterior mediastinal lesion . ct is recommended for further evaluation recommendations ct chest notification the findings were discussed by dr . with dr .	No Finding	15659181	53130454	878ffc5b-fbc8c37b-45a5b548-6883c9d4-5fa06364
1288	the lungs are hyperinflated but clear of focal consolidation . there is relative increased lucency in the right upper lung which is similar compared to prior . elsewhere, interstitial markings are somewhat more prominent when compared to prior suggesting pulmonary vascular congestion . there is no focal consolidation suspicious for pneumonia nor pleural effusion . cardiac silhouette is moderately enlarged . median sternotomy wires and mediastinal clips are noted . no acute osseous abnormalities . pulmonary vascular congestion without overt edema or focal consolidation .	Edema	17962324	50545797	c768ecd2-dec91075-b6e6d204-6a9d0da8-e1ce939a
1289	pa and lateral chest radiographs in comparison to the prior study, there has been no significant interval change in the left hilar mass with volume loss and opacification in left upper lobe, which likely represents postobstructive pneumoniacollapse . the right lung is clear . no large pleural effusion or pneumothorax is seen . no significant interval change since the prior study in the extensive left upper lobe consolidation and hilar mass . no large pleural effusions .	Consolidation&&Lung Lesion	18067737	58232231	f33df19b-40b70f49-e2089e24-af20049c-136fb213
1290	the patient is rotated to the right . nevertheless, there is no appreciable cardiomegaly . lungs are grossly clear, and pleural effusions are minimal, if any . caliber of the mediastinum is difficult to assess, however, because of rotation . there could be distention of the azygos and other mediastinal veins . if that determination is important to make regarding the presence of pericardial effusion, then a repeat film should be obtained with careful attention to proper positioning .	Enlarged Cardiomediastinum&&Pleural Effusion	14641474	58836797	29fa67ed-eafe7bd7-b310f744-078a1939-72c2aacb
1291	the et tube tip is approximately cm above the carina . the patient is substantially rotated which precludes assessment of the chest . within those limitations, there is most likely no change in the right pleural effusion, moderate and no evidence of pulmonary edema . the patient is most likely after placement of interatrial septal defect closure device . the left internal jugular line and the right internal jugular line are in appropriate positions .	Pleural Effusion&&Support Devices	11204646	59646951	8bc5adc6-1e5dc4bc-b2fd436a-6c72b0a6-52ffe3c5
1292	upright ap and lateral views of the chest a left subclavian central venous catheter tip terminates in the svc . cardiac, mediastinal and hilar contours are within normal limits, with mild aortic arch calcifications . subsegmental atelectasis is most pronounced in the lung bases . hazy focal opacity is noted at the confluence of the left first anterior rib with the left fifth posterior rib, which appears unchanged, and no discrete nodular opacity was seen on the prior cta of the chest from . no pleural effusion or pneumothorax is seen . there is diffuse demineralization of the osseous structures, with unchanged posterior fusion hardware in the thoracic spine spanning two adjacent compression deformities .	Atelectasis	14353044	56321140	200f5a93-8ca89ca4-c8399b9c-c65fba89-1fb40abc
1293	supine ap view of the chest endotracheal tube tip terminates approximately cm from the carina . a nasogastric tube is seen, with the tip at least to the level of the gastroesophageal junction, and off the inferior borders of the film . cardiac, mediastinal and hilar contours are unchanged, with evidence of mild pulmonary edema and small bilateral layering pleural effusions . no pneumothorax is identified .	Edema&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	13700088	51819517	2b48fff3-ec94225d-0c7dc92c-383e271f-ff7c44bd
1294	the patient is somewhat oblique, limiting the evaluation . however, there is no evidence of pneumothorax . overall, probably little change .	No Finding	11474065	58952033	418536fe-ce5ff76a-25c69892-fa4beedf-88916c53
1295	endotracheal tube tip terminates approximately . cm from the carina . an orogastric tube tip is noted within the distal stomach . lung volumes are low . heart size is normal . mediastinal contours are unremarkable . crowding of the bronchovascular structures is noted, and mild pulmonary vascular congestion is likely present . additionally, more focal somewhat linear opacities within both upper lobes appear to be associated with fibrotic changes . no pleural effusion or pneumothorax is identified, although the right costophrenic angle is excluded from the field of view . diffuse gaseous distention of the bowel loops are noted within the upper abdomen . no acute osseous abnormality seen . surgical anchors are noted projecting over the right shoulder . . standard positions of the endotracheal and orogastric tubes . . focal, somewhat linear opacities within both upper lobes which may be due to a chronic interstitial process . correlation with prior imaging is recommended . aspiration or infection, however, cannot be completely excluded . . mild pulmonary vascular congestion in the setting of low lung volumes .	Edema&&Lung Opacity&&Pneumonia&&Support Devices	10933609	50636786	8452bd2c-ba775d23-e46872fa-f0e9c5bd-63897743
1296	heart size is borderline enlarged but unchanged . mediastinal and hilar contours are normal . pulmonary vasculature is normal . hyperinflation of the lungs with bullous emphysematous changes are again noted in the upper lobes . lungs are clear without focal consolidation . no pleural effusion or pneumothorax is present . pulmonary vasculature is normal . right-sided rib cage deformities are chronic . partially visualized is cervical spinal fusion hardware . no acute cardiopulmonary abnormality . bullous emphysema .	No Finding	19991135	54742755	1b02ffa5-a6da06e3-9063b9ef-5e540245-c18323b5
1297	the chest findings are completely stable, and there is no evidence of new pulmonary parenchymal infiltrates that could represent a pneumonia . heart size is also unchanged, and no evidence of pulmonary vascular congestion or pleural effusion exists . no pneumothorax in the apical area . stable chest findings, no evidence of new acute pulmonary infectious process that could account for unexplained leukocytosis .	No Finding	15192710	56918682	e8bee7e8-3d046a2b-a495f848-e8247e92-8a180494
1298	a new enteric catheter ends either at the gastric antrum or first portion of the duodenum . lung volumes are low, causing exaggeration of the heart size and accentuation of the pulmonary vasculature . the lungs are clear . the heart size is normal . the descending thoracic aorta is slightly tortuous . there are no pleural effusions . no pneumothorax is seen . . no acute cardiac or pulmonary process . . new enteric catheter ends either in the gastric antrum or first portion of the duodenum .	No Finding&&Support Devices	15438386	54350641	76e72399-4ee134f7-c1d4538e-8c0a7451-bacc3a48
1299	right upper and lower lobe opacities are new since the prior day, with indistinctness of the pulmonary vessels, suggesting pulmonary edema . however, concurrent pneumonia cannot be excluded, in the correct clinical setting . the right picc line terminates in the lower svc, and the et tube terminates . cm above the carina . unchanged calcified pulmonary granulomas in the left lung . no pneumothorax . stable cardiomediastinal borders . new right upper and lower lobe opacities with indistinctness of the pulmonary vessels suggests pulmonary edema . however, in the correct clinical setting, concurrent pneumonia cannot be excluded . notification the above findings were communicated via telephone by dr . at on , min after discovery .	Edema&&Lung Opacity&&Pneumonia	12185775	57024984	98bf2cef-0c6a64e5-89934255-e10b6ef7-c38474b7
1300	the dobbhoff tube appears to be in the oropharynx with the tip seen projecting over the mouth floor . pulmonary edema is present . bilateral pleural effusions are noted .	Edema&&Pleural Effusion&&Support Devices	16334516	50030496	569f5628-f5c36d3e-40a91b60-1fe58583-1f997220
1301	the patient has received a nasogastric tube . the course of the tube is unremarkable, the tip of the tube projects over the middle parts of the stomach, the side port is at the level of the gastroesophageal junction . the tube could be advanced by approximately cm . no evidence of complications . the radiograph is otherwise unchanged .	No Finding&&Support Devices	13031876	51040656	8ed93a6c-a257c9c3-b7011ef7-9fd0fc17-8b045b94
1302	the heart size is normal with normal cardiomediastinal contours . there is residual opacity in the left lower lobe, decreased in size since , when it was seen to correspond to a cavitary lesion . there is a persistent vague opacity in the right upper lobe, seen on the previous chest ct, which may represent sequelae of prior infection or persistent inflammation . there is new opacity at the right cardiophrenic angle, which may be atelectasis but could also represent pneumonia in the appropriate clinical setting . the pulmonary vasculature is unremarkable . no pneumothorax or pleural effusion . the osseous structures are normal . there has been interval removal of a picc . no radiopaque foreign bodies are present . . new right cardiophrenic angle opacity, which may represent pneumonia in the appropriate clinical setting . . persistent right upper lobe and improved left lower lobe opacities .	Lung Opacity&&Pneumonia	19748558	51391219	e585ac0f-fc079ecc-ae54b1f8-1121c4b0-52a0b7f0
1303	the lungs are hyperinflatedwell expanded . costochondral calcification is noted . no definite focal consolidation is seen . there is no pleural effusion or pneumothorax . the cardiac and mediastinal silhouettes are stable . no acute cardiopulmonary process .	No Finding	13881772	57977763	c3eeff7f-5128e28a-d1f3fadb-2db97e3e-c47fbc96
1304	clips project over the upper aspect of the abdomen . the dialysis catheter tip sits in the superior right atrium . the heart size is at the upper limits of normal . the mediastinal and hilar contours are within normal limits . perihilar opacities represent pulmonary edema, slightly worse than prior exam . a subtle nodular opacity is present in the left suprahilar region and is new from . blunting of the bilateral costophrenic angle suggests small amount of pleural effusion . . cardiomegaly with worsening pulmonary edema . . subtle left suprahilar nodular opacity may represent a focal area of edema repeat imaging after diuresis may be considered .	Cardiomegaly&&Edema&&Lung Lesion&&Lung Opacity	17340686	58528625	253ff311-29b03520-fb3b41cc-943dee43-7ac172d5
1305	heart size and mediastinum are unremarkable . right picc line tip is at the level of low svc . lungs are essentially clear . there is no pleural effusion or pneumothorax . left upper quadrant surgical clips are redemonstrated, unchanged .	No Finding&&Support Devices	15114531	52411503	a5d43c71-b0543e47-518c2349-26b2fed4-a34fd3bc
1306	the pre-existing opacities at the right lung base have improved . the left lung base is unchanged . overall, the signs indicative of pulmonary edema have slightly decreased in severity but they are still clearly present . unchanged moderate cardiomegaly and left calcified lung granulomas .	Cardiomegaly&&Edema&&Lung Opacity	12185775	53053450	9911ed32-2bf726d7-dfcdceb1-dc248f4e-b62bb269
1307	endotracheal tube is seen with tip within cm of the carina and should be withdrawn . enteric tube is seen with tip at the gastric fundus, side port likely just beyond the ge junction . low lung volumes are seen . surgical chain sutures project over the right mid lung with associated linear opacity, potentially atelectasis . increased opacity at the right perihilar region . median sternotomy wires and mediastinal clips are identified . linear opacity at the left lung base may represent atelectasis . the bones are diffusely osteopenic . endotracheal tube within cm of the carina and should be withdrawn . right mid lung surgical chain sutures with associated linear opacity, potentially atelectasis or scarring . increased density in the right hilar region, for which dedicated pa and lateral suggested when patient is amenable . additional film had been taken at the time of this dictation .	Atelectasis&&Lung Opacity&&Support Devices	16334516	57879373	39291b24-1045b1ed-af35c04e-d467233c-9c0a3be0
1308	there is a new moderate-to-large right-sided pleural effusion with volume loss suggesting extensive coinciding parenchymal atelectasis, substantially increased since the prior studies . there is a persistent patchy left basilar opacity, but with general improvement in aeration of the left lower lobe and resolution of a small left-sided pleural effusion . there is no pneumothorax . a mild interstitial abnormality in each lung suggests mild fluid overload . post-operative changes are noted along the right chest wall including rib deformities, as seen previously . substantial increase in right-sided pleural effusion with volume loss .	Pleural Effusion	13263843	57474634	5a8173dc-ba88a84f-b2bdec60-eb030b78-73682cd4
1309	there are continued multifocal areas of consolidation with abscess formation especially at the right base . monitoring and support devices remain in place .	Consolidation&&Support Devices	13964474	57106816	f0707946-32499bba-77b6424d-f14642eb-587039a5
1310	heart size remains enlarged . hilar contours are unchanged . endotracheal tube, upper enteric tube and left picc remain in unchanged position . widespread multifocal parenchymal opacities remain unchanged from immediate prior study . subtle lobulated lucencies in the right mid lung are suggestive of pneumatoceles . left-sided pleural effusion is improved . there is no pneumothorax . multifocal lung infection persists, with possible pneumatoceles, but with some improvement of left pleural effusion . if clinical improvement is uncertain, ct may be helpful to document changes .	Pleural Effusion&&Pneumonia	16662264	50111035	432f5b8d-dbf9d5f6-b2ae5422-ee46f656-00caa39c
1311	there is no evidence of pneumothorax following unsuccessful cvp attempt . cardiac silhouette is enlarged and there is increased prominence of ill-defined pulmonary vessels, consistent with elevated pulmonary venous pressure . the elevation of the right hemidiaphragmatic contour is more prominent on this examination .	Cardiomegaly&&Enlarged Cardiomediastinum	14841168	55807374	3dd7fadc-472e29be-47a89d67-912975dd-439fad53
1312	the patient was extubated in the meantime interval . heart size and mediastinum are unremarkable but there is interval development of interstitial pulmonary edema, associated with bilateral pleural effusions, small, but appear to be increased since the prior study . the worsening in the right lower lung although most likely associated with edema, can potentially represent interval development of right lower lobe pneumonia . attention to this area on the subsequent radiographs is recommended and if clinical symptoms of pneumonia are present, it should be treated as pneumonia .	Edema&&Pleural Effusion&&Pneumonia	16015751	52795401	75420d75-4f45654a-e63a41a1-da1ad953-680cdde5
1313	there has been mild interval decrease of a still moderate right pleural effusion . there is increased opacification involving the right mid lung zone, likely atelectasis and effusion . there are stable fibrotic changes involving both lungs with left apical scarring compatible with known prior tuberculosis exposure . there are no new focally occurring opacities concerning for pneumonia . there is no evidence of pneumothorax . cardiomediastinal and hilar contours are stable, with the heart size within the upper limits of normal . pulmonary vascularity is not increased . there are multiple healed right rib deformities . status post right-sided thoracentesis with still a moderate layering right pleural effusion . no evidence of pneumothorax .	Pleural Effusion	13849733	58414605	b80c8698-bd19b3ad-2bfa7ec4-e5c4a4ae-ddc9c4f4
1314	upright ap and lateral views of the chest there are low lung volumes . the heart size is normal . the aorta remains slightly tortuous with vascular calcifications noted . there is crowding of the bronchovascular structures, but no overt pulmonary edema is present . patchy opacities in the lower lobes may reflect areas of developing infection or atelectasis . no pleural effusion or pneumothorax is present . there are multilevel degenerative changes of the thoracic spine . multiple clips are again noted within the left axilla . degenerative changes of both acromioclavicular joints are noted . old right-sided rib deformities are visualized . low lung volumes with mild patchy opacities in the lung bases . this could reflect atelectasis, but infection cannot be completely excluded .	Atelectasis&&Lung Opacity&&Pneumonia	18978682	54629839	8c75550e-9aac921d-95015c3f-ac9bc81b-13abd432
1315	a portable ap radiograph of the chest demonstrates resolution of the small right-sided pneumothorax . there is a small layering right-sided pleural effusion which is similar in size to the prior study . the chest tube is unchanged . a small amount of subcutaneous emphysema on the right is unchanged . there is no left-sided effusion or pneumothorax . severe cardiomegaly is unchanged . the hilar and mediastinal contours are normal . there is very mild interstitial pulmonary edema which is slightly decreased from yesterday . . small right pneumothorax has resolved . . small right pleural effusion is stable . . mild interstitial pulmonary edema has minimally improved .	Edema&&Pleural Effusion	16826047	52819811	4f49b2cf-afac9d76-538a44c3-0d040070-15d0571b
1316	loculated fluid right base and chronic fluid in left base . there is probably a small amount of increased fluid over the prior radiograph . there is cardiomegaly and unusually orientated sternal wires probably reflecting sternal dehiscence .	Cardiomegaly	12189285	50770541	f65bb572-2af0f780-91ab57cd-38f9c60e-6f908c45
1317	there is again diffuse bilateral pulmonary opacifications, more prominent on the right . although this could represent severe pulmonary edema, the possibility of supervening pneumonia or even developing ards must be considered . monitoring and support devices remain in place .	Edema&&Lung Opacity&&Pneumonia&&Support Devices	19757720	55489891	5db1ff54-6a22902f-51402f15-27dc7310-21a1183c
1318	the lungs are hyperinflated but clear of consolidation . nodular opacities at the lung bases are compatible with nipple shadows as opposed to pulmonary nodules . cardiac silhouette is unchanged . mitral annular calcifications are again noted . old healed left lower rib fractures are again noted no acute cardiopulmonary process .	No Finding	13881772	50211839	711d6472-5ff3166e-7741ea62-00213982-c3a8a67b
1319	in comparison with the study of earlier in this date, there is little interval change . small left apical pneumothorax persists .	Pneumothorax	19182863	58403484	a90a82d0-03e68c29-c64d2bbe-96653ba7-bb772dd9
1320	right-sided chest tube has been removed . there is a hydropneumothorax in the inferior right chest . the amount of fluid has increased compared to the study from two days prior . the thick irregular pleural disease around the right lung is again visualized . the left lung is clear . cardiac and mediastinal silhouettes are unchanged .	Enlarged Cardiomediastinum&&Pneumothorax	11569093	53825501	aa48f5aa-bc33341a-d09fad73-1b881cf5-ec400de4
1321	ap upright and lateral views the chest provided . cardiomegaly again noted with hilar congestion without overt signs of edema . no large effusion or pneumothorax . no convincing signs of pneumonia . bony structures are intact . mediastinal contour stable . cardiomegaly with mild pulmonary vascular congestion .	Cardiomegaly&&Edema	16050730	57294152	31b932ba-757c9228-940b6753-513b8ecb-705d05b5
1322	a dual-lead left-sided aicd is again seen with leads extending to the expected positions of the right atrium and right ventricle . the right costophrenic angle is not fully included on the image . there are bilateral pleural effusions, which may be at least partially loculated . right upper lobesuprahilar opacity underlying fiducial seed has increased since the prior study, raising concern for progression of malignancy . streaky right infrahilar opacity underlying chain sutures, may relate to chronic changes, although appears to have increased since the prior study . the cardiac and mediastinal silhouettes are stable . . increased nodular opacity in the medial right apexright suprahilar region underlying fiducial seeds, worrisome for progression of malignancy . . bilateral left greater than right pleural effusion, which is likely loculated at least on the left . . right infrahilar streaky opacity may relate to prior surgerychronic changes but more acute component not excluded .	Lung Lesion&&Lung Opacity&&Pleural Effusion	13067703	51807934	d7f19d0e-f85e6043-96b8d9b9-fd64fd5b-7594b0ea
1323	there has been a decrease in density of the perihilar opacities, which may represent a combination of pulmonary edema and pneumonia . no pleural effusions or pneumothorax . the cardiomediastinal contours are stable . decrease in extent and density of the perihilar opacities since . this likely represents a decrease in pulmonary edema with remaining residual opacities likely representing pneumonia .	Edema&&Lung Opacity&&Pneumonia	18309149	52901628	02277520-0c2f2dfc-48595e9d-67e7b3d0-51eb5d78
1324	the lungs are moderately well inflated . there is unchanged mild prominence of lung vasculature without frank pulmonary edema . mild cardiomegaly . no pleural effusions . left upper chest wall pacemaker and pacer wires, right-sided central venous catheter terminating at the cavoatrial junction, sternotomy sutures, bilateral humeral prosthesis, all remain unchanged compared to the prior radiograph . . mild prominence of lung vasculature without pulmonary edema . . no pleural effusion or pneumothorax .	No Finding	19075045	52521827	959366ef-34cddc43-1c3e238c-99503ed8-b5fc863c
1325	the heart is normal in size . the mediastinal and hilar contours appear within normal limits . there is no pleural effusion or pneumothorax . the lungs appear clear . no evidence of acute disease .	No Finding	19748558	51371355	de6f3d70-eadfcea2-4074743a-28118cf6-707e9cfd
1326	in comparison with the study , there is continued substantial increase size of the cardiac silhouette with pulmonary edema that may be minimally better than on the previous study . in the appropriate clinical setting, the possibility of superimposed pneumonia could not be excluded, especially in the absence of a lateral view . central catheter again extends to the mid to lower svc .	Cardiomegaly&&Edema&&Pneumonia&&Support Devices	15131736	54335229	de8ba3a7-575f2651-ec81a20e-b45631f7-2acc972a
1327	there is new almost complete collapse of the left lower lobe . there is no pneumothorax . small right and moderate left pleural effusions are unchanged . cardiomediastinum is shifted towards the left side . left ij catheter tip is in the upper to mid svc .	Atelectasis&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	11607628	52802608	4785f611-3df41361-06251ad6-a56655b1-6b5a088a
1328	opacification at the base of the right lung is due substantially to moderate right pleural effusion present for at least a week, but there is new consolidation at the upper margin of this abnormality concerning for pneumonia, and mild pulmonary edema has developed since . severe cardiomegaly is more pronounced and atelectasis at the left lung base unchanged . small left pleural effusion is presumed . left-sided central venous catheter ends in the mid svc . no pneumothorax . was paged at am . when the findings were recognized and we discussed the findings by telephone a minute later .	Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	14851532	59207607	9f03f488-52d9e9df-006302a9-227c8b18-48e15125
1329	double-lumen left-sided dialysis catheter is seen terminating in the right atrium, stable in position . there is stable enlargement of the cardiac silhouette . the aortic knob remains calcified . there is prominence of the pulmonary vasculature, similar to prior . there may be small bilateral pleural effusions . the lateral view is suboptimal due to patients overlying arm and a posterior lung consolidation is not excluded . no evidence of pneumothorax .	Cardiomegaly&&Consolidation&&Pleural Effusion&&Support Devices	17340686	58351865	f2166859-f4629ed4-014033b5-930fc410-8a9f51c9
1330	the right-sided pleural drain is unchanged in position . the loculated pleural effusion within the right hemithorax are again seen, and appears minimally increased in size . right perihilar mass is better seen on the recent ct . there has been interval increase in mild pulmonary edema . costophrenic angle on the lateral view is blunted, which is new compared to prior study indicating a new left pleural effusion . the cardiomediastinal silhouette is difficult to assess but appears largely unchanged . interval development of mild pulmonary edema and likely increase in size of moderate sized loculated pleural effusion on the right . new small left pleural effusion .	Edema&&Pleural Effusion	16826047	54920051	d2e3dff5-381ea801-b587e5f8-7a35a88a-9c9b66a5
1331	heart size and mediastinum are stable . the right upper lung and left upper lung opacities are better appreciated on the previous examination as well as lower lobe opacities . no evidence of pneumothorax is present .	Cardiomegaly&&Enlarged Cardiomediastinum&&Lung Opacity	16848073	55592328	b0b25621-e94059fd-7edf2e6e-78f2c194-f085dc8c
1332	chronic moderate loculated pleural effusions are essentially unchanged, accompanied by persistent basilar opacification, probably rounded atelectasis . in the remainder of the lungs, in the upper lobes, there are no findings to suggest pneumonia or cardiac decompensation . heart is top normal size, not appreciably changed . fragmentation and misalignment of sternal wires has not progressed since . no pneumothorax .	Atelectasis&&Lung Opacity&&Pleural Effusion	16360107	57086341	e3878a3c-d7eccddd-4784c189-6b006b3b-e58c987a
1333	views of the chest . right picc has been removed . the lungs are well expanded and clear . there is no pleural effusion or pneumothorax . the heart is normal in size with normal mediastinal contours . no acute intrathoracic process .	No Finding	15857729	52057634	0d200bb3-f8564775-b6f65f57-a21dd9b7-d25d90ff
1334	compared with the prior film, inspiratory volumes are lower . a right ij line is present, tip overlying distal svc, new compared with the prior film . left-sided pacemaker is present, with lead tips over the right atrium and right ventricle . prosthetic aortic valve again noted . the cardio mediastinal silhouette, including mild cardiomegaly, is unchanged . there is possible minimal upper zone redistribution . there is bibasilar atelectasis . no frank consolidation or gross effusion identified . incidental note made of partially imaged bilateral shoulder prostheses . as above .	No Finding	19075045	55652630	a4ced79c-68a99c35-e4a2aa15-21423671-0559dedf
1335	pa and lateral views of the chest pain . the lungs are clear . cardiomediastinal silhouette is normal . no acute osseous abnormalities detected . stent is identified in the upper abdomen . no acute cardiopulmonary process .	No Finding	15857729	59698726	91031e5e-6f1e3df2-774ccea8-0e77fbca-e12d0749
1336	cardiomegaly is substantial . replaced mitral valve is in unchanged position . the central venous line and the pacemaker are unchanged, but there is interval progression of interstitial opacities, concerning for interval development of interstitial pulmonary edema . on , approximately five minutes after the findings were made .	Cardiomegaly&&Edema&&Lung Opacity&&Support Devices	19759491	50570852	d38829e5-de299cae-0949b857-f5286934-49f3fde5
1337	a right internal jugular line ends at upper svc, swan-ganz catheter through the left internal jugular approach ends approximately in the main pulmonary artery and endotracheal tube terminating . cm above the carina, all are appropriate in position . two feeding tubes are seen coursing below the diaphragm into the stomach however, their distal end is off the radiograph view . two abdomen drains, one in the right hypochondriac region and other in epigastric region are unchanged in course and position . bilateral lung volumes are low . small right pleural effusion and lower lung atelectasis has improved . increased retrocardiac density obscuring the left hemidiaphragm margins suggesting low lung atelectasis is unchanged . small left pleural effusion is stable . top normal heart size, mediastinal and hilar contours are unchanged .	Atelectasis&&Pleural Effusion&&Support Devices	19623993	56908039	85023ebc-975e666f-4be00ab3-0de8159d-71962698
1338	compared to the previous radiograph, the lung volumes have increased, reflecting improved ventilation . there is minimal atelectasis at both lung bases but no evidence of a focal parenchymal opacity suggesting pneumonia . borderline size of the cardiac silhouette without pulmonary edema . no pleural effusions . no hilar or mediastinal abnormalities .	Atelectasis&&Cardiomegaly	12340737	58757200	6eb24aca-5687f160-c7d0c498-3d8a1abf-05bf0b8c
1339	there is a small apical pneumothorax on the right, there may be minimal residual basilar pneumothorax . extensive subcutaneous gas is seen bilaterally, much more prominent on the left .	Pneumothorax	12736592	59091975	e1e69a8a-e168c0b4-3d6c41a5-108dc21b-9f8205cd
1340	as compared to the previous image, the patient is now in moderate pulmonary edema . no pleural effusions . unchanged cardiomegaly and low lung volumes . unchanged left pectoral pacemaker position . no pneumonia .	Cardiomegaly&&Edema&&Support Devices	13896515	51050206	3eb5d0cd-b53603ab-1055c1ab-0136cead-bd105e22
1341	compared to prior study there is no significant interval change .	No Finding	15131736	53690114	a0cd68a8-1dc96fff-377965f8-4882b5d1-4563578d
1342	ap single view of the chest has been obtained with patient in sitting semi-upright position . comparison is made with the next preceding similar study dated . status post sternotomy and bypass surgery with marked cardiomegaly remains unchanged . unchanged position of permanent pacer in left anterior axillary position, icd device electrode terminating in right ventricle and additional dual right atrial and right ventricular endovascular eletrodes as before . additional thin wire electrode reaching obtuse marginal vein via coronary sinus for lv facing . pulmonary congestive pattern observed on multiple portable chest examinations during the last weeks persist . in comparison with the next preceding image of no significant interval change is identified . no pneumothorax is present .	Cardiomegaly&&Support Devices	15207316	50162885	ffe15776-720f5fb1-efcda596-e36276d8-5e97941e
1343	cardiac silhouette size is normal . the mediastinal and hilar contours are unremarkable . the pulmonary vasculature is not engorged . no focal consolidation, pleural effusion or pneumothorax is detected . elevation of the right hemidiaphragm is unchanged . multiple clips are again noted in the right paramediastinal region . no acute cardiopulmonary abnormality .	No Finding	19907884	57258004	6e2797cc-f1c60fb3-30a651cc-c23cf3d1-b15803bb
1344	no significant change within the airspace opacity at the left mid lung zone . again seen medial right base airspace opacity, unchanged right ij port-a-cath is unchanged in position . sternotomy wires . cardiac valve replacement is noted . heart is enlarged, unchanged . again seen prominent bilateral hilar in haziness the pulmonary vascular consistent pulmonary vascular congestion . this preliminary report was reviewed with dr . , radiologist . no change in the left midlung airspace opacity or in the airspace opacity at the right medial lung base .	Lung Opacity	11022245	52391187	df81aa63-051ce829-f15a7ba0-391d8fb4-f81549e5
1345	rounded right midlung opacity compatible with previously described septic embolus is decreased in size from the prior study . left midlung rounded consolidation is more conspicuous than previously seen . potential etiologies include developing pneumonia, additional septic embolus or collection of fissural fluid, though the lateral argues against the latter . small left pleural effusion is noted along with left greater than right bibasilar atelectasis . marked enlargement of the cardiac silhouette is similar to the study from though notably larger than the immediate post-procedure study from . left picc is in satisfactory position in the superior cavoatrial junction . median sternotomy wires and aortic valve replacement are also noted . . more conspicuous left midlung opacity concerning for developing pneumonia or septic embolus . . improved small left pleural effusion and left greater than right bibasilar atelectasis . findings were discussed by telephone with , np, by dr . on at .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Pneumonia	11022245	53978610	957e4fa0-2b741119-9fb1f79c-62130589-86d6cbed
1346	there is little interval change and no evidence of acute cardiopulmonary disease . no vascular congestion, pleural effusion, or acute focal pneumonia . of incidental note is an azygous fissure, of no clinical significance .	No Finding	19028690	51378502	0a788d46-a00044c9-e0df1484-22595fd9-1b836a06
1347	port-a-cath is unchanged in position with its tip positioned in the expected location of the mid svc . a right pleural drain is in place with increased opacity in the right lung and probable increase in size of the loculated right pleural effusion . findings are concerning for a superimposed consolidationpneumonia . the left lung remains essentially clear . the heart is difficult to assess given the effacement of the right heart border . the prominence of the mediastinum may reflect in part adjacent loculated pleural fluid . no pneumothorax is seen . increased right pleural loculated effusion with chest tube in place . increasing consolidation in the right lung is concerning for pneumonia .	Consolidation&&Pleural Effusion&&Pneumonia&&Support Devices	16826047	58248722	ef34a791-15321a3d-aa9eca93-84157fc9-6fccd907
1348	comparison is made with prior study , . mild cardiomegaly is stable . the aorta is tortuous . left lower lobe opacity has improved, consistent with improving pneumonia . right lower lobe opacity has increased, likely due to increasing atelectasis including a more focal elongated dense small opacity in the right lower lobe medially that has worsened . there is no pneumothorax or pleural effusion . wedge-shaped deformity in a mid thoracic vertebral body is unchanged . improving pneumonia in the left lower lobe . worsening opacity in the right lower lobe which could be due to increasing atelectasis, but developing pneumonia cannot be excluded and followup is recommended .	Atelectasis&&Lung Opacity&&Pneumonia	11213613	50567642	2ae448b2-53515c0d-312135f4-a7a50238-20ffa8b0
1349	one portable ap upright view of the chest . the right apical opacity is stable and concerning for either a nodule or infection . there are low lung volumes which exaggerates the bibasilar atelectasis . anterior fusion hardware is seen . the cardiac, mediastinal and hilar contours are normal . . right apical opacity concerning for either infection or nodule . . other than low lung volumes, no significant change compared to most recent study .	Lung Lesion&&Lung Opacity&&Pneumonia	13031876	57045066	b1286b1b-54d1211b-a25a3203-41c53701-f8ba9413
1350	in comparison with the study of earlier on this date, there is slightly less subcutaneous gas along the right chest wall . little change in the small amount of subcutaneous gas along the left chest wall .	No Finding	17770657	56030465	6e7ba50c-a093a0ce-c9809007-6ffac781-93024486
1351	right upper lobe pneumonia continues to develop . pulmonary edema is clearing . bibasilar consolidation, unchanged since , could be more pneumonia or combination of edema and basal atelectasis . the heart is partially obscured, probably moderately enlarged . small-to-moderate bilateral pleural effusions unchanged . no pneumothorax .	Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Pleural Effusion&&Pneumonia	16508811	58303567	10c8ac36-a2853890-23c30e54-90a676c0-9a66c8eb
1352	manage although there are no prior chest radiographs available for review, this study is read in conjunction with chest ct scans most recently . multiple lung nodules range in diameter up to . cm, left lower lobe . left hilar enlargement conforms to adenopathy . there is no pleural effusion . the heart is mildly enlarged .	Cardiomegaly&&Lung Lesion	14794396	54335521	b9515644-3201e291-84f9839a-308ca0a6-fb3dc5c3
1353	portable ap semi-upright chest radiograph shows decreased degree of inspiration compared to recent prior studies . taking this into consideration, no focal parenchymal consolidation is seen to suggest new pneumonia . the heart and mediastinal structures and bony structures are unremarkable . positioning of right-sided picc line is unchanged .	Pneumonia&&Support Devices	14727722	57592473	40903370-03c46950-d892c4a4-e3e64eb3-250703a9
1354	frontal and lateral chest radiograph demonstrates mildly hypoinflated lungs with bilateral perihilar reticular interstitial opacities consistent with vascular crowding and prominence of interstitial markings bilaterally, similar to previous examination and characterized as interstitial lung disease on ct chest dated . no pleural effusion or pneumothorax . no new focal opacity . abnormal contour or of the right hemidiaphragm is stable since . the cardiomediastinal silhouette is stable . limited study of the upper abdomen is unremarkable and visualized osseous structures are notable for diffuse osteopenia and a chronic healed left mid clavicular fracture . kyphosis is again noted with multiple thoracic compression fractures, unchanged from previous examination . stable prominence of interstitial markings bilaterally consistent with interstitial lung disease, best assessed on ct chest dated . no evidence of pneumonia .	Lung Opacity	13475033	59915934	4584e73d-af69492e-8ad8e520-97439184-5c788f58
1355	when compared to prior, there has been no significant interval change . lungs are grossly clear . there is no large effusion or edema . cardiomediastinal silhouette is within normal limits . rightward deviation of the trachea at the thoracic inlet is compatible with known underlying left-sided thyroid enlargement . surgical clips seen projecting over the thoracic inlet . left chest wall dual lumen central venous catheter is now seen . multiple vascular stents project over the left upper extremity and mediastinum . severe degenerative changes noted at the shoulders bilaterally . old healed right posterior rib fractures are also noted . no acute cardiopulmonary process .	No Finding	14236258	59438963	099dc924-692466a3-cd889469-1d9dee6c-3a61f779
1356	there is interval placement of a left internal jugular catheter with tip terminating in the upper svc . there is no pneumothorax . cardiomediastinal and hilar silhouettes are stable . there is stable scarring or atelectasis at the left lung base as well as calcifications at the costochondral junction . the lungs are otherwise clear . new left ij catheter with tip in the upper svc, no pneumothorax .	No Finding&&Support Devices	18224196	55108041	d504dbe8-1c4f781c-0df439c0-f9d111e3-383d8361
1357	the lungs are well expanded and clear . coarsened interstitial markings are unchanged . cardiomediastinal silhouette is slightly enlarged but unchanged from prior exam . there is no pneumothorax or pleural effusion . an old fracture of the left clavicle is noted . no acute cardiopulmonary process . unchanged cardiomediastinal silhouette .	Enlarged Cardiomediastinum	13475033	53358228	10c89fd8-d213373d-7803e8df-fe8a4a8d-2d9a9503
1358	on the prior study, there was a femoral swan-ganz catheter that is no longer visualized . it is off the film . it has likely been pulled back . left ij line tip is in the svc . cardiac pacer with wires is again visualized . et tube is unchanged . bilateral pleural effusions have increased in size compared to the prior study . the heart size is moderately enlarged and is larger than on the prior exam . there is pulmonary vascular redistribution with perihilar haze . the overall impression is that of worsening chf .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	10886362	56034024	fdd8adcf-96e61323-ef98915c-c91ab8b9-7bf45f5e
1359	a portable supine frontal chest radiograph demonstrates a right internal jugular catheter, which now terminates in the low svc . lung volumes remain low, without definite focal consolidation, pleural effusion, or pneumothorax . repositioned right internal jugular catheter, which now terminates in the low svc .	No Finding&&Support Devices	19907884	57885384	838d96da-8d9d8d8d-2aacafdf-9f280c96-573b74db
1360	comparison is made to previous study from five hours earlier . bilateral pleural effusions are again seen, right side worse than left . there is cardiomegaly . there is mild-to-moderate pulmonary edema with prominence of pulmonary interstitial markings . there is a right ij catheter with distal lead tip in the right atrium . this could be pulled back cm for more optimal placement . there is calcification adjacent to the soft tissues of the right shoulder which can be seen with calcific tendinitis or tumoral calcinosis .	Cardiomegaly&&Edema&&Lung Lesion&&Lung Opacity&&Pleural Effusion&&Support Devices	12952223	50802157	ceeb934a-c305e7cc-8fb84dc9-13a7b24c-ef709a44
1361	the inspiratory lung volumes are appropriate . there is improved pulmonary vascular engorgement since the prior study of and no pulmonary edema . the lungs are clear without pleural effusion, focal consolidation or pneumothorax . the cardiac silhouette is normal in size . the mediastinal and hilar contours are unchanged with persistent prominence of the azygos vein . no acute cardiopulmonary process . improved pulmonary vascular engorgement since .	No Finding	19623993	54507407	a839e43c-1d7f9788-1f4d11ef-8bf9c279-74ebcc3f
1362	there has been placement of a new right-sided subclavian central line with the distal lead tip in the right atrium . heart size is enlarged but stable . there are moderate bilateral pleural effusions . the right-sided appears partially loculated . bibasilar opacities are also seen and unchanged . there is mild pulmonary edema .	Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	16360107	56101582	c1580ec9-32506bce-3fcc607e-df23d243-031e5cb4
1363	no evidence of pulmonary edema or other acute lung changes . no pneumothorax . no pleural effusions . normal size of the cardiac silhouette . normal hilar and mediastinal contours .	No Finding	19800337	56050160	00c3905c-c62bcac5-af952060-8b2bd330-cc4848ac
1364	the pre-existing mild pulmonary edema has increased in severity and is now moderate . this is reflected by increased vascular diameters and left predominant perihilar haze . no pleural effusions . no focal parenchymal opacity suggesting pneumonia . the areas of left basal atelectasis are constant in appearance .	Atelectasis&&Edema&&Pneumonia	18615099	53498293	93f5ae76-d350d7b5-e47e23fd-d455db66-00627ccc
1365	there are increased interstitial markings bilaterally not significantly changed from , but no focal opacities . heart size is top normal . the aorta is tortuous . there is no pleural effusion or pneumothorax . sternotomy wires as well as mediastinal surgical clips from prior cabg are re-demonstrated and unchanged in position . diffuse increased interstitial markings are compatible with minimal interstitial edema . no focal opacities concerning for pneumonia .	Edema&&Lung Opacity&&Pneumonia	16957952	59610928	b5d3da06-fd20e016-8b1924e1-3ff9ceed-fb365036
1366	portable ap upright chest radiograph is obtained . lung volumes are low . there is mild ground-glass opacity involving both lungs concerning for pulmonary edema . no large pleural effusions are seen, though trace effusions are likely present . heart size appears top normal . no pneumothorax . bones appear intact . pulmonary edema, likely with trace pleural effusions .	Edema&&Pleural Effusion	16855430	54733030	d240a096-eb1996ea-8a08a168-367aa57b-96adf6ad
1367	no definite proof of pneumonia . unchanged borderline size of the cardiac silhouette without evidence of overt pulmonary edema . minimal atelectasis at the left lung base and minimal bilateral pleural effusions restricted to the dorsal costophrenic sinuses, better appreciated on the lateral than on the frontal radiograph . known skeletal changes .	Atelectasis&&Cardiomegaly&&Pleural Effusion	19765968	50775929	b4e5e6d9-372dda3f-636a7faa-cac88b07-a21496fe
1368	bibasilar atelectasis is mild . no pleural effusion or pneumothorax . moderate cardiomegaly, severe pulmonary artery dilatation and moderate pulmonary vascular congestion are similar . mild basilar atelectasis . chronic moderate cardiomegaly and probable pulmonary hypertension . recurrent cardiac decompensation .	Atelectasis&&Cardiomegaly	19454978	50810335	b52282c3-1c808e3a-7ffee928-83083ac2-8cff0c2d
1369	pa and lateral chest radiograph a large right and a moderate-sized left pleural effusion, have increased since the prior study . consolidation has worsened at both lung bases, concerning for pneumonia, particularly on the right . mild pulmonary edema is new . moderate to severe cardiomegaly is unchanged . there is no pneumothorax .	Cardiomegaly&&Consolidation&&Edema&&Pleural Effusion&&Pneumonia	18224196	56822629	ccd9df65-03a33fd6-372e070c-1b36c943-a18d8378
1370	new feeding tube, without a wire stylet, ends in the mid esophagus just below the level of the carina . moderate-to-large right pleural effusion is probably increased in volume, but comparison is difficult because patient is supine on this study, erect on the earlier study today . consolidation at both lung bases is probably due to worsening atelectasis but of course pneumonia and large scale aspiration are not excluded . patient is rotated to her left which distorts the cardiac silhouette, probably mildly enlarged but unchanged . the left rib fractures are in various stages of healing . thoracic aorta is tortuous and heavily calcified . no pneumothorax . i discussed these findings by telephone at the time of dictation .	Atelectasis&&Cardiomegaly&&Consolidation&&Fracture&&Pleural Effusion&&Pneumonia&&Support Devices	11934114	50921864	07b49600-045da45b-0a9a9c85-40312bf9-29eb90ba
1371	the extent of substantial patient or respiratory motion greatly degrades the image, making it very difficult to adequately assess the pulmonary vascularity and the lungs . a repeat study is recommended .	No Finding	14841168	51745439	f66fce26-7c002d5f-2c12f63f-8dd12c3a-92ec73bf
1372	increased retrocardiac density and the left lower lung opacity, which likely represents a combination of atelectasis andor consolidation has minimally worsened since . on single frontal view, if any of this represents infection cannot be ruled out and needs further clinical correlation . right lung is clear . a right internal jugular line sheath ends at upper svc . heart size is mild-to-moderately enlarged and unchanged . mediastinal and hilar contours are unremarkable .	Atelectasis&&Cardiomegaly&&Consolidation&&Lung Opacity&&Pneumonia&&Support Devices	19565388	58520961	49d5c433-1f63df75-aa22694c-c8e8079d-d23cdaa9
1373	there has been interval removal of the right-sided port-a-cath . the heart size is within normal limits as well as the mediastinal contours . there is no evidence of pneumomediastinum . there is no pneumothorax . mild bibasilar atelectasis is present with a small right pleural effusion . . no evidence of pneumomediastinum or pneumothorax . . mild bibasilar atelectasis with small right pleural effusion .	Atelectasis&&Pleural Effusion	19016834	56061315	0ac2b288-52510797-df0a6b75-70a649b5-d526e4dd
1374	there are faint bibasilar opacities with possible bronchial wall thickening which are nonspecific but similar to that seen on . these findings are in the same distribution as seen previously on . otherwise, cardiac silhouette is within normal limits . the aorta is unremarkable . osseous structures demonstrate degenerative changes of bilateral glenohumeral joints . bibasilar faint opacities and bronchial wall thickening . these findings are nonspecific and may be seen with bronchiectasis, an infectious process, or bronchiolitis obliterans as previously noted . further evaluation may be obtained with ct if necessary . these findings were discussed by dr . with dr . telephone at pm .	Lung Opacity&&Pneumonia	15192710	55395733	fb97dc99-52ef2345-cca09851-57c3d33d-c0fcf34c
1375	comparison is made with prior study performed five hours earlier . cardiac size is top normal . there is no pneumothorax or pleural effusion . diffuse bilateral lung opacities have minimally improved in the right upper lobe . there are no other interval changes .	Lung Opacity	14081759	52995335	b3281e41-ce38300f-dce229b7-74d8e99e-aac1c9c5
1376	comparison to prior study, at . a single portable erect chest film, at am . . a feeding tube is seen coursing below the diaphragm with the tip not definitively identified on this examination . . there is a right-sided loculated pleural opacity, which most likely represents loculated fluid and does not appear to be significantly changed . there is volume loss with shift of the mediastinum to the right and aeration of only a portion of the right lung . a more focal oval consolidation in the left upper-to-mid lung is also seen suggestive of pneumonia, but is not significantly changed . more patchy opacity at the left base may reflect other areas of pneumonia or patchy atelectasis . no pneumothorax . no evidence of pulmonary edema . overall cardiac and mediastinal contours are likely stable given differences in positioning .	Atelectasis&&Consolidation&&Enlarged Cardiomediastinum&&Lung Opacity&&Pneumonia&&Support Devices	14387068	57293911	a3dbcc01-a336ba92-1a8702d2-124e81f5-6a525305
1377	moderate right pleural effusion is reaccumulating after apparent removal of the right pigtail pleural drain, while displacement of the right hemidiaphragm downwards and the mediastinum leftwards suggest increasing positive pressure in the right hemithorax . left lung is over-perfused and now mildly edematous . was paged, covered by , at the time of dictation .	Edema&&Enlarged Cardiomediastinum&&Pleural Effusion	14387068	56469870	92666ac1-70ccc2f3-66bc3d47-ed08bd0e-d444a359
1378	comparison is made to the previous study from . there is a very tiny right apical pneumothorax following removal of the right-sided chest tube . there is persistent elevation of the right hemidiaphragm with atelectasis at the right lung base and a right-sided pleural effusion . a rounded opacity is seen in the right suprahilar region and is stable . the left lung is relatively clear aside from atelectasis at the left lung base and a small left-sided pleural effusion .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Pneumothorax	13352405	57908576	833af053-d28a9f68-f624c5c0-dae1203f-3952d8a4
1379	low lung volumes with bilateral pleural effusions and relatively extensive areas of bilateral basal atelectasis . mild fluid overload might be present . no newly appeared focal parenchymal opacities . the right internal jugular vein catheter and the sternal wires are in constant position .	Atelectasis&&Pleural Effusion&&Support Devices	12952223	57876776	26d9c6a6-23aadec2-4f13a9f7-d2bfdb99-ba5c03ff
1380	lung volumes are low . no new focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is seen . peripheral opacity in the left lung base appears improved from the prior study, and may represent residual atelectasis with scarring . heart and mediastinal contours are stable with unchanged calcified aorticopulmonary window lymph node compatible with prior granulomatous disease . right-sided port-a-cath is similarly positioned . sternal wires appear intact on these views . the patient is status post cabg . no radiographic evidence for acute cardiopulmonary process .	No Finding	11413236	55277653	aef6ded2-a74cef0f-acdbb6d6-a96e3909-9fc8c2e9
1381	the ng tube extends inferiorly beyond the diaphragm into the fundus of the stomach . again seen is moderate cardiomegaly . the pulmonary vascular congestion is stable . there are no new focal consolidations . the fissural loculation of pleural fluid along the left chest wall has not changed compared to the prior exam . there is no pneumothorax . ng tube extends below the diaphragm into the fundus of the stomach .	No Finding&&Support Devices	18906643	58406467	ef578547-4e4219db-c1753821-922ec956-1d6e6770
1382	new heterogeneous opacity of the left lower lung is consistent with left lower lobe pneumonia . right lung volume loss status post thoracotomy is similar to prior exam . chain sutures overlying the lateral right lung and right hilum, and scarring of the right lung base are unchanged . heart size and cardiomediastinal contours are stable . . left lower lobe pneumonia . . stable changes status post right thoracotomy with right upper lobe lobectomy and apical radiation fibrosis .	Pleural Other&&Pneumonia	13263843	55413705	41bee34e-e9476a64-f28f2775-7d097a58-d88789f6
1383	the monitoring and support devices are constant in position . the pre-existing right basal opacity, with maximum in the infrahilar area, is not substantially changed . on the left, there is decreased visibility of the left hemidiaphragm, suggesting the appearance of either atelectasis or small left pleural effusion . unchanged moderate cardiomegaly . the right costophrenic sinus is unremarkable .	Atelectasis&&Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Support Devices	10268877	57873452	f8e1f272-c87c4a00-60025a33-09d9a7ea-c1125ac6
1384	interval placement of icd pacing device, with icd lead in the right ventricle, additional leads overlying the expected location of the right atrium and a lead for biventricular pacing . pa and lateral chest radiographs would be helpful to confirm appropriate lead positioning when the patients condition allows . there is no evidence of pneumothorax . cardiomegaly is accompanied by pulmonary vascular congestion and apparent asymmetrical pattern of pulmonary edema, left greater than right . moderate left pleural effusion is also demonstrated . this may be reevaluated at the time of standard pa and lateral chest exam .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	13896515	50464024	bacfc58a-88a0d80f-0f80cf67-aaf650c5-90e661d7
1385	lung volume has increased, with reduced opacification of the right lung base, probably for reduced atelectasis . there are no consolidations suspicious for pneumonia . heart size is still enlarged with mild enlargement of vascular pedicle, normal post-cardiac surgery findings . there is mild vascular congestion . metallic clips are inline and intact . right pectoral pacemaker has two leads following their expected courses and ending in the right atrium and right ventricle . there is no pneumothorax or pleural effusion . patient has had avr .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pneumonia&&Support Devices	19075045	51128200	3d369d5e-63a6e5b5-2da13aad-a02c9aa2-42d8e9fd
1386	small region of opacification in the left mid lung could be atelectasis or early pneumonia . lungs are otherwise clear . there is no pleural effusion . heart size is probably top normal, but difficult to assess given severe chest cage deformity by virtue of scoliosis . right pic line ends in the mid svc and a nasogastric tube passes below the diaphragm and out of view . no pneumothorax .	Atelectasis&&Lung Opacity&&Pneumonia&&Support Devices	18110020	53051689	98137eef-20e5fe78-d9065728-7b29c856-f6a77003
1387	left picc is unchanged in position compared to the prior radiograph . it enters via a left-sided approach, and makes a vertical descent at the level of the aortic arch, in keeping with known left-sided superior vena cava . the tip of the catheter continues to terminate just above the level of the diaphragm to the left of midline, and could be withdrawn approximately cm to ensure positioning within the lower left superior vena cava . cardiomediastinal contours are stable in appearance . moderate right pleural effusion with subpulmonic component has slightly increased in size . adjacent area of opacity within the right middle and lower lobe has also slightly worsened .	Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Support Devices	19182863	59847128	22353454-97e7e0d1-d2711b39-b8159585-512d3c23
1388	ap view of the chest . right picc is seen with tip at the upper svc . relatively low lung volumes are seen . the lungs however remain clear without consolidation, effusion or pulmonary vascular congestion . cardiac silhouette appears moderately enlarged, likely accentuated due to low lung volumes and ap technique . right picc in the upper svc .	No Finding&&Support Devices	15857729	58732756	c536f749-2326f755-6a65f28f-469affd2-26392ce9
1389	lungs are fully expanded and aside from a small linear band of atelectasis or scarring in the left lower lobe, essentially clear . effacement of the aortopulmonic window is a long-standing feature, not clinically significant . cardiomediastinal and hilar silhouettes are otherwise normal . there is no pleural abnormality .	Atelectasis&&Lung Opacity	11924226	53372149	7e445e5a-27e30425-98d438f2-9619da9c-e53b8453
1390	there is little change since . a right subclavian approach port tip remains in the lower svc . two chest tubes overlie the right base with lucency demonstrated about one, which may represent a small basilar pneumothorax . there is a moderate right pleural effusion with pleural fluid demonstrated layering along the apex and also demonstrated along medially adjacent to the mediastinum . there is persistent asymmetric opacification with increased asymmetric pulmonary vascularity involving the right lung . there is moderate right lower lobe atelectasis and minimal left basilar atelectasis . there is no evidence of pneumothorax . the cardiomediastinal and hilar contours are stable . a calcified lymph node is demonstrated in the region of the aortopulmonary window, stable since . evaluation of her heart size is limited in the setting of diffuse right-sided central opacification . no significant change since . a moderate right pleural effusion and asymmetric opacification involving the right hemithorax is likely related to progressive changes related to her known disease processand or a component of asymmetric edema .	Edema&&Lung Opacity&&Pleural Effusion	14969719	59937017	ea9b867c-c8a2b175-f813e34d-9ae7229d-23ab7c24
1391	new, small region of peribronchial opacification in the left lung just superior and lateral to the left hilus, could be early pneumonia . lungs elsewhere are clear . cardiomediastinal and hilar silhouettes and pleural surfaces are normal .	Lung Opacity&&Pneumonia	15114531	59791814	31639564-55c66aa7-7df2435c-cd3f159f-35b723f1
1392	a portable frontal chest radiograph demonstrate an unchanged cardiomediastinal silhouette, which is top-normal in size . bilateral opacities are consistent with moderate pulmonary edema . no definite focal consolidation or pneumothorax is identified . there are likely trace bilateral pleural effusions . moderate pulmonary edema .	Edema	18767957	50744964	1ef64d55-b80da23e-67810283-ad56b0ab-22c83b5b
1393	right internal jugular line terminates at the junction of the brachiocephalic trunk and left port-a-catheter ends at lower svccavoatrial junction . mild-to-moderate left and minimal right pleural effusion associated with lower lung atelectasis are unchanged since . mild pulmonary congestion is similar . heart size is normal . mediastinal and hilar contours are unchanged .	Atelectasis&&Edema&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	15758946	59924609	f92f8eca-d4526790-a1842ee9-1c5b4666-a0e18256
1394	left-sided port-a-catheter is similar in position, terminating at the cavoatrialright atrial junction . patient has diffuse increase in interstitial markings bilaterally consistent with patients underlying history of chronic interstitial lung disease with likely overlying pulmonary edema improved since , but similar in appearance as compared to . no definite focal consolidation or pleural effusion . multilevel vertebroplasties are seen along the thoracic spine, similar to prior . pulmonary edema superimposed on known lung fibrosis .	Edema&&Pleural Other	10439781	55811525	3ea6406a-214fd5a4-1e6e4b0e-195445b8-1ea913b3
1395	the monitoring and support devices are unchanged . lung volumes have decreased . a pre-existing small left pleural effusion has increased in extent . the low lung volumes contribute to crowding of the vascular and bronchial structures at the lung bases . slight patient rotation to the left also emphasizes the extent of the pre-existing left parenchymal opacity . the sternal wires are of unchanged alignment .	Lung Opacity&&Pleural Effusion&&Support Devices	16334516	50913309	f1939ee3-c5f53319-6a12cc79-3a32f440-2cec4540
1396	pa and lateral chest views have been obtained with patient in upright position . the heart size is unchanged and remains within normal limits . the thoracic aorta and mediastinal structures are unremarkable . the pulmonary vasculature is not congested . on previous examinations identified multifocal parenchymal infiltrates have further undergone marked regression . there remain, however, some mostly linear densities in the areas of the previous infiltrates in the right middle lobe and left lingular area . no new acute abnormalities are seen, no pleural effusion is identified nor is there any pneumothorax in the apical area . further improvement of previously identified multifocal pneumonic infiltrates . as there persist a few remnants further followup is recommended to ascertain stability .	Lung Opacity	16662264	54504950	d3b0d36d-5201ca16-3476454c-0e031e78-004217a2
1397	there is mild hyperexpansion likely due to underlying obstructive lung disease . minimal left base atelectasis is evident . no focal consolidation or superimposed edema is noted . mediastinum is unremarkable . the cardiac silhouette is within normal limits for size . no effusion or pneumothorax is noted . degenerative changes are seen throughout the thoracic spine and in bilateral shoulders . clips are evident posteriorly in the medial left upper quadrant . likely underlying obstructive lung disease . no superimposed acute process identified .	No Finding	15338518	58005336	c9411698-f64564b3-5ea07940-87d583ad-154d647b
1398	comparison to at . a single portable supine chest film at am . marked thoracolumbar scoliosis which markedly distorts the appearance of the thoracic cavity . however, given differences in positioning between studies, the lungs remain clear . no pulmonary edema or pleural effusions are appreciated . overall, cardiac size is stable . scattered air is seen in nondistended loops of bowel .	Cardiomegaly	18110020	57746739	5f26481a-d3858281-c46fc79d-2f850d48-53f84f5d
1399	the heart size remains unchanged and is within normal limits . unremarkable position of previously described left-sided picc line terminating in mid portion of svc . the pulmonary vasculature is not congested and no pneumothorax can be identified . on previous examinations remaining multifocal density have generally improved . in particular, a lesion identified on the last examination overlying the right upper lobe area laterally third right intercostal space has cleared up almost completely . densities located in the right middle lobe as well as those seen in the left upper lobe lingula persist, but have also undergone a slight improvement . again, no pneumothorax has developed, no new infiltrates are seen and the lateral and posterior pleural sinuses remain free from any pleural effusion . improvement of multifocal infiltrates but persistent densities in right middle lobe and peripheral lingula . further followup examination must be guided by patients symptomatology .	Lung Opacity	16662264	57219522	c190fb7d-da5b3a51-5f074369-736f62a6-589d6474
1400	there is little change in the monitoring and support devices including a persistent left superior vena cava . heart and lungs are essentially unchanged . no reaccumulation of left effusion or pneumothorax .	No Finding&&Support Devices	19182863	57188350	334a4b19-e795f613-8d2902bb-9395ee99-28f4cf54
1401	there is unchanged alignment of the sternal wires . the valvular replacement is unchanged . unchanged lung volumes with, however, improved transparency at the lung bases and reduction in extent of the pre-existing interstitial opacities . in the lung apices however, signs of minimal basal apical blood flow redistribution remain present . unchanged borderline size of the cardiac silhouette . minimal dorsal pleural effusions, seen on the lateral radiograph only .	Cardiomegaly&&Lung Opacity&&Pleural Effusion	19182863	51148398	0346b4e3-a2e79a1e-8ec8970d-712bb522-84ed88dc
1402	portable ap chest radiograph is obtained with patient in the upright position . cardiomediastinal contours are stable . on the left, there are unchanged areas of basal atelectasis and a moderate left pleural effusion that is unchanged . there is improvement in the pulmonary edema with persistence of mid right lung hazy opacification laterally, possibly suggesting consolidation in this region . as edema apperas to be improving, persistent right opacification is concerning for consolidation and pneumonia should be considered in the appropriate clinical context .	Consolidation&&Edema&&Lung Opacity&&Pneumonia	12074041	53353190	172a847d-d8c6570a-3cb0cff9-cb4ca0bd-3a8b93f1
1403	a single portable ap semi-upright view of the chest was obtained . right ij central venous catheter projects over the right atrium . an icd pacing device with biventricular leads appears unchanged in position . lung volumes remain low with right basilar atelectasis . cardiomediastinal silhouette is stable . there is no focal consolidation or pleural effusion . no pneumothorax . . interval placement of a right ij catheter with tip in the right atrium, consider pulling back by cm for optimal placement . . otherwise, no substantial changes compared to the prior examination .	No Finding&&Support Devices	12595991	59808558	d06735eb-af56afba-fcf0d03b-004b6c6c-93909724
1404	there is progressive decrease in the opacification at the bases, consistent with the clinical diagnosis of resolving pneumonia . however, there is still some opacification especially at the left base and overlying the cardiac silhouette . this is consistent with a lingular consolidation .	Cardiomegaly&&Consolidation&&Lung Opacity&&Pneumonia	16662264	56513752	4dc103db-597e938a-f6b0373d-e7703fa2-94e9efdd
1405	the tip of the endotracheal tube is cm above the carina . this could be pulled back cm for more optimal placement . the right-sided central line has the distal lead tip in the cavoatrial junction, stable . the right ij central line has the distal lead tip in the mid svc . it is pulled back slightly it is now oblique to the svc wall . there are again seen bilateral pleural effusions and left retrocardiac opacity . there is likely an unchanged element of mild fluid overload, stable . the nasogastric tube side port is again at the ge junction .	Lung Opacity&&Pleural Effusion&&Support Devices	11880923	51876627	237483cb-a677cdd0-002483d2-76d60cbd-57b82bb8
1406	the monitoring and support devices remain unchanged . there appears to be some increasing haziness of the right hemithorax, which would be consistent with some increasing pleural effusion . however, this is difficult to assess since it could reflect changes in patient position . the pulmonary vessels appear more engorged than on the previous study and there continues to be substantial enlargement of the cardiac silhouette .	Cardiomegaly&&Pleural Effusion&&Support Devices	18460230	53631792	369dc5bd-70bd89d0-2d90fa80-f319ec1d-fb2802aa
1407	comparison multiple chest radiographs from back to . pa and lateral views of the chest the right loculated pleural effusion has decreased in size from . there is a little to no remaining effusion on the left and there has been interval resolution of the mild interstitial pulmonary edema . there are no focal consolidations to suggest active infectious process . there is no pneumothorax . the hilar and cardiomediastinal contours are normal . the hemidiaphragms are flattened and the ap diameter is increased . . no evidence of pneumothorax or other procedural complication . . smaller right loculated effusion . . resolution of mild interstitial pulmonary edema . . stable radiographic evidence of copd .	Pleural Effusion	19016834	56630223	d915fd90-d34450bb-ed88704e-ead739d2-470fa99f
1408	ap and lateral views of the chest demonstrates unchanged cardiomegaly . the patient is area of rounded atelectasis in the left mid lobe appears to have somewhat resolved . no focal opacities concerning for infection . left lower lobe atelectasis is present . no pleural effusion or pneumothorax . there is possible minimal increased left lung hazy opacity which could be due to edema . possible mild edema .	Edema	15809646	57526648	eb48e944-d1f04023-e3dc8926-7ddd1131-a91ef09a
1409	a new right picc line has been inserted . the tip projects over the mid svc . the course is unremarkable . there is no evidence of complication, notably no pneumothorax . otherwise, the radiograph is unchanged .	No Finding&&Support Devices	19075045	53961269	8183f090-2b6765ef-92984c04-0bd04826-f32d16dd
1410	et tube tip is . cm above the carina . ng tube tip is in the stomach . left central venous line tip is at the level of mid svc . heart size and mediastinum are enlarged . pulmonary edema has substantially improved since the prior study .	Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Support Devices	12185775	50729749	42ca390f-5819f578-c74fd59e-a7561a1a-0040b454
1411	a right internal jugular approach central venous catheter tip projects within the mid svc . a left internal jugular approach swan-ganz catheter tip is within the main pulmonary artery . an endotracheal tube is . cm above the carina . enteric feeding tube courses below the diaphragm . a right basilar chest tube is in stable position . interstitial pulmonary edema is improved, with remaining mild pulmonary vascular congestion . there is bibasilar opacification, likely atelectasis with low lung volumes . there are no new focal opacities concerning for pneumonia . there are no pleural effusions or pneumothorax . the cardiomediastinal and hilar contours are stable . there is moderate cardiomegaly . improvement in interstitial edema with otherwise no significant change .	Edema	19623993	54937394	27dd77c0-a8c3f1a1-f33fb0c9-928377b3-b5ae13f7
1412	there are no prior studies available for comparison . there is moderate cardiomegaly . there is tortuosity of the aortic arch and is most likely dilated . there is no pneumothorax or pleural effusion . there is mild vascular congestion . right lower lobe opacities are likely atelectasis . several old left rib fractures are noted . . likely aortic aneurysm, when clinically feasible, ct with contrast is recommended . . mild vascular congestion . . right lower lobe atelectasis . . cardiomegaly . findings were discussed with by phone at pm on .	Atelectasis&&Cardiomegaly&&Edema	17168993	50844004	f247ce2e-c31bcf04-9a2b6df8-40d590b5-a96518b7
1413	there is continued enlargement of the cardiac silhouette with congestive failure . poor definition of the hemidiaphragms is consistent with bilateral pleural effusion and compressive atelectasis . there is an area of more coalescent opacification in the right upper zone that is asymmetric with the opposite side . in the appropriate clinical setting, this could well represent a developing focus of pneumonia .	Atelectasis&&Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Pneumonia	16508811	57231469	2d1e6273-8e13a27a-10e404d2-b5ff44ae-03ad30ce
1414	a left ij swan-ganz catheter is present, tip overlying the distal right pulmonary artery . clinical correlation is requested, as this lies relatively distal . allowing for considerable differences in technique, the cardiomediastinal silhouette is unchanged . upper zone re-distribution and mild vascular plethora is similar . moderate-sized right effusion, with underlying collapse or consolidation at the right base, and increased retrocardiac density consistent with lower lobe collapse andor consolidation are essentially unchanged . extreme left costophrenic angle is excluded from the film, but no gross effusion is identified . no pneumothorax detected .	Atelectasis&&Consolidation&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	12847817	57961005	e5016e53-efcd5086-45dab98d-ead14337-5b2b24b4
1415	compared with earlier the same day , there is somewhat improved aeration in the left lung . a dense opacity previously seen in the left mid and upper zones now shows partial aeration with residual patchy opacity . the left hemidiaphragm is likely still elevated . no definite pneumothorax is identified . subcutaneous emphysema again noted . left chest tube is present, unchanged . aside from some atelectasis at the right base and possible minimal blunting of the right costophrenic angle, the right lung remains grossly clear . mediastinum remains midline . the tracheal contour is grossly unchanged .	No Finding	12530259	54186218	fbad1142-d5b71f5c-b7c34de3-9e985bf2-02239890
1416	there is little change in the appearance of the mediastinum with no evidence of post-procedure pneumomediastinum or pneumothorax . there is some indistinctness of pulmonary markings at the right base, raising the possibility of some elevated pulmonary venous pressure . blunting of the costophrenic angles is seen bilaterally .	Edema&&Enlarged Cardiomediastinum	16848073	55956580	2672a5f6-256a738f-b6a24dbc-0e439c1c-d27f0b35
1417	mild cardiomegaly has worsened since accompanied by increasing pulmonary vascular engorgement, indicating greater intravascular volume or mild biventricular heart failure is developing . right infrahilar consolidation consistent with pneumonia is unchanged . et tube in standard placement . swan-ganz catheter ends in the main pulmonary artery, right jugular introducer ends in the upper svc, and a nasogastric tube ending in the upper stomach would need to be advanced at least cm to move all the side ports below the diaphragm .	Cardiomegaly&&Consolidation&&Edema&&Pneumonia&&Support Devices	14312560	50617748	513c2a6c-c081efd7-5d2b0a10-5ae31d2c-1664a879
1418	the pre-existing pulmonary edema has minimally decreased in severity and extent . low lung volumes and moderate to massive cardiomegaly persists . no pleural effusions . no pneumonia . no pneumothorax .	Cardiomegaly&&Edema	15131736	57913253	e81642df-ca0321d7-9a90c5ce-db185fb3-f79598ce
1419	there are new opacities in the superior segment of the left lower lobe and in the right lower lobe, most consistent with multifocal pneumonia . no pleural effusion or pneumothorax . cardiomediastinal and hilar contours are normal . new multifocal pneumonia in the right and left lower lobes . these findings were discussed with dr . by dr . on by telephone at the time of discovery .	Pneumonia	16508811	53708518	92afaf0a-1599ea5d-299de00c-663008be-231fd983
1420	dual-lead left-sided pacer device is again seen, unchanged in position . the patient is status post median sternotomy . the cardiac silhouette remains mild-to-moderately enlarged . mediastinal and hilar contours are stable . mild left basilar atelectasis is seen without definite focal consolidation . no pleural effusion or pneumothorax .	Atelectasis&&Cardiomegaly&&Enlarged Cardiomediastinum&&Support Devices	15144601	51244891	ce4d53fc-3f17c875-c053c0b1-43ce1358-096e6002
1421	cardiomediastinal contours are unchanged . esophageal stent is in unchanged position . right lower lobe pneumonic consolidation is unchanged . aeration of the left lower lobe has improved . there is no pneumothorax . right pleural effusion is small and stable . pneumoperitoneum is less conspicuous than before .	Consolidation&&Enlarged Cardiomediastinum&&Pleural Effusion	19016834	53515169	af20fb83-3a400800-9bd658e7-a793f80f-3762604f
1422	compared to the previous radiograph, the patient has been intubated . the tip of the endotracheal tube projects . cm above the carina . the pre-existing cardiomegaly with signs of moderate fluid overload is unchanged . the patient has also received a nasogastric tube . the tube shows a normal course . the tip is not included in the image, but likely positioned in the stomach .	Cardiomegaly&&Support Devices	15131736	50142753	8bd29787-5b4afe07-79a4efa4-193d9424-42eea377
1423	the hemodialysis catheter has been removed . severe cardiomegaly with moderate pulmonary fluid overload persists, larger pleural effusions are not present . there currently is no indication for pneumonia . no pneumothorax .	Cardiomegaly&&Pleural Effusion&&Pneumonia	13473495	59693688	c87c7c06-4d0a740d-c4c78513-1e63bfe1-7b9e08f8
1424	there has been interval removal of a previously seen right central venous catheter . no focal consolidation, pleural effusion, or evidence of pneumothorax is seen . the cardiac silhouette is top normal to mildly enlarged . the aortic knob is calcified . no overt pulmonary edema is seen . no findings to suggest pneumonia .	Pneumonia	13975291	51140249	0b573d4b-fece5236-ea941b33-c752a0ab-b5cfdd68
1425	portable upright ap view of the chest patient is status post esophagectomy and gastric pull-through procedure with a stent redemonstrated within the neoesophagus . cardiac silhouette size is normal . the mediastinal contour is similar . there is persistent opacification of the right lung base with a small right pleural effusion, not significantly changed in size . left lung is clear . there is no pneumothorax . no pulmonary vascular congestion is present . there is continued opacification of the right lung base, possibly reflecting a combination of pleural effusion with atelectasis, though infection cannot be excluded . small right pleural effusion is unchanged .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Pneumonia	19016834	51719671	7d45bb0a-531ab42d-d3820493-112d47e5-6eafa5a1
1426	moderately severe pulmonary edema is worsening, accompanied by increasing small-to-moderate bilateral pleural effusions and progressive moderate-to-severe cardiomegaly . right jugular line ends in the upper right atrium . et tube is in standard placement . no pneumothorax . thoracic aorta is heavily calcified and at least tortuous if not dilated, but probably not acutely changed .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	10975446	55185117	0d768fcf-0bb1bca1-eb1fe1d6-686b876b-675a2e95
1427	heart is normal size . there has been an increase in pulmonary vascular plethora and mild interstitial abnormality, could be early edema, but there is no evidence of pleural or pericardial effusion . no focal pulmonary abnormality is present .	Edema	19028690	53266756	46b732fa-3e6e9bc7-4487868d-2db2ea7c-b27ecdd1
1428	tip tip of the endotracheal tube is at least cm above the carina an should be advanced at least cm . house staff paged . esophageal drainage tube passes into the stomach and out of view . right brachiocephalic vein stent unchanged in position or appearance including mild central narrowing . lung volumes are improved substantially and any previous pulmonary edema has nearly resolved . moderate cardiomegaly is stable . no pneumothorax .	Cardiomegaly&&Support Devices	14744884	52630162	0619df15-9da411e1-9a47d1bf-973bbcf8-97f09ae0
1429	the patient remains intubated, the egd in unchanged position . the same holds for a previously described left subclavian central venous line terminating overlying the svc at the level cm above the carina . right-sided chest tube remains in place, also in unchanged position . extensive bilateral chest wall emphysema as before . no new local parenchymal infiltrates are seen, and the heart is not enlarged . stable chest findings with extensive bilateral chest wall emphysema .	No Finding	16751749	50195073	a94afe1d-af9219e1-0a7b8d8c-96262c1c-2f5b9d27
1430	a single portable frontal chest radiograph was obtained . the tip of a nasogastric tube terminates in the upper esophagus . lung volumes are low, accentuating the central pulmonary vasculature . small amount of fluid or thickening of the right minor fissure is unchanged . there is no new consolidation, effusion, or pneumothorax . there is a moderate amount of air in the stomach . nasogastric tube tip in the proximal esophagus . the tube should be removed and placement re-attempted . after discovery of the findings at on .	No Finding&&Support Devices	13979643	57913072	581dfa62-66e36227-8f7c3128-aec0feaa-c7111e6e
1431	the endotracheal tube is low, with the tip terminating just above the carina . recommended retracting at least cm for optimum positioning . nasogastric tube ends in the proximal portion of the body of the stomach with sidehole at the level of the gastroesophageal junction, and recommended further advancement . a right ij approach venous pacer lead ends at the level of the right ventricle . the lung volumes are extremely low . mild pulmonary congestion is seen . small left pleural effusion with likely compressive atelectasis of the left lung base is noted . the cardiomediastinal and hilar contours are stable, with mild cardiomegaly . no pneumothorax is seen . old healing left rib fracture is again seen . . et tip terminating at the carina, recommended retraction . . ng tube sideholes are at the level of the gastroesophageal junction, recommended further advancement . . right ij approach venous pacer lead ends at the level of the right ventricle . . small left pleural effusion and left basal atelectasis . the above findings were discussed with dr at pm on via telephone .	Atelectasis&&Pleural Effusion&&Support Devices	19565388	56220925	0f20cabf-36c73318-eec1255d-ebc5dd0a-3389d19c
1432	pa and lateral chest radiographs there is blunting of the left costophrenic angle correlating with effusion better appreciated on the lateral projection . additionally, there is an ovoid lucent area in the retrocardiac region on the frontal projection seen anteriorly on the lateral projection suggesting a hydropneumothorax of uncertain etiology . the left lung appears clear without focal nodule, mass, or consolidation . in the right lung base is a small nodule measuring mm which may reflect a nipple shadow or alternatively a pulmonary parenchymal nodule or osseous lesion . the remainder of the lungs appear clear . no overt pulmonary edema or vascular congestion is identified . cardiomediastinal and hilar contours are within normal limits . . concern for small left-sided hydropneumothorax of uncertain etiology . . mm right lower lobe pulmonary nodule . differential includes nipple shadow, osseous lesion, or pulmonary parenchymal nodule . followup radiographs with oblique projections and nipple markers could be considered . alternatively, ct of the chest could also be performed for further characterization of the left-sided pleural process and the right lower lobe nodule . . no confluent consolidation or pulmonary edema . communicated the above results to dr . at pm by telephone .	Lung Lesion&&Pneumothorax&&Support Devices	12433421	55644325	00791688-1fab1483-c2c6bc65-78567732-ff0cf7cc
1433	as compared to recent radiographs, there is interval development of right lower lobe opacity that might reflect interval development of atelectasis, potentially complicated by infectious process . there is also pleural effusion demonstrated, new . left upper lobe calcified granulomas are unchanged .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Pneumonia	12185775	51760501	a14afef8-c2d8e65e-bef0d58f-e5cc0cf9-ce597a39
1434	the et tube is still slightly low, . cm above the carina . right ij line tip is at the cavoatrial junction . there are bilateral pleural effusions, vascular plethora, patchy areas of alveolar edema . the overall impression is that of chf and underlying infectious infiltrate cannot be excluded . compared to the prior study, the fluid status is slightly worse .	Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	10975446	55747813	520be031-be2101c2-d3c096ac-08925edb-0177dee8
1435	the right picc line has been pulled back . the line projects over the axillary vein . the newly placed dobbhoff tube is curled in the pharynx . both devices need to be repositioned . borderline size of the cardiac silhouette . partial left lower lobe atelectasis . mild fluid overload . no evidence of complications, notably no pneumothorax . at the time of dictation, pm, on , the referring physician, . , was paged for notification . findings were discussed over the telephone .	Atelectasis&&Cardiomegaly&&Pneumothorax&&Support Devices	13031876	54507675	3b7947ed-a2cd5417-8e4e8b35-e081b743-6844ceca
1436	lung volumes are reduced . diffuse interstitial opacities most pronounced within the periphery and lung bases with architectural distortion are unchanged compared to the previous chest ct and compatible with chronic interstitial lung disease, previously characterized as uip or fibrosing nsip . previously noted hazy opacities in both lungs has resolved . no new areas of focal consolidation are demonstrated . there is no pulmonary vascular congestion, pleural effusion or pneumothorax . mild degenerative changes are noted in the thoracic spine . the cardiac and mediastinal contours are unchanged . findings compatible chronic interstitial lung disease, previously characterized on chest ct as uip or fibrosing nsip . no new areas of focal consolidation or pulmonary edema .	Consolidation&&Edema&&Lung Opacity	10867202	57761141	62cd4342-77a1737e-da11be7c-6914655a-20dc273b
1437	there is mild enlargement of the cardiac silhouette, increased from prior . small bilateral pleural effusions have increased from the prior . there is new mild pulmonary edema . bibasilar opacities likely reflect a combination of effusions and atelectasis although, underlying infection cannot be excluded . mild cardiomegaly, bilateral pleural effusions and pulmonary edema . bibasilar opacities likely reflect a combination of effusion atelectasis although, underlying infection cannot be excluded .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia	16553329	59891116	17a72ae0-23c30abe-90d2e3d6-03c3c393-2cbeda3d
1438	portable ap chest radiograph . the swan-ganz catheter has been withdrawn cm, but still should be withdrawn an additional cm . there is otherwise no significant interval change . again noted is a vascular stent in the left subclavian artery and moderate bilateral pleural effusions, greater on the right . mild interstitial edema has not significantly changed .	Edema&&Pleural Effusion&&Support Devices	12847817	56973241	6e155ca6-fbba81ca-123ca9ce-4d7817ed-a687f7be
1439	ap and lateral views of the chest were provided . lung volumes are low, similar to the prior study . the previously noted dense consolidation of the right upper lobe has improved with diffuse streaky opacities remaining . there are findings consistent with chronic lung disease such as sarcoidosis . prominence of the pulmonary interstitial markings is due to mild heart failure . there is no pleural effusion or pneumothorax . the cardiomediastinal silhouette is notable for a tortuous aorta . bones are slightly osteopenic . . improving right upper lobe consolidation . . mild heart failure . . findings of chronic lung disease, most likely sarcoidosis .	Cardiomegaly&&Consolidation&&Edema	10933609	50290463	f576c221-e516f6b2-ee125faa-a1af8c31-ed2991b8
1440	the opacification at the right base is again consistent with known empyema . drainage tubes remain in place . left lung remains within normal limits .	Lung Opacity&&Support Devices	13352405	53925537	33291277-e041bbda-50a4d443-2208be5e-06e2289d
1441	substantial amount of metastatic involvement of the lungs have increased in the interim since . heart size and mediastinum are unchanged as well as the replaced aortic valve . the stenting in the gastroesophageal junction is redemonstrated, as well as malpositioned stent which is most likely located in the stomach .	Cardiomegaly&&Enlarged Cardiomediastinum&&Support Devices	16773796	50471313	578647f3-d342067e-7191625c-86464c45-87eeaa13
1442	multifocal patchy opacities in the right middle, right upper, and bilateral lower lobes are concerning for pneumonia . the most severe consolidation is in the right middle lobe . the lungs are without pleural effusion or pneumothorax . the cardiac and mediastinal contours are normal . multifocal pneumonia most severe in the right middle lobe . with dr .	Pneumonia	19800337	59700587	cc5ac61e-f2bd2109-93d1046f-d8eba485-5a753deb
1443	heart size and cardiomediastinal contours are normal . lungs are clear without focal consolidation, pleural effusion, or pneumothorax . cervical spine fusion hardware and clips in the left upper abdomen are similar to prior . no acute cardiopulmonary process .	No Finding	15114531	57554056	b4ea00dd-29a8687d-10b1e7eb-d6d1cd5b-ebd65d6c
1444	rotated positioning . a dobbhoff tube is present -- the radiopaque tip overlies the upper stomach . focal density in the left upper quadrant appears to represent contrast in relation to the stomach near the ge junction an additional nasogastric type tube is present, tip extending beneath the diaphragm off film . an et tube is present -- the tip is obscured but appears to lie approximately . cm above the carina . the right subclavian central line tip overlies the distal svc . sternotomy wires, mediastinal and upper abdominal clips are present . there is upper zone redistribution and diffuse vascular blurring, consistent with chf . there is increased retrocardiac density, consistent with left lower lobe collapse andor consolidation . there are small-to-moderate bilateral effusions, with underlying collapse andor consolidation . . dobbhoff tube tip overlying stomach . residual contrast appears unchanged compared with at am . the absence of interval change is atypical and raises question of local pooling of contrast . clinical correlation requested . . bilateral effusions with underlying collapse andor consolidation, unchanged . . chf findings, also grossly unchanged .	Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Pleural Effusion&&Support Devices	13135946	53363173	4d4debb7-b1377375-9b140439-417adb5f-b593b670
1445	ap and lateral chest radiograph demonstrate mild cardiomegaly . interval worsening of patchy and linear bibasilar opacity . there are small bilateral pleural effusions . again demonstrated is pneumobilia within the right upper quadrant . a right internal jugular central line is identified its tip terminating in the right atrium . about the insertion site of the catheter, there is subcutaneous air noted . the trachea appears to be mildly displaced to the right compatible with known left sided thyroid nodule as demonstrated on ct dated . worsening bibasilar opacities, which may be due to atelectasis, with or without coexisting pneumonia .	Atelectasis&&Lung Opacity	19454978	55947692	5338edd0-50f5acc9-e2b17f61-df5423a3-36b08d58
1446	since the prior radiograph of , pulmonary edema has resolved . a moderate left pleural effusion persists . pleural catheter has apparently been removed . no visible pneumothorax .	Pleural Effusion	13896515	55597572	1f96d075-e46aa57f-d3aa1e67-42ce2b69-83381327
1447	the three right-sided chest tubes are in unchanged position . there still is no evidence of a right pneumothorax, the soft tissue air collection in the right chest wall is reduced in extent and severity . unchanged appearance of the left lung, unchanged hyperexpanded right colonic flexure with elevation of the right hemidiaphragm . distended stomach with mild elevation of the left hemidiaphragm .	Support Devices	13352405	55573533	73e90944-f811f9cb-ee08ddb9-7a4a4a84-34818999
1448	right picc tip is in theright atrium . moderate to severe cardiomegaly and widened mediastinum are unchanged . sternal wires are aligned . pacer leads are in standard position . there is no pneumothorax or large pleural effusions . mild fluid overload is unchange .	Cardiomegaly&&Enlarged Cardiomediastinum&&Support Devices	13896515	57811906	c9829806-80ccefe4-60749d0a-05402ead-54784a88
1449	low lung volumes are again demonstrated . chronic interstitial abnormality is again seen as well as more focal opacities within the left lung base, left perihilar region, and right upper lobe which are not significantly changed when compared to the prior exam . the cardiac, mediastinal and hilar contours are relatively unchanged with marked calcification of the aortic knob . no pneumothorax or large pleural effusion is demonstrated . the right picc has been removed . assessment of the pulmonary vascularity is limited . relatively unchanged appearance of the chest compared to prior exam . persistent opacities within the right upper lobe, left lung base and left perihilar region are redemonstrated on a background of chronic interstitial lung disease which on the prior chest ct was thought to reflect uip or fibrosing nsip . as before, these more focal opacities may reflect progression of chronic interstitial lung disease, acute exacerbation of interstitial lung disease, or possibly infection .	Lung Opacity&&Pneumonia	10867202	53652133	6a0e1f5d-e6e23298-495f2580-9ef21652-d843b243
1450	the patient is status post coronary artery bypass graft surgery . there is a new moderate interstitial abnormality with peribronchial cuffing and indistinct vascular prominence, most consistent with mild-to-moderate pulmonary vascular congestion . the heart is mildly enlarged with a left ventricular configuration . the cardiac, mediastinal and hilar contours appear unchanged . there is no pleural effusion or pneumothorax . the bones are probably demineralized . a mild anterior wedge compression deformity along the lower thoracic spine appears unchanged . mild degenerative changes along the mid-to-lower thoracic spine are also similar . findings most consistent with mild-to-moderate pulmonary vascular congestion .	Edema	16957952	57454413	158479af-cf9c24d6-99ee742e-bbb91960-bfa7f46c
1451	the patient is status post median sternotomy . right-sided port-a-cath tip terminates in the right atrium . lung volumes are low . this accentuates the cardiac silhouette size which is likely mildly enlarged . calcified mediastinal nodes are re- demonstrated reflective of prior granulomatous disease . mediastinal and hilar contours are otherwise unremarkable . there is no pulmonary vascular congestion . patchy bibasilar airspace opacities most likely reflect atelectasis . there is no pleural effusion or pneumothorax . no acute osseous abnormalities detected . low lung volumes with probable bibasilar atelectasis .	Atelectasis	11413236	55972946	db1c4e24-acd97bc7-d5e97d65-04ffb3e5-9c036419
1452	in the region of the lingular mass, there is a persistent opacity measuring approximately . cm and decreased in comparison to the postbiopsy opacity noted in but greater than expected for postoperative hemorrhage at this time and thus raising suspicion for a possible infectious process . otherwise, the right lung is clear . mediastinal and cardiac silhouettes appears normal . osseous structures are grossly unremarkable . in the region of the known lingular mass, there is a persistent opacity measuring approximately . cm which is decreased in comparison to the postbiopsy opacity noted in but greater than expected for postoperative hemorrhage at this time thus raising suspicion for a possible infectious process . these findings were discussed by dr . with dr . telephone at am on .	Lung Lesion&&Lung Opacity&&Pneumonia	16435402	56116675	d439d39d-cacf925c-2737a0f6-204add42-44e8cd99
1453	portable upright radiograph of the chest there is mild cephalization of the pulmonary vasculature which is suggestive of increased pulmonary venous pressures . the lungs are clear . rightward deviation of the trachea in the superior mediastinum is unchanged and due to the patients known history of thyromegaly . there is no pleural effusion or pneumothorax . the heart is not enlarged . a hemodialysis catheter terminates at the cavoatrial junction . again noted are multiple old left rib fractures as well as degenerative changes of the bilateral glenohumeral joints .	No Finding	14236258	51196890	0e94f694-f43b9926-aae6e13a-c3d97e2d-3a975b5b
1454	a right-sided picc is seen with tip projecting over the mid svc . there is a tiny left pleural effusion, as seen on outside hospital abdominal ct dated . there is patchy opacity in the left lower lobe, improved compared with . no focal consolidation or pneumothorax is seen . heart and mediastinal contours are stable . pneumobilia and right upper quadrant drain are noted . right picc with tip projecting over the mid svc . patchy opacity in left lower lobe, improved compared with . pneumobilia and right upper quadrant drain .	Lung Opacity&&Support Devices	14147380	51464763	4c2fb727-6b6a721b-befb2d0a-f87fb73f-ee302214
1455	two frontal views of the chest show greater opacification in the left lower lung which could represent new pneumonia, less likely asymmetric edema because edema has not worsened elsewhere . focal areas of possible hemorrhage in the right suprahilar and left lateral suprahilar lungs are unchanged, as well as the likely hematoma along the track of the right pleural tube . heart size normal . no detectable pneumothorax . extensive subcutaneous emphysema unchanged . tracheostomy tube in standard placement .	Edema&&Lung Opacity&&Pneumonia&&Support Devices	16751749	57387398	c2e5830a-4b63b683-99043c6b-d9c3e685-cd66aa23
1456	the nasogastric tube has been removed . the lung volumes remain extremely low and areas of friable extensive atelectasis are seen at both lung bases . there is no pulmonary edema and no larger pleural effusions are visualized . mild cardiomegaly . unchanged position of the left pectoral pacemaker .	Atelectasis&&Cardiomegaly&&Support Devices	12595991	52173177	465880ed-ec1f9352-286bce36-cb6b9286-50c2af29
1457	comparison is made with prior study pet-ct . there is mild cardiomegaly . pacemaker leads are in a standard position . right picc tip is in the cavoatrial junction . the sternal wires are aligned . ng tube tip is out of view below the diaphragm . et tube is in a standard position . extensive bilateral dense consolidations are new from prior study, they can represent trali or ards . severe extensive pneumonia is in the radiologic differential diagnosis . if any, there is a small right pleural effusion . patient has known fibrosis in the right lower lobe .	Cardiomegaly&&Consolidation&&Pleural Effusion&&Pleural Other&&Pneumonia&&Support Devices	15378103	55163409	fa5caeed-1ed5d77a-c60b51dc-3251debf-af961447
1458	comparison is made to previous study from at am . there are again seen bilateral pleural effusions and a left retrocardiac opacity, stable . the right cordis and feeding tube are stable in position . aortic valve replacement is again seen and unchanged in position . there is mild prominence of pulmonary interstitial markings, which is stable .	Lung Opacity&&Pleural Effusion&&Support Devices	18224196	56589683	cd70d994-3c669ab2-ccd5f3bc-4276428d-b7fa3155
1459	the lung volumes have minimally decreased . in the retrocardiac lung areas there is a very subtle parenchymal opacity that projects over the spine on the lateral radiograph . in the light of the clinical history, this opacity is suspicious for pneumonia . there is no other lung parenchymal abnormality . no pulmonary edema . no pleural effusions . normal hilar and mediastinal contours . at the time of dictation, dr . was paged to notification at am, .	Lung Opacity&&Pneumonia	11924226	56353295	cd42734e-8fe721ac-423f5e55-6f472c98-fa3838a2
1460	as before et tube is in standard placement, nevertheless lung volumes are lower and there is new mild left lower lobe atelectasis . also new is pulmonary vascular congestion and early edema, even though heart size is normal and unchanged . there may be a small left pleural effusion . no pneumothorax .	Atelectasis&&Edema&&Pleural Effusion&&Support Devices	16015751	55645174	97772d75-88b9c893-d5ad4dd5-f7763053-ca0dd70a
1461	comparison is made to the patients prior study of . single portable ap chest film of at hours is submitted . . overall cardiac enlargement and stable cardiomediastinal contours . interval decrease in lung volumes with probable perihilar and mild pulmonary edema . no definite pleural effusions . no evidence of pneumothorax . no acute bony abnormality .	Cardiomegaly&&Edema&&Enlarged Cardiomediastinum	19844485	52890842	a394c19b-0162826e-0284eb07-bdb3fa8c-6cdf1a8b
1462	tip of the new endotracheal tube is in standard placement . no pneumothorax or mediastinal widening . lung volumes are minimally lower than they were on , and there may be new small bilateral pleural effusion . extensive pulmonary nodulation due to metastasis is unchanged . there is no good evidence for new edema or consolidation except for suggestion of mild atelectasis at the base of the left lung . heart size is normal, unchanged .	Consolidation&&Edema&&Pleural Effusion&&Support Devices	16409152	54423575	20e44254-9f4485b6-a2900fa5-1137bf64-76cc897f
1463	two frontal views of the chest show new mild interstitial pulmonary edema . interval increase in mediastinal caliber therefore is probably due to distention of mediastinal veins . heart size is slightly larger but still within normal range . pleural effusions are minimal, if any . no focal pulmonary abnormality . no pneumothorax . et tube is in standard placement and a nasogastric tube passes below the diaphragm and out of view .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	19028690	53538935	2d6b1758-4d435266-6ef48a91-dd03791b-703f57d6
1464	the extensive right lower lung opacity and the opacity along the right chest tube are constant . massive air collection in the soft tissues, leading to dissection into muscle tissue and subsequent display of multiple linear structures . there is no currently obvious pneumothorax . unchanged position of the monitoring and support devices, with exception of the nasogastric tube that has been removed in the interval . unchanged small cardiac silhouette .	Cardiomegaly&&Lung Opacity&&Support Devices	16751749	57734204	b4cdbc46-c91c088a-014cfd36-cf752c93-ee08be9e
1465	there is increased opacification in the left lung base with obscuration of the left hemidiaphragm when compared to . again noted is hyperinflation and flattening of the diaphragms suggesting emphysema . the cardiomediastinal silhouette is within normal limits . left lower lobe pneumonia, more apparent than on .	Pneumonia	11052935	56129930	9870d11d-3a0d9c78-f49f71c6-58644dd5-ce1b85fb
1466	there is little overall change in the appearance of the monitoring and support devices and the diffuse bilateral pulmonary opacifications, again worse on the right .	Lung Opacity&&Support Devices	13964474	55218216	32eb07cd-6dba43b7-858fb880-1a9bc182-6360bd42
1467	frontal radiograph of the chest demonstrates no evidence of free mediastinal air . there is no widening of the mediastinum . the lungs are well expanded . there is no evidence of acute cardiopulmonary process . the cardiomediastinal silhouette is unchanged . conclusion no pneumothorax or pneumomediastinum . otherwise, unremarkable chest radiograph . the above findings were communicated to dr . by dr . page at , five minutes after discovery was made .	No Finding	16848073	59657255	0211af7b-115fc73f-cf17f4b2-f1582601-de4a787a
1468	moderate cardiomegaly is stable . widened mediastinum with tortuous aorta is unchanged . there is mild pulmonary vascular congestion, but no overt edema . no focal consolidation identified . no pneumothorax . moderate cardiomegaly . mild pulmonary vascular congestion, but no overt edema .	Cardiomegaly	16853729	57739082	5e587c3b-2593ff0d-f7ac821e-4955e532-83ba9419
1469	a right subclavian approach dialysis catheter is again noted with tip terminating in the right atrium . a left subclavian vein stent is visualized projecting over the left lung apex . moderate cardiomegaly is again visualized . the mediastinal and hilar contours are unremarkable . there is no pneumothorax or large pleural effusion . lung volumes are slightly low without focal consolidation concerning for pneumonia . there is no overt pulmonary edema . no acute cardiopulmonary process .	No Finding	13473495	58858468	2c306616-b3005c87-d05f4dd6-a7f274c1-e15bf2a1
1470	cardiomediastinal contours are unchanged . cardiac size is normal . the lungs are clear . there is no evidence of atelectasis, pneumothorax, pleural effusion or lung consolidation .	Enlarged Cardiomediastinum	19389547	55082399	c1e9b246-6477636a-838f88a9-d6004e1b-a1acc4ae
1471	cardiomegaly and widened mediastinum are unchanged . large right pleural effusion is unchanged . there is no pneumothorax . there is mild improved vascular congestion . sternal wires, replaced aortic and tricuspid valves are again noted . displaced fractures of first, second and third left ribs are unchanged .	Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Fracture&&Pleural Effusion&&Support Devices	19182863	54846230	ef80aef9-5a1e915b-1a9459ba-caabc17e-7743008a
1472	the heart size is stable and mildly enlarged . mediastinal and hilar contours are within normal limits . the lungs show no consolidation or pulmonary edema . there is no pleural effusion or pneumothorax . the previously described right picc tip has been removed . no acute findings . mild cardiomegaly .	Cardiomegaly	16855430	54172798	51e9421b-c2f395da-5dd48889-7e307aca-1472d6a6
1473	portable ap chest radiograph in the interim since the most recent prior examination, there has been development of a moderate amount of air within the pleural space . there is moderate fluid within the right pleural space . there is mild inflation of the right upper lobe with a collapsed right lower lobe . there is no shift of the mediastinum . the left lung shows no focal consolidation, pleural effusion or pneumothorax . the mediastinum appear unremarkable . moderate pneumothorax with moderate pleural effusion, inflated right upper lobe and collapsed right lower lobe . no significant shift of the mediastinum . at on via telephone .	Atelectasis&&Pleural Effusion&&Pneumothorax	14387068	54176477	1de4e2d6-0112fe2a-07780296-bc4a23d6-fbcc2872
1474	as compared to chest radiograph from the same day, nasogastric tube has been advanced with the first side port in the proximal stomach . endotracheal tube is cm from the carina . right-sided ij catheter in the low svc . overall no substantial change of the lungs with moderate right-sided effusion, small left effusion and moderate cardiomegaly . mild pulmonary vascular congestion unchanged . asymmetric opacity in the right lower lobe also may represent superimposed pneumonia . nasogastric tube has been advanced with the first side port in the body of the stomach . overall no substantial change of the lungs .	No Finding&&Support Devices	14851532	54703104	86d32dd1-50a12d52-f95eadf5-8f436965-b8669247
1475	comparison is made to the patients prior study of at am . . there continues to be bilateral interstitial process, but this has improved since the prior study, and is more similar to baseline of , therefore, likely reflecting chronic age-related or small airways changes . more focal patchy opacity at the left base likely reflects compressive atelectasis given the pleural effusion, although pneumonia can not be excluded . no pneumothorax is seen . overall, cardiac and mediastinal contours are stable .	Atelectasis&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Pneumonia	11893091	54669609	bc998aad-c88d87cc-d89c4aa6-63477af5-c75767d8
1476	ap portable upright chest radiograph was provided . the lungs are hyperinflated with upper lobe lucency compatible with emphysema . no focal consolidation, effusion, or pneumothorax seen . cardiomediastinal silhouette is normal . bony structures are intact . severe emphysema without superimposed consolidation .	Consolidation	11052935	58831403	2528f6e5-586bb3a0-e00e7283-5c594954-fe27b052
1477	sternal wires, valve prosthesis, cardiac device, and mild cardiomegaly are unchanged . there is new left lower lobe infiltrate and small left effusion . there is also a small right effusion . new left lower lobe infiltrate and effusion .	Lung Opacity&&Pleural Effusion	19759491	55187337	be022b6e-69a878a5-39db0aac-453cd12d-627ea0a0
1478	following right thoracocentesis, a large right pleural effusion has substantially improved with residual mild-to-moderate fluid . mediastinum is central in position . ill-defined opacity in the right upper lung is consolidation unless proven otherwise . a . discrete, nodular opacity in the left mid lung is a calcified granuloma as demonstrated from ct component of petct dated . mild atelectasis is present in the right lower lung and middle lobe . right-sided port-a-cath ends at lower svc . . following thoracocentesis, large right pleural effusion has substantially resolved with residual mild-to-moderate fluid and minimal right lung base and middle lobe atelectasis . . opacity in the right upper lobe is consolidation unless otherwise proven . . -mm granuloma in the left mid lung .	Atelectasis&&Consolidation&&Lung Opacity	14969719	58351102	b758e8f4-574ee6a8-32a4c691-81f94a5b-96a0773c
1479	small areas of air fluid levels in the right apex have decreased . right chest tube remains in place . right subcutaneous emphysema is unchanged . right perihilar opacities have improved . aeration in the right lower lobe has improved . there is no pleural effusion or pneumothorax on the left . patient has known severe emphysema .	Lung Opacity&&Support Devices	19991135	56228041	a062926a-2918aecc-14c2b674-37e2e4cf-dc0884d3
1480	portable upright ap view of the chest left-sided dual-chamber pacemaker is noted with leads terminating in the right atrium and right ventricle . the heart size is normal . the mediastinal and hilar contours are unchanged, with mild calcification of the thoracic aorta . the lungs are clear . pulmonary vascularity is normal . no pleural effusion or pneumothorax is visualized . there are no acute osseous abnormalities .	No Finding	12369221	59986698	417d5c5e-b521f965-35306684-68e7deb2-cda06f5c
1481	the lung volumes are slightly low, causing accentuation of the pulmonary vasculature and exaggeration of the heart size . persistent right middle lobe heterogeneous opacity is concerning for chronic aspiration, although pneumonia could have a similar appearance . the lungs are otherwise clear . the cardiac and mediastinal contours are normal . there are no pleural abnormalities . likely chronic aspiration involving the right middle lobe although pneumonia could have a similar appearance . otherwise, no acute cardiac or pulmonary process .	Pneumonia	15659181	59037095	ffc87b00-0815c74e-636e48b5-42d8bca2-443af381
1482	portable ap chest radiograph in the interim since the most recent prior chest radiograph of obtained at , there has been placement of a pigtail catheter . there is resolution of the right-sided pleural effusion . the moderate-to-large right pneumothorax is more visible . the right lung appears collapsed . there is no significant shift of mediastinum . portions of the left costophrenic angle are not included in field-of-view . within this limitation, the left lung shows no focal consolidation, pleural effusion or pneumothorax . the cardiac, mediastinal and hilar contours are normal . interval placement of pigtail catheter with resolution of right-sided pleural effusion with a moderate-to-large right pneumothorax with no significant shift of mediastinum and collapsed right lung . findings discussed with at on via telephone .	Pneumothorax&&Support Devices	14387068	51435896	dba61a64-de733cca-c91730b7-7870dfef-c173ffd9
1483	an ap upright radiograph of the chest is provided . there is no significant change from the prior examination . moderate cardiomegaly is stable . chronic parenchymal opacities which are better demonstrated on the prior chest ct are also unchanged . there is no evidence of superimposed airspace opacification or pulmonary edema . there is no pneumothorax or pleural effusion . median sternotomy cerclage wires are intact . the right pectoral aicd and its leads are unchanged . . stable moderate cardiomegaly . stable chronic parenchymal changes . . no evidence of acute pulmonary edema .	Cardiomegaly	13606683	53417168	63bc3ab0-da8f9dcb-006bcd2c-5af27843-de7a7597
1484	there is no evidence of mild-to-moderate pulmonary edema, associated with a likely small pleural effusion on the right . newly occurred atelectasis at the right lung base . no other focal parenchymal opacities . at the time of dictation and observation, the referring physician, . was paged for notification on , am . covered by dr . .	Atelectasis&&Pleural Effusion	13881772	50646741	9d1a91d8-eb3582a2-bb42cc96-d27dd42d-b5592d9f
1485	the et tube, the esophageal stent are unchanged . the right internal jugular line has been discontinued . there is no definitive evidence of pneumoperitoneum . right mid lower lung opacification is unchanged as well as left mid lower lobe opacities . no appreciable pneumothorax is seen .	Lung Opacity&&Support Devices	13964474	50909414	22f15611-56e81b77-6ec98f91-5d740640-14d8260c
1486	left pleural effusion appears to be unchanged associated with small amount of right pleural effusion . left retrocardiac opacity most likely reflects atelectasis but infectious process cannot be excluded as well as aspiration . the rest of the lungs are clear . heart size and mediastinal silhouette are stable .	Atelectasis&&Cardiomegaly&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Pneumonia	12433421	59200772	91af0bee-3cac0612-4e8721e3-9dfdf4a1-ae5edab8
1487	lungs appear grossly clear . subtle areas of scarring in the right mid lung not significantly changed from recent ct . no focal consolidation concerning for pneumonia . no effusion or pneumothorax . cardiomediastinal silhouette is stable . vertebroplasty changes at the lower thoracic spine noted . chronic right fourth rib resection noted . no acute findings .	No Finding	11474065	58721487	859b40aa-1f46d6a7-7f299ecf-38260eb3-897580c1
1488	the cardiac, mediastinal and hilar contours appear stable . the heart is normal in size . there is no pleural effusion or pneumothorax . the lungs appear clear . the patient is status post anterior cervical fusion . surgical clips project over the left upper quadrant . there has been no significant change . no evidence of acute cardiopulmonary disease .	No Finding	15114531	57377735	eaf779dc-f580b7b8-168b1b3c-53ee66c1-21268250
1489	there has been placement of an endotracheal tube with its tip approximately . cm above the carina . other monitoring and support devices remain in place . diffuse bilateral pulmonary opacifications persist, as does a pleural air collection at the right base .	Lung Opacity&&Support Devices	14387068	53036982	983753d4-6a60ce18-3858cac6-ba36bba0-942df8a1
1490	patient is status post median sternotomy and coronary artery bypass surgery . icd remains in place as well as a right picc . cardiac silhouette is mildly enlarged, and accompanied by mild pulmonary vascular congestion . persistent patchy right basilar opacity and new patchy left lower lobe opacity as well as a persistent linear area of atelectasis in the left lower lobe . the etiology of the basilar opacities is uncertain, but could represent aspiration, infectious pneumonia, or a dependent distribution of edema in the setting of known upper lobe predominant emphysema .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pneumonia&&Support Devices	16059470	57952807	2b0c69d6-c2dc4934-db59e90a-2e58d454-ee26f72e
1491	pa and lateral views of the chest there are low lung volumes . this accentuates the size of the cardiac silhouette which is likely top normal . there is crowding of the bronchovascular structures but no evidence of pulmonary edema . the mediastinal and hilar contours are otherwise within normal limits . previously described subpleural left lower lobe opacity seen on prior chest radiograph which corresponds to an area of pleural fat on ct appears more prominent on the current exam . bilateral patchy opacities in the lung bases may reflect areas of infection or atelectasis . there are small bilateral pleural effusions . no pneumothorax is identified, and there are no acute osseous abnormalities . . ill-defined patchy opacities in lung bases which may represent areas of infection or atelectasis . small bilateral pleural effusions are present . . subpleural opacity in the left lower lobe appears more prominent on the current exam, and corresponds to an area of pleural fat as noted on the prior chest ct .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Pneumonia	11212873	53762508	551bcedc-af6b269e-41826aa7-ff9d0f78-4825ae4f
1492	comparison is made with prior study of . moderate cardiomegaly is stable . pulmonary edema has markedly improved . retrocardiac opacities have improved . this could be due to atelectasis, but superimposed infection cannot be excluded . elevation of the right hemidiaphragm is unchanged . there is no pneumothorax or enlarging pleural effusion .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pneumonia	10449297	54721755	2c7390b4-a9b82059-5a1fef21-94d721ee-f062ceb8
1493	endotracheal tube has been minimally advanced, it currently projects . cm above the carina with its tip . the existing extensive bilateral parenchymal opacities are unchanged in extent . new bilateral pleural effusions might have developed . unchanged moderate cardiomegaly . unchanged right central venous access line and nasogastric tube . no pneumothorax .	Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Support Devices	13078497	58410688	b60d9052-3235c4b8-59510f55-a43f5ffd-e99a36d2
1494	since , following insertion of a new right basal pleural tube, substantial volume of pleural effusion has been evacuated and a small pneumothorax has developed at the base and at the apex of the postoperative right lung . mild edema at the base of the left lung has increased . small left pleural effusion is unchanged . heart is mildly enlarged as before . apparent widening of the mediastinum is due to combination of chronic atelectasis and juxtamediastinal pleural fluid . it has not changed over several days . right pic line ends in the upper svc .	Atelectasis&&Edema&&Enlarged Cardiomediastinum&&Pleural Effusion&&Pneumothorax&&Support Devices	13263843	50844750	e76f5f9e-dbd482e9-9bf04876-ac6e1cae-a59d9637
1495	the cardiomediastinal and hilar contours are stable . the aorta is again noted to be tortuous . the patient is status post cabg with median sternotomy wires in place . the second most superior median sternotomy wires again noted to be fractured . there is no pleural effusion or pneumothorax . the lungs are well-expanded with stable scarring at the right costophrenic angle . there is no new focal consolidation concerning for pneumonia . there is no overt pulmonary edema . the upper abdomen is unremarkable aside from surgical clips . no acute cardiopulmonary process .	No Finding	10523725	59223989	a8d732de-7a28af8e-8a5a6a3f-c66be26f-ad23f1aa
1496	the lungs remain hyperinflated, suggesting chronic obstructive pulmonary disease . no focal consolidation, pleural effusion, or evidence of pneumothorax is seen . the cardiac and mediastinal silhouettes are stable and unremarkable . hilar contours are also stable . no acute cardiopulmonary process . no significant interval change . please note that peribronchovascular ground-glass opacities at the left greater than right lung bases seen on the prior chest ct of were not appreciated on prior chest radiography on the same date and may still be present . additionally, several pulmonary nodules measuring up to mm are not not well appreciated on the current study-ct is more sensitive .	Lung Lesion&&Lung Opacity	10402372	51966612	b5da9d38-5e0c570b-e88b17c1-029654a9-a4f8a0b3
1497	there is unchanged evidence of free intra-abdominal air . esophageal stent is in unchanged position . unchanged massive right parenchymal opacities . opacities on the left appeared to increase in severity . no other changes .	Lung Opacity	13964474	55540365	0fa9b2f2-d7510ec8-dd44542a-5132940a-96ef2890
1498	frontal semi-upright portable chest dialysis catheter ends in the right atrium, unchanged in position . peribronchial cuffing and increased interstitial markings are compatible with mild pulmonary edema, unchanged from the prior study . moderate cardiomegaly is stable . there is no substantial pleural effusion or pneumothorax . calcified granuloma again noted in the right lower lung .	No Finding	17340686	53956186	e199d51c-58d0356d-8ed19c9f-64ddb8ec-cd3fdc7a
1499	pa and lateral views of the chest are compared to previous exam from . when compared to prior, there has been no significant interval change . again seen are predominantly linear bibasilar opacities, more apparent on the lateral view on todays exam . superiorly, the lungs remain clear . enlarged cardiomediastinal silhouette is grossly stable given differences in technique and patient position . no significant interval change since exam from two days prior demonstrating persistent bibasilar opacities and enlarged cardiomediastinal silhouette .	Enlarged Cardiomediastinum&&Lung Opacity	16853729	57835182	5320dce2-60fde2c2-0590fad0-36474905-b3318771
1500	comparison to prior study of at . a single portable semi-erect chest film at is submitted . . left subclavian central line has its tip in the superior vena cava . endotracheal tube has its tip below the thoracic inlet, unchanged . nasogastric tube is seen coursing below the diaphragm . right chest tube remains in satisfactory position . . extensive subcutaneous emphysema which somewhat limits evaluation of the lungs . the lungs remain markedly hyperinflated consistent with known underlying emphysema . when compared to previous studies dating back to , the more focal airspace opacity in the left upper to mid lung has progressed and therefore is concerning for an evolving pneumonia . there has been interval decrease in elliptical opacity in the right mid lung near the chest tube likely representing fluid loculated within the horizontal fissure . no pneumothorax can be appreciated . overall cardiac and mediastinal contours are likely stable .	Enlarged Cardiomediastinum&&Lung Opacity&&Pneumonia&&Support Devices	16751749	59143968	4fa7066f-1353fcd0-c894483b-a6140dd1-91994574
1501	there is no pneumothorax, pneumomediastinum, or deep cervical air . recommend repeat pa and lateral radiographs of the chest to verify these findings . the lungs are well expanded . there is no evidence of acute cardiac or pulmonary process . cardiomediastinal silhouette is unremarkable . no pneumothorax, pneumomediastinum, or deep cervical air . recommend repeat pa and lateral imaging later today to verify these findings . otherwise unremarkable chest radiograph . these findings were communicated to dr . by telephone by dr . .	No Finding	16848073	53276158	e5d1a79a-101a6822-e589102f-05d0d1c7-fe74e5e5
1502	a left picc has been re-positioned with the tip now terminating in the left brachiocephalic vein . replacement is recommended . there are persistent low lung volumes and increased opacification of the right lung base reflecting increased small bilateral pleural effusions and worsening atelectasis . left basilar atelectasis is also increased . there is no pneumothorax . the pulmonary vasculature is mildly engorged without overt pulmonary edema . the cardiomediastinal silhouette remains mildly enlarged but stable . tortuosity of the thoracic aorta and calcification of the aortic knob is again seen . . retraction of the left picc with tip terminating in the left brachiocephalic vein in comparison to . replacement is recommended . . increased small bilateral pleural effusions and bibasilar atelectasis with decreased lung volumes from . . unchanged mild pulmonary vascular congestion . findings were reported by dr . telephone at pm .	Atelectasis&&Edema&&Pleural Effusion&&Support Devices	16855430	52011718	9a29ce3a-c06e22b5-44f5cc18-85e115b8-cbc710d9
1503	new et tube ends . cm above the carina . right jugular line is in lower svc . left upper lobe rounded atelectasis was better assessed in recent ct, and there is minimal chronic thickening of the pleura at the costodiaphragmatic angles . conclusion . tube and lines are in adequate position . . the remaining of the exam is unchanged without significant acute cardiopulmonary findings .	No Finding&&Support Devices	15809646	54479348	5e2d7a5c-0cca16ec-3dff48d4-bab26e70-6bea7f6d
1504	as compared to the preoperative radiograph, there is a minimal decrease in overall lung volumes . as a consequence, a small retrocardiac atelectasis is seen . however, there is no evidence of pneumonia . borderline size of the cardiac silhouette . the presence of a minimal left pleural effusion cannot be excluded . normal hilar and mediastinal contours .	Atelectasis&&Cardiomegaly&&Pleural Effusion	15338518	52944435	1ab129c3-79b49414-0d5287c9-5e9ab48a-b1cfae33
1505	prominent bilateral interstitial lung markings are on changed . there is no focal consolidation, pleural effusion or pneumothorax . the heart and mediastinum are magnified by the projection, but stable dating back to . regional bones and soft tissues are unremarkable . mildly prominent bilateral interstitial opacities which may be due do atypical infection reverses edema .	Edema&&Lung Opacity&&Pneumonia	13475033	50920770	288e9b61-c5cfce3d-38a26f8f-2f3f97f6-fdf08c07
1506	pa and lateral views of the chest left-sided aicdpacemaker device is noted with leads terminating in the right atrium, right ventricle, and coronary sinus, unchanged . mild enlargement of the cardiac silhouette is stable, with aortic knob calcifications re-demonstrated . the pulmonary vascularity is normal, and the lungs are clear . no pleural effusion or pneumothorax is present . there are mild degenerative changes in the thoracic spine with anterior bridging osteophytes .	No Finding	12595991	58621321	e3fc5bd6-0ebd345c-dd63d96c-6844627c-1b6cf82b
1507	patient is status post median sternotomy and aortic valve repair . a left-sided dual-chamber pacemaker device is noted with leads terminating in the right atrium and right ventricle . heart size is normal . the aortic knob is calcified . mediastinal and hilar contours are unremarkable . apart from minimal atelectasis in the lung bases, the lungs are clear without focal consolidation . there is no pulmonary edema . no pleural effusion or pneumothorax is seen . no acute osseous abnormalities demonstrated . no acute cardiopulmonary abnormality .	No Finding	16043637	51725613	5e6a1e77-fe7d7c1c-14f0897f-85cfc35e-7b7fd799
1508	portable semi-erect ap chest radiograph demonstrates a dobbhoff tube seen descending in an uncomplicated course and terminating in the stomach in appropriate position . a left internal jugular line is seen at the level of the mid to low superior vena cava . there has been interval removal of swan ganz catheter . there is re- demonstration of left lung consolidations within the lower and upper lobe which appear unchanged when compared to chest radiograph dated . the right lung is grossly unchanged . there is no pneumothorax identified . the cardiomediastinal and hilar contours are stable in appearance . an ivc filter is identified adjacent to the spine in the right mid abdomen . dobbhoff tube in nondistended stomach .	No Finding&&Support Devices	16334516	57884279	320ec4bc-eb78eb77-b0088c51-9c38d6dc-d4677778
1509	swan-ganz catheter and enteric tube are not constant position . moderate cardiomegaly persists . lung volumes remain low . right pleural effusion appears smaller although this may be due to more upright positioning . worsening left retrocardiac opacity may reflect atelectasis or aspiration . the mediastinal and hilar contours are unchanged . there is no pneumothorax . the aortic arch is calcified . . persistent low lung volumes and small right pleural effusion . worsening left retrocardiac opacity could reflect atelectasis or aspiration .	Atelectasis&&Lung Opacity&&Pleural Effusion	14851532	55060932	d05c84b4-68e7175f-6e3d46fb-1d4c825e-be9e4e29
1510	again seen is mild cardiomegaly, pulmonary vascular redistribution and patchy alveolar infiltrates . the lateral film is limited by the arm projecting over the lateral lungs . there is increased opacity at both bases and it is unclear if this is due to atelectasis or focal infiltrate . the overall impression is that of pulmonary edema which is similar compared to the study from earlier the same day .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity	12074041	53840157	ebfa6753-3f0b7933-ca42ef98-0ce8ca94-b03f6676
1511	icd with biventricular pacing lead remains in place . stable cardiomegaly accompanied by pulmonary vascular congestion and new interstitial edema, superimposed upon chronic areas of linear scar in the mid and lower lungs . lungs are overinflated, suggestive of copd . small pleural effusions are present bilaterally . bones are diffusely demineralized . . congestive heart failure with interstitial edema and small pleural effusions . . hyperinflated lungs, in keeping with known emphysema on prior ct chest of .	Cardiomegaly&&Edema&&Pleural Effusion	13606683	53546263	1a329778-20bfaa24-80dfc02f-7f896fba-39d0dd88
1512	there is now a right ij central venous catheter with tip projecting over the lower svc . remainder of the exam is unchanged noting bilateral parenchymal opacities . there is no pneumothorax . right ij central venous catheter tip projecting over the lower svc .	No Finding&&Support Devices	14851532	59116935	00005197-869d72f3-66210bf4-fa2c9d83-b613c4e7
1513	upright ap view of the chest evaluation of the study is somewhat limited by patient rotationthere are low lung volumes . the cardiac silhouette size is enlarged, similar when compared to the prior study . there is mild pulmonary edema with perihilar haziness and vascular indistinctness, not significantly different when compared to prior study . a small to moderate right pleural effusion is increased when compared to the prior exam . right basilar opacification may reflect atelectasis, though infection cannot be completely excluded . no pneumothorax is present . gaseous distention of the stomach noted . mild pulmonary edema with increased size of small to moderate right pleural effusion and right basilar opacity, possibly reflecting atelectasis but infection is not excluded .	Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia	10532326	52195893	445fdcdb-f4896587-4f3f5bf8-e3a051ad-290f10ae
1514	a mesh stent is seen traversing from the left upper abdomen across the midline and anteriorly . this is not in the esophagus . multiple pulmonary lung metastases are again noted .	No Finding	16773796	53145122	a463b913-a54ea4ef-38bc3985-0d13db59-fa42b204
1515	the heart size remains mildly enlarged . the aorta is tortuous . the patient is status post left lower lobectomy with elevation of the left hemidiaphragm . the left mid posterior chest wall deformity is again demonstrated with associated right basilar opacity compatible with changes from chest wall reconstruction . there is persistent left basilar atelectasis . right lung is clear . no pleural effusion or pneumothorax is definitely visualized . there is no pulmonary vascular congestion . mild degenerative changes are noted in the thoracic spine . similar postoperative appearance of the left chest compared to the recent chest ct without acute cardiopulmonary abnormality .	No Finding	15446959	50714348	e5a35d58-daafa26b-836bd682-17f54c3c-a3f33527
1516	there is increase in moderate left loculated pleural effusion . the left lung opacification has also increased, concerning for worsening infection . right upper lobe scarring is unchanged . there is no pneumothorax . the mediastinal and cardiac contours are normal . by reviewing the initial chest x-ray of , there was scarring in bilateral upper lobes which could either reflect scarring from previous aspiration, but sarcoid could also be a possibility . conclusion . increase in moderate left loculated pleural effusion . . worsening of left lung pneumonia . wet read was done by dr . at pm, .	Pleural Effusion&&Pneumonia	10933609	51115198	16cf598d-2b1a30e2-627a4c64-25720237-cab9c186
1517	there are no new lung opacities . right lower lobe lung nodule measuring mm is stable since the ct scan of . biapical post-radiation changes are also chronic . mediastinal and cardiac contours are stable . there is no pneumothorax or pleural effusion . fusion between the posterior arch of the sixth and seventh right ribs is congenital . conclusion there is no significant change since prior exam . there is no pneumonia .	No Finding	14295224	54583911	a4545835-8e2344ba-657ac4df-46fb4c91-d34c50ee
1518	frontal chest radiograph a right ij and left picc are unchanged in position . an ngt terminates within the stomach . the heart size is normal . the hilar and mediastinal contours are unchanged since the pm . examination . again seen is a lucency across the right minor fissure, representing a small pneumothorax, unchanged in appearance since the prior study . however, there has been an interval increase of a moderate-sized right pleural effusion . the left lung remains clear . a pigtail catheter is positioned at the left lung base . . unchanged small right pneumothorax tracking along the minor fissure . . interval increase of a moderate-sized right pleural effusion since the pm . study . . no left pneumothorax . the initial findings were discussed by dr . with dr . telephone at pm .	Pleural Effusion&&Pneumothorax	16319601	53053588	8511e432-1707518d-687c14ac-488cb51f-b03fb332
1519	two frontal images of the chest were obtained . this exam is limited by underpenetration due to patients body habitus and by rotation of the patient . there is increased vascular congestion since previous imaging . the right ij catheter is seen with the tip in the mid to low svc . no pneumothorax or other complications are identified . the relative radiolucency of the left lung compared to the right lung is likely an artifact secondary to patient rotation . there is no clear evidence of pleural effusion on this exam . cardiomediastinal silhouette is unchanged . worsening pulmonary vascular congestion . new right ij line with tip in the mid to low svc .	Edema&&Support Devices	13473495	55720395	525f290c-cf5cb6e5-11ee38a0-a2a67848-2f55c7df
1520	the tracheostomy tube is in place . there are diffuse bilateral interstitial and alveolar infiltrates, with increased retrocardiac density . there is obscuration of the right hemidiaphragm, which i suspect reflects some layering pleural fluid superimposed on the diffuse process . the cardiomediastinal silhouette is enlarged, but stable . incidental note is made of degenerative changes in both shoulders and in the lower cervical spine . compared with at pm . the overall appearance is similar, though the right hemidiaphragm is less well seen on the current exam .	Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Support Devices	10268877	58694539	939d75ca-033409db-c7d21422-6f4813ef-6ead21a8
1521	severe cardiomegaly is longstanding, though slightly improved since . pulmonary arteries are chronically enlarged indicating pulmonary arterial hypertension . moderate pulmonary edema and small right pleural effusion have increased since . transvenous right atrial and left ventricular pacer and right ventricular pacer defibrillator leads are in standard placements, unchanged . no pneumothorax .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	15207316	54725023	5074824c-4ee15da0-f4e892d3-3ade326d-d8c8c508
1522	portable ap chest radiograph the cardiac silhouette demonstrates borderline cardiomegaly . atelectasis is noted at the right lung base . there is no evidence of focal consolidation, pleural effusion or pneumothorax . the diaphragms appear mildly flattened, and the lungs are hyperinflated, suggestive of copd . known granuloma is again noted within the left upper lobe . the aorta appears tortuous .	Atelectasis	15612622	53971934	fa62fc78-9b66c0fd-aa7ee648-8b82e0fc-b0e5c0d4
1523	there is continued pulmonary vascular congestion . increased opacification at the bases, especially on the right, could merely reflect atelectasis in a patient with low lung volumes . however, the possibility of superimposed aspiration would have to be considered in the appropriate clinical setting . monitoring and support devices remain in place .	Atelectasis&&Edema&&Lung Opacity&&Support Devices	19623993	54806202	34395a9b-ad2db3ef-2c80999f-d0c5077b-42fb9957
1524	there is no longer any pulmonary edema . moderate left and small right pleural effusions are minimally increased since . left lower lobe opacification is more severe, probably atelectasis . the heart is normal size . mediastinal veins are borderline dilated, but the pulmonary vascularity is normal . right jugular line ends in the upper svc and left subclavian line in the lower . no pneumothorax .	Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	15758946	56618601	dbbd8ca0-a3e78630-061e92f4-cc6ea2d3-05314ad2
1525	there is little overall change . again there is moderate pulmonary edema with probable bilateral effusions and substantial volume loss in the left lower lobe . in the appropriate clinical setting, superimposed pneumonia would have to be considered .	Edema&&Pleural Effusion&&Pneumonia	15259244	52488909	2501dbf9-714acd96-ca4fba08-e02967b8-23f99f37
1526	pa and lateral chest radiograph left ventricular pacemaker device is again noted with appropriately positioned right atrial and right ventricular leads . mild cardiomegaly is unchanged from . mild pulmonary venous congestion with cephalization and predominantly perihilar opacities consistent with mild interstitial pulmonary edema appears similar to chest radiograph of . there is no evidence of pleural effusion or pneumothorax . there is linear atelectasis at the left lung base, similar to the prior examination . loss of height of a upper mid thoracic vertebral body is unchanged compared to . findings suggesting mild interstitial pulmonary edema along with mild cardiomegaly and linear atelectasis at the left lung base . no evidence of acute pneumonia or pneumothorax .	Atelectasis&&Cardiomegaly&&Edema	11928692	55947318	2c5c8a39-6ae3dd9e-2b4d5279-6bb07505-1b57f5ab
1527	there is unchanged elevation of the left hemidiaphragm with subsequent decrease in volume of the left hemithorax . otherwise, the lungs are more transparent than on the previous examination, likely to reflect improved ventilation . unchanged mild subpleural scarring bilaterally, but no evidence of acute lung changes . no evidence of larger pleural effusions . no pneumothorax .	Pleural Other	18338007	51131475	52a90633-9e1c7301-df020424-ea6324fd-64b0c5f6
1528	the inspiratory lung volumes are low . the cardiac silhouette is moderately enlarged, but stable from the prior study . the mediastinal and hilar contours are not significantly changed from the prior radiograph allowing for patient rotation on the current examination . no significant pleural effusion or pneumothorax is detected . a small amount of fluid is noted in the right minor fissure . mild pulmonary edema is present . a right dual-chamber dialysis catheter is in position with the tip terminating at the cavoatrial junction or proximal right atrium . the visualized upper abdomen is gasless . mild pulmonary edema . moderate cardiomegaly .	Cardiomegaly&&Edema	13473495	56929753	2386d449-ff60da90-15b0f79f-2a63ae3d-146cb799
1529	the patient is status post cabg with intact sternotomy wires . there is stable mild cardiomegaly . the aorta is tortuous and minimally calcified there is minimal linear atelectasis at the left lung base . there is no airspace consolidation or edema . there is no pneumothorax or pleural effusion . no acute process .	No Finding	16957952	52543396	f6300671-0644a211-45639c11-c0ef0484-67a8c5c0
1530	single frontal view of the chest demonstrates interval placement of a right subclavian approach central venous catheter with tip in the lower svc . there is no pneumothorax . a left pectoral cardiac pacer is stable in location with the leads terminating in the right atrium and right ventricle . the lung volumes are low, accentuating mild pulmonary edema . there is retrocardiac opacity and blunting in the left costophrenic angle which may reflect atelectasis and a small effusion . appropriate central line positioning without pneumothorax . other findings unchanged since preceding exam .	No Finding&&Support Devices	13067703	57241942	72173005-a21c911f-2db2f17d-033364e2-aaee101d
1531	right-sided pleural effusion is again seen largely unchanged . there is left-sided ground glass opacity which has slightly improved consistent with improving pulmonary edema . endotracheal tube is seen in appropriate position, cm from the carina . ng tube is seen entering the stomach and out of field of view . incidental note of right lateral pleural calcification which is better seen on ct imaging . improving pulmonary edema with unchanged bilateral pleural effusions .	Edema&&Pleural Effusion	13078497	55206854	89211728-267e6ae0-5cf3d9d3-8ed03442-8764ee24
1532	following extubation, lung volumes are the same, but atelectasis is worsened at the lung bases, particularly the right . there is no pneumothorax, and small pleural effusions are common . mild increase in borderline cardiac enlargement is also a common sequel to extubation . stomach is moderately-to-severely distended with air and fluid . right jugular sheath ends in the upper svc . was paged at pm . when the findings were recognized .	Atelectasis&&Cardiomegaly&&Pleural Effusion	14851532	58464643	4d43eeba-0e94bfc5-ca416d6f-449ceb69-688d7ae5
1533	compared to chest radiographs since , most recently . heart size top- normal, improved . lungs clear . no pleural abnormality . mediastinal contours explained by benign fat deposition .	Cardiomegaly&&Enlarged Cardiomediastinum	13975291	58907220	496ca4eb-96600429-f794c4d3-8b1b7172-f615041e
1534	the et tube tip is cm above the carina . the temporary pacemaker leads terminate in the expected location of the right ventricle . the patient continues to be rotated . within the limitations, the appearance of the mediastinum is stable . left retrocardiac opacity cannot be excluded, most likely representing atelectasis . right upper lobe opacity is unchanged as well, with atelectasis or infectious process being a possibility . no interval development of pneumothorax or increase in pleural effusion has been demonstrated .	Atelectasis&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	19565388	52284572	d8b4f432-f9b2ab7a-8362727d-579d538a-00b1edd5
1535	subtle basilar opacities seen similar to the prior study may relate to nipple shadows and are not appreciated on the lateral view . no definite focal consolidation is seen . there is no pleural effusion or pneumothorax . the cardiac and mediastinal silhouettes are stable and unremarkable . no acute cardiopulmonary process .	No Finding	16662264	55808828	a0b02b80-6dbd9219-a3aea9eb-20011893-d884618c
1536	the patient is status post coronary artery bypass graft surgery . the cardiac, mediastinal and hilar contours appear unchanged . there is no pleural effusion or pneumothorax . mild background interstitial abnormality appears unchanged without superposition of any discrete focal opacity . findings are very similar to the prior examination . mild interstitial abnormality suggesting pulmonary vascular congestion, but little if at all changed from baseline .	Edema	16957952	52529720	eaf0eb79-03580da7-ae1a0398-5fcef938-acdb31dd
1537	patient has received a new right dual-lumen dialysis catheter through the right internal jugular approach ending at mid svc . bilateral lung demonstrates increased interstitial marking and pulmonary vascular prominence likely from cardiac decompensation . heart size is mildly enlarged, but unchanged to prior studies . small pleural effusions seen on previous radiograph dated have resolved . no pneumothorax . no discrete opacities concerning for pneumonia . mediastinal silhouette is normal . prominent interstitial marking, mildly enlarged heart size and prominent vascular markings likely from cardiac decompensation .	Cardiomegaly&&Lung Opacity	18855147	53815637	482e79ef-a82c1a49-c033fcfb-5111777e-a1d59d81
1538	the heart size is normal . the mediastinal and hilar contours are unchanged and within normal limits . right brachiocephalic venous stent is again demonstrated . lungs are clear and the pulmonary vascularity is normal . no pleural effusion or pneumothorax is present . there are no acute osseous abnormalities . no acute cardiopulmonary abnormality .	No Finding	14744884	53941529	c541b4b9-e18c9d0c-428f0bcd-4b4fcf3c-ca7acd25
1539	there is persistent pulmonary edema present and this is unchanged on the left side and slightly more pronounced on the right as compared to the earlier exam . there is stable cardiomegaly . there is no pneumothorax .	Cardiomegaly&&Edema	15131736	54622603	fe0232d1-c95b0422-80d78fe1-e50e1bd0-85e85cc2
1540	the lungs are clear of consolidation or effusion . right pleural based thickening at the base laterally is again seen . there is no evidence of pulmonary vascular congestion . cardiomediastinal silhouette is stable in . no acute osseous abnormality detected . no acute cardiopulmonary process .	No Finding	10523725	56078456	5c549479-dcb2c159-300ce6a6-b8362dc7-c43d8f1d
1541	there is overall little change compared with prior exam dated with slight decrease in hazy opacification of the right hemithorax and improvement in pulmonary vascular engorgement and small right pleural effusion although this could be attributable to upright positioning of the patient compared to semi erect positioning on the previous study . cardiac silhouette remains moderately enlarged . the right ij central venous catheter is unchanged in position with the tip projecting over the mid svc . mild bibasilar atelectasis is unchanged . little change since prior study with slightly improved appearance of the vascular congestion and right pleural effusion although this could be due to different technique .	Edema&&Pleural Effusion	19182863	55146164	377bdbe0-9a73de16-b40c56a1-d44cdbcc-0051da03
1542	moderately severe pulmonary edema has worsened again . the relatively greater opacification at the right lung base seen previously was due to a combination of edema, atelectasis and right pleural effusion, so it is not necessary to invoke possible pneumonia to explain the current radiographic findings . moderate-to-severe cardiomegaly is chronic . pulmonary vascular engorgement and distention of mediastinal veins have worsened . no pneumothorax . large calcified granulomas longstanding in the upper lungs .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia	12185775	51309585	42a56014-a47bf1c7-ea0611ef-536278b4-881a4f91
1543	there is extensive cardiomegaly which is stable since the previous studies . there is mild pulmonary interstitial edema . there are bilateral pleural effusions, right side worse than left . the right-sided effusion is a layering component along the more medial aspect . there are no pneumothoraces identified . there are extensive degenerative changes of the thoracolumbar spine with loss of vertebral body height and areas of vertebroplasty .	Cardiomegaly&&Edema&&Pleural Effusion	17669276	51318409	4669639e-0eb499f7-605cb393-d4ef9323-7f6c47df
1544	cardiac silhouette size is top normal . mediastinal and hilar contours are unchanged . there is no pulmonary vascular congestion . there is a small right pleural effusion with chronic elevation of the right hemidiaphragm, unchanged compared to the previous exam . right basilar atelectasis is again demonstrated . no left-sided pleural effusion or pneumothorax is present . there are multiple old left-sided rib fractures . multilevel degenerative changes are visualized in the thoracic spine . chronic left ac joint dislocation is re- demonstrated . relatively unchanged exam with continued small right pleural effusion, chronic elevation of the right hemidiaphragm and right basilar atelectasis .	Atelectasis&&Pleural Effusion	13352405	58706366	e25c21c7-070fdd75-c67d52b8-9e091b7c-6c560ed4
1545	as compared to the previous image, no relevant change is seen . status post sternotomy and valvular replacement . borderline size of the cardiac silhouette . mild elongation of the descending aorta . left pectoral port-a-cath . no pneumonia, no pulmonary edema, no pleural effusions . the icd wires are in unchanged position, projecting over the right atrium and over the right ventricle .	Cardiomegaly&&Support Devices	16043637	55214075	8b1136e5-87e823d7-65c62300-10d83255-4f550379
1546	there is a small right pleural effusion with some fluid seen tracking in the minor fissure and which may be partially loculated . scattered patchy opacities projecting predominantly over the right lung raises concern for an infection, less likely asymmetric edema . there is left basilar atelectasis . the lungs are relatively hyperinflated with flattening of the diaphragms, suggesting chronic obstructive pulmonary disease . the cardiac and mediastinal silhouettes are relatively stable .	Atelectasis&&Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Pneumonia	10959054	59557609	d6ee29da-bcb41124-a58ef710-c184f244-9d677f90
1547	ap single view of the chest has been obtained with patient in sitting semi-upright position . comparison is made with the next preceding similar study obtained hours earlier during the same day . there is marked improvement of the previously identified massive pleural effusion occupying major portions of the right hemithorax . new pigtail end small caliber catheter is now seen on the right base and explains the evacuation of the pleural effusion that occurred during the interval . no pneumothorax has developed . the lung parenchyma on the right side appears free as this can be identified by the single ap chest view . on the left side, there is also a small caliber pigtail end catheter in the basal space of the pleura but no evidence of pleural effusion is seen . a previously described left-sided advanced picc line remain in unchanged appropriate position and terminating just cm below the level of the carina . an ng tube remains and is seen to point with the dobbhoff tip towards the pylorus . bilateral small caliber pigtail and pleural drainage lines in place . pleural effusions have practically been eliminated . no pneumothorax .	Pleural Effusion&&Support Devices	16319601	54613857	7776d1fb-792c88a8-721a0773-7d142590-639999fb
1548	comparison to . new platelike atelectasis at the right lung bases . the pre-existing right basal parenchymal opacity is stable . unchanged appearance of the heart and of the left lung .	Atelectasis&&Cardiomegaly&&Lung Opacity&&Support Devices	18309149	59798967	4768d670-31d218ed-86c26700-a7daf75d-5fe57928
1549	ap single view of the chest has been obtained with patient in sitting semi-upright position . position of previously described right-sided picc line is unchanged, seen to terminate in mid portion of svc . no pneumothorax is present . pulmonary congestive pattern as before with perivascular haze and slightly more marked diffuse densities on the left base, similar as it was before . no significant interval change can be identified . no new abnormalities on the right base . stable chest findings, no new abnormalities .	No Finding	13031876	58856677	fd82faa7-31410b18-fae37f67-70086b23-f1ead160
1550	a small to moderate right pleural effusion is not significantly changed compared to the prior radiograph . associated consolidation at the right lung base is likely compressive atelectasis, although infection in this region cannot be excluded . there is a diffuse interstitial abnormality that has increased compared to the prior radiograph, likely mild pulmonary edema . the heart size remains top normal . the mediastinal contours are normal . prominence of the right hilar region is unchanged, compatible with postradiation fibrosis, better evaluated on the ct from . there is no pneumothorax . . unchanged small to moderate right pleural effusion . . right lower lung consolidative opacification, likely compressive atelectasis, although infection in this region cannot be excluded . . mild pulmonary edema .	Atelectasis&&Consolidation&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia	19720782	59642258	74634e78-46bff1c6-0f55af35-ffc09ea6-543ee803
1551	a single portable chest radiograph was obtained . a dobbhoff tube projects over the stomach . the tip is folded back on itself and points towards the body of the stomach . lung volumes are low . retrocardiac atelectasis has increased slightly . no effusion, consolidation, or pneumothorax is present . dobbhoff tube in the stomach . the tip is folded back on itself and points towards the stomach body .	No Finding&&Support Devices	19623993	54350292	da234986-086e6232-706fdd79-a63870a6-7801b85d
1552	a right transsubclavian right atrial pacer and right ventricular pacer defibrillator leads in standard placements, no pneumothorax, pleural effusion or mediastinal widening . previous mild pulmonary edema has improved, moderate-to-severe cardiomegaly has not . there may be a new small left pleural effusion . conventional radiographs recommended when feasible for further evaluation .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	12475198	55620198	da0fe691-6fcfcca4-8246f750-cb8b78a2-eec222bc
1553	left picc is in stable position, tip in the mid svc . there has been interval progression of the bilateral parenchymal opacities more so on the left which appears more confluent in the perihilar region most compatible with pulmonary edema . more dense retrocardiac opacity silhouetting the hemidiaphragm suspicious for superimposed effusion . cardiac silhouette is enlarged but unchanged . progression of pulmonary edema and persistent left effusion . superimposed infection would be difficult to exclude .	Edema&&Pleural Effusion	16855430	58797209	f63472c6-7fff6462-6df9fd25-2705bc5e-08edc54f
1554	portable ap upright view of the chest was provided . midline sternotomy wires are again noted . there is a left chest wall pacer with lead tip in the region of the right ventricle . the heart is top normal in size . the mediastinum is slightly prominent, stable, reflecting an unfolded thoracic aorta . aortic calcifications are present . increased perihilar opacity is noted as well as consolidation containing an air bronchogram within the right upper lobe . findings are concerning for pneumonia . no effusion is seen . there is no pneumothorax . the bony structures appear intact . perihilar and right upper lobe consolidation concerning for pneumonia .	Consolidation&&Pneumonia	13291370	53346804	0dbe8ef1-802b094a-36fae3c2-0d15af98-7a5547ab
1555	tip of the new dobbhoff feeding tube, with a wire stylet in place, ends in the mid-to-low stomach . right internal jugular sheath ends at the junction of the brachiocephalic veins and the right supraclavicular dialysis catheter orifices are in the right atrium . a small-to-moderate right and moderate left pleural effusion are slightly larger than earlier in the day . left perihilar consolidation, probably atelectasis, is unchanged . there is probably no pulmonary edema . no pneumothorax . moderate postoperative widening of the cardiomediastinal silhouette, which progressed after tracheal extubation is stable since earlier in the day, but should be followed to exclude mediastinal bleeding .	Atelectasis&&Consolidation&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	15259244	51427308	cd20a77e-2332eb46-6c09f2d2-e0e8d1d9-8f18baf1
1556	the heart is normal in size . the mediastinal and hilar contours appear within normal limits . there is no pleural effusion or pneumothorax . there is a new opacity in the right lower lobe concerning for pneumonia, superimposed on preexisting patchy medial right middle lobe opacification that appears more chronic, also comparing to , although the lungs had been clear on earlier radiographs from . increasing right basilar opacity worrisome for pneumonia . follow-up radiographs are recommended within eight weeks in order to ensure resolution . if opacification were to persist, then chest ct should then be considered .	Lung Opacity&&Pneumonia	15659181	58778783	7954b023-74e12365-5c4fbe43-07ef3edc-a3caf1df
1557	bilateral apical chest tubes are in place . there is no evident pneumothorax or enlarging pleural effusions . bilateral subcutaneous emphysema has improved on the left . cardiomediastinal contours are unchanged . there are low lung volumes . bibasilar opacities have improved . there are no new lung abnormalities . sternal wires are aligned .	Enlarged Cardiomediastinum&&Lung Opacity&&Support Devices	12736592	59832157	6cae57f0-a273ce3b-37f19db1-4f1b9cd5-6584ad17
1558	all pre-existing parenchymal opacities have completely resolved . the lung volumes are low . borderline size of the cardiac silhouette with no evidence of overt pulmonary edema . no pleural effusions . no pneumothorax .	Cardiomegaly	14794396	51900597	b94eec73-cb649388-7099d440-7f1bbf0c-f1a3b98d
1559	heart size is top-normal opacities in the upper lungs and at the left mid lung field are similar to previous study consistent with chronic areas of scarring with no new consolidations to suggest infectious process . no pleural effusion or pneumothorax has been demonstrate .	Cardiomegaly&&Consolidation&&Lung Opacity	14992360	52523882	690e5219-a0d2190e-2017488b-4a4feda7-4ef08c2d
1560	the patient has been intubated . the tip of the endotracheal tube projects . cm above the carina . the patient has also received a nasogastric tube . the course of the tube is unremarkable, the tip of the tube is not visible on the current image . the right internal jugular vein catheter is in unchanged position . the atelectatic opacity at the right lung base is slightly increasing . there also is a disruption in the air column of the right main bronchus, so that bronchoscopic evaluation or clearance of potentially present mucus might be indicated .	Atelectasis&&Lung Opacity&&Support Devices	11204646	57844625	ae38c715-8eeb617e-ad8ab0a9-9f23fdef-9e43fccf
1561	single ap erect portable view of the chest was obtained . there has been interval placement of a left-sided chest tube which appears to terminate approximately at the level of the medial left diaphragm and may extend to the mediastinum . there has been re-expansion of the left lung with opacity in the left mid-to-lower lung which could be due to pulmonary hemorrhagecontusion, partial collapse, or less likely infection . subcutaneous emphysema is seen along the left chest wall . interval placement of left chest tube with reexpansion of the left lung, with opacityconsolidation in the left mid-to-lower lung fields with shift of the mediastinum to the left may be due to partial lung collapse, although underlying pulmonary contusionhemorrhage is may be present . the left chest tube appears to extend to the level of the medial left diaphragm and may encroach upon the mediastinum . left chest wall subcutaneous emphysema .	Atelectasis&&Consolidation&&Enlarged Cardiomediastinum&&Lung Opacity&&Support Devices	15192710	55815964	8556763c-b1bc6f79-edf4b821-e6261f21-f1f60684
1562	there is stable appearance of the mediastinum and the heart . there is substantial improvement of bilateral bibasilar aeration with decrease in pleural effusion . there is right upper lobe opacity, less pronounced than on the prior study but still present and might reflect area of scarring, although pulmonary nodule not seen on the chest ct due to obscuration by the consolidations might be a possibility and should be followed in three months with chest radiograph . displaced first left rib fracture is redemonstrated . the rest of the ribs do not show substantial evidence of displacement .	Cardiomegaly&&Consolidation&&Enlarged Cardiomediastinum&&Fracture&&Lung Lesion&&Lung Opacity&&Pleural Effusion	13586204	54331436	e9db2620-0e24b6e8-95e9724b-676a2818-20b18e7a
1563	mild-to-moderate cardiomegaly is stable . there has been improvement in now mild-to-moderate pulmonary edema . there is no pneumothorax or enlarging pleural effusions .	Cardiomegaly&&Edema	13896515	58678573	020b5099-d3d7ffdf-de17c3ce-3474f286-010786e6
1564	the heart remains moderately enlarged . the mediastinal contours are unchanged . there is moderate pulmonary edema, similar compared to the prior exam, with a small to moderate left pleural effusion, also relatively unchanged . probable small right pleural effusion is likely present . no pneumothorax is identified . left basilar opacification likely reflects compressive atelectasis . there is no pneumothorax or acute osseous abnormality . moderate pulmonary edema and unchanged small to moderate left and small right pleural effusions . retrocardiac opacity likely reflects compressive atelectasis .	Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion	16855430	54115583	b17112f4-c4b08b8b-00a18968-0495ad7f-80aab2f4
1565	comparison to . no relevant change . the position of the endotracheal tube, of the left central venous access line and of the feeding tube is stable . moderate trach intracardiac atelectasis . mild cardiomegaly . mild pulmonary edema . a pre-existing right lower lung atelectasis has resolved .	Atelectasis&&Cardiomegaly&&Edema&&Support Devices	14841168	50796456	32857e2f-0b7d1d34-77083bdf-dc8f1be8-d456e85c
1566	the ng tube tip is in the stomach, which still has a large amount of air within it . there is volume loss at both bases and a probable small left effusion . there is pulmonary vascular re-distribution and mild cardiomegaly . left subclavian line tip is in the svc .	Cardiomegaly&&Pleural Effusion&&Support Devices	13979643	51912167	72495859-c12db810-4238b6ac-b6d8ab2d-76505b30
1567	ap, lateral, and oblique radiographs of the chest are somewhat limited in the determination of the exact termination point of the right picc, which is difficult to visualize amongst the mediastinal structures . however, it appears to terminate in the lower portion of the svc . there has been marked improvement in the bilateral effusions and heterogeneous opacities when compared to the prior study . prominent interstitial lung markings reflect the patients baseline pulmonary fibrosis . there is no pneumothorax . the aorta is stably tortuous with atherosclerotic calcifications in the arch . . new right picc is difficult to visualize but likely ends within the lower svc . . marked interval improvement in what was likely multifocal pneumonia as well as near complete clearance of the bilateral pleural effusions compared to . . stable interstitial lung markings consistent with chronic pulmonary fibrosis .	Lung Opacity&&Pleural Other&&Pneumonia&&Support Devices	10867202	57163975	97a5f522-bb4f6eac-5f7d4736-30880e7b-872ea26f
1568	heart is upper limits normal in size . the right subclavian vascular stent is unchanged . the lungs are clear without infiltrate or effusion . no significant interval change . no focal infiltrate .	No Finding	14744884	59397956	ef98f5b9-a2a8261a-8138e17e-bc61edb2-729d5908
1569	pa and lateral views of the chest the lungs are clear . there is mild, stable cardiomegaly . there is no pneumothorax or pleural effusion . mild pulmonary vascular engorgement is stable .	Cardiomegaly	14177219	57001920	0e7807f6-04937b8e-ac237c79-1200da23-76b0b8e3
1570	increased focal opacification demonstrated within the left lower lobe in setting of known transbronchial biopsy is likely related to focal hemorrhage superimposed on known area of focal opacificationthough is out of proportion to expected . there is no pneumothorax or pleural effusion . bronchiectasis of the left lower lobe is unchanged . the cardiomediastinal and hilar contours are stable demonstrating mild tortuosity of the thoracic aorta . heart size is within normal limits . incidentally noted is a benign bone island demonstrated within the left humeral head . interval increase in opacification in the left lower lobe that in the setting of known transbronchial biopsy is likely related to hemorrhage superimposed on the known previously noted focal opacification, though aspiration and interval progression of the disease process are also possibilities . no evidence of pneumothorax .	Lung Opacity	15192710	55650924	f65458e7-7ef7e73f-fea3b7ca-40749fee-38fb4aeb
1571	since the prior radiograph there was interval insertion of right internal jugular line with its tip terminating in the level of cavoatrial junction . there is no evidence of pneumothorax or apical hematoma . the et tube tip is . cm above the carina . the replaced mitral valve and the pacemaker leads are in unchanged position . overall there is no change in widespread parenchymal opacities, bibasal atelectasis and pleural effusion .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Support Devices	18322589	51678067	69982ede-6e53070b-c053c36f-4d80ecf2-944f39c4
1572	a port-a-cath terminating in the upper part of the superior vena cava appears unchanged since the more recent of the prior two studies . the patient is status post sternotomy . a calcified prevascular lymph node appears unchanged . the cardiac, mediastinal and hilar contours appear stable . the lung volumes are low . streaky basilar opacity consistent with minor scarring is similar in the lingula . there is no substantial parenchymal opacity . no evidence of acute disease .	No Finding	11413236	58971300	19cd7ef0-e01da8c2-54eba4e0-a3a25327-1ab839b7
1573	no focal consolidation, pleural effusion, or evidence of pneumothorax is seen . mediastinal contours are stable . the hila are less prominent likely due to decrease in previous mild fluid overload . the heart is top normal to mildly enlarged . no acute cardiopulmonary process .	No Finding	18767957	50227249	7618afaf-76046145-f7086e54-e915e61e-1241a1fa
1574	neither on the prior radiograph nor on the current study evidence of pneumothorax is seen on the right side . the patients head obscures the left apex and prevents assessment of that area . bilateral pleural effusions are demonstrated, but there is interval improvement of pulmonary edema . dilated right upper mediastinal contours relate to tortuous vessel as depicted by chest ct obtained at prior to the radiograph .	Edema&&Enlarged Cardiomediastinum&&Pleural Effusion&&Pneumothorax	12952223	54189049	8f77326f-be687abf-b18cafbf-e051af2c-5ec25d49
1575	cardiomediastinal contours are unchanged . the air component of the hydropneumothorax in the right apical region has resolved, now there is only fluid in the pleural space . patient has known severe emphysema . the perihilar opacities have almost resolved . thoracostomy in the right sixth rib is again noted . multiple surgical chains projecting the right hilum . there is no evidence of pneumonia, chf or new lung opacity .	Enlarged Cardiomediastinum&&Lung Opacity&&Pneumothorax	19991135	50634986	d8f5555c-d8bcf97c-3a9d5596-17b9f854-6e15d081
1576	the heart size is unchanged in size, and a left cardiac pacer device is in stable position with its lead in appropriate position . the patient is status post aortic valve replacement and median sternotomy . the lungs are clear of focal consolidation, pleural effusion or overt pulmonary edema . a right picc terminates in the lower svc . no acute cardiopulmonary process .	No Finding	16043637	55430187	5f4fdb1c-97aed97d-fa4a3b1b-9da4ea33-e9df38ee
1577	there is no pneumothorax or pneumomediastinum . the cardiomediastinal silhouette is normal . a small right pleural effusion is unchanged . since the prior radiograph, there has been increased nodular peribronchial opacification, most readily explained by chronic aspiration . mild hazy opacification at the left base is unchanged and likely represents chronic atelectasis . . no pneumothorax or pneumomediastinum . . increasing peribronchial opacification at the right base likely represents aspiration, possibly pneumonia .	Lung Opacity&&Pneumonia	19016834	56761306	460564da-f530de8e-fabb35c1-53d562ae-404235d0
1578	moderate pulmonary edema has worsened and mild-to-moderate bilateral pleural effusions have increased sincen . bilateral lower lung opacities is combination of effusion, atelectasis and pulmonary edema . heart size is normal . bilateral hila are prominent due to an engorged pulmonary vasculature, however, mediastinum is unremarkable . moderate-to-severe pulmonary edema and bilateral mild-to-moderate pleural effusions, increased since .	Edema&&Pleural Effusion	16772702	53060219	ede20c8a-3e1c0c67-30c5c122-dfcf20cc-b8acc6ae
1579	ap upright and lateral views of the chest provided . vascular stents are noted in the left and right brachiocephalic vein . calcifications in the left upper quadrant correspond with the spleen . cardiomegaly is stable with interval increase in bilateral ground-glass opacity consistent with pulmonary edema . subtle nodularity in the right lower lung raises potential concern for a superimposed pneumonia . no large effusion or pneumothorax is seen . the mediastinal contour is stable . mild hilar engorgement is noted . hyperdense appearance of the osseous structures are is consistent with renal osteodystrophy . no free air below the right hemidiaphragm is seen . cardiomegaly, mild edema, with possible superimposed pneumonia .	Cardiomegaly&&Edema&&Pneumonia	19061282	55597534	1cbfd6d5-9adcc975-837ade15-105b6280-655efe4f
1580	pa and lateral views of the chest are compared to previous exam from . right chest wall port is again seen with catheter tip in the lower svc . right-sided pleural catheter is seen which appears to course in the fissure . significant amount of right-sided pleural effusion has slightly increased since prior with fluid also seen within the major fissure . no pneumothorax seen . there is underlying parenchymal opacity as well, potentially atelectasis however, infiltrate is also possible . left lung is grossly clear . cardiac silhouette is enlarged but stable in configuration . osseous and soft tissue structures are unremarkable . increase in size of right-sided pleural effusion with pleural catheter in place . expected associated right base atelectasis with possibility of infection not excluded .	Atelectasis&&Pleural Effusion&&Pneumonia&&Support Devices	16826047	59633653	1d7c427a-6e76e27f-2aa441d5-dc1ce213-c075b375
1581	the lungs appear hyperinflated, but are without consolidation or parenchymal abnormality . the cardiomediastinal silhouette appears unremarkable . no pleural effusion or pneumothorax is seen . bilateral, stable, and symmetric apical pleural scarring is seen . surgical clips are seen in the left upper abdominal quadrant . no acute cardiopulmonary disease .	No Finding	15114531	57132221	38a9b23d-4349cfb4-451a3bfd-346ed01f-b4360327
1582	more dependent distribution of right pleural effusion is due to more positioning of the patient . previously questioned new right upper lobe consolidation is smaller than assumed . moderate cardiomegaly and pulmonary vascular congestion persist . there is probably minimal pulmonary edema . et tube in standard placement . right jugular line ends in the upper svc . nasogastric tube ends at the diaphragm and would need to be advanced at least cm to move all side ports into the stomach .	Cardiomegaly&&Consolidation&&Edema&&Pleural Effusion&&Support Devices	14851532	54548504	3f6f35af-03521081-03baee76-dd388d3b-a0fd1305
1583	there may be some increasing opacification at the right base . it is unclear whether this represents slight increase in pleural fluid or merely difference in patient position . no evidence of pneumothorax . left lung is essentially clear .	Lung Opacity&&Pleural Effusion	16826047	57304735	6d68975e-d2edf733-8d606be2-0293f596-9d2ed6a6
1584	moderate right pleural effusion has improved, pulmonary vascular engorgement has decreased slightly . there is no pulmonary edema or likely pneumonia . moderate to severe cardiac enlargement is stable . no pneumothorax . patient has had three valve replacements . sternal wires are aligned and intact .	Cardiomegaly&&Pleural Effusion&&Support Devices	19182863	59761780	7f83f5d5-3afe2911-3b666b80-5dbde6e1-f2a9d980
1585	ap single view of the chest has been obtained in this patient with semi-upright position . analysis is performed in direct comparison with the next preceding portable chest examination of . status post right upper lobectomy unchanged . cardiac enlargement as before may have even increased slightly . on previous examination identified small caliber pigtail end catheter in the right lateral pleural sinus is still present . the amount of pleural fluid density has increased mildly . no pneumothorax has developed . overall increased hazy appearance of the lung bases coinciding with perivascular haze in the pulmonary vessels is suggestive of increased chf in this patient . no new discrete local parenchymal infiltrates suggestive of pneumonia are identified .	Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	13263843	52138943	de739d0b-2345495b-255f0e3b-00ccbf4c-ab4d3400
1586	lung volumes are slightly low, causing exaggeration of the heart size and accentuation of the pulmonary vasculature . diffuse bilateral interstitial opacities are consistent with mild pulmonary edema . the heart is mildly enlarged, as before . the descending thoracic aorta is slightly tortuous, unchanged . there is a right tunneled ij catheter ending in the right atrium . no pleural effusions . no pneumothorax . stable mid-thoracic compression fracture . . mild interstitial pulmonary edema . . unchanged mild cardiomegaly .	Cardiomegaly&&Edema	13475033	59968351	9eef23a6-9ec5cac1-17521310-3e505395-c63ed35d
1587	frontal and lateral radiographs of the chest were acquired . there is a diffuse interstitial abnormality, with a perihilar predominance, suggestive of mild interstitial pulmonary edema . moderate enlargement of the cardiac silhouette is not significantly changed . a small left pleural effusion is not significantly changed . there is no definite right pleural effusion . the mediastinal contours are unchanged . there is a small hiatal hernia, not significantly changed . there is no pneumothorax . surgical clips project over the upper abdomen on the lateral radiograph . multilevel degenerative changes of the thoracolumbar spine are noted . anterior wedging of a lower thoracic vertebral body is not significantly changed . . mild interstitial pulmonary edema . no focal consolidation . . moderate cardiomegaly, not significantly changed . . unchanged small left pleural effusion .	Cardiomegaly&&Edema&&Pleural Effusion	11512104	51244125	fc2119d4-3818479e-d3d0ace5-6704f713-0a4fd7c0
1588	the previously visible right internal jugular vein catheter has been removed . the patient is still intubated, with an unchanged position of the endotracheal tube, nasogastric tube and the right picc line . unchanged moderate cardiomegaly . unchanged mild-to-moderate right pleural effusion, unchanged mild fluid overload and areas of moderate retrocardiac atelectasis . there is no newly occurred focal parenchymal opacity .	Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices	11204646	54351633	4f7d591a-e6d9f7a8-05c5e886-421a776a-66a7a9eb
1589	previously reported right lower lobe pneumonia has nearly resolved with only mild residual peribronchiolar opacification remaining in the right infrahilar area . a small right pleural effusion has nearly resolved . localized bronchiectasis and scarring in the right upper lobe is similar to older studies . a small nodule at the right lung base is similar to previous ct of . postoperative changes in the chest are similar including post radiation alterations and findings related to previous esophagectomy and pull-up procedure . near resolution of right lower lobe pneumonia . additional followup chest x-ray in weeks may be helpful to document complete resolution or stability of residual right infrahilar opacity .	Pneumonia	14295224	56592251	fd446187-4918e937-9c58f354-86463aca-af75d8a6
1590	the patient is status post right thoracotomy . moderate layering right pleural effusion is present as well as right basilar atelectasis . left lung is grossly clear, but there is an apparent small left pleural effusion . subcutaneous emphysema is present in the right chest wall consistent with recent surgery .	Atelectasis&&Pleural Effusion	11474065	51394568	b0a2d047-4a01cf2e-c1d43e01-61ef7442-722d8f4e
1591	the patient is status post esophagectomy and gastric pull through . the lungs are hyperinflated . there are new patchy airspace opacities in the bilateral lung bases, concerning for aspiration . chronic medial right apex pleural thickening and triangular peripheral interstital opacities in the right mid lung field are again seen . a hazy opacity consistent with chronic scarring related to radiation treatment is again seen in the medial right upper lobe . an mm nodular opacity is again seen within the right lower lobe, unchanged from prior exam . there is atelectasis at the left lung base . a chronic right pleural effusion is again noted . there is no left pleural effusion . cardiomediastinal silhouette is stable . there is no pneumothorax . visualized osseous structures are unremarkable . . new bibasilar patchy airspace opacities, concerning for aspiration pneumonia . . stable right upper lobe radiation treatment related changes and stable right lower lobe pulmonary nodule . . unchanged small right pleural effusion .	Lung Lesion&&Lung Opacity&&Pleural Effusion&&Pneumonia	14295224	50071311	9d610a3e-d49aa652-74dee660-f60d66e8-8cb3cee5
1592	compared to the previous radiograph, the monitoring and support devices are unchanged . a pre-existing right pleural effusion has slightly increased in extent . subsequent areas of atelectasis are bilaterally constant . constant appearance of the cardiac silhouette . no hilar or mediastinal abnormalities .	Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices	12952223	56373739	a19573c3-98f76c03-5552fc10-4d2cb79e-bce663a8
1593	the et tube tip is cm above the carina . the ng tube tip is in the stomach . the right picc line tip is at the mid svc level . cardiomediastinal silhouette is unchanged . there is improvement of left lower lobe atelectasis, but there is progression of left lower lobe predominantly multifocal opacities, highly concerning for infectious process or aspiration . small bilateral effusion cannot be excluded . there is no evidence of pneumothorax .	Atelectasis&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	13031876	52544398	e710f16b-2b715eb0-92032ee6-259afceb-f365ac9a
1594	an opacity at the base of the right lung is not similar in appearance to chest radiograph on and may represent overlapping structures . however, an opacity in the retrocardiac clear space on the left is new . additionally, there is an opacity at the left posterior costophrenic the cardiomediastinal silhouette and hilar contours are normal . there is no pneumothorax . sternotomy wires and surgical clips are again seen and not significantly changed in appearance . left basilar opacity which could be compatible with infection . recommend repeat imaging after treatment . if no clincal concern for infection, consider chest ct for further evaluation .	Lung Opacity&&Pneumonia	17962324	59875098	9188d253-7432f199-b8668189-c4b015e6-24ed4f79
1595	comparison is made to previous study from . there is a right-sided central venous line with distal tip at the cavoatrial junction . there is a feeding tube whose distal tip is below the ge junction . there is air-fluid level projecting over the right lower lobe consistent with the patients known empyema . the pigtail catheter at the right base is no longer seen . there is also a left-sided small pleural effusion . no pneumothoraces are seen .	Pleural Effusion&&Support Devices	14387068	55693842	839ef707-03863b69-f7079a97-b5b91539-90449683
1596	the sharp pleural line is no longer seen in the left apical region . there may be a residual tiny pneumothorax in the left apex . continued enlargement of the cardiac silhouette . mild indistinctness of pulmonary vessels suggests some elevated pulmonary venous pressure . retrocardiac opacification persists, consistent with some volume loss in the lower lobe . overlying wires obscure the lower portion of the right hemithorax .	Cardiomegaly&&Edema&&Lung Opacity&&Pneumothorax	19182863	58756659	2fc29ea1-355cc172-27d15937-3df170a0-932a4069
1597	the endotracheal tube is too high, at the thoracic inlet . this finding was called to the ccu nurse, at pm . at the time of dictating this report by dr . . otherwise, the appearance of the lungs is unchanged . pacemaker and left ij line are unchanged .	No Finding&&Support Devices	10886362	50301215	60c60c6e-1471b41d-d8ae011a-299592ea-7c39d5e7
1598	comparison is made with prior study performed eleven hours earlier . there are lower lung volumes . bibasilar opacities are worsened, consistent with worsening pleural effusions and adjacent atelectasis . moderate pulmonary edema is stable with no pneumothorax . cardiomegaly is unchanged . right hd catheter is in unchanged position .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	15259244	58464159	93c7dad2-501ec9ee-b423b86d-71f2b828-1e3f0573
1599	left-sided chest wall pacemaker appears in unchanged position, with leads terminating in the right ventricle and lead terminating in the right atrium . there is mild cardiomegaly, stable as compared to prior examination . there is redemonstration of prominent interstitial markings and mild hilar engorgement, which could be secondary to mild pulmonary edema . no new focal consolidation concerning for pneumonia . there is no large pleural effusion or pneumothorax . there is redemonstration of right upper lobe scarring and upper zone lucency, reflecting known emphysema . a curvilinear lucency at posterior to the sternum on the lateral view may reflect a small pneumothorax . nodular opacity in the left mid lung is stable since . no acute osseous injury . . equivocal small right pneumothorax . short-term followup upright chest radiograph or ct recommended . . unchanged mild pulmonary edema superimposed on a background of moderate emphysema . no focal consolidation . with dr .	Edema&&Pneumothorax	14992360	53426027	75dba8a3-5f23d588-d3d4556c-daef69cf-8ed524b4
1600	there is substantial interval increase in right pleural effusion . there is also interstitial pulmonary edema that appears to be more pronounced . there is no pneumothorax . cardiomediastinal silhouette is unchanged . left internal jugular line tip is unchanged in appearance located within the persistent left svc . prominence of the pulmonary artery is re-demonstrated consistent with pulmonary hypertension .	Edema&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	19182863	50878394	be5e433f-dac94987-b9ea5176-f3dc3125-517fe63d
1601	widening of the upper mediastinum to the right of the midline could be due to fluid filling in the esophagus, drained by an upper alimentary tube, ending in the lower third of the right paramedian mediastinum . et tube is in standard placement . lungs are well expanded . pulmonary edema is mild . extensive subcutaneous emphysema can be a normal finding this early after this type of surgery . there is no pneumothorax . the heart is normal size .	Edema&&Enlarged Cardiomediastinum&&Support Devices	16848073	56216095	cadd4a61-f20934b5-eb57e9f4-3b4f3b61-8718edab
1602	et tube is present . the tip is obscured but appears to lie in satisfactory position above the carina . an orogastric-type tube is present, tip extending beneath diaphragm off film . left ij central line tip overlies proximal svc . a dual-lumen right ij catheter appears to overlie the distal svc and svcra junction . no pneumothorax is detected . suspect background copd . heart size is borderline with left ventricular configuration . there is upper zone redistribution, without overt chf . there is increased retrocardiac opacity, with partial obscuration of the diaphragm, consistent with left lower lobe collapse andor consolidation . probable small left effusion . there is also a small right effusion with a small amount of associated collapse andor consolidation . compared with at pm, the pleural-parenchymal findings are quite similar, possibly minimally improved at the right base . the radiopaque tip of the dobhoff-type tube has been advanced and now extends off the film .	Atelectasis&&Cardiomegaly&&Consolidation&&Lung Opacity&&Pleural Effusion&&Support Devices	11880923	50164479	e3e38420-1d7a57bd-dd17b115-35334f4f-c3d1695b
1603	there are new bilateral small pleural effusions and areas of bilateral parenchymal opacities at the lung bases . these changes are suggestive of atelectasis rather than pneumonia, given the symmetry of the appearance . however, close monitoring with radiographs should be performed . an apparent enlargement of the aortic knob is caused by the change in the patients head position . however, this change should also be received close attention on radiographic monitoring to be performed in the next hours . at the time of dictation and observation, am, on , the referring physician, . , was paged for notification .	Atelectasis&&Lung Opacity&&Pleural Effusion	19150427	52424977	1788a491-dde38c10-84084270-8ac256d3-7f69a1f6
1604	there is an increase in interstitial markings and an increase in diameter of the pulmonary vasculature . in conjunction with the increased cardiac silhouette, these findings are suggestive of mild to moderate pulmonary edema . the presence of a minimal left pleural effusion cannot be excluded, given blunting of the left costophrenic sinus . at the time of observation and dictation, am, the referring physician . was paged for notification, on . given that no lateral radiograph was performed, the compression fractures cannot be evaluated . the findings were discussed over the telephone at am .	Cardiomegaly&&Edema&&Fracture&&Lung Opacity&&Pleural Effusion	13978244	55677495	cddeb4e3-ad72632a-69704edb-de0e13c2-5df7f092
1605	a known mass in the left upper lobe is not clearly identified . no new opacity pulmonary edema, pleural effusion or pneumothorax . the cardiac and mediastinal contours are stable . no new opacity concerning for infection .	Lung Opacity&&Pneumonia	13450581	50580104	92a1d719-e7404cd8-e6e9d5c1-fce29388-120afc34
1606	moderate left pleural effusion is considerably smaller than it was on , and mild interstitial pulmonary edema has improved . the postoperative enlargement of the cardiomediastinal silhouette has also improved . tip of the et tube at the thoracic inlet, is probably in standard placement . upper enteric drainage tube passes into the stomach and out of view . swan-ganz catheter ends in the proximal pulmonary artery . transvenous right atrial and right ventricular pacer leads in standard placements . no pneumothorax .	Edema&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	19075045	52664853	f90cf339-aa7d8134-75731035-a7d65403-efba5d83
1607	one portable view . comparison with the previous study done . bilateral pulmonary opacities and pleural thickening andor fluid are re-demonstrated . the heart and mediastinal structures are unchanged . a right internal jugular catheter remains in place .	No Finding	15809646	58808413	2756fb1d-45bdeff0-4f3cab91-67c49af9-04c378d9
1608	multifocal parenchymal opacities, predominating on the right at the level of the hilus as well as in the retrocardiac and left lateral basal lung areas . the concern for multifocal pneumonia must be raised . in addition, a small left pleural effusion could be present . moderate cardiomegaly, no pulmonary edema . right internal jugular vein catheter in situ . no pneumothorax .	Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	15792940	52559222	e1b1e9b3-4c57d726-b37866dd-872d5448-027a7484
1609	cardiac silhouette remains mildly enlarged with dual-channel pacer and prosthetic aortic valve in a patient with intact midline sternal wires . no evidence of pulmonary vascular congestion, acute pneumonia, or pleural effusion at this time .	Cardiomegaly&&Support Devices	16043637	50063962	bc34419f-ff9f5a7d-e909fa2f-7f6b33c4-80d138b8
1610	on upright portable chest radiograph there is continued increased lucency of the right upper lung however, the pleural fold is no longer evident . there is persistent bilateral subcutaneous gas in the soft tissues of the neck as well as persistent trace pneumomedistinum at the level of the trachea . lungs are clear . no pleural effusion . cardiac and hilar contours are unremarkable . equivocal findings of right pneumothorax . persistent pneumomediastinum or subcutaneous emphysema .	Pneumothorax	16319601	59825509	4598aebc-969c6b3b-a13242a3-a9bd01f3-b870c101
1611	sternotomy wires are unchanged . the heart and mediastinal contours are within normal limits and stable . there has been interval decrease in a left-sided pleural effusion with some persisting left basilar atelectasis . the right lung is clear . a line between the posterior aspects of the left third and fourth rib space is more compatible with a skin fold rather than the visceral pleura of the lung, so pneumothorax is not favored . however, given the recent instrumentation, if growing clinical concern for pneumothorax exists, short-interval followup may be considered .	Atelectasis&&Pleural Effusion&&Pneumothorax&&Support Devices	12538508	55670303	4639cd47-e73a89d3-48315552-a87979a8-7dd4f191
1612	mild pulmonary edema has improved . new right pleural drain, following sternal debridement . small bilateral pleural effusions and severe left lower lobe atelectasis unchanged . heart size normal . et tube, swan-ganz catheter, upper enteric drainage tube, midline drains in standard placements . no pneumothorax .	Atelectasis&&Edema&&Pleural Effusion&&Support Devices	14851532	55244705	1cbf90c3-079d9678-607bf65b-a3840c0f-02de10b9
1613	there is mild fluid overload and a plate-like atelectasis at the left lung bases that has minimally increased in extent . the pre-existing minimal left pleural effusion is unchanged . unchanged course of the nasogastric tube . no pneumothorax .	Atelectasis&&Pleural Effusion&&Support Devices	16853729	56382918	98bd2c4d-e47c5249-9e187925-65a4159d-5fb2cc1e
1614	no focal consolidation, pleural effusion, or evidence of pneumothorax is seen . the cardiac and mediastinal silhouettes are stable . no acute cardiopulmonary process . no significant interval change .	No Finding	16524406	54562273	db019b7e-d9ed7caa-dce2242f-4d94ffd2-276acfb6
1615	the patient has taken a better inspiration . the enlargement of the cardiac silhouette persists with mild to moderate pulmonary edema and right pleural effusion with volume loss in the right middle and probably right lower lobes . the swan-ganz catheter is unchanged, with the tip projecting beyond the mediastinal border . it could be pulled back approximately cm for more optimal positioning .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	14851532	55657134	15f947b4-1be82012-29928936-17ccf8d3-135a3760
1616	ap semi upright and lateral views of the chest provided . midline sternotomy wires again noted, the majority of which are extensively fragmented, unchanged . there is no focal consolidation concerning for pneumonia . no large effusion or pneumothorax . no signs of congestion or edema . there is a linear density in the left mid lung which could represent a focus of scarring or atelectasis . chronic left rib deformities are again noted . no free air below the right hemidiaphragm . clips in the right upper quadrant noted . as above .	No Finding	19499595	55609137	c04f1959-6d763649-3561d2d3-baf924f7-bac2214b
1617	on the initial image, the dobbhoff tube tip is seen in the mid portion in the esophagus . on the second image, the dobbhoff tube has been advanced and is appropriately sited within the fundus and body of the stomach . there are old healed rib fractures on the right side . there is some atelectasis and some increased density at the left lung base . no pneumothoraces are seen . cardiac size is within normal limits .	Atelectasis&&Fracture&&Lung Opacity&&Support Devices	11906222	57232140	64927291-fe42a66c-af054049-3d17501b-5de4163c
1618	the patient has received a new orogastric tube . the course of the tube is unremarkable, the tip of the tube projects over the middle parts of the stomach . there is no evidence of complications . the other monitoring and support devices are in unchanged position . the massive bilateral lung abnormalities are constant in appearance .	No Finding&&Support Devices	13964474	51102601	01eaece3-70d48ee8-709d04c6-967fa1f4-a486c1fb
1619	comparison is made to the patients previous studies dated at . . left-sided nerve stimulating device remains in place . there has been interval removal of the right chest tube, where there is a stable small right apical pneumothorax . patchy opacities in the retrocardiac region as well as in the right upper and lower lung are likely unchanged given differences in technique . no pleural effusions are seen . overall, cardiac and mediastinal contours are stable . no evidence of pulmonary edema .	Enlarged Cardiomediastinum&&Lung Opacity&&Pneumothorax&&Support Devices	17112432	50407173	2a0ce644-defed4a1-f1d778d7-8da5ba60-b5d8e243
1620	heart size is normal . the mediastinal and hilar contours are unchanged . dense atherosclerotic calcifications are noted at the aortic knob . atelectasis is noted in the lung bases without focal consolidation . mild elevation of the right hemidiaphragm is chronic with lateralization of the diaphragmatic apex, likely attributable to the presence of a small subpulmonic effusion . no pneumothorax is present . there is no pulmonary vascular congestion . diffuse gaseous distention of bowel loops are seen in the upper abdomen . posterior fixation hardware is noted within the thoracic spine with re- demonstration of diffuse osteopenia and multiple compression deformities . small right pleural effusion . no acute cardiopulmonary abnormality otherwise demonstrated .	Pleural Effusion	14353044	50710771	746e9051-aea1fe10-f765dc71-17daa29f-ae4a658d
1621	large fluid or pneumothorax on the right with air-fluid level in the posterior aspect of the lung . massive generalized right-sided pleural thickening with slight decrease of the right hemithorax . fibrotic changes of the lung parenchyma . on the left, there is no abnormality of the pleura or lung parenchyma . the left aspect of the heart border is unremarkable .	Cardiomegaly&&Pleural Other&&Pneumothorax	11569093	59718086	3e6f368b-a8391960-74c08b06-25d8dafc-0c6e61fe
1622	lung volumes are low . extensive bilateral opacities are unchanged from the prior examination and likely reflect the patient underlying severe interstitial lung disease . there is possibly increased opacification of the right lower lung, which may represent mild edema . hilar and cardiomediastinal contours are unchanged . calcification of the aortic arch is noted . there is no pneumothorax . there is no pleural effusion . minimally increased opacification of the right lower lung may reflect mild edema superimposed on chronic severe interstitial lung disease .	Edema&&Lung Opacity	10867202	51723789	bcb5e90b-c7d3f928-7bd202ee-4e772a8f-e2240e90
1623	 . new right upper lobe collapse and worsening pulmonary edema . this was discovered and called to dr . on at am . . multifocal pulmonary opacities may represent pneumonia or hemorrhage . . innumerable metastatic pulmonary nodules .	Atelectasis&&Edema&&Lung Lesion&&Lung Opacity&&Pneumonia	12702423	53164365	25449c50-88b4c67a-5aab7423-4c477c4b-843d4f4c
1624	ap, upright and lateral views of the chest were provided . lung volumes are low, though there is evidence of pulmonary edema . small effusions are difficult to exclude . the heart is impossible to assess . previously noted endotracheal tube and ng tubes have been removed . the imaged osseous structures are intact . pulmonary edema with probable small bilateral effusions . limited exam .	Edema&&Pleural Effusion	15131736	59361128	d8fc9055-45df8285-80757692-6ab96494-af6f56a0
1625	et tube is not visualized on this study . temporary pacemaker is seen with lead in the right ventricle . since prior radiographs, lung volumes are low . opacity at the left base may represent atelectasis and small effusion . opacity at the right upper lung is improved . no pneumothorax . the cardiomediastinal silhouette is unchanged .	Atelectasis&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Support Devices	19565388	58204690	fbd637bc-15953c2d-d5c723d3-e8c2ba4f-c1103de6
1626	 . nerve stimulating device is seen overlying the lateral left upper lung . right apical pneumothorax appears stable . patchy opacities in the right upper lobe in the right mid and lower lung are unchanged, which could reflect resolving contusions, although pneumonia cannot be entirely excluded . the left lung is essentially clear with the exception of a linear opacity in the retrocardiac region which may represent an area of subsegmental atelectasis or scarring . no evidence of pulmonary edema . no pleural effusions . multiple right-sided rib fractures with associated pleural thickening are again noted .	Atelectasis&&Fracture&&Lung Opacity&&Pleural Other&&Pneumonia&&Pneumothorax&&Support Devices	17112432	56998267	be319f71-2b1ab302-55580f5d-ffc6e9e0-9e90689a
1627	midline sternotomy wires and mediastinal clips are again noted . there is a right chest wall port-a-cath with its tip in the mid svc . a calcific density in the region of the ap window corresponds with a calcified lymph node on prior ct . lung volumes are low limiting evaluation . there is bibasilar atelectasis with bronchovascular crowding . no convincing signs of pneumonia though evaluation is limited . no large effusion or pneumothorax . heart size is difficult to assess . mediastinal contour is stable . bony structures are intact . limited exam with given low lung volumes with bibasilar atelectasis, difficult to exclude a superimposed pneumonia .	Atelectasis	11413236	51499550	d40ff923-1ae1c675-0bf6d047-42ce5585-8d8da7bb
1628	there is no change in the left pneumonectomy space which remains full of fluid . more superior posterior appciyt may represent debris or clot . there is stable shift of mediastinal structures to the left . the right lung is clear and hyperexpanded . mediastinal clips and left subcutaneous emphysema are unchanged . expected post-operative appearence of maturing pnuemonectomy space .	No Finding	12410066	55755138	b3c74d2a-5af41aa3-b45b6c26-d2267e9d-7c4138ac
1629	chronic left-sided rib fractures are again noted . the cardiomediastinal and hilar contours are unchanged from . pleural thickening and blunting at the right costophrenic angle is again demonstrated, and is stable from the prior exam in and likely represents pleural scarring and a small pleural effusion . no focal consolidation or pneumothorax is identified . multiple chronic appearing left-sided rib fractures . no pneumothorax . blunting of the costophrenic angle on the right likely represents pleural scarring and a small effusion, not significantly changed from .	Fracture&&Pleural Effusion&&Pleural Other	13352405	53780576	bced25e3-835951a9-cb1436cd-d095e342-730a3489
1630	comparison is made to previous study from . there is unchanged cardiomegaly . there are again seen bilateral pleural effusions, right side worse than left . underlying consolidation at that location cannot be excluded . effusion on the left has improved slightly . there is some mild prominence of pulmonary interstitial markings without overt fluid overload . no pneumothoraces are seen .	Cardiomegaly&&Consolidation&&Lung Opacity&&Pleural Effusion	19182863	58589640	e8721312-3402fc01-b4761c82-db71f1ea-afe8e0c2
1631	compared with at pm, there is slight increased hazy opacity at right greater than left bases, atelectasis . attention to these areas on followup films is recommended to exclude early pneumonic infiltrates . the cardiomediastinal silhouette and upper zone redistribution are unchanged . bilateral pigtail type catheters are present . no pneumothorax or gross effusion is detected on either side . there is elevation of the right hemidiaphragm, more pronounced than on the earlier film . a dobbhoff-type tube is present, radiopaque tip overlying the stomach . a left subclavian picc line tip overlies the distal svc .	Atelectasis&&Enlarged Cardiomediastinum&&Lung Opacity&&Support Devices	16319601	58441911	70436a46-05756b2a-02e507fa-d6b6c39f-0770f3ca
1632	the opacification at the right base has decreased . this could reflect improving effusion and atelectasis, or merely be a manifestation of a more upright position of the patient . otherwise, little change .	Atelectasis&&Lung Opacity&&Pleural Effusion	19016834	53078046	f0b2495b-1f5bba25-28b2aff5-41d9fd3a-a364895f
1633	lung volumes are lower, small to moderate right pleural effusion and atelectasis in the right middle and lower lung zones have worsened . greater widening of the upper mediastinum could be due to distention of the neoesophagus . no pneumothorax . right pleural tube in place . subcutaneous emphysema in the right chest wall is probably improving since . mild-to-moderate pulmonary vascular engorgement is best appreciated in the left lung, increased since . nasogastric tube ends at the level of the diaphragm . right pleural tube unchanged in position . mild cardiomegaly stable . no pneumothorax .	Atelectasis&&Cardiomegaly&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	16848073	57279525	414e1798-ab5aec7c-6beacfd6-c951f535-2bc666eb
1634	heart size and mediastinum are unchanged in appearance . interval decrease in right pleural effusion is demonstrated . no appreciable pneumothorax is seen after this study .	Cardiomegaly&&Enlarged Cardiomediastinum&&Pleural Effusion	13263843	51477948	62ead2ae-e6300763-500bb324-bc688f11-0083ba24
1635	there is continued enlargement of the cardiac silhouette with increasing pulmonary edema . retrocardiac opacification again is consistent with volume loss in the left lower lobe with probable pleural effusion .	Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion	15131736	50725635	734c67d2-b59dd146-cf5a3db9-59c50b7d-f735c758
1636	there is no acute findings . there is no pneumonia . stability of the right middle lobe calcified nodule . there is no pneumothorax and no pleural effusion . the cardiac and mediastinal contours are stable . consolidated fracture of the axillary portion of the seventh right rib degenrative changes of the right shoulder . conclusion there is no pneumonia .	No Finding	19928916	53913561	585dc46b-7d735766-e8302451-9285b2c6-eb6c295a
1637	a single portable ap chest radiograph was obtained . the tip of a dobbhoff catheter projects over the stomach . the tip of a right picc line ends in the low svc . there is interval improved aeration of lungs with persistence of a right basilar loculated hydropneumothorax . a pigtail catheter remains in unchanged position . there is a small left pleural effusion . . dobbhoff tube in the stomach . . unchanged right basilar loculated hydropneumothorax .	Pneumothorax&&Support Devices	14387068	58866273	95aeb67d-dda857ec-1fa24d4f-f0b7d118-eaf906ea
1638	when compared to previous exams, there has been no significant interval change . right-sided chest tube remains in place . loculated fluid seen laterally similar to prior ct as well as within the major fissure where the chest tube is located . underlying parenchymal opacity again noted and based on scout film from prior ct has not significantly changed . there is no left-sided pleural effusion . focal left midlung opacity is unchanged from prior . cardiomediastinal silhouette is difficult to adequately assess given obscuration of the right heart border . no acute osseous abnormalities detected . no definite interval change .	No Finding	16826047	56433442	d263e868-0cc6db67-58f15831-a2a8a9ac-4c59911c
1639	presenting with fevers and cough . comparisons chest radiograph from the back to . pa and lateral views of the chest there is a greater degree of right lower lobe consolidation which, in comparison to the radiographs, obscures the right hemidiaphragm to a greater degree . there is overlying right basilar atelectasis . the right hemidiaphragm is staby elevated . the remainder of the right lung is clear . there is stable left basilar atelectasis, but the left lung is otherwise clear . the hilar and cardiomediastinal contours are normal . there is no pneumothorax or pleural effusion . pulmonary vascular markings are normal . opacification of the right lower lobe consistent with atelectasis and, given the clinical presentation, aspiration pneumonia is probable . findings communicated to dr . by dr . telephone on at am .	Atelectasis&&Lung Opacity&&Pneumonia	19565653	58125581	060cf092-fe76bdf7-19fee515-26cbef2c-5c16ba6f
1640	ap view of the chest . a temporary pacemaker lead is unchanged and in appropriate position . mild cardiomegaly is unchanged . no focal consolidation, pleural effusion or pneumothorax . temporary pacemaker lead is in appropriate position . no acute cardiopulmonary process .	No Finding&&Support Devices	12475198	58387960	8f34e6a7-a9a93480-381afaf2-33925be7-c183ae6f
1641	the patient is status post median sternotomy . the cardiac and mediastinal silhouettes are stable . no focal consolidation, pleural effusion, or evidence of pneumothorax is seen . evidence of dish is seen along the thoracic spine . no acute cardiopulmonary process . no significant interval change .	No Finding	17318449	54809707	80b3c768-af7774d2-b929f0f3-cc00f7e1-a8bb88eb
1642	new right lung opacities, a represented as multiple pulmonary nodules, highly concerning for aspirationpneumonia . bleeding would be less likely . rest of the findings are unchanged .	Lung Lesion&&Lung Opacity&&Pneumonia	11474065	55048341	e0e15315-038cc10d-12da55fb-533193ff-f67ce0bd
1643	the previously seen left lower lobe opacity has resolved . there is no new focal consolidation, pleural effusion, or pneumothorax . the cardiomediastinal silhouette is normal . there are no acute bony findings . resolved left lower lobe pneumonia . no new acute cardiopulmonary process .	Pneumonia	18343726	53012323	ceb97930-fe5ec7d6-6ee4c8aa-56e46341-d0fbfd43
1644	frontal radiograph of the chest . compared to the prior study, the patient has been extubated . there is no change in the right internal jugular central venous catheter . enteric tube has been removed . marked cardiomegaly is unchanged with pericardial effusion noted on recent ct . widened mediastinum is unchanged . degree of bilateral pulmonary vascular congestion and increased interstitial markings indicative of pulmonary edema is unchanged . left lower lobe ateleftasis or pneumonia, opacity . interval extubation and removal of enteric tube with unchanged severe cardiomegaly, moderate pericardial effusion, and moderate pulmonary edema .	Cardiomegaly&&Edema	14727722	59816233	5e2919b3-f5b224d9-f8a61359-61a65dbd-1f996976
1645	small bilateral pleural effusions, including a fissural component in the right major fissure, have increased slightly since . there is no pulmonary edema and no pneumothorax . moderate-to-severe enlargement of the cardiac silhouette is chronic and unchanged . there is no appreciable pulmonary vascular engorgement . a dual-channel right supraclavicular dialysis set ends in the right atrium, and left picc line ends low in the svc .	Cardiomegaly&&Pleural Effusion&&Support Devices	15259244	57809151	76ee4972-231e2314-e4e35ff5-8d2cd919-a98450dd
1646	endotracheal tube terminates . cm above the carina . nasogastric tube terminates within the body of the stomach . right internal jugular catheter ends in the lower svc . previously described right upper lung opacity is less conspicuous than on the prior . bibasilar opacities are larger and could reflect atelectasis or an aspiration event . worsening infection cannot be excluded . small left pleural effusion is likely also present . the heart is normal in size, normal cardiomediastinal silhouette . slight improvement of right upper lung opacity with increased bibasilar opacities possibly reflecting atelectasis or aspiration though worsening infection cannot be fully excluded .	Atelectasis&&Lung Opacity&&Pneumonia	12966004	55553875	d506da5a-b2dad80c-f31e282e-15154de3-b4385bea
1647	since the prior studies, there is reaccumulation of the right pleural effusion, at least moderate . post-sternotomy wires in a patient with history of replaced aortic and tricuspid valve are noted . there is no evidence of failure . the heart size and mediastinum are stable . no left pleural effusion is noted . no pneumothorax is seen . note again is made that there is unchanged appearance of displaced fractures of first, second, and third ribs on the left .	Cardiomegaly&&Enlarged Cardiomediastinum&&Fracture&&Pleural Effusion	19182863	54545153	c77042ae-4fa479fe-d1c13bb4-d811b2ee-781bb3a8
1648	there is interval increase in bilateral upper lobe opacities, right greater than left . evidence of scarring is again seen with retraction of the hila bilaterally . no large pleural effusion or pneumothorax is seen . evidence of a left-sided rib fracture is again seen, although not well evaluated . cardiac and mediastinal silhouettes are stable . interval increase in bilateral upper lobe, right greater than left opacities raises concern for infectious process superimposed on chronic changes .	Lung Opacity&&Pneumonia	10933609	50289849	ed54d9af-c03fa3e8-2c18f99d-c0c65bc5-98bf2656
1649	ng tube tip is in the stomach . right internal jugular line tip is at the level of lower svc . distended stomach bubble is present . small to moderate right pleural effusion is present, unchanged . mild interstitial pulmonary edema is unchanged th .	Edema&&Pleural Effusion&&Support Devices	14851532	53685384	d3033719-9b507af8-6e6975ac-c32ea556-6f68613d
1650	right internal jugular line has been pulled back to the distal svc . mild edema still present in both lungs along with mild cardiomegaly and mediastinal vascular engorgement . more discrete consolidation in the right lower lung, where there is also a clear atelectasis, and in the infrahilar left lower lobe could be due to concurrent pneumonia .	Cardiomegaly&&Consolidation&&Edema&&Pneumonia&&Support Devices	15321868	53118049	5ad9e573-14e0965d-8b13a6a1-42aa4edf-949f7839
1651	there is no evidence of focal consolidation . there is left lower lobe atelectasis . there is no pleural effusion or pneumothorax . the cardiac and mediastinal contours are normal . no acute cardiopulmonary process .	No Finding	13700088	54082940	a0a7577d-53a8748e-450244b3-39cec864-8a18f0cf
1652	pain status post median sternotomy and cabg . several fractured wires are again seen . the cardiac silhouette remains top-normal to mildly enlarged . the lungs are clear without focal consolidation . no pleural effusion or pneumothorax is seen . no acute cardiopulmonary process .	No Finding	19499595	51527425	84dac834-d9f40739-755532a0-1ddab50a-cae07005
1653	the lung volumes have increased . there is unchanged evidence of mild interstitial fluid overload . unchanged size of the cardiac silhouette . no pleural effusions . unchanged position and course of the right double-lumen catheter .	Cardiomegaly&&Support Devices	18855147	54043642	b361a1e1-b9c3ab9d-c2cc8344-2903cfd8-3888d7b9
1654	this radiograph was obtained for purposes of assessing a dobbhoff tube placement . the tube is identified to the level of the distal stomach, but the radiograph does not include the lower abdomen, and the tip cannot be visualized for this reason . additional abdominal radiograph may be helpful for this purpose if warranted clinically . exam is otherwise remarkable for moderate partially layering pleural effusions bilaterally, with adjacent lower lobe atelectasis andor consolidation .	Atelectasis&&Consolidation&&Pleural Effusion&&Support Devices	13881772	57160250	db9446ce-77c54de3-b0148302-3a4c913e-fe9db438
1655	allowing for differences in technique and projection, there has been little change in the appearance of the chest since the recent study of one day earlier . widespread heterogeneous areas of consolidation continue to affect the right lung more than the left . there has been slight worsening in the right lung base with otherwise no relevant changes .	Consolidation	12475198	50620952	dca8209b-bd3fa52c-e5ca606b-9a0cfd8f-006336b3
1656	the cardiomediastinal silhouette is prominent but stable . the cardiac silhouette is enlarged with prior coronary stenting noted . calcification at the aortic knob is unchanged . a large bore left-sided central venous catheter is unchanged in position with the tip terminating in the right atrium . the pulmonary vasculature is prominent with mild interstitial pulmonary edema, slightly improved from . there is increased right perihilar opacification from the most recent prior study also likely due to pulmonary edema . streaky opacities at the bilateral lung bases most likely reflect atelectasis however, superimposed infection is not excluded in the appropriate clinical context . there is a small right pleural effusion . no pneumothorax detected . radiopaque densities projecting over the left lateral lung base are likely external to the patient . there is no evidence of free air beneath the right hemidiaphragm . . mild pulmonary edema . increased opacification at the bilateral lung bases may be related in part to dependent pulmonary edema and atelectasis . . no widening of the mediastinum . stable cardiomegaly .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity	17340686	50602713	09248f93-7275a552-c55b735a-29981340-e0b66153
1657	frontal and lateral radiographs of the chest were acquired . multiple ekg leads project over the chest wall on both radiographs . a ventriculoperitoneal shunt courses along the right cervical and thoracic region, extending out of the field of view inferiorly . the lungs are clear . the heart size is normal . the mediastinal contours are normal . there are no pleural effusions . no pneumothorax is seen . multiple old right-sided rib fractures are redemonstrated . a severe compression deformity of a mid thoracic vertebral body is not significantly changed . no acute cardiac or pulmonary process .	No Finding	11906222	59697640	20ae33e5-c3a0b30d-d737101f-b47e9ae1-d804765a
1658	previously seen pulmonary edema has resolved . heart size and mediastinum are unchanged, as well as the vascular stent and splenic calcifications . no free air demonstrated . no definitive pneumothorax is seen .	Cardiomegaly&&Enlarged Cardiomediastinum	19061282	52364562	4641a697-8f606459-f9c55881-5ef83f11-ea8af252
1659	portable chest radiograph demonstrates unremarkable mediastinal, hilar and cardiac contours . there is improved aeration of the lung bases particularly on the right . no reaccumulation of pleural effusions or development of pneumothorax . dobbhoff tube is seen with tip in the mid stomach . left-sided picc line tip terminates in the distal svc . no reaccumulation of pleural fluid or development of pneumothorax .	Pleural Effusion	16319601	59680684	2e87f158-0b24dcfb-c1faa72a-75f96efd-3e82f4c4
1660	moderately severe interstitial pulmonary edema has worsened accompanied by new or increased small left pleural effusion . moderate cardiomegaly is chronic . there has been no change in the course or location of transvenous right atrial and left ventricular pacer leads and right ventricular pacer defibrillator leads originating from the left axillary generator .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	13896515	50449690	985f40a6-13022580-845b32b1-fccaba5a-60bffb12
1661	pa and lateral chest radiographs the cardiomediastinal and hilar contours are normal . the lungs are well expanded and clear, without focal consolidation, pleural effusion or pneumothorax . mild degenerative changes are seen in the thoracic spine .	No Finding	15840907	54355585	df7b8cfc-12798a16-4d5f66d6-63417bad-c5e6fca0
1662	frontal chest radiograph a right ij terminates at the superior cavoatrial junction . the heart is mildly enlarged . the hilar and mediastinal contours remain within normal limits . mild central pulmonary vascular congestion and pulmonary edema is unchanged since . a small right pleural effusion has enlarged . there is no pneumothorax or a focal consolidation . enlargement of a small right pleural effusion since am . unchanged mild central pulmonary vascular congestion and interstitial edema .	Edema&&Pleural Effusion	19182863	58598132	9f7a166b-fe5ab568-4dcfc13e-974262a9-8b6ccc98
1663	comparison is made with prior study performed the same day earlier in the morning . there has been interval worsening in opacification in the left hemithorax this is consistent with increasing atelectasis of the remaining upper lobe and increasing pleural effusion . in the right lung, there are atelectasis in the lower lobe . left ij catheter is in unchanged standard position . left chest wall subcutaneous emphysema has also improved . cardiomediastinal structures are midline partially excluded by the pleural parenchymal abnormalities on the left . there is left apical pneumothorax probably unchanged . findings were discussed with dr by phone at am on .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Pneumothorax&&Support Devices	12530259	56521967	658f37a6-2df3c400-2edbe336-7e2bfeea-ae16d58d
1664	the right picc tip is in the lower svc . et tube is in the standard position . ng tube tip is out of view below the diaphragm . left lower lobe atelectasis has worsened . right lower lobe atelectasis has improved . there is no pulmonary edema or pneumothorax . of note, the left lateral cp angle was not included on the film .	Atelectasis&&Support Devices	10268877	56063579	519f8e91-8489edf4-ff870026-b846bb39-f4746655
1665	portable ap chest radiograph there is borderline cardiomegaly . there is no pneumothorax or focal consolidation . no large pleural effusion is seen . indistinct pulmonary vasculature is consistent with interstitial pulmonary edema, which is slightly increased since .	Edema	13896515	56840019	3e9bfa41-70250cb0-d33887c3-436560fc-339ed2d6
1666	left-sided dual lumen central venous catheter tip terminates in the low svc in courses through a stent within the left brachiocephalic and superior vena cava . a vascular stent is also noted within the left upper extremity . cardiac silhouette size is normal . mediastinal and hilar contours are unchanged unchanged with similar rightward deviation of the trachea due to a known left thyroid goiter again noted . the pulmonary vasculature is not engorged . minimal patchy opacities in the lung bases likely reflect areas of atelectasis . there may be trace bilateral pleural effusions, but no focal consolidation or pneumothorax is present . clips are noted about the neck . remote fractures of the right posterior ribs are again seen . bibasilar atelectasis with possible trace bilateral pleural effusions .	Atelectasis&&Pleural Effusion	14236258	53403421	209500b4-f8bc630b-f0a648c8-da518e7f-ab714f17
1667	in comparison to radiograph, a tracheostomy tube is been placed, in standard position, with no visible pneumothorax or pneumomediastinum . heart has slightly decreased in size in the interval, and pulmonary vascular congestion and edema have resolved in the interval . there remains dense opacification in the left retrocardiac region accompanied by a a decreasing small left pleural effusion . a vascular catheter courses from the inferior vena cava and extends superiorly beyond the right atrium into the superior vena cava, terminating at the level of the right tracheobronchial angle . additional lateral chest radiograph may be helpful to determine precise positioning of the catheter .	Lung Opacity&&Pleural Effusion&&Support Devices	19061282	59317044	f8f0ddd7-c4671c6e-c2f37429-85d69299-f23286bf
1668	the pre-existing right lung opacity has slightly increased in extent . in addition, there is blunting of the right costophrenic sinus, potentially suggestive of a new small pleural effusion . the findings would be consistent with a combination of pulmonary edema and pneumonia . the lung volumes remain low . unchanged massive cardiomegaly and mild-to-moderate pulmonary edema . no left pleural effusion . change in the right humeral head could indicate chronic right shoulder subluxation .	Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia	16055653	57222195	75a92fd3-de039272-23790693-7ddfce74-cb96a026
1669	lung volumes are low . bilateral basilar interstitial abnormality is new . moderate cardiomegaly is similar . there is no effusion, consolidation, or pneumothorax . sternotomy wires are intact . acute interstitial pulmonary edema .	Edema	17318449	53060440	cf5f1f4f-b4d8bc5b-dccb823c-51fa4849-94f65859
1670	et tube tip is . cm above the carina, at the level of the lower medial clavicular heads . an ng tube is present -- tip and side port over the stomach . again seen are dense alveolar infiltrates in both lungs, densest at the right base and with relative sparing at the left upper zone . no supine film evidence of pneumothorax and no gross effusion identified .	Lung Opacity&&Support Devices	16662264	54148527	a5e12fb0-a6b7eb2f-af54b5f2-9af3ca0e-342b0299
1671	the lung volumes have slightly increased, likely reflecting improved ventilation . otherwise, the appearance of the lung parenchyma, the mediastinum and the cardiac silhouette, including the monitoring and support devices as well as sternal fixations, is stable .	Cardiomegaly&&Enlarged Cardiomediastinum&&Support Devices	14851532	54299422	819e8838-813f6f6e-a6c5d098-e747a8aa-68e03a8b
1672	one portable ap upright view of the chest . right hemodialysis catheter ends in the right atrium . there is pulmonary edema and pulmonary vascular congestion . there is no focal parenchymal opacities concerning for pneumonia . there is no pneumothorax . no definite pleural effusions . the cardiac, mediastinal, and hilar contours are normal . moderate pulmonary edema . these findings were discussed with dr . at pm . on by telephone .	Edema	15259244	53282268	e71f51f3-72341a6f-e930d575-66d2c3ef-339886c5
1673	cart focal is substantial . mediastinal silhouette is stable . pulmonary edema has developed in the interim, extensive . it obscures previously seen asymmetric left suprahilar opacity that might reflect infectious process . followup of the left lung opacity concerning for infection is recommended . right pleural effusion is large and unchanged .	Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pneumonia	14851532	51078371	66e86adc-70548bf4-9981e744-42d0da07-838b4d2a
1674	pa and lateral views of the chest were compared to previous exam from . when compared to prior exam, there has been interval improved aeration of the left upper lung . left perihilar mass compatible with patients history of recurrent small cell carcinoma is again seen . persistent elevation of the left hemidiaphragm . right lung remains clear of focal consolidation . there is no right-sided pleural effusion . there is, however, probable small left pleural effusion . cardiomediastinal silhouette is otherwise unchanged . osseous and soft tissue structures are unremarkable . dual-lead pacing device again seen . interval improved aeration of the left upper lobe compared to previous exam from two weeks ago . otherwise, no acute change, noting left hilar mass compatible with patients known history of recurrent lung cancer .	Lung Lesion	18067737	50431066	a6dc99c7-6d793ce2-188bd506-b751deab-79f8ebbb
1675	the heart is at the upper limits of normal size . the mediastinal and hilar contours appear unchanged . hyperinflation is noted with persistent reticular opacities projecting over the left lower lung but markedly improved since the prior radiographs . thin flowing anterior syndesmophytes are present throughout the thoracic spine . this appearance has an association with spondyloarthropathies . . improving pneumonia . . thin spinal syndesmophytes suggesting the possibility of an inflammatory arthropathy such as could be seen with ankylosing spondylitis clinical correlation is suggested .	Pneumonia	14081759	50184397	6631d848-2c0cb2c2-f85d6490-f5df355f-11011cb8
1676	frontal and lateral views of the chest and additional views of the left-sided ribs were obtained . a bb marker projects over the lateral ninth and left ribs indicating patients site of concern . no displaced fracture is seen . the lungs are clear without focal consolidation . no pleural effusion or pneumothorax is seen . the cardiac and mediastinal silhouettes are unremarkable . there may be very minimal left basilar linear atelectasisscarring . no acute cardiopulmonary process . no displaced rib fracture seen .	Fracture	13448574	54759244	f762fbc6-ca1926fb-06f3ef2a-b996a151-66a3b743
1677	compared to the film from earlier the same day, the appearance of the lungs with the patchy nodular infiltrates bilaterally is unchanged . the et tube is cm above the carina .	Lung Opacity&&Support Devices	13078497	56888186	fdd036df-52fef6fa-3b7ff466-ad816cd9-f9fe7db7
1678	pa and lateral views of the chest the cardiac silhouette size is normal . the mediastinal contour is unremarkable . there is enlargement of the right hilum suggestive of underlying lymphadenopathy . multiple nodules are demonstrated throughout both lungs, the largest within the right lung base measuring . no focal consolidation, pleural effusion, or pneumothorax is present . there is likely minimal left lower lobe atelectasis . no acute osseous abnormalities are visualized . multiple bilateral pulmonary nodules compatible with metastatic disease . right hilar enlargement suggestive of underlying lymphadenopathy . ct of the chest is recommended for further evaluation .	Lung Lesion	16409152	55851227	6e9a74d7-21c84522-a747db35-77dec447-6c76dd6e
1679	there is no focal consolidation, effusion, or pneumothorax . the cardiomediastinal silhouette is normal . imaged osseous structures are intact . no free air below the right hemidiaphragm is seen . no acute intrathoracic process .	No Finding	19623993	58865157	879c5bd5-8fde6e6e-470c4bdb-323689b2-fac6fa7e
1680	pa and lateral chest radiograph the cardiac silhouette is top normal . there is no pneumothorax or focal consolidation . trace fluid within the right fissure is noted . there is indistinct pulmonary vasculature consistent with mild pulmonary edema .	Edema	13896515	52852042	e196e03a-34fb9428-f771233d-53d2e101-d419be46
1681	the monitoring and support devices, including the esophageal stent, and the right-sided pigtail catheter, are unchanged . the extensive known parenchymal opacities on the left and on the right are unchanged in extent and severity . there is no evidence of newly occurred focal parenchymal opacity . unchanged right pleural effusion, no left pleural effusion . unchanged size of the cardiac silhouette .	Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Support Devices	13964474	57999899	52481f07-4d1746a3-47375a8c-8b8d33cd-ca8e4e96
1682	moderate bilateral pleural effusions, larger on the right than on the left, are unchanged . the previously noted pulmonary edema has resolved . there is no consolidation . mild right basilar atelectasis persists . there is no pneumothorax . moderate enlargement of the cardiomediastinal silhouette is stable . . stable moderate bilateral pleural effusions . . resolution of pulmonary edema .	Pleural Effusion	18224196	55452685	4b21950a-5565f60b-5e86b9fd-fde33a71-2a564240
1683	endotracheal tube terminates cm above the carina . the nasogastric tube passes into the stomach, and off the inferior margin of the film . there is a new right picc, which can be followed into the upper svc . the heart remains moderately enlarged, while vascular congestion, edema, and bilateral pleural effusions are little changed . there is no new opacity to suggest pneumonia . there is no pneumothorax . persistent calcification of the aortic knob .	Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	14841168	54401838	22592a1d-d2060a7c-1e748138-5ac977c0-0d6a2587
1684	cardiac silhouette size is normal . the mediastinal and hilar contours are unchanged with evidence of prior esophagectomy and gastric pull-through . atherosclerotic calcifications within the aortic arch are re- demonstrated . ill-defined patchy opacities are noted involving the right mid and lower lung fields as well as to a lesser extent within the left lung base, findings which are suspicious for aspiration pneumonia . blunting of the costophrenic angles posteriorly on the lateral view suggests small bilateral pleural effusions, new in the interval . no pneumothorax or pulmonary vascular congestion is present . there are no acute osseous abnormalities . multifocal ill-defined patchy opacities involving the right mid lung field and both lung bases concerning for aspiration pneumonia . new small bilateral pleural effusions .	Lung Opacity&&Pleural Effusion&&Pneumonia	14295224	52764071	e3592dcd-ca0b0f88-415e34bf-6f5bb257-2502a74e
1685	there is no pneumothorax . moderate right pleural effusion is stable . small left pleural effusion and left lower lobe atelectasis or consolidation have increased . the cardiac silhouette is moderately enlarged . the pulmonary vasculature is normal and there is no pulmonary edema . right jugular line ends in the upper svc .	Atelectasis&&Cardiomegaly&&Consolidation&&Pleural Effusion&&Support Devices	13755940	58666319	57b2666a-699fa6ab-57992ba2-54520a2e-7ee60ae6
1686	left ij line with tip just crossing midline is again seen . there continues to be near-complete opacification of the left hemithorax . an air-fluid level is now seen with some improved aeration of the left upper lobe . the right lung is clear .	Lung Opacity&&Support Devices	12530259	59686145	f7004aaf-2d802820-6fb668c7-79ec741c-1147c01a
1687	enteric tube is seen coiled within the stomach, tip off the inferior field of view . the lungs are clear of focal consolidation . the cardiac silhouette is slightly enlarged, unchanged . no acute osseous abnormality detected noting degenerative changes at the right glenohumeral joint and possible post traumatic changes in the proximal left humerus, incompletely visualized . cardiomegaly without acute cardiopulmonary process . incompletely visualized changes of the proximal left humerus . please correlate clinically .	Cardiomegaly	19549821	59966980	c810fda6-49f22def-580efb22-d9ed1837-c3e002b1
1688	severe cardiomegaly is unchanged . the mediastinal and hilar contours are similar . there is mild pulmonary vascular engorgement, also unchanged . bibasilar airspace opacities could reflect atelectasis though infection or aspiration cannot be excluded . no large pleural effusion or pneumothorax is seen . mild pulmonary vascular engorgement and bibasilar opacities possibly reflecting atelectasis but infection or aspiration cannot be excluded .	Atelectasis&&Lung Opacity&&Pneumonia	13473495	58878473	7e96d7f1-3095daed-1e42c172-37ea991c-747f03a3
1689	there is a decreased though persistent right-sided hydropneumothorax with interval incomplete reexpansion of the right lung . no significant mediastinal shift identified with unremarkable mediastinal, hilar, and cardiac contours . right lower lung opacifications may reflect combination of reexpansion edema and atelectasis . minimal left lung atelectasis noted . improving right hydropneumothorax with right lower lung opacifications, atelectasis versus edema are likely .	Atelectasis&&Edema&&Lung Opacity&&Pneumothorax	14387068	50296389	36309315-d8541009-0bd1a6c7-61a61b57-a33c1b81
1690	pa and lateral views of the chest are obtained . there is mild interstitial pulmonary edema without focal consolidation to suggest pneumonia . no large pleural effusion or pneumothorax is seen . heart size is grossly stable . central pulmonary vasculature appears engorged . bony structures are intact . mild chf . no signs of pneumonia .	Cardiomegaly&&Edema	13700088	55908245	c8f77e9b-ae1d0935-5fc5b81a-bbae4b84-91567aec
1691	the patient is rotated with respect to the film . lung volumes are low and the left hemidiaphragm is markedly elevated, similar to prior . cardiomediastinal contours appear stable . indistinct appearance of the pulmonary vascular markings is compatible with mild interstitial edema . no focal consolidation, substantial pleural effusion, or pneumothorax . no radiopaque foreign body . mild pulmonary edema .	Edema	18338007	50744319	36f6dd1e-fefeef89-03c80035-d373c61b-1a4e895b
1692	interval placement of feeding tube, which coils in the stomach, and subsequently courses cephalad with distal tip directed cephalad above the level of the clavicles within the proximal thoracic esophagus . exam is otherwise remarkable for improving pulmonary edema and slight decrease in mass-like opacity at left apex which has been more fully evaluated by prior ct . left retrocardiac opacity and bilateral pleural effusions appear similar . nurse was informed of the malposition of the feeding tube at pm . on by telephone at the time of discovery .	Edema&&Lung Lesion&&Lung Opacity&&Pleural Effusion&&Support Devices	14851532	51373840	9bff71ab-e64fa16c-fb22884b-26584905-9f6b4cb7
1693	pa and lateral chest compared to through , extent of peribronchial thickening and impaction of extensive bibasilar bronchiectasis may have increased slightly since the most recent prior lateral chest radiograph, . there is really no change in the appearance of the frontal views as recently as . generalized hyperinflation is due to emphysema . heart size is normal . there is no pulmonary edema, consolidation . a tiny right pleural effusion may be new, but probably not clinically significant . findings would therefore be attributed to decompensation of emphysema and bronchiectasis .	Lung Opacity&&Pleural Effusion	10402372	54715839	b4220d24-884a0275-1552d547-a339b365-4417b9d5
1694	left apical pneumothorax is tiny if any . the benefit of the lateral view . we can see that although the large region of opacification in the left lower lung is improving . there are actually two responsible abnormalities, a region of consolidation or atelectasis in the lingula, and a pleural collection in the left lower hemithorax adjacent to region of consolidation . one or both of these lesions is presumably a hematoma from recent transbronchial biopsy . pa and lateral views therefore are recommended for subsequent followup . right lung is clear . the heart is normal size .	Atelectasis&&Consolidation&&Lung Opacity&&Pneumothorax	15192710	58817744	b4090c18-9828842b-111e341f-0673f4ad-e42afebc
1695	the patient has received a right chest tube . the chest tube is in correct position . there is a substantial decrease in extent of the pre-existing right pleural effusion . no pneumothorax is seen . minimal air collection in the soft tissues at the site of drain insertion . unchanged moderate cardiomegaly, unchanged normal appearance of the left lung . right port-a-cath in situ .	Pleural Effusion&&Support Devices	16826047	56785550	adae90d7-feef7abe-f9447062-dd02daab-bc446b77
1696	during the examination interval, the two right-sided chest tubes have been removed . no pneumothorax has developed . pleural thickenings and blunting of lateral pleural sinus in right hemithorax persist rather unchanged . no new abnormalities . stable chest findings, no evidence of pneumothorax following chest tube removals .	No Finding&&Support Devices	18309149	50035498	2d669c63-3ec31080-3ee62b8b-7002f5b5-bf8e73b6
1697	heterogeneous opacification in the right lung, particularly the upper lobe has worsened . left lower lobe remains airless . overall findings are most consistent with spreading pneumonia and chronic left bronchial occlusion . small left pleural effusion is presumed . heart size top normal, decreased since . tip of the new endotracheal tube is at the level of the lower margin of the clavicles, no less than cm from the carina, standard placement . nasogastric tube ends in the mid stomach . no pneumothorax .	Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	16313531	52300884	fe59a37b-153a2ffa-4552395e-09148941-f3badae1
1698	pa and lateral chest radiograph a large-bore central catheter terminates in the expected location of the right atrium, unchanged from prior . the lungs are clear . there is no focal consolidation or pneumothorax . there is no vascular congestion or pleural effusions . mediastinal and hilar contours are within normal limits . the cardiac silhouette is mildly enlarged though unchanged . mild indentation of the left trachea at the level of the clavicles is unchanged compared to prior chest ct from and likely reflects an underlying tracheal deformity as no compressive mass lesion is evident on the prior ct . . no acute cardiopulmonary process . . stable mild cardiomegaly . . unchanged proximal tracheal deformity suggestive of underlying tracheomalacia .	Cardiomegaly	13475033	54028344	4a5283d6-157b6054-3840ea3d-d27e7ba1-d6689022
1699	mild opacity in the right lower lobe likely corresponds to an infectious process given the clinical concern . follow up is recommended . mild cardiomegaly and tortuous aorta are stable . opacities in the left hemithorax are consistent with post-operative changes, better evaluated by prior ct from . there is no pneumothorax or increasing pleural effusions . left hemidiaphragm is elevated as before . left perihilar opacities, though difficult to evaluate, are grossly unchanged from prior study .	Cardiomegaly&&Lung Opacity&&Pneumonia	15446959	51765753	532b41c5-aa84f4e3-0680a169-3354c664-82013589
1700	the et tube tip is . cm above the carina . the ng tube tip is in the stomach . heart size and mediastinum are stable . there is interval progression of left lower lobe consolidation, a tendency has been demonstrated for last couple of days .	Cardiomegaly&&Consolidation&&Enlarged Cardiomediastinum&&Support Devices	13031876	52075994	13f765a9-102224ff-2f70f012-43cbb0b5-05acd962
1701	ap portable view of the chest . the lungs are relatively hyperinflated . linear opacities at the left lung base again suggestive of atelectasis versus scarring . indistinct pulmonary vascular markings are seen particularly in the left upper and right lower lung . this could be due to asymmetric mild interstitial edema in the setting of the background of chronic lung disease noting that infection is also possible . the cardiac silhouette appears slightly enlarged . median sternotomy wires again noted . asymmetric increased interstitial markings potentially due to edema superimposed on underlying chronic lung changes versus infection .	Edema&&Lung Opacity&&Pneumonia	13606683	53357801	d829d785-9cf108d0-cc72151c-457d3b95-b2d38263
1702	compared with earlier on the same day am, there has been progressive opacification of the left lung, with only a small residual lucent focus ~ . cm at the left lung apex . as before, there is evidence that the left hemidiaphragm is elevated, but now the mid portion of the lung is also opacified . there is slight leftward deviation of the trachea, new compared with at am . otherwise, the mediastinum remains midline . the lucency at the left lung apex may represent either a small amount of aerated lung or a small loculated ptx . no definite medial ptx component or penumomediastinum . however, the lateral edge of the descending aorta remains faintly visible . subcutaneous emphysema again noted, slightly improved . left chest tube again noted, unchanged . there is a slightly displaced fracture or osteotomy of the left posterior rib . in retrospect, this has been present since , but appears slightly more displaced on this study . the right lung shows mild vascular plethora, without overt chf . probable minimal atelectasis at the right lung base . however, the right lung remains grossly clear . rapid progressive opacification of the left upper and mid lung, with evidence of volume loss and persistent left hemidiaphragm elevation . clinical correlation is requested in this patient status post left lobectomy . difficult to determine whether a small pneumothorax or small amount of pneumomediastinum is still present . no fluid level detected to suggest hyrdropneumothorax . slightly displaced left posterior th rib fracture or osteotomy . note is made that the patient is sp thoracotomy . right lung clear except for mild vascular plethora and minimal basilar atelectasis . ordering house officer paged ar approximately pm on the day of the exam .	Fracture&&Lung Opacity&&Pneumothorax	12530259	54946834	4c91821b-955decb6-08bf90f3-372970dc-45cb6ac2
1703	the endotracheal tube tip lies approximately . cm above the carina . nasogastric tube extends to at least the mid body of the stomach, where it crosses the inferior margin of the image . right ij catheter extends to about the level of the cavoatrial junction . change in appearance of the right pleural effusion may reflect differences in patient position . bilateral atelectasis and pulmonary edema are essentially unchanged .	Atelectasis&&Edema&&Pleural Effusion&&Support Devices	12952223	58055058	37e045d0-5af0d058-12f0ea0b-100224f6-7464d84d
1704	reappearance of moderate right pleural effusion obscures the right heart border . there is elevation of the right hemidiaphragm . the cardiac silhouette continues to be mildly enlarged with no signs of vascular congestion . no focal consolidation is seen . left internal jugular catheter ends in a known left persistent vena cava . reappearance of moderate right pleural effusion .	Pleural Effusion	19182863	54167884	9f188b25-a57547b5-c0fafc1a-be325b3f-6cbae579
1705	there is a right pleural effusion which is unchanged since prior exam . again seen is a right hilar opacity consistent with fibrosis, better assessed on recent ct . a subtle left lower lobe opacity is seen, which may represent atelectasis, but pneumonia cannot be excluded . the lungs are otherwise clear . the cardiomediastinal silhouette is unchanged from prior exam . visualized osseus structures are unremarkable . . subtle left lower lobe opacity, which may represent atelectasis, but pneumonia cannot be excluded . pa and lateral radiographs could allow for better assessment of this opacity . . stable right pulmonary effusion .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Pneumonia	19720782	50043351	f4a818e5-89d51e2d-9f478ecb-8774a1bf-739673b3
1706	severe right lung consolidation has developed or worsened appreciably since . interstitial abnormality in the left lung is more pronounced today than it was in , and could be mild edema . small left pleural effusion is unchanged since a torso ct on . right pic line ends in the upper svc . resected posterior right upper ribs noted . was paged to report these findings at am . as soon as they were discovered .	Consolidation&&Edema&&Pleural Effusion&&Support Devices	13263843	54651626	b87403e9-8463e40a-a104367f-cb96ab7e-b13e08a2
1707	no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is detected . heart and mediastinal contours are stable . known lung nodules are better assessed by ct . median sternotomy wires and mediastinal clips are again noted . no radiographic evidence for acute cardiopulmonary process .	No Finding	11879886	56855230	2aadeb6e-8b5af4b3-f3ddd4f9-8d552d40-d8a5e821
1708	left subclavian catheter tip is in the upper svc . mild to moderate pulmonary edema has increased . no other interval change from prior study .	Edema&&Support Devices	12185775	53768980	3398c38d-190a9992-bebb2e85-7ca0c527-214906cb
1709	there are some increasing atelectatic changes at the left base with some blunting of the costophrenic angle that could reflect a small amount of pleural fluid . otherwise, little change with no definite focal pneumonia or vascular congestion .	Atelectasis&&Pleural Effusion	15114531	56295717	63d37384-184136e7-97b99c44-25b314ac-ecd14631
1710	a right port-a-cath and two right chest tubes are visible . the position of chest tubes are constant . the extent of the right pleural effusion is unchanged, the effusion is distributed in a slightly different manner . unchanged right basal atelectasis . unchanged moderate cardiomegaly . unremarkable left lung . there is no evidence of pneumothorax .	Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices	16826047	52602627	543b4069-deab8e00-eacd542d-26643f2e-557d2591
1711	chronic bilateral pleural effusions are again seen, decreased on the left . there is bibasilar atelectasis . the cardiac silhouette is top normal to mildly enlarged . the aorta is mildly calcified . patient is status post median sternotomy with the superior most wire again seen to be fractured . there is elevation of the right hemidiaphragm .	Atelectasis&&Fracture&&Pleural Effusion	16360107	52598379	4f4218c0-7e3de34f-abade5db-964b2d47-addcc964
1712	the patient has taken a better inspiration . there is enlargement of the cardiac silhouette with some evidence of elevated pulmonary venous pressure, though less prominent than on the previous study . intact midline sternal wires are seen in a patient with previous cabg procedure and a dual-channel pacemaker in place . axial clips are again seen . some mild atelectatic changes and possible small effusions are seen at the bases, as on prior study .	Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices	13921768	53713960	d8406953-e1473794-aadfa8d2-d7225820-6d7e558a
1713	an endotracheal tube terminates at the thoracic inlet in standard placement . lung volumes are low, but the lungs are grossly clear . there is no pneumothorax . old healed bilateral rib fractures are unchanged . the heart and mediastinum are magnified by the projection . endotracheal tube terminates at the thoracic inlet . grossly clear lungs .	No Finding&&Support Devices	18079481	54657781	441735fc-34bd0286-fa539675-6602e72a-1fed5ed4
1714	there is unchanged evidence of moderate-to-severe pulmonary edema . however, the interstitial component of the edema is more prominent on the current image . the presence of a small pleural effusion cannot be excluded . unchanged mild cardiomegaly . unchanged position of the left pectoral port-a-cath .	Cardiomegaly&&Edema&&Pleural Effusion	10439781	52077644	5fb4fd93-f41ffe10-432dff5b-080386a2-de609585
1715	portable ap upright chest radiograph is obtained . lungs are clear bilaterally . no signs of pneumonia or chf . no pleural effusion or pneumothorax . cardiomediastinal silhouette is stable . bony structures are intact . no free air below the right hemidiaphragm . no acute intrathoracic process .	No Finding	18893199	58971994	44388ee4-a43ff605-7edf7add-37dd01f3-7596e2a5
1716	lung volumes are low . cardiac and mediastinal silhouette is stable . there has been interval removal of right internal jugular central venous catheter . no definite focal consolidation is seen . there is no large pleural effusion or pneumothorax . no overt pulmonary edema . low lung volumes without acute cardiopulmonary process .	No Finding	14727722	54717370	e5f2a417-f5d646ca-33f15b0f-5b7c75b3-2b9611d5
1717	the patient is status post median sternotomy and aortic and tricuspid valve surgery . stable appearance of cardiomediastinal contours . persistent interstitial edema . patchy and linear bibasilar atelectasis is also demonstrated as well as a small right pleural effusion . left internal jugular catheter remains in place within the left superior vena cava . . small right pleural effusion with adjacent right basilar atelectasis . . cardiomegaly and interstitial edema .	Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion	19182863	50903895	658ef774-35bbcbca-076591cf-e4bb58ca-243724d2
1718	ap single view of the chest has been obtained with patient in sitting semi-upright position . in comparison with the next preceding chest examination of , the ett has been removed . previously existing chest tube on the left side and advanced from below has been removed . no pneumothorax has developed in the apical area . mild obscuration of left-sided diaphragm suggestive of some postoperative small amount of pleural effusion, but no other new abnormalities are identified . a right-sided internal jugular approach central venous line remains in place . its termination point projects into the upper portion of the right atrium . this position is unchanged compared with the previous study . no evidence of pneumothorax following chest tube removal .	No Finding&&Support Devices	11565803	58056251	04e57623-af378474-c0649f6f-0260ef77-8d56543d
1719	there is a new retrocardiac opacity . a right ij has been removed . small bilateral pleural effusions are seen . cardiomediastinal silhouette is unchanged compared to prior . new retrocardiac opacity concerning for pneumonia in the appropriate clinical setting . notification the findings were relayed by text page by dr . with dr . in addition, the impression will be put in the critical dashboard . the impression above was entered by dr .	Lung Opacity&&Pneumonia	19454978	57331547	7d047120-d24a497e-fc26ea7e-6c3acc0c-ce5bc190
1720	the cardiac, mediastinal and hilar contours appear stable . deshiscences among sternal wires appear unchanged . moderate bilateral pleural effusions appear stable a and seem to be due to chronic collections which were also characterized on prior ct with associated round atelectasis especially at the right lung base . there has been little if any change . although there is no evidence of acute process should be noted that background abnormalities may lower the sensitivity of chest radiography . stable chronic abnormalities including bilateral moderate loculated pleural effusions and areas of round atelectasis .	Atelectasis&&Pleural Effusion	16360107	56241369	67a32863-338f2899-5e526d84-2639d564-a2204b9b
1721	a focal consolidation is noted within the right upper lobe . there is no evidence of pleural effusion, pneumothorax, or pulmonary edema . mild cardiomegaly is stable . redemonstrated are right subclavian and left brachiocephalic vascular stents, unchanged in position from prior examination . new right upper lobe consolidation compatible with pneumonia .	Consolidation&&Pneumonia	19061282	59941176	b8dfd605-1122ed45-3fd45f18-5d90932a-5f2dab90
1722	no focal opacity to suggest pneumonia is seen . no pneumothorax or significant pleural effusion is present . no pulmonary edema is seen . there are multiple calcified nodules consistent with prior granulomatous disease . however, a right upper lobe nodule measuring mm is concerning . this previously measured mm on the ct , though comparison is limited across these modalities . the heart size is top normal . there is tortuosity and calcification of the thoracic aorta . a left-sided dual-lead pacemaker is unchanged . the patient is status post median sternotomy . surgical clips in the right upper quadrant are consistent with cholecystectomy . . no evidence of pneumonia . . right upper lobe nodule measuring mm on this examination . this measured mm on the prior ct, though comparison across modalities is limited . given the concerning appearance, this nodule would be better followed by dedicated ct .	Lung Lesion	17763117	54066754	2562051f-7aa8f63a-d00bafea-ddf082c6-838ba1fd
1723	the tracheostomy tip is approximately . cm above the carina . the right subclavian line tip is at the level of mid svc . the patient is after placement of the percutaneous gastrostomy . the right chest tube is in place . substantial amount of subcutaneous air is seen, although minimally improved since the prior study . loculated air collections are noted bilaterally, unchanged in the short interim . prominence of the pulmonary arteries, consistent with pulmonary hypertension, as well as bullous changes in the apices, are redemonstrated . no definitive pneumothorax is seen . right lower lobe consolidation with internal areas of cavitation is better assessed on the ct torso obtained on .	Consolidation&&Support Devices	16751749	57123927	9119a930-f6f4b42c-7a484c12-258d4a4a-b033a356
1724	ap single view of the chest has been obtained with patient in sitting semi-upright position . comparison is made with the next preceding portable chest examination with the patient in supine position as of . again noted is status post sternotomy and significant enlargement of the cardiac silhouette . previously described permanent pacer in left axillary position with two intracavitary electrodes in unchanged location . unchanged position of left internal jugular approach central venous line terminating in upper portion of svc . no pneumothorax has developed . diffuse haze over both lung bases as before obliterating the diaphragmatic contours and indicative of bilateral pleural effusions partially layering posteriorly . the pulmonary venous congestive pattern persists . an intra-aortic balloon pump device is seen to terminate in the descending thoracic aorta about cm below the level of the lower thoracic arch contour . this is unchanged . no significant interval changes during the last hours interval . the described changes with postoperative status, chf, pleural effusion and intra-aortic balloon pump device in place is of course compatible with the patients hypoxia .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	10886362	54849848	9189763d-c3b6ee12-d0d89f14-29a0cb1f-e3dee331
1725	no focal consolidation is seen there is no pleural effusion or pneumothorax . the cardiac and mediastinal silhouettes are unremarkable . no acute cardiopulmonary process .	No Finding	14312560	55983006	8385af08-8516e6ef-1401e3b8-75199f0d-5e5877e1
1726	the cardiac, mediastinal, and hilar contours appear unchanged . the lung volumes are low . there is a patchy left basilar opacity obscuring the cardiac border and apex of the left hemidiaphragm, worrisome for pneumonia . elsewhere, the lungs appear clear . there are no pleural effusions or pneumothorax . new left basilar opacity worrisome for pneumonia .	Lung Opacity&&Pneumonia	12074041	52874646	af39d55c-0622bc39-b9865798-29ff5a61-eb7cfb93
1727	comparison is made with prior study and ct . there is a large amount of air in the right pleural space, despite the presence of two chest tubes . et tube tip is in standard position, cm above the carina . cardiac size is normal . widened mediastinum can be post-operative . patient has severe emphysema . left lower lobe opacities could represent mild interstitial edema . the remaining right lung is partially collapsed . surgical clips project in the right hilum, and mid lung .	Atelectasis&&Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Support Devices	19991135	54910031	d04bbcbd-5143439e-50ebe9a8-71380f67-44f8d127
1728	frontal and lateral views of the chest demonstrate heterogeneous opacities in the left mid lung . similar opacities are also seen in the right lung base . no pleural effusion or pneumothorax . hilar and mediastinal silhouettes are unremarkable . heart size is normal . no pulmonary edema . multifocal pneumonia . follow-up exam following resolution of the symptoms is recommended .	Pneumonia	19748558	54913354	7ee153a9-e00f7cd0-8c44b852-d83a1175-db28c1e7
1729	the lungs are hyperinflated and the diaphragms are flattened, consistent with copd . multiple surgical clips are seen about the mediastinum, consistent with prior surgery . a linear wire-like density is again noted in the retrosternal region, unchanged . previously seen anterior chest wall drains have been removed . on todays exam, the heart is not enlarged . the aorta is unfolded . there is prominence of a hila suggesting element of pulmonary hypertension, probably unchanged . there is some linear atelectasis andor scarring at both lung bases . ring-like opacity in the left upper zone seen on the prior study has resolved, with only minimal residual scarring . no chf or new focal infiltrate is detected . no effusions are identified . no pneumothorax is detected . relative lucency at the right base is thought to represent an artifact due to overlying soft tissues of the chest . . background copd, with suspected pulmonary hypertension . . status post sternotomy, with mediastinal clips . no chf . . no acute infiltrate identified . residual scarring noted, detailed above . . no pneumothorax detected .	Lung Opacity	17770657	56969126	ca198d4c-70be63ec-5974f3e9-d6320a38-4eb83158
1730	support and monitoring devices are in standard position, and cardiomediastinal contours are stable . mass-like area of consolidation at left apex appears slightly less dense and has been more fully evaluated by recent ct . moderate layering right pleural effusion and small left pleural effusion are similar, with adjacent bibasilar areas of atelectasis or consolidation .	Atelectasis&&Consolidation&&Enlarged Cardiomediastinum&&Lung Lesion&&Pleural Effusion&&Support Devices	14851532	54155919	fb7ca346-c681578f-ca4991f6-03844d32-706f3694
1731	there is little overall change in the degree of aeration of the lungs . some suggested increased opacification at the left costophrenic angle could reflect some increasing effusion . no evidence of pneumothorax . evidence of prior right upper lobe lobectomy and radiation therapy, better demonstrated on recent ct scan .	Lung Opacity&&Pleural Effusion	13263843	56506647	28c782b9-7eb7d267-5a9a998f-25d24646-e811e771
1732	the cardiomediastinal and hilar contours are normal . there is no pleural effusion or pneumothorax . lung volumes are increased compared to the most recent prior study . diffuse interstitial abnormality with small nodules not significantly changed . pulmonary vasculature is within normal limits . diffuse interstitial abnormalities, small nodules, with no appreciable progression . improved lung volumes .	No Finding	12303667	54218896	e4e0e4ff-71138eac-7cef38bd-ce820887-d59037ff
1733	lung volumes are low compared to the previous study . left-sided aicd device is noted with single lead terminating in unchanged position in the right ventricle . heart size appears at least mildly enlarged . the mediastinal and hilar contours are unremarkable . there is crowding of the bronchovascular structures without overt pulmonary edema . streaky opacities in the lung bases likely reflect areas of atelectasis . no pleural effusion or pneumothorax is present . there are no acute osseous abnormalities . low lung volumes with probable bibasilar atelectasis . no evidence of pulmonary edema .	Atelectasis	14556809	50432000	7a75be73-77ed1349-e974ef60-e017dcfa-5be7d3fa
1734	the patient is after median sternotomy and cabg with stable appearance of heart and mediastinum . lungs are essentially clear with no pleural effusion or pneumothorax . elevated right hemidiaphragm is unchanged .	Enlarged Cardiomediastinum	15272972	55253443	bfabef8c-049764f6-b4560c11-45386b68-f02bcda5
1735	in comparison with the study , there again are patchy areas of increased opacification at both bases, very worrisome for bilateral pneumonia . the remainder of the examination is unchanged .	Lung Opacity&&Pneumonia	16508811	53632136	cf4509de-e07c9ef6-ac4ef196-5d471150-97723ba4
1736	pa and lateral views of the chest a large dilated, debris-filled, possibly fluid filled esophagus is again appreciated, abutting the right mediastinum, in this patient with known achalasia . the finding appears more prominent as compared to the right study of but similar to . there is a questionable air-fluid level in the proximal thoracic esophagus . the possibility of progressed slowed emptying of the esophagus is raised . there is no evidence of aspiration . there is no pleural effusion or pneumothorax . the cardiac silhouette is difficult to assess .	Cardiomegaly&&Enlarged Cardiomediastinum	11569042	58961408	3ea573fe-97c9bfbd-53a4c4ff-bf9dc7f4-65fd2f0a
1737	moderate-to-severe overinflation with known areas of bronchiectasis and perifocal parenchymal opacities . the opacities are unchanged in distribution and severity . normal size of the cardiac silhouette . normal hilar and mediastinal structures . no newly appeared focal parenchymal changes .	Lung Opacity	10402372	56711198	840febf0-f7f07a57-33f1bfa8-6a02494a-8dc4cb09
1738	cardiac silhouette size remains mildly enlarged and multiple mediastinal clips from prior cabg are again noted . the aorta remains tortuous and diffusely calcified . pulmonary vasculature is not engorged . hilar contours are similar . ill-defined focal opacities are again noted within both upper lobes as well as within the left lower lobe, not substantially changed in the interval, and better assessed on the previous ct . no new focal consolidation, pleural effusion or pneumothorax is present . no acute osseous abnormalities detected . clips are noted within the midline upper abdomen . re- demonstration of multifocal parenchymal opacities compatible with adenocarcinoma, better assessed on the previous ct . no acute cardiopulmonary abnormality .	Lung Lesion&&Lung Opacity	14851532	56997833	ff9fed32-307dfd9e-3f70b114-c9234fbc-6a057052
1739	a dual-lead pacemaker implanted in the left chest wall has two leads terminating in the expected location of the right atrium and right ventricle respectively . mild hyperexpansion is unchanged . a small right pleural effusion is new . there are no focal opacities to suggest pneumonia . mild cardiomegaly is stable . the hilar contours and pulmonary vasculature appear normal . the mediastinal silhouette is unchanged . tortuosity of the thoracic aorta is re-demonstrated . . small right pleural effusion is new however, there is no evidence of pneumonia and no other significant appreciable change . . mild cardiomegaly is unchanged . the above results were communicated via telephone by dr . at pm . as requested .	Cardiomegaly&&Pleural Effusion	10754184	56625924	e12e1dd7-9b6e4d27-63a06a72-937c9716-451f2db8
1740	cardiac silhouette size is normal . mediastinal and hilar contours are normal . pulmonary vasculature is not engorged . as seen on the previous chest radiograph are ill-defined opacities within the left upper lobe and left lung base . the right lung is clear apart from subsegmental atelectasis or scarring at the right lung base . no new focal consolidation, pleural effusion or pneumothorax is present . there are no acute osseous abnormalities . cholecystectomy clips are seen in the right upper quadrant of the abdomen . ill-defined opacities within the left upper lobe and left lung base are unchanged from previous radiograph, and likely worse or new compared to the most recent chest ct . this could be due to an infectious etiology or cryptogenic organizing pneumonia, given that ground-glass opacities have been seen on prior chest cts in a waxing and waning fashion .	Lung Opacity&&Pneumonia	16435402	52314112	7bd2406e-7c8114ad-31d1b818-28c7e563-6a1a6176
1741	no evidence of focal parenchymal opacities indicative of pneumonia . the orogastric tube has been removed . unchanged borderline size of the cardiac silhouette without pulmonary edema . the lateral radiograph reveals a minimal pleural effusion bilaterally, restricted to the dorsal parts of the costophrenic sinus .	Cardiomegaly&&Pleural Effusion&&Pneumonia	14312560	59332489	ae39f4d0-b0da3b02-52929cd2-b6698aad-a681fd22
1742	there has been interval removal of the right-sided central venous catheter . a port-a-cath visible on the left has its tip terminating in the cavoatrial junction . an ovoid lucency projects over the right tracheobronchial angle and a crescentic lucency is seen along the junction of the left heart border and aortic lumen and a small subdiaphragmatic crescentic lucency is also seen beneath the right hemidiaphragm . subcutaneous emphysema is seen along the right chest wall . overall, the lungs are clear . there is no large pleural effusion or pneumothorax . an old healed rib fracture is seen in the eighth posterolateral rib on the right . clips are seen in the epigastric region of the abdomen . mediastinal lucencies concerning for pneumomediastinum subcutaneous emphysema subdiaphragmatic free air, all new compared to prior study, and in the setting of recent surgery may reflect air dissecting along the fascial planes . correlate with other history of instrumentation or trauma . an initial report of these findings was given by dr . in person on .	No Finding	15758946	51808820	35d6d97a-9cbb9f6a-78b7bf1d-f7a49df3-fa17a2b5
1743	the lung volumes have increased, likely reflecting improved ventilation or increased ventilatory pressure . a pre-existing opacity in the right lung has almost completely resolved . on the left, atelectasis in the retrocardiac lung regions, a small perihilar opacity and a mild-to-moderate left pleural effusion, persist . no new parenchymal opacities . unchanged size of the cardiac silhouette .	Atelectasis&&Cardiomegaly&&Lung Opacity&&Pleural Effusion	16334516	50645830	0336687b-390c6d13-fe15ecd8-f66d495e-b90db625
1744	heart size is normal . mediastinum is normal . there is interval placement of bravo ph capsule projecting over the expected location in the distal esophagus . surgical clips in the left upper abdomen are unchanged . lungs are clear and there is no pleural effusion or pneumothorax . overall, there is minimal interval change including left lower lobe linear opacity that might represent atelectasis, although small infectious process in this area cannot be excluded . note is also made of a large trachea, approaching . cm in coronal and cm in the sagittal diameter in this patient with known tracheomalacia . new left lower lobe linear opacity that might reflect developingresolving infectious involving infectious process versus atelectasis . tracheomegaly .	Atelectasis&&Lung Opacity&&Pneumonia	15114531	51380921	a628980c-8235948c-af0bf50a-9aec5850-fcd593fc
1745	moderate cardiomegaly is unchanged compared to exams dating back to , however appears slightly increased compared to exams from . there has been interval increase in moderate pulmonary vascular congestion and diffuse bilateral interstitial lung markings as well as peribronchiolar cuffing concerning for pulmonary edema . widening of the superior mediastinum is due to mediastinal lipomatosis and tortuous vessels as seen on the prior ct from . right-sided morgagni hernia is unchanged . there is no large pleural effusion or pneumothorax . compression deformities of the mid thoracic spine are unchanged compared to the prior exam . interval increase in moderate cardiomegaly with increased diffuse interstitial markings concerning for pulmonary edema, however an atypical infection is not excluded .	Cardiomegaly&&Edema&&Lung Opacity&&Pneumonia	13475033	56512741	f0efdf99-db7193c1-b47f4ffa-dd90a48e-2071134d
1746	single portable view of the chest is compared to previous exam from earlier the same day at pm . there has been interval placement of a left-sided chest tube projecting over the left lower hemithorax . there is overlying subcutaneous gas . lucency still persists adjacent to the mediastinum on the left . otherwise, there has been no change . multiple right-sided rib fractures are better seen on the prior exam . interval placement of a left-sided chest tube projecting over the left hemithorax .	No Finding&&Support Devices	12736592	51566590	9fd949c5-ac707f23-cce74dc3-069335d6-c3d02d66
1747	chest pa and lateral radiograph demonstrates unchanged cardiomediastinal and hilar contours . no overt pulmonary edema is evident though chronic mild interstitial abnormalities are stable . faint opacification projecting over the left mid lung may represent developing infectious process . there is no definitive correlate on the lateral radiograph . no pleural effusion or pneumothorax present . mild separation of superior aspect of sternotomy line with intact sternotomy sutures . faint increased opacification in left mid lung may indicate developing infectious process . could further evaluate with right anterior oblique view to further evaluate lung .	Lung Opacity&&Pneumonia	10274145	53356050	4e60f3da-37ed157d-a469a568-0b2ee907-4b01c924
1748	there is unchanged evidence of bilateral chest tubes . known rib fractures, known soft tissue gas accumulations bilaterally . the presence of a minimal right apical pneumothorax cannot be excluded . no evidence of tension . minimal fluid overload, borderline size of the cardiac silhouette . no focal parenchymal opacity suggesting pneumonia .	Cardiomegaly&&Fracture&&Pneumonia&&Pneumothorax&&Support Devices	12736592	52442135	ca418dad-d4092480-3bf56e1f-9b920db8-8b8361de
1749	heart size and mediastinum are stable . tortuous aorta is re-demonstrated . right pleural effusion appears to be unchangedminimally smaller since the prior study, again most likely loculated posteriorly and laterally . aeration of the right lower lung has minimally improved . left lung is essentially clear . multiple rib fractures are re-demonstrated bilaterally .	Cardiomegaly&&Enlarged Cardiomediastinum&&Fracture&&Pleural Effusion	13352405	53475803	fc9d24b9-ab585ce7-32abcbae-b223b872-d70b72cf
1750	cardiomediastinal contours are unchanged with cardiomegaly and tortuous aorta . there is no evidence of pneumonia . there is mild vascular congestion . there is no pneumothorax or pleural effusion . there are mild degenerative changes in the thoracic spine . there is s-shaped scoliosis .	Cardiomegaly&&Edema&&Enlarged Cardiomediastinum	13475033	50093179	4a021054-bbc5de8b-8b37348e-b2c5feec-9767dc05
1751	frontal and lateral radiographs of the chest were acquired . the lungs are clear . the cardiac and mediastinal contours are normal . there is blunting of the right costophrenic angle, consistent with scarring or a trace pleural effusion . there is no left pleural effusion . no pneumothorax is seen . note is made of a gastric pull-through . . no acute cardiac or pulmonary process . . possible tiny right pleural effusion versus scarring .	Lung Opacity&&Pleural Effusion	16848073	53387141	1a0d4a94-6ef86f39-cbfdfcac-7dd9b3a7-a693ce1d
1752	severe cardiomegaly is a stable . mild vascular congestion is unchanged . retrocardiac opacities have improved consistent with improving atelectasis . if any there is a small left effusion . there is no pneumothora .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion	15131736	54906849	87528f6b-d04a6330-74d35720-8c8af75d-54f79a11
1753	there are moderately low lung volumes bilaterally with an increase in left lower lobe atelectasis . bilateral pleural effusions are seen . there is a stable enlarged cardiomediastinal silhouette . a right ij catheter sheath is seen terminating in the mid svc . a right subclavian double-lumen catheter is seen to terminate within the right atrium . an ng tube is again seen entering the stomach and then out of the field of view . there is no pneumothorax . bilateral pleural effusion with stable cardiomediastinal silhouette . low lung volumes bilaterally with increased left mid and lower lung atelectasis .	Atelectasis&&Enlarged Cardiomediastinum&&Pleural Effusion	15259244	57867628	88d66a2e-11751a81-a9daf8df-433b48ec-34cd1570
1754	there are decreasing right lung volumes . an area of opacity at the right lung base could correspond to atelectasis or pneumonia . in addition, the lower region of the right hilus appears slightly denser than before, so that a hilar process cannot be excluded . the left lung appears unchanged . there is borderline size of the cardiac silhouette . an upright pa and lateral radiograph should be obtained . if this is still ambiguous, ct should be performed to rule out a right hilar process . at the time of dictation, , am, the referring physician, . , was being covered by dr . , was paged for notification .	Atelectasis&&Cardiomegaly&&Lung Opacity&&Pneumonia	13979643	58088902	3cbd3bc6-39526273-ad8ae42e-93fe3364-f9d21652
1755	ap upright and lateral views of the chest were provided . there is a calcified nodule again seen projecting over the left mid lung as seen on prior ct . there is no focal consolidation, effusion or pneumothorax seen . the heart size is top normal . mediastinal contour is stable . tracheobronchial tree calcification is noted . bony structures appear intact . no acute traumatic injuries .	No Finding	15612622	52026509	c84b7521-c75b5b52-ce5dc9c4-ec6fb779-a69ee6b1
1756	one of the right chest tubes appears to have been removed . no definite pneumothorax is appreciated . post-surgical changes persist in the right hemithorax and there is extensive subcutaneous gas along the right lateral chest wall .	No Finding&&Support Devices	19991135	58283482	f6a7a470-9e057a45-d244e0e5-3efe1422-bb946478
1757	since prior radiograph, there has been development of small pleural effusion on the right with fluid within the fissure . opacity at the right base is similar as on prior radiographs and may represent atelectasis however, infection cannot be excluded . there is atelectasis at left lung base . peripheral left upper lobe opacity is unchanged . there is no pneumothorax . cardiomediastinal silhouette is stable . there are degenerative changes in the thoracic spine . re-accumulation of small right pleural effusion with opacity at the right base, with non-specific consolidation at right lung base which could be infectious . follow-up to resolution .	Consolidation&&Lung Opacity&&Pleural Effusion&&Pneumonia	12699874	54061371	72de19ce-ad49323e-c750d7aa-7aefad64-932f50e0
1758	compared to the previous radiograph, there is no relevant change . the monitoring and support devices are in constant position . bilateral pleural effusions with slightly different distribution but overall unchanged extent . subsequent areas of predominantly basal atelectasis . no evidence of newly occurred focal parenchymal opacities . minimal fluid overload . no pneumothorax .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Support Devices	15758946	57083382	9f5b44e9-6f162589-6533517c-f73c712d-9cef61a7
1759	mild-to-moderate cardiomegaly is accompanied by upper zone vascular redistribution, vascular indistinctness and mild interstitial edema . a slightly more confluent opacity at the right lung base medially may reflect asymmetrical dependent edema, but followup radiographs may be helpful to exclude a developing infection in this region . small bilateral pleural effusions have improved since previous study . calcified right hilar lymph nodes are unchanged .	Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion	11893091	56555909	8a301a4d-4df7ca0e-b32741cd-f7fe73d9-4605a414
1760	since the prior study, there has been interval increase in perihilar opacities, right greater than left, which may be due to infectious process with possible superimposed edema . the cardiac silhouette remains mildly enlarged with left ventricular configuration . the aortic knob is calcified . no large pleural effusion is seen, although trace effusions are difficult to exclude . no pneumothorax . interval development of right perihilar opacity while could relate to asymmetric edema, infectious process is also in the differential . no large pleural effusion however, trace bilateral pleural effusions difficult to exclude .	Edema&&Lung Opacity&&Pneumonia	15393401	57486536	804b2558-1b928d2d-a41b4959-275e9da9-5ccdeca5
1761	heart size remains mild to moderately enlarged . the mediastinal contour is unchanged . a a right subclavian vein stent appears unchanged . mild to moderate pulmonary edema is worse in the interval . patchy opacities in the lung bases likely reflect areas of atelectasis . minimal right pleural effusion is noted . no pneumothorax is identified . nodes osseous abnormalities detected . mild to moderate pulmonary edema, slightly worse in the interval with trace right pleural effusion and bibasilar atelectasis .	Atelectasis&&Edema&&Pleural Effusion	14744884	50324889	d6326d09-908b90e7-7f3c10fc-620713fc-4e490c4a
1762	upright ap and lateral views of the chest the cardiac silhouette size is unchanged, and appears mildly enlarged . mediastinal and hilar contours are stable, and there is no evidence of pulmonary edema . no focal consolidation, pleural effusion or pneumothorax is present . there are mild degenerative changes of the thoracic spine .	No Finding	19028690	55310022	ee0ef8eb-6e0b96dd-964fb803-b19c1c2c-cd735b21
1763	hilar and mediastinal vascular engorgements have improved, mild-to-moderate cardiomegaly has not . substantial bibasilar opacification can be explained by atelectasis . pleural effusions are presumed but not appreciable . tip of the endotracheal tube at the thoracic inlet is no less than . cm from the carina and should be advanced cm for more secured seating . right internal jugular line ends in the mid-to-low svc, and a nasogastric tube passes far into the stomach . no pneumothorax .	Atelectasis&&Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Support Devices	16055653	51069079	de44206d-3a107422-191fdf32-35511457-92f6967c
1764	the patient is status post median sternotomy . in the interval since the prior study, there has been increase in the interstitial markings bilaterally and prominence of the hila suggesting moderate pulmonary edema . small pleural effusion may also be present . basilar opacities may relate to fluid overload however, infectious process is not excluded . moderate pulmonary edema . possible small pleural effusion seen posteriorly on the lateral view . underlying basilar infection not entirely excluded .	Edema&&Pleural Effusion&&Pneumonia	16672854	58255680	6c07c33a-7fa8c707-954343f0-26c7f512-379005a9
1765	the patient has been extubated . parenchymal opacities in the left lung are similar to mildly worsened . a left internal jugular vein catheter terminates in the mid svc . the ng tube is no longer present . again seen is the large right subpulmonic effusion . the small left pleural effusion is unchanged . there is no pneumothorax .	Lung Opacity&&Pleural Effusion&&Support Devices	11569093	59995358	51b6ffe9-580e1dd3-9aa94073-a614dd4f-e41809b0
1766	compared to the prior radiograph, lung volumes remain low . streaky opacity in the left lung base is likely atelectasis, and similar to the prior radiograph . no focal opacity identified at the left lung base on concurrent ct . moderate cardiomegaly is unchanged . the mediastinal and hilar contours are stable . no pneumothorax is identified . no focal consolidation concerning for pneumonia .	Pneumonia	14841168	50792961	786239e7-5c2c7f97-0c5c6b36-f8e00af3-91804ffc
1767	heart size is normal . mediastinum is normal . there is interval improvement, but no complete resolution of the left lower lobe opacity . there are no new opacities noted to suggest new infectious process . there is no pleural effusion . there is no pneumothorax . . partial improvement of previously demonstrated left lower lobe pneumonia . reevaluation of the patient in four weeks with chest radiograph is recommended for documentation of complete resolution . if clinically warranted, assessment with chest ct might be considered . . suspected hiatal hernia .	No Finding	18343726	55340847	093baa2b-62a8c5b2-9255859f-2edf2dcf-4f5ed090
1768	there has been no significant interval change . re- demonstrated is diffuse increase and interstitial markings bilaterally consistent with chronic lung disease, grossly stable . no focal consolidation is seen . there is no pleural effusion or pneumothorax . the cardiac and mediastinal silhouettes are stable . no significant interval change .	No Finding	13475033	50956811	34c46b78-c751bfe6-f38375be-f360ffe3-d6a24fda
1769	the lungs are clear without focal consolidation, pleural effusion or pneumothorax . there is no pulmonary edema . the heart is normal in size, and the mediastinal contours are normal . no acute cardiopulmonary process .	No Finding	15659181	51363438	6bee882f-357d1846-ca771638-0a877fc8-6d19d615
1770	the previously seen right lower lobe opacification has decreased substantially . there has also been a mild decrease in the amount of vascular engorgement suggesting improvement in mild biventricular heart failure . in retrospect, given the rapid change, the opacification likely represented fluid overload . the heart size is at the upper limits of normal . the sternal wires are intact and midline . there is longstanding midline lucency in the manubrium and upper body is due to incomplete sternal fusion there is no evidence of other incision complications . a picc can be traced to the mid svc . . mild improvement of pulmonary vascular congestion . . less opacification at the right lower no evidence of pneumonia on todays radiograph . results were communicated with the surgery team by dr . .	Edema	10274145	59166131	2cc38dd6-d1f5970f-055155bc-e9e8fccd-8ec98168
1771	 . endotracheal tube has its tip . cm above the carina . there has been interval repositioning of the dobbhoff feeding tube which now has its tip projected over the stomach . in addition, there has been interval placement of right subclavian picc line, which has its tip in the right atrium . pullback of approximately cm would be advised in order to position the tip in the mid to distal svc . the patient is status post median sternotomy with stable postoperative cardiac and mediastinal contours . there continued to be patchy opacities at both bases with some layering pleural fluid, likely suggestive of compressive atelectasis rather than bilateral pneumonia . clinical correlation is advised . no pneumothorax is seen . calcification of the aorta is consistent with atherosclerosis . the iv nurse, , was notified of the need for repositioning on by phone at pm .	Atelectasis&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Support Devices	12952223	53389484	f0f2783b-afa3d964-f7b57c94-97500fd5-5b85adee
1772	there is persistent prominence of the left hilum which appears site less confluent as compared to , but more prominent as compared to chest radiograph from , underlying lymphadenopathy not excludedno focal consolidation is seen . there is no pleural effusion or pneumothorax . the cardiac and mediastinal silhouettes are stable . prominence of the left hilum appears slightly less confluent as compared to the prior study, but otherwise persists again, underlying lymphadenopathy is not entirely excluded, and could be further assessed for on nonurgent chest ct . no focal consolidation .	No Finding	15659181	53619001	a9a7d29d-d6bfc7f0-0cf3ce22-1a6a9dbc-1df52ce1
1773	status post thoracotomy, moderate cardiac enlargement and evidence of aortic valve prosthesis as well as tricuspid valve annuloplasty as before . the removal of the right-sided pleural effusion of the preceding day remains successful as the right-sided diaphragmatic contour and pleural sinus is free, demonstrating the pigtail-end catheter in unchanged position . no pneumothorax has developed . the pulmonary vascular pattern again demonstrates perivascular haze throughout which in comparison appears slightly increased again . this may have led to question a left-sided pneumonia, a diagnosis which is questionable . persistent successful status post right-sided thoracocentesis, mildly increasing pulmonary congestive pattern with perivascular haze . diagnosis of left-sided pneumonic infiltrate is questionable unless compelling clinical findings are present .	Lung Opacity	19182863	51889790	404c92ca-507a2663-933cb795-d5538049-f6ed552e
1774	portable ap chest radiograph was reviewed in comparison to prior study dated . et tube tip, pacemaker leads, ng tube, replaced mitral valve are unchanged in appearance . there is also no change in the cardiomediastinal silhouette . interval improvement of pulmonary edema is demonstrated which is still at least moderate . bilateral pleural effusions are noted, small to moderate .	Edema&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	18322589	53572321	2fb974ec-04c5bfca-85b4c5fb-85b767ee-9ccd38d2
1775	there is still enlargement of the cardiac silhouette with some elevation of pulmonary venous pressure, though substantially less than on the prior study . the more focal opacification at the left base is not appreciated at this time . there is fluid within one of the major fissures, though no substantial free pleural effusion .	Cardiomegaly&&Lung Opacity	19759491	59691119	5ad83d61-44f64350-e0fe61c9-c78a0842-626ecb1f
1776	dual-lumen dialysis catheter tip is in the right atrium . the previously noted left internal jugular line has since been removed . moderate cardiomegaly is stable . patient is status post median sternotomy with fractured median sternotomy wires which appear in disarray representative of sternal nonunion . again visualized are small bilateral pleural effusions, greater on the right than the left with bibasilar atelectasis . . small ilateral pleural effusions with bibasilar atelectasis . no focal consolidations . . fractured and misaligned median sternotomy wires are stable, indicating chronic sternal nonunion .	Atelectasis&&Fracture&&Pleural Effusion	12189285	59956784	a4398b56-ec603dc8-a33c3c3b-d4969bf3-6ae3e7b1
1777	the patient is status post median sternotomy and cabg . left-sided aicd is unchanged in position . patchy right lower lobe opacity is seen, worrisome for consolidation which could be due to infection or aspiration . no pleural effusion or pneumothorax is seen . the cardiac and mediastinal silhouettes are stable with the cardiac silhouette top normal . patchy right lower lobe opacity is seen, worrisome for consolidation which could be due to infection or aspiration .	Consolidation&&Lung Opacity&&Pneumonia	16059470	55714183	19e1160c-64331a2f-1c1287f4-deca2aae-a62a7beb
1778	single frontal view of the chest demonstrates evidence of prior cabg and median sternotomy . the lungs are mildly hyperinflated allowing for somewhat lordotic patient positioning, suggestive of emphysema . there is minimal interstitial edema . the heart is top normal in size . the mediastinal and hilar contours are unremarkable . . mild interstitial pulmonary edema . . findings suggestive of underlying emphysema .	Edema	17288844	52481016	c57c824d-1eddb1d5-5933f11b-3da0b20b-0bd14eef
1779	the patient has taken a better inspiration . the heart is normal in size and there is no vascular congestion, pleural effusion, or acute focal pneumonia .	No Finding	14312560	57784780	2ad8c1ee-2b9971e8-22aef719-feb89bce-e6c1aa69
1780	severe cardiomegaly and pulmonary vascular congestion have increased, exaggerated by low lung volumes . there is no pulmonary edema or pneumonia . vascular deficiency in the lung apices, particularly the right suggests emphysema . transvenous right atrial and left ventricular pacer and right ventricular pacer defibrillator leads are unchanged in their respective positions . et tube in standard placement . no pneumothorax or appreciable pleural effusion .	Cardiomegaly&&Edema&&Support Devices	12595991	58608964	fab6875e-e58537aa-922ded04-7be27ddc-15a63067
1781	pa and lateral upright chest radiographs were reviewed in comparison to prior study . there is interval expected increase in the left hemithorax effusion with more superior location of the air-fluid level . subcutaneous air on the left appears to be slightly decreased . right lung is essentially clear . left mediastinal shift appears as expected . there has been interval removal of the epidural anesthesia catheter .	Pleural Effusion	12410066	51765454	c29fbf77-80a0a173-85f3cdfd-37459ee3-341a72e3
1782	the apparent small pneumothorax tracking along the minor fissure is not definitely appreciated . there is hazy opacification of the right hemithorax with poor definition of the hemidiaphragm, consistent with layering pleural effusion and compressive atelectasis at the base . mild atelectatic changes are also seen on the left . the nasogastric tube has been removed . right ij catheter and left subclavian catheter remain in place .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Pneumothorax&&Support Devices	16319601	53409681	f5ffe72f-2177cc32-4bf7c5fa-c241b35c-447b2120
1783	the patient has been extubated . the nasogastric tube was removed . the left central venous access line persists . lung volumes are stable . mild to moderate fluid overload . improvement of a pre-existing right basal atelectasis .	Atelectasis&&Support Devices	14841168	55795536	df44930a-9212c400-9890cd67-b4f66cb6-c3319429
1784	as compared to the previous image, no relevant change is seen . the alignment of the sternal wires and the course of the pacemaker wires is constant . borderline size of the cardiac silhouette . mild elongation of the descending aorta . no pulmonary edema . the left picc line is difficult to evaluate, given that it parallels the radiodense pacemaker leads . no pneumothorax .	Cardiomegaly&&Support Devices	16043637	58121758	e84c9b1f-a3692bc5-ec24fb5f-c4874a9d-79cada2a
1785	ap and lateral views of the chest were provided . there is a moderate left pleural effusion, increased since the prior exam . there is a stable small right pleural effusion . the pulmonary vasculature is prominent consistent with pulmonary edema . opacity in the left lung most likely represents atelectasis . the heart size is top normal and there are aortic knob calcifications . there is no pneumothorax . increased left pleural effusion and pulmonary edema . left lung opacity most likely represents atelectasis, although an early developing infiltrate cannot be entirely excluded . recommend repeat radiographs after diuresis to rule out underlying infectious process .	Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion	15380734	55418359	5051fc01-30c7f31e-a08187d6-28940c33-8ba36cc3
1786	the lungs are well inflated and clear . the cardiac silhouette is normal . the left hilum appears enlarged . there is no pleural effusion or pneumothorax . . no focal consolidation . . enlarged left hilum which could reflect hilar lymphadenopathy . ct is recommended for further evaluation . notification findings discussed with dr by dr phone at am on .	No Finding	15659181	56771404	7c32ce35-7b1034c4-629b82bd-91ec7754-06210160
1787	right mid and right lower lobe opacities are new, are worrisome for aspiration . left lower lobe atelectasis is unchanged . there are low lung volumes . small right pleural effusion is unchanged . cardiomediastinal contours are stable . there is no pneumothorax .	Atelectasis&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion	13979643	55454852	be562971-612bb3bb-8057a83f-8874a5f4-59394944
1788	as compared to prior study of day earlier, a moderate right pleural effusion appears slightly larger, but positional differences may contribute to this apparent change . partially loculated moderate left effusion is unchanged, and cardiomediastinal contours are stable . mild gastric distension in the upper abdomen is new . no other relevant changes .	Enlarged Cardiomediastinum&&Pleural Effusion	19182863	51140141	a08fd798-d0a9076f-264c3f63-acc21aa0-d648d9d2
1789	portable upright radiograph of the chest there are ill-defined opacity at the bilateral lung bases which was not present on the prior examination . the remainder of the lungs are clear . the hilar and cardiomediastinal contours are normal . there is no large pleural effusion or pneumothorax . the pulmonary vascular markings appear normal . a right picc line terminates at the cavoatrial junction and incidental note is made of several old right rib fractures .	Lung Opacity&&Pneumonia	17720924	58728926	9df378ca-1a460144-f9bb32fc-35303d15-8b86f4c9
1790	pulmonary vascular congestion in the left lung has worsened since and several nodular foci in the left lung have increased in size, though partially obscured by edema . right lung remains entirely collapsed . patient has had right upper thoracoplasty . heart is probably not enlarged . left pleural effusion is small, increased slightly since . right subclavian pic line ends in the upper svc . there is no pneumothorax .	Atelectasis&&Edema&&Pleural Effusion&&Support Devices	13263843	57878445	0c49c7b0-26167f04-e2cfa26a-15361a7f-6a33c4b8
1791	again seen is the right middle lobe infiltrate . there is also left lingular infiltrate that is slightly increased in conspicuity compared to prior . there are small bilateral pleural effusions that have increased compared to prior . the patchy upper lobe infiltrate seen on ct is not as well visualized on the chest x-ray . bilateral pneumonia with increased effusion .	Pleural Effusion&&Pneumonia	16662264	58623741	a03ac33d-fe835365-82973c3a-0bf2e738-fbb8a2f1
1792	the lungs are hyperinflated but clear of focal consolidation or vascular congestion . previously bilateral effusions are no longer visualized . cardiomediastinal silhouette, osseous and soft tissue structures are unchanged . interval resolution of previously seen layering effusions . no acute cardiopulmonary process .	No Finding	13881772	58581962	f84cbcd6-8eef4c5e-b8c536b9-7121aa4e-7233d805
1793	the heart remains mildly enlarged . there is mild interstitial pulmonary edema which is similar to prior exam . no large effusion is seen . eventration of the right hemidiaphragm is noted . mediastinal contour is stable . no focal consolidation suggestive of pneumonia . the bony structures appear intact . no free air below the right hemidiaphragm . aortic calcifications are again noted . mild cardiomegaly and mild interstitial edema .	Cardiomegaly&&Edema	13475033	54830140	fd6d0847-90e245d6-5e8b9257-3f6a857c-cc3dccc6
1794	the lungs are well expanded and clear . the cardiomediastinal and hilar contours are unremarkable . there is moderate aortic tortuosity, unchanged . a small right-sided pleural effusion is unchanged . there is no pneumothorax . sternotomy wires are intact . multiple fractures in early stages of healing are noted in the right rib cage . stable small right sided pleural effusion .	Pleural Effusion	12736592	57368679	f7349b90-c86e0ac7-2794b96b-e665dc2a-b3f47921
1795	right pleural catheter has been removed with slight decrease in pleural effusion and no definite pneumothorax . small left effusion has decreased in size . atelectasis is seen at the right base, and no focal consolidation or pulmonary edema is seen . mild cardiomegaly persists, and the median sternotomy wires are intact . the left central venous line is in appropriate position in a known left-sided svc . right pleural catheter removed with decreased right effusion and no definite pneumothorax .	No Finding	19182863	59504314	f04b1aeb-e42a14c0-ad437e4e-dee054c7-e24bbe86
1796	right pic line has been pulled back to the low right axilla since . moderate right pleural effusion and large right hilar mass unchanged . new opacification at the base the left lung could be early edema or incipient pneumonia, particularly due to aspiration . heart size is normal .	Edema&&Lung Lesion&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	19720782	50799000	c0a270fd-e635e760-25105a1f-25fde453-b521148c
1797	lungs are clear . there is no consolidation, effusion, or edema . the cardiomediastinal silhouette is within normal limits . no acute osseous abnormalities . no acute cardiopulmonary process .	No Finding	13120957	57697281	95133322-5ad8fb3e-dea16125-70e718db-6cef790a
1798	lung volumes have improved and pulmonary and mediastinal vascular engorgement have decreased since . there is no good evidence for pneumonia and pleural effusions are small if any . mild-to-moderate cardiomegaly unchanged . right pic line ends just before the junction of the brachiocephalic veins . no pneumothorax .	Cardiomegaly&&Pleural Effusion&&Support Devices	14841168	50305989	2f10769e-95f1782e-58bcd178-a4cd46d2-cd832272
1799	upright ap view of the chest there are low lung volumes . the heart size is normal . the aorta remains tortuous . there is crowding of the bronchovascular structures, but no overt pulmonary edema . linear opacities at the lung bases likely reflect atelectasis . possible trace left pleural effusion is present . no pneumothorax . no free air under the diaphragms . there is gaseous distention of the stomach .	Atelectasis&&Pleural Effusion	13979643	53102363	c063f72d-3383a805-adfef1af-05414ba2-9eba728c
1800	there are increased pulmonary vascular markings and redistribution . prominent azygos vein is also noted . there is mild cardiomegaly, unchanged . no focal consolidation, pleural effusion, or pneumothorax is seen . the ng tube courses through the esophagus and terminates outside the field of view . mild volume overload .	No Finding	14312560	54145592	2e02dd1a-6c84da2d-c2df5435-9ac1ab07-f7351caa
1801	the cardiac silhouette is unchanged . there is increasing opacity at the right lung base . as previously noted, there is volume loss . this volume loss could now be accompanied by a small right pleural effusion . the left hemidiaphragm is also less visible, suggesting the potential for a small left pleural effusion . the monitoring and support devices, in particular the position of the endotracheal tube is constant . at the time of observation and dictation, am, on , the referring physician .	Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Support Devices	11204646	52989952	d31b7429-f370f8c7-ceb83fb9-f7188520-153ffb88
1802	there is unchanged evidence of mild-to-moderate pulmonary edema . the pre-existing scars in the lung parenchyma, notably at the left lung apex and left lung base are constant in appearance . constant size of the cardiac silhouette . no larger pleural effusions . the dobbhoff catheter has been pulled back . the catheter is now malpositioned in the esophagus and needs to be advanced by at least cm to ensure position in the stomach . unchanged position of the left picc line . unchanged alignment of the sternotomy wires .	Cardiomegaly&&Edema&&Lung Opacity&&Support Devices	16334516	54611996	dd28d7b2-1303acd7-f23b52ab-4c24a9ab-f7296720
1803	heart size is enlarged, unchanged . post sternotomy wires are stable . pacemaker defibrillator leads terminate in right atrium and right ventricle, the pacemaker is left-sided . mediastinum is stable . bilateral interstitial changes at the need and lower lungs appear to be slightly improved . no pneumothorax or appreciable pleural effusion is seen . previously demonstrated multifocal consolidations have substantially improved and the currently seen changes might potentially represent the sequela or previous alveolar consolidations .	Cardiomegaly&&Consolidation&&Support Devices	12475198	57980670	c6f1c4e9-f329ac22-634957fc-4f7f9884-fa9f9fc8
1804	lung volumes are somewhat low . allowing for this, there is no focal consolidation, effusion, or pneumothorax . the cardiomediastinal silhouette is normal . imaged osseous structures are intact . no free air below the right hemidiaphragm is seen . no acute intrathoracic process .	No Finding	19623993	52893597	61ed122d-80b347e7-d2269b6b-e28fb75e-e5585f0f
1805	there is moderate amount of right-sided subcutaneous emphysema which is similar in appearance compared to prior . right-sided chest tube is again visualized . there is no increase in the pneumothorax . bilateral parenchymal opacities are again visualized and not significantly changed . the tracheostomy tube is in standard location . right subclavian line tip is in the mid svc .	Lung Opacity&&Pneumothorax&&Support Devices	16751749	55336208	1479bd69-820c7589-5e02e82e-b713275f-99aed79d
1806	large area of consolidation at the right lung base either pneumonia or blood aspiration has not improved appreciably since . the somewhat smaller region of presumed pulmonary hemorrhage in the axillary region of the left mid lung has remained stable . emphysema is responsible for severe hyperinflation . if there is any left pneumothorax it is medial, and unchanged . solitary right pleural tube traverses a sleeve-like opacity that is probably a hematoma . there is no appreciable right pleural effusion . the heart size is normal . et tube and left subclavian line are in standard placements and a nasogastric tube passes below the diaphragm and out of view .	Consolidation&&Lung Opacity&&Pneumonia&&Pneumothorax&&Support Devices	16751749	56723000	40abd28b-1aff0d0a-65b3fc64-515e3b46-9caef400
1807	in the interval, the patient has been extubated . the right picc line persists . also, persisting is a left basal opacity, combined to a left retrocardiac atelectasis . the opacity could have an inflammatory component but shows no progression . unchanged size of the cardiac silhouette . unchanged normal appearance of the right lung .	Atelectasis&&Cardiomegaly&&Lung Opacity&&Support Devices	13031876	53742043	3a3c2ff3-83520f66-952df228-3aa9936e-a98b9087
1808	nasogastric tube terminates within the stomach . side port is just below the expected gastroesophageal junction level . endotracheal tube has been removed . cardiomediastinal contours are stable in appearance . mild pulmonary vascular congestion is new . minimal patchy right basilar opacity has slightly worsened, and left basilar atelectasis has improved .	Atelectasis&&Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Support Devices	18517718	55049074	34a10323-881113ce-bd77fb85-f57b5c48-160f4e7b
1809	right lower lobe opacities are present although compared to there has significantly improved . the time course of improvement does not fit well for pneumonia and more likely represented atelectasis superimposed with edema . the left lung is clear . cardiac size is stable . the patient is status post median sternotomy and valvular replacements .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pneumonia	19182863	58242694	bd31883a-45fff94f-a6b462e8-9b2d4696-f2d2a0e5
1810	evaluate for consolidation, fluid overload, or other cause of chest pain . comparison none available . pa and lateral views of the chest there is central pulmonary vascular congestion with moderate pulmonary edema . the chronicity of these findings is unknown due to the lack of comparison studies . there is no focal consolidation, pneumothorax, or pleural effusion . congestive heart failure, likely acute . acute myocardial infarction should be ruled out as the cause of failure given patients young age and acuity of presentation . the patient was transferred to the emergency department for further evaluation . in the ed was contacted by dr . telephone on at .	Cardiomegaly&&Edema	12658584	54766893	d978970a-5331f2f1-940f4bea-9da9bbf3-4724f2cf
1811	endotracheal tube ends approximately . cm above the carina and is appropriate in position . intraaortic balloon pump lies approximately . cm from the apex of the aortic arch . the patient is status post median sternotomy with intact sternal sutures . gastric tube courses below the diaphragm into the stomach however, its distal end is beyond the field of view . asymmetric, mild, right pulmonary edema has improved over last hours . normal heart size . the mediastinal and hilar contours are unchanged . there is no pleural effusion . asymmetric mild right pulmonary edema has improved over last hours . intraaortic balloon pump lies approximately . cm from the apex of aortic arch .	Edema	17288844	51904170	cf6229c4-0dbb5dd3-64610954-17ed414a-c7d2837d
1812	there is stable mild cardiomegaly . the hilar and mediastinal contours are unremarkable . median sternotomy wires appear to be intact . there is a left-sided ij central venous line in appropriate position in a known left sided svc . there is a right-sided pigtail catheter, which appears to be in unchanged position . there has been a slight interval increase in the small right pleural effusion . there is a stable small left pleural effusion . no evidence of a pneumothorax . right-sided pigtail catheter appears to be in appropriate position, however there has been a slight interval increase in the small right pleural effusion .	Pleural Effusion&&Support Devices	19182863	56024131	217ccc9a-8b9a6468-8d34855f-37b8c95a-fe29df0b
1813	a new nasogastric tube has been placed . the current tube shows a normal course and a correct position in the proximal parts of the stomach . there is no evidence of complications, notably no pneumothorax . the other monitoring and support devices and the remaining appearance of the radiograph is constant .	No Finding&&Support Devices	11880923	58556085	68f0511d-a790a0bc-cb8ef94a-c9af3e71-ab0c9352
1814	the right hemidiaphragm is elevated . aside from linear atelectasis in the right base, the lungs are clear . there is no pneumothorax or pleural effusion . cardiomediastinal contours are normal . the sternal wires are aligned .	No Finding	17327592	51857131	23f44245-c3dac2e5-2fe37a44-0f33bdee-fb440ccf
1815	a right-sided port-a-cath tip sits in the lower portion of the svc . the heart and mediastinal contours are within normal limits . the lungs are largely clear with only minimal atelectasis in the right base in accordance with a small right pleural effusion . there is no pneumothorax . small right pleural effusion with associated atelectasis no pneumothorax .	Atelectasis&&Pleural Effusion	19016834	53015743	2e15d44b-391ff16c-0474e263-a0536b97-de75b719
1816	large opacity in the left upper lobe has resolved . now the left upper lobe lesion is again noted with a new fiducial seed . there is no pneumothorax or pleural effusion . cardiomediastinal contours are unchanged . the right lung is clear .	Enlarged Cardiomediastinum	13450581	53613536	ce26e6f2-6bff880c-7e350e95-0571671b-15e0c25b
1817	pleural effusions bilaterally, right more than left, the distribution of which has changed, but not their overall extent . in the interval, the patient has been extubated . the other monitoring and support devices remain in place . unchanged size of the cardiac silhouette . unchanged mild fluid overload .	Cardiomegaly&&Pleural Effusion&&Support Devices	11880923	58606191	44c09f7b-0aed1234-2a1a02ab-3e91e954-54be38b1
1818	the patient has been extubated and lung volumes are lower . there has been a disproportional increase in caliber of the mediastinum, which could be due to bleeding or vascular engorgement due to cardiac tamponade . lung periphery shows no vascular engorgement, so left heart function is not incriminated . there is no pneumothorax or appreciable pleural effusion, left basal pleural tube is still in place . bibasilar atelectasis is only moderate and unchanged . right subclavian line ends in the right atrium . was paged as soon as this examination appeared for review and i discussed the findings with at the time of dictation .	Atelectasis&&Enlarged Cardiomediastinum&&Support Devices	12124741	57169558	7ceecc91-32932b6b-bf0ae761-92a74cf7-fe124fbc
1819	a left-sided pacemaker is in appropriate position . sternotomy wires again seen . an aortic valve replacement is again noted . faint haziness over the lower lung fields bilaterally, likely from patients body habitus . this is unchanged . there is no new focal consolidation, pleural effusion or pneumothorax . cardiomediastinal and hilar contours are normal . no acute cardiopulmonary process, unchanged compared to .	No Finding	16043637	52793175	1b3d4f71-68977c5e-a070ff6b-29584c84-b70bf667
1820	there are low lung volumes . again seen bilateral loculated pleural effusions and right base opacity which may be due to atelectasis . there is persistent elevation of the right hemidiaphragm . the cardiac and mediastinal silhouettes are grossly stable . patient is status post median sternotomy with the superior two most wires again seen to be fractured deshiscence . again seen bilateral loculated pleural effusions and right base opacity which may be due to atelectasis . persistent elevation of the right hemidiaphragm .	Atelectasis&&Lung Opacity&&Pleural Effusion	16360107	54826768	1c6b6253-4298b326-603a70e5-89968c12-4c6900f8
1821	the heart is moderately enlarged . there is a widespread interstitial abnormality with indistinct pulmonary vascularity and upper zone redistribution, most consistent with moderate pulmonary edema . there is no definite pleural effusion or pneumothorax . findings most consistent with moderate pulmonary edema .	Edema	15131736	51125097	65b85d44-6bcf71a2-508b0589-a48d95ed-d4997747
1822	as compared to the prior study, there is interval improvement in the reticular nodular opacities within the lungs with no evidence of new consolidation developed on the current examination . heart size is enlarged . tortuous aorta is redemonstrated, most likely related due to presence of scoliosis . no pleural effusion or pneumothorax is seen .	Cardiomegaly&&Consolidation&&Lung Lesion&&Lung Opacity	13475033	52367439	d8b26443-22f41aab-1b372737-45d002d7-8bb1d226
1823	as compared to the prior examination, there has been minimal interval change . redemonstrated is a pacemaker seen with leads extending to the right atrium and right ventricle . the patient is status post aortic valve replacement with sternotomy wires noted to be well aligned . there is minimal right-sided basilar atelectasis . unchanged from prior examination is a diffuse haziness seen overlying both lung fields, likely secondary to the patients body habitus . there is no focal consolidation, pleural effusion, pneumothorax, or pulmonary identified . stable, moderate cardiomegaly is noted . mediastinal contours are normal . no radiographic evidence for acute cardiopulmonary process .	No Finding	16043637	51177209	0240c2bd-1a2d54ea-8ccdf075-26529d30-cc00fd94
1824	an et tube is present, in satisfactory position . an ng tube is present, tip beneath diaphragm, extending off film . a thin-caliber tube extends along the mediastinum, with the tip overlying the gastric fundus . an additional line overlying the mediastinum may lie outside the patient . a right ij central line is present, tip over distal svc . no pneumothorax is detected . there is mild cardiomegaly . there is some increased retrocardiac density consistent with left lower lobe collapse andor consolidation, and minimal atelectasis at the right base . no gross effusion . no chf . compared with at am, no definite interval change .	Atelectasis&&Cardiomegaly&&Consolidation&&Enlarged Cardiomediastinum&&Support Devices	13881772	57115906	f7c1ec7a-0d984a70-7c3d7474-03681daa-d3cb5959
1825	there has been previous median sternotomy and mitral valve replacement . a right internal jugular dialysis catheter continues to terminate in the right atrium, and biventricular pacericd leads are unchanged in position as well . stable cardiomegaly accompanied by worsening interstitial edema . additionally, a more confluent area of opacity is present in the left lower lobe, partially obscuring the left hemidiaphragm . this is concerning for developing pneumonia . small pleural effusions are present bilaterally . . left lower lobe consolidation suspicious for pneumonia . . worsening interstitial edema and small pleural effusions .	Consolidation&&Edema&&Pleural Effusion&&Pneumonia	19759491	59984376	87f64c4d-93ab83e7-04f10c4b-a9ed71f7-d05889f2
1826	lungs are low in volume . congestion of the pulmonary vasculature, small bilateral pleural effusions and presence of septal lines reflects mild pulmonary edema . consolidations in the right mid lung and retrocardiac location could reflect a concurrent pneumonia . cardiac size is top normal with a normal cardiomediastinal silhouette . . bilateral consolidations could reflect a multifocal infectious process . . bilateral small pleural effusions with mild pulmonary edema .	Consolidation&&Edema&&Pleural Effusion&&Pneumonia	16662264	52307671	13b4969f-569b4e51-d63f9659-778309be-d1ef9815
1827	portable upright chest radiograph demonstrates interval decrease in lung volumes, and interval development of moderate alveolar and interstitial pulmonary edema . there are no definite effusions . there is no pneumothorax . the cardiac silhouette remains mildly enlarged . calcification of the aortic knob is unchanged . interval development of moderate pulmonary edema, compatible with cardiac decompensation .	Edema	13896515	59108077	bfb7a467-e88452aa-9ca0804d-6b66419b-ebbeec35
1828	pa and lateral chest radiograph is provided . there is no focal consolidation, pleural effusion or pneumothorax . bibasilar opacities are present, more prominent on the left, which most likely represents atelectasis . a pacemaker is seen with leads in appropriate positioning . there are surgical clips seen in the epigastric area . no acute cardiopulmonary process . bibasilar opacities most likely representing atelectasis .	Atelectasis&&Lung Opacity	18287845	57464511	64e9fab8-be276430-8b0b8d08-b7aff644-5d287946
1829	the endotracheal tube, nasogastric tube and right internal jugular vein catheter are unchanged . the pre-existing pulmonary edema might have mildly improved, there is increased retrocardiac and right basal atelectasis . no pleural effusions . no major atelectasis .	Atelectasis&&Edema&&Support Devices	18906643	50110450	de63ae30-040537e7-cda1fd69-c64661bd-ab9be172
1830	cardiomegaly is severe and unchanged . mediastinal silhouette is enlarged, unchanged as well . vascular congestion is severe . there is potentially mild interstitial edema overall similar to previous examination . no appreciable pleural effusion demonstrated . no focal consolidations that would explain suspected aspiration demonstrated .	Cardiomegaly&&Edema&&Enlarged Cardiomediastinum	15131736	50927676	0e980298-0aa23b64-1ce41467-47d7e2a2-f9ed5194
1831	there is a right chest port, with catheter extending into the low svc . small right pleural effusion has decreased from prior study . there is no apparent left pleural fluid . there is no pneumothorax or pneumomediastinum . hilar and cardiomediastinal contours are unchanged . no parenchymal opacity to suggest pneumonia or aspiration .	Pleural Effusion	19016834	59608214	e26df0e6-03380fa6-44f4ce97-dbb30b9d-c1bc0ec5
1832	the contour of the elevated right hemidiaphragm and adjacent pleural thickening are unchanged since following removal of the short right pleural drainage catheter . region of atelectasis at the right lung base is best appreciated on the lateral view . lungs are otherwise clear . heart size is normal . there is no pneumothorax or definite increase in right pleural fluid volume .	Atelectasis&&Enlarged Cardiomediastinum&&Pleural Effusion&&Pleural Other	13352405	52659811	a2566d1b-00966175-0f4ab3bf-f1a2acbb-3061c18a
1833	frontal view of the chest was obtained . large bilateral pleural effusions are present with adjacent opacities most consistent with compressive atelectasis . cephalization and indistinct appearance of the pulmonary vasculature are consistent with pulmonary edema . heart size is not well assessed but appears enlarged . mediastinal contours are stable . pulmonary edema with bibasilar opacities consistent with moderate to large pleural effusions with adjacent atelectasis . superimposed infection cannot be excluded .	Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia	16553329	55534474	02e9477c-659b97b0-28c5c1b2-6f4e0865-3e04a039
1834	there is no focal consolidation, pe pulmonary edema, or pneumothorax . the lateral view radiograph suggests small bilateral pleural effusions in the posterior costophrenic sulcus . the cardiomediastinal silhouette, including mild cardiomegaly, is unchanged . a vascular stent projects over the left axilla, new from prior studies . probable small bilateral bold pleural effusions . otherwise, no acute cardiopulmonary process .	Pleural Effusion	16553329	53481703	129b160a-a04df689-fd8a2f39-c04a597d-736a0245
1835	there has been removal of a substantial amount of right pleural fluid . there has been re-expansion of the ipsilateral lung with no evidence of pneumothorax . continued enlargement of the cardiac silhouette with some engorgement of pulmonary vessels consistent with elevated pulmonary venous pressure .	Cardiomegaly	19182863	56367677	f0af6b21-c203468f-f3fc3442-bd92e0bb-bf562d09
1836	moderate to severe cardiomegaly is stable . mild pulmonary edema has improved . retrocardiac opacities have improved consistent with improving atelectasis . there is no evident pneumothorax or increasing effusions .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity	15131736	53318102	5698b16b-b25ed251-4149b897-8f2393c0-1a6fed9b
1837	heart size is mildly enlarged . the mediastinal and hilar contours unremarkable . calcified granulomas are noted within the left upper lung field . no focal consolidation or pneumothorax is present . the pulmonary vascularity is not engorged . there are small bilateral pleural effusions, best seen on the lateral view . no acute osseous abnormalities demonstrated . small bilateral pleural effusions . please note that chest cta is recommended if there is a concern for pulmonary embolism .	Pleural Effusion	16553329	53158507	eb00136d-bf3de8a4-e4b112fb-e086aa9e-97dc80ff
1838	there is no interval change . there is again seen a nasogastric tube which is appropriately sited . there are bilateral pleural effusions and left retrocardiac opacity . there are no pneumothoraces or signs for overt pulmonary edema .	Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	11934114	59763671	91c320f3-73212556-e2380f4b-f3331485-e35cf39e
1839	compared with at am, the bilateral pigtail catheters have been removed . the dobbhoff-type catheter is still present with radiopaque tip over stomach . the left subclavian picc line is present, with tip over distal svc . no reaccumulated effusions and no obvious pneumothorax is detected at this time . there is mild vascular plethora, without overt chf . minimal patchy atelectasis in the right cardiophrenic region and slight increased retrocardiac density is unchanged . a focal ~ . mm nodular density is seen in the left mid zone measuring immediately above the left anterior fourth rib, near its intersection with left posterior seventh rib . this is not fully characterized, but may correspond to an area of atelectasis seen on the chest ct . attention to this area o n follow-up films is requested .	Atelectasis&&Lung Lesion&&Support Devices	16319601	58890811	b542ed36-509621f6-282a38be-7e4ac3dc-55592aa5
1840	patient is known to have extensive metastatic disease within the chest with loculated left pleural effusion . overall appearance of the chest appears essentially stable compared with multiple prior exams . please note evaluation for subtle differences would be limited due to extensive underlying metastatic burden . heart size cannot be readily assessed . mediastinal contour appears grossly stable . no pneumothorax is seen . imaged osseous structures appear grossly intact . extensive metastatic disease in the chest, which appears grossly stable compared with prior exams .	No Finding	12702423	51407808	005f2399-b87f52cf-d010c801-5426064b-05e4afd4
1841	there is little change . currently, there is no evidence of pneumothorax . the lung volumes are normal . only at the right lung base, minimal atelectasis is seen . the image shows absence of pleural effusions and pulmonary edema . unchanged borderline size of the cardiac silhouette with moderate tortuosity of the thoracic aorta . the soft tissue air collection in the right chest wall is constant . unchanged sternal wires and clips after cabg .	Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion	12736592	51374401	8069ee50-f6767717-3fd52486-9653f799-3d94d99b
1842	the dobbhoff tube has been inserted, currently following appropriate course . the left perihilar mass noted on the prior study is now associated with widespread opacities surrounding it, which may reflect bleeding or aspiration or interval development of infection . bilateral pleural effusions have developed in the interim, small . no change in the right rib fractures is demonstrated, better assessed on the current study . retrocardiac atelectasis has progressed in the interim . given the multiple attempts to adjust the dobbhoff tube, the bibasilar opacities and the left perihilar opacity may reflect aspiration, but infectious process cannot be excluded and should be closely followed .	Atelectasis&&Fracture&&Lung Lesion&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	15185305	52381727	2b387f17-5b587878-eab57bc7-959a3a13-68001f85
1843	frontal and lateral chest radiographs a large caliber left approach central venous catheter terminates in the right atrium, unchanged from prior . there is new opacification of the retrocardiac space which could reflect pneumonia or aspiration in the appropriate clinical circumstance . atelectasis is also within the differential . mild diffuse interstitial abnormality is unchanged compared to multiple prior radiographs . there is no large pleural effusion . no pneumothorax is evident . there is evidence of stable pulmonary hypertension and vascular engorgement, unchanged from prior . moderate cardiomegaly is unchanged . deformity of proximal right humerus appears chronic . . new retrocardiac opacity which could reflect aspiration, infection or atelectasis . . unchanged background interstitial abnormality and central vascular enlargement .	Atelectasis&&Lung Opacity&&Pneumonia	17340686	56349601	28846b1c-da929f47-35763299-12d7c8fa-da2e4559
1844	lungs are well inflated . mild bilateral apical scarring noted . subtle peribronchial opacity only seen on frontal view in the left lung superior and lateral to the left hilus is unchanged since prior examination . the lungs are otherwise clear . no pleural effusion or pneumothorax . heart size, mediastinal contour, and hila are unremarkable . visualized osseous structures are notable for anterior cervical spine fusion device . mediastinal clips are again seen within the left upper quadrant . persistent subtle peribronchial opacity in left lung is worrisome for early pneumonia in the appropriate clinical setting .	Lung Opacity&&Pneumonia	15114531	51986565	232aed3a-74900285-3fa279f4-43c5af2a-e8406c03
1845	a right lower lobe nodule is similar in appearance to prior radiograph and ct, however true volume cannot be measured on radiography . otherwise, the lungs are clear . there is no additional nodule, consolidation, effusion, or pneumothorax . the heart and mediastinal contours are normal . there is mild tortuosity of the descending aorta . osseous structures are unremarkable . . no acute cardiopulmonary process . . -mm right lower lobe nodule . as per the patients ct , the patient is due to have a followup chest ct to assess right lower lobe nodule, to reassess right lower lung nodule .	Lung Lesion	16015751	54907683	f9d601d7-0eb2306d-2e66934e-5db0f766-edb49564
1846	a right-sided chest tube remains in unchanged position . there has been interval increase in extent of opacification of the right hemithorax, compatible with increasing size of a large layering right pleural effusion . additionally, right basilar atelectasis is noted . minimal patchy opacity in the left lung base may also reflect atelectasis . the heart size remains moderate to severely enlarged . mediastinal contours are relatively unchanged . mild element of pulmonary vascular congestion is likely present . no pneumothorax is identified . no acute osseous abnormalities are seen . increased size of large layering right pleural effusion with right basilar atelectasis . probable mild pulmonary vascular congestion and left basilar mild atelectasis . right-sided chest tube remains in unchanged position .	Atelectasis&&Edema&&Pleural Effusion&&Support Devices	16826047	59836321	1452c2ed-ce6c7d7b-02bcde56-a4636a4f-849b5534
1847	previously seen left perihilar consolidation has resolved in the interval . the bilateral pleural effusions have also resolved . paratracheal opacity in the upper thorax, likely secondary to goiter seen on chest ct from , in conjunction with mediastinal nodes also seen on that study . no focal consolidation, pleural effusion, or evidence of pneumothorax is seen . the cardiac silhouette is top normal to mildly enlarged, with left ventricular configuration . mediastinal contours are stable . there is an old rib deformityfracture of the posterior lateral left seventh rib, also seen on the prior chest ct . . no acute cardiopulmonary process . . paratracheal opacity most likely relates to enlarged thyroid gland seen on chest ct from , and followup recommendations per that ct remains .	Lung Opacity	13353878	57540712	e90de45f-b12a6a45-721981dc-7df46eae-aa3318e1
1848	comparison is made to the patients prior study dated . . interval removal of a double-lumen right internal jugular large-bore catheter . the heart remains mildly enlarged . overall mediastinal contours are likely stable given patient rotation on the current study . lung volumes are somewhat low with no focal airspace consolidation to suggest pneumonia . some crowding of the perihilar vasculature, but no overt pulmonary edema . no effusions . no large pneumothorax .	Cardiomegaly&&Enlarged Cardiomediastinum	14841168	53576176	a916f2a6-990e0179-c6395681-9159f006-35377a30
1849	unchanged extensive right pleural effusion with right pleural pigtail catheter . no evidence of right pneumothorax . unchanged normal appearance of the left lung and the left heart border .	Pleural Effusion&&Support Devices	18309149	51357526	243970e9-b0a7958c-31bb275a-b862a345-294f46b1
1850	the patient has developed multifocal bilateral for pneumonia is, with accompanying bilateral small pleural effusions . the effusions are better visualized on the lateral and on the frontal film . normal lung volumes . borderline size of the cardiac silhouette without pulmonary edema . no pneumothorax . normal hilar and mediastinal contours .	Cardiomegaly&&Pleural Effusion&&Pneumonia	16662264	51370405	03549470-b3b9bbfa-9829200c-9e8fbdda-228a6817
1851	comparison to previous studies dated at . single portable ap upright chest film at is submitted . . stable cardiac enlargement, status post median sternotomy for cabg . interval removal of the gastric tube, endotracheal tube and left internal jugular central line . persistent streaky opacities in both lungs which may reflect subsegmental atelectasis . in addition, there is perihilar vasculature indistinctness, which likely reflects persistent but improving perihilar edema . no large effusions . no evidence of pneumothorax .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Support Devices	13896515	52605645	6350bc28-5c2d7079-26abfdf4-fb25349a-5e8564d3
1852	the patient has had prior esophagectomy with a gastric pull-through . a new right lower lobe airspace opacity is likely due to aspiration pneumonia . the left lung is clear . there is no pneumothorax . cardiomediastinal silhouette is stable . new right lower lobe aspiration pneumonia . with dr .	Pneumonia	14295224	52692431	ac311552-a76f7711-c263444b-9819dc86-6fd39b27
1853	the cardiac silhouette size is within normal limits . the mediastinal and hilar contours are normal . the pulmonary vascularity is not engorged . streaky bibasilar airspace opacities likely reflect atelectasis . there is no pleural effusion or pneumothorax . no acute osseous abnormality is identified . calcified vessels are seen within the left upper abdomen . mild bibasilar atelectasis .	Atelectasis	13881772	50949626	1e457cbb-b441fc85-d8d29551-0cb1fed9-15dee5bd
1854	collapse has returned in the right lung, highlighting small-to-moderate air and fluid collection in the right lower hemithorax . mild pulmonary edema has worsened in the left lung and a small left pleural effusion has increased . a pleurx catheter projects over the right diaphragmatic region . right picc line ends in the upper svc . no pneumothorax on the left .	Atelectasis&&Edema&&Pleural Effusion&&Support Devices	13263843	52332522	2c6c22f3-33a5cbf1-a81aa482-24c67693-17d97e01
1855	heart size and mediastinum are grossly stable . interval increase in right pleural effusion is suspected, although in part it may be related to different character of that study being semi-erect as opposite to portable study on the prior examination as well as more symmetric and not rotated image acquisition . left retrocardiac opacity might reflect area of atelectasis, slightly worse since prior examination . it also might be due to large hiatal hernia . infectious process, developing in this location would be another possibility .	Atelectasis&&Cardiomegaly&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Pneumonia	12736592	51043428	4acde369-1065a3cb-52a94a1e-fdc234c2-b18a2846
1856	the lungs are grossly clear without focal consolidation, large effusion or overt pulmonary edema . the cardiac silhouette is enlarged but similar compared to prior . median sternotomy wires and mediastinal clips are again noted . known compression deformities in the spine are not clearly delineated on this exam . no acute cardiopulmonary process .	No Finding	16957952	59350509	e376439c-52cdf885-41f17afb-9a4a3fea-43c74d55
1857	ap and lateral chest radiographs demonstrate very low lung volumes and probable bibasilar opacities, likely atelectasis, though consolidation cannot be excluded . bilateral small pleural effusions are also present . the cardiomediastinal silhouette appears widened due to low lung volumes . there is no pneumothorax . old right mid clavicular fracture is noted .	Atelectasis&&Consolidation&&Enlarged Cardiomediastinum&&Fracture&&Lung Opacity&&Pleural Effusion	15438386	50994417	dd7b0ab6-fd3ea03d-b2a70c10-5eca94a7-a74d42be
1858	lung volumes remain low . heart size is mildly enlarged but unchanged . the aortic knob is calcified . diffuse parenchymal opacities with architectural distortion and bronchiectasis is re- demonstrate compatible with known chronic fibrotic lung disease, overall similar compared to the prior exam . no new areas of focal consolidation, pleural effusion or pneumothorax is seen . no pulmonary edema is demonstrated . relatively similar appearance of diffuse chronic chronic lung disease . no new gross focal consolidation identified .	Consolidation	10867202	50482798	13b3f835-9d35e2fb-bef55a2d-4bf1a470-21b7626c
1859	severe cardiomegaly persists . a left subclavian vascular stent is re- demonstrated . mediastinal contours are unchanged . there is pulmonary vascular congestion,slightly worse in the interval . a small amount of fluid is noted within the minor fissure . no focal consolidation, pleural effusion or pneumothorax is demonstrated . pulmonary vascular congestion, slightly worse in the interval .	Edema	13473495	50319774	ac2bc5fb-c181f807-907ef393-692441ee-057ffb40
1860	there are somewhat better lung volumes . continued enlargement of the cardiac silhouette with extensive parenchymal opacities bilaterally consistent with known fibrotic lung disease .	Cardiomegaly&&Lung Opacity	10867202	57513198	a4d62fc4-613c998d-9a906778-5703a1a3-21507e30
1861	compared to the film from earlier the same day, there is no significant interval change .	No Finding	10886362	54962274	68ea99a4-bd75cd2b-df54e0c2-ae1f3e13-c5a9bca4
1862	there is decrease in the diffuse bilateral pulmonary opacifications . this most likely represents improving pulmonary vascular status . monitoring and support devices are unchanged .	Lung Opacity&&Support Devices	16508811	51985577	92104a74-78d6ae95-2b62a235-6f522a7c-13202ce0
1863	the patient is status post median sternotomy and cabg . the heart remains moderately enlarged . aortic knob calcifications are again seen . low lung volumes are present with crowding of the bronchovascular structures . there is no overt pulmonary edema, with a small left pleural effusion likely present . retrocardiac opacity may reflect atelectasis . infection cannot be excluded . the right costophrenic angle is excluded, but no large right pleural effusion is demonstrated . there is no pneumothorax . left basilar opacity may reflect atelectasis but infection is not excluded . small left pleural effusion . low lung volumes .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Pneumonia	18828251	56693397	7e950526-ccc5960e-735b0f76-a80365d9-139f5bff
1864	there is notable interval improvement in the right pleural effusion . there is a dense opacification with a rounded contour below the aerated right residual lung . though the contour has the appearance of an elevated right hemidiaphragm, this appears to represent a large subpulmonic effusion when compared to chest ct . there is improved aeration of the right lung with residual opacifications likely representing combination of atelectasis and known malignancy cannot exclude superimposed infectious process . atelectatic changes are noted within the left lower lung with a slightly greater degree of collapse in the posterior medial subsegment . small left pleural effusion identified . abnormal contour of the right upper mediastinum is consistent with known malignancy . left-sided cardiomediastinal borders are unremarkable . interval mild improvement in right pleural effusion with likely a large residual subpulmonic pleural effusion . dense opacifications in the now apparent right residual lung likely represents a combination of atelectasis and known malignancy . small left pleural effusion .	Atelectasis&&Lung Opacity&&Pleural Effusion	13263843	54904275	30fc1707-e38a1f76-d52f9649-78068351-e33cb1b3
1865	the monitoring and support devices are in constant position . cad patch over the left hemithorax leads to increased opacity . unchanged size of the cardiac silhouette . unchanged appearance of the lung parenchyma . no pneumothorax .	Cardiomegaly&&Lung Opacity&&Support Devices	13881772	57674353	0d41d944-b75b4101-f204d112-11fcfa1c-96d2169d
1866	portable ap chest radiograph was compared to prior study obtained the same day earlier . the recently introduced dobbhoff tube tip is at the level of mid portion of the esophagus and should be further advanced . no changes in the appearance of the multifocal lung opacities and cardiomediastinal silhouette demonstrated .	Enlarged Cardiomediastinum&&Lung Opacity&&Support Devices	13031876	58064262	230ac524-96234f88-f3c96285-860bdf99-6b6ad9d2
1867	there is a new single lead pacemaker with the lead extending in the expected location for a persistent left-sided svc placement, with tip projecting over the expected location of the right ventricle . there is a moderate right pleural effusion that is slightly smaller than the prior exam . right ij cordis tip projects over the mid svc . the upper lungs are clear . the patient is status post sternotomy and valve replacement .	Pleural Effusion&&Support Devices	19182863	59467289	c0c921be-f6f18f17-4191ce0a-02049b91-242e197b
1868	there has been placement of nasogastric tube whose tip and side port are below the gastroesophageal junction appropriately sited . there are again seen large bilateral pleural effusions, right greater than left and a left retrocardiac opacity . these findings are stable .	Lung Opacity&&Pleural Effusion&&Support Devices	11934114	52020944	df76c29b-3a305594-6510b7d9-7054ad7c-fb7278a0
1869	ap single view of the chest has been obtained with patient in sitting semi-upright position . comparison is made with the next preceding pa and lateral chest examination of . comparison of the frontal views demonstrates increase of pulmonary parenchymal densities in the area of the biopsies, most likely caused by post-biopsy hemorrhages . no other new pulmonary abnormalities are seen, and most importantly, there is no evidence of any pneumothorax on this single view chest examination .	No Finding	16662264	56986640	66e2a71f-4c89386c-3cd769ac-021891b7-e0b1bf2b
1870	the heart size and mediastinum are unremarkable . the lungs are essentially clear . no pleural effusion or pneumothorax is seen . there is interval improvement of left lower lung opacity seen on the prior examination .	Lung Opacity	15192710	52848963	4afda2b2-61dece87-deb99419-3918b8db-b52160b8
1871	a portable ap semi-erect chest film at is submitted . . interval placement of a feeding tube, which courses below the diaphragm with the tip likely within the stomach . the patient is markedly rotated to the right, limiting evaluation of the cardiac and mediastinal contours . overall, however, there is a more focal airspace opacity in the left mid and lower lung, which may reflect asymmetric pulmonary edema or an infectious process, less likely atelectasis . clinical correlation is advised . possible layering left effusion .	Atelectasis&&Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	10532326	59775769	d80a6738-8d88d0fb-04d18b57-35d87a21-0ec6ff6a
1872	there is little overall change in the peribronchial thickening and impaction with extensive bibasilar bronchiectasis . this is again extremely well seen on the lateral radiograph . hyperexpansion of the lungs is consistent with emphysema and the cardiac size is normal . no evidence of pulmonary edema . no evidence of acute focal pneumonia . little change in the severe bronchiectasis and emphysema .	No Finding	10402372	59239338	df947133-0a0bb9b7-96bc6378-2eeb01c8-dcb9c4d5
1873	right chest wall port is again seen . streaky left basilar and right upper lung opacities are seen suggestive of atelectasis or scarring . calcified mediastinal nodes are again seen . cardiomediastinal silhouette is within normal limits . no acute osseous abnormality detected . no acute cardiopulmonary process .	No Finding	11413236	58800563	4c940923-a59ab393-7984e607-b473ed13-af98d60c
1874	right internal jugular central line terminates in the mid svc . endotracheal tube is appropriately positioned . cm above the carina . a left picc terminates in the lower svc . again seen are moderate pleural effusions, similar to the previous exam . a vertical line in the right hemithorax represents a skinfold . there is no pneumothorax or focal consolidation . mild pulmonary edema is stable . cardiomegaly is unchanged . no significant interval change since the prior exam .	No Finding	17669276	53637827	ce079139-3dd3fe97-6c8688b6-c1ff49b1-d8b8585f
1875	a portable ap upright view of the chest was obtained . again seen is a right-sided dialysis catheter terminating in the right atrium . heart is mildly enlarged . pulmonary vasculature is mildly engorged . a rounded opacity at the right base, present sicne , may represent asymmetric pulmonary edema, but other processes such as pulmonary abscess cannot be excluded . no large effusion, or pneumothorax . . mildly enlarged heart and pulmonary vascular engorgement, unchanged . . rounded right basilar opacity may represent asymmetric edema, but other processes such as abscess cannot be excluded . at a minimum follow up with conventional palateral radiographs is recommended, ideally ct should be considered .	Cardiomegaly&&Edema&&Lung Opacity	17340686	54124205	a63e169d-68ac0a93-f335ef61-a4d2e226-449d7927
1876	single portable view of the chest is compared to previous exam from . the lungs are clear . cardiomediastinal silhouette is normal . osseous and soft tissue structures are unremarkable . no visualized free intraperitoneal air is seen below the diaphragm . no acute cardiopulmonary process .	No Finding	15857729	52428322	754c8b94-ddf3a484-279e5c47-973dad5c-3e52b57c
1877	frontal and lateral radiographs of the chest demonstrate stable mild enlargement of the cardiac silhouette . there is stable appearance of fragmentation and misalignment of the sternal wires . the chronic loculated pleural effusions are unchanged with persistent bibasilar opacification . there is slight increase in pulmonary vascular congestion compared to the prior study . no pneumothorax is detected .	Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion	16360107	50456365	5d4e8798-538c8cb8-095c11a2-e34b3a85-0f96f1b3
1878	single portable supine ap image of the chest . the right ij central line has been pulled back in the interval and now terminates in the superior direction junction . the lungs are well expanded . there has been interval mild increased cephalization of the pulmonary vessels, which may be partly or wholly due to supine positioning, making it difficult to evaluate for pulmonary edema . there is no pleural effusion or pneumothorax . the cardiomediastinal silhouette is stable . . right ij central line terminates in the superior cavoatrial junction . . interval mild increased cephalization of the pulmonary vessels, which may be partly or wholly due to supine positioning, making it difficult to evaluate for pulmonary edema .	Edema&&Support Devices	19454978	53961391	97264070-c4f4a7bf-14e97575-719452ba-811afedf
1879	again seen is low position of the et tube, . cm above the carina . the appearance of the lungs is unchanged . right ij line tip at cavoatrial junction is unchanged .	No Finding&&Support Devices	10975446	56390608	0baf5e16-bb057c79-97a74dac-e4631d48-f99f01d7
1880	nasogastric tube has been withdrawn terminating at the gastroesophageal junction and would need to be advanced at least cm to move all the side ports into the stomach . severe thoracolumbar scoliosis distorts the shape of the chest cage which is quite small . borderline cardiomegaly is stable . right lung is clear . atelectasis at the base of the left could be due partially to chest cage deformity, and there might be a small left pleural effusion . no pneumothorax .	Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices	18110020	59523573	6cbf6e4a-3f35b74e-ea811e34-73b49766-fa916b88
1881	since prior exam, the patient has undergone a right thoracentesis . the right pleural effusion has nearly completely resolved . patchy interstitial opacity at the right base likely represents some reexpansion edema and residual atelectasis . there is no evidence of pneumothorax . a small left pleural effusion appears slightly larger than on the prior exam from earlier this morning . left basilar consolidation is likely atelectasis . other patchy bilateral opacities are unchanged, and consistent with the known pneumonia . the cardiomediastinal silhouette is normal . . significant interval decrease in size of the right pleural effusion . no evidence of pneumothorax . . new right basilar consolidation is likely some reexpansion pulmonary edema . . slight interval enlargement of small left pleural effusion with associated atelectasis .	Atelectasis&&Consolidation&&Edema&&Pleural Effusion	16662264	54098643	cccfa82d-f56ed730-031b5dac-53bafa2b-f20378ad
1882	retrocardiac opacification could be due to atelectasis, although an infectious process cannot be excluded . there is minimal right basilar atelectasis . pulmonary vascular congestion is seen without evidence of interstitial pulmonary edema . a small left pleural effusion is possible . there is no right pleural effusion . no pneumothorax is seen . the heart size is normal . the mediastinal contours are normal . . left retrocardiac opacification could be atelectasis or infection . . pulmonary vascular congestion without evidence of interstitial edema . . possible small left pleural effusion .	Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia	14608347	57261102	dd4d07ba-c78dcfab-fc8fc38e-e425a71b-29874f79
1883	there is little change and no evidence of acute cardiopulmonary disease . the heart is normal in size and lungs are clear without vascular congestion or pleural effusion .	No Finding	13989850	54340460	6ef62beb-9dc09cbe-d856c78a-ffcdf46e-c41bf566
1884	since , moderate-to-large right pleural effusion with right lung atelectasis and left lower lung volume loss reflected as increased retrocardiac density are unchanged . left upper lung is clear . mildly enlarged heart, mediastinal and hilar contours are unchanged .	Atelectasis&&Cardiomegaly&&Enlarged Cardiomediastinum&&Pleural Effusion	11934114	53100359	dc63738e-e751f65e-82a68318-2d812b04-d30cf7f3
1885	the cardiac silhouette is mildly enlarged but there is no evidence of vascular congestion or pleural effusion . no definite acute focal pneumonia . calcified granulomas are seen in the left lung and hilar region .	Cardiomegaly	12185775	58139207	84a95f3a-a7060282-499a7492-bc0c8ebd-3fb68b34
1886	moderate cardiomegaly is re- demonstrated . the aorta is tortuous . pulmonary vasculature is not engorged . patchy opacities are seen in the left lung base, potentially atelectasis but infection or aspiration cannot be excluded . streaky atelectasis is also demonstrated in the left lung base . no pleural effusion or pneumothorax is present . no acute osseous abnormality is visualized . patchy left basilar opacity may reflect atelectasis, but infection or aspiration cannot be excluded in the correct clinical setting .	Atelectasis&&Lung Opacity&&Pneumonia	17398573	51909919	cc9633ee-0f1c87c6-d3eab33a-ac1eccd5-1bd7608f
1887	the lungs are well expanded and clear . there is scarring in the left lung base, unchanged from prior exam . cardiomediastinal silhouette is unremarkable . there is no pneumothorax or pleural effusion . visualized osseous structures are unremarkable . no acute cardiopulmonary process .	No Finding	15182529	52917147	c2402f4a-6c5552e7-e0b4749a-2b88ba69-f59a01a6
1888	opacification of the left lower lung is new since . the left main bronchus is so heavily calcified, it looks like a stent, but the lumens are opacified, particularly left lower lobe bronchuc suggesting large scale aspiration or retained secretions . right lung is low in volume but clear . the heart is mildly to moderately enlarged exaggerated by very low lung volumes .	Cardiomegaly&&Lung Opacity	16313531	58455247	00c7d4e9-802b89b1-4bd840b3-e5fd2fc9-5d38566e
1889	cardiomegaly is stable . there is no focal consolidation concerning for pneumonia . there is no pleural effusion, pneumothorax or pulmonary edema . scoliosis is again noted . an old left clavicular deformity is noted . no evidence of acute cardiopulmonary process . no evidence of pneumothorax .	No Finding	13475033	51830719	cfdc6369-be819fb3-b05a78fa-9695a910-82883c69
1890	the right-sided chest tube is in unchanged position . no evidence of pneumothorax, no pleural effusion . minimal atelectasis at the left lung base . normal size of the cardiac silhouette . no pulmonary edema .	Atelectasis&&Support Devices	19389547	52600197	789709af-ab78dbbd-bd973f37-aa5edc4c-cb7f975a
1891	there is no focal consolidation, effusion, or pneumothorax . the cardiomediastinal silhouette is normal . imaged osseous structures are intact . no free air below the right hemidiaphragm is seen . elevation of the right hemidiaphragm is unchanged from chest radiograph no acute intrathoracic process .	No Finding	19907884	54596345	a5bb1dd6-32ef2b29-b27f45f5-4980a5b0-34f11cf0
1892	the et tube is . cm above the carina . the right lower lung opacity is again visualized . the heart is moderately enlarged . there is pulmonary vascular redistribution with ill-defined vascularity compatible fluid overload . an underlying infectious infiltrate cannot be excluded . ng tube tip is off the film, at least in the stomach . severe degenerative changes of the right humeral head are again seen . et tube . cm above the carina .	No Finding&&Support Devices	17340686	56162656	3800242f-50b7f001-e4bbe30b-53ec3863-df4fe7dc
1893	the lungs are well expanded and show a right upper and right and left lower lobe opacity . the cardiomediastinal silhouette and hilar contours are normal . no pleural effusions or pneumothorax is present . right upper and right and left lower lobe opacities are concerning for pneumonia .	Lung Opacity&&Pneumonia	13881772	52834337	5f7c7fb3-6f209488-379bbb42-6c8cebf3-f91a4d93
1894	the nasogastric tube shows a normal course . the tip of the tube projects over the proximal parts of the stomach, the sidehole is located at the gastroesophageal junction . the tube should be advanced by approximately cm to ensure position in the more central parts of the stomach . no complications, notably no pneumothorax . minimal atelectasis at the left lung base, that is unchanged . borderline size of the cardiac silhouette .	Atelectasis&&Cardiomegaly&&Pneumothorax&&Support Devices	10532326	55414814	2f682808-399e26c2-81fe867a-d6b93077-913dccae
1895	there has been placement of a right ij catheter that extends to the lower portion of the svc . no evidence of pneumothorax or widening of the mediastinum . in comparison with the prior study, there are even lower lung volumes, but otherwise little change in the appearance of the heart and lungs .	Cardiomegaly&&Support Devices	16055653	56465441	807aa21b-591fc5c2-928a2b58-33af8636-1de7e3a9
1896	the lungs are clear without focal consolidation, effusion, or overt pulmonary edema . the cardiomediastinal silhouette is stable given differences in positioning and technique . slight compression deformity of a lower thoracic vertebral body is unchanged . compressed lumbar vertebral body is obscured on this image . there is a sliver of lucency below the left hemidiaphragm on the frontal and adjacent to the right hemidiaphragm on the lateral . no definite acute cardiopulmonary process . sliver of free intraperitoneal air suspected, not unexpected within a few days after intra-abdominal surgery .	No Finding	16957952	59427483	77283979-b7b02317-bf3cf53e-4068c643-ba29c7d7
1897	dual-lead pacer is seen with leads in the right atrium and ventricle as before . there is no pneumothorax or pleural effusion . hyperinflation is again seen compatible with preexisting chronic pulmonary disease . right middle and lower lobe opacities are redemonstrated without new lesions . there is a slight change in morphology with increased lucency of one of the more medial opacities . they are overall unchanged in distribution and as a whole slightly decreased in size . cardiomediastinal silhouette and hilar contours are unchanged . right basal nodules as a whole minimally decreased since the prior study . differential for these lesions includes amiodarone toxicity and cryptogenic organizing pneumonia . while chest radiographs are likely suitable for monitoring for change over time, a baseline ct examination can be obtained to allow for better characterization .	Lung Lesion&&Pneumonia	10754184	51837636	2eb05c0b-30b37945-71fb6374-45cab675-82128ecc
1898	the right lower lobe consolidation has cleared . no evidence of acute focal pneumonia, vascular congestion, or pleural effusion . vascular shunts are again seen, as are the multiple rounded calcifications projecting over the spleen .	No Finding	19061282	50529099	e56aa514-47bbf828-9caeef29-26cbcace-d4f3c1cc
1899	when compared to prior, there are persistent but potentially slightly less conspicuous bilateral increased interstitial markings throughout the lungs . there is no new consolidation or effusion . the cardiomediastinal silhouette is enlarged but stable . no acute osseous abnormalities identified, compression deformities in the thoracic spine were better seen on prior exam . old mid left clavicular fracture is again noted . perhaps mild interval improvement in the appearance of the increased interstitial markings throughout the lungs which persist . no new consolidation .	Consolidation&&Lung Opacity	13475033	51788121	598a87a7-0c33ee5b-7a11cdc4-ad0d69cf-a5ca8524
1900	patient is status post median sternotomy and cabg . heart size is normal . the mediastinal contours are unchanged . right hemidiaphragm remains elevated with associated right basilar atelectasis . pulmonary vasculature is not engorged . left lung is grossly clear . no pleural effusion or pneumothorax is demonstrated . there are no acute osseous abnormalities . mild to moderate multilevel degenerative changes are noted in the thoracic spine . unchanged chronic elevation of the right hemidiaphragm with right basilar atelectasis . no new focal consolidation .	Atelectasis&&Consolidation	17327592	52874049	a67e2e2b-c5902ccf-adf291f3-51b417af-5b71eeaa
1901	portable ap semi-upright radiograph is presented for review . endotracheal tube terminates . cm above the carina . nasogastric tube courses into the stomach and out of view . improved aeration is seen in the left base with some minimal residual atelectasis . mild pulmonary vascular congestion is seen without findings of edema . cardiomediastinal contours are unchanged .	Atelectasis&&Edema&&Enlarged Cardiomediastinum&&Support Devices	10268877	58011676	6dd4f93a-409046d9-76f232eb-f7cb1b45-834abf5c
1902	the heart appears at least mildly enlarged . the mediastinal and hilar contours appear unchanged . there is a new mild interstitial abnormality suggesting congestive heart failure ,and in addition, a small to moderate pleural effusion on the right and a small effusion on the left . fissures appear thickened . findings consistent with mild pulmonary edema including pulmonary pleural effusions .	Edema&&Pleural Effusion	13881772	51540424	3c6607cb-2b24a862-ba454139-42d40dec-a4aed625
1903	ap single view of the chest has been obtained with patient in sitting semi-upright position . bilateral pleural densities blunting the right-sided pleural sinus persist . so, evidence of pneumoperitoneum is still visible . no other new pulmonary abnormalities are seen, and there is no evidence of pneumothorax in the apical area . observe that the heart size is within normal limits .	No Finding	19016834	59970698	02088c92-5c6bfe4f-9fd824af-09b698c6-a2ac2b87
1904	frontal radiographs of the chest demonstrate unchanged cardiomegaly . lung volumes are low . there is pulmonary vascular congestion and moderate pulmonary edema increased from the prior . bibasilar and retrocardiac opacities likely representing combination of pleural effusion and atelectasis with moderate to large pleural effusion on the right increased in size underlying consolidation cannot be excluded . left vascular stent is unchanged .	Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Lung Opacity&&Pleural Effusion	12847817	52295860	9e4ff803-49fb5448-9a9d7215-dda7fcf0-edfff263
1905	frontal and lateral chest radiographs demonstrate stable cardiomegaly and tortuous aorta . no focal opacification concerning for pneumonia identified . no pleural effusion or pneumothorax identified . multiple thoracic compression deformities are unchanged since . dense calcifications are noted within the right coronary artery as well as the aorta . no acute cardiopulmonary process . stable cardiomegaly . stable thoracic compression fractures .	Cardiomegaly&&Fracture	13475033	58306324	7b764993-32d1c941-d0ddfd50-1022cf30-82cdcfc7
1906	frontal and lateral radiographs of the chest were acquired . there is new mild interstitial pulmonary edema . a small right pleural effusion may be minimally increased . there is also likely a trace left pleural effusion . there is no focal consolidation . the heart size is not significantly changed . there is no pneumothorax . midline sternotomy wires are noted . . new mild interstitial pulmonary edema . . minimally increased small right pleural effusion and trace left pleural effusion .	Edema&&Pleural Effusion	17669276	58214761	73ca3214-e0c93052-7e191b81-356439da-354da5eb
1907	there has been placement of a left subclavian pacer with leads in the right atrium and apex of the right ventricle . no evidence of post procedure pneumothorax . the cardiac silhouette remains enlarged . the degree of pulmonary vascular congestion has decreased .	Cardiomegaly&&Edema&&Support Devices	12810135	53948906	54e6075a-d4d2c1d4-d742150c-7e4e64c8-f98b4179
1908	there is increased opacity at the left lung base, with associated volume loss . this could represent worsening of effusion and atelectasis, though developing pneumonia cannot be excluded . additional increasec opacity in the right suprahilar region may reflect additional focus of airspace disease . elsewhere, the lungs remain well aerated . a small amount of right pleural fluid is present . heart size is persistenly enalrged . there is pulmonary vascular engorgement without frank edema, which is little changed from prior study .	Lung Opacity&&Pneumonia	16855430	54844091	efdbb954-7179fa49-509d0620-ab87eace-f42022d3
1909	the lungs are mildly hyperinflated, as evidenced by flattening of the diaphragms on the lateral view . diffuse interstitial markings, compatible with known chronic interstitial lung disease, are unchanged . there is no pleural effusion or evidence of pulmonary edema . there is no focal airspace consolidation worrisome for pneumonia . mild to moderate cardiomegaly is unchanged . the mediastinal and hilar contours are unremarkable . a coronary artery stent is noted . there is a levoscoliosis of the thoracic spine . stable changes of chronic interstitial lung disease without evidence of a superimposed acute cardiopulmonary process .	Lung Opacity	13475033	51345585	b7ae7112-d3ab965d-c43adc90-30533667-3b307ee3
1910	this examination was centered in the thoracoabdominal region . the apices of the lungs were not included on the film . large right hydropneumothorax is grossly unchanged . right basal pigtail catheter is in place .	Pneumothorax&&Support Devices	14387068	57268374	b10b437e-7ddd8f3e-e403e6b0-aaa91576-737f857d
1911	there are low lung volumes . right upper lobe scarringchronic fibrosis in the right greater than left upper lobes are again seen . new since the prior study, there is left mid lung streaky opacity and to a lesser extent in the left lower lobe . no pleural effusion is seen . the cardiac and mediastinal silhouettes are stable . stable right greater than left upper lobe fibrotic changes . new opacity in the left mid-to-lower lung raises concern for infectious process versus possibly asymmetric edema . recommend followup to resolution .	Edema&&Lung Opacity&&Pneumonia	10933609	55646831	e26fdf14-791d85bf-3beaee42-3ec8bcee-4a05efee
1912	an og tube is in place with the tip in the stomach . however, the sidehole appears to be above the esophagogastric junction . right ij catheter tip extends to the mid-to-lower portion of the svc . endotracheal tube remains in good position . there is increasing bilateral opacifications consistent with worsening pulmonary edema . moderate-to-large right and small left layering pleural effusions with compressive atelectasis at the bases .	Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	19757720	59572378	13255e1f-91b7b172-02baaeee-340ec493-0e531681
1913	there has been interval removal of a right-sided picc line . the cardiac silhouette remains enlarged . there has been resolution of bilateral pleural effusions . again visualized are two calcified left upper lobe granulomas . . resolution of bilateral pleural effusions . . heart size remains enlarged . this could be indicative of cardiomyopathy or a pericardial effusion .	Cardiomegaly	12185775	53462705	d20291fc-8d626aa2-b3b2ef02-6f8b81ac-12f2432d
1914	hyperinflation reflects copd . heart size is normal . there is no pulmonary edema or appreciable pleural effusion . sternal augmentation and stabilization device unchanged in position . a small amount of retrosternal pneumomediastinum is to be expected . no evidence of bleeding .	Support Devices	17770657	52930375	97bbae6e-3d8e3ff8-4be7f377-ce5fb58c-572b0bac
1915	pa and lateral chest radiographs demonstrate mild hyperinflation, consistent with known emphysema . additionally, interstitial edema, small right pleural effusion, and mild cardiomegaly are new when compared to . left basilar scarring and pleural thickening are chronic . median sternotomy wires and aortic prosthesis are unchanged . there is no focal consolidation or pneumothorax . chf with interstitial edema superimposed upon baseline emphysema .	Cardiomegaly&&Edema	13606683	55528477	242c5252-f4f60ea2-60a0a808-024076cc-54ea11ce
1916	cardiac size is normal . a small right pleural effusion is new . there are low lung volumes . persistent residual peribronchial opacities in the upper lobes bilaterally and medial left lower lobe have minimally improved from prior study . there are no new lung abnormalities . there is no evident pneumothorax .	Lung Opacity&&Pleural Effusion	10933609	52866895	2584ab7b-dd93b49c-2783f1d8-ee64a307-80ff57b5
1917	the patient is status post coronary artery bypass graft surgery . the sternum is not well assessed with this technique . the cardiac, mediastinal and hilar contours appear unchanged, including mild cardiomegaly as well as calcification and tortuosity of the aorta . there is no pleural effusion or pneumothorax . the chest is probably hyperinflated to some degree . a coarse irregular reticular opacification in the left upper lung is a stable chronic-appearing but non-specific finding . streaky opacities at the left lung base suggest minor scarring . a stable focal nodular opacity projecting over the right upper lobe . as before, a small nipple shadow projects over the right mid chest . no evidence of acute disease .	No Finding	14851532	56271024	f403c773-516b1bf3-4068dd21-67aadc38-513ad05f
1918	ap semi upright view of the chest provided . there is no focal consolidation or pneumothorax . right pleural effusion is similar to prior . there is a new moderate to large left pleural effusion . cardiomegaly is similar to prior . imaged osseous structures are intact . no free air below the right hemidiaphragm is seen . . there is a new moderate to large left pleural effusion . . right pleural effusion is similar to prior .	Pleural Effusion	19182863	57825235	fe58949c-440ecca2-acbe699f-ccfa0603-90cc7117
1919	the patient is status post median sternotomy and cabg, with again most of the sternotomy wires seemed to be fractured . a left-sided aicd is stable in position . minimal left base atelectasisscarring is seen . there is blunting of the left costophrenic angle on the lateral view, which may be due to a trace pleural effusion . no pneumothorax or focal consolidation is seen . calcified nodule in right upper lobe is again consistent with granuloma . the cardiac silhouette is top normal . the aortic knob is calcified .	Atelectasis&&Fracture&&Lung Opacity&&Pleural Effusion&&Support Devices	16059470	58625748	8b6b90be-a3f009d8-fcfdce19-97533664-0f73e66c
1920	the dobbhoff tube shows now normal course . the tip projects over the middle parts of the stomach . no complications, notably no pneumothorax . otherwise, the image is unchanged .	Pneumothorax&&Support Devices	15338518	50581506	37f7e3ca-93ef1bc3-81e615c8-a061addd-3a3b6dbf
1921	stable bilateral layering pleural effusions with bibasilar airspace process likely reflecting compressive atelectasis . there has been interval appearance of mild interstitial and pulmonary edema . left-sided pacer remains in place with the lead traversing a left superior vena cava to the right ventricular apex . status post median sternotomy with mitral annular ring . no pneumothorax .	Atelectasis&&Edema&&Pleural Effusion&&Support Devices	19182863	58039954	702ea80d-45e751b9-f310cea5-80c50417-c80de945
1922	the patient has taken a much better inspiration . there is enlargement of the cardiac silhouette with evidence of pulmonary vascular congestion that is less prominent than on the previous study . retrocardiac opacification is consistent with volume loss in the lower lobe and there is blunting of both costophrenic angles . no evidence of pneumothorax . no acute focal pneumonia is identified .	Cardiomegaly&&Edema&&Lung Opacity	14851532	54199404	c1d88bcb-41125f69-0bde8f97-cf27b9f3-3e411312
1923	there are low lung volumes which accentuate the bronchovascular markings . bibasilar opacities are seen, which most likely represent atelectasis, although aspiration or infection are not excluded in the appropriate clinical setting . no pleural effusion or pneumothorax is seen . the cardiac and mediastinal silhouettes are stable and unremarkable .	Atelectasis&&Lung Opacity&&Pneumonia	17897339	59433297	6acc427b-57dfcb76-42bfe32a-060177db-044a5c6f
1924	the pre-existing right upper lobe pneumonia is completely resolved . the pre-existing signs of mild fluid overload, however, are still present . the pre-existing cardiomegaly is unchanged . several calcified lung nodules are also unchanged . unchanged alignment of the sternal wires . no acute pneumonia, no pleural effusions .	Cardiomegaly&&Lung Lesion&&Pneumonia	18828251	51246566	fe5ade20-832e5f10-2fcedcb6-4c3c8557-e8bfb513
1925	small bilateral pleural effusions are seen on the lateral chest radiograph with the right pigtail catheter at the lung base . cardiomegaly continues to be seen with no pulmonary edema or focal consolidation . median sternotomy wires are intact, and left-sided ij central venous line is in appropriate position . small bilateral pleural effusions are seen .	Pleural Effusion	19182863	59009773	4d9ec74c-58ee4dca-9bf9fe37-360c15ab-2b67b1a8
1926	heart size and mediastinum are stable . lungs are clear with no new focal consolidations . there is no pleural effusion or pneumothorax . the right picc line tip is at the level of low svc .	Cardiomegaly&&Consolidation&&Enlarged Cardiomediastinum&&Support Devices	15114531	54440330	6e40a0ff-0f24e50f-e0dbabb8-6b7a3207-d50720d0
1927	ap view of the chest patient is status post median sternotomy, cabg, and mitral valve replacement . a left-sided aicd device is noted with leads terminating in the right atrium, right ventricle, and coronary sinus . mild enlargement of the cardiac silhouette is redemonstrated, with unchanged tortuosity of the thoracic aorta . there is perihilar haziness with vascular indistinctness and diffuse alveolar opacities compatible with moderate pulmonary edema . no large pleural effusion or pneumothorax is seen . there are no acute osseous abnormalities .	Cardiomegaly&&Edema	18322589	58349137	f59791dd-2e8e1e7a-607b2f6e-18b713c7-aed09023
1928	the previously identified bilateral basal parenchymal infiltrates have increased in extension and occupy also the periphery of the lungs mid field area . the lateral pleural sinuses remain free from any massive pleural effusion and no pneumothorax is seen in the apical area . comparison also indicates that the heart shadow has increased in size . remarkable is a more marked distention of the azygous vein, which would indicate increased right-sided cardiac filling pressure . nicu telephone was used for communication at pm . no contact was established with referring physician, , was reached by telephone, findings were transmitted .	Cardiomegaly&&Lung Opacity&&Pleural Effusion	16662264	53652977	b6259590-ac02402d-a7f53e0c-5ab10b89-b8c49017
1929	examination centered at the diaphragm shows new nasogastric tube ending in the stomach . lung bases show persistent small-to-moderate bilateral pleural effusion . upper abdominal gas pattern is unremarkable .	Pleural Effusion&&Support Devices	12433421	53499416	ea90382d-329c4f3b-73ff1b45-e7f3f9f7-63cd342d
1930	relatively low lung volumes are seen . that said, there has been interval resolution of the previously seen right-sided pneumonia . the lungs are now clear . there is no effusion and no evidence of pulmonary edema . median sternotomy wires and coronary artery stents are identified . degree of cardiomegaly is unchanged . no acute osseous abnormalities . no acute cardiopulmonary process .	No Finding	19150427	52284383	4d33ac8f-8d9c4251-e9defb1a-a8f77096-4e2a228e
1931	the size of the large right parahilar air-fluid level is slightly decreased . overall, the massive and predominantly central bilateral parenchymal opacities of mixed morphology are stable in extent and severity . unchanged normal size of the cardiac silhouette . unchanged absence of pleural effusions . unchanged mild elevation of the left hemidiaphragm .	Lung Opacity&&Pleural Effusion	17270742	51271572	fa46f7c1-2f7b2152-3371f918-8971f374-e6405bae
1932	chest pa and lateral radiograph demonstrates mild linear atelectasis and associated volume loss in the left lower lung base . no focal opacifications concerning for pneumonia identifiedstable blunting noted of the left costophrenic angle is likely due to pleural thickening and scarring . no definite pleural effusions evident . interval development of a fracture of the most inferior sternotomy suture . no acute process . interval development sternotomy suture fracture without evidence of dehiscence .	Fracture	13606683	56272498	67e8e551-3fb614a6-58610388-c92da136-a8d32ff8
1933	upright ap view of the chest the heart size is mildly enlarged . the aortic knob is calcified . there is mild pulmonary edema noted with perihilar haziness and vascular indistinctness . small bilateral pleural effusions are present, left greater than right, with bibasilar airspace opacities . no pneumothorax is identified . there are no acute osseous abnormalities . mild congestive heart failure with small bilateral pleural effusions and bibasilar airspace opacities, likely reflecting atelectasis, though infection cannot be excluded .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia	12952223	55062075	e652c211-269bf80b-7db4a010-71e01204-f164bb7c
1934	moderate enlargement of the cardiac silhouette is again noted, unchanged . the aorta is mildly tortuous and demonstrates mild atherosclerotic calcification . hilar contours are within normal limits . previous pattern of mild interstitial pulmonary edema has nearly completely resolved, with no focal consolidation, pleural effusion or pneumothorax identified . there are multilevel degenerative changes in the thoracic spine, with slight loss of height of a low thoracicupper lumbar vertebral body, unchanged . multiple clips in the upper abdomen are unchanged . interval resolution in previous pattern of interstitial pulmonary edema . no radiographic evidence for pneumonia .	Edema	11512104	53379869	294ebc2b-bda5301f-54062c24-9d36e9fe-0770d722
1935	pa and lateral chest radiographs are provided . there is no focal consolidation, pneumothorax or pleural effusion . the lungs are hyperinflated . cardiomediastinal silhouette is unremarkable . there is no free air under the right hemidiaphragm . there are no concerning osseous lesions . no acute cardiopulmonary process .	No Finding	19748558	59372049	baf21f49-b3c34e24-016e1cf0-2d79e385-87cef256
1936	consistent with the given history, large-bore dual-lumen dialysis catheter from a right internal jugular approach is in stable and standard course and position from a right internal jugular approach . a left internal jugular central venous catheter device has been removed in the interval . no consolidation or edema is evident . the mediastinum is unremarkable . the cardiac silhouette is enlarged . this is an interval change compared to the most recent prior study but has been noted on other prior studies . subtle blunting of the right costophrenic angle suggests a tiny effusion . no pneumothorax is evident . there are no displaced fractures . small bilateral pleural effusions . interval marked enlargement of the cardiac silhouette relative to the most recent prior exam . however, other more remote exams have demonstrated enlargement of the silhouette, thereby suggesting the possibility of waxing and waning pericardial effusion . correlate clinically .	Cardiomegaly&&Pleural Effusion	15259244	58008930	35b21042-72d1e131-7566b7a8-5f8005c0-b27fc76d
1937	portable ap view of the chest demonstrates confluent opacity in the right mid and lower lung . there is relative sparing of the right apex . rounded lucencies projecting over right hemithorax, are suggestive of cavities or abscess formation . small-to-moderate right pleural effusion is likely . ground-glass opacities most pronounced in the left mid lung zone . there is no large left pleural effusion . no pneumothorax is seen . heart size is difficult to discern due to adjacent opacities . partially imaged upper abdomen is unremarkable . confluent opacity involving mid and lower right lung with round lucencies, suggestive of cavitation andor abscess formation . ground-glass opacification of the left mid lung . small-to-moderate right pleural effusion . findings concerning for infection with cavitary lesions in the right lower lung . correlation with ct exam from the outside hospital, which by report was performed at the osh .	Lung Lesion&&Lung Opacity&&Pleural Effusion&&Pneumonia	13964474	54765591	6911b0d3-34d72504-00da42b3-d727c19f-52754910
1938	endotracheal tube and nasogastric tube remain well positioned . there is a new right ij line, extending to the mid svc . no pneumothorax . stable diffuse opacity in the right hemithorax, compatible with layering effusion as seen on neck ct . no left effusion . bibasilar opacities are not significantly changed . stable hilar and cardiomediastinal contours .	Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Support Devices	12699874	51233868	5e44766b-fb081bc1-02952485-11552e37-ed98a6d3
1939	ap upright portable chest radiograph obtained . there are bilateral small layering pleural effusions, not significantly changed from the prior chest radiograph . there is a metallic stent again noted in the region of the left subclavian vein . mild interstitial pulmonary edema is likely present . the heart and mediastinal contour appear stable . bony structures appear grossly intact . mild interstitial edema with bilateral small pleural effusions, essentially unchanged from the prior exam .	Edema&&Pleural Effusion	16772702	55198378	49c6a0af-c1fc71ef-9a008d1f-a69a11c6-ae390e99
1940	pa and lateral chest radiographs right suprahilar opacity with its fiducial marker is stable for at least two months . small bilateral pleural abnormalities and a large region of rounded atelectasis in the left lower lobe are also unchanged . heart size, and mediastinal and pulmonary vascularity are normal and there is no edema . pacemaker leads are in unchanged positions, intact .	No Finding	13067703	50999536	c1875b25-77500901-b90303e0-9b5c3aac-2b57b80c
1941	the lungs are well expanded and clear . cardiomediastinal and hilar contours are unremarkable . there is no pleural effusion or pneumothorax . sternotomy wires are again noted, with fracture of the two upper wires unchanged from prior exam . no evidence of acute cardiopulmonary process .	No Finding	15518538	55758533	44fd9408-57bb7612-99f6002c-71e76b77-a2040d14
1942	the lungs are clear without focal consolidation . no pleural effusion or pneumothorax is seen . cardiac and mediastinal silhouettes are unremarkable . suggestion of mitral anulus calcification is seen . no acute cardiopulmonary process .	No Finding	16508811	54074259	8b3bc5d6-b73f3699-9273fe20-4aac09c6-d0ef8954
1943	comparison is made to the patients prior study of . single ap upright portable study dated at is submitted and compared to prior study of . . subtle streaky opacities at both lung bases likely reflect atelectasis, although an early pneumonia cannot be entirely excluded . no pulmonary edema . no pleural effusions or pneumothorax . the cardiac and mediastinal contours are . no acute bony abnormality .	Atelectasis&&Enlarged Cardiomediastinum&&Lung Opacity&&Pneumonia&&Pneumothorax	19549821	59953900	a6af277c-9bba350e-4a71b3e8-137d82db-cb01dd0e
1944	portable ap radiograph of the chest was compared to and . since , there is interval progression of extensive consolidation involving almost the entire left lung, consistent with worsening pneumonia . since the radiograph obtained a day ago no appreciable change is demonstrated . most likely the patients pleural effusion was tapped on the right with currently decreased amount of right pleural effusion and presence of loculated basal pneumothorax . pigtail catheter is in place .	Consolidation&&Pleural Effusion&&Pneumonia&&Pneumothorax&&Support Devices	14387068	58340268	2608e773-08c16868-0fac8b34-f79c46da-e7c1319e
1945	cardiac silhouette is within normal limits and there is no evidence of acute pneumonia or vascular congestion . mild atelectatic changes are suggested at the bases . specifically, no evidence of pneumothorax or pneumomediastinum following the procedure .	Atelectasis	16848073	57765976	8f79faef-d6ab7ef3-75eb04f9-26fe138d-a9352552
1946	the cardiac and mediastinal silhouettes are stable . no lobar consolidation is seen . there is subtle increased interstitial markings in the left mid lung zone, with possible mild peribronchial thickening . no pleural effusion or pneumothorax is seen . there is persistent compression of a mid thoracic vertebral body . slight increase in interstitial markings in the left mid lung zone which may in part relate to peribronchial thickening although atypical infection not excluded . the remainder of the study is unchanged .	Lung Opacity&&Pneumonia	13475033	50641273	68bd5521-ca187f93-ae93cbe6-8bb8f491-3fb2dd0f
1947	a left-sided internal jugular catheter is stable in position . a right-sided internal jugular dialysis catheter is also stable . there is no pneumothorax . bibasilar pulmonary opacities are increasing from the prior examination done yesterday and are likely related to increasing pulmonary edema and atelectasis . bibasilar airspace opacities are increasing and are likely related to worsening pulmonary edema and atelectasis .	Atelectasis&&Edema&&Lung Opacity	16508811	50818829	c2f49f11-42bbe227-0e97f6b4-10ea93f4-e05ef9fb
1948	right internal jugular line ends at cavoatrial junction . since , there are no relevant changes in the lungs . mediastinal and mild pulmonary vascular congestion, and left lower lobe atelectasis are unchanged . no evidence of pulmonary edema . thoracic aorta is generally large .	Atelectasis&&Edema&&Support Devices	19454978	56732549	955b5b7c-e2c4d556-9acb1f7d-ca2828f9-f57d4c56
1949	left-sided dual lumen dialysis catheter tip terminates in the proximal right atrium, unchanged . the heart is mild to moderately enlarged with left atrial prominence . mediastinal contours are unchanged . there is mild to moderate moderate pulmonary edema, with more focal opacity seen in the right lung base, new from the prior study . small bilateral pleural effusions are noted . there is no pneumothorax . no acute osseous abnormalities are visualized . clips are seen within the upper abdomen . mild to moderate pulmonary edema, similar compared to the prior study, with more focal opacity in the right lung base concerning for an area of infection .	Edema&&Lung Opacity&&Pneumonia	17340686	53574399	fcacd1e7-993853b9-c2a8e32f-c4fff20c-7792291b
1950	compared to the prior study where right there is no significant interval change . median sternotomy wires are again visualized along with surgical clips degenerative changes throughout the thoracic spine . there is no focal infiltrate or effusion . no significant interval change .	No Finding	15032623	58801080	924e87c2-147bd825-9fe46cda-0cd4a1e3-f76f63a0
1951	single ap view of the chest was reviewed . there has been interval increase in the right pleural effusion, now moderate, with right basilar atelectasis . mild edema is also seen . there is no pneumothorax . the presence of the right pleural effusion limits assessment of the right cardiomediastinal contours, but the remainder of the cardiomediastinal and hilar contours appear stable . median sternotomy wires are in similar configuration with aortic and tricuspid valve replacements . increase in right pleural effusion, now moderate, with underlying atelectasis . mild pulmonary edema . repeat chest radiograph after resolution of right pleural effusion is recommended to reassess the lungs and mediastinum .	Atelectasis&&Edema&&Enlarged Cardiomediastinum&&Pleural Effusion	19182863	59041802	ffd60688-5da7c1d3-4229e284-c84ba788-c00f4302
1952	the right picc line has migrated outward so that the tip is with in the axillary region, outside of the chest cavity . otherwise little change .	No Finding&&Support Devices	16043637	58106953	3ce5c898-0662e770-176651fe-92d12c6e-a6d793f8
1953	the patient is status post median sternotomy and cabg . left-sided dual-chamber pacemaker device is present with leads terminating in the right atrium and right ventricle . moderate cardiomegaly is unchanged . mild pulmonary vascular engorgement is likely present, similar compared to the prior study . probable small bilateral pleural effusions are present . pleural thickening within the lung apices is is unchanged . no pneumothorax is identified . streaky bibasilar opacities likely reflect a combination of atelectasis with chronic fibrotic changes, more so in the right lung base . no pneumothorax is detected . no acute osseous abnormalities seen . elevation of the right hemidiaphragm is unchanged . remote fracture of the proximal right humerus is again noted . mild pulmonary vascular congestion, similar compared to the previous exam, with probable small bilateral pleural effusions . bibasilar streaky airspace opacities could reflect a combination of atelectasis with chronic changes .	Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion	12110863	53008088	22a06cfc-11fababd-02d9a890-42cbc80e-34757e33
1954	the endotracheal tube and nasogastric tubes have been removed . lung volumes are stable or even increased . continued enlargement of the cardiac silhouette with some evidence of increased pulmonary venous pressure . pacemaker device remains in place .	Cardiomegaly&&Support Devices	18417750	54413043	171a0854-5913620e-72072890-3fec961c-fc4bf535
1955	the lungs are clear without consolidation or edema . an ill-defined density projecting adjacent to the cardiac apex is likely nipple shadow . mediastinum is unremarkable . the cardiac silhouette is within normal limits for size . no effusion or pneumothorax is noted . the visualized osseous structures are unremarkable . no acute pulmonary process .	No Finding	16662264	54193371	f781fb92-d5c744fe-58574051-17d2e843-3ba0a211
1956	compared to prior chest radiographs through . consolidation in the left lower lobe has been present for more than a week, improved slightly . this could be pneumonia, but atelectasis is more likely . severe cardiomegaly is stable . there is no longer any pulmonary edema . pleural effusion is likely, but not large .	Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Pleural Effusion&&Pneumonia&&Support Devices	14841168	59481059	b3a377e6-a4f90277-7bd8361f-bfc64687-a4ee054b
1957	severe cardiomegaly and mediastinal and hilar vascular engorgement persists but there has been very significant improvement in previous pulmonary edema, now only minimal, persisting at the base of the right lung . small right pleural effusion is likely . no pneumothorax .	Cardiomegaly&&Edema&&Pleural Effusion	12185775	55958316	b570093b-0dc0e880-c0006423-ad6a31ed-d87e89fa
1958	the mediastinal contour is somewhat prominent, which likely in part reflect patients slight leftward rotation as no mediastinal mass was seen on prior ct . the lungs are hyperinflated compatible with copd . a calcified granuloma is again noted in the left mid lung . calcified lymph nodes in the left hilum are better assessed on the prior ct . heart size is top normal . no definite evidence of pneumonia or chf . no pleural effusion or pneumothorax . the imaged osseous structures appear intact . hyperinflated lungs without evidence of pneumonia or chf . slight mediastinal prominence likely reflects patients slight leftward rotation .	No Finding	15612622	59063233	48a254ba-4d6ccab1-b254dcf7-a7f305bc-9aae746b
1959	previous pulmonary edema and pulmonary vascular engorgement have resolved . small right and small-to-moderate left pleural effusion are also decreasing . heart size normal . et tube, right internal jugular line, and a left subclavian infusion port are in standard placements . nasogastric tube passes into the stomach and out of view . no pneumothorax .	Pleural Effusion&&Support Devices	15758946	51850726	bb2896e3-7eeb9cba-9b026443-c0ee46b8-694ab8ed
1960	comparison to , . the position of the right picc line and of the endotracheal tube are stable and correct . the tip of the endotracheal tube projects approximately cm above the carina . increasing areas of right basal and left retrocardiac atelectasis . otherwise unchanged radiographic appearance of the lung and of the heart .	Atelectasis&&Cardiomegaly&&Support Devices	11022245	57732352	7c113cab-8f9bee61-2b8ef272-d3fb769c-21b9dd1c
1961	endotracheal tube has been removed . indwelling swan-ganz catheter has ended in the right descending pulmonary artery for at least days an should not be advanced . moderate to severe cardiomegaly and pulmonary vascular congestion persists . right pleural effusion is small to moderate depending upon the extent of atelectasis in the right middle and lower lobe which which could both be collapsed . no pneumothorax .	Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	14851532	56617468	53013423-847183db-f162b5ca-9a000174-6427b00e
1962	there is a linear opacity in the lower lung projecting over the middle mediastinum, which is nonspecific and seen on lateral view only, but may represent infection . linear opacity over the right lower lung likely represents linear atelectasis or scarring . no pleural effusion or pneumothorax is detected . heart and mediastinal contours are stable with persistent mild cardiomegaly . sternal wires and valve hardware are noted .	Atelectasis&&Cardiomegaly&&Enlarged Cardiomediastinum&&Lung Opacity&&Pneumonia&&Support Devices	19182863	54839174	4d994f76-a7de771a-cf65cd0f-c1250201-f04a9626
1963	the picc line tip is in the mid svc . there is bilateral lower lobe infiltrates, left greater than right bilateral pleural effusions, left greater than right dense retrocardiac opacity and mild pulmonary vascular redistribution and alveolar infiltrate most marked on the right . compared to the prior study, there has been some progression of the lower lobe infiltrates . the overall impression is that of chf but an underlying infectious infiltrate cannot be excluded .	Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	12185775	59668999	827f0d63-8f046ac6-10747136-2c3bac93-b95d8a29
1964	the patient is status post median sternotomy again with a top normal-sized cardiac silhouette and mildly tortuous thoracic aorta . hilar contours are unremarkable . lung volumes are low with right base atelectasis as well as increased focal retrocardiac opacity with lateral posterior lower lobe correlate . right-sided port-a-cath is again demonstrated terminating at the cavoatrial junction . there is no pleural effusion or pneumothorax . there is no overt pulmonary edema . calcified mediastinal lymph nodes are again noted . low lung volumes with a focal retrocardiac opacity with lower lobe correlate on lateral view . this may represent either atelectasis or infection, and correlation with clinical presentation is recommended .	Atelectasis&&Lung Opacity&&Pneumonia	11413236	52541396	46bdab14-1fa0233c-c0b0841d-4c0869de-6564ff0d
1965	there is a pleurx catheter in place . no evidence of pneumothorax . bibasilar opacification is consistent with atelectasis and effusion . indistinctness of pulmonary vessels is consistent with elevated pulmonary venous pressure .	Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	10410641	59146650	05dad5f1-e33191fc-c4063ab8-15fcf471-3f82205d
1966	current study demonstrates persistent right lower lobe consolidation with right infrahilar opacity and small amount of pleural effusion . no evidence of cavitation is demonstrated . left lung is clear . given the persistence of the abnormality, chest ct might be considered to exclude the possibility of post-obstructive infectious process .	Consolidation&&Lung Opacity&&Pleural Effusion&&Pneumonia	19016834	51549323	d1d3f29c-29490dfe-67ee738d-f029c586-6e269d50
1967	there is unchanged cardiomegaly . there is improvement of the pulmonary interstitial edema . there remains a left retrocardiac opacity . no pneumothoraces are seen .	Cardiomegaly&&Edema&&Lung Opacity	15131736	52604478	687582eb-5fef8f7a-db199474-71f15674-1418c028
1968	vascular stents are unchanged in position . no focal consolidation is seen . there is no large pleural effusion or pneumothorax . the cardiac and mediastinal silhouettes are stable . no pulmonary edema is seen . no acute cardiopulmonary process .	No Finding	19061282	56970093	56800e51-37c27e17-e57356ac-463bc851-663bdfa9
1969	moderate-to-severe cardiomegaly is chronic . there is no pulmonary edema today or focal consolidation to suggest pneumonia . conventional radiographs would probably be more revealing than bedside studies . pleural effusion minimal if any . no evidence of central lymph node enlargement .	Cardiomegaly&&Pleural Effusion	13473495	53743811	b68909bd-ab26c600-5bce4577-31a3f9ad-8bac4c2c
1970	heterogeneous opacities in the right upper lung and left lower lung are new compared to radiographs from and concerning for infection . a small to moderate left pleural effusion is substantially increased . there is no definite right pleural effusion . heart size is top normal . unfolding of the thoracic aorta is unchanged . aortic calcifications are again noted . segmental left rib fractures are unchanged . . new right upper and left lower lung heterogeneous opacities are concerning for pneumonia . . increased small to moderate left pleural effusion . by dr . via telephone on .	Lung Opacity&&Pleural Effusion&&Pneumonia	17206933	51664027	ff6e7a7d-9a6dcd6f-295e7a94-b49fbcc3-502bd3ab
1971	ap upright and lateral radiographs of the chest demonstrate low lung volumes . when compared to radiograph dated , there has been little interval change . the cardiomediastinal and hilar contours remain unchanged, the heart moderately enlarged . prominent vasculature and prominence of the hila is suggestive of pulmonary hypertension . obscuration of the bilateral costophrenic angles is consistent with likely small bilateral pleural effusions versus atelectasis . no acute osseous abnormalities identified . chronic moderate cardiomegaly and probably pulmonary hypertension, unchanged in appearance when compared to prior examination dated . no overt pulmonary edema or pneumonia .	Cardiomegaly	15131736	59762262	69a388e4-94fb2974-fac79369-7a8ffbfd-0331e4d3
1972	triple-lead left-sided aicd is again seen with leads extending to the expected position of the right atrium, right ventricle, and coronary sinus . the lead extending to the coronary sinus, the distal aspect of which is partially obscured by the overlying battery pack . there are extremely low lung volumes that accentuate the bronchovascular markings . the left lung base is obscured by patients overlying battery packs and not well evaluated . right basilar atelectasis is seen . there is blunting of the right costophrenic angle, which may be due to small pleural effusion . aortic knob calcification is again seen . the cardiac silhouette is grossly stable . there is gaseous distention of the stomach and possibly the colon . suboptimal evaluation of the left mid to lower lung due to overlying battery pack . if this is areas of high clinical concern, consider repeat with re-positioning of the patient . there are extremely low lung volumes . right basilar atelectasis is seen . blunting of the right costophrenic angle could be due to small pleural effusion . gaseous distention of the stomach and possibly of the bowel .	Atelectasis&&Pleural Effusion	12595991	54046592	6b246587-087f7413-b47b8a33-a9e5c257-20aaf460
1973	portable ap chest radiograph was reviewed in comparison to . heart size is top normal and stable as well as tortuous aorta . lungs are clear . there is no pleural effusion or pneumothorax . hyperinflation is noted on the right that might be consistent to substantial emphysema .	No Finding	17962324	56599347	2e25b67d-2fe26860-9bd31e83-0ae5d783-44e5bc1e
1974	midline sternotomy wires and mediastinal clips are again noted . the lungs appear clear bilaterally without definite signs of pneumonia or chf . the patient is known to have multiple pulmonary metastases which are not well seen . a lesion in the left lower lobe projects over the posterior margin of the heart on the lateral view . a nodular opacity is again noted in the left upper lobe . no pleural effusion or pneumothorax . heart size is stable . mediastinal contour is also stable . bony structures appear intact . known lung metastases are again noted though better assessed on prior ct . no definite signs of superimposed acute process .	No Finding	11879886	54972841	12fcd1f0-96b6eb00-a6a5ee27-7e8d19ee-63f16bc2
1975	analysis is performed in direct comparison with the next preceding chest examination of . heart size is normal . relatively wide mediastinal and cardiac contours are compatible with previously on ct documented mediastinal lipomatosis . accessible aortic contours are unremarkable . the pulmonary vasculature is not congested . no signs of acute or chronic parenchymal infiltrates are present and the lateral and posterior pleural sinuses are free . skeletal structures of the thorax grossly unremarkable . in comparison with the next preceding study, no significant interval change can be identified . prominence of soft tissue structures surrounding the skeletal structures of the thorax are indicative of rather advanced adiposity . stable chest findings, no evidence of pulmonary congestion or acute parenchymal infiltrates in this patient with history of cough .	Lung Opacity	17257913	57420525	614cf968-41dc136f-73eb6d42-6b73032b-e0dde637
1976	large right pleural effusion has remained stable since . there is extensive new opacification in the left lung in a generally perihilar distribution, most readily explained by pulmonary edema though pulmonary hemorrhage and pneumonia could be contributory . heart is enlarged, but hard to assess because of adjacent right pleural effusion . right jugular line ends in the mid svc . no pneumothorax .	Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	14471276	53261956	1c46590a-4ab8d375-c539829a-8adff157-efdba049
1977	pa and lateral views of the chest demonstrate hyperexpansion of the lungs and relative flattening of the bilateral hemidiaphragms, consistent with emphysema . the cardiomediastinal silhouette is stable . there is no evidence of pulmonary edema, pleural effusion or focal consolidation concerning for pneumonia . multilevel degenerative changes are present in the thoracic spine . bilateral nipple shadows should not be confused for pulmonary nodules . . no acute cardiopulmonary process . . emphysema .	No Finding	19549821	56042734	c7c68b52-54b2bc92-e88ecc8c-e4048535-e3dbb409
1978	comparison is made with prior study performed one hour earlier . dobbhoff tube has been replaced, now tube tip is in the stomach . there are no other acute interval changes .	No Finding&&Support Devices	11880923	50993278	0e77afe7-43ac6d41-4086ded7-baee7795-75274784
1979	patient has had median sternotomy and mitral valve replacement and tricuspid valvular surgery . lungs are hyperinflated but clear . heart is not enlarged . small bilateral pleural effusions are stable, probably not clinically significant . there no findings in the lungs to suggest amiodarone toxicity .	Pleural Effusion&&Support Devices	18224196	52296113	e0112e51-895b5e80-732b15a1-fd8008b4-e8bf044d
1980	there is some improved aeration in the medial aspect of the left lung . however, substantial opacification persists in this hemithorax . right lung remains clear .	Lung Opacity	12530259	54434117	240ac503-263c23a7-986ec4c8-17bf733c-143e5fd6
1981	lung volumes continue to be low . bilateral loculated pleural effusions are again seen and grossly unchanged . a right basilar opacity may be due to atelectasis, but there is persistent elevation of the right hemidiaphragm . compared with the prior study, increased interstitial lung markings suggest the presence of mild interstitial pulmonary edema . patient is post cabg with wondering median sternotomy wires, consistent with known chronic sternal dehiscence . . compared with the prior study, there is worsened interstitial pulmonary edema . . grossly unchanged bilateral loculated pleural effusions .	Edema&&Pleural Effusion	16360107	53330219	b8375637-30c4d9cb-3bd3bb64-a6a4446a-c149911f
1982	the heart size is normal . the hilar and mediastinal contours are normal . obscuration of the right heart border would ordinarily suggest right middle lobe pneumonia, but there is no corresponding abnormality on the lateral view, and lungs are otherwise clear . there is no pleural effusion or pneumothorax . because the abnormal appearance of the right middle lobe is seen only on the frontal view, if clinical findings warrant suspicion of early pneumonia, follow up chest radiographs should be obtained .	Pneumonia	15659181	56790426	82d144fd-f088da1b-377b3165-5f6cfb78-e3e4ae80
1983	there is little overall change . the endotracheal tube is not precisely seen on the study, suggesting that it may have its tip in the mid cervical region or higher . little change in the appearance of the heart and lungs . nasogastric tube extends well into the stomach with the tip distal to the cardioesophageal junction . the large central catheter tip is in the region of the mid portion of the svc .	Cardiomegaly&&Support Devices	18855147	59227699	853f7149-553cb4b1-fe4e0131-75f81ca8-f910c92b
1984	ap upright portable chest radiograph obtained . midline sternotomy wires are again noted . there are tiny bilateral pleural effusions, slightly increased from prior exam . there is no definite sign of pneumonia or overt chf . the heart size is stable . mediastinal contour is widened reflecting an unfolded thoracic aorta . no pneumothorax . bony structures appear intact . small bilateral pleural effusions, mildly increased from prior .	Pleural Effusion	17669276	58317281	137c9581-82049ac3-2bce7676-8032c119-9845711c
1985	moderate cardiomegaly is all stable compared to the prior exams dated back to at least . there has been an interval increase in bilateral moderate pulmonary edema with interstitial thickening and perihilar vascular congestion compared to the prior exam from . there may be small bilateral pleural effusions . there is no evidence of pneumothorax . the visualized osseous structures are unremarkable . note is made of a left subclavian stent, overall unchanged in position compared to the prior exam . moderate pulmonary edema, overall increased compared to the prior exam from .	Edema	13473495	57333607	9748d26b-62549e8c-0a4fec22-48ae4480-691c7013
1986	a left pacer defibrillator unit has leads in the right atrium, right ventricle, and coronary sinus . the endotracheal tube seats . cm above the carina . midline sternotomy wires and mediastinal clips are unchanged . right-sided central venous catheter tip seats at the cavoatrial junction . an endogastric tube courses inferiorly with its side port projecting over the stomach . the cardiomediastinal contours are unchanged . bibasilar atelectasis persists with small bilateral pleural effusions . the lung parenchyma demonstrates minimally improved opacities, signifying improving edema or hemorrhage . there is no pneumothorax .	Atelectasis&&Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Support Devices	18322589	55604705	e3f6ff40-982c86c0-0c5ce5f6-f79305f7-a1fbdeea
1987	the pulmonary vascular congestion has decreased . opacification at the right base is again consistent with effusion and volume loss . less prominent effusion and atelectasis is seen at the left base . right chest tube remains in place without pneumothorax . extensive opacification in the right paratracheal region is consistent with the known invasive esophageal tumor .	Atelectasis&&Edema&&Lung Lesion&&Lung Opacity&&Pleural Effusion&&Support Devices	16848073	50955589	0c931dce-4d5b295c-0a68da5e-9d5c6169-3d3ef2da
1988	right lower lobe peribronchial consolidation is stable . retrocardiac atelectasis have markedly improved . cardiomegaly is stable . vascular stents in the mediastinum are again noted . tracheostomy tube is in standard position . large central catheter projects in the lower svc, a second large catheter tip projects in the left upper quadrant of the abdomen . there is no evident pneumothorax .	Atelectasis&&Cardiomegaly&&Consolidation&&Enlarged Cardiomediastinum&&Support Devices	19061282	57069327	8531a641-5f0bd3c1-b6e592c6-294f4e41-1dc643c3
1989	there has been the development of areas of opacification at the left base most likely reflecting atelectasis and mild effusion . in the appropriate clinical setting, supervening pneumonia would have to be considered . port-a-cath remains in place .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Pneumonia	11413236	53966135	30441716-407a53b5-7bec00c6-abac7a61-d6054dfd
1990	the lungs are clear without consolidation, effusion, or pneumothorax . left chest wall dual lead pacing device is seen with lead tips in the right atrium and right ventricular apex . median sternotomy wires and mediastinal clips are again noted . multiple bilateral rib fractures are noted, most of which appear chronic . there is non visualization of the cortical margin of the right posterior eighth rib fracture which raises possibility of acuity . multiple rib fractures identified bilaterally with possible acuity of the right posterior eighth rib fracture, to be correlated with patients site of pain . otherwise no acute cardiopulmonary process .	Fracture	18487334	57241138	4bc5f178-5d714644-9cc072b9-d1ac0ed5-b4db2ba0
1991	the left lung is clear . there is stable elevation of the right hemidiaphragm . mild atelectasis is noted in the right lung base along with basilar scarring, causing patchy opacity in the right lung base, better assessed on prior ct torso from . the heart size is normal . no pulmonary edema, pleural effusion, or pneumothorax . atelectasis and scarring is noted at the right lung base, better assessed on prior cta torso from . otherwise, no acute cardiopulmonary process .	Atelectasis&&Lung Opacity	18309149	51907814	2b9d6438-d4549d50-64eabcc2-0159f860-4702ea69
1992	comparison is made to prior study of . the endotracheal tube, feeding tube, and right ij central venous catheter are stable in position . there is again seen cardiomegaly and left retrocardiac opacity, which is unchanged . there are no pneumothoraces or signs for overt pulmonary edema . a small right-sided pleural effusion is also present .	Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	11607628	56862577	54f4c142-ff4415c6-17466d42-d7531983-33acac69
1993	compared to chest radiographs since , most recently . chronic moderate to severe non fibrotic interstitial pulmonary abnormality has been present for years . intermittent radiographic exacerbation has been attributed to volume overload . today the abnormality is comparable in severity to many previous examinations and less severe than some . that is not an indication of acute pneumonia or even pulmonary edema . moderate cardiomegaly is long-standing, also less severe today than at some times in the past and there is no pleural effusion .	Cardiomegaly	13475033	56492056	b271e268-5ff07642-0d37e1c1-760b6df6-f50c46b0
1994	the patient is rotated which somewhat limits evaluation . the patient is status post median sternotomy and aortic valve replacement . heart size is moderately enlarged but unchanged . the aorta is tortuous and calcified . there is mild interstitial pulmonary edema, relatively unchanged . at least small bilateral pleural effusions are present . bibasilar airspace opacities may reflect compressive atelectasis . there is no pneumothorax . degenerative changes are noted in both glenohumeral and acromioclavicular joints with narrowed acromial humeral intervals suggestive of underlying rotator cuff disease . there is evidence of prior vertebroplasty at the thoracolumbar junction . mild pulmonary edema and small bilateral pleural effusions, similar compared to the prior exam . persistent bibasilar airspace opacities could reflect compressive atelectasis but infection or aspiration cannot be excluded .	Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia	17669276	50926698	b7d77fd6-bf863ed1-0d7c7510-dde731ba-1e25abec
1995	comparison to at . portable ap upright chest film, at is submitted . . given patient rotation, the overall cardiac and mediastinal contours are likely stable . the heart remains moderately enlarged and the aorta remains unfolded and tortuous . there is no evidence of pulmonary edema . the lungs appear grossly clear . there is some blunting of the left costophrenic angle, which may reflect pleural thickening andor a small pleural effusion . no pneumothorax is seen . no focal airspace consolidation is seen to suggest pneumonia . prominent opacity in the right paratracheal region is felt to likely be vascular in etiology .	Cardiomegaly&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Pleural Other	16853729	51634830	9ef32bb6-e50747e2-dcc3e2c5-8eb088ab-1299485a
1996	compared to prior chest radiographs since , most recently . severe cardiomegaly is chronic . mediastinal veins were acutely distended and pulmonary edema, exaggerated by low lung volumes, had worsened between and . today lung volumes have improved, edema has decreased, but the severe cardiomegaly and mediastinal venous engorgement are still present . pleural effusions are presumed, but not large .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	15131736	54323585	5b07d9a6-0d3955a8-5134f6fa-5357ca78-485cd5af
1997	comparison is made to the prior radiographs from . the right-sided picc line has been re-adjusted and the distal tip is now within the distal svc . the heart size is within normal limits . there is a small left-sided pleural effusion and left retrocardiac opacity . there is some atelectasis at the lung bases . no pneumothoraces are seen .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Support Devices	18978682	52752137	75130ab9-d00d9240-ca6e83c3-57d1ae06-ba5a458b
1998	there has been an increase in the bilateral pulmonary edema status post extubation as evidenced by increased dense opacification, which is now nearly confluent consistent with severe pulmonary edema . the cardiomediastinal silhouette is difficult to evaluate given intervening pulmonary edema opacity, however appears unchanged . there is no pneumothorax . there has been complete obscuration of the costophrenic angles suggestive of bilateral pleural effusions . right ij catheter is unchanged in position and ends in the upper svc . sternotomy wires are unchanged in position, aligned along the midline with no evidence of sternal dehiscence . worsening, now severe, bilateral pulmonary edema . supervening pneumonia can certainly not be excluded in the appropriate clinical setting . interval removal of endotracheal tube . cardiomediastinal silhouette stable .	Edema&&Enlarged Cardiomediastinum&&Pneumonia	13078497	50406925	c9fec029-7cff7a68-c85274cf-7a560cce-becdcb7e
1999	comparison is made to the prior study from . there is a right ij catheter with distal lead tip in the proximal right atrium . heart size is mildly enlarged but unchanged . there is a left retrocardiac opacity and bilateral pleural effusions which are small . there is mild pulmonary fluid overload . overall, these findings are stable .	Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Support Devices	19454978	56651744	495aa78d-7ad88491-fe7e2c29-d712e346-43f1b1a9
2000	in comparison with these study of , there has been placement of a left ij swan- catheter with the tip in right pulmonary artery close to the mediastinal border . endotracheal tube and nasogastric tube have been removed . allowing for low lung volumes, there is little overall change in the appearance of the heart and lungs .	Cardiomegaly&&Support Devices	19075045	54025444	a2082ebd-e2e4d325-ba2534ae-474619f3-c8f5ba9e
2001	the heart size is normal . mediastinal and hilar contours are unremarkable . the pulmonary vascularity is within normal limits . scattered calcifications within the upper lung fields bilaterally likely reflect the sequela of prior granulomatous disease . no focal consolidation, pleural effusion or pneumothorax is seen . there is likely minimal retrocardiac atelectasis . no acute osseous abnormalities are demonstrated . there are mild degenerative changes of the thoracic spine as well as within the imaged left ac joint . no acute cardiopulmonary abnormality .	No Finding	16553329	53060980	81cfd2c3-1f5ca0a7-0c161ae2-ee73d31b-b51df559
2002	the monitoring and support devices are unchanged . the lung volumes have increased, likely reflecting increased ventilatory pressure . the pre-existing combination of a right parenchymal opacity and diffusion has decreased in extent and severity . the retrocardiac lung parenchyma has also slightly increased in transparency . no evidence of new parenchymal opacities . a left pleural effusion is not present . in the left perihilar areas, there is minimal peribronchial cuffing and an increase in diameter of the vascular structures, so that mild pulmonary edema cannot be excluded .	Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	11880923	50940921	6ccb4ace-96b61a6d-da4ac48b-808f3b8e-7d4547a8
2003	stable cardiomegaly . normal mediastinal and hilar contours . stable, subsegmental atelectasis in the right middle lobe . otherwise, the lungs are clear . pleural surfaces are normal . no evidence of an acute cardiopulmonary process .	No Finding	17147859	50242373	60df340a-31a5266d-2f3912a7-3758a59c-9a5baa79
2004	the cardiac, mediastinal and hilar contours appear stable including calcification of the aortic arch and moderate tortuosity of the descending thoracic aorta . irregular opacification in the superior segment of the left lower lobe appears similar to the prior radiographs . nodularity in the right upper lobe also appears stable . however, on this study and since the more recent chest ct are bilateral pleural effusions as well as thickening of fissures an a mild interstitial abnormality predominantly visualized at the lung bases . new basilar reticulation, bilateral pleural effusions and thickened fissures all most suggestive of new mild pulmonary edema .	Edema&&Lung Opacity&&Pleural Effusion	14851532	57470809	b8bed4d3-d993a18e-0991e847-d35ed326-8aebc923
2005	the patient is status post median sternotomy and aortic valve replacement . there is minimal bibasilar atelectasis . no focal consolidation, pleural effusion, or pneumothorax is seen . cardiac and mediastinal silhouettes are unremarkable . no acute cardiopulmonary process .	No Finding	16043637	53520984	1cc3aae6-387f9950-c591a39d-320f3621-7c4e1b19
2006	there is little change . specifically, no evidence of pneumothorax or displacement of pacer leads, which extend to the right atrium and apex of the right ventricle .	No Finding	12810135	54423763	f3d55fb5-65898a76-c35f1782-805b2fd0-ffaa1772
2007	mild-to-moderate pulmonary edema has worsened . nasogastric tube ends in the mid stomach . left pic line tip is in the mid svc . there is no pneumothorax . left pleural effusion is small on the left, if any . greater opacification in the right lower lobe and elsewhere could be combination of dependent edema and atelectasis but could also be an early focus of pneumonia . careful followup advised .	Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	13979643	52684832	a9757208-a33ffdfd-f85aa4b3-e2f7e4ba-8c77011e
2008	the study is somewhat limited secondary to positioning . the patient is markedly rotated . again seen is a large-bore dual-lumen catheter from a left subclavian approach . elevation of the right hemidiaphragm is again evident and slightly exaggerated . there is engorgement of the vascular pedicle and cephalization of the pulmonary vascularity, which is likely at least in part due to the supine positioning . linear atelectasis is seen in the retrocardiac left lower lobe . no focal consolidation is seen . the mediastinum again demonstrates a tortuous aorta exaggerated by the rotation . likewise, the cardiac silhouette is stable, but exaggerated . no large effusion is noted . blunting of the right costophrenic angle is relatively stable . there is no pneumothorax . limited study, but overall grossly stable . the slight engorgement is noted principally in the left hilar region may be in part due to recumbency .	No Finding	14841168	51322686	4ab443e8-381a282a-dfe41cd5-8edde8bf-72cbeb68
2009	lung volumes have improved since . cardiomegaly is chronic and severe, as are dilated pulmonary arteries, this examination neither suggests nor excludes the diagnosis of acute pulmonary embolism . there is no good evidence for edema or pneumonia and no appreciable pleural effusion or pneumothorax .	Cardiomegaly	15131736	54212695	435f9f3d-20761ab9-c5f2bca8-9d5b204f-3520a1a0
2010	the position of the et tube, right picc line, and the ng tube are unchanged . extensive parenchymal consolidations appear to be minimally improved since the prior study . cardiomediastinal silhouette is unchanged .	Consolidation&&Enlarged Cardiomediastinum&&Support Devices	13078497	54020063	fa1a0e84-a634126f-abeb0c16-873ec16b-221c189a
2011	as compared to the previous image, the nasogastric tube has been advanced . the tip of the tube now projects over the middle parts of the stomach . the stomach is markedly dilated . mildly distended small bowel loops . filter in the inferior vena cava .	No Finding&&Support Devices	13979643	57065575	1982caee-73cd2f56-0f1d96b7-2b66f5fc-69c0c582
2012	patient is status post median sternotomy and cabg with multiple fractured sternotomy wires again demonstrated, better seen on the prior ct . heart size remains mildly enlarged . mediastinal and hilar contours are normal . pulmonary vasculature is normal . no focal consolidation, pleural effusion or pneumothorax is identified . biliary stent is seen within the upper abdomen on the lateral view . no acute osseous abnormalities present . no acute cardiopulmonary abnormality .	No Finding	19499595	51712579	cbcc7f2d-85037ab8-b4a6295b-36cbbacc-09003a12
2013	pa and lateral chest views obtained with patient in upright position . comparison is made with the next preceding ap single view chest examination of . the heart size is at the upper limit of normal variation . the heart configuration suggests a relative prominence of the left ventricular contour, a finding which in conjunction with the moderately widened and elongated thoracic aorta suggests the possibility of systemic hypertension . there is no acute pulmonary congestion . in the right hemithorax pleural thickenings are identified and seen to clear along the lateral chest wall . this coincides with the previously described local resection of the posterior aspect of the fourth rib related to previously performed tracheal reconstruction . these post-operative changes have not undergone any significant interval change . no pneumothorax is present . on the lateral view the posterior pleural sinuses are free from any free fluid, pleural effusion . stable post-operative chest findings . no new acute infiltrates and no pneumothorax .	Lung Opacity	11474065	57174042	0a8acf4e-79fa1809-f8cb320e-ec64a315-52784159
2014	pa and lateral radiographs of the chest were acquired . as before, the lungs are hyperinflated, with flattening of the hemidiaphragms and enlargement of the retrosternal airspace, consistent with asthma andor copd . very subtle hazy opacities in the right lower lobe are new compared to the prior study from , possibly atelectasis or a very early pneumonia . a calcified left lung granuloma is unchanged . the lungs are otherwise clear . enlargement of the cardiac silhouette is not significantly changed . the mediastinal contours are normal aside from unchanged mild tortuosity of the descending thoracic aorta . there are no pleural effusions . no pneumothorax is seen . . likely right lower lobe atelectasis, although a very early pneumonia cannot be excluded . . findings consistent with copd . pertinent findings were discussed with dr . by at pm . via telephone on the day of the study .	Atelectasis&&Pneumonia	15612622	50640881	98267606-76ec973b-5884e28c-692b590a-093841f0
2015	severe elevation right hemidiaphragm which was new or substantially worsened on is unchanged . severe cardiomegaly stable . no pulmonary edema or appreciable pleural effusion . aside from right lower lobe atelectasiscommensurate with the elevated hemidiaphragm, lungs are clear . courses of the leads for the atrial biventricular pacer defibrillator system, a standard and no pneumothorax . unchanged .	Cardiomegaly&&Pneumothorax&&Support Devices	12595991	55907924	9c8bbef1-95e3b0fb-eea57c06-586fe950-918a79be
2016	monitoring and support devices are constant . constant cardiomegaly with relatively extensive retrocardiac atelectasis and the potential presence of a small left pleural effusion . mild pulmonary edema . areas of atelectasis at the right lung base . no newly occurred parenchymal opacities . no pneumothorax .	Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	10268877	55430988	befa8b27-2bfd96b0-d50f7eda-deffa4f9-dd7e7314
2017	the heart size is moderately enlarged . the mediastinal silhouette and hilar contours are unchanged . a moderate to large right-sided pleural effusion is slightly increased in volume compared to prior examination with collapse of much of the right lower lobe and right middle lobe . there is also some consolidation at the base of the right upper lobe which could be due to compressive atelectasis . there is no left effusion . the upper lung zones appear clear . there is no pneumothorax . slightly increased moderate to large right-sided pleural effusion with collapse of much of the right middle lobe and right lower lobe . superimposed pneumonia cannot be excluded given the appropriate clinical circumstance .	Atelectasis&&Pleural Effusion&&Pneumonia	12847817	53025898	e1463bfe-02353b8a-fe58ada7-b6000ba2-b57da915
2018	ap and lateral views the chest were viewed . the cardiomediastinal and hilar contours are stable with severe cardiomegaly . there is no pleural effusion or pneumothorax . there is no focal consolidation concerning for pneumonia . a possible small nodule is the right mid lung zone could be evaluated electively with chest ct if indicated . no acute process . possible nodule in the right mid lung zone . nonurgent chest ct may be obtained for further evaluation . this recommendation with dr . telephone at am on .	Lung Lesion	13473495	57665537	c6d9dcd8-49e961d7-227e2c94-92994086-9831113b
2019	compared to radiograph, cardiomegaly and pulmonary vascular congestion are persistent findings . worsening patchy and linear opacities in the left mid and lower lung are likely due to atelectasis, and although coexisting infection is not fully excluded . no other relevant changes .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pneumonia	11052273	56107641	c92eb013-1e459dcb-d3e846b5-def9d7f0-42bed786
2020	portable supine radiograph of the chest . there is diffuse indistinctness of the pulmonary vasculature, suggestive of mild interstitial pulmonary edema . although the heart size is likely exaggerated by the technique, there is moderate cardiomegaly which is stable from but not present on . the lungs are clear . the there is no pneumothorax or pleural effusion . chronic rightward tracheal deviation secondary to thyromegaly . . mild interstitial pulmonary edema . . apparent moderate cardiomegaly, unchanged from but new from , likely exaggarated by low lung volumes and techniqe but dilated cardiomyopathy or pericardial effusion should be considered .	Cardiomegaly&&Edema	15857729	52552967	9ce5a44f-66532667-66a23383-cbbb4b96-4a927036
2021	the cardiac, mediastinal and hilar contours appear stable . there is no pleural effusion or pneumothorax . since the very recent prior studies, there is a substantial new opacity in the right lower lobe concerning for pneumonia . the bones appear demineralized . there is mild-to-moderate rightward convex curvature again centered along the lower thoracic spine with incompletely characterized lumbar compression deformities . moderate degenerative changes are again noted along lower thoracic levels . findings consistent with pneumonia in the right lower lobe . depending on clinical circumstances, the possibility of aspiration could also be considered .	Pneumonia	15612622	53964812	77986392-2dac3752-b145c42b-2ba010de-d49de562
2022	previous right pleural effusion has cleared and moderate cardiomegaly has improved to mild . lungs are clear . hilar and mediastinal contours and pleural surfaces are unremarkable .	Cardiomegaly	12658584	59756815	80e284b5-fdeeb82c-1b888818-0881ac87-eeaaeffa
2023	comparison is made with prior study performed a day before . right upper lobe opacity has increased concerning for increasing pneumoniaaspiration . there is also increase in opacities in the left lower lobe, consistent with aspiration . other multifocal consolidations in the left upper lobe, right perihilar region, and right lower lobe are unchanged . large right lower lobe fluid collection is unchanged allowing the difference in positioning of the patient . lines, tubes, and stent are in unchanged standard positions .	Consolidation&&Lung Opacity&&Pneumonia&&Support Devices	13964474	52510673	4d85d642-5e8316ad-ceed42bd-9bd4615a-20c66bf0
2024	single semi-erect portable view of the chest was obtained . opacity projecting over the right mid to lower lung is likely due to pleural effusion with overlying atelectasis, underlying consolidation cannot be excluded . if want to know full extent of pleural effusion, consider decubitus views . there is a nodular opacity projecting over the lateral right lower hemithorax, most likely representing nipple shadow, although attention at followup once pleural effusion resolved is suggested . there is a small left pleural effusion . the cardiac silhouette is top normal to mildly enlarged . the aortic knob is calcified .	Atelectasis&&Consolidation&&Lung Lesion&&Lung Opacity&&Pleural Effusion	11934114	51328698	f9a68aca-c5a51654-80b6c990-e35e78ae-63dcc3b2
2025	pulmonary vascular congestion, hilar enlargement and moderate cardiomegaly are longstanding . there is no pulmonary edema . pleural effusions are small if any . thoracic aorta is heavily calcified, tortuous and generally large, but there is no evidence of focal aneurysm or interval change . no pneumothorax .	Cardiomegaly&&Edema&&Pleural Effusion	10975446	53829371	d093e190-64d95289-7b99a592-ca302be2-6987d800
2026	portable ap -degree upright view of the chest was reviewed and compared to the prior studies . an endotracheal tube ends cm above the carina . a left-sided internal jugular line ends in the upper svc and a right-sided internal jugular line ends in the mid superior vena cava . upper enteric tube passes into the stomach and off the radiograph . right upper lobe predominant pulmonary edema has improved on todays study, however, right upper lobe atelectasis persists . right middle lobe atelectasis is also unchanged . upper lung vascular redistribution and enlarged pulmonary arteries are chronic . moderate-to-severe cardiomegaly is unchanged . a small right pleural effusion has increased . median sternotomy wires are aligned and intact . . minimal improvement in mild pulmonary edema, most prominent in the right upper lung . . unchanged atelectasis in the right upper and middle lobe . . increased small right pleural effusion . . unchanged moderate-to-severe cardiomegaly .	Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion	18906643	59345475	2c2a8c78-1629add6-99b9b1e7-913212fa-faa7a8ac
2027	comparison to prior study of . portable ap chest film dated at hours is submitted for interpretation . note that the patient is markedly rotated to her right on the current examination which limits evaluation of the cardiac and mediastinal contours . . the lungs appear well inflated . there is prominent pulmonary vascularity suggestive of fluid-replete state, but no evidence of pulmonary or interstitial edema at this time . no pleural effusions . no evidence of pneumothorax . no acute bony abnormality .	No Finding	16524406	56536310	924ee1f2-b4628f80-13244a4a-e74a358f-825abf61
2028	cardiomediastinal contours are within normal limits and without change . minimal bibasilar atelectasis is present, but there are no new areas of consolidation to suggest the presence of a new site of pneumonia . nasogastric tube continues to terminate in the stomach, but side port is in close proximity to the gastroesophageal junction .	Atelectasis&&Consolidation&&Pneumonia&&Support Devices	18517718	52573831	c1b6f0b0-c201e15c-84aa8630-f1c9dba3-2c2a1773
2029	upright ap view of the chest the cardiac, mediastinal and hilar contours are normal . the lungs appear slightly hyperinflated, but no focal consolidation is present . left costophrenic angle is excluded from the field of view . no large pleural effusion or pneumothorax is present . multiple clips are demonstrated overlying the right breast and axillary region .	No Finding	16435402	59788853	2e8951da-ac479fb3-79e5a820-7bb84b0f-5b41ef08
2030	a frontal view of the chest was obtained . the patient is rotated . slightly increased retrocardiac opacity is likely atelectasis although infection cannot be excluded in the appropriate clinical setting . there is linear atelectasis in the left mid lung . there is no pleural effusion or pneumothorax . cardiac and mediastinal silhouettes and hilar contours are stable allowing for patient position . no upper abdominal or osseous abnormality is identified . retrocardiac opacity is likely atelectasis although infection cannot be excluded in the appropriate clinical setting . if further imaging evaluation is needed, a lateral view could be obtained .	Atelectasis&&Lung Opacity&&Pneumonia	16313531	58096693	5df5745b-a26b6124-07ab0ff7-a79cf0ca-d84b7fa1
2031	lungs are hyperinflated, flattening of the diaphragms, suggesting chronic obstructive pulmonary disease . -mm calcific focus in the left mid chest is stable . cardiac silhouette top normal to mildly enlarged . the aorta is tortuous . minimal lingular atelectasis is seen . there is also mild biapical pleural thickening . no focal consolidation is seen . there is no pleural effusion or pneumothorax . the mediastinal contours are stable and do not appear widened . there is diffuse osteopenia . stable mediastinal contour which is not widened .	Enlarged Cardiomediastinum	15612622	50093776	b68832f5-cb74ec26-125ffe9e-4e092765-e97f8be0
2032	single portable supine ap image of the chest . the right ij central line has been pulled back in the interval, but still terminates in the right atrium . the lungs are well expanded and clear . there is no pleural effusion or pneumothorax . the cardiomediastinal silhouette is stable . . right ij central line terminates in the right atrium . pullback of cm could be performed to have the tip located in the superior cavoatrial junction, if desired . . no acute cardiopulmonary process .	No Finding&&Support Devices	19454978	53886138	9bdc75bb-bfb40b21-54ac066c-4c718750-ef2b4f22
2033	the heart is normal in size . the mediastinal and hilar contours are unremarkable . there is no pleural effusion or pneumothorax . there is a vague nodular focus projecting over the right lateral lung measuring about mm in diameter . otherwise the lungs appear clear . vague nodular opacity projecting over the right mid lung, likely a nipple shadow, but confirmation with a repeat pa view with nipple markers is recommended when clinically appropriate . no evidence of acute disease .	Lung Lesion&&Lung Opacity&&Support Devices	16015751	57619468	3352c0d5-7f41c92d-b1178750-7dc794c6-979ffba3
2034	mild cardiomegaly has been stable compared to exams dated back to at least . unchanged widening of the superior mediastinum is due to both mediastinal lipomatosis and tortuous vessels as seen on the prior ct from . re-demonstrated is a right-sided morgagni hernia . there is no pleural effusion or pneumothorax . no new focal consolidations concerning for pneumonia are identified . loss of a height of t vertebral body is not significantly changed compared to the prior ct from . visualized osseous structures are otherwise unremarkable . . no acute intrathoracic abnormalities identified . . persistent mild cardiomegaly .	Cardiomegaly	13475033	58680008	3f111bf1-0ce0a81f-76b66ed5-c8517077-9373dbea
2035	single frontal radiograph of the chest was performed and reveals no acute cardiopulmonary process . the cardiomediastinal and pleural structures are unremarkable . there is scarring in the upper lungs with superior traction of the hila . there is no pleural effusion or pneumothorax . heart size is normal . surgical hardware is seen at the right glenohumeral joint and are seen within the abdomen with cardiophrenic angle may represent a small left pleural effusion as was previously seen approximately one month prior . no acute cardiopulmonary process .	No Finding	10933609	57629869	93894f42-2000f601-7b1944a8-7c4c0711-3d3a2a9b
2036	as compared to the previous chest radiograph of day earlier, there is not been appreciable change in the appearance of the chest .	No Finding	19182863	57967105	c1dd019a-29949553-f64d3355-1ab093c4-cd18e32c
2037	as compared to a previous radiograph, the tube is still relatively high and could be advanced by to cm . unchanged bilateral pleural effusions, unchanged moderate pulmonary edema and mild cardiomegaly . the nasogastric tube shows normal course .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	12185775	59700205	b9ff10af-33a535a6-4ffd1888-a0611f65-784a39da
2038	there is an opacity at the base of the left lung that is consistent with a left lower lobe pneumonia . the cardiomediastinal silhouette and hilar contours are normal . the pleural surfaces are clear without effusion or pneumothorax . left lower lobe pneumonia .	Pneumonia	15114531	52266880	117eb2b7-898e9ead-83d83cb1-c1bd5852-60ba72f4
2039	comparison is made with prior study performed six hours earlier . et tube has been repositioned, now the tip is in standard position, . cm above the carina . diffuse lung opacities have worsened in the left lower lobe, this new focal opacity in the left lower lobe could be due to atelectasis and or aspiration .	Atelectasis&&Lung Opacity&&Support Devices	12185775	53746608	366fb478-ae411f4e-e18c46c8-5c2b8704-e2f26465
2040	lung volumes are low . heart size is mildly enlarged . mediastinal and hilar contours are unremarkable . the pulmonary vascularity is not engorged . there is no focal consolidation, pleural effusion or pneumothorax . there is minimal atelectasis in the lung bases . there are multiple old remote bilateral rib fractures . mild loss of height of multiple thoracic vertebral bodies is present with diffuse demineralization, similar to the prior study . mild bibasilar atelectasis .	Atelectasis	18079481	58357438	84d86cc8-682db79b-a57522b4-e65281b6-4d040d2f
2041	post-sternotomy wires and replaced most likely mitral valve are unchanged in appearance . no progression of interstitial pulmonary edema is demonstrated and might reflect need for dialysis . bilateral pleural effusions, right more than left, have developed in the interim, most likely small to moderate in size . no new focal consolidation to suggest infectious process is seen with re-assessment after dialysis is required .	Consolidation&&Pleural Effusion&&Pneumonia&&Support Devices	15259244	51130329	b3a59eff-ce2b4a69-c5090087-1a2a391b-2605a57c
2042	moderately severe pulmonary edema is evenly distributed in the left lung . on the right, there is greater perihilar opacification extending into the lower lobe which could be asymmetric edema or concurrent pneumonia . a roughly spherical -mm wide opacity filling the apex of the right hemithorax should be considered a lung mass until proved otherwise . there is no appreciable pleural effusion . heart size is normal . pulmonary vasculature is engorged . bulge in the left lower mediastinal contour is probably due to hiatus hernia, but could be a paraspinal lesion . findings discussed by telephone at the time of dictation with dr . .	Edema&&Enlarged Cardiomediastinum&&Lung Lesion&&Lung Opacity&&Pneumonia	11569042	58517699	d9ebed54-0d6d34ff-31652ffe-bcd2f65d-009a29ee
2043	in comparison with a series of images from and , there has been progressive decrease in the pleural fluid in the left hemithorax, though some persists . elevation of the hemidiaphragm with mild shift of the mediastinum to the left is consistent with previous surgery . the right lung is clear and there is no vascular congestion .	Enlarged Cardiomediastinum&&Pleural Effusion	12530259	51322756	35b23c83-dd3843f8-b3df9c7a-694fec14-2972fec9
2044	as compared to the previous examination from earlier today, has been re intubation . the tip of the endotracheal tube projects approximately cm above the carinal, the tube could be advanced by - cm . the other monitoring and support devices are in unchanged position . unchanged appearance of the cardiac silhouette and of the lung parenchyma . known right vascular stent . no evidence of pneumothorax .	Cardiomegaly&&Support Devices	14744884	57843717	b6c0d2ce-6f3d53f3-df8a2161-37fbfb66-a1f871b4
2045	the et tube tip was . cm above the carina . the ng tube tip is in the stomach . heart size and mediastinum are stable and there is substantial interval improvement in widespread parenchymal opacities, although they are still significantly involving the entire lungs .	Cardiomegaly&&Enlarged Cardiomediastinum&&Lung Opacity&&Support Devices	16662264	54519421	f41b8b56-99c24f61-a0a4c8d3-c53f7f17-0467e007
2046	the dobbhoff tip is malpositioned, continuing towards the right main bronchus . this position was corrected as demonstrated on the subsequent radiograph obtained minutes later . the right internal and right subclavian central venous lines are in unchanged position, terminating at the level of superior svc and right atrium respectively . the replaced mitral valve is in expected position . severe cardiomegaly is unchanged . the patient appears to be increased pulmonary edema as compared to the recent radiograph, associated with bilateral pleural effusions .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	15259244	51299369	bd1321c9-fbaf9718-c06fef48-a5c3ccaa-5d48ccd1
2047	pulmonary edema on has almost entirely cleared, with a small perihilar residual and persistence of small bilateral pleural effusions . moderate-to-severe cardiomegaly is longstanding .	Cardiomegaly&&Pleural Effusion	16855430	50348450	449420e9-bd45dc1c-91a5471c-ef301a2d-f5734a2d
2048	the patient has received a new nasogastric tube . the tube shows a normal course, the tip is not included on the image . otherwise, there is no relevant change, with the exception of mild decrease of the pre-existing parenchymal opacities caused by pleural effusions and subsequent areas of atelectasis at both lung bases .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Support Devices	18322589	50924449	d1cd470b-709eb217-69977228-14bf4f2f-c0457196
2049	lung volumes are low . mild to moderate enlargement cardiac silhouette is unchanged, accentuated by the presence of low lung volumes . the aorta remains tortuous . mediastinal and hilar contours are stable . there is continued mild pulmonary vascular congestion without overt pulmonary edema . patchy and linear opacities in the lung bases likely reflect areas of atelectasis . no pneumothorax or pleural effusion is clearly evident . percutaneous gastrostomy catheter is incompletely imaged . low lung volumes with mild pulmonary vascular congestion and bibasilar atelectasis .	Atelectasis&&Edema	16853729	58771580	5ad11416-2d53dd53-96e1fcda-ca3b80c0-c0fb1e6f
2050	the lungs remain hyperinflated, consistent with chronic obstructive pulmonary disease . the cardiac silhouette is enlarged . evidence of hiatal hernia is again seen . the aorta is calcified and tortuous . there is mild pulmonary vascular congestion . there is blunting of the right costophrenic angle which may be due to overlying soft tissue, though a small pleural effusion cannot be excluded . bibasilar atelectasis is seen without discrete focal consolidation . . cardiomegaly and minimal pulmonary vascular congestion . blunting of the right costophrenic angle may be due to overlying soft tissue, although a trace effusion cannot be excluded . . hiatal hernia .	Cardiomegaly&&Edema&&Pleural Effusion	15896572	53128548	edbc95bb-75d52166-1e3ecf1b-24889c9f-9598b9a9
2051	there is marked improvement in extent and severity of the pre-existing parenchymal opacities . unchanged borderline size of the cardiac silhouette . no pleural effusions . the nasogastric tube has been removed . endotracheal tube and the right internal jugular vein introduction sheath are in constant position .	Cardiomegaly&&Lung Opacity&&Support Devices	10268877	51715880	1b966ed7-06a3bfa3-fee1b692-81c9a0b7-7678b5ec
2052	portable ap upright chest radiograph obtained . midline sternotomy wires and mediastinal clips are again noted . there has been interval placement of a right ij central venous catheter with its tip located in the distal svc or cavoatrial junction . no pneumothorax . otherwise, no change .	No Finding&&Support Devices	12736592	50141921	d50452d1-8652542d-f45133ab-196c1ef0-7bb886e0
2053	single portable view of the chest is compared to previous exam from earlier the same day at pm . there has been interval placement of a right-sided chest tube . left-sided chest tube is again seen with some persistent left basilar pneumothorax . cardiomediastinal silhouette is stable as are the osseous and soft tissue structures which are better characterized by ct scan .	Enlarged Cardiomediastinum&&Pneumothorax&&Support Devices	12736592	55696171	f5108618-8f9b67ff-661df382-f791f1ad-7a660047
2054	the tip of the endotracheal tube now measures approximately . cm above the carina . nasogastric tube again courses beyond the lower margin of the image in the distal stomach . the left hemidiaphragm is not as sharply seen and there is increased opacification in the retrocardiac region, consistent with volume loss in the left lower lobe and areas of plate-like atelectasis . continued mild pulmonary vascular congestion .	Atelectasis&&Edema&&Lung Opacity&&Support Devices	10268877	54658698	b0cabafd-224d8d46-c113bb88-27e041f4-2ecf273b
2055	the lungs are probably slightly hyperinflated . prominence of the trachea is consistent with known tracheomalacia . the heart is at the upper limits of normal or slightly enlarged . no chf, focal infiltrate, or effusion is identified . minimal atelectasis at the left lung base is new compared with . c-spine fixation hardware seen at the edge of these films is new compared with . upper abdominal surgical clips noted .	Atelectasis&&Support Devices	15114531	51118326	d36468b8-28879f9b-60f283a2-3c470f80-1d2c2b39
2056	portable semi-erect chest film on at is submitted . . right internal jugular swan-ganz catheter with its tip in the right pulmonary artery, unchanged . endotracheal tube has its tip at the thoracic inlet in satisfactory position . nasogastric tube is seen coursing below the diaphragm . there is blunting of left costophrenic angle with some retrocardiac opacity likely reflecting a small effusion with patchy compressive atelectasis . pneumonia cannot be entirely excluded . improving with residual minimal interstitial edema . left upper and mid calcified nodules likely reflect granulomata . no pneumothorax . overall, cardiac and mediastinal contours are stable .	Atelectasis&&Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	12185775	50491354	11b1705d-30db94a7-a7782a30-f6fbb83d-d63373de
2057	semi-erect portable frontal chest radiograph minimally displaced right-sided rib fractures appear similar compared to prior trauma radiographs from and are better characterized on followup ct torso from the same day . known left-sided rib fractures are also better characterized on prior ct . there is no evidence of pneumothorax . linear opacities in the lung bases correspond with known subsegmental atelectasis including increased left basilar opacity since the prior radiographs . the left upper lung appears better aerated, however . new mild blunting of the bilateral costophrenic angles suggestive of developing small bilateral pleural effusions . a known manubrium fracture is not well characterized on this single frontal view . mediastinal contours appear similar compared to recent prior suggesting probable stability of the known retrosternal hematoma . hilar and cardiac contours are within normal limits . cervical spinal hardware is incompletely imaged . there has been interval placement of probable epidural catheter in the mid thoracic spine . . unchanged multiple rib fractures, better characterized on prior ct . no pneumothorax . . stable mediastinal contours, though incompletely evaluated manubrial fracture and retrosternal hematoma . . new left basilar opacity suggesting atelectasis . . suspected very small developing pleural effusions .	Atelectasis&&Enlarged Cardiomediastinum&&Fracture&&Lung Opacity&&Pleural Effusion	13586204	54712047	cd9d349b-0c057599-fc4663a0-98ae4d7c-774a31ce
2058	the patient remains intubated with the et tube tip is cm above the carina . the ng tube tip passes below the diaphragm with its tip not clearly seen on the current examination . the right internal jugular line tip is at the level of mid svc . the patient is in pulmonary edema, moderate, progressed since the prior study, associated bilateral pleural effusions . pleural calcifications are redemonstrated . there is no pleural effusion or pneumothorax .	Edema&&Pleural Effusion&&Support Devices	17838301	51924942	ce5b980a-39d861d4-c9184dee-08626cce-313eb439
2059	comparison is made with prior studies including . small bilateral pleural effusions, right greater than left, have increased in size . the lungs are grossly clear . there is no evident pneumothorax . the cardiac silhouette is unchanged including the tumor that distorts the right mediastinal and cardiac borders .	No Finding	13023326	59569764	ca6c3a22-e08cabaf-4c95b666-384ca2dc-25e4e850
2060	there is no pneumothorax, pleural effusion or evidence of hemorrhage in the lung or mediastinum . emphysema is severe . heart size is normal . the complex of nodule and large bullae in the axillary region of the right upper lobe is essentially unchanged .	Enlarged Cardiomediastinum&&Lung Lesion	19991135	57757467	727e2aa5-ddfdd2ff-b5723867-520a758e-c81ca8e2
2061	cardiomediastinal contours are unchanged . fluid in the right fissure has resolved . there is no pneumothorax or pleural effusion . the lungs are hyperinflated consistent with emphysema . left lower lobe atelectasis is grossly unchanged . right lower lobe opacities have increased consistent with worsening pneumonia . multiple medistinal surgical clips are unchanged . anterior mediastinal tubes are in unchanged position .	Atelectasis&&Enlarged Cardiomediastinum&&Lung Opacity&&Pneumonia&&Support Devices	17770657	53231312	e21e6bf0-7434a403-cec6f190-febf1e0a-d1b58336
2062	heart size is enlarged, unchanged . mediastinum is stable . right lung opacity has improved, but there is still present right basal opacity that potentially might reflect infectious process . there is also left mid lung opacity which is new and might reflect additional focus of infection as well . followup of the patient with four weeks after completion of antibiotic therapy is required .	Cardiomegaly&&Lung Opacity&&Pneumonia	18512911	52125634	7091653d-d864c150-9da5f9ab-c3343eae-d86212ce
2063	cardiac and mediastinal silhouettes are stable . there is stable diffuse prominence of the interstitial markings . no pleural effusion or pneumothorax is seen . stable prominence of the interstitial markings bilaterally . no new focal consolidation seen .	Consolidation&&Lung Opacity	13475033	56836177	686a2b90-af0e2b68-75f6acc2-ea6fecdc-a69f5c88
2064	there is no pulmonary edema . pneumonia in the superior segment left lower lobe is continuing to resolve . there is no pneumothorax or pleural effusion . hyperinflation indicates emphysema . patient has had sternectomy .	Pneumonia	14851532	57735649	5ed57121-75e45b45-cfdc4f14-e8706b9a-5413f693
2065	mild pulmonary edema has improved and mediastinal vascular engorgement has decreased substantially . heart is normal size, unchanged . moderate left and small right pleural effusion have both improved, reflecting previous hemodynamic decompensation . right internal jugular, left subclavian infusion port are in standard placements . nasogastric tube ends in the stomach . no pneumothorax .	Edema&&Pleural Effusion&&Support Devices	15758946	50697229	be78e28d-1c76d439-9b5e832e-b0935ea9-62e6cf91
2066	large right pleural effusion has increased . there are worsening opacities in the right lower lobe, and right perihilar region which could be due to worsening atelectasis, but in the appropriate clinical setting, superimposed infection is also possible . there is no evident pneumothorax or pleural effusion on the left side . left pigtail catheter remains in place . ng tube tip is out of view below the diaphragm . left picc tip is in the lower svc . there is minimal atelectasis in the left mid lung .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	16319601	51811901	e294dffe-151d42b4-1956add7-1160c620-1eac45cb
2067	the heart is moderately enlarged . the aortic arch is calcified . again noted is mild prominence of the main pulmonary artery contour in the aortopulmonary window . there is no pleural effusion or pneumothorax . there is persistent minor atelectasis at the left lung base, but otherwise, the lungs appear clear . no evidence of acute cardiopulmonary disease .	No Finding	19731864	55499739	06df3b11-81898aee-955508ec-3c40c0bd-2c592b21
2068	sternotomy with valve prosthesis . endotracheal tube tip is cm above carina . right ij central line tip is near cavoatrial junction . cardiac pacemaker . there is worsening of left basilar opacity . left costophrenic angle is not fully seen . no pneumothorax . shallow inspiration accentuates heart size, pulmonary vascularity . pulmonary vascularity has mildly improved . improved right basilar, perihilar opacities . right shoulder arthroplasty . worsened left basilar opacity, may represent atelectasis, consider pneumonitis in the appropriate clinical setting . pulmonary vascularity has mildly improved .	Atelectasis&&Lung Opacity	19075045	58071016	e043f870-1670fd0c-cf68f196-4f351347-4a665c39
2069	cardiomegaly is stable . pulmonary edema is improved and is now moderate . there is no new focal consolidation or pneumothorax . moderate pulmonary edema, improved from prior .	Edema	15131736	57124801	c2b22508-19420edd-b20d6189-f63a4ebf-54d99e64
2070	lung volumes are somewhat low, however, no focal opacity to suggest pneumonia is seen . no pleural effusion, pulmonary edema or pneumothorax is present . a stent in the region of the left brachiocephalic vein is unchanged . surgical chain suture is noted in the right lower lobe . a calcification seen projecting over the cardiac silhouette to the left of the aorta is not clearly localized on this single frontal radiograph, however, was not present on the examination of . the heart size is normal . . no evidence of acute cardiopulmonary process . . rounded calcification projecting over the cardiac silhouette not well localized on this single frontal radiograph . this could represent a calcified granuloma, however, was not present on the examination of . pa and lateral radiographs may be performed for further evaluation and localization .	No Finding	12847817	58905647	1b02e072-fa368bfc-a9a77874-e1a0094e-7cac5d6a
2071	comparison is made with next preceding two-view chest examination obtained six hours earlier during the same day . heart size remains normal . no configurational abnormalities identified . unchanged appearance of thoracic aorta . no pulmonary vascular congestion is present . no new pulmonary parenchymal infiltrates are identified and the lateral and posterior pleural sinuses are free . there is evidence of a metallic fixation plate in the lower portion of the cervical spine and in the upper left abdominal quadrant surgical clips are noted cause of operation not identified . similar as on the preceding portable chest examination, a right-sided picc line is identified, seen to terminate in the svc at a level cm below the carina . no evidence of acute infiltrate in patient with history of productive cough .	No Finding	15114531	55940912	a025f08e-de9dddc4-8716a1ac-899ce213-d7289c7a
2072	heart size and mediastinum are unchanged in appearance . widespread parenchymal opacities in the left hemithorax in the right upper lobe appear to be overall unchanged with some improvement in the left, most likely related to recent thoracocentesis . there is no evidence of pneumothorax . overall, multiple parenchymal abnormalities are better depicted on the chest ct from .	Cardiomegaly&&Enlarged Cardiomediastinum&&Lung Opacity	10933609	55794889	f0bb1f2a-8ac4c2cb-b85dec90-1fc00f8e-931106fe
2073	pa and lateral views of the chest were obtained demonstrating clear well expanded lungs without focal consolidation, effusion, pneumothorax . there is no free air below the right hemidiaphragm . cardiomediastinal silhouette is normal . bony structures are intact . no signs of pneumonia or other acute process .	No Finding	19623993	54625738	0f257273-0fa8c76f-737b4a98-eedda2aa-44d82e39
2074	mild cardiomegaly is chronic . there is no pulmonary edema or vascular abnormality . lungs are low in volume, but clear of pneumonia . bilateral healed rib fractures noted .	Cardiomegaly&&Fracture	18079481	50683984	e879a54e-7828601c-1bb4483c-39b8dd60-b49d41c7
2075	single upright portable chest radiograph demonstrates unremarkable mediastinal, hilar and cardiac contours . however, subcutaneous emphhysema identified in the soft tissues of the neck and bilateral supraclaviaular region . linear lucency tracking along the trachea concerning for pneumomediastinum . there is a stable left picc line with tip at the cavoatrial junction . there is suggestion of a pleural fold approximately . cm from the apex with a paucity of lung markings in this region which may suggest a moderate-sized pneumothorax not evident on the prior study however, there appears to be no evidence of the expected associated volume loss . small rounded radiopaque density is noted projecting in the right mid lung and crossing a different bony structure than on prior study, indicating it is not within the bone and may represent a calcified granuloma . no pleural effusion evident . no osseous abnormality identified . subcutaneous emphysema at thoracic inlet . upper pneumomediastinum . possible moderate right pneumothorax . recommend repeat fully upright chest radiograph . communicated these findings to dr via telephone at on .	Pneumothorax	16319601	57274207	5ca8e895-727feeb6-2817230e-65ce2e3b-5b8f315f
2076	the patient has undergone sternal rewiring . the patient is now extubated and the nasogastric tube and the swan-ganz catheter have been removed . the other monitoring and support devices are in unchanged position . lung volumes have slightly decreased, and small bilateral pleural effusions as well as areas of atelectasis are still visible . no pneumothorax is visualized . the obviously postoperative opacity at the upper medial left aspects of the mediastinum is constant in appearance .	Atelectasis&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Support Devices	14851532	53313689	b83f6019-238aa535-591efc94-e0670815-dc1ea130
2077	both the lungs are well expanded . no focal pulmonary opacity concerning for pneumonia . no pleural effusion or pneumothorax . the heart size is top normal . cardiomediastinal silhouette is unremarkable . no acute cardiopulmonary process .	No Finding	16853729	55739720	53b32671-685e3433-612784a3-6c684cd8-e06dd901
2078	the patient is status post median sternotomy as well as pacemaker placement with leads terminating in right atrium and ventricle . there is also a aortic valve prosthesis . the heart size remains normal . there are no focal opacities concerning for an infectious process . no pleural effusion and no pneumothorax . no evidence of acute intrathoracic process .	No Finding	16043637	51392471	c02bdcc0-549bf4f3-5f78b267-f547a2ea-ad315318
2079	cardiac, mediastinal and hilar contours are stable . the patient is status post esophagectomy and gastric pull-through . chronic scarring within the medial aspect of the right upper lobe is compatible with post radiation changes . tenting of the right hemidiaphragm is compatible chronic volume loss in the right lung . worsening opacification within the right upper lobe is concerning for recurrent pneumonia or aspiration . mm nodular opacity within the right lower lobe is unchanged . the left lung is clear . blunting of the right costophrenic angle is chronic, and likely reflects a chronic small pleural effusion . no pneumothorax . no acute osseous abnormalities demonstrated . . worsening opacification within the right upper lobe which is concerning for recurrent pneumonia or aspiration . follow up radiographs are recommended after treatment to ensure resolution of this finding . . status post esophagectomy and gastric pull-through with right upper lobe medial scarring related to prior radiation treatment . . unchanged mm right lower lobe pulmonary nodule .	Lung Lesion&&Lung Opacity&&Pneumonia	14295224	59920150	802aa49f-a2a5d56e-91eab903-012ba3a8-2bfc4156
2080	since the prior study, there is slight improvement in the perihilar opacities with still present lower lobe opacities with slightly more confluent area in the right lower lobe . these findings overall are still concerning for interstitial pulmonary edema . there is a possibility of underlying metastatic disease that cannot be assessed on the current examination except for known right middle lobe nodular opacity projecting on the radiograph as well .	Edema&&Lung Lesion&&Lung Opacity	17340686	55275807	0b7b73cc-54f3192d-fe2a9118-3709076b-46329431
2081	greater opacification involving the left chest with a gradient from top increasing to the diaphragmatic surface is probably a large pleural effusion, increased since . smaller right pleural effusion has also increased . the left lower lung is partially obscured and may be mildly atelectatic but otherwise unchanged . right lung is grossly normal . cardiomediastinal silhouette is unremarkable . et tube in standard placement, left pic line in the low svc or at the superior cavoatrial junction . enteric drainage tube passes into the stomach and out of view .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Support Devices	16319601	55001052	7d1a5c64-703847ae-fbf3b643-c3e08a4b-4153d0d7
2082	portable upright ap view of the chest the patient is status post median sternotomy and cabg . evaluation of the cardiac silhouette size is difficult due to the presence of a chronic, moderate-to-large left pleural effusion, which appears slightly increased in size when compared to prior study . there is persistent left basilar opacification, likely reflecting compressive atelectasis . the right lung demonstrates mild atelectasis at the lung base, but is otherwise clear . no pneumothorax is identified . there is no pulmonary vascular congestion . the aorta remains tortuous and calcified . moderate-to-large chronic left pleural effusion, slightly increased compared to the prior study with persistent left basilar opacification, likely reflecting compressive atelectasis, though infection cannot be completely excluded .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Pneumonia	12538508	51621137	0beab5cd-dd1bb454-0df993cf-f3c0ae3d-8f0e0c27
2083	comparison to . unchanged monitoring and support devices that are all in correct position . moderate cardiomegaly persists . a fissure oral fluid accumulation on the right has completely resolved . left retrocardiac atelectasis and potential minimal left pleural effusion is stable . mild fluid overload is unchanged .	Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices	14841168	57731696	ebaf1946-49389902-bfa1191f-e932bc43-ece7d70d
2084	portable upright view of the chest demonstrates low lung volumes . there is no pleural effusion or pneumothorax . heart size is top normal . hilar and mediastinal silhouettes are unchanged . there is perihilar vascular congestion . interstitial markings are prominent, suggest possible mild interstitial pulmonary edema . right-sided port-a-cath is stable position projecting over cavoatrial junction .	Edema&&Enlarged Cardiomediastinum&&Lung Opacity	10650001	50124332	3878f00f-4b737c96-dff939c5-2f24a10d-23db2293
2085	in comparison to , no relevant change is seen . old right rib fracture . known copd . mild overinflation . no pneumonia, no pleural effusions, no pulmonary edema .	Fracture	19991135	56587463	7558ad38-de530501-5c2ff2a1-d74fe121-ba0cf77a
2086	the patient is status post prior median sternotomy and cabg . a left chest wall dual lead pacemaker is present . a right central venous catheter is unchanged, the tip extending to the superior cavoatrial junction . no focal consolidation, pleural effusion or pneumothorax identified . mild unchanged central pulmonary vascular congestion . the size and appearance of the cardiomediastinal silhouette is unchanged . partially evaluated bilateral shoulder prostheses . unchanged central pulmonary vascular congestion without evidence for pulmonary edema .	Edema	19075045	51398188	406ff57a-8c66ca32-af21faa2-a53b08d6-7b5a0bdf
2087	pa and lateral views of the chest a moderate-sized, loculated right pleural effusion is similar when compared to the prior study, though a small left pleural effusion appears to be new in the interval . again demonstrated is volume loss in the left lung with leftward shift of mediastinal structures and unchanged architectural distortion, bronchiectasis, and pleural thickening involving the left upper lobe . right basilar hazy opacity likely reflects compressive atelectasis . streaky opacity within the left lung base may also reflect an area of atelectasis . there is no pneumothorax . no acute osseous abnormality is seen . there is no pulmonary vascular congestion, and the cardiomediastinal silhouette is stable . . unchanged moderate loculated right pleural effusion, with new small left pleural effusion . . bibasilar airspace opacities likely reflect atelectasis . . evidence of prior granulomatous infection .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Pneumonia	13849733	52695304	8da031ac-a6a0b018-0f1bc1ef-3f1b915f-feba9e7a
2088	large right pleural effusion is increasing . concurrent increase in caliber of the cardiac silhouette could be due to worsening cardiomegaly or the development of pericardial effusion since mid . pleural fluid has exacted substantial atelectasis from the right middle and lower lobes to explain the failure of the mediastinum to have shifted appreciably into the left chest . previous mild pulmonary edema in the left lung has improved . no pneumothorax .	Atelectasis&&Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Pleural Effusion	19182863	51514260	9b185b4a-ebb47e2f-e969fede-cab4dc44-38b3d84b
2089	top-normal heart size is unchanged compared to prior exams dating back to . there is mild perihilar fullness, slightly improved compared to the prior exam . small bilateral pleural effusions, right greater than left are persistent . coronary calcifications or stent are identified . scarring projecting over the mid left lung is persistent . mild bibasilar atelectasis is unchanged . right-sided picc line appears to terminate in the mid svc . there is no evidence of a pneumothorax . . persistent small bilateral pleural effusions, right greater than left . . slight interval improvement in the mild to moderate pulmonary edema .	Edema&&Pleural Effusion	14851532	58103833	445b99e9-01f5072d-77cc64c9-359902d0-e84c80c3
2090	small left pleural effusion and worsening of bibasilar peribronchial infiltration indicate progressive infection . there is more internal debris in the large cavitary lesions in both upper lobes, which could be retained hemorrhage . the fluid contents of the very large right lung abscess have decreased suggesting continued internal aspiration, which may account for the worsening of bibasilar infiltration .	Lung Lesion&&Lung Opacity&&Pleural Effusion&&Pneumonia	17270742	55233589	a7911dd6-f061c0a0-424f7e91-c27237d4-97faf732
2091	the three right-sided chest tubes are in unchanged position . there is no convincing evidence of right pneumothorax . extensive soft tissue air collection in the cervical and thoracic right-sided soft tissues . mild-to-moderate pleural effusions with areas of atelectasis at the right lung base . mild elevation of the right hemidiaphragm . borderline size of the cardiac silhouette, no left pleural effusion, normal-appearing left lung . the clips in the right chest wall are in unchanged position .	Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices	13352405	53207240	876608af-2d7efebf-d51bcb03-9b230997-e9f7797a
2092	there is a further mild increase in the otherwise extensive, diffuse and bilateral interstitial opacities . these opacities are accompanied by small bilateral pleural effusions and mild increase in diameters of the pulmonary vasculature . overall, despite the normal size of the cardiac silhouette, the findings are still strongly suggestive of interstitial lung edema . no additional newly appeared parenchymal opacities . no pneumothorax .	Edema&&Lung Opacity&&Pleural Effusion	16772702	59293706	0b08c349-d6da596b-18713b4e-e42ab4c4-35971a4f
2093	the tip of the endotracheal tube now measures approximately . cm above the carina . other monitoring and support devices are essentially unchanged . the left hemidiaphragm is again poorly seen, consistent with volume loss in the lower lobe with probable effusion . this latter observation is supported by haziness of the left hemithorax, consistent with layering fluid . the right lung is essentially clear . overall, cardiac size remains enlarged . poor definition of pulmonary vessels is consistent with increased pulmonary venous pressure .	Cardiomegaly&&Pleural Effusion&&Support Devices	13649937	57936326	8d737f78-cdcd1c7a-d434e99f-2f86c50c-e24fdcfe
2094	the patient has been intubated . the tip of the endotracheal tube projects approximately . cm above the carinal . the course of the nasogastric tube is unremarkable, the tip projects over the middle parts of the stomach . the right internal jugular venous introduction sheet is unchanged . increasing atelectasis at the left lung bases . unchanged appearance of the right lung .	Atelectasis&&Support Devices	19061282	59838108	82b52867-74eba7eb-689f334c-c20056f2-3590de32
2095	mild cardiomegaly is similar to prior . pleural effusions have nearly completely resolved since the prior exam . no focal consolidation or pneumothorax . left lung base linear opacities are compatible with scarring or atelectasis . a mitral valve prosthesis is noted . sternotomy wires are intact . osseous structures are unremarkable . left lung base atelectasis or scarring . near-complete interval resolution of bilateral pleural effusions .	Atelectasis&&Lung Opacity	18224196	54882267	59a459f5-0bd58411-1d739d65-1d7477bf-92d830cb
2096	the patient has received a new nasogastric tube . the tube is coiled in the oropharynx and does not reach the esophagus . the stomach is moderately distended and filled with gas . known left carotid stent . the pre-existing signs indicative of interstitial lung edema have decreased . no evidence of complications, notably no pneumothorax .	Edema&&Lung Opacity&&Pneumothorax&&Support Devices	18855147	52178503	f79f9dd9-f65e43a2-492aec2c-5859d568-299fa79d
2097	there is a new right pigtail catheter in the right lower hemithorax . the large right hydropneumothorax appears essentially unchanged from the prior exam within the limitations of technique . bilateral hazy opacification is suggestive of mild pulmonary edema . focal opacity in left upper lobe is consistent with pneumonia and similar to the prior study . ng tube is seen terminating in the stomach . cardiomediastinal silhouette is stable . . new right pigtail catheter . . no evidence for significant change in right hydropneumothorax . . focal opacity in left upper lobe, most likely pneumonia . . findings suggesting mild pulmonary vascular congestion .	Edema&&Lung Opacity&&Pneumonia&&Pneumothorax&&Support Devices	14387068	54780158	859fa416-f6343ef9-59e07aef-7332f765-4e2be7d0
2098	comparison multiple chest radiographs from to and baseline examination of . semi-upright ap view of the chest the endotracheal tube has been retracted to appropriate position approximately cm above the carina . the left ij central venous line and nasogastric tube are in unchanged and appropriate position . the pulmonary edema has resolved . the moderate, left greater than right bilateral pleural effusions are unchanged . minimal cardiomegaly also stable . there is no pneumothorax . . endotracheal tube appropriately retracted to cm above the carina . . resolution of pulmonary edema . . stable moderate left greater than right bilateral pleural effusions . . stable mild cardiomegaly .	Cardiomegaly&&Pleural Effusion&&Support Devices	11607628	50790949	eaa862a2-6c57e3ea-bad4024a-564f7f14-d963c808
2099	mild pulmonary edema is clearing, but severe cardiomegaly and severe bibasilar atelectasis are not . pleural effusions are presumed but not large . no pneumothorax .	Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion	15131736	50650921	54b04013-9b1c7ca0-452a3623-7e225698-0696e372
2100	a pigtail was introduced into the right pleural cavity . the major part of the pre-existing right pleural effusion appears to be drained . however, a new air inclusion in the right basal pleural space . this pleural air does not manifest as an apical pneumothorax . in fact, in the apical and lateral parts of the right hemithorax, there is still abundant fluid visualized . the volume of the right hemithorax, overall, has not increased . however, a short-term followup is required to assess for potential developing tension . normally appearing lung parenchyma on the left . unchanged left heart border and tortuosity of the thoracic aorta .	Pleural Effusion&&Pneumothorax	11569093	52011372	5f961326-0ccce927-f726948a-19e43255-88306b58
2101	comparison is made to previous study from . there is an endotracheal tube whose distal tip is . cm above the carina appropriately sited . there is a left-sided ij line with distal lead tip in the mid svc . there is a nasogastric tube whose tip and sideport are below the ge junction . there is a persistent left retrocardiac opacity . there is some atelectasis at the left lung base . there is improved aeration at the right lung base . no pneumothoraces are seen .	Atelectasis&&Lung Opacity&&Support Devices	10268877	54934220	2d0d0dd1-758ad05c-5f33e8fa-08a1e0dc-63d862be
2102	portable ap radiograph of the chest was reviewed in comparison to , and multiple prior studies dating back at least to the chest ct from . extensive parenchymal opacities appear to be unchanged since the prior study involving the entire lungs . there is small amount of bilateral pleural effusion most likely present . there is a right internal jugular line tip terminating at the level of superior svc . there is no substantial difference overall since the prior examination demonstrated . although the presumed diagnosis of this patient with pulmonary edema, other factors contributing to the parenchymal involvement such as diffuse widespread infection or ards should be clinically considered .	Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	13078497	55700894	942513ab-2cb022a3-69e4a885-1f192714-5d54f844
2103	lung volumes are slightly less as compared to the prior study . again, there is enlargement of the cardiomediastinal silhouette which is slightly more prominent as compared to the prior study, which may be due to ap techique and lower lung volumes . left-sided pacer device is stable . right-sided abandoned leads are also unchanged . there is mild pulmonary vascular congestion . no definite focal consolidation is seen . there is no pleural effusion or evidence of pneumothorax .	Edema&&Enlarged Cardiomediastinum&&Support Devices	11293517	52833948	6f5a78a6-606c4fec-8ff6aaa9-b8ebe20c-88539ae6
2104	severe infiltrative pulmonary abnormality has been present without appreciable change since , progressing on a substrate of chronic interstitial lung disease that worsened appreciably between and small-to-moderate bilateral pleural effusions and mild cardiomegaly are unchanged . no pneumothorax . et tube in standard placement . nasogastric tube passes into the stomach and out of view . a right jugular line ends just above the junction of brachiocephalic veins . no pneumothorax .	Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Support Devices	13078497	58231918	96a447ee-f2ddbe8e-c71c996f-b05a48a3-485f4469
2105	comparison is made to previous study from . the dobbhoff tube has been removed . there has been placement of nasogastric tube whose tip and side port are well below the gastroesophageal junction in the distal body of the stomach . however, there is a loop in the distal nasogastric tube . the cardiac silhouette and mediastinum is prominent but stable . there is improvement of the atelectasis at the lung bases . there remains low lung volumes . there are no pneumothoraces .	Atelectasis&&Cardiomegaly&&Enlarged Cardiomediastinum&&Support Devices	16853729	51121202	d0b136c5-f0844e8c-66112b7b-2c23ee98-5d07fb5c
2106	portable ap upright chest radiograph obtained . the heart is moderately enlarged and there is diffuse pulmonary edema . effusions are likely also present . pulmonary edema, cardiomegaly, likely pleural effusions .	Cardiomegaly&&Edema&&Pleural Effusion	16855430	58141048	f1b89b54-27c193cd-47878997-195a1a2f-9d7bbffb
2107	the heart continues to be enlarged with mild pulmonary vascular congestion . increased ap diameter of the chest reflects copd . no focal consolidation, pleural effusion or pneumothorax is seen . a left-sided cardiac pacing device has its leads over the right atrium and ventricle . prominence of the pulmonary artery is noted, reflecting pulmonary hypertension . cardiomegaly with mild pulmonary vascular congestion .	Cardiomegaly&&Edema	18929056	54801364	94c11798-961e79c2-6916a44a-2f90e301-46fa937d
2108	there is little change . evidence of previous surgery with an intact is midline sternal wires, but no evidence of pulmonary or skeletal metastases .	No Finding	15272972	54092122	68710c1c-c25658b5-17ec54e1-6038ff18-c2cd7f78
2109	comparison is made with prior study performed one hour earlier . dobbhoff tube tip projects in the right lower hemithorax most likely in a subsegmental bronchus . lung volumes are lower, there are no other interval changes . by phone on at pm . at the time of the interpretation of the study .	No Finding&&Support Devices	11880923	52804047	c115eec1-f2d94bdd-80412327-e5bc01c5-988b885e
2110	enteric tube tip in the proximal stomach . right ij line tip mid svc . endotracheal tube tip in good position . sternotomy . there is cardiac pacemaker . minimal new left basilar atelectasis . suggestion of tiny left pleural effusion . enteric tube tip in the proximal stomach .	No Finding&&Support Devices	18487334	54716295	ef4d5d47-62ec7452-7097cc7f-0096727c-ed1cb6cf
2111	pa and lateral chest radiograph the cardiac, mediastinal and hilar contours are within normal limits . both lungs show mildly low lung volumes with crowding of bronchovascular markings . bibasilar atelectasis is noted . subclavianbrachiocephalic venous stent is unchanged in position .	Atelectasis	14744884	59794546	002ec547-39998a44-001fa06f-b2d03591-048c0d40
2112	the dobbhoff tube has been advanced distally from its position on prior abdominal radiograph . the tip of the dobhoff tube terminates in the region of the second portion of the duodenum . the heart remains mildly enlarged with bilateral hilar opacification . a right supraclavicular central venous catheter is noted terminating in the svc . there is no pneumothorax . there is no abdominal free air . post-pyloric positioning of the dobbhoff tube in the region of the second portion of the duodenum .	No Finding&&Support Devices	19623993	51096107	5142f79d-ca2bee0e-d70061cd-e31c5917-98f78f0e
2113	support and monitoring devices are in standard position . cardiomegaly is accompanied by pulmonary vascular congestion and worsening edema . increasing confluent opacity in the right perihilar and infrahilar regions may reflect asymmetrical edema or developing pneumonia . known right middle lobe mass is partially obscured by this process . moderate layering right pleural effusion and small left pleural effusion are also demonstrated .	Cardiomegaly&&Edema&&Lung Lesion&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	17340686	55921730	fcefff91-22ab7055-235f085c-ea9ac8ad-bbdaa83c
2114	comparison to at . a portable ap upright chest film, at is submitted . . the dobbhoff feeding tube is seen coursing down into the stomach and then courses back up into the upper esophagus where the tip is positioned . removal with an attempt at repositioning of the dobbhoff feeding tube would be advised at this time . the endotracheal tube remains in place and the tip is difficult to identify as this is the location where the dobbhoff feeding tube appears to be coiled within the esophagus . however, it is likely unchanged in position . there has been median sternotomy . stable postoperative cardiac and mediastinal contours . there are layering effusions bilaterally with some associated patchy airspace disease, which most likely represents compressive atelectasis . overall, there has been interval improvement in the pulmonary edema . no pneumothorax is seen . results of this examination were conveyed directly to the patients nurse, , on at am . the patients nurse stated that the feeding tube has already been withdrawn and a new feeding tube has been put in place .	Atelectasis&&Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Support Devices	12952223	58485731	abaf3f48-e5ba0e33-b7c52893-aa44a3b8-7aa9a7d2
2115	the lungs are clear without consolidation or edema . there is no pleural effusion or pneumothorax . the cardiomediastinal silhouette is normal . the previously seen pneumonia from has resolved . no acute cardiopulmonary process .	No Finding	18835687	51719198	91bd4888-7f1222f4-5b4fe46d-db77d37b-077c6f19
2116	ap portable view of the chest is obtained . previously seen left juxtahilar opacity lateral to the fiducial seeds has decreased in size and persists since the prior study . no new focal consolidation is seenthere is prominence of the right hilum which is slightly increased since the prior study, which may relate to patient positioning, although underlying increased lymphadenopathy cannot be excluded . a left subclavian central venous catheter is again seen, unchanged in position . cardiac and mediastinal silhouettes are stable . chronic right chest wall deformity again seen . . left suprahilar opacity and fiducial seeds are again seen, although appears slightly less prominentsmall in size, although as mentioned on the prior study, could be further evaluated by chest ct or pet-ct . . right hilum appears slightly more prominent as compared to the prior study, which may be due to patient positioning, although increased right hilar lymphadenopathy is not excluded .	Lung Opacity	12145137	54100996	c875e4c8-ab736220-04569ba0-857889ce-042ea536
2117	the heart is mildly enlarged . there is perihilar fullness with a new widespread mild interstitial abnormality, which includes fairly prominent patchy perihilar opacities . on the other hand, dense left basilar consolidation has nearly cleared . however, there are new patchy right basilar opacities in addition to background interstitial prominence . there is no pleural effusion or pneumothorax . the mediastinal and hilar contours appear unchanged . . interval clearance of left basilar consolidation . . patchy right basilar opacities, which could be seen with minor atelectasis, but given the context clinical correlation is suggested regarding any possibility for recurrent or new aspiration pneumonitis at the right lung base . . increased new interstitial abnormality, suggesting recurrence of fluid overload or mild-to-moderate pulmonary edema aspiration could also be considered . inflammation associated with atypical infectious process is probably less likely given the waxing and waning presentation .	Atelectasis&&Edema&&Lung Opacity&&Pneumonia	16050730	57847867	9762049c-4ede04ad-3686cd0b-abfae75d-795cb083
2118	ng tube tip is in the stomach . there are low lung volumes . bibasilar atelectases larger on the left side are grossly unchanged from prior study . left picc tip is in the mid-to-lower svc . mild pulmonary edema is stable . widened mediastinum is stable . residual contrast is seen in the loops .	Atelectasis&&Edema&&Enlarged Cardiomediastinum&&Support Devices	13979643	50000708	541c9d66-7525d9cf-90e766f7-fd80dc83-37b380d6
2119	the cardiomediastinal silhouette is stable . the lungs are symmetrically expanded . slightly increased opacity at the right base may represent atelectasis however developing pneumonia cannot be excluded . there is no pleural effusion or pneumothorax . slightly increased opacity at the right base may represent atelectasis however early consolidation cannot be excluded . clinical correlation is advised .	Atelectasis&&Consolidation&&Lung Opacity	13978244	56886005	3891bb0c-3698159b-42c6500c-2c690e15-10917f35
2120	indwelling support and monitoring devices are in standard position . cardiac silhouette remains enlarged, and pulmonary edema continues to improve, with residual asymmetrical edema worse on the right than the left . small pleural effusions are not substantially changed .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	10715477	52363927	701d2394-b800427d-91a53aa7-5fb33fd1-663b37c1
2121	midline sternotomy wires are again noted . the left ij central venous catheter has been removed . there is improved aeration in the lung bases as compared with the prior exam . the heart is markedly enlarged, which appears grossly stable compared with prior exam . there is no sign of pneumonia or overt chf . bony structures are intact . aortic calcifications noted . stable cardiomegaly without signs of pneumonia or chf .	Cardiomegaly&&Edema&&Pneumonia	10715477	52467293	fbaf1e44-468cb5b9-2cd8fc25-a7f7e778-1dde8b89
2122	the patient has received a right pigtail catheter inserted in the pleural cavity . extent of the previously present right pleural effusion has decreased . however, substantial portion of effusion remains . no complications, notably no pneumothorax . unchanged appearance of the left lung and the cardiac silhouette .	Cardiomegaly&&Pleural Effusion&&Pneumothorax&&Support Devices	18309149	50336741	928e66f1-87ef1b9e-0ce33e37-760d835a-a539e8b9
2123	one portable ap view of the chest . again seen is mild pulmonary edema, mostly on the right, with slight improvement compared to . right pleural thickening or loculated effusion is again seen and unchanged . there has been surgical removal of the right fourth rib posteriorly . . persistent but improved mild pulmonary edema compared to prior study on . . right pleural thickening or loculated effusion is stable . these findings were discussed with at pm on by telephone .	Edema&&Pleural Effusion&&Pleural Other	11474065	59155076	ea2bfc51-e27284b8-51af06f3-06ed8266-9f18eb54
2124	the lung volumes are low with bibasilar opacities silhouetting with the hemidiaphragms and diffuse vascular congestion . there is cardiomegaly and tortuosity of the thoracic aorta . likely small left pleural effusion . no pneumothorax . findings compatible with pulmonary edema . likely bibasilar linear atelectasis .	Atelectasis&&Edema	15131736	53091531	5cdfb771-109f66be-85ce962d-5d7f0653-ae3c1100
2125	the endotracheal tube has been slightly pulled back . it now projects roughly cm above the carina . the lung parenchyma has minimally increased in transparency, potentially reflecting improved ventilation or higher respiratory pressures . small bilateral pleural effusions are likely . unchanged evidence of mild fluid overload and cardiomegaly .	Cardiomegaly&&Pleural Effusion&&Support Devices	12952223	56581630	ffa922f9-60c9f991-d3cb83aa-6f446e5e-f6be9611
2126	moderate cardiomegaly, known left pectoral pacemaker . no pleural effusion . no current pulmonary edema . no pneumonia . multiple dot-like calcifications that are unchanged .	Cardiomegaly&&Support Devices	17763117	53177649	9b350f75-7f987b20-092a7bbf-84be3535-8bc72c1f
2127	the lungs are clear of focal consolidation or pleural effusion . there are however increased interstitial markings throughout the lungs and enlarged cardiac silhouette which is unchanged from prior . there is no acute osseous abnormality detected . findings suggestive of interstitial edema . no superimposed acute consolidation or effusion . unchanged cardiomegaly .	Cardiomegaly&&Edema	18767957	59343122	8af32f0b-aeaad02d-8979cb3c-7935b38a-e1461335
2128	small-to-moderate left pleural effusion has increased slightly over the past several days . moderate enlargement of the cardiac silhouette accompanied by mediastinal vascular engorgement is also slightly more pronounced . pulmonary vasculature is engorged but there is no edema . consolidation has been present without appreciable change in the left lower lobe since at least . mediastinum widened at the thoracic inlet by a combination of tortuous vessels and mediastinal fat deposition . right jugular introducer ends just above the junction with left brachiocephalic vein .	Cardiomegaly&&Consolidation&&Pleural Effusion	12185775	50127750	23f0b24d-61c1f12c-eb2434aa-f6d2c69e-86a2cd20
2129	the endotracheal tube terminates no less than . cm above the carina . an orogastric tube terminates within the stomach with the side port near the gastroesophageal junction . a left internal jugular central venous line terminates in the mid svc . a right subclavian triple-lumen catheter terminates in the lower svc . there has been interval reduction in heart size as well as marked improvement in pulmonary edema . small bilateral pleural effusions are slightly smaller . there is a persistent left retrocardiac opacity . there is no pneumothorax . . endotracheal tube is appropriately positioned, . cm above the carina . . the orogastric tube should be advanced by - cm to ensure that the side port is beyond the gastroesophageal junction . . improvement in decompensated congestive heart failure . . persistent retrocardiac opacity representing consolidation or atelectasis .	Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Lung Opacity&&Support Devices	11880923	56440140	421dff97-6d2b4aab-02ed28a8-54dd67f9-da2f957b
2130	bedside frontal radiograph centered at the diaphragm shows nasogastric tube ending in the proximal duodenum, and the distal portions of a transvenous right ventricular pacer defibrillator and left ventricular pacer leads, as well as a right picc lead that ends in the upper right atrium and retained epicardial leads . previous mild pulmonary edema has improved, but there is still substantial consolidation at the right lung base probably largely atelectasis . there is no appreciable pleural effusion in the imaged portion of the chest . the apices of the lungs are not included in this image . mild-to-moderate cardiomegaly is unchanged . intestinal gas pattern is unremarkable .	Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Support Devices	18322589	58898395	b4a939d3-05849610-14a75408-ef6f57b3-c3a0f6fb
2131	there is slightly rotated positioning . compared with earlier the same day pm, there is progression of opacification of the right lung, with only a small partially aerated portion of the lung seen in the upper zone . there may be some volume loss on the right, though this is difficult to confirm, due to rotation . the left lung is grossly clear, with resolution of previously seen left base opacity . no left-sided chf, focal infiltrate, or effusion is identified at this timeclips noted over lower mediastinum . considerable interval increase in the degree of opacification of the right lung . this may represent a combination of pleural fluid and collapse andor consolidation . given the rapid change, is there reason to suspect mucous plugging findings discussed with the covering house officer, dr . , at ~ pm . on the day of the exam , phone .	Atelectasis&&Consolidation&&Lung Opacity&&Pleural Effusion	11569093	54721804	d87efb8c-2b6c913c-52f20a43-a8cbf2ba-2b20410d
2132	ap upright and lateral views of the chest were provided . in this patient with known achalasia and dilated esophagus, there is no change in the appearance of the dilated distal esophagus which contains ingested debris . there is no sign of aspiration . heart size cannot be readily assessed . no large pleural effusion . no pneumothorax . bony structures intact . dilated distal esophagus as seen previously containing ingested food contents . no signs of aspiration . please refer to prior ct torso for full descriptive details of esophageal abnormalities .	No Finding	11569042	55883502	e03dd9c2-d0a3ddb0-0e9d72c3-1b4c5f92-9593c85f
2133	consistent with the given history, a chest tube is noted and is directed medially in the upper mediastinum with a location that is highly suggestive of intrafissural placement . there is increased lucency at the lung base, particularly outlining the right hemidiaphragm, which likely indicates a residual component of the pneumothorax . diffuse bilateral pulmonary nodules consistent with widespread metastatic disease are again present . there is air noted around a ray cage device in the lower thoracic spine, surrounded by posterior spinal stabilization rods . extensive surgical clips are noted within the medial left upper quadrant . it is difficult to discern the left hemidiaphragm . there is increased retrocardiac opacity, although similar to the prior exam . a port-a-cath is evident in stable and standard course and position . the osseous structures are difficult to assess, but are grossly stable . the course of the chest tube projecting over the right chest suggests an intrafissural position, which may limit the ability to evacuate the pneumothorax . a visceral pleural line remains evident and most apparent at the lung base with an extension of the air to the spinal hardware as noted on the ct earlier today . widespread metastatic disease of the lungs is again seen . there is no radiographic evidence currently of tension physiology .	Pneumothorax&&Support Devices	17704774	51526655	78ecaf71-9fdb0b43-b0134402-8c5e739f-2c6c0ea2
2134	cardiomediastinal silhouette is unchanged . interstitial opacities are similar . there is no interval increase in pleural effusion or pneumothorax .	Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Pneumothorax	14851532	55116033	22fe9215-499eca85-e1ae812f-e8e4bc0a-31234c00
2135	right picc line tip is at the level of mid svc . cardiomegaly is substantial . the patient is in pulmonary edema . right mid lung consolidation cannot be excluded . bilateral pleural effusions are most likely present . no appreciable pneumothorax is seen .	Cardiomegaly&&Consolidation&&Edema&&Pleural Effusion&&Support Devices	15131736	51485773	474f9207-e0279fb3-96a3641e-438ab1d1-01b657e9
2136	comparison is made with prior study and . there is no evident pneumothorax . cardiac size is top normal . the cardiomediastinum is midline, there is total reexpansion of the left lung . left perihilar opacities have almost resolved . there is some atelectasis though in the left upper lobe, increasing from prior study . the right lung is grossly clear . there is no pleural effusion .	Atelectasis&&Enlarged Cardiomediastinum	12410066	54151331	b90cb61d-b1b5ea1a-a31a7d69-c780a725-53c32bf6
2137	the cardiac silhouette is normal in size . the hilar and mediastinal contours are within normal limits . there is mild atelectasis at the right lung base . no definite focal consolidation concerning for pneumonia is identified . there is no pleural effusion or pneumothorax . no acute cardiopulmonary process .	No Finding	15659181	55562335	cd202e14-5a239c8c-8bba8f71-28fcffad-3ee8715f
2138	swan-ganz catheter is at the level of the right ventricle outflow tract . the port-a-cath catheter tip can be seen at the level of cavoatrial junction . there is enlargement of the left ventricle, unchanged . there is no evidence of pneumothorax . there is no appreciable pleural effusion demonstrated . there are mild right lower lobe opacities that might potentially reflect area of atelectasis .	Atelectasis&&Lung Opacity&&Support Devices	16826047	58211311	bb14208e-dd68a9a6-a211bb19-b3762b65-dbfc6379
2139	dominant central cavitary lesions are similar in appearance . widespread preibronchial abnormality is worsened concerning for worsening infection . no pneumothorax or pleural effusion seen . heart is normal in size . stable cavitary lesions but worsening peribronchial opacities concerning for worsening airways-related infection .	Lung Lesion&&Lung Opacity&&Pneumonia	17270742	50989704	8de65847-743ba591-16ca4044-0b5f1002-f1545e14
2140	portable ap radiograph of the chest was reviewed in comparison to obtained at pm . diffuse parenchymal opacities are unchanged . tubes and lines are unchanged in position . no interval development of pneumothorax or increase in pleural effusion is demonstrated .	Lung Opacity&&Pleural Effusion&&Support Devices	13078497	59434734	f6ffc380-e1eb4786-ef83de2d-ead9be69-83666d37
2141	left chest wall dual lumen central venous catheter has been removed . there is a left brachiocephalicsuperior vena cava stent . the lungs are clear of consolidation or pulmonary vascular congestion . cardiac silhouette is enlarged likely exaggerated due to technique and positioning . multiple posterior healed right rib fractures are identified . no acute cardiopulmonary process .	No Finding	14236258	55328340	cb7831a4-b96e79a9-fb92a40e-661f84c9-35010799
2142	when compared to radiograph dated , there has been interval removal of endotracheal tube and enteric feeding tube . a left-sided internal jugular catheter is seen terminating at the mid svc . there is no pneumothorax . lung volumes are persistently low with mild to moderate left-sided pleural effusion unchanged in appearance . cardiac silhouette is constant with sternotomy wires intact . no new focal consolidations . no new focal consolidations concerning for pneumonia .	Consolidation&&Pneumonia	16334516	59014702	c09fde7b-fe3f3f21-4ea1ee09-6a8497f7-7e901050
2143	enteric and et tubes are no longer visualized . degree of pulmonary edema perhaps minimally less extensive when compared to prior . cardiomegaly is again seen . retrocardiac region is not well-visualized potentially in part due to overlying soft tissues and atelectasis although underlying infection cannot be excluded . moderate pulmonary edema . retrocardiac opacity potentially in part technical although underlying infection can not be excluded . appearance is similar compared to prior . consider pa and lateral if patient is amenable .	Edema&&Lung Opacity&&Pneumonia	15131736	59242045	1432843f-fca7eaa3-df3e65b3-c45419fa-71029980
2144	heart size and mediastinum are unchanged including cardiomegaly, moderate . the bilateral pacemaker wires are unchanged in appearance . lungs are clear . there is no pleural effusion or pneumothorax . overall, no evidence of acute cardiopulmonary process seen .	Cardiomegaly&&Enlarged Cardiomediastinum&&Support Devices	11293517	57114968	f3499bab-551f399f-54dd30a2-e6b1a38f-872a4405
2145	frontal ap and lateral views of the chest were obtained . the patient is rotated . the left pectoral icd leads end in the expected locations of the right atrium and right ventricle . the patient is status post median sternotomy with intact wires . a right picc ends in the upper svc . there is no focal consolidation, pleural effusion or pneumothorax . opacity at the right cardiophrenic angle corresponds to mediastinal fat on ct . aortic knob calcifications are noted . there is pulmonary vascular engorgement and mild cardiomegaly . a nodule in the right upper lung is not well visualized on this study and is better evaluated on chest ct . multiple calcified granulomas are noted . pulmonary vascular engorgement without overt pulmonary edema . no pneumonia .	No Finding	17763117	53418217	4c813a56-c3955f56-d8575305-9347eb08-6c581dc1
2146	ap upright and lateral views of the chest are provided . dual-lead pacemaker is in unchanged position . a metallic stent projects over the heart in the expected location of the aortic valve . hardware is noted in the lower thoracic spine with evidence of vertebroplasty in a lower thoracic vertebral body . cardiomegaly is unchanged . there is no definite sign of pulmonary edema . no pleural effusion or signs of pneumonia . mediastinal contour is stable . bony structures appear unchanged . a wedge deformity is seen just above the level of vertebroplasty in the lower t-spine which is unchanged . cardiomegaly without signs of failure or edema . other findings as described above .	Cardiomegaly&&Edema	18417750	59047668	9c04078c-dee8c858-bc2a105e-d5fb538e-ac5a7c69
2147	right pleural scarring is chronic . lungs are clear . cardiomediastinal silhouette is normal .	Pleural Other	12136799	54457720	44a2ba52-bf35cfa7-d309c49c-306c1f3e-ba524d4a
2148	portable ap upright chest radiograph obtained . in this patient with known small cell lung cancer, there is stable soft tissue densityprominence of the right pulmonary hilum which is unchanged from prior exams . there is a small right pleural effusion which appears stable from prior exam and is somewhat loculated, tracking along the right lung apex . there is no overt evidence of pneumonia . there are subtle nodular opacities within the periphery of both lungs which are of unknown etiology or significance . overall heart size appears stable . bony structures are intact . stable right hilar prominence and right pleural effusion . subtle nodular opacities in the periphery of the lungs are indeterminant . nonemergent ct may be performed to further assess .	Lung Lesion&&Lung Opacity&&Pleural Effusion	19720782	50371697	65275408-6db6d9a9-13c023c8-a6a96579-434dee3d
2149	lung volumes are low, limiting evaluation of the lung bases, with perihilar atelectasis . within this limitation, no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is seen . the aorta is tortuous . heart size is difficult to evaluate in the setting of markedly low lung volumes . a right-sided port-a-cath tip projects at the level of the cavoatrial junction, as seen previously . density in the aortopulmonary window appears similar compared to prior and likely corresponds to calcified nodes, as seen on prior ct . sternal wires appear intact . low lung volumes, limiting evaluation of the lung bases and heart size, without radiographic evidence for acute cardiopulmonary process on this single frontal view .	Cardiomegaly	11413236	51568216	4ffe5eff-a5a604c2-4da5dcda-0801d405-88939c8f
2150	there is new mild interstitial edema . lateral view is suboptimal, but no focal consolidation or pneumothorax is appreciated . there is possibly a small left-sided pleural effusion . cardiomegaly and aortic tortuosity are again noted . pacing hardware is in similar position . interval development of interstitial pulmonary edema . these findings were discussed with dr . by dr . by telephone at am .	Edema	13762730	52603243	ea8f47d3-a878270a-7a5e0d98-b1d62b7e-6061c574
2151	frontal and lateral views of the chest demonstrate left pectoral single lead aicd with stable position of lead terminating in the right ventricle . the heart appears globular and enlarged, more pronounced as compared to , morphology suggestive of pericardial effusion . there is plate-like atelectasis in the left base with associated pleural effusion, which is decreased since preceding exam . there is no pneumothorax or frank edema . mild blunting of the right costophrenic angle is unchanged . . short interval development of massive cardiomegaly with globular configuration, concerning for pericardial effusion . . trace left effusion with plate-like atelectasis . possible trace right effusion, unchanged . findings reported to dr . by phone at am .	Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices	11607628	52356321	ae7fb131-28d05c98-90cbbc4c-f05c219a-1d0fed84
2152	there is increase in the left upper lobe consolidation accompanied by increased prominence of pulmonary vessels consistent with elevated pulmonary venous pressure . there is a possible small pleural line that could be reflection of a small apical pneumothorax on the right, there is suggestion of a vessel running beyond this line in the far apical region, raising the possibility that this could represent merely a skinfold .	Consolidation&&Pneumothorax&&Support Devices	14992360	50857625	c644ef55-2c1480c0-fa4e0e08-a92b5aa0-5b7ceb6c
2153	small-to-moderate right pleural effusion has increased postoperatively since , but pulmonary vascular congestion has improved . heart size is normal . lungs are grossly clear . et tube is in standard placement, nasogastric tube passes below the diaphragm and out of view . dual-channel dialysis catheter ends in the region of the superior cavoatrial junction . a catheter entering the right heart from a left jugular introducer has been withdrawn from the main pulmonary artery to the cavity of the right ventricle . a second introducer in the left jugular is unchanged in position . no pneumothorax or appreciable left pleural effusion .	Edema&&Pleural Effusion&&Support Devices	11880923	55084084	627948e7-0ba4b65a-61e23ed8-9cdf34c6-1578bb43
2154	cardiac silhouette remains enlarged . pulmonary vascular congestion has slightly improved and is more substantially improved compared to . left retrocardiac atelectasis has slightly decreased in extent, and a small left pleural effusion is also slightly smaller compared to the prior study . small right pleural effusion is not changed, and a minor area of opacity at the right base appears similar to the recent study but improvement compared to earlier radiographs . calcified granulomas in left upper lobe are unchanged . no new areas of consolidation are evident to suggest an acute pneumonia . no new areas of consolidation to suggest a source of infection .	Consolidation&&Pneumonia	12185775	59200846	d1cb903c-16d23127-ba525151-91a0fa21-20a12246
2155	as compared to previous radiograph, the patient has been extubated . otherwise, there is no relevant change . the bilateral massive parenchymal opacities are constant, constant moderate cardiomegaly .	Cardiomegaly&&Lung Opacity	10439781	53567394	5eae8395-ea7af71c-6d518498-6d193886-1c2d0853
2156	low lung volumes seen on the current exam . there is secondary crowding of the bronchovascular markings . vague opacity again seen in the left mid to upper lung in the region of patients known underlying mass . lingular opacity is most compatible with a prominent fat pad . cardiomediastinal silhouette is stable . atherosclerotic calcifications again seen at the aortic arch . no definite acute cardiopulmonary process given portable technique and poor inspiratory effort .	No Finding	13450581	52299675	1f3770d8-292e129a-67319735-0573718a-8fcb1e31
2157	right internal jugular central venous catheter terminates in the low svc as before . enteric tube courses into the stomach . since the prior study the lungs appear better aerated bilaterally . moderate right pleural effusion is slightly decreased . left retrocardiac opacity is improving . the heart remains mildly enlarged . mediastinal and hilar contours are stable . the aortic arch is calcified . there is no pneumothorax . improving lung aeration bilaterally with resolving left retrocardiac opacity and decreasing size of moderate right pleural effusion .	Lung Opacity&&Pleural Effusion	14851532	59215725	c1f46658-8c56b8e3-70c04ec6-a15e02a0-31c42988
2158	a left port-a-cath terminates within the mid svc . lower lung volumes are noted, leading to crowding of the bronchovascular structures . mild atelectasis is seen at the left lung base . a calcified lymph node is again noted within the aorticopulmonary window . there is no evidence of focal consolidation, pleural effusion, pneumothorax, or frank pulmonary edema . the patient is status post median sternotomy, and cardiomediastinal silhouette is within normal limits . no evidence of acute cardiopulmonary process .	No Finding	11413236	58006032	6edd5960-4028d9f1-6f2353cb-61d0c6bf-5048c68e
2159	the patient was intubated . exact location of the ett tip is difficult to determine, given overlay by multiple metallic devices at the level of the sternum . however, the approximate location above the carina is cm . the other monitoring and support devices are constant . constant appearance of the lung parenchyma, the pleura, with a known right pleural effusion as well as of the cardiac silhouette .	Cardiomegaly&&Pleural Effusion&&Support Devices	14851532	57629170	7fa40636-0f1e59a3-7231587d-33eea7f2-79d6fae8
2160	portable ap radiograph of the chest was reviewed in comparison to prior study obtained on . et tube tip is . cm above the carina . right central venous line terminates at the level of cavoatrial junctionproximal right atrium . ng tube tip passes the diaphragm, most likely terminating in the stomach . right upper quadrant drain is in place . overall, no substantial change since the prior study has been demonstrated .	No Finding&&Support Devices	11880923	51225417	b17b746f-83d45733-2eb4936d-2f91288c-413fe50f
2161	the lungs are clear without focal consolidation . no pleural effusion or pneumothorax is seen . cardiac and mediastinal silhouettes are unremarkable . no acute cardiopulmonary process .	No Finding	13989850	53049402	135201b0-4fcaa92b-4ddb24bd-c100f251-566a7a5b
2162	low lung volumes are present . the heart size is normal . the mediastinal contours are unremarkable . the right picc has been removed . as before, there is continued upward retraction of the hila with bilateral upper lobe scarring, similar when compared to the prior study . findings may reflect prior sarcoidosis or tuberculosis . patchy opacity in the right lung base may reflect atelectasis . infection cannot be excluded . no pleural effusion or pneumothorax is identified . there are no acute osseous abnormalities . projecting over previous left upper quadrant of the abdomen is a surgical clip . bilateral upper lobe scarring with upward retraction of hila suggestive of sarcoidosis or prior tuberculosis which is similar compared to prior studies . patchy opacity in the right lung base may reflect atelectasis but infection cannot be excluded .	Atelectasis&&Lung Opacity&&Pneumonia&&Support Devices	10933609	56535476	fa80d52e-25c85b24-0302d3d0-f2052c45-6faebca9
2163	there is mild cardiomegaly . the aorta is tortuous and calcified . the mediastinal and hilar contours appear unchanged . there is a similar mild interstitial abnormality with prominence of central pulmonary vascularity, suggesting mild vascular congestion . in addition, patchy streaky opacities in the right mid and lower lung suggest a background of minor scarring or atelectasis . although evaluation is limited, there is no definite pleural effusion . no pneumothorax is demonstrated, although it is noted that the left lung apex is obscured by a flexed chin . essentially stable findings suggesting mild pulmonary vascular congestion .	Edema	10975446	51473674	e0f5b52f-7723f470-e1b422a4-73ef70cb-2a76d9c3
2164	bilateral pleural effusions are seen as well as persistent pulmonary edema . stable mild cardiomegaly noted . no interval changes are seen . pulmonary edema, small bilateral pleural effusions, mild cardiomegaly .	Cardiomegaly&&Edema&&Pleural Effusion	16855430	57663243	71bfff81-56c6477b-3432d360-6d1f41d2-8b2d7988
2165	the lung volumes have increased . the right internal jugular vein introduction sheath has been removed . the pre-existing right pleural effusion has completely resolved . on the left, however, the pre-existing pleural effusion persists and has minimally increased in extent . there are subsequent areas of retrocardiac and basal atelectasis . borderline size of the cardiac silhouette . two calcified lung nodules in the left apex .	Atelectasis&&Cardiomegaly&&Lung Lesion&&Pleural Effusion	12185775	55391561	d3905d7d-0e7ed6e5-b6ec0f08-c5b5dcd8-ad786679
2166	the monitoring and support devices are unchanged . there is improved ventilation of the lung bases, with almost complete resolution of a pre-existing small right basal atelectasis . no newly occurred focal parenchymal opacity suggesting pneumonia . normal size of the cardiac silhouette . no pulmonary edema . no pneumothorax .	Pneumonia&&Support Devices	11906222	56779415	345c27ae-8dc96bd7-cd59fd7f-e18c90bc-71bf8122
2167	the heart size is normal . lung volumes are low . biapical fibrotic changes with traction bronchiectasis is re- demonstrated . minimal blunting of the left costophrenic angle suggests a trace left pleural effusion . streaky bibasilar airspace opacities likely reflect atelectasis . no pneumothorax is identified . known fracture of the left th rib is not clearly delineated on this exam . clips are seen projecting over the left upper quadrant . no new fractures are seen . there is crowding of the bronchovascular structures but no overt pulmonary edema is demonstrated . chronic fibrotic changes within both lung apices . low lung volumes with probable bibasilar atelectasis, though infection or aspiration cannot be excluded . small left pleural effusion . known left th rib fracture is not clearly seen on the current exam .	Atelectasis&&Fracture&&Pleural Effusion&&Pneumonia	10933609	50205123	5df8c586-2f6adf15-722e6f13-ffa8a117-acd92b9a
2168	there is no evident pneumothorax or enlarging pleural effusions . cardiomediastinal contours are unchanged . there are low lung volumes . left picc tip is in the mid svc . ng tube tip is in the stomach . bibasilar atelectases, larger on the right side, are stable . calcified granulomas in the right upper lobe are again noted . ill-defined rounded opacity in the left upper lobe is persistent . when clinically feasible ct is recommended for further evaluation .	Atelectasis&&Enlarged Cardiomediastinum&&Lung Opacity&&Support Devices	16319601	50623490	2cf87e9a-4f6ad24d-c073cac1-4fb3f677-79f26de4
2169	there has been interval placement of a right pleural pigtail catheter projecting over the right lower chest and protruding no more than cm into the chest with associated interval decrease in size of a right pleural effusion . a right pleural effusion remains, with right basilar opacity likely representing persistent atelectasis . the cardiac silhouette is normal in size . the mediastinal contours are normal . the known prominent subcarinal node is not well appreciated . interval right pleural pigtail catheter placement, which projects of the lower right chest, and protrudes not more than . cm into the chest . there has been interval decrease in size of a right pleural effusion, persistent right basilar atelectasis is seen .	Atelectasis&&Pleural Effusion&&Support Devices	13352405	54232840	e3d8d85e-48f2c05f-b72dd0c6-fbd2ceea-656be377
2170	pa and lateral chest radiograph demonstrates clear lungs bilaterally . cardiomediastinal and hilar contours are within normal limits . there is no pleural effusion or pneumothorax . visualized osseous structures demonstrates no acute abnormality . no air under the right hemidiaphragm is identified . no acute abnormalities .	No Finding	14641474	58195876	a431832f-c2debb14-58876089-dc9b0d60-95e4c67f
2171	pa and lateral chest views were obtained with patient in upright position . comparison is made with the next preceding ap single view chest examination of as well as an ap and lateral chest examination of . the next previous portable chest examination observed mild regression of the right-sided pleural effusion following successful thoracocentesis was only temporary and fluid effusion has increased again however, not as much as it was on examination of . no new shift of mediastinum is identified and no pneumothorax is seen . no significant cardiac enlargement is observed and in the accessible pulmonary vasculature, no evidence of interstitial or alveolar edema can be identified . there is a small amount of pleural effusion accessing also on the left base but clearly less marked than on the right side . reoccurrence of right-sided pleural effusion in patient with history of pancreatic carcinoma . no radiographic evidence of chf, cardiac enlargement or fluid overload .	Pleural Effusion	10410641	57107868	d471efcd-b9883de0-61154002-0ed78c74-1fe5a5e5
2172	a left chest wall central line terminates in the right atrium . there is no pneumothorax . lung volumes are extremely low . prominence of the interstitial markings is likely due to mild pulmonary edema . the cardiac silhouette is enlarged as seen previously . there are no appreciable pleural effusions . degenerative changes are noted within the right humeral head . no evidence of pneumothorax . no significant change since the prior exam .	No Finding	17340686	52185534	b0777bfe-820d4a8b-e6e4ec7a-7aacd190-f85113cf
2173	single portable view of the chest was obtained . there has been interval placement of a right transjugular central venous catheter, distal tip not well evaluated, appears to extend to the expected location of the mid svc, although exact location is not well evaluated on this study . there is diffuse opacification of the right hemithorax which maybe due to underlying fluid and consolidation . the esophageal stent has migrated projecting over the right apex as compared to the prior study of . the left lung is grossly clear . right ij extending to the expected location of the mid svc, although not well evaluated due to overlying opacity . no definite pneumothorax . right hemithorax nearly completely opacified which appears slightly increased as compared to the prior study, although in the prior study the patient was upright so there may be shift in fluid . the esophageal stent projects superiorly into the right apex, stable since the prior study but migrated in position as compared to .	Lung Opacity	19016834	57441180	aab91d0b-db2c766c-d2a2b41b-1fed8561-7e2d060c
2174	there are stable fibrotic changes involving both lungs with left apical scarring related to known prior tuberculosis exposure . there is a stable moderate layering right pleural effusion since . there are no new focally occurring parenchymal opacities concerning for pneumonia . there is no evidence of pneumothorax . cardiomediastinal and hilar contours are stable, with heart size within the upper limits of normal . pulmonary vascularity is not increased . stable layering moderate right pleural effusion since .	Pleural Effusion	13849733	59560734	871b39ac-d22367db-2644f680-703ffc97-e29ad517
2175	there is stable massive cardiomegaly which does not show any improvement in past hours . there is significant dilatation of the main pulmonary artery which also has not abated . lung volumes are low and unchanged with left-sided atelectasis essentially the same . there is no pneumothorax . ij catheter sheath is seen in position terminating within the mid svc . a supraclavicular triple-lumen catheter is seen terminating within the right atrium . moderate bilateral pleural effusions are unchanged . no decrease in massive cardiomegaly or pulmonary artery dilatation . echocardiography is recommended to further evaluate this finding . these findings were reported to physician assistant, ms . , at pm . via phone by .	Cardiomegaly	15259244	54007778	c249e803-7af4d888-0de68b91-d6fda68a-387c0f5d
2176	there is no focal consolidation, pneumothorax or pneumomediastinum . opacities at the bases are likely atelectasis . the cardiomediastinal silhouette is unremarkable .	Atelectasis&&Lung Opacity	16848073	51836430	1d1bc795-245a8bf2-267d7b91-209d78ab-a1e3f52f
2177	the lungs are clear of confluent consolidation, effusion, or overt pulmonary edema . cardiomegaly is stable . enlarged pulmonary arteries are also seen, unchanged . atherosclerotic calcifications seen at the aortic arch . imoression cardiomegaly and enlarged pulmonary arteries without definite acute cardiopulmonary process .	Cardiomegaly	15131736	59800551	f83f160f-ac1a55c0-b03c517c-05c99d7e-931e1444
2178	there is little overall change . again there is enlargement of the cardiac silhouette with indistinctness of pulmonary vessels consistent with mild elevation in pulmonary venous pressure . no evidence of pleural effusion or acute focal pneumonia . dual-channel pacer device remains in place with leads in appropriate position .	Cardiomegaly&&Edema&&Support Devices	16043637	56648385	0b71f9fb-3c56b3bf-52d2654d-3143a294-060a965c
2179	pa and lateral views of the chest demonstrate moderate-to-severe cardiomegaly, similar in comparison with the prior ap radiograph, but increased since . there is interval improvement in right lower lobe opacity since the prior study, however hazy opacification persists, difficult to discern whether new since the prior study or whether never fully resolved . infection vs assymetric pulmonary edema . the cardiac silhouette remains quite enlarged, which may be due to cardiomyopathy or pericardial effusion . coronary artery calcificationstenting is seen . there is no pleural effusion or pneumothorax . interval improvement in right lower lobe opacity since the prior study, however hazy opacification persists, difficult to discern whether new since the prior study or whether never fully resolved . infection vs assymetric pulmonary edema . recommend follow-up to resolution and consider chest ct to exclude an underlying lesion as was also suggested on prior chest radiograph from . cardiac silhouette remains quite enlarged, which may be due to cardiomyopathy or pericardial effusion .	Cardiomegaly&&Edema&&Lung Opacity&&Pneumonia	15840907	59748962	1dfc0e48-5089885c-04550c95-ad10c948-f2488a05
2180	moderate right basilar atelectasis is similar . the left lung is well inflated . ground-glass opacification in the right lower and middle lobes has improved since prior exam of and significantly improved since . no pneumothorax is present . cardiac and mediastinal contours are normal . improved aeration of the right lower and middle lobes with persistent ground-glass opacity . suggest continued chest x-ray followup in one month to evaluate for continued evolution .	Lung Opacity	13964474	57561947	540eb477-f05ddda1-09bc6606-ab931f74-e466d39e
2181	pa and lateral views of the chest were provided demonstrating midline sternotomy wires and a dual-lead pacer which appear unchanged with lead extending into the region of the right atrium and right ventricle . lungs are clear without signs of pneumonia or edema . no effusion or pneumothorax . cardiomediastinal silhouette appears normal . the imaged bony structures are intact . no acute findings in the chest .	No Finding	18487334	50674735	34385126-4e8184f2-e9ac8e38-eb0d5a59-31d37002
2182	tip of the endotracheal tube at the upper margin of the clavicles is no less than cm from the carina, with the chin in neutral or elevation . it could be advanced safely mm to achieve better seating . moderate right pleural effusion stable . moderate-to-severe cardiomegaly stable . upper lobe pulmonary vasculature mildly engorged, but no appreciable pulmonary edema . right pic line tip ends in the right atrium . right internal jugular dual-channel catheter ends in the upper svc .	Cardiomegaly&&Pleural Effusion&&Support Devices	11204646	55470597	ea99a6c6-34280d75-9f1ddc1c-837b3a69-a94986ea
2183	bilateral lower lobe predominant airspace opacities have worsened, and may reflect evolving infectious pneumonia . peripheral interstitial opacities likely reflect coexisting interstitial edema . small left pleural effusion has increased in size, and a small right pleural effusion is new .	Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia	16508811	52670967	2905a219-0044b483-8315fff6-2258fe9f-a288ed45
2184	one view of the chest the lungs are well expanded and shows a right lower lobe opacity . the cardiac silhouette is enlarged . the mediastinal silhouette and hilar contours are normal . no pleural effusion or pneumothorax is present .	Atelectasis&&Pleural Effusion	12658295	56477444	b5ba8da0-31b932cf-ce8505a8-183cf855-29f186d7
2185	the patient is rotated slightly to the left . the patient is status post median sternotomy and cabg with several sternotomy wires again seen to be fractured . cardiac and mediastinal silhouettes are stable . multiple old anterior lateral left-sided rib deformities are again seen . no focal consolidation . no large pleural effusion . no evidence of pneumothorax . no significant interval change given differences in patient position .	No Finding	19499595	57517941	4c9812bf-f392e749-e5a9e763-24de2d49-20271034
2186	the degree of bilateral opacification may be slightly less prominent . substantial enlargement of the cardiac silhouette persists .	Cardiomegaly&&Lung Opacity	17189198	54003688	2247b067-ee0f755a-9ea52034-1cc6095d-1d4ea3df
2187	portable frontal chest radiograph shows no significant change in previously described left lung opacification and volume loss, compatible with collapse, with elevation of a probably paralyzed left hemidiaphragm . the right lung remains clear . further evaluation with ct would provide a better evaluation of the airways to evaluate for cause of collapse .	Atelectasis&&Lung Opacity	12530259	52583710	c76fb4a5-73d1b805-ea3945ae-5f50ad50-145ab073
2188	a region of consolidation in the right lower lung has been abnormal since at least mid , and has improved but not cleared . moderate cardiomegaly is chronic . pulmonary vascular congestion, also longstanding . there is no pulmonary edema . pleural effusion is minimal if any . no pneumothorax .	Cardiomegaly&&Consolidation&&Edema&&Pleural Effusion	11474065	50017760	645dd223-bb4a40c3-d6a19aeb-fcd36a22-ca6478a3
2189	post-surgical changes are again noted within the esophagus . bilateral pleural effusions are noted, right greater than left, and appear slightly decreased in comparison to prior study from yesterday . cardiomediastinal silhouette remains stable . the lungs are without any focal consolidations or pneumothoraces . slight decrease in bilateral pleural effusions with otherwise stable post-changes in comparison to prior study from yesterday .	Pleural Effusion	16848073	51780481	79a1d194-0d324545-7c4ad0fc-c75075d7-91c97dc4
2190	the heart size remains unchanged . the previously described pneumonic infiltrates located to the right middle lobe and left upper lobe lingula have progressed in extension . new additional parenchymal infiltrates are now also seen in the left upper lobe apical segment and a few scattered small patchy infiltrates are observed in the right hemithorax mid lung field as well . in addition, there is now clear blunting of the right and left lateral pleural sinuses extending into the posterior pleural sinuses as identified on the lateral view . the pulmonary vascular pattern does not show increased congestion in comparison with the previous study . progression of previously existing bilateral parenchymal infiltrates and newly developed additional infiltrates are observed . in addition, bilateral pleural effusions have developed in the absence of evidence of pulmonary vascular congestion . referring physician, , was paged for stat report at pm .	Edema&&Lung Opacity&&Pleural Effusion	16662264	55847451	dc259d24-611aa4fd-ede77026-cf06f0b3-9c9ae10a
2191	the lungs are low in volume but clear . the cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal . no pleural effusion or pneumothorax is present . note is made of left axillary clips .	No Finding	18978682	52754826	a5fd5e55-4159fef2-6f0ac33c-f57ea303-1d5e8f7a
2192	pa and lateral views of the chest left-sided dual-chamber pacemaker leads terminating in the right atrium and right ventricle are noted . there is mild enlargement of the cardiac silhouette, which is stable . the aorta remains tortuous and diffusely calcified . pulmonary vascularity is normal . the lungs remain hyperinflated . no pleural effusion or pneumothorax is seen . there is minimal atelectasis at the lung bases, but no areas of focal consolidation . no acute osseous abnormality is present .	Atelectasis	18929056	56043376	928427f2-ea258174-1e7a326a-223e2d87-14e3a792
2193	minimal edema persists in the right lower lung, considerable improvement since . mildly enlarged heart is unchanged . there is no appreciable pleural effusion and no pneumothorax or substantial atelectasis . et tube is in standard placement . nasogastric tube passes into the stomach and out of view . depending on clinical circumstances, the markedly unilateral pulmonary edema on could have been due to previous right decubitus positioning or concurrent pulmonary edema and a large pulmonary embolism preventing perfusion to the left lung . and i discussed those findings and their clinical significance by telephone at the time of dictation .	Cardiomegaly&&Edema&&Support Devices	17288844	53092956	930dd047-b21f81bf-197ca30e-463d627b-aedbcdc3
2194	three right pleural tubes, two apical, one basal, are unchanged in their respective positions since , pm . nevertheless, moderate right pleural effusion is increasing and severe atelectasis or consolidation persists at the base of the right lung . borderline cardiomegaly is stable . left lung is grossly clear . right apical pneumothorax is miniscule .	Atelectasis&&Cardiomegaly&&Consolidation&&Pleural Effusion&&Pneumothorax&&Support Devices	18309149	50853840	c1379178-96a24a21-fe62e710-94cf9946-111ded9a
2195	esophageal stent is again seen, appears more inferior in position as compared to the prior study . right perihilar chronic changes are seen . there is slight increase in the right mid lung opacity which could be due to underlying infection, possibly in the superior right lower lobes . no pneumothorax is seen . . inferior migration of patients esophageal stent as compared to the prior study . . slight increase in right mid lung patchy opacity may due to consolidation in the superior right lower lobe which could be due to an infection . the above findings were discussed with dr . on via telephone .	Consolidation&&Lung Opacity&&Pneumonia	19016834	59584894	2f8885a1-06440c4f-d3013600-227e0bbf-1a438c73
2196	et tube and nasogastric tube are in standard placements . midline drain ends at the level of the sternal notch . right jugular line tip in the mid svc . new paramedian drains could be superficial . moderate right pleural effusion has increased, and left lower lobe atelectasis is worsened . cardiomediastinal silhouette is essentially normal . no pneumothorax .	Atelectasis&&Pleural Effusion&&Support Devices	17770657	54995727	03f5be94-94356058-6e153b3e-9d89dc4b-bc540c4c
2197	single frontal portable view of the chest please note that the right costophrenic angle is excluded from view . vascular markings are seen extending to the lung apices bilaterally with no evidence of pneumothorax . the lungs remain clear . right picc and gastric tube are unchanged .	No Finding	18110020	59221699	81450711-ce3a0e1f-48fce3df-720d7107-44bf0a49
2198	portable ap semi-upright chest radiograph is obtained . there is pulmonary vascular congestion and mild pulmonary edema which is new from prior exam . no large pleural effusion or pneumothorax . cardiomediastinal silhouette appears stable . bony structures are intact . pulmonary edema .	Edema	16772702	54001264	c6cd8924-91d9c0b3-cb90ad47-aa32d3f4-86a66ea8
2199	since the prior study, there is interval progression of interstitial pulmonary edema . heart size and mediastinum are unchanged in appearance . there is also no change in the position of the tubes and lines .	Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Support Devices	18855147	53707610	2dff1f81-10a9bf5a-27bc2fca-33511bd6-db94a774
2200	a single portable upright view of the chest is provided . dobbhoff tube is seen curling within the stomach . right-sided picc terminates at the cavoatrial junction . right basilar loculated hydropneumothorax is again present with no change . right-sided pigtail catheter is in unchanged position . left lung is incompletely imaged, but appears clear .	Pneumothorax&&Support Devices	14387068	51664945	9196cf10-d7be030b-9eb57d37-e9f760c5-b583cca5
2201	single frontal view of the chest demonstrates a right port-a-cath in unchanged position, terminating at the cavoatrial junction . median sternotomy wires are present, along with surgical clips in the left upper quadrant . the heart is mildly enlarged, but stable compared with prior examinations, with redemonstration of calcified mediastinal lymph nodes . a rounded opacity in the lower left lung likely correlates to a calcified granuloma as seen on ct of the chest from . there is no evidence of pneumonia, pleural effusion, pneumothorax or overt pulmonary edema . the lung volumes are low, accentuating bibasilar atelectasis . no subdiaphragmatic free air is present . no subdiaphragmatic free air or other acute cardiopulmonary process .	No Finding	11413236	59753947	8062997c-91b95843-31ddb21e-b92bf46a-73af4721
2202	previous pulmonary edema is not recurred . there is no pneumothorax or pleural effusion . heart is not enlarged . right pic line ends in the upper svc .	Edema&&Support Devices	18110020	50971332	5ffb8e9f-1dc93608-ff50a406-6235935c-ab05fa59
2203	there has been a lobectomy performed on the left . chest tube is in place and there is no definite pneumothorax . post-surgical opacification is seen at the left base consistent with atelectasis, effusion, and possible consolidation . the trachea has been pulled over to this side and there is mild mediastinal shift . atelectatic changes are seen at the right base . of incidental note is small amount of gas along the upper chest border on the left .	Atelectasis&&Consolidation&&Lung Opacity&&Pleural Effusion&&Support Devices	11378150	59467402	2dcfc978-4f2b7c37-42839158-5805b52a-43671df7
2204	no relevant change is seen . constant alignment of the sternal wires . constant moderate cardiomegaly and clips of the cabg . the extent of the partly loculated bilateral pleural effusions is constant . the areas of atelectasis at the left and right base are constant . the mild pulmonary edema, pre-existing on the previous examination, is constant in severity .	Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion	16360107	52437271	9e80889a-f414a035-63eed5d0-37d21607-88a2a076
2205	opacifications within left lung base, the right mid lung zone as well as within the right lower lung zone appear consistent with multifocal areas of consolidation . the upper lung zones are relatively clear . surgical clips are noted within the upper mediastinum . chest tube remains in place .	Pneumonia	17770657	54130139	7688e895-1ec37491-98ad4a70-8efc45b7-f8ba74da
2206	the left-sided chest tube is again seen, unchanged . compared with earlier the same day am, the small left apical pneumothorax is again noted, itself unchanged . however, on the current exam, air is noted along the medial surface of the left lung . this may represent a portion of the apical pneumothorax that is dissecting medially or, alternatively, a small pneumomediastinum . in retrospect, this may have been present on the earlier film, but is better seen on the current exam due to increased contrast . it was not clearly present on film . again seen is subcutaneous emphysema, which appears bmore pronounced . opacity at the left base shows some interval improvement, with the elevated left hemidiaphragm now better defined . some residual atelectasis andor consolidation and residual pleural fluid are likely present . small left apical ptx is unchanged, but small medial ptx vs pneumomediastinum along upper left lung medially . subcutaneous emphysema has likely also progressed . interval improvement in left base opacity . findings paged to the ordering house officer at approximately pm . on the day of exam . at approximately pm, findings were discussed with covering house officer , phone .	Lung Opacity	12530259	54170209	c177928c-699001c4-7f0cb68c-de208759-e10a09ee
2207	minimal biapical scarring is unchanged . the lungs are otherwise clear without consolidation or edema . there is no pleural effusion or pneumothorax . the cardiomediastinal silhouette is normal . no acute cardiopulmonary process .	No Finding	19623993	51375357	8ce5c1e8-5314070b-aed98ebb-f5135400-c6c11c2f
2208	there is again substantial elevation of the right hemidiaphragmatic contour . opacification above this could reflect atelectasis, though in the appropriate clinical setting supervening pneumonia would have to be considered . some prominence of the cardiac silhouette persists in a patient with intact midline sternal wires . no evidence of vascular congestion and the left lung is essentially clear .	Atelectasis&&Cardiomegaly&&Enlarged Cardiomediastinum&&Lung Opacity&&Pneumonia	17327592	53734902	d43e3c28-8d1a4b0c-ef446460-413e4e0b-df3a80ef
2209	portable chest radiograph demonstrates interval insertion of a dobbhoff tube which is coiled within in the stomach and then turns back to terminate in the esophagus at the level of the clavicles . there is a left-sided picc line with tip terminating in the mid svc . there are multifocal opacifications, worst in the lung bases, which may represent atelectasis, though infectious process is consideration, possibly aspiration . dense opacification projecting over the right mid lung corresponds to a loculated fissural effusion evident on the prior ct . dobbhoff tube with tip coiled in stomach and tip terminating in the upper esophagus . multiple opacifications likely represent multifocal pneumonia, possibly due to aspiration . loculated pleural effusion in the right fissure .	Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	17770657	51024049	0fef51dc-8e713f62-0c7f23dc-fb145074-68b8ec4b
2210	there are no old films available for comparison . the heart is moderately enlarged . there is a right ij cordis with tip in the upper svc . there is mild pulmonary vascular re-distribution, but no definite infiltrates or effusion .	Cardiomegaly&&Pleural Effusion	10268877	54558182	672a57a9-30dbdb02-4e0a1676-fbf127b4-e2f52011
2211	the lungs are hyperinflated but clear of consolidation . the cardiomediastinal silhouette is within normal limits . osseous structures are unremarkable . no acute cardiopulmonary process .	No Finding	11052935	57171514	1de015eb-891f1b02-f90be378-d6af1e86-df3270c2
2212	there continues to be moderate cardiomegaly and volume loss at both bases . there is a small left effusion . there is no focal infiltrate . pacemaker and mitral valve replacement and sternotomy wires are unchanged no significant change .	No Finding	19759491	53927305	dc433c13-ef033a1e-75763e20-db477b3f-da3e909b
2213	there is mild decrease in the still substantial opacification along the mid and lower lateral chest wall on the right, most likely reflecting a loculated effusion . apparent pleural catheter remains in place, as does the port-a-cath . little overall change in the appearance of the heart and lungs .	Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Support Devices	16826047	51707663	7bc6a484-606eb095-e1f6f658-ef47cd8f-5c1d2c86
2214	severe cardiomegaly is stable . widened mediastinum has minimally increased . bilateral effusions moderate in size have increased . moderate vascular congestion has worsened . bibasilar opacities larger on the left side have increased , a combination of atelectasis and effusion . ng tube tip is out of view below the diaphragm . et tube tip is in the standard position . right ij catheter tip is in the proximal svc .	Atelectasis&&Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Support Devices	14727722	59875077	1e26d8ef-0ea74c80-7ea8a0b8-18ef7113-3ea5c204
2215	again seen are posterior fixation hardware in the thoracic spine, unchanged in position . elevation of the right diaphragm appear unchanged since . minimal right pleural effusion is seen . the lungs are clear . there is no evidence for pulmonary edema or focal pneumonia . the heart size is normal . the mediastinum and hilar contours are unchanged and normal . no pneumonia .	No Finding	14353044	57674897	4e3be0c2-0bf7b260-9ee5b4e0-56975598-6b3bd28e
2216	right-sided double lumen central venous catheter tip terminates in the proximal right atrium . heart size is mildly enlarged . the mediastinal and hilar contours are unremarkable . pulmonary vasculature is not engorged . aeration of the lungs has markedly improved compared to the previous radiograph, with patchy opacities demonstrated in the lung bases, potentially infectious or atelectasis . no pleural effusion or focal consolidation is present . no acute osseous abnormalities detected . patchy opacities in the lung bases may reflect atelectasis however infection is not excluded .	Atelectasis&&Lung Opacity&&Pneumonia	16508811	56381590	b4f28648-ad5e7b85-c9c36b5c-975bd159-3da2a25f
2217	pa and lateral views of the chest the patient is status post median sternotomy and cabg . the heart remains moderate to severely enlarged . the mediastinal contours are stable with aortic knob calcifications visualized . there is consolidative opacity within the right lung, most pronounced within the right upper lobe . additionally, ill-defined hazy opacity is noted within the left perihilar region . there is no pleural effusion or pneumothorax visualized . mild degenerative changes are seen within the thoracic spine . . consolidative opacity within the right upper lobe is concerning for pneumonia . . hazy opacity within the right lung base as well as within the left perihilar region may reflect superimposed pulmonary edema, though infection within the right lung base also is not excluded .	Consolidation&&Edema&&Lung Opacity&&Pneumonia	18828251	50037292	10a6246b-f2e3ec72-8c956609-ee81d40f-4a962883
2218	there is known scarring at the bases of the right upper lobe, associated with a minor degree of volume loss as well as scarring in the left lung, the level of the upper and lower hilus . status post sternotomy and cabg . lung volumes are low . there are no pleural effusions . normal size of the cardiac silhouette . no pulmonary edema . no pneumonia .	Lung Opacity	16334516	52628998	21291544-3a540481-114dd644-ac5c71c2-69673493
2219	pa and lateral chest views were obtained with the patient in upright position . analysis is performed in direct comparison with the next preceding pa and lateral chest examination of . previously described heart size, mediastinal structures, and permanent pacer with dual electrode system remain unchanged . the same holds also with the previously described loculated pleural effusion that blunts the left-sided lateral pleural sinus . parenchymal densities in the posterior portion of the left lower lobe remain unchanged as they present on the lateral view . the only significant difference is the appearance of substantial amount of subdiaphragmatic air which was not found on the preceding chest examination . telephone contact with referring physician, . , explained this finding as the patient is daily abdominal dialysis . stable chest findings . persistent loculated pleural density on the left base and parenchymal density occupying posterior portions of the left lower lobe .	No Finding	13067703	58819781	b56a09de-a517e1c9-1e37badb-c8820169-834c4cd1
2220	single portable upright chest radiograph was obtained . linear atelectasis at the right base is more discrete compared to prior exam . no consolidation, effusion or pneumothorax is present . moderate cardiomegaly is stable . a tiny right effusion is noted . surgical clips and sternotomy wires are intact . a left chest cardiac device has two leads in stable position . tiny right pleural effusion .	Pleural Effusion	18615099	57137730	f0e11656-d359330e-8e7c2e5d-09c9d0d0-583da81f
2221	single lead pacing hardware is in similar position . elevation of the right hemidiaphragm is again noted . linear opacity projecting over the right mid lung likely represents atelectasis . no focal consolidation, pleural effusion, or pneumothorax is seen . the heart size is mildly enlarged .	Atelectasis&&Cardiomegaly&&Lung Opacity&&Support Devices	14556809	52810254	3555a31b-7de6859b-3d2e1279-2c0be9b8-f1030977
2222	interval repositioning of left intra-aortic balloon pump, with tip now terminating . cm below the superior aspect of the aortic knob . swan-ganz catheter terminates within the right hilar region, likely in the distal interlobar pulmonary artery . this could be withdrawn a few centimeters for standard positioning . other indwelling devices are in standard position . stable cardiomegaly, accompanied by pulmonary vascular congestion and moderate edema with a mid and lower lung predominance in this patient with known upper lobe predominant emphysema . bilateral moderate pleural effusions are present, with interval increase in size on the left .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	13606683	58789863	79931253-dc5d4f8a-ed5d56b8-d117d4ed-6e8ffc71
2223	the severity of the pre-existing pulmonary edema has slightly worsened . the lung volumes have decreased . there are no larger pleural effusions . moderate cardiomegaly persists .	Cardiomegaly&&Edema	13896515	58469571	db0ff7a9-8860e50f-7b50f798-2e24594e-9c16c38d
2224	the monitoring and support devices are constant . borderline size of the cardiac silhouette with signs of pulmonary edema in addition the parenchymal opacities, likely represent pneumonia . the retrocardiac atelectasis, the presence of a small left pleural effusion cannot be excluded .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	19565388	59025691	704b81fb-eb6b3580-0bf2d329-f5aa33e7-5e85c2ae
2225	the patient has received a swan-ganz catheter . catheter shows a normal course, the tip, however, is located too much distal in the right pulmonary artery and must be pulled back by approximately cm . otherwise, the radiograph is unchanged, low lung volumes, mild cardiomegaly, vascular stents in situ . moderate to extensive right pleural effusion and mild left pleural effusion, both with evidence of atelectasis in the basal lung regions . no pneumothorax .	Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices	12847817	54656023	c9d61fcf-0566cce5-a12caae5-5c86b25f-20caac6a
2226	diffuse increased opacity of the right lung, with several air bronchograms . a pre-existing right pleural effusion seems to have moderately decreased . no changes in the left lung . unchanged monitoring and support devices . unchanged aspect of the cardiac silhouette .	Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Support Devices	19757720	50149345	dd0edd5f-bbfc870a-23c7b603-2ee5bd53-caedb97b
2227	rounded calcified nodule in the region of the posterior right lung base is seen and represents calcified granuloma on cts dating back to , likely secondary to prior granulomatous disease . previously seen pretracheal lymph node conglomerate and right hilar lymph nodes are better seenevaluated on ct . no focal consolidation is seen . there is no pleural effusion or pneumothorax . cardiac and mediastinal silhouettes are stable with possible slight decrease in right paratracheal prominence . no radiographic findings to suggest pneumonia .	Pneumonia	10046166	57379357	e5ba5704-ce2f09d3-e28fe2a2-8a9aca96-86f4966a
2228	final addendum addendum interval increase in pleural effusion, as well as pneumoperitoneum were discussed with dr . the patient had a recent laparoscopic procedure to explain pneumoperitoneum . there is interval increase in pleural effusion on the right . there is also evidence of pneumoperitoneum . given the recent surgery, attention to exclude the possibility of perforated esophagus is required .	Pleural Effusion	19016834	50600020	5bf49704-2e8accc0-671e467c-ff02da5d-9245891c
2229	the patient is rotated to the left . large area of opacification involving the right mid to lower lung suggests pleural effusion with overlying atelectasis, underlying consolidation cannot be excluded . there is also blunting of the left costophrenic angle which may be due to pleural effusion . the left retrocardiac opacity and obscuration of the left hemidiaphragm is seen, may be due to pleural effusion and atelectasis although underlying consolidation not excluded . the cardiac and mediastinal silhouettes are shifted leftward of midline presumably due to patient positioningrotation . suggest repeat with better positioning when patient able .	Atelectasis&&Consolidation&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion	11934114	55027268	e32d8967-9d4234f1-98ac9b11-3c5e73f4-cc690e1a
2230	the lung volumes have slightly decreased . as a consequence, mild atelectasis are seen at the lung bases . no pleural effusions . no pulmonary edema . no pneumonia .	Atelectasis	13484161	54526081	95906129-89721086-cc8154fa-07c91f7e-3c5ea511
2231	frontal and lateral radiographs of the chest were acquired . chronic deformity of the upper right thorax relates to prior chest wall resection . suture chain along the right perihilar region is consistent with prior right upper lobectomy, as is right apical scarring and superior retraction of the right hilus . there is also suture chain noted along the lateral aspect of the upper right lung . there is no focal consolidation . there is no definite right pleural effusion . scarring is seen at the right lung base, not significantly changed . there is no left pleural effusion . no pneumothorax is seen . the heart size is normal . the mediastinal contour is unchanged . multilevel degenerative changes of the thoracic spine are noted . . no acute cardiac or pulmonary process . . chronic post-surgical changes of the right lung and chest wall, as described above .	No Finding	13263843	59379876	f2519fc1-a453a942-fcb47d26-f30fa862-72fc2107
2232	ap upright portable view of the chest was obtained . in the interval since the prior study, there has been development of a very large left pneumothorax with collapse of the left lung . there may be slight tension component . the right lung is clear . no pleural effusion . the left cardiac border appears somewhat flattened, which may be due to tension . interval development of large left pneumothorax . the above findings were discussed with dr . via telephone on .	Pneumothorax	15192710	56661680	537866b5-4423c6f9-f01223bc-1a4b2a8a-a550fd36
2233	there is prominence of the interstitial markings suggesting moderate interstitial edema . no large pleural effusion is seen . there is no evidence of pneumothorax . the cardiac silhouette is enlarged . the aorta is tortuous . enlarged cardiac silhouette and moderate interstitial edema .	Cardiomegaly&&Edema	13484161	55799349	d45a4f1c-aa9b0b1d-714e476e-b6f28f01-34d6bcdc
2234	the hand of the patient obscures the lower half of the left chest . there is enlargement of the cardiac silhouette with indistinctness of engorged pulmonary vessels, consistent with elevated pulmonary venous pressure . in the appropriate clinical setting, superimposed basilar pneumonia could be considered .	Cardiomegaly&&Edema&&Pneumonia	16050730	52052294	e6298e5b-366c6725-3be73135-100fb888-3168c3b2
2235	the nasogastric tube has been removed . the double-lumen dialysis catheter on the right remains unchanged . unchanged mild-to-moderate cardiomegaly with signs of mild interstitial lung edema . no pleural effusions . no focal parenchymal opacity suggesting pneumonia . minimal atelectasis in the retrocardiac lung areas .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pneumonia&&Support Devices	18855147	54198369	4055e006-3d0171d5-07ea571b-cf29d489-7847ba6e
2236	there are persistent, stable bilateral upper lung reticular nodular opacities consistent with history of sarcoidosis . no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is seen . the heart size is normal . mediastinal and hilar contours are stable . . no focal consolidation to suggest pneumonia . . stable bilateral upper lungs zone fibrosis consistent with history of sarcoidosis .	Pleural Other&&Pneumonia	14147787	57740891	f8355430-64704941-eeb44da9-4b52d4e6-371c314e
2237	a hazy opacity is present in the right lung which may represent aspiration, pleural effusion or hemorrhage . retrocardiac opacity at the left base is unchanged . moderate cardiomegaly is stable . slight prominence of the pulmonary vasculature with cephalization and enlarged pulmonary arteries are consistent with mild pulmonary edema . tracheostomy tube is in place . there are no displaced rib fractures . . hazy opacity in the right lung which may represent aspiration versus pleural effusion or hemorrhage . . mild pulmonary edema . . no displaced rib fractures .	Edema&&Fracture&&Lung Opacity&&Pleural Effusion	10268877	53452091	e35d7c70-3f278882-4f133ee9-184f4d7e-fa32a4d7
2238	no previous images . there is mild hyperexpansion of the lungs, suggesting some underlying chronic pulmonary disease . however, no evidence of acute pneumonia, vascular congestion, or pleural effusion . of incidental note is an old healed rib fracture on the right .	Fracture	11906222	53854854	567bcd19-6ab220b4-8f8eb57b-5f94b009-a4007fc7
2239	the heart is of normal size with normal cardiomediastinal contours . the known gastric pull-through for esophageal cancer is not distended . bony coalition between the posterior arch of the sixth and seventh right ribs is congenital . there is increased vague opacity in the right mid lung superimposed on the site of bony coalition . opacity in this area is increased since but is similar to , and may represent recurrent pneumonia . a right lower lobe nodule is similar in size through . no pleural effusion or pneumothorax is present . the pulmonary vasculature is unremarkable . no radiopaque foreign body . right mid lung opacity, waxing and waning since , compatible with recurrent pneumonia . follow-up is recommended after therapy to exclude neoplasm given the patients history of malignancy . final impression was communicated via phone call to dr . by on at pm .	Lung Opacity&&Pneumonia	14295224	55779414	e12bad7a-760b3371-e15d9215-21ede9cc-79748575
2240	mild pulmonary vascular congestion is present, and previously present mild pulmonary edema has resolved . there is no new focal opacity, pleural effusion or pneumothorax . the cardiac and mediastinal contours are stable . mild pulmonary edema is improved from .	Edema	15131736	51140617	fbc1d1b7-2217f22b-74904fff-5061c77a-930f05c8
2241	elevation of the right lung base is unchanged . a moderate right pleural effusion is not significantly changed . there is no focal consolidation or pneumothorax, although the lung apices are partially obscured by overlying soft tissues of the neck . prominence of the right perihilar region is unchanged and compatible with radiation changes . the cardiomediastinal contours are stable . pulmonary vascular congestion is unchanged .	Edema&&Enlarged Cardiomediastinum&&Pleural Effusion	19720782	52924835	45aa1a09-ed50dffa-f91421ee-590a536a-9867ca96
2242	there are multiple bilateral rib fractures of varying age as well as old left clavicular fracture . large hiatal hernia . a heterogeneous opacity concerning for pneumonia is seen in the inferolateral right upper lobe . the left lung is clear . there is no pleural effusion . no pneumothorax . there is no pulmonary vascular congestion . the cardiac, mediastinal, and hilar contours are normal . . right upper lobe pneumonia . . multiple rib fractures of varying age . old left clavicular fracture . . stable large hiatal hernia . these findings were discussed with dr . on by telephone .	Fracture&&Pneumonia	18659631	59480672	4dab8652-904d5fa6-0cbdc7ce-b4ef75fa-17ddb82e
2243	patient is status post right upper lobectomy . as compared to prior chest radiograph from , there has been interval improvement of right pleural effusion . there is volume loss in the right hemithorax with associated cardiomediastinal shift to the right and tenting of the right hemidiaphragm . post-radiation changes are noted along the right perihilar region . left pleural effusion is stable and there is atelectasis at the left lung base . there are no new focal consolidations . there is no pneumothorax . sclerosis of the first and fourth rib as well as resection of the second and third rib are again noted, related to prior surgery . right picc terminates in the lower svc . interval decrease of right pleural effusion, stable left pleural effusion . no new focal consolidations .	Consolidation&&Pleural Effusion	13263843	58319427	28e4376e-045edb59-84977ca1-d0deb357-1d35d4b9
2244	no relevant change as compared to the previous image . moderate cardiomegaly . right picc line . no pleural effusions . no pneumonia, no pulmonary edema .	Cardiomegaly&&Support Devices	15131736	56905708	c35cd6f5-6d2f944e-e7517ba8-3d33af2c-aeb61176
2245	the mediastinal and left chest tube has been removed and there is no evidence of pneumothorax . the overall appearance of the heart and lungs is essentially unchanged . persistent pulmonary vascular congestion with opacification, especially at the left base consistent with effusion and volume loss in the lower lobe . less prominent changes are seen at the right base .	Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion	10886362	57211901	c5317373-5acdf384-4d5fee0f-423f29ef-22858502
2246	in comparison with the previous study, there is now an endotracheal tube in place with its tip only about . cm above the carina . this information wasd conveyed to dr . . intestinal tube extends well into the stomach . left ij catheter tip is unchanged . the extensive right apical lateral consolidation has substantially cleared . the opacification involving much of the left lung has decreased . it is unclear whether this represents clearing pneumonia or possible decrease in asymmetric pulmonary edema . opacification at the left base silhouetting the hemidiaphragm is consistent with pleural effusion . right hemidiaphragmatic contour is elevated, possibly relating to pleural effusion, with streaks of atelectasis at the base .	Atelectasis&&Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	11569093	58407493	967d441a-a13a3abb-92836835-665f96e3-d5916b82
2247	the previously malpositioned picc line in the left jugular vein has been pulled back . however, on todays examination, the picc line appears to project over the right axillary region . the line should be completely withdrawn and repositioned . the previous right internal jugular vein catheter was removed . there is unchanged mild cardiomegaly at lower lung volumes . these low lung volumes are essentially caused by an elevation of the right hemidiaphragm, better appreciated on the lateral than on the frontal radiograph . no current evidence of larger pleural effusions, pulmonary edema, or pneumonia . unchanged pacemaker leads and left pectoral pacemaker generator .	Cardiomegaly&&Support Devices	12595991	51474707	f2baee8f-ab9bb3f0-cd412d19-fa6f5014-d0388839
2248	compared to the prior exam there is no significant interval change .	No Finding	15131736	57823021	093c153e-d1acd85f-f43aa2c9-b469c946-c50bed41
2249	the left upper lobe opacity has substantially increased in size as compared to prior chest ct most likely reflecting bronchoscopy hemorrhage . cm craniocaudal dimension to . cm in the craniocaudal dimension . there is new left retrocardiac opacity that might reflect small area of atelectasisaspiration . the rest of the lungs are clear . there is no appreciable pleural effusion and there is no pneumothorax .	Atelectasis&&Lung Opacity	19404187	59383411	9c428194-407d67aa-d8f7441b-6010da36-1768a83e
2250	the patient has undergone vats decortication . a total of three right-sided chest tubes are in situ . at the right lateral lung bases, at the site of chest tube insertion, there is evidence of a small basal pneumothorax . mild basal atelectasis on the right . mild right soft tissue air inclusions . the left lung is unchanged .	Atelectasis&&Pneumothorax&&Support Devices	18309149	52707748	126d1e0c-613de8a4-7f1cfd82-86511457-4cc0543f
2251	low lung volumes are seen with secondary crowding of the bronchovascular markings . left chest wall port is seen with catheter tip within the right atrium . there is no large confluent consolidation or large effusion . calcified bilateral hilar nodes are identified . cardiomediastinal silhouette is within normal limits for technique and low inspiratory volume . no definite acute cardiopulmonary process given limitation of low lung volumes and portable technique .	No Finding	11413236	59218667	722a3b68-5254c3ea-469c8294-7e6fb73d-46f35121
2252	comparison is made with the next preceding portable ap single view chest examination of . the patient is now examined in standing upright position . there is status post sternotomy and significant cardiac enlargement as before . within the cardiac shadow, metallic portions of three different valve prostheses can be identified . one is a circular metallic ring in the position of the aortic valve, the second one a similar oval-shaped ring formation in the mitral valve position, and the third one an open circle rather typical for a tricuspid valve annuloplasty . correlating the position of these valves to the outer contours of the heart, one can state that there is remaining marked enlargement of the left atrium, but the increased distance between the tricuspid valvuloplasty and the anterior heart border speaks much in favor of a right ventricular enlargement as well as an enlarged right atrium . prominence of the ascending aortic contour is moderate . the pulmonary vasculature is presently not congested, and on previous portable examination identified edema pattern as well as evidence of right-sided pleural effusion has normalized . no new parenchymal abnormalities are seen, and no pneumothorax is identified in the apical area . again observed is a fractured second rib in the left apical area, apparently the result of previous sternotomy and intrathoracic cardiac intervention . when comparison is extended to the next preceding pa and lateral chest examination of , the patient is in better condition now as the cardiac enlargement has regressed and the pleural effusion has been absorbed completely . marked improvement of chf in patient with history of triple valve replacement .	Cardiomegaly&&Edema&&Support Devices	19182863	55598285	4d92da88-7369aa66-983734e4-bfcb6662-72f56c2d
2253	there is a severe increase in extent of the bilateral parenchymal opacities . these are strongly suggestive for severely increasing pulmonary edema . in addition, a small right pleural effusion has newly occurred . there is unchanged evidence of cardiomegaly . no pneumonia, retrocardiac atelectasis is present . at the time of dictation, , am, referring physician, . , was paged for notification .	Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion	18322589	51231499	aedfcdd8-6438b27a-5d6b20d6-08c03afc-b40c0830
2254	an ap single view of the chest has been obtained with patient in sitting semi-upright position . analysis is performed in direct comparison with the next preceding pa and lateral chest examination of . on the previous examination, the patient had a pigtail drainage catheter placed anteriorly to the chest wall in an apparent presternal soft tissue cavity in this patient with a history of sternal dehiscence . the pigtail catheter has been removed . on the present frontal single view examination, one can identify a thin-wall line apparently entering the right lower anterior chest wall reaching the superior portion of the thorax where it terminates overlying the infraclavicular junction . on this single chest view, no pneumothorax can be identified and no new pulmonary abnormalities are seen . unfortunately, the examination did not include a lateral view at this time, which is the essential component to evaluate the presternal anatomy in the patients anterior chest wall . the chest ct examination is reviewed from this study is apparent that the anterior chest wall cavity is filled with large amount of fluid, which communicates through the dehisced sternum into the mediastinal structures . additional lateral view is mandatory for evaluation of this unusual finding . potential drainage could be monitored under fluoroscopic control .	No Finding&&Support Devices	17770657	57426879	86deb04a-2c61843d-5acda394-6b0cd2e7-40be9dd0
2255	right-sided pleural catheter remains in place . a small lateral pneumothorax is present below the level of the minor fissure . additionally, a pleural effusion has increased in size and is partially layering on this semi-upright radiograph . a small loculated component has developed medially at the right apex as well . cardiac silhouette remains enlarged and is accompanied by mild pulmonary vascular congestion . worsening confluent opacity at the right lung base is probably due to atelectasis, though infection should also be considered in the appropriate clinical setting .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Pneumothorax&&Support Devices	16826047	55573557	386f3989-399f50ac-f80589aa-642b131d-16e64e70
2256	the lung volumes are low . mild fullness in the right hila may indicate early developing infection in the correct clinical setting . opacity of the left base stable over multiple prior studies and most likely represents atelectasis . moderate cardiomegaly is stable . no pneumothorax or pleural effusion . mild fullness in the right hila may indicate early developing infection in the correct clinical setting .	Pneumonia	19454978	54452010	8adb9931-4175c4ce-48e51965-ef56eb3d-4c575d17
2257	there is a right-sided picc line which ends in the mid svc . there has been interval increase in pulmonary vascular congestion without frank interstitial edema . no focal consolidations are identified . there is a small right-sided pleural effusion . the heart size is unchanged . the hilar and mediastinal contours are stable . there is no pneumothorax . interval increase in vascular engorgement . no frank interstitial edema . no focal consolidations identified .	No Finding	14177219	57812270	efff7e71-8fb08183-a867eeaa-1bf8c237-82103b3e
2258	frontal and lateral views of the chest are compared to previous exam from . there is new multifocal consolidation in the right upper lobe, within the right perihilar region and possibly in the retrocardiac region as well . lungs are otherwise notable for parenchymal architectural distortion at the upper lungs bilaterally . there is no effusion . cardiomediastinal silhouette is within normal limits . osseous and soft tissue structures are unremarkable . multifocal regions of consolidation, new since exam from two weeks prior, compatible with pneumonia in the proper clinical setting . recommend repeat after treatment to document resolution .	Consolidation&&Pneumonia	10933609	59225625	f79eadd6-c024fbbc-dec2a8a7-0d75c594-a53f0aa1
2259	tip of the endotracheal tube is at the upper margin of the clavicles . with the chin in neutral or slight flexion the distance to the carina no less than mm is - cm above optimal placement . right internal jugular line ends in the upper svc . swan-ganz catheter traverses a left jugular introducer and ends in the right pulmonary artery . although the nasogastric tube passes into the stomach, a loop projecting over the midline at the upper margin of the film could be in the hypopharynx and should be evaluated clinically . mild pulmonary edema has improved . small bilateral pleural effusions are presumed . heart size is normal and the mediastinal veins are no longer engorged . no pneumothorax .	Edema&&Pleural Effusion&&Support Devices	19623993	50961878	8b0cada7-ecc1d1e7-0910b65f-cf44db21-afca8926
2260	pa and lateral chest views were obtained with the patient in upright position . previously described right subclavian approach port-a-cath system remains in unchanged position . the heart size and mediastinal structures are also unaltered and grossly within normal limits . the pulmonary vasculature is not congested . the previously described local pleural densities have further regressed, in particular a rather bulging prominence and thickening of the pleural space in the mid portion of the right lateral chest wall has regressed . basal right-sided pleural effusion blunting the lateral pleural sinus and extending into the posterior pleural sinus and corresponding posterior pleural space remain unchanged . no new abnormalities are identified . as before, general impression of copd persists . mild regression of previously identified mostly loculated pleural effusions . no new pulmonary or cardiovascular abnormalities .	Pleural Effusion	19016834	57537037	ea1b22a8-7ee63c4a-1ad1ae64-defd894b-1a52dcac
2261	increasing left hemithorax opacity with linear areas of lucency which may represent air bronchograms . this finding is consistent with edema or developing consolidation . there are persistent low lung volumes . aorta is diffusely tortuous and calcified . pacer device with leads terminating within the right atrium, right ventricle of an enlarged heart is unchanged in position . endotracheal tube is seen terminating . cm from the carina . ng tube is seen entering the stomach and out of view of the radiograph . internal jugular catheter is seen in appropriate position within the low svc . increasing left-sided opacity which may represent increase in edema or developing consolidation . endotracheal tube is seen . cm from carina it is recommended that tube be withdrawn so that it terminates between and cm from the carina . these findings were reported to dr . by at am .	Consolidation&&Edema&&Lung Opacity&&Support Devices	13649937	58340193	dee14392-cc692fb3-6f2ebd41-a3c076db-05568231
2262	comparison is made to prior study dated . portable upright chest film at is submitted . . interval appearance of bilateral layering pleural effusions and associated airspace opacity which most likely reflects compressive atelectasis, although a pneumonia or aspiration should also be considered . no evidence of pulmonary edema . status post median sternotomy with stable postoperative cardiac and mediastinal contours . right-sided pacer in place . no pneumothorax . relative paucity of vasculature in the apices suggests a component of underlying emphysema .	Atelectasis&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	13606683	58039737	4a5f0ca9-a2d5198d-f01da2b2-1477e643-9b23e5ee
2263	mild pulmonary edema has improved, severe cardiomegaly has not . mediastinal veins are not particularly dilated . there is no large pleural effusion . dialysis catheter ends in the right atrium . no pneumothorax .	Cardiomegaly&&Edema&&Support Devices	12963531	52085657	f983cdd1-c3d0de12-3db3f665-cdadb3af-3ffd4c47
2264	there has been placement of an endotracheal tube with the tip approximately . cm above the carina . the left swan-ganz catheter tip is in the proximal pulmonary artery . hemodialysis catheter tip remains in the right atrium . left ij catheter is in the region of the juncture with the left subclavian vein . abdominal drains are seen bilaterally . nasogastric tube extends only to the lower thoracic esophagus . it could be advanced - cm, which was conveyed to dr . by the resident on-call . mild indistinctness of pulmonary vessels suggests some elevated pulmonary venous pressure .	Edema&&Support Devices	11880923	51034232	9a09516b-ceca3649-56487727-bbd3b10c-a0cbd7b8
2265	moderately severe pulmonary edema which developed on has substantially improved . only a small residual remains, but there is still moderate left and small right pleural effusion . the heart is normal size, and mediastinal veins are no longer dilated . et tube, left subclavian infusion port, right internal jugular line are in standard placements . nasogastric tube would need to be advanced cm to move all the side ports into the stomach . no pneumothorax .	Edema&&Pleural Effusion&&Support Devices	15758946	55901243	f329badd-5f934b2d-44503f43-93b04e89-810e8f0c
2266	the cardiac size is normal . the aorta is very tortuous, and appearance of the widened mediastinum is stable at least since . there is no evidence of pneumonia, chf, pneumothorax, or pleural effusion .	Enlarged Cardiomediastinum	17337033	51304693	3b8fc3bd-66391218-68c48776-0cbde359-ec4f0e4d
2267	there has been increase in moderate right pleural effusion . if any there is a small left pleural effusion . there is mild stable vascular congestion . cardiomediastinal contours are unchanged . swan-ganz catheter tip is in the main pulmonary artery . there is no evident pneumothorax . left chest tube remains in unchanged position . sternal wires are in unchanged position .	Pleural Effusion	13135946	52547146	d0ce0dbb-82f88ba2-6467498e-a4e23f78-c203cf06
2268	top normal heart size and mild pulmonary vascular congestion have not changed appreciably . probably no pulmonary edema nor substantial pleural effusion, no evidence of intrathoracic infection . non-healed fracture noted in the anterior left fourth rib .	Fracture	19765968	50660013	bc589c1d-1abbef0a-78f9c190-81bdf6e8-e1429133
2269	cardiac size is top normal . right lower lobe opacity could be due to atelectasis but superimposed infection cannot be excluded in the appropriate clinical setting . widened mediastinum is unchanged from . there is no pneumothorax or large pleural effusion .	Atelectasis&&Enlarged Cardiomediastinum&&Lung Opacity&&Pneumonia	19028690	52470466	3ed8d7a0-5e77fb18-5c0a7929-b75d0b38-7c3a1f98
2270	with the exception of slight improved aeration at the left lung base, there has not been a substantial change in the appearance of the chest since the recent study of one day earlier .	No Finding	15338518	56387971	2689618d-d2d66d76-59bc106d-e3cc0c85-91cc995f
2271	single ap portable view of the chest the lungs are clear . cardiomediastinal silhouette and hilar contours are unremarkable . there are no pleural effusions noted . there are no pneumothoraces noted . the bones appear intact .	No Finding	11924226	58367071	fe5dd4a7-d88ab43b-fe20fb3b-aa6f0fe1-c9efd533
2272	the large right perihilar consolidation with surrounding ground glass has substantially improved in the interim . giving the absence of this abnormality on prior ct from , it most likely reflects substantial infectious process and should be closely followed for documentation of complete resolution . malignant involvement is substantially less likely . lateral view demonstrates air-fluid level in the neoesophagus, expected in appearance . small amount of right pleural effusion cannot be excluded, might be secondary to the infection .	Consolidation&&Pleural Effusion&&Pneumonia	19016834	56354256	6a6317b8-aaf9ba61-33753b9f-5d504bc8-94bae3e5
2273	the left picc line tip is at the level of mid svc . heart size is enlarged . mediastinum is enlarged . perihilar interstitial opacities are noted . bilateral pleural effusion is present . right pigtail catheter tip is in place . no pneumothorax is seen . since the prior study, there is substantial interval progression of pulmonary edema . the apical opacity on the left is unchanged .	Edema&&Lung Opacity	14851532	50686747	6da80776-b8a61cbe-7898eaa5-29b7ca8f-c0ea57e5
2274	mild cardiomegaly is similar to prior . cardiomediastinal contours are stable . indistinct appearance of the pulmonary vasculature is compatible with pulmonary edema . nodular opacity projecting over the right mid lung is similar to . blunting of the right costophrenic angle and indistinctness of the left costophrenic angle are compatible with small bilateral pleural effusions . retrocardiac opacity may represent atelectasis though pneumonia is not excluded . no pneumothorax . dialysis catheter terminates in the right atrium . the right humeral head is chronically deformed and an adjacent calcified loose body is again seen . mild pulmonary edema, similar to , with small bilateral pleural effusion and retrocardiac opacity compatible with atelectasis, although pneumonia may be considered in the appropriate clinical setting .	Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia	17340686	51782829	6b0e83ab-6cdfeb29-98310cca-4b6aa8f5-8455fe63
2275	there are low lung volumes and persistent elevation of the right hemidiaphragm . the lungs are clear without focal consolidation . no pleural effusion or pneumothorax is seen . the cardiac and mediastinal silhouettes are stable . low lung volumes and persistent elevation of the right hemidiaphragm . no significant interval change .	No Finding	19907884	57427881	92134f99-0e73faba-1280ad81-218c68ba-933a85c5
2276	there is persistent opacification of the medial right lower lung . there is a small right pleural effusion . no pneumothorax is detected . there is no evidence for pulmonary edema . the aorta is tortuous . the patient is status post left upper lobectomy surgical changes with volume loss are evident . right lower lobe pneumonia, which has not cleared, and small right pleural effusion .	No Finding	10885696	56443683	5b429228-9769c874-369577de-11d25077-c9ad1f2b
2277	there are continued low lung volumes . bilateral pleural effusions with compressive atelectasis at the bases persist . mild pulmonary vascular congestion is again seen . right ij catheter remains in place .	Atelectasis&&Edema&&Pleural Effusion&&Support Devices	12952223	58509428	a07fcdb2-cfd4c07c-10798b86-59623927-3210f2a2
2278	ap semi-upright portable chest x-ray was provided . similar to the prior exam, there is a moderate-to-large right-sided pleural effusion with overlying atelectasis . underlying consolidation cannot be excluded . there has been interval improvement in the left pulmonary opacities . cardiomediastinal silhouette appears grossly stable from the prior study . there is no pneumothorax . stable moderate-to-large right-sided pleural effusion . underlying consolidation cannot be excluded . improvement in the left pulmonary edema .	Consolidation&&Edema&&Pleural Effusion	14471276	52991108	d1136eed-65e29502-7df50d94-26d66f4a-513b4e1c
2279	cardiomediastinal contours are unchanged . multiple calcified nodules throughout the lungs are unchanged . otherwise the lungs are clear . the lungs are mildly hyperexpanded . there is no pneumothorax or pleural effusion . there are mild degenerative changes in the thoracic spine . no acute cardiopulmonary abnormalities .	No Finding	12185775	53295276	31b151ec-75ddc4a9-e85ecaab-f72df771-c55ef3b5
2280	again seen, is enlargement of the cardiac silhouette . the hilar and mediastinal contours are stable . there has been interval improvement of the previously noted pulmonary edema . no new focal consolidation concerning for infection is identified . there are chronic areas of scarring in the left lower lobe, as well as a stable nodular opacity at the left heart border . post-sternotomy wires are seen intact . the pacemaker defibrillator leads are unchanged in position . there is no pleural effusion or pneumothorax . overall interval improvement of the previous noted pulmonary edema . no pneumonia .	Edema	13606683	50447060	b849e290-2a7cce04-71ba4fd8-ef1d13ad-15cdd04a
2281	frontal chest radiograph the lungs remain underinflated, resulting in bronchovascular crowding . again seen is mild pulmonary vascular congestion and interstitial edema . multiple rib fractures are again seen . an endotracheal tube terminates cm above the carina, and the et tube cuff is hyperinflated . an orogastric tube terminates within the stomach . there is no pneumothorax . small pleural effusions are present . . et tube terminating cm above the carina . the endotracheal tube cuff is hyperinflated . . unchanged appearance of low lung volumes with superimposed mild interstitial edema and central vascular congestion . . orogastric tube terminating within the stomach . the initial findings were discussed by dr . with the icu nurse, via telephone at the time of interpretation, pm .	Edema&&Support Devices	18079481	51858688	c405b126-03d888ca-314564ad-3797a458-30e53586
2282	single frontal view of the chest . lung volumes are very low and marked elevation of the left greater than right hemidiaphragm is similar to prior . bibasilar atelectasis is unchanged . cardiomediastinal contours are stable . pulmonary vascular markings appear normal . no focal consolidation or large pleural effusion . low lung volumes without radiographic evidence of aspiration or focal consolidation .	No Finding	18338007	52546911	65c9e42e-6093fd2c-66ffbba3-b6fa9d18-48594809
2283	there is extensive pulmonary edema bilaterally . there are bilateral pleural effusions, left greater than right . there is partial collapse of the left lung secondary to pleural effusion . part of the right pleural effusion appears to be in the fissure . cardiomediastinal silhouette is obscured by pulmonary edema and pleural effusions . extensive pulmonary edema . bilateral pleural effusions, left greater than right . partial left lower lobe collapse secondary to effusion .	Atelectasis&&Edema&&Pleural Effusion	18615099	57165304	efeee902-a228cde6-a6a4b031-7c26bc53-842009b9
2284	the picc line on the right has migrated slightly more proximally with the distal lead tip now in the proximal svc . heart size is within normal limits . there is a left retrocardiac opacity and a small left-sided pleural effusion . there is no signs for acute pulmonary edema or pneumothoraces . calcified granulomas are seen within the left upper lobe . as above .	No Finding	12185775	53349756	f0d18848-8b3b0e31-92ab7c89-0a569510-bac46a4e
2285	lung volumes remain low . the previous noted left lower lung opacity is less conspicuous on this repeat study, and was likely artifactual due to rightward rotation . on the lateral view, there is now a retrocardiac opacity without clear correlate on the frontal view, which was also present on prior radiographs . the cardiomediastinal silhouette and hilar contours are unchanged . there is no pleural effusion or pneumothorax . retrocardiac opacity without clear correlate on frontal radiograph of unclear significance . however in the appropriate clinical setting, this can represent pneumonia .	Lung Opacity&&Pneumonia	14841168	51054780	e48e959d-10d7b785-3ba7d6d0-87d614c1-19ed06cc
2286	the heart size is at the upper limits of normal os slightly enlarged, increase in size compared to prior exam . the mediastinal contours demonstrate calcified atherosclerotic disease of the aortic knob, similar to prior exam . perihilar opacities are present as well as an engorged appearance of the pulmonary vasculature and interstitial edema . no definite large pleural effusion is present, and there is no pneumothorax . cardiomegaly and pulmonary edema, concerning for heart failure .	Cardiomegaly&&Edema	13896515	50246988	8f98b8f6-592203f8-128d7f76-bf2331d4-78b1c4af
2287	mild interstitial edema has recurred . moderate left lower lobe atelectasis is improved with mediastinum returning to the midline, but there is still a small to moderate left pleural effusion . the heart is not enlarged and the mediastinal vasculature is not engorged . et tube, right pic line are in standard placements and a feeding tube passes below the diaphragm and out of view . no pneumothorax .	Atelectasis&&Edema&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	13031876	57019853	cc421e05-ba52c579-96137ca0-fa81a980-c78a2d2f
2288	mild pulmonary edema worsened slightly since earlier in the day . no pneumothorax . small left pleural effusion and moderate left basal atelectasis are unchanged . pulmonary artery catheter ends in the right pulmonary artery . transvenous right atrial and right ventricular pacer leads are unchanged in longstanding locations including the more medial than usual positioning of the tip of the right atrial lead . mild-to-moderate cardiomegaly comparable to the preoperative appearance .	Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	10886362	53460154	b4391db8-8076224b-e326c566-f0ee0cd4-94341441
2289	large bilateral pleural effusions have increased . bibasilar atelectasis have increased, more on the left . cardiomegaly and low lung volumes are stable . transvenous pacer leads terminate in the standard position in the right atrium and the right ventricle . mild pulmonary edema is new . sternal wires are aligned . right picc tip is obscured by transvenous pacer leads .	Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	15109122	57990557	e51de97b-284b687e-ba74eec4-51cb1569-ab258ee6
2290	an et tube is present -- the tip lies approximately . cm above the carina . right subclavian central line tip overlies the svcra junction . no pneumothorax is detected . status post sternotomy, with prosthetic valve and multiple clips in the mediastinum, near the thoracic inlet, and in the upper abdomen . unusual density overlying the gastric fundus may represent some residual oral contrast within the stomach . attention to this area on followup films is requested . there are bilateral effusions, with some underlying atelectasis . retrocardiac opacity is consistent with left lower lobe collapse andor consolidation . upper zone redistribution and mild diffuse vascular blurring likely reflects chf . interval placement of the et tube, tip in satisfactory position above the carina . otherwise, overall similar . radiopacity over stomach - residual contrast . clinical correlation requested . lll collpase consolidation . bilateral effusions . probable chf .	Cardiomegaly&&Consolidation&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	13135946	58519194	a012623c-3d2f7d18-ccd7f833-c984c099-56fbef61
2291	compared to the prior study there is interval increase in the cardiomegaly and pulmonary vascular redistribution . there are patchy areas of alveolar infiltrate bilaterally compatible with fluid overload . the et tube is . cm above the carinal . large bore catheter tip is in the right atrium . ng tube is unchanged . no pneumothorax fluid overload . an underlying infectious infiltrate cant be excluded .	Lung Opacity&&Pneumonia	17340686	53739758	cfe95f11-8443d7dd-4d3b5c96-d6c7892c-e037193e
2292	comparison . no relevant change . low lung volumes with moderate cardiomegaly and mild pulmonary edema . no pleural effusions . no pneumonia . moderate scoliosis with asymmetry of the ribcage .	Cardiomegaly&&Edema	16050730	57723077	d4dae1e3-f77d7d94-06b441f0-f5f8ffab-230cd387
2293	single frontal portable view of the chest the prior ng tube has been removed with a new ng tube placed which ends in the stomach . there has been interval placement of a g-tube . a right picc ends in the lower svc, stable . there are no new lung opacification to suggest pneumonia . there is no pneumothorax . the cardiomediastinal silhouette remains unchanged .	No Finding	18110020	53663749	083a3e76-48cf31d2-b2f088df-9c323345-ef72f46f
2294	mild bibasilar atelectasis is seen . subtle opacity at the right lung base most likely represents atelectasis, less likely consolidation . no definite discrete focal consolidation is seen . there is no pleural effusion or pneumothorax . the cardiac silhouette is top normal to mildly enlarged . the aorta is calcified and tortuous . degenerative changes are seen along the spine .	Atelectasis&&Consolidation&&Lung Opacity	15438386	59022925	57f7f75e-91517fb3-4071303d-6f325ed5-5daca800
2295	severe pulmonary edema is unchanged . cardiac size cannot be evaluated, is obscured by the lung abnormalities . there is persistent small right basal pneumothorax despite the presence of a pigtail catheter . small bilateral pleural effusions are unchanged allowing the difference in positioning of the patient . lines and tubes are in unchanged standard position . right lower lobe denser opacity consistent with a large area of atelectasis is unchanged .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumothorax&&Support Devices	14387068	58900575	1fe087b5-76e46847-985f4986-3046404a-2184844a
2296	the heart is again mild to moderately enlarged . the cardiac, mediastinal, and hilar contours appear stable . there is no definite pleural effusion or pneumothorax . although not nearly as striking is the prior study, the pulmonary vascularity is indistinct, and the appearance suggests mild vascular congestion, without definite focal opacity . hemidiaphragms are flattened . fissures are minimally thickened . findings suggesting mild pulmonary vascular congestion .	Edema	16855430	53829822	8b38d41a-f5185160-d311d652-8d19e4c2-9f97688a
2297	single portable view of the chest is compared to previous exam from . compared to prior, there has been no significant interval change . dense retrocardiac opacity is again seen silhouetting of the hemidiaphragm . the right lung remains grossly clear . mild pulmonary vascular congestion is unchanged . cardiac silhouette is enlarged, but stable and notable for a prosthetic device . no significant interval change since noting left basilar opacity due to combination of pleural effusion with underlying atelectasis and possible consolidation .	Atelectasis&&Consolidation&&Lung Opacity&&Pleural Effusion	15259244	52697942	928a3662-7a9bc2d9-1808833b-79fd5d7b-76aabf9d
2298	the heart is enlarged . central pulmonary vascular congestion and mild pulmonary edema have slightly improved since . there is no pneumothorax . a small left pleural effusion is unchanged .	Cardiomegaly&&Edema&&Pleural Effusion	15131736	56615285	64c24dca-a414a27f-c24e46d6-b41d673e-1a01d73e
2299	again, there is diffuse increase in interstitial markings bilaterally consistent with chronic interstitial lung disease . no new areas of focal consolidation are seen . no pleural effusion or pneumothorax is seen . the cardiac and mediastinal silhouettes are stable . no acute cardiopulmonary process . chronic interstitial lung disease, stable since the prior study .	Lung Opacity	13475033	55876368	031113f9-e2466fb7-08d11a74-231bed81-45441968
2300	bilateral pleural effusion, moderate on the right and moderate-to-large on the left and severe bibasilar atelectasis have not improved since . pulmonary vasculature is engorged, but edema is minimal if any . severe cardiac enlargement is stable . dual-channel dialysis catheters ends in the right atrium . no pneumothorax .	Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	15259244	50903359	4a9977bd-7c6765ff-7951cc3c-36666101-51dfc3fa
2301	lung volumes are low . the heart remains mildly enlarged . aortic knob is calcified . mediastinal and hilar contours are unchanged, with a small hiatal hernia again noted . pulmonary vascularity is within normal limits . no focal consolidation, pleural effusion or pneumothorax is present . multiple clips are seen in the right upper quadrant compatible with prior cholecystectomy . degenerative changes of the left glenohumeral joint are incompletely assessed . no acute cardiopulmonary process .	No Finding	11512104	52398109	5d4e5d0a-add681d2-faf8a518-e0062eff-6554d2d2
2302	semi-upright portable chest radiograph demonstrates interval improved aeration of the bilateral upper lungs however, there is persistent if not slightly improved bibasilar opacifications, possibly due to atelectasis and bilateral pleural effusions, though superimposed infectious process is not excluded . improved aeration of upper lungs with stable if not slightly improved bibasilar opacifications, likely a combination of atelectasis and effusions, though pneumonia is not excluded .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Pneumonia	16855430	52509761	27c8aa21-0a66ebf9-667f13ca-9695345c-caa66257
2303	in comparison to prior radiograph of day earlier, there has been improved aeration at both lung bases . no other relevant change since recent study .	No Finding	14841168	52070116	93545eeb-752a09e2-3a5afc63-bbdfdacf-0161e920
2304	again, low lung volumes are seen with relative elevation of the right hemidiaphragm which is unchanged . the lungs are clear without effusion, pulmonary vascular congestion or pneumothorax . again seen are surgical clips in the right paramediastinal region . the cardiomediastinal silhouette is within normal limits . no acute osseous abnormality is detected . no free air is seen below the diaphragm . no acute cardiopulmonary process .	No Finding	19907884	59325966	c6db0413-f3266e66-031e9892-2809b536-c13cf9f2
2305	rotated positioning . the patient is status post sternotomy, with cardiomegaly . there is upper zone redistribution and diffuse vascular blurring, consistent with chf . the left hemidiaphragm is elevated, likely accentuated by what appears to be air within the fundus, dilating the gastric fundus . aside from some increased retrocardiac density, no frank consolidation or gross effusion is identified . chf with upper zone redistribution and diffuse vascular blurring . minimal left lower lobe opacity also noted . of note, the chest ct from described innumerable pulmonary nodules . it would be difficult to distinguish interstitial metastatic disease from the findings on the current study, but the upper zone redistribution and overall blurring does appear more pronounced than on and that rapid change supports the diagnosis of chf .	Cardiomegaly&&Edema&&Lung Lesion&&Lung Opacity&&Support Devices	11879886	56268607	da8cd0dd-573be530-0024ff8e-15e20b59-21e4a61d
2306	mild linear atelectasis in the right lung is unchanged . there is no new consolidation, pleural effusion, or pneumothorax . the cardiomediastinal and hilar silhouettes are normal . no focal consolidation concerning for pneumonia .	Pneumonia	19623993	57254304	d8d6bec6-48c8a366-841c2d03-d9845540-66735bb4
2307	compared to the study from the prior day, the dual-lead pacemaker is unchanged . there is increased cardiomegaly, which is moderate-to-severe . bilateral hazy vasculature, pulmonary vascular redistribution, and alveolar edema . there are small bilateral effusions, right greater than left and kerley b lines . compared to the prior exam, the chf is worsened .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	11893091	57134673	8da4fdec-ab3ac0b3-1e702eda-3bfc96b5-1f8974b2
2308	comparison to . no relevant change is seen . low lung volumes . stable correctly positioned monitoring and support devices . moderate cardiomegaly with retrocardiac atelectasis . minimal left pleural effusion . mild fluid overload but no overt pulmonary edema .	Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices	19075045	59707249	bbad6bc5-31fe40b0-2bc52219-211c9426-e57faa9b
2309	upright frontal and lateral chest radiographs the patient is status post left upper lobectomy, with expected persistent left lung volume loss and shift of mediastinal structures . the cardiac, mediastinal, and hilar contours are unchanged, allowing for differences in technique and rotation of the patient . biapical scarring is again seen . there is no pneumothorax or new consolidation .	No Finding	10885696	57959841	a7fdae9e-97d1a4d6-df3c7f40-29a51d88-39463d76
2310	right chest wall port-a-cath terminates in the upper svc . postoperative mediastinum, including calcified left suprahilar lymph node, and cardiomegaly are unchanged from . bibasilar atelectasis is mild . no evidence of pneumonia or pulmonary edema .	No Finding	11413236	51943964	2f1eba54-06686151-156f45ff-76e953f6-03665181
2311	swan-ganz catheter tip is in the distal right main pulmonary artery . cardiomegaly is stable . mild vascular congestion is unchanged . bibasilar opacities larger on the right are unchanged . there is no evident pneumothorax . pacer leads are in standard positio .	Cardiomegaly&&Edema&&Lung Opacity&&Support Devices	19075045	55863688	e9d9f329-da18eb49-3fe8868a-a0852356-4e2cc1a8
2312	there again is enlargement of the cardiac silhouette with pulmonary edema, which appears to have slightly progressed . continued low lung volumes . pacer device remains in place .	Cardiomegaly&&Edema&&Support Devices	13896515	52607379	3ae4f21a-20a3c90a-520e7d42-5f306168-85d0d88e
2313	a left pectoral pacemaker is unchanged in position with two leads terminating in the right atrium and right ventricle as before . the patient is status post median sternotomy and aortic valve repair with aortic valve prosthesis, unchanged in position and intact-appearing sternotomy wires . the cardiac silhouette and mediastinal contours are mildly increased in size in comparison to the most recent prior study likely attributable to slightly decreased lung volumes compared to the prior exam . the mediastinal and hilar contours are within normal limits . hazy opacification of the bilateral lung bases is likely related to underpenetration of soft tissues on technique . there is no focal consolidation concerning for pneumonia, pleural effusion or pneumothorax . no overt pulmonary edema is present . no acute cardiopulmonary abnormality .	No Finding	16043637	54026146	39f8070e-150fed7a-edc48fc5-4957b38f-cd627a7e
2314	dual-chamber pacemaker and aortic valve are in stable position . sternal wires are intact . right upper extremity picc line terminates at the superior cavoatrial junction . there is slight elevation of the right hemidiaphragm, and seen on prior studies . no definite parenchymal consolidation . no pleural effusion or pneumothorax . heart size is mildly enlarged . . right upper extremity picc line terminates at the superior cavoatrial junction . . stable cardiomegaly . . no definite evidence of pneumonia .	Cardiomegaly&&Support Devices	16043637	50654010	be4aa5f6-99ccaf97-2b5e3e91-41ef9449-536d6ae5
2315	the right-sided picc line has been retracted and now terminates at the level of the mid clavicular line along the expected course of the right subclavian vein . the heart is mild-to-moderately enlarged with left ventricular configuration . the mediastinal and hilar contours appear unchanged . persistent band-like opacities in the left mid lung suggest minor atelectasis or scarring . there is a patchy new nonspecific opacity in the right lower lung, although suggestive of minor atelectasis . developing pneumonia is difficult to exclude, however . there is no pleural effusion or pneumothorax . severe degenerative changes involving the right shoulder are partly visualized . . retraction of picc line, which now terminates in the mid subclavian vein . . patchy right basilar opacity, although compatible with minor atelectasis . the possibility of developing pneumonia is not entirely excluded, however, and short-term followup radiographs could be considered if symptoms were to persist or worsen .	Atelectasis&&Lung Opacity&&Pneumonia&&Support Devices	18512911	54242750	cb8f1bee-76ec4235-a62de65b-43589ff5-04413eab
2316	mild pulmonary edema and mediastinal and pulmonary vascular engorgement have improved since . small right pleural effusion has decreased . lobar collapse has not recurred . mild-to-moderate cardiomegaly is unchanged . no pneumothorax .	Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion	12185775	53850178	cab19714-ab5c9c6b-9130cd3c-ca463b15-840b0cc4
2317	single portable chest radiograph demonstrates no evidence of pneumothorax . there is a stable large right layering pleural effusion as well as bibasilar atelectasis . no focal opacification concerning for pneumonia identified . heart, mediastinal, and hilar borders are unremarkable . there is a left-sided picc line with tip at the cavoatrial junction as well as a right-sided venous sheath catheter terminating in the upper svc . no pneumothorax . stable right large pleural effusion .	Pleural Effusion	16319601	55588562	a54a1c95-9ef227c1-e64321cb-98c9470d-761b66f8
2318	single portable chest radiograph is provided . a left central line catheter tip terminates within the right atrium . compared to the previous exam there is increased radiodensiy in the right lower lung zone and since the left lower lung is difficult to evaluate, it is unclear if this is a unilateral process . the heart remains severely enlarged . multiple pulmonary nodules are better visualized in the prior ct . there is no pneumothorax or pleural effusion . severe degenerative changes within the right shoulder are noted . increased radiodensity in the right lower lung zone which may represent asymmetric pulmonary edema or pneumonia .	Edema&&Pneumonia	17340686	53239683	8d9be95b-acae4c91-b54b7471-ffba1791-2685235f
2319	portable ap chest radiograph demonstrates worsening bilateral pleural effusions and associated atelectasis, greater on the right . there is also worsening pulmonary vascular congestion . there is no pneumothorax . right internal jugular catheter probably terminates in the right atrium . worsening pulmonary edema and bilateral pleural effusions . results were relayed to , pa-c by phone at approximately pm .	Edema&&Pleural Effusion	12952223	50380203	ca3df6c0-8ce90248-b3cecb87-71db5654-312cdcf6
2320	interval continue worsening of moderate pulmonary edema . increasing small bilateral effusions . no other interval change from prior study .	Edema&&Pleural Effusion	13473495	54904335	b32d0041-1490ad2c-bb80e629-0738da5e-cd128891
2321	the cardiac silhouette size remains mildly enlarged . patient is status post right upper lobectomy and right upper chest wall resection with evidence of volume loss in the right lung and posttreatment changes in the right upper lung field, unchanged . left hilar enlargement is unchanged, with mild pulmonary vascular congestion present . moderate to large right pleural effusion and small left pleural effusion are again demonstrated, not significantly changed in the interval . right basilar opacification is similar . no pneumothorax is identified . the aorta remains tortuous and calcified . mild pulmonary vascular congestion with moderate to large right pleural effusion and small left pleural effusions . right basilar opacification may reflect atelectasis andor infection .	Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia	13263843	55058862	64b9eb3b-f34fa8a9-fc75f27f-53cc3b2c-eca0f252
2322	small right pleural effusion has slightly increased in size compared to with associated right lung basilar atelectasis . lungs are otherwise clear without focal consolidation or pulmonary edema . left ij central venous line ends in a known left svc . the cardiac silhouette continues to be mildly enlarged, and the median sternotomy wires are intact . the mediastinal and hilar contours are normal . small right pleural effusion has slightly increased since .	Pleural Effusion	19182863	56466110	a7747cf0-5a042d25-ae9af09d-d8f2956d-ecfb087d
2323	no focal consolidation, pleural effusion, or pneumothorax is detected . heart and mediastinal contours are unchanged compared to prior with mild central pulmonary vascular engorgement . elevation of the right hemidiaphragm is again noted . single-lead pacer is seen in similar position . mild central pulmonar vascular engorgement .	No Finding	14556809	53292802	f853039e-e541ff3f-875071bd-62705831-03bd8d9e
2324	there is interval worsening of now mild-to-moderate interstitial pulmonary edema and small-to-moderate bilateral layering pleural effusions . there is no evidence of pneumothorax . there is associated bibasilar atelectasis with no focal opacities concerning for pneumonia . the cardiomediastinal and hilar contours are stable demonstrating moderate cardiomegaly . note is made of multiple left-sided rib fractures that in retrospect can be demonstrated on radiographs from . . worsened now mild-to-moderate interstitial pulmonary edema and small-to-moderate bilateral layering pleural effusions . . left-sided rib fractures in retrospect apparent since at least .	Edema&&Fracture&&Pleural Effusion	11934114	57363067	d8bc7ccc-a2bac7c8-1dd6d0a5-5ed27c66-4f556bac
2325	single lead pacemaker in situ with the lead tip in the right ventricle . no cardiomegaly . no features of cardiac decompensation . prominent pulmonary arteries suggesting pulmonary arterial hypertension . no pleural effusion . consolidation in the left lower lobe . suspected left lower lobe pneumonia .	Pneumonia	18570152	52210901	8328656b-7a7c59ec-fba66d3e-d4e3b7d3-2d5332bc
2326	portable frontal chest radiograph known heterogeneous consolidation in the left mid lung is not well seen on this single frontal view . additional known nodules are also not well characterized on this radiographic examination . linear opacities in the lung bases are similar compared to prior and likely reflect subsegmental atelectasis . no overt pulmonary edema is identified . increased attenuation in the right mid-lung could reflect pneumonia or asymmetric pulmonary edema . mild blunting of the bilateral costophrenic angles is unchanged and possibly due to small effusions or chronic pleural thickening . cardiomediastinal and hilar contours are within normal limits . . unchanged subsegmental basilar atelectasis and possible small bilateral pleural effusions . . increased opacity in the right mid lung may reflect pneumonia or possibly asymmetric pulmonary edema .	Atelectasis&&Edema&&Lung Lesion&&Lung Opacity&&Pleural Effusion&&Pneumonia	14851532	59839373	2c64848d-cd007bfa-b3e2c794-d206cd7b-26b4ec95
2327	there is stable marked enlargement of the heart with mild pulmonary vascular congestion without overt edema . retrocardiac opacity with subtle air bronchograms could reflect left lower lobe pneumonia . small left pleural effusion cannot be excluded . there is no pneumothorax or right pleural effusion . possible left lower lobe pneumonia . if clinical status permits, pa and lateral radiographs would allow for better evaluation . these findings were discussed with dr . by dr . at on by phone .	Pneumonia	13473781	59067739	043df04d-931d53c9-ae497983-ce79d340-656e2354
2328	lung volumes are low, similar when compared to the prior study . even allowing for the projection, the heart is enlarged . there is prominence of the pulmonary vasculature which appears hazy consistent with a degree of congestive heart failure . no overt pulmonary edema seen . left lower lobe atelectasis, unchanged . no consolidation or pneumothorax seen . findings consistent with congestive heart failure . appearances are grossly unchanged compared to the prior study .	Cardiomegaly&&Edema	15131736	52449022	526dc590-f658c26e-49300669-427e7124-ac0f1350
2329	the patient is status post sternotomy and probably coronary artery bypass graft surgery . the heart is mildly enlarged . the mediastinal and hilar contours appear unchanged, including a prominent left-sided epicardial fat pad . the lung volumes are low . streaky lingular opacity suggesting minor atelectasis or scarring appears unchanged . minimal blunting of the right costophrenic sulcus is more suggestive of similar slight atelectatic change, less likely persistent trace pleural effusion . there has been no significant change . stable appearance of the chest . no evidence of acute disease .	No Finding	18088200	57801123	80f8c1cf-51619e01-2da83861-7c12a49d-f6858e53
2330	the lungs are low in volume but appear clear aside from some retrocardiac atelectasis . the heart is normal in size . normal cardiomediastinal silhouette . no pleural effusion or pneumothorax is seen . no definite rib fractures are identified . no acute intrathoracic process .	No Finding	17897339	58768954	b78b1110-28e93f4d-b7e0e8f6-22552c4c-b967810b
2331	a single portable semi-erect chest radiograph was obtained . aeration of the lungs has improved since . in particular the apices are better aerated . persistent alveolar opacity remains in a bibasilar predominance . small right effusion, if any, is unchanged . there is no new abnormality of the heart or mediastinum . there is no pneumothorax or consolidation . an endotracheal tube remains in the upper airway . an enteric catheter extends inferiorly out of field of view . right-sided picc line tip terminates in the low svc . pacemaker leads are in unchanged positions . median sternotomy wires are intact . improved aeration of the apices since . extensive bilateral dense consolidations remain at the bases . given rapid improvement, trali or ards are more likely etiologies than pneumonia .	Consolidation&&Pneumonia	15378103	57432088	e18e6623-ee725070-b05a75c1-a11fea0c-9d3f0868
2332	the patient has had median sternotomy and mitral valve replacement . heart size is normal . multiple lung nodules are almost certainly widespread pulmonary metastases developed between and . there is no pneumonia, pulmonary edema, pleural effusion, or pneumothorax . interval increase in caliber of the right paratracheal stripe is probably due to venous engorgement .	Lung Lesion&&Support Devices	16773796	51214350	88569944-e427b76f-c9db3157-972a1ec1-4d0f7523
2333	frontal view of the chest was obtained . a right subclavian central catheter terminates in the lower svc . metallic clips overlie the right upper quadrant . the heart is of normal size with normal cardiomediastinal contours . vague bibasilar opacities are nonspecific but may represent infection . no pleural effusion or pneumothorax . vague bibasilar opacities, which may represent infection in the appropriate clinical setting .	Lung Opacity&&Pneumonia	18835687	50014127	73da0836-553a87de-58ef0562-f9c31de6-c47927ac
2334	ap upright portable view of the chest was obtained . there are small bilateral pleural effusions with overlying atelectasis . no definite focal consolidation is seen . there is no pneumothorax . the aorta is calcified and tortuous . the cardiac silhouette is mildly enlarged . small bilateral pleural effusions with persistent mild enlargement of the cardiac silhouette .	Cardiomegaly&&Pleural Effusion	19454978	55065784	c2a99a61-6ccc4c17-7a976c51-c9961784-bdfe8a3e
2335	there has been no significant interval change . diffusely increased interstitial markings are again noted, potentially due to chronic disease . there is no confluent consolidation or effusion . cardiomediastinal silhouette is stable . compression deformities in the lumbar spine are again noted . no acute cardiopulmonary process .	No Finding	16957952	52796134	4732ed95-933b87bb-7e3ef418-22b2990f-9b0a9efa
2336	extensive right pleural effusion with areas of atelectasis and an unchanged left picc line . small nodular opacity, projecting over the border of the ventral aspect of the left fourth rib is unchanged since several examinations .	Atelectasis&&Lung Lesion&&Lung Opacity&&Pleural Effusion&&Support Devices	16319601	51236160	d021e279-fc2a15cf-aa08b3db-9b75b05d-324ffb18
2337	heart size is normal . previously present pulmonary edema has nearly completely resolved with only minimal residual interstitial edema remaining . pleural effusions have also decreased in size with small effusions remaining, left greater than right .	Edema&&Pleural Effusion	16772702	55845276	9470e916-1ba08135-e208f625-63d7a64b-2a009f98
2338	the patient has taken a better inspiration . cardiac silhouette is within normal limits and there is no evidence of vascular congestion or pleural effusion . no acute pneumonia . multiple old healed rib fractures are seen . there again are calcified hilar and mediastinal lymph nodes, compatible with the sequela of known sarcoidosis .	Fracture	15776774	57251948	0cdfb937-27e0834d-4d8d1c40-cee9e187-98390c95
2339	right hemodialysis catheter again terminates in the right atrium . there is minimal increase in bilateral airspace opacities suggesting pulmonary edema . moderate cardiomegaly is unchanged . the pulmonary artery is enlarged . the aortic arch is calcified . previous rounded opacity at the right base is re-demonstrated . there is no large pleural effusion or pneumothorax . . moderate cardiomegaly and mild-to-moderate interstitial pulmonary edema . . round lesion at the right lung base is unchanged .	Cardiomegaly&&Edema	17340686	52618697	a336fc81-7ee080cf-fe8b1be1-38aa5c12-add53acc
2340	ap portable upright chest radiograph was provided . midline sternotomy wires and left chest wall pacer device again noted with pacer lead extending into the region of the right atrium and right ventricle . multiple mediastinal clips are noted . as seen on prior high res ct, areas of scarring evidenced by subtle linear reticular opacity at the right lung base present . the heart is mildly enlarged . there is no definite effusion, though the left cp angle is excluded . no pneumothorax . no signs of chf or discrete signs of pneumonia . bony structures are intact . cardiomegaly with stable area of scarring at the right lung base .	Cardiomegaly&&Lung Opacity	12110863	52268728	67412cf5-519f1711-72f5a403-2e6ec7fa-84dfa6b6
2341	a right port catheter tip ends in the mid svc . sternal wires are intact and midline . there are small bilateral pleural effusions, slightly larger on the left than on the right . the cardiac silhouette is moderately enlarged . there is mild engorgement of the pulmonary vasculature . there has been improvement in the previously noted pulmonary edema with minimal residual edema . there is plate-like atelectasis seen in the left base . there is no consolidation or pneumothorax . . small bilateral pleural effusions . . improvement in pulmonary edema .	Edema&&Pleural Effusion	12124741	57320234	72a15dc0-cfcca17f-201baf20-76f2e298-e4123143
2342	the monitoring and support devices are in unchanged position . moderate cardiomegaly with moderate right pleural effusion, accompanied by areas of bilateral basal atelectasis, right more than left . mild fluid overload . no newly appeared parenchymal opacities .	Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices	14841168	58057712	d78cb088-c3cad3f2-7a6176d6-7a4ca5df-dbe9326c
2343	patient is status post cabg with median sternotomy and aortic valve replacement . moderate-to-severe emphysema with apical predominance . mm nodular opacity in the right upper lobe has not changed . heart is top-normal in size . no focal consolidation, pleural effusion or pneumothorax . vertebroplasty changes are seen in the mid-thoracic spine . no acute intrathoracic process .	No Finding	11016935	51683155	7e26f6a7-ec126822-1bcdc587-a3f5d439-b4715eae
2344	moderately sever bilateral pulmonary edema has worsened in comparison to prior radiograph acquired hours apart . severe emphysema is present . no new relevant findings in the lungs . heart size, mediastinal and hilar contours are stable .	Cardiomegaly&&Edema&&Enlarged Cardiomediastinum	17032538	59221051	ad848298-a6a13b00-3540b2ac-2e0e927d-908befad
2345	minimal positional increase in density at the left lung bases . no evidence of pneumonia . borderline size of the cardiac silhouette without pulmonary edema . no pleural effusions .	Cardiomegaly	13989850	52009754	ea461ed9-98d6fcdc-bcffddd8-6b2f85a7-07d19d2e
2346	again seen are bilateral lower lobe opacities, left greater than right . these have slightly changed their appearance and still could be due to either volume loss or infectious infiltrate . there are probable small bilateral effusions . there is mild pulmonary vascular redistribution and mild cardiomegaly .	Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Pneumonia	18512911	58891549	4a07ec47-07219c0a-f144f691-b0625175-f58f47d0
2347	pa and lateral chest radiograph mild interstitial edema is identified . there is azygos engorgement . no pleural effusions are identified . moderate cardiomegaly is stable since prior examinations . moderate to severe lower thoracic compression fracture is again noted, slightly worse compared to the prior examination .	Cardiomegaly&&Edema&&Fracture	16672854	54046805	53467c86-8205cb70-cc0e9d9c-e218feb5-36807cc9
2348	portable ap radiograph of the chest was reviewed in comparison to obtained at pm . there is slight interval increase in the apical collection of the fluid that potentially might reflect accumulation of pleural effusion versus bleeding . the rest of the findings are unchanged . there is no pneumothorax .	Pleural Effusion	14969719	59559249	13000d1f-353d86fd-4af88491-cf6e8f84-153def16
2349	comparison is made to the next preceding portable chest examinations of . the patient remains intubated, the ett in unchanged position . same holds for the right internal jugular approach double-lumen catheter terminating in the mid portion of the svc . heart size is enlarged as before . the most significant interval change in comparison with the preceding studies is a markedly increased perivascular haze, peripheral kerley b lines on the bases, and beginning central edema around the hilar areas . no significant amount of pleural effusion can be identified in the lateral pleural sinuses, nor is there any pneumothorax in the apical area . increasing marked pulmonary congestion compatible with pulmonary edema . page was placed to referring physician, at pm .	Edema	18855147	51493934	82fb374b-501cd085-de6db06c-337de2f5-3f5d1157
2350	there is now no evidence of pneumothorax . previous change could have been simulated by a skinfold . the extensive bilateral predominantly basal parenchymal opacities are constant in appearance and severity . unchanged appearance of the cardiac silhouette .	Cardiomegaly&&Lung Opacity	16662264	58952060	ec537dc4-f5eeec2d-56cb7b79-4732911f-612e645a
2351	there again are bilateral pleural effusions with compressive atelectasis, much more prominent on the left . continued enlargement of the cardiac silhouette with mild elevation of pulmonary venous pressure . pacer leads are unchanged .	Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices	19182863	57051632	d8d27634-c797ba3f-79f7384e-6dd55810-93915d51
2352	again seen are bilateral loculated pleural effusions, consistent with prior ct in . median sternotomy wires and surgical clips are noted . ill-defined opacities at the right base are unchanged from multiple priors and most likely represent atelectasis . there is no pleural effusion or pneumothorax . the cardiomediastinal silhouette is within normal limits . . no acute cardiopulmonary abnormality . . chronic loculated pleural effusions and right basilar atelectasis, unchanged .	Atelectasis&&Pleural Effusion	16360107	57578542	124f973d-d060d2cb-f7f48073-f3b3298e-8e8bcfac
2353	there is little change in the diffuse bilateral pulmonary opacifications, more prominent on the right . endotracheal tube remains in place .	Lung Opacity&&Support Devices	13964474	58187408	03687e0f-cfea2f97-6062fceb-1c006210-6f147d31
2354	in the left mid lung is a . cm rounded opacity with an air-fluid level concerning for a cavitary lesion . this was no present in the prior exam . the remainder of the lungs are unremarkable . there is no pneumothorax, pleural effusion, or edema . the cardiomediastinal silhouette is normal . no fracture is visualized . . -cm left-sided cavitary lesion . . no displaced rib fracture seen . results were discussed with dr . on via telephone by dr . .	Fracture&&Lung Lesion	19748558	59041431	9905499f-c48f304d-f9efd154-a921881b-f71b7f86
2355	single portable view of the chest there is no pneumothorax or definite pleural effusion . there is no focal airspace consolidation . the lung volumes are low . there is mild prominence of the pulmonary vasculature, albeit less than prior exam . despite technique, the heart size is enlarged, but unchanged from prior . sternotomy wires and cabg clips are noted . small granulomas are again seen in the right lung base .	Cardiomegaly	18828251	55101327	92fd0922-955eb1c3-1cccf867-afd0d2e5-1e5a368b
2356	the right internal jugular approach venous catheter remains in the mid svc . an enteric feeding cord tube courses through the stomach out of field of view . there are scattered areas of linear atelectasis . there is persistent moderate interstitial pulmonary edema . there are no new focal opacities concerning for pneumonia . there are no pleural effusions or pneumothorax . the cardiomediastinal and hilar contours are stable demonstrating moderate cardiomegaly . no significant interval change . moderate interstitial pulmonary edema .	Edema	19623993	52548008	69185846-837b415c-5aa118ec-802f32df-bdc6985a
2357	there is no evidence of pneumothorax on either side which can be identified with this portable single view examination . comparison with the next previous study suggests that the right-sided massive pleural densities have changed in position slightly and as much, there is improved aeration of the right upper lobe area and the previously identified large pleural density in the right axillary area impressing on the aerated lung tissue has clearly decreased . on the other hand, it is impossible to assess whether the loculated pleural effusion has shifted more to the lower areas . again, portable chest examination does not allow assessment of the right-sided subhilar and parenchymal abnormalities . no new abnormalities are identified in the left hemithorax as there was no repeat lateral view, one cannot comment on the amount of pleural effusion on the left side identified on the preceding study . the draining pleurx catheter remains in place .	Pleural Effusion&&Support Devices	16826047	52520063	88c6c717-a8632896-fd029484-3dee5f36-331a78dc
2358	comparison is made to prior study, . moderate-to-severe cardiomegaly is unchanged . there are low lung volumes . left port-a-cath tip is in the right atrium . there is no pneumothorax or pleural effusion . mild-to-moderate pulmonary edema is stable .	Cardiomegaly&&Edema	10439781	54623776	52814624-7ca716ba-f3cccedc-7b8a65a3-24083019
2359	one ap portable view of the chest . endotracheal tube ends cm from the carina . nasogastric tube ends in the stomach . left aicd device leads terminate in the appropriate positions . after ett placement, there are increased lung volumes, and still severe pulmonary edema . cardiomegaly is stable . small right pleural effusion is stable . retrocardiac atelectasis is unchanged . no evidence of pneumonia . sternotomy wires are seen . . endotracheal tube ends cm from the carina . better lung volumes after intubation but still severe pulmonary edema .	Edema&&Support Devices	18322589	56196471	3316f535-55fb94a2-9ced6576-f0cb4da1-83d82a05
2360	there is no pneumonia or pulmonary edema . extensive intrathoracic malignancy includes scores of nodules of various sizes in the right lung which may have grown more numerous and enlarged over just a two-day interval . there is extensive bilateral hilar and mediastinal adenopathy and much larger confluent metastases in the left hemithorax with associated pleural thickening . there is no pneumothorax .	Lung Lesion&&Pleural Other	12702423	54932317	d5bdde56-163d7da0-c0c9fbcd-b1e3b312-4ad7853c
2361	the heart is of normal size with stable cardiomediastinal contours . a small right pleural effusion is similar to the exam hours prior . no focal consolidation or pneumothorax . there is small atelectasis at the right base . chronic-appearing right rib fractures are similar to prior . sternotomy wires and mediastinal clips are intact . no relevant change from study hours prior . stable small right pleural effusion .	Pleural Effusion	12736592	54232340	a160eb01-5f36fb58-b0a04a57-1773448e-934b5036
2362	there has been placement of an orogastric tube that extends into the upper stomach . the side hole is just distal to the esophagogastric junction . other monitoring and support devices remain in place . little change in the bilateral parenchymal opacification, partly due to atelectasis and partly to pulmonary edema .	Atelectasis&&Edema&&Lung Opacity&&Support Devices	13881772	59893280	63f5ab00-ca3eaded-279304bf-6d6bfcb6-52295e79
2363	mild cardiomegaly has been stable compared to exams dated back to at least . there is increased mild pulmonary vascular congestion, otherwise the hilar and mediastinal contours are unremarkable . there has been an interval increase in diffuse interstitial markings throughout the lungs bilaterally, as well as new small bilateral pleural effusions . there is no evidence of pneumothorax . the visualized osseous structures are unremarkable . diffuse bilateral interstitial opacities, very likely secondary to increased pulmonary edema from congestive heart failure, on a background of patients known chronic interstitial lung disease . short term follow up radiographs after diuresis is recommended to ensure resolution and to exclude other process such as atypical pneumonia or acute exacerbation of interstitial lung disease . recommendations short term follow up radiographs to exclude atypical pneumonia . notification findings dw dr . by dr . at a on the day of the exam by phone .	Cardiomegaly&&Edema&&Lung Opacity&&Pneumonia	13475033	50354419	473b3723-2a628ba8-ee2c35cc-2e8cd7b0-166f5104
2364	prominent interstitial markings are again seen, not significantly changed . there is no overt pulmonary edema . there is no pleural effusion . cardiomediastinal silhouette is stable . coronary artery calcifications andor stents are noted . chronic compression deformity in the lower thoracic spine . unchanged increased interstitial markings most likely due to chronic interstitial process although component of interstitial edema is possible .	Edema&&Lung Opacity	13475033	56998787	ca74e920-4ca91dba-8ccc5185-617107a8-82e5a48a
2365	pa and lateral images of the chest . the lungs well expanded . bilateral upper lobe opacities consistent with chronic fibrosis are again seen, unchanged from prior exam . the lungs are otherwise clear . there is no pleural effusion or pneumothorax . the cardiomediastinal silhouette is unremarkable . no acute cardiopulmonary process . stable fibrotic changes in the upper lungs .	No Finding	10933609	52624179	c89c7ca8-466643b7-e8480932-1b791a6f-4ae17f31
2366	lung volumes are diminished which exaggerates the cardiomediastinal configuration . however, even accounting for this change, there has been a relative dramatic increase in the size of the cardiac silhouette with now somewhat globular morphology . ill-defined opacity is noted in the retrocardiac left lower lobe which is likely atelectasis given the volume loss . there is no focal consolidation . no definite effusion or pneumothorax is seen . the osseous structures are unremarkable . incidental note is made of internal fixation hardware, incompletely evaluated, involving the mid diaphysis of the right clavicle . tubing loops over the epigastric region and with the tip projecting at the dome of the left hemidiaphragm over the cardiac silhouette . interval enlargement of the cardiac silhouette even accounting for patient and technical factors . this likely signifies at least an increase in the size of the apparently known pericardial effusion .	Cardiomegaly	15881535	56093476	210f9c01-9e0728bf-4b8ec9bf-34d1564e-16cf509c
2367	frontal views of the chest the cardiac silhouette is again noted to be markedly enlarged but unchanged from approximately four hours prior . again, this is consistent with an underlying pericardial effusion . further obscuration of the pulmonary vascularity indicates development of mild pulmonary edema . small bilateral pleural effusions are presumed . no pneumothorax . retrocardiac opacification is likely atelectasis, although pneumonia cannot be excluded . . severe cardiomegaly, unchanged from four hours prior and worrisome for underlying pericardial effusion . . interval development of mild pulmonary edema from .	Cardiomegaly&&Edema	15840907	50225181	2fba7496-4ddb5c26-026164b8-c3e4e111-e43f94f9
2368	large bilateral effusions with associated consolidations are unchanged . cardiomediastinal contours are stable . the upper lungs are grossly clear . stable position of right central catheter and pacer lead . vascular congestion has improved .	Consolidation&&Edema&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	19182863	52921410	270ee8d2-c6faa805-d42cb329-a3cd5951-c4b26875
2369	right pleural effusion appears to be slightly decreased, although still present . mediastinal contour is stable . small amount of left pleural effusion is unchanged . no appreciable pneumothorax is seen .	Enlarged Cardiomediastinum&&Pleural Effusion	16848073	50428004	9fc99576-0fb8a306-e51be584-113ca1f6-dd9e9cd7
2370	the heart size is top normal . the hilar and mediastinal contours are normal . the lungs are hyperinflated, otherwise no focal consolidations concerning for pneumonia are identified . mild left basilar linear atelectasis scarring is again seen . there is no pneumothorax or pleural effusion . incidental note is made of a mm lung nodule projecting over the right anterior second rib interspace . aortic annular calcifications are again noted . old healed left lower lobe rib fractures are stable . . no acute intrathoracic abnormalities identified . hyperinflated lungs . . mm lung nodule projecting over the anterior second right rib interspace, was not well seen on the prior exam . a ct may be helpful for further evaluation . . extensive aortic annular calcifications raise concern for aortic stenosis . notification were dw dr . by dr . by phone at a on the day of the exam .	Lung Lesion	13881772	59217830	959ee516-d090d9d5-a95977ac-303cdde2-c9309e8c
2371	the left pic line is unchanged in position compared to the prior radiograph . it enters a left-sided approach and makes a descent at the level of the aortic arch in keeping with known left-sided superior vena cava . there is stable mild cardiomegaly . the hilar and mediastinal contours are unremarkable . there has been slight interval improvement of the large right pleural effusion associated with atelectasisconsolidation . there is no pneumothorax . the replaced valves tricuspid and aortic are redemonstrated . there has been mild improvement of the previously noted interstitial edema . there has been interval improvement in the opacities in the left mid and lower lungs . . slight interval improvement in the large right pleural effusion . . improvement in the previously noted bilateral pulmonary edema . . stable left lower lung opacities compared to the prior exam .	Edema&&Lung Opacity&&Pleural Effusion	19182863	57446197	e7917cda-a7acb02f-631867d3-7fc91d5b-db5cdeef
2372	there has been some decrease in the area of airspace consolidation in the left upper zone, consistent with some improvement in a left upper lobe pneumonia . the remainder of the study is unchanged .	Consolidation&&Pneumonia	13896515	51236861	2cddaebd-e35f201c-ce55aa88-db2ae4c5-ead064b4
2373	comparison is made with prior study performed four hours earlier . ng tube tip is in the stomach . there is increased atelectasis in the left lower lobe . otherwise, no other interval changes .	Atelectasis&&Support Devices	13979643	50516010	7fd87264-5aad0a8e-dd249580-11d2cec0-4c595a17
2374	there is no focal consolidation or effusion . there is a dominant nodule in the left perihilar region measuring approximately . additional smaller nodules project over the bilateral lung apices . given history of prior malignancy, underlying metastases would be of concern . nonurgent chest ct is suggested to further evaluate . cardiomediastinal silhouette is within normal limits . left chest wall dual lead pacing device is seen as well as median sternotomy wires . chronic deformity of the proximal left humerus suggests prior fracture . bilateral pulmonary nodules concerning for metastatic disease . nonurgent chest ct is suggested to further evaluate .	Lung Lesion	17163861	56902932	4e2deb58-2087d69f-a4c1a7c8-776af924-1bd0202d
2375	there is little overall change . again there is substantial enlargement of the cardiac silhouette with evidence of pulmonary vascular congestion with asymmetric edema, more prominent on the right . retrocardiac opacification with poor definition of the hemidiaphragm is consistent with volume loss in the lower lobe . there may well be small bilateral pleural effusions .	Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion	15393401	56556003	5cccf2bd-bfd996be-96074827-f468cba2-16a37ebd
2376	ap single view of the chest was obtained with patient in sitting semi-upright position . comparison is made with the next preceding similar study of obtained at pm . findings on a new portable chest examination are practically identical with those of the previous study . position of pigtail end catheter in the right lower hemithorax unaltered . the same holds for the right-sided pleural effusion and the hydropneumothorax with rather high degree of right lung collapse . no new abnormalities identified . no significant mediastinal shift is observed . unchanged size and position of right-sided hydropneumothorax over the last -hour examination interval .	Pneumothorax	14387068	54518631	647aafbc-96122ceb-7150d6ce-c281d11c-148e092c
2377	an et tube is present, tip in satisfactory position approximately . cm above the carina . an ng tube is present, tip extending beneath diaphragm off film . there are extensive mediastinal clips . mediastinal drain and linear metallic density overlying right heart are unchanged . there is hyperinflation suggesting copd . there is moderate cardiomegaly . prominence of both pulmonary hila, with suggestion of a tapered appearance, which could reflect pulmonary hypertension . there is upper zone redistribution and possible mild vascular plethora . left lower lobe collapse andor consolidation and a small left effusion . hazy opacity overlying the minor fissure is noted, atelectasis or small amount of layering fluid . there is atelectasis at the right base . no pneumothorax is detected . mediastinum remains midline . compared with at pm, chf findings and opacities at the right base are slightly improved .	Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	17770657	58054788	a9a99a2a-c9d9d9ac-79deb41a-91e78881-d886c96d
2378	ap and lateral views of the chest were compared to previous exam . when compared to prior, previously seen right-sided pneumothorax is slightly smaller . there has, however, been interval enlargement of the right-sided pleural effusion . slight leftward deviation of the mediastinum is unchanged . the left lung remains clear . the cardiomediastinal contours are stable . the osseous and soft tissue structures are unremarkable . slight interval decrease in size of right-sided pneumothorax however, interval enlargement of the right-sided pleural effusion . stable mild leftward deviation of the cardiomediastinal silhouette .	Enlarged Cardiomediastinum&&Pleural Effusion&&Pneumothorax	14387068	53567752	58081a4f-fb575b5b-d178ec1c-b8b6a415-24868cdf
2379	moderate cardiomegaly has improved . combination of mediastinal fat and possible middle lobe atelectasis should not be mistaken for pneumonia . lungs are otherwise clear . there may be a very small new right pleural effusion . thoracic aorta is generally large and tortuous but not focally aneurysmal . no evidence of tuberculosis .	Atelectasis&&Cardiomegaly&&Pleural Effusion&&Pneumonia	17398573	50918803	809123a3-3a8ec764-0d6f069f-d1b0935b-161bfff4
2380	a portable semi-erect chest film at am . . right internal jugular central line with its tip in the distal superior vena cava . persistent low lung volumes with worsening opacities at both bases with associated indistinctness of the pulmonary vascularity . therefore, i would favor the presence of pulmonary edema rather than an infectious process . clinical correlation, however is advised . no pneumothorax is appreciated . overall, cardiac and mediastinal contours are difficult to assess given low lung volumes and patient rotation on the current examination . clips within the left upper quadrant are again seen .	Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pneumonia&&Support Devices	12379369	51749906	3609ba5b-c6aace8b-4557ed37-bf396c15-50b6ba75
2381	frontal chest radiograph there is moderate cardiomegaly which is new since . central pulmonary vessels are engorged, and there is mild interstitial edema with a large right pleural effusion . a trace left pleural effusion is also present . there is no pneumothorax . moderate cardiomegaly, new since , with large right and small left pleural effusions, central vascular congestion, and mild interstitial edema, concerning for cardiac decompensation .	Cardiomegaly&&Edema&&Pleural Effusion	18309149	51264956	0172482f-ff4eeb46-e6e40eaa-2659ae08-97fb1158
2382	pa and lateral radiographs of the chest demonstrate clear lungs . there are bilateral nipple shadows overlying the lower lung fields, which should not be confused with an intrapulmonary process . there is no pneumothorax or pleural effusion . the hila and cardiomediastinal contours are normal . pulmonary vascularity is normal . callus formation around the posterior left eighth rib is consistent with remote history of fracture . cholecystectomy clips can once again be seen in the right upper quadrant of the abdomen . no evidence of pneumonia . note findings were communicated to dr . by dr . by telephone on at .	No Finding	16435402	57889845	fe5bce5c-5c949faf-1120fe46-1ac9de4b-5c4f5072
2383	the feeding tube extends below the level of the diaphragms but beyond the field of view of this radiograph, likely within the distal stomach . a left chest wall dual lead pacemaker is present . the tip of the right picc line extends to the level of the mid svc . no focal consolidation, pleural effusion or pneumothorax identified . the size and appearance of the cardiomediastinal silhouette is unchanged . the feeding tube extends below the level the diaphragms but beyond the field of view of this radiograph, likely however within the distal stomach . no other significant interval change since the prior radiograph .	No Finding&&Support Devices	18487334	50492868	f3c65ae4-81c03654-c3fe857f-dec24a17-a5a118b9
2384	pa and lateral views of the chest are obtained . the previously noted right ij central venous catheter has been removed . midline sternotomy wires and mediastinal clips are stable . there is slight elevation of the left hemidiaphragm with left basilar atelectasis with overall improvement in left basilar aeration compared with prior study . the right lung is clear . heart is top normal . mediastinal contour is stable . bony structures are intact . right ac joint arthropathy is again noted . no free air below the right hemidiaphragm . persistent left lung base atelectasis . otherwise, unremarkable .	Atelectasis	16043240	59721249	bffeb923-b2e49523-b66fa14c-e5d62eb0-93afffd1
2385	opacification of the left hemithorax is a combination of increasing pleural effusion and a presumed increasing atelectasis in the remaining left upper lobe . cardiomediastinal contours are midline . there is probably a tiny residual left apical pneumothorax . the right lower lobe atelectasis has improved . left ij catheter tip is unchanged . left chest wall subcutaneous emphysema has improved .	Atelectasis&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Pneumothorax&&Support Devices	12530259	53979536	d10aee8d-b58fd31c-ac3debb5-48dda89f-2765b3de
2386	there is little change and no evidence of acute cardiopulmonary disease . cardiac silhouette is mildly prominent, but there is no vascular congestion, pleural effusion, or acute focal pneumonia .	Cardiomegaly	14727722	50268484	b74575dc-72fdefcf-956cda70-9feec40f-0ad80c33
2387	right peripheral inserted catheter tip is reaching the axillary vein . it is not central . there is mild cardiomegaly . moderate pleural effusions on the left and small right effusions have increased on the left compared to . mild-to-moderate pulmonary edema has minimally increased . there is no pneumothorax . a stent projects in the left axillary region .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	16772702	56873244	11cf8439-fffd1ea4-a0467c38-e71c3db4-caa074c5
2388	the patient has had left lower lobectomy and posterior chest wall reconstruction . there has been no interval change since in the large fluid collection contained by the left chest wall graft . right lung is clear . the extent of leftward mediastinal shift is probably unchanged due to slight differences in patient positioning and the left hemidiaphragm remains elevated . heart is moderately enlarged . no pneumonia or pulmonary edema .	No Finding	15446959	54692227	6bfb9064-03f991cd-bc8d36dd-fd64d740-edfaab18
2389	endotracheal tube tip is still within cm of the carina . enteric tube seen with tip at the gastric fundus, side port not clearly identified on the current exam . right ij line in stable position . the appearance of the lungs is unchanged with hazy bilateral opacities, the streaky left basilar likely atelectasis and post-op changes in the right mid lung . prominence of the right hilum is unchanged . et tube within cm of the carina . this was discussed with dr . at pm . on by dr . at time of interpretation .	No Finding&&Support Devices	16334516	57911714	dc1267a2-3ee022b5-d80f7ef1-f88a4e83-8d0de660
2390	ap single view of the chest has been obtained with patient in sitting semi-upright position . unchanged appearance of cardiac enlargement without typical configurational abnormality . mediastinal structures also unchanged . the pulmonary vasculature is not congested anymore and there is no evidence of pleural effusion as the lateral pleural sinuses are free . no new pulmonary parenchymal infiltrates can be identified . no pneumothorax is seen in the apical area . as before, a right internal jugular approach central venous line is seen and terminates in the mid portion of the svc . no evidence of new acute pulmonary infiltrates . observe that chest image quality is limited related to patients morbid obesity .	Lung Opacity	13473495	58228725	5bc1f7d3-d0c163be-13a38541-42a5e89e-4c074884
2391	stable cardiomegaly accompanied by pulmonary vascular congestion and worsening edema . a more confluent area of opacity in the right lower lobe could reflect a superimposed pneumonia given clinical suspicion for this entity . small to moderate right and small left pleural effusion are present, but there is no visible pneumothorax .	Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia	14851532	55671568	a182520b-602fa4e1-b77eda67-469d74a8-9403dc79
2392	low lung volumes, borderline size of the cardiac silhouette . no pneumonia . no pleural effusions . no pulmonary edema . normal aspect of the hilar and mediastinal structures .	Cardiomegaly	13989850	53791685	dcdc908d-8f4a46cf-0dff1d17-7bf04375-a24a33a8
2393	elevation of the right lung base and hemidiaphragm has been pronounced since at least , accounting for atelectasis at the lung base . the right upper lung and the entire left lung are clear and the left lung is hyperinflated suggesting airway obstruction or emphysema . heart is normal size . there is no pneumonia or pulmonary edema . no pleural effusion or pneumothorax .	Atelectasis	19565653	56188631	d2d3a213-793a92c9-4c2f0695-bf38104e-033b7d22
2394	low lung volumes . moderate cardiomegaly with minimal fluid overload . no overt pulmonary edema . no pleural effusions . no pneumonia .	Cardiomegaly	17340686	58040849	9cf8e1b3-4a4ea8dd-33fc8814-862d81e5-34c105d1
2395	the previously seen pulmonary edema has resolved . there is no edema, pneumonia, pleural effusion, or pneumothorax . bibasilar atelectasis is unchanged, including atelectasis in the retrocardiac region . elevation of the right hemidiaphragm is stable . the cardiomediastinal silhouette is normal . a feeding tube is seen in the stomach with the tip out of the field of view . . resolution of pulmonary edema . . stable bibasilar atelectasis .	Atelectasis	18517718	54151404	6b1a712d-b6ee334a-b3bc78ad-38095ded-c4486183
2396	ap and lateral views of the chest are compared to previous exam from . postoperative changes of left upper lobectomy are again seen with resection cavity completely opacified, without visualized pneumothorax . slightly increased linear right basilar opacity is seen . elsewhere, the lungs are hyperinflated but clear of confluent consolidation . cardiomediastinal silhouette is stable as are the osseous and soft tissue structures . right basilar opacity may be due to atelectasis however, infection is not completely excluded . stable postoperative changes of left upper lobectomy .	Atelectasis&&Lung Opacity&&Pneumonia	11378150	52705433	70e31905-dd605e80-305f056b-4f88ec80-cbb4b3fb
2397	since the prior radiograph, there has been improvement in pulmonary edema . a small right pleural effusion is mostly resolved . there is some scarring seen at the right base . cardiomediastinal silhouette is slightly enlarged but unchanged . there is no focal consolidation or pneumothorax . right dialysis catheter is seen, unchanged in position . interval improvement in pulmonary edema and small right pleural effusion .	Edema&&Pleural Effusion	18855147	54616934	7cb35601-837df231-b3efc10a-3a761298-85f39d17
2398	ap view of the chest right internal jugular central venous catheter tip terminates in the upper svc . left-sided port-a-cath tip terminates in the cavoatrial junction . cardiac, mediastinal and hilar contours are stable with unfolding of the thoracic aorta . surgical chain sutures are noted within the right mid lung field with adjacent scarring . no pleural effusion or pneumothorax is visualized . multiple clips are seen within the left upper abdomen, compatible with prior nephrectomy . there are old right-sided rib fractures .	No Finding&&Support Devices	15758946	58167653	3beddebe-77318989-f0a94514-750bd4e3-c009749d
2399	mild to moderate cardiomegaly is stable . compared to the prior radiograph, the degree of pulmonary edema is unchanged . no new focal consolidation or pneumothorax . persistent bilateral pleural effusions and bibasilar atelectasis . no change in the degree of pulmonary edema, with persistent bilateral pleural effusions and bibasilar atelectasis .	Atelectasis&&Edema&&Pleural Effusion	15131736	54867671	6cd580d7-5ec74248-17b89c75-a4a99d48-97e58fe4
2400	the lungs are well expanded . moderate cardiomegaly has improved since . the mediastinal silhouette and hilar contours are normal . sternal wires are intact . mitral valve ring is noted . no definite pleural effusion is present . improved moderate cardiomegaly . no evidence of cardiac decompensation .	Cardiomegaly	15259244	51811172	178a003a-0d5784da-664f8272-6c14ae7b-135dfadb
2401	examination is marked semi-upright . only upright views are sensitive for detection of small amounts of subdiaphragmatic gas . none is seen on this study . et tube and a dual-channel left supraclavicular central venous line are in standard placements respectively . moderate cardiomegaly is stable . previous mild pulmonary edema has improved . pulmonary and mediastinal vascular congestion and moderate-to-severe left lower lobe atelectasis persist . small amount of pleural effusion is presumed, left greater than right . no pneumothorax .	Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	14841168	51351495	5636d20b-bf2bc860-a877f98d-84cf4456-7d982baa
2402	the patient is status post median sternotomy and aortic and tricuspid valve repair . there has been interval developmentincrease in bilateral, right greater than left, pleural effusions with overlying atelectasis . right base opacity may relate to effusion and atelectasis, although underlying consolidation cannot be excluded . the cardiac silhouette remains mildly enlarged . the aorta is calcified and tortuous . displaced anterolateral left second rib fracture is again seen . there is minimal pulmonary vascular congestion . interval increasedevelopment of bilateral, right greater than left, pleural effusions with overlying atelectasis . right base opacity may be due to a combination of pleural effusion and atelectasis, however, underlying consolidation cannot be excluded . cardiomegaly and minimal pulmonary vascular congestion .	Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Lung Opacity&&Pleural Effusion	19182863	59039129	62d1a94d-08be6886-1860ef56-16cc47a7-abbc574e
2403	lung volumes are low . elevation of the right hemidiaphragm appears similar . cardiomegaly is again noted . minimal linear left basilar opacity appears similar and likely represents atelectasis . of note, evaluation is slightly limited in the absence of lateral view . no pleural effusion or pneumothorax is seen on this single view . no focal consolidation is seen on this single view . aortic calcifications are again noted . radiopaque material in the left abdomen may represent previously ingested oral contrast . stable frontal chest radiograph . limited evaluation in the setting of single frontal view lateral view would be helpful for more thorough evaluation . this was discussed with dr . by dr . by phone at pm .	No Finding	10449297	56486000	144841f5-0126909a-cde81d66-1db1375d-b3ed7127
2404	there is a left picc which terminates within the upper svc . the lungs are clear of focal consolidation, pleural effusion or pneumothorax . the heart size is normal . the mediastinal contours are normal . no acute cardiopulmonary process . left picc terminates within the proximal svc .	No Finding&&Support Devices	15114531	54616688	fd043f2e-fb851408-681f3799-13b1ec21-5a635d01
2405	cardiomediastinal silhouette and hilar contours are unremarkable . residual hazy opacities persist at bilateral lung bases and inferior lingula from prior recent infection but are significantly improved from prior study . there is no pleural effusion or pneumothorax . there is no new focal consolidation . the osseous structures are grossly unremarkable . hazy bibasilar opacities, likely the residua from recent prior infection greatly improved in appearance . no new focal consolidation .	Consolidation&&Lung Opacity&&Pneumonia	16662264	56776331	ec2613ac-d859c02c-90a0d8c7-09a107c4-990690ec
2406	again seen is a dual lumen central venous catheter which terminates in the lower svc coursing through a brachiocephalicsvc stent . no definite consolidation is identified . there is mild pulmonary vascular congestion . cardiac silhouette is top normal . there are likely small bilateral pleural effusions . no pneumothorax is present . mediastinal contour with rightward deviation of the trachea secondary to a thyroid goiter is again noted . as above .	No Finding	14236258	59938198	e2a298e7-794b6f39-1efd0c79-f922ddff-2b8f0010
2407	single ap view of the chest . low lung volumes again seen . interstitial opacities appear more conspicuous on the current exam which could be due to component of lower lung volumes and technique however superimposed component of interstitial edema is suspected . there is no confluent consolidation . the cardiac silhouette appears slightly enlarged compared to prior but some of this is may be due to lordotic positioning . median sternotomy wires and mediastinal clips are again noted . suspected component of interstitial edema superimposed on chronic interstitial process . cardiomegaly which has progressed since prior although some of this may be positional .	Cardiomegaly&&Edema	13896515	53091413	1e758c6a-4edc885c-05366f8b-05549d3d-fa35c2cf
2408	evaluate for infiltrates . comparisons multiple chest radiographs from back to . portable supine radiograph of the chest lung volumes are low, despite endotracheal intubation . there is worsening engorgement of the mediastinal vasculature and central pulmonary vascular congestion . there is also new mild pulmonary edema and bibasilar atelectasis . there is no pneumothorax or pleural effusion . the endotracheal tube is in appropriate position approximately cm above the carina . a hemodialysis catheter terminates in the cavoatrial junction . . worsening pulmonary and mediastinal vascular congestion with low lung volumes and new mild pulmonary edema . . no evidence of pneumonia .	Edema	14841168	55438661	a3c2266d-8b1ffac0-48100adb-18621806-7ba7faa5
2409	single frontal portable view of the chest the right-sided picc has been repositioned and now ends in the mid svc . the ng tube courses to the stomach, although the tip is excluded from view . lung volumes remain low . retrocardiac opacity persists and is consistent with atelectasis and a small pleural effusion as seen on abdomenpelvis ct . pulmonary edema has resolved . no evidence of pneumonia . retrocardiac opacity is consistent with atelectasis and a small pleural effusion as seen on abdomenpelvis ct .	Atelectasis&&Lung Opacity&&Pleural Effusion	13031876	53555445	ab6185a7-10a51f83-2bb26ac5-db07531e-eb9d7b85
2410	bilateral interstitial and airspace opacitification, predominantly basal has worsened substantially since . moderate enlargement of the cardiac silhouette and hilar vasculature are chronic . small bilateral pleural effusions are presumed . recurrent, moderately severe, pulmonary edema, worsened since . bibasilar opacification, likely edema and atelectasis .	Atelectasis&&Edema&&Lung Opacity	17189198	57840198	f2b84959-05a7275a-931bd2c9-4755b948-797561fe
2411	small right, moderate left pleural effusions both increased since . heart size top normal . edema, generally improved since is redeveloping in the left upper lung . mm right upper lobe nodule and the much larger mass at the left apex medially are presumably due to bronchogenic carcinoma . consolidated lung in the infrahilar portions of both lower lobes has not improved since . whether this is atelectasis alone or concurrent pneumonia is radiographically indeterminate . no pneumothorax .	Atelectasis&&Consolidation&&Edema&&Lung Lesion&&Pleural Effusion&&Pneumonia	14851532	58957750	ba4dca32-34db70b8-58f97bd4-a77b4632-6e2ee9ca
2412	the lungs are clear without focal consolidation . no pleural effusion or pneumothorax is seen . the cardiac and mediastinal silhouettes are unremarkable . no acute cardiopulmonary process .	No Finding	18767957	56415175	88dd4b9d-f5dc2b18-5e9e6141-943b90b2-39b71300
2413	since , there are no relevant changes in the lungs . mild to moderate right-sided pleural effusion is unchanged . mild mediastinal shift on the right side and cardiomediastinal silhouetteare similar . mild atelectasis in right lower lung is unchanged . no new relevant findings . right port-a-cath ends at lower svc and a right chest tube drain ends at right lung base .	Atelectasis&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	14969719	50950402	9b81caad-45950b63-68fae78a-caa9bc51-74483a78
2414	the cardiomediastinal contours show a mildly engorged azygous vein, but there is no pulmonary edema . there continues to be severely low lung volumes with chronic diaphragmatic elevation, more prominent on the left than the right, which obscures assessment of the heart and most of the lungs . the upper portions of the lungs are clear of consolidation . there is no pneumothorax . an anchor is noted in the right humeral head and a fracture through the proximal humeral neck is seen, similar in appearance to prior shoulder radiograph dated . the right ac joint continues to be widened .	Cardiomegaly&&Enlarged Cardiomediastinum&&Fracture	18338007	57561035	0c0c6328-356ed105-d08d85dc-d48519a5-37ce609c
2415	postsurgical changes of a right upper lobectomy and right upper rib resection are unchanged . radiation changes are stable . there is associated volume loss with elevation and tenting of the right hemidiaphragm . there is atelectasis of the right middle lobe, unchanged from prior exams . the previously seen right lower lobe nodular opacities have improved since the prior studies in . there is no new opacification . there is no pleural effusion or pneumothorax . the cardiomediastinal silhouette is shifted rightward due to volume loss, but otherwise normal in shape and contour . the osseous structures are unremarkable . . stable post-surgical and post-radiation changes of the right lung . . interval improvement of previously seen right lower lobe opacification . . no new opacity, effusion, or pneumothorax .	Lung Opacity&&Pleural Effusion&&Pneumothorax	13263843	57953072	414fca72-91452400-5dfedcd2-5363eab9-ff09d8c2
2416	portable ap radiograph of the chest was reviewed in comparison to prior study obtained on . there is interval decrease in pleural effusion on the right, which is still present, at least moderate and loculated . there is no appreciable pneumothorax demonstrated although it can be obscured by loculated right apical fluid . left lung is essentially clear except for left mid lung opacity which is unchanged from the prior examination, corresponding to a consolidation seen on recent ct torso .	Consolidation&&Pleural Effusion	14387068	51346944	f376a6b6-0447ef09-f99ba585-ac93baaf-321b89a9
2417	pleurx catheter is again seen on the right with its tip at the level of the right sixth and seventh posterior rib interspace . there is persistent effusion and consolidation within the right lung, though there is slight improvement in the aeration in the right upper lung as compared with the prior chest radiograph . there is persistent loculated right pleural effusion for which a slight increased fluid component is seen along the right lateral upper lung . the left lung is unchanged and clear . heart size cannot be assessed due to effacement of the right heart border . bony structures appear intact . persistent consolidation and loculated right pleural effusion with pleurx catheter in unchanged position .	Consolidation&&Pleural Effusion&&Support Devices	16826047	57622301	d1d6666e-15233295-0295b986-083aa34f-88ba93b2
2418	a right-sided large-bore central catheter is again seen, terminating in the right atrium, unchanged from the prior study . mild diffuse interstitial opacities are stable, thought to represent chronic hypersensitivity pneumonitis on chest ct from . no focal consolidation, pleural effusion, or evidence of pneumothorax is seen . the cardiac and mediastinal silhouettes are stable, with the cardiac silhouette mildly enlarged with the aorta calcified and tortuous . thoracic scoliosis is again seen . there is stable compression of a mid-to-lower thoracic vertebral body . again seen is mild indentation of the left trachea at the level of the clavicles, unchanged compared to multiple priors since . no significant interval change .	No Finding	13475033	55135726	a2512fa8-095ec040-e32a3e91-1c4f753a-099de7a9
2419	endotracheal tube terminates approximately - mm above the carina . consider retracting the endotracheal tube by approximately cm for better seating . orogastric tube is seen coursing into the stomach and is appropriate position . bilateral lung volumes remain low . multiple nodular opacities in bilateral lungs from known metastases are better evaluated on prior chest ct dated . mild bilateral lower lung atelectasis is unchanged . new peribronchial opacities in the left lower lung and right lung base are concerning for aspiration . cardiomediastinal silhouette is stable . bilateral lower lung peribronchial opacities, new since , are concerning for an aspiration . pre-existing bibasal mild atelectasis is unchanged .	Atelectasis&&Lung Opacity	16409152	53967875	b197e096-c5bf8b0f-c2a04ee0-f6eb2370-9cb07b7c
2420	a new central venous catheter terminates in the left brachiocephalic vein . there is no pneumothorax . otherwise, there has been no significant short-term change . status post placement of new left internal jugular central venous catheter no pneumothorax identified .	No Finding&&Support Devices	16508811	51274564	ee20ed6a-2dc0af0c-24d33cf6-5386e01a-c281e8c5
2421	large right pleural effusion is unchanged in size . there is associated right basilar atelectasisscarring, also stable . healed right rib fractures are noted . on the left, there is persistent apical pleural thickening and apical scarring . linear opacities projecting over the lower lobe are also compatible with scarring, unchanged . there is no left pleural effusion . there is no pneumothorax . hilar and cardiomediastinal contours are difficult to assess, but appear unchanged . vascular stent is seen in the left axillarysubclavian region .	Lung Opacity&&Pleural Effusion&&Pleural Other	13849733	54538310	a1ab8f5f-581bbc83-95dcba8d-3f8da9e4-4df624e8
2422	the picc extends only to the left brachiocephalic vein before its junction with the superior vena cava . continued low lung volumes may account for some of the prominence of the transverse diameter of the heart . bibasilar opacification most likely reflects atelectatic changes . possibility of supervening pneumonia would have to be considered in the appropriate clinical setting . the pulmonary vascular congestion is less prominent than on the prior study .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pneumonia&&Support Devices	10268877	55785509	2b68ac0e-611f3a5f-ddd4047f-97ef55a1-538b75df
2423	portable upright chest film at is submitted . . the heart remains markedly enlarged which may reflect cardiomegaly, although a pericardial effusion should also be considered . there is prominence of the perihilar vasculature but no overt pulmonary edema on the current study . calcified diaphragmatic plaques are seen suggestive of prior asbestos exposure . no focal airspace consolidation is seen to suggest pneumonia . no pneumothorax . no pleural effusions .	Cardiomegaly	17838301	58449130	4255ddc7-829f3037-52171b91-e25d271a-75bb4204
2424	normal heart, lungs, hila, mediastinum and pleural surfaces .	No Finding	19213022	58404829	3214e64d-afc36832-c264b9cd-9eb7a079-59a7eedd
2425	a newly placed nasogastric tube terminates in the distal stomach . the right ij central venous catheter and an et tube are unchanged in position . the bilateral lung apices have been excluded from the field of view, limiting assessment for pneumothorax . severe bilateral airspace opacities are unchanged . a small layering right pleural effusion is not appreciably changed . ng tube ends in distal stomach . remaining lines and tubes in satisfactory position . right lower lobe pneumonia with stable severe bilateral airspace opacities, which may be due to pulmonary edema or hemorrhage . moderate layering right pleural effusion not appreciably changed .	Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	15857729	56676503	b128a59a-4eb90799-c8564692-8e582714-82706ad2
2426	there is little overall change in the appearance of the heart and lungs . continued low lung volumes with bilateral pleural effusions and compressive atelectasis with some elevation of pulmonary venous pressure . in the appropriate clinical setting, supervening pneumonia would have to be considered . there has been removal of the right chest tube with no evidence of pneumothorax . the intestinal tube has also been removed .	Atelectasis&&Cardiomegaly&&Pleural Effusion&&Pneumonia	12952223	59873563	b3e4ebe4-483b4cbe-499b39c6-b6299065-c14cba2d
2427	the cardiac silhouette is unremarkable . the right hilum is prominent, but stable in comparison to multiple priors . no definite pleural effusions identified . there is no pneumothorax . again seen is a left-sided aicd, with stable position of the single lead in the right ventricle . no acute intrathoracic abnormality .	No Finding	14556809	53779297	ba22c676-fe74f3b9-b6e53609-c7281450-9f52ce69
2428	single portable view of the chest is compared to previous film from earlier the same day at . new right ij line is seen with tip projecting over the mid svc . there is no visualized pneumothorax . endotracheal tube is approximately . cm from the carina and should be withdrawn several centimeters for optimal positioning . enteric tube is also slightly withdrawn with side port just proximal to the ge junction and should be advanced . right mid lung surgical chain sutures again seen . streaky right mid lung and left lung base opacities may be due to atelectasis . fullness of the soft tissues in the right hilar region are seen, the etiology of which is uncertain . given prior surgery there could be scarring or post-treatment changes, although underlying mass is possible, and dedicated imaging should be performed when patient is amenable . mediastinal clips with median sternotomy wires again noted . filter projecting over the ivc . new right ij line with tip projecting over the mid svc . no pneumothorax . endotracheal tube tip . cm from the carina and should be withdrawn for optimal positioning . ng tube side port proximal to the ge junction and should be advanced for optimal positioning . discussed by dr . with dr . the phone at pm . on at time of discovery .	No Finding&&Support Devices	16334516	52385480	d2c67694-56bd35b7-4aad9a81-9c1ca076-546a019a
2429	low lung volumes are again noted . there are however persistently increased interstitial markings which appear slightly progressed compared to prior . there is no pleural effusion . the cardiac silhouette is enlarged, as on prior . left subclavian stent is again seen . pulmonary edema is slightly worse than on recent exam .	Edema	13473495	55610892	e2639104-28411e18-bfafdd6f-8f7fed3a-0801198b
2430	the position of the nasogastric tube, endotracheal tube and left subclavian line appears unchanged . position of the right chest tube is also unchanged . a small right apical pneumothorax is present . no new infiltrates are seen . extensive subcutaneous emphysema is again noted .	Pneumothorax	16751749	54214300	3b132e00-e784c635-410bd026-a7a98d77-878308f5
2431	ap and lateral views of the chest the lungs are clear, without focal infiltrate, pleural effusion, or pneumothorax . the heart size is normal . the mediastinal silhouette is unremarkable . a left mid clavicular fracture is noted and better characterized on dedicated clavicular films . a left lower lung opacity is likely a nipple shadow .	Fracture	19213022	51320163	4977b9cb-187b6611-2a2cd5ec-75b12655-890f56b5
2432	cardiomegaly is stable . vascular congestion has improved, now is mild . right lower lobe atelectasis has increased . aeration of the left hemidiaphragm has minimally improved . left ij catheter tip is in the mid svc . there is no evidence of pneumothorax . small bilateral pleural effusions are unchanged .	Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	10715477	51674154	79edb832-7fe769b7-54cdefca-41c39583-d11ca0dd
2433	degree of cardiomegaly is similar . atherosclerotic calcifications are again noted at the aortic arch . engorged central pulmonary vessels are again seen without evidence of overt pulmonary edema . retrocardiac region is likely obscured due to overlying soft tissues . cardiomegaly with pulmonary vascular congestion without overt pulmonary edema .	Cardiomegaly&&Edema	15131736	50740166	96039f47-3e02e23d-f1c42efb-ed41fb27-4376aa85
2434	the patient is status post median sternotomy . again, several of the sternal wires are fractured . no definite focal consolidation is seen . there is no pleural effusion or pneumothorax . the cardiac and mediastinal silhouettes are stable . no significant interval change .	No Finding	19499595	58177798	9b8c8c16-1ff93d63-c49fdc62-8256171e-4c4acb9d
2435	areas of streaky opacity are again seen in the upper lobes, minimally changed from , likely reflects residua of recent pneumonia vs . scarring . effusion is seen . no pneumothorax . no signs of pulmonary edema . the heart appears stable in size . the mediastinal contour is unchanged . bony structures are intact . anchors are partially imaged at the right glenoid . resolving bl upper lobe pneumonia .	Pneumonia	10933609	52935265	9587ec7a-e6b7082f-0b22b670-b924b608-674375e2
2436	there are low lung volumes . bibasilar atelectases are larger on the left side . cardiac size is top normal . right central catheter tip is at the cavoatrial junction . there is no pneumothorax . left lower lobe subpleural triangular opacity is again noted . sternal wires are aligned .	Atelectasis&&Lung Opacity&&Support Devices	11413236	56440391	f657e490-c4ee9ad0-e9dfe8bd-62775c28-a599c37d
2437	there continues to be severe cardiomegaly and low lung volumes . aeration in the right is improved, but there continues to be areas of volume lossinfiltrate in both lower lungs . overall, the fluid status is slightly improved compared to the study from the prior day . an underlying infectious infiltrate, particularly in the lower lobes cannot be excluded .	Cardiomegaly&&Lung Opacity&&Pneumonia	13473495	58371511	da734734-eed7fe7d-743a3acd-22fb50e8-3bafca7a
2438	the et tube terminates . cm above the carina . there is an enteric tube which extends well below the diaphragm . again seen is severe cardiomegaly, stable since at least . the lung volumes continued to be low with evidence of elevated pulmonary venous pressure and moderate bilateral pleural effusions, left greater than right . there appears to be slight interval worsening of the bibasilar atelectasis . there is no evidence of a pneumothorax . note is again made of stable elevation of the right hemidiaphragmatic contour . slight interval worsening of atelectasis at the left lung base . stable moderate bilateral pleural effusions, left greater than right .	Atelectasis&&Pleural Effusion	13473495	53351384	b740f79e-73da2f17-0d2dac03-2e639b9e-4e01c770
2439	the heart size is mildly enlarged . prosthetic aortic valve is again visualized . sternal wires are seen . there is no focal infiltrate or effusion . there is some ill definition of the left heart border that could be due to rotation and fat pad, but a small underlying infiltrate cannot be excluded .	Cardiomegaly&&Lung Opacity&&Support Devices	16043637	50740442	bda348c8-c2a90c97-af289a1e-0d1b064c-564703d7
2440	compared to the most recent prior study of , the appearance of the chest is unchanged . the patient is status post median sternotomy with multiple mediastinal surgical clips compatible with prior cabg . a mitral valve prosthesis is unchanged in position or appearance . the cardiac silhouette is mildly enlarged but stable . the mediastinal contours are within normal limits and stable with minimal calcification of the aortic knob . mild pulmonary vascular congestion is unchanged . no significant pleural effusion is present . on the lateral radiograph, there is opacification along the fissure of the left lung corresponding to left basilar opacification on the frontal radiograph . this finding is unchanged from the prior study and may represent partial lobar collapse or fluid trapped within the fissure . no pneumothorax is detected . persistent mild edema and left lower lobe atelectasis vs fluid in the fissure . unchanged from . bronchial obstruction cannot be excluded .	Atelectasis&&Edema	19759491	52749045	897059e3-92ae214b-1458e44d-75eb5510-5098e1f8
2441	there is a new asymmetric perihilar opacification of the right mid lung . this is superimposed on moderate bilateral pleural effusions, similar to increased on the right and perhaps somewhat decreased on the left . increased opacification at the right lung base may also reflect increasing atelectasis associated with a pleural effusion, although an area of infection is not excluded . pulmonary vessels show upper zone redistribution and kerley lines are present suggesting coinciding mild congestive heart failure but generally similar in extent . new large area of focal right perihilar opacification, superimposed on pleural effusions as well as findings associated with mild pulmonary edema . the asymmetry suggests superimposed pneumonia as the etiology, or perhaps aspiration in the appropriate clinical setting alternatively asymmetric pulmonary edema could be considered . short-term follow-up radiographs may be helpful to reassess .	Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia	13881772	54920956	a2c767ad-f88d5b23-c8ac6a06-187b6f12-31b3b997
2442	the lungs show mild bilateral lower lobe confluent opacities with a new opacity in the right upper lobe . the previously noted effusions have now resolved . the cardiomediastinal silhouette, hilar contours and pleural surfaces are normal . unchanged bilateral lower lobe opacities that could represent resolving pneumonia with a new focal opacity in the right upper lobe that is nodular in nature and should be re-imaged after adequate treatment to confirm resolution .	Lung Opacity&&Pneumonia	16662264	58598370	90700f34-2bf7712e-44ca9a85-f62ca3ec-083c083b
2443	the left chest tube has been slightly pulled distally . there is no change in the left lower lung opacity as well as subcutaneous air in the right chest wall . no pneumothorax is seen .	Lung Opacity&&Support Devices	15192710	50868037	fee8113b-2d2bb8d6-2c1144c0-0c0e3d04-ad5597a4
2444	comparison is made to the prior study from at am . there has been removal of the endotracheal tube . there is a right-sided ij catheter with distal lead tip at the cavoatrial junction . there is again seen some volume loss on the left side . there are no pneumothoraces . there is likely a left-sided pleural effusion as well as atelectasis . this is stable from the prior study .	Atelectasis&&Pleural Effusion&&Support Devices	19454978	52312858	93681764-ec39480e-0518b12c-199850c2-f15118ab
2445	diffuse interstitial opacities have not significantly changed from prior . posterior costophrenic angles are sharp . thickening along of the major fissures may represent fluid or pleural thickening . cardiac silhouette is enlarged but stable in configuration . right chest wall dual lead pacing device is again seen . there is a new right chest wall tunneled dual lumen catheter with distal tip in the right atrium . there is no new confluent consolidation . no acute osseous abnormality detected . no significant interval change since prior . diffusely increased interstitial markings compatible with interstitial edema versus chronic changes . no superimposed acute process .	Edema&&Lung Opacity	19759491	52381425	971bdcae-04538cff-c7a81ae5-3f843c01-5162ca39
2446	as before lung volumes are low and the heart is mildly enlarged . there is no pneumothorax, pleural effusion or consolidation .	Cardiomegaly	19907884	57560204	29d26885-efc84164-2901f05a-89f605c8-9d4338ff
2447	the lungs are clear . the heart size is normal . mediastinal contours are normal . there are no pleural abnormalities . degenerative changes of the thoracic spine are seen . no acute cardiac or pulmonary process .	No Finding	14855790	53038366	5d3b28e1-1aac3fe6-a4122890-9105accb-061b8489
2448	the heart is normal in size . the mediastinal and hilar contours appear within normal limits and do not suggest substantial lymph node enlargement . there is no pleural effusion or pneumothorax . the lungs appear clear . mild degenerative changes are similar along the thoracic spine . no evidence of acute disease . no convincing evidence for sarcoidosis .	No Finding	13448574	53776243	52b95950-9baac352-83f0d8c5-1959eabc-a5a3ea0b
2449	comparison is made with prior study performed three hours earlier . cardiomegaly is stable . the lungs are clear . there is no pneumothorax . left pleural effusion is small .	Cardiomegaly&&Pleural Effusion	13484161	56546504	c771fda7-294984e2-40d6b8b3-eeec5c1c-95760ad3
2450	there is mild to moderate cardiomegaly . there is a moderate left pleural effusion with no right pleural effusion . there is no pneumothorax . moderate pulmonary edema is seen, worse compared to the most recent prior study but similar compared to the study from . there has been interval removal of the right picc . left axillary pacemaker is again noted . . moderate left pleural effusion with moderate pulmonary edema, worsened compared to the most recent prior study . . mild to moderate cardiomegaly .	Cardiomegaly&&Edema&&Pleural Effusion	13896515	55034480	2e5d54e8-b4da07e8-382932ca-35a87571-9089a9fb
2451	left upper lobe volume loss is similar to prior study . there is no new consolidation, effusion, or pneumothorax . leftward mediastinal shift is unchanged . posterior fracture of the left sixth rib is unchanged . fracture of the two uppermost mediastinal wires is stable . stable left lung volume loss after left upper lobe lobectomy .	No Finding	11378150	55092691	3b9b84d5-b76eb1db-a43caa85-b33c92a4-4ed50db2
2452	there is no pneumothorax or pleural effusion . cardiac size is normal . patient has severe emphysema . bilateral chest tubes are in unchanged position . multifocal consolidations in the upper lobe and lower lobe bilaterally, worse in the left upper lobe and right lower lobe have increased in the right lower lobe, consistent with multifocal pneumonia and or hemorrage . severe subcutaneous emphysema in bilateral chest wall is unchanged . et tube is in standard position . ng tube tip is in the stomach . there are no other changes from eight hours before .	Consolidation&&Pneumonia&&Support Devices	16751749	57915081	e4c3ba18-a70b953e-2a8ca4d7-ea576b97-ced50e07
2453	previous vascular congestion has improved, and moderate cardiomegaly is smaller . the left major fissure is delineated by a roughly cm long radiopacity superolateral to it . this could be either pneumonia in the left upper lobe or fissural pleural effusion . it has been present since . it may require ct scanning to distinguish between these two possibilities . left internal jugular line ends at the origin of the svc and a dual-channel right supraclavicular dialysis catheter ends in the right atrium . no pneumothorax . i discussed these findings by telephone .	Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	18906643	56984180	39bea45f-8269a068-67fbcd81-495f87cc-bde587cb
2454	midline sternotomy wires and mediastinal clips are again noted . the previously noted port-a-cath has been removed . the lungs are clear bilaterally without focal consolidation, effusion, or pneumothorax . cardiomediastinal silhouette is stable . bony structures are intact . no free air below the right hemidiaphragm is seen . no acute findings in the chest .	No Finding	12124741	53352013	783fc94d-12b747b1-600f2e10-c1c51d2a-97240f95
2455	right ij access dialysis catheter again noted with its tip in the region of the right atrium . increased retrocardiac opacity raises concern for pneumonia . findings appear progressed from prior exam . the heart size is stable . no pneumothorax or pleural effusion . mediastinal contour unchanged . hilar congestion again noted . . retrocardiac opacity concerning for pneumonia . . hilar congestion .	Lung Opacity&&Pneumonia	16508811	57988903	8d8b26e3-3c8ee293-aad9533f-8fc6f107-c58c3f36
2456	extensive right pleural effusion, potentially combined with some degree of pleural thickening, relatively extensive atelectatic changes in the right lung bases . the extent of the ventilated lung parenchyma on the right is small and located around the right perihilar areas . unremarkable left heart border, moderate tortuosity of the thoracic aorta . normal appearance of the left lung without evidence of parenchymal changes or left pleural effusion .	Atelectasis&&Pleural Effusion&&Pleural Other	11569093	50008596	2f108c10-c8669b9a-f7f02e0f-272d2904-dd0b345e
2457	pa and lateral views of the chest there is mild enlargement of the cardiac silhouette which is unchanged . mediastinal and hilar contours are stable . the pulmonary vascularity is not engorged . chronic interstitial abnormalities are again seen diffusely, more pronounced at the lung bases with fibrotic changes . no focal consolidation, pleural effusion or pneumothorax is identified . there is diffuse calcification of the aorta . no acute cardiopulmonary abnormality . chronic interstitial lung disease, which on the prior ct of the chest from suggested usual interstitial pneumonia .	Lung Opacity&&Pneumonia	19640059	57629666	2f7e40ab-fd3ebb8f-1f00d1a6-1aecdf69-793d8d35
2458	a single ap chest view was obtained with patient in semi-upright position . comparison is made with the next preceding chest examination of . status post sternotomy and moderate cardiac enlargement as before . no pulmonary vascular congestion is identified . a significant new finding consists of bilateral nodular densities widely disseminated in both lungs, preferentially in the lower lobes . otherwise, no new chest abnormalities are identified on this single-view examination as the lateral pleural sinuses are free and there is no evidence of pneumothorax in the apical area . appearance of multiple nodular densities in both lungs highly suggestive of secondary metastases in this patient with history of gi bleed . referring physician, . was notified via page at pm .	Cardiomegaly&&Lung Lesion	16773796	54715799	b8f0ce5f-ae088cd3-92d27847-3b4570bb-1305056f
2459	specifically, there is no evidence of pulmonary vascular congestion or acute focal pneumonia . cervical fusion device is seen .	No Finding&&Support Devices	15114531	57221524	f43ed85f-f693419c-ca41ad14-854149c7-81bf7afe
2460	endotracheal tube is seen with tip approximately cm from the carina . otherwise, there has been no significant interval change . bilateral parenchymal opacities suggestive of edema are seen noting that infection cannot be excluded .	Edema&&Lung Opacity&&Pneumonia&&Support Devices	15131736	50677639	2f1dce28-88730e39-d63f2655-c6d7afd5-b3868e09
2461	new endotracheal tube and left internal jugular line are in standard placements respectively . small bilateral pleural effusion, left greater than right, unchanged over nine hours . left lower lobe atelectasis, moderate-to-severe, unchanged . possible destructive lesion, anterior aspect, right fifth rib is without correlation on recent abdomen ct . suggest detailed rib views when feasible .	Atelectasis&&Pleural Effusion&&Support Devices	12433421	57966185	8b8058e3-2e73b083-ad0be703-248c6dde-e81698ed
2462	comparison is made with prior study performed hours earlier . new et tube tip is cm from the carina and could be withdrawn a couple of centimeters for more standard position . aeration of the lungs has improved . small right and small-to-moderate left pleural effusions are unchanged . there is less atelectasis in the left lower lobe . left ij catheter tip is in the upper to mid svc . ng tube tip is out of view below the diaphragm . cardiomegaly is stable .	Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices	11607628	52031993	c1016405-3f0dea97-b9f2b667-dcebc0d2-67732c57
2463	there is again a small apical pneumothorax . areas of opacification in the right lower and left upper lung are decreasing .	Lung Opacity&&Pneumothorax	19182863	55691383	74c3dfed-ea7a4283-d0682584-6835d770-f9eff630
2464	ng tube tip is in the stomach . et tube is in the standard position . right picc tip is at the cavoatrial junction . transvenous pacer leads are in standard position . cardiomegaly is stable . there are persistent low lung volumes . pulmonary edema has improved, now mild to moderate . bibasilar opacities, right greater than left, are a combination of pleural effusions and atelectasis .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	18322589	54432661	a6570b30-b8ae383d-4d11eb8e-49ea1084-6c57d8a8
2465	in comparison with scout image from ct from , again seen is a large left perihilar mid-to-lower lung opacity which on the prior ct corresponded to innumerable pulmonary nodules, although superimposed infection cannot be excluded . nodular opacities in the right lung to a lesser extent than on the right are again seen . there is blunting of the left costophrenic angle likely corresponding to pleural effusion and is also seen on prior ct . left greater than right pulmonary opacities similar as compared to scout image from ct from , given differences in technique, although superimposed infectious process cannot be excluded . slight blunting of the left costophrenic angle is likely due to small left pleural effusion .	Lung Opacity&&Pleural Effusion&&Pneumonia	12702423	58466818	2dbe3e39-beef7811-9031988b-a6c7348b-c98a9ab6
2466	allowing for the ap projection, there is good expansion of the right lung with no evidence of acute pneumonia or pneumothorax . fracture of the mid shaft of the right clavicle with overriding of the fragments and several rib fractures on the right are seen .	Fracture	15938635	56495546	2f2f5511-1fc4dccc-bbc1203a-f97f7298-b099de12
2467	prior right ij line is no longer visualized . there are new bibasilar regions of consolidation . indistinct pulmonary vascular markings seen more superiorly . the cardiac silhouette is enlarged but stable in configuration . there is vertebral body height loss of a mid thoracic vertebral body and severe height loss in a lumbar vertebral body which based on frontal projection were likely present on . no acute osseous abnormality identified . bibasilar regions of consolidation compatible with infection in the proper clinical setting . superimposed component of vascular congestion .	Consolidation&&Edema&&Pneumonia	19454978	52686545	3a0553aa-9c31867a-e614b9d9-628054fd-27e6053f
2468	the patient has received a dobbhoff catheter . the tip of the catheter projects over the middle parts of the stomach, the course of the catheter is unremarkable, there is no evidence of complications, notably no pneumothorax . borderline size of the cardiac silhouette . mild areas of atelectasis at the left and right lung bases . no evidence of other parenchymal opacities, notably no evidence of pneumonia .	Atelectasis&&Cardiomegaly&&Support Devices	16853729	52489936	c9532e5b-e9cb7923-1d3cf2ef-05e252e8-dcf11149
2469	the heart is at the upper limits of normal size . the mediastinal and hilar contours appear unchanged . there is mild interstitial abnormality suggestive of slight fluid overload, but no focal consolidation . the lungs are hyperinflated . there is no pleural effusion or pneumothorax . a moderate anterior wedge compression deformity situated along the lower thoracic spine appears unchanged since the prior studies . similar mild interstitial abnormality which could be seen with slight fluid overload .	No Finding	13475033	51259731	a3c40907-043e8021-0482ce61-34670856-7cd45fdf
2470	endotracheal tube tip is . cm above carina . enteric tube tip in the proximal stomach . right ij central line tip in the low svc . cardiac pacemaker in place . there are chronic rib fractures . lungs are clear . surgical in the abdomen . enteric tube tip is in the proximal stomach .	No Finding&&Support Devices	18487334	59981256	92a2a181-8f508ced-b3cb8aae-f4da8efa-3df4edc0
2471	moderate cardiomegaly is longstanding . there is no particular vascular engorgement, no edema and no pleural effusion . transvenous right atrial pacer and right ventricular pacer defibrillator leads follow their expected courses, unchanged . new left pic line ends at the junction of brachiocephalic veins .	Cardiomegaly&&Support Devices	17763117	59357257	937a086b-d6d3022b-88e3053e-885699b2-46431cc5
2472	opacities at the right lung base have decreased compared to the preceding radiographs from and . the remainder of the lungs are clear . mild cardiomegaly is unchanged . the mediastinal contours are unchanged . blunting of the right costophrenic angle suggests a tiny effusion . there is no definite left-sided effusion . no pneumothorax . . decreased right basilar opacities, likely resolving atelectasis . . likely trace right pleural effusion .	Atelectasis&&Lung Opacity&&Pleural Effusion	16050730	54240852	525c7667-53fd7624-6f104340-1895a29c-1ee766f1
2473	the lung parenchyma is diffusely increased in density . this is mainly caused by an increase in interstitial structures and subtle alveolar opacities . there are b lines and small effusions are still present . in combination with the obvious cardiomegaly, moderate-to-severe interstitial pulmonary edema is to be suspected . referring physician . was paged for notification at the time of dictation, am, on .	Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	15419510	51288835	5ae25c72-34cb9d49-a4da40d2-b675e012-73e45602
2474	pulmonary vascular congestion has worsened appreciably since pm . lung volumes remain exceedingly low from chronic elevation of the diaphragm . the heart is at least mildly enlarged, exaggerated by low lung volumes and mediastinal vasculature chronically dilated, is more distended today . no pneumothorax .	Cardiomegaly&&Edema	18338007	54174765	6d7e8320-4a212d21-d96325bf-9360fb31-20719637
2475	there is hazy left basilar opacity which has been seen on multiple previous examinations . elsewhere the lungs are clear of consolidation . enlargement of the cardiac silhouette is similar compared to prior and likely exaggerated by portable technique and prominent mediastinal fat . atherosclerotic calcifications noted throughout the aorta . persistent left lower lung opacity potentially atelectasis or scarring given findings on multiple priors . please note that superimposed infection is not entirely excluded . consider pa and lateral for further assessment if desired .	Atelectasis&&Lung Opacity&&Pneumonia	14841168	59573711	fb8b94a3-98ec59dc-d148e378-62063c90-58baaa12
2476	the endotracheal tube has been removed . the patient has taken a slightly better inspiration . continued enlargement of the cardiac silhouette without definite pulmonary edema . atelectatic changes are seen at the bases . some coarseness of interstitial markings raises the possibility of underlying chronic pulmonary disease . right ij catheter tip is in the mid-to-lower svc .	Atelectasis&&Cardiomegaly&&Lung Opacity&&Support Devices	15809646	53528690	bed7c512-ac375506-2b7022e0-a8e257bc-dfe0c8c2
2477	one semierect portable ap view of the chest . endotracheal tube ends cm from the carina . the right internal jugular line ends in the mid svc . a left subclavian line ends in the low svc . ng tube tip is out of view . the moderate left pleural effusion is unchanged . the right pleural effusion has increased and is now small to moderate in size . there is decrease in mild pulmonary vascular engorgement and no pulmonary edema . no opacities concerning for pneumonia . the heart and mediastinum are normal . no pneumothorax . . stable left moderate pleural effusion . increased right pleural effusion, now small to moderate in size . . no pulmonary edema . decrease in mild pulmonary vascular engorgement .	Pleural Effusion	15758946	56167449	97e428ce-51d4215e-210ed55c-4327be47-4a10e46c
2478	the et tube is low, . cm above the carina . there are increased lung markings bilaterally in this patient with known bilateral basilar atelectasisinfiltrateaspiration . an ij line tip is at the cavoatrial junction .	Atelectasis&&Lung Opacity&&Support Devices	10975446	53843466	f5694e30-74276190-ca787eed-b4262479-f73aec86
2479	midline sternotomy wires and prosthetic cardiac valves are redemonstrated . the heart is stable and top normal in size . there is improvement in overall pulmonary aeration with minimal lower lung atelectasis . no pneumothorax or pleural effusion is seen . bony structures are intact . improved aeration in the lungs with no effusion and mild bibasilar atelectasis .	No Finding	19182863	55661010	010357e5-15fa3bea-a68903e4-6326524d-9a77b7db
2480	comparison is made to previous study from . there is again seen a left-sided central venous line with the distal lead tip in the mid svc . there is again seen whiteout of the entire right lung . a pleural catheter is seen at the right base . there is some prominence of the pulmonary interstitial markings in the left lung without definite consolidation . overall, these findings appear relatively stable . there has been prior surgery in the right upper lung with removal of a portion of a rib .	Lung Opacity&&Support Devices	13263843	58632637	1f47d792-eda2bffe-f8173c15-50577b80-bfbd2e17
2481	small biapical pneumothorax unchanged since earlier in the day . pleural tubes removed . moderate left lower lobe atelectasis and small accompanying pleural effusion also stable . heart size top normal . normal postoperative cardiomediastinal silhouette . right jugular line ends in the upper right atrium, unchanged .	Atelectasis&&Pleural Effusion&&Pneumothorax&&Support Devices	16043240	50307780	05422169-24d04e58-5084d62b-7d1d9ce1-16bfe2af
2482	there is an irregular rounded opacity in the left mid lung zone, which was previously seen on and and thought to represent an area of round atelectasis which has resolved in the interim and recurred . bilateral pleural plaques and pleural thickening is unchanged from prior studies . increased hazy opacification of the lungs may represent mild pulmonary edema . no pleural effusion or pneumothorax is detected . the cardiac silhouette is mildly enlarged but stable . prominence of the mediastinum is unchanged with tortuosity of the thoracic aorta . the lungs remain hyperinflated suggesting copd . . recurrent rounded atelectasis in the left mid lung as seen on the prior ct of . . asbestos related lung disease . . hazy opacification of the bilateral lungs may represent mild pulmonary edema .	Atelectasis&&Edema&&Lung Opacity	15809646	57372388	f2029c31-2acb877f-a7000d23-c119d2f1-b5d4844b
2483	patient is status post median sternotomy . right-sided port-a-cath tip terminates in the upper svc, unchanged . cardiac silhouette remains moderately enlarged but unchanged . multiple calcified mediastinal lymph nodes are again demonstrated suggestive prior granulomatous disease . the mediastinal and hilar contours are otherwise unremarkable . lung volumes are persistently low with streaky atelectasis seen in the right lung base . no focal consolidation, pleural effusion or pneumothorax is seen . the pulmonary vasculature is not engorged . persistently low lung volumes with streaky right basilar atelectasis .	Atelectasis	11413236	51644170	68fca727-3938158e-eb97e5dc-141e63e2-53d66c78
2484	lung volumes are lower exaggerating what is at least worsened moderate pulmonary edema . more focal areas of opacification in the lateral left mid lung and infrahilar right lung could be atelectasis and edema but pneumonia is of serious concern . the moderately enlarged cardiac silhouette and dilated pulmonary arteries are larger today, and there is more mediastinal vascular engorgement . dual channel right supraclavicular central venous line ends in the upper right atrium as before . there is no appreciable pleural effusion and no pneumothorax .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pneumonia&&Support Devices	17340686	53247313	54a9e5bc-2d3b9e9a-43c44b54-7c16e7b1-f923f86c
2485	since the prior study, there is no change in extremely irregular opacification of both lungs, mostly involving the right lung with slight interval improvement in particular in the right mid lung . this improvement, which is rapid, most likely reflects the element of pulmonary edema . pneumonia improvement over such a short period of time would be less likely, although still possible .	Edema&&Lung Opacity&&Pneumonia	12475198	52676650	fa8076ac-14c9330b-4614e083-9dad73d7-6d91e842
2486	comparison is made to previous study from . the endotracheal tube and right-sided ij central venous line are unchanged in position and appropriately sited . there is also a left-sided subclavian catheter with distal lead tip in the proximal svc . there is stable cardiomegaly . there are again seen bilateral pleural effusions and a left retrocardiac opacity . there are no signs for overt pulmonary edema . there are no pneumothoraces .	Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	11204646	51866834	ae0ca9f1-a6aa65c0-b8754692-be29d5b4-8ce0e6ff
2487	heart size remains mildly enlarged . aortic knob is densely calcified . the mediastinal contour is unchanged . right hilar opacity is similar to the previous examinations . rounded opacity projecting over the right mid lung field likely reflects fluid loculated within the major fissure . a moderate right pleural effusion and trace left pleural effusion are noted, and there is mild pulmonary edema . patchy opacity in the lung bases may reflect atelectasis but infection or aspiration is not excluded . no pneumothorax is present . emphysematous changes are again seen in the lungs . . mild pulmonary edema and moderate size right and small left pleural effusions . small amount of fluid is loculated within the right major fissure . . patchy opacity in the lung bases may reflect atelectasis but infection or aspiration cannot be excluded . . unchanged chronic right hilar opacity .	Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia	19720782	57501180	6849debe-9dbcc764-0a6286d7-242f3a36-43c4b94c
2488	there are lower lung volumes . bibasilar atelectasis have increased . right port a cath tip is in the is confluence of the brachiocephalic vein . there is no pneumothorax . cardiomegaly is stabl .	Atelectasis&&Cardiomegaly	11413236	54517998	93173301-ef0856de-7bf3d950-005faeed-a2f8a466
2489	overall cardiac and mediastinal contours are stable . calcified hilar lymph nodes are consistent with known sarcoidosis . deformity of the right upper chest wall with some right lateral pleural thickening and scarring and volume loss in the right medial lung base are stable . the left hemidiaphragm is now better visualized and no developing airspace consolidation is appreciated . no pulmonary edema . no pneumothorax . lower thoracic vertebroplasties best visualized on the lateral projection .	Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Other	11474065	53521887	c1735f23-afbc50c0-23b33129-f274cfa7-737f29c2
2490	the patient is status post median sternotomy and cabg . the heart size remains moderately enlarged . the mediastinal contour is unremarkable and unchanged . mild pulmonary vascular congestion is improved compared to the previous exam . retrocardiac streaky opacity likely reflects atelectasis . blunting of the right costophrenic sulcus suggests that there may be a trace pleural effusion . no pneumothorax is identified . degenerative changes of the right glenohumeral joint with joint space narrowing and osteophytic spurring is present . mild pulmonary vascular congestion and retrocardiac atelectasis .	Atelectasis&&Edema	16672854	57752575	3478fd3c-a34b3e6d-0a9a1cf3-726cb9cd-ec1381aa
2491	the right internal jugular line tip is at the level of low svc . heart size and mediastinum are stable . bibasal areas of atelectasis have progressed in the interim . there is interval improvement of the left perihilar opacity . no pneumothorax or interval increase in pleural effusion demonstrated . pleural plaques along the left chest wall are redemonstrated as well as the rib fractures .	Atelectasis&&Cardiomegaly&&Enlarged Cardiomediastinum&&Fracture&&Lung Opacity&&Pleural Effusion&&Support Devices	14851532	50625218	52d136b0-5d17c0a3-0a234b7d-4bd4ad14-707309d5
2492	frontal and lateral views of the chest demonstrate left pic catheter tip projecting over distal svccavoatrial junction . no pneumothorax . bilateral multifocal consolidations involving predominantly right lung, possibly also involving the lingula appear more conspicuous from exam . small bilateral pleural effusions are present . there is no pulmonary edema . hilar and mediastinal silhouettes are unremarkable . heart size is normal . the partially imaged upper abdomen is unremarkable . . multifocal consolidations, predominantly involving the right lung, possibly also involving the lingula, appear more conspicuous from exam, compatible with multifocal pneumonia .	Consolidation&&Pneumonia	16662264	56007699	4d0cd285-e11ff67a-d4f1a9ed-0286ae1b-f74190b1
2493	the patients chin obscures visualization of the lung apices . stable linear opacification in the left mid lung likely represents atelectasis or scarring . calcified bilateral pleural plaques are again seen . no new focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is detected . cardiomegaly persists . the aorta is tortuous with calcification . stable cardiomegaly without radiographic evidence for acute change .	Cardiomegaly	17838301	50037760	0788829b-5419d8e4-5ce8eb81-87a77c03-98c15a1a
2494	cardiac size is normal . the aorta is tortuous . there is known severe emphysema . the patient is status post right upper lobe resection . small bilateral pleural effusions have minimally increased on the right . surgical chain projects in the right upper lobe . the lungs are grossly clear . no new abnormalities .	Pleural Effusion	16622813	50921860	066a59e3-316782a3-2d4238bc-d5354678-1ec6dcd9
2495	single portable view of the chest is compared to previous exam from . tracheostomy tube is again noted . left picc tip is not clearly delineated on the current exam . again there is mild pulmonary vascular congestion . streaky opacities at the lung bases suggestive of atelectasis however infection cannot be excluded . cardiomediastinal silhouette is stable as are the osseous and soft tissue structures . no significant interval change since prior . pulmonary vascular congestion . bibasilar opacities potentially due to atelectasis however, infection is not excluded .	Atelectasis&&Edema&&Lung Opacity&&Pneumonia	10268877	54137212	e279d10a-22b3d14a-0527c87a-bbd31c9b-de232422
2496	the monitoring and support devices are constant . low lung volumes, borderline size of the cardiac silhouette . mild pulmonary edema . moderate retrocardiac atelectasis . no evidence of pneumonia .	Atelectasis&&Cardiomegaly&&Edema&&Support Devices	19623993	55786650	12d4cda1-a51a4015-46e05368-b984cb4f-10b1be5c
2497	again seen is severe enlargement of the cardiac sillouhette . there is no focal consolidation, pleural effusion, or pneumothorax . the mediastinal and hilar contours are unchanged . a right central venous catheter has been removed . severe enlargement of the cardiac siillouhette, unchanged, likely cardiomegaly .	Cardiomegaly	12963531	50827294	ddd9741c-9e15a25a-d4b08e32-9ee083c4-b7671def
2498	mild to moderate vascular congestion has increased . bibasilar atelectasis have increased . if any there is a small right effusion . no other interval change from prior study .	Atelectasis&&Edema&&Pleural Effusion	13473495	53400246	3b45981c-22a218c1-895088c8-70cb300c-bb013a16
2499	ongoing filling of the left pneumectomy cavity with fluid . the position of the air-fluid level is comparable to yesterdays image . unchanged position of the mediastinum . unchanged appearance of the right lung . no evidence of pneumonia .	Enlarged Cardiomediastinum	12410066	53759718	49161810-83365478-dc512674-770d2cd4-ed6f7f77
2500	et tube tip is cm above the carinal . ng tube tip is in the stomach . vascular congestion is mild to moderate . there is no appreciable pleural effusion . there is no pneumothorax .	Edema&&Support Devices	15131736	52259319	f3ef0ecb-ccfce0d5-19aa565a-74bee17a-411e1628
2501	the lateral views are somewhat underpenetrated in part due to the patients overlying arm . given this, there is persistent mild elevation of the right hemidiaphragm . minimal left basilar atelectasis is seen . there is no focal consolidation . no large pleural effusion is seen . slight blunting of the right costophrenic angle is chronic . the cardiac and mediastinal silhouettes are grossly stable as comparison with . no overt pulmonary edema is seen . likely left basilar atelectasis . otherwise, no acute cardiopulmonary process .	Atelectasis	14841168	57041570	cd4c13d7-949c45ee-8508ec30-c9fed36f-bea3a8f6
2502	postoperative mediastinum with median sternotomy wires in place and multiple surgical clips . heart size is normal . diffuse right greater than left opacities have progressed compared to prior study in the background of emphysema . no large pleural effusion or pneumothorax . diffuse right greater than left pulmonary opacities likely representing pulmonary edema in the background of severe emphysema .	Edema&&Lung Opacity	13921768	53297811	1816d50c-d9282769-fd97cb8d-d105e548-27569b20
2503	the et tube tip is . cm above the carina . the right picc line tip is at the level of low svc . cardiomediastinal silhouette is unchanged . extensive consolidations throughout the lungs are demonstrated with slight improvement at the level of mid left lung . bilateral pleural effusions are unchanged .	Consolidation&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	13078497	59307024	d60ada4f-e51bcc38-d167a258-52f452e1-8dc95433
2504	moderate to severe cardiomegaly is chronic . compared to , pulmonary vascular congestion has improved and there is no pulmonary edema . small left pleural effusion is likely, also improved . patient has had median sternotomy and mitral valve replacement . right supraclavicular dual channel catheter, commonly used for hemodialysis, ends in the right atrium . transvenous left ventricular pacer and right ventricular pacer defibrillator leads are unchanged in their respective positions . the atrial lead cannot be traced . lateral view recommended .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	19759491	53202055	c4d47932-145d1a89-7f6d200d-9b16a4d6-84c0d0f0
2505	heart size is enlarged . mediastinum is stable . multifocal opacities are present, overall similar to previous study but potentially minimally improved . no appreciable pneumothorax . old rib fractures, unchanged .	Cardiomegaly&&Fracture&&Lung Opacity	14851532	50875682	264b88e4-6c089e5c-86f6e75e-aba9afc2-5effc446
2506	interval placement of right internal jugular central venous catheter, with tip terminating in the body of the right atrium, with no visible pneumothorax . low lung volumes accentuate the cardiac silhouette and bronchovascular structures . even allowing for this factor, there are apparent new perihilar opacities, particularly in the right infrahilar region . this is concerning for acute aspiration given rapidity of development . bilateral upper lobe fibrosis is again demonstrated and may be due to sarcoid or other granulomatous process .	Cardiomegaly&&Lung Opacity&&Pleural Other&&Support Devices	10933609	51816597	b6958192-e9ba61f7-b0d3e5ab-5562c733-a0ad2714
2507	pa and lateral chest radiographs were provided . lung volumes are significantly low . there is no focal consolidation, pleural effusion or pneumothorax . there is bibasilar atelectasis . the cardiomediastinal silhouette is unchanged . median sternotomy wires are intact . a right chest wall port-a-cath terminates at the cavoatrial junction . there is no free air under the hemidiaphragms . osseous structures are intact . low lung volumes but no acute process and no evidence of free peritoneal air .	No Finding	11413236	56921446	154a0276-f9cc72dc-9907f2e1-f1f11272-93cc90ff
2508	the et tube tip is . cm above the carina . the ng tube tip passes below the diaphragm terminating in the stomach . bilateral opacities appear to be unchanged, in particular involving lower lungs . cardiomegaly is severe and unchanged .	Cardiomegaly&&Lung Opacity&&Support Devices	13473495	50904351	7fd5a9f9-eb754381-b51f8e5c-136df0a1-c34d6fc8
2509	the right picc has been removed in the interim . the lungs are well-expanded and clear . no focal consolidation, effusion, edema, or pneumothorax . the heart size is normal . the mediastinum is not widened . surgical clips project over the left upper quadrant, unchanged . anterior spinal fixation in the lower cervical spine is partially imaged . multilevel degenerative changes in the thoracic spine are mild . rightward curvature of the thoracic spine could be positional though was also present on . no focal pneumonia .	No Finding	15114531	59688743	09eef487-ce5f18a5-ba553a04-30f2617c-4f4a6692
2510	views were obtained of the chest . innumerable pulmonary metastases are re-demonstrated and better assessed on the recent ct without intervally developed focal consolidation, pleural effusion or pneumothorax . the esophageal stents again project over the upper abdomen consistent migration into the stomach as depicted on the recent ct . the heart and mediastinal contours are unchanged with postsurgical changes noted in the mediastinum . osseous abnormalities described in the recent ct are not well assessed on the current examination . innumerable pulmonary metastases and migrated esophageal stents, residing within the stomach, without evidence of acute process .	No Finding	16773796	53607277	b1009aff-e698f80d-330e0345-8dc761eb-889e6c69
2511	limited evaluation due to respiratory motion especially in the lower lungs . the previously seen right basilar patchy opacity appears improved . a granuloma is seen in the right upper lobe . the interstitial markings are slightly prominent due to patients known emphysematous changes of the lungs . the cardiomediastinal silhouette and hila are normal . an icd device is seen . rue picc line ends in the distal svc . there are no displaced rib fractures . limited, negative . picc in appropriate position . limited evaluation due to motion artifact, repeat cxr might be considered .	No Finding&&Support Devices	16059470	57192814	a78450bf-630d9aa5-d48a79f1-41a5d2c2-802321fb
2512	ap upright radiograph re-demonstrates satisfactorily positioned endotracheal tube, left subclavian catheter and nasogastric tube with slightly decreased lung volumes and possibly slight interval increase in degree of mild interstitial edema . left basal atelectasis is increased with slight right basal atelectasis and effusions not well seen on this study possibly due to positioning . enlarged pulmonary arteries suggest pulmonary arterial hypertension .	Atelectasis&&Edema	10268877	51623828	9dcbd7ac-9d6ca173-f7e669fd-bb419597-97f58083
2513	there has been a right thoracentesis with removal of a substantial amount of fluid from the pleural space . no evidence of pneumothorax . mild atelectatic changes at the right base . otherwise, little change .	Atelectasis	19182863	50171741	27975aed-15b0a97c-df48c48f-85f941bc-eef08eea
2514	compared to the study from the prior day, there is no significant interval change .	No Finding	13078497	58226576	fd439b65-e984a9f7-40022797-f1661b2b-8687abfc
2515	the monitoring and support devices are unchanged . opacification at the right base is unchanged, again consistent with collapse of the middle and lower lobes . the left lung remains clear .	Atelectasis&&Lung Opacity&&Support Devices	14841168	59061065	f74a6e2d-7ecce9f0-cf647641-73115c8d-2af49e3d
2516	in comparison to chest radiograph, a very subtle opacity has developed at the right lung base in could potentially represent an early focus of pneumonia . no other relevant change .	Lung Opacity&&Pneumonia	18487334	58899269	96f00041-94cc6063-63bfa4e2-d764e039-a73d562c
2517	pa and lateral views of the chest are compared to previous exams from and . linear opacities at the left greater than right base are suggestive of subsegmental atelectasis . mildly indistinct pulmonary vascular markings are seen suggestive of mild failure however, there is no definite confluent consolidation . small left pleural effusion is seen . cardiac silhouette is enlarged but stable . again seen is a prosthetic valve . median sternotomy wires are again seen with fracture at the inferior most wire . osseous and soft tissue structures are otherwise unremarkable . mildly indistinct pulmonary vascular markings suggestive of mild failure without frank pulmonary edema .	No Finding	13606683	58107496	d03946f6-e754867a-37047566-61f55fee-16408685
2518	the left lung is well expanded and clear . the right lung shows a persistent right lower lobe opacity with an associated effusion, mildly progressed from the preceding radiograph . the cardiomediastinal silhouette, and hilar contours are normal . no pneumothorax is present . old bilateral rib fractures are noted . right lower lobe opacity, possibly atelectasis, with associated moderate sized effusion .	Atelectasis&&Lung Opacity&&Pleural Effusion	13352405	55176260	93ca5245-a3a6c687-b3723eb4-4e89b56b-3cda2cc7
2519	left lower lobe collapse has improved . moderate bilateral pleural effusion is present, stable on the left, increased on the right and there is a suggestion of new consolidation in the right lower lobe that could be a large pneumonia . confirmation with conventional radiographs recommended when feasible .	Atelectasis&&Consolidation&&Pleural Effusion&&Pneumonia	12433421	51301343	c84df635-43b1c5bd-cbd8fd29-e41b2428-dae6a1b9
2520	as similar to multiple prior exams, there is a relative hazy density in the bilateral hilar regions with pulmonary vascular indistinctness . the hemidiaphragms are not well defined . the cardiomediastinal silhouette is markedly enlarged with widening superiorly and an enlarged cardiac silhouette inferiorly . the patients chin overlies the lung apices, limiting the evaluation . no gross pneumothorax is seen . limited study due to body habitus . there are low lung volumes which result in bronchovascular crowding, but beyond that there is likely moderate pulmonary edema presumably cardiogenic in etiology . there may also be small bilateral pleural effusions .	Edema&&Pleural Effusion	16855430	58324748	c8591b84-dfb9bd0c-54f0a9f4-e5258ccd-4fec4b57
2521	the lungs are low in volume but otehrwise clear . left hemidiaphragm is somewhat obscured in its lateral-most component, though this could be projectional . the left lung base is poorly imaged . there is no definite pleural effusion or pneumothorax . stable marked cardiomegaly is noted . questionable opacity in left base . when the patients clinical status improves, repeat evaluation by pa and lateral chest radiograph is recommended to exclude a pleural effusion or left basilar parenchymal process .	Lung Opacity	12340737	51192088	eae9b998-2b29a12b-6d6fd4c2-8227ce7b-7f1c4262
2522	comparison is made to the prior study from at am . there is again seen a very large right-sided hydropneumothorax . there is collapse of the right lung . a right basilar pleural catheter is again seen on the edge of the film . there has been decrease in the size of the pleural effusion density on the right however, this may be partially due to positioning .	Atelectasis&&Pleural Effusion&&Pneumothorax&&Support Devices	14387068	57824615	d10ce07f-f461b9b2-314b3356-7fb190a4-1dac6294
2523	no consolidation, pleural effusion or pulmonary edema is seen, and the cardiac silhouette continues to be mildly enlarged . right-sided cardiac device is stable in position with appropriate lead placement unchanged . median sternotomy wires are intact . resolution of previously seen pneumonia .	No Finding	19759491	50910303	de862699-c552320b-11e6f6c8-5087a74f-98f0b80d
2524	lungs are low in volume but clear . there is no pleural effusion or pneumothorax . a left subclavian port-a-cath is seen terminating in the superior cavoatrial junction . heart is top normal in size and normal cardiomediastinal silhouette . slight leftward deviation of the trachea is stable and perhaps due to thyroid enlargement . no acute intrathoracic process .	No Finding	12124741	52979134	ebf694d1-74d14ed6-c1695437-a0c9b0f3-cb905ce8
2525	lungs are clear . no evidence of pulmonary edema or pneumonia . focal opacity over anatomical region of lingula which is perceived only on frontal view represents a pericardial fat . heart size, mediastinal and hilar contours are normal . there is no pleural effusion or pneumothorax . no pulmonary edema .	Lung Opacity	17720924	58245185	b2322fdd-cfe8ca16-f58f8a07-206b7440-5ff93a26
2526	comparison with prior chest radiographs through with the most recent from . a new aicd device with lead positioned through the left transvenous approach end into the right ventricle and is appropriate . no focal lung opacities concerning for pneumonia . heart is top normal size . mediastinal and hilar contours are normal . no evidence of pneumothorax .	Pneumonia&&Support Devices	11540283	51230608	e68bb7df-05039df8-44346b6b-c34ca52e-a92432c7
2527	moderate pulmonary edema is new . bibasilar opacities are a combination of pleural effusion and atelectasis . cardiomegaly is stable . right hd catheter is in the standard position .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	15259244	50758061	43042279-0b8f5bb0-a45d17b6-f8d3b29f-0c787952
2528	cardiac silhouette remains enlarged and is accompanied by persistent pulmonary vascular congestion and interstitial edema . patchy bibasilar atelectasis also appears similar compared to the prior study .	Atelectasis&&Cardiomegaly&&Edema	10975446	58917552	34058be0-81c50b36-9b2c0874-23eca60a-7789a943
2529	the lungs are clear without focal consolidation . no pneumothorax or pleural effusion is seen . there is mild atelectasis seen at the right lung base . a left-sided pacer is present with wires terminating in the right atrium and right ventricle . again noted is a metallic stent projecting over the expected location of the aortic valve . hardware is in the lower thoracic spine with evidence of vertebroplasty . the heart size is enlarged but unchanged . an unchanged wedge deformity is seen superior to the vertebroplasty . stable cardiomegaly without findings of failure . no acute intrathoracic process .	Cardiomegaly	18417750	59381739	35901623-dfa281b0-60bd2a48-cb5eacfb-bbab810e
2530	the lungs are hyperinflated but without focal consolidation . no pleural effusion or pneumothorax is seen . minor left basilar linear atelectasisscarring is again seen . the cardiac and mediastinal silhouettes are stable and unremarkable . no acute cardiopulmonary process . no significant interval change .	No Finding	13881772	58789310	c230ce72-acc26270-caefebe0-f6b07913-7033227d
2531	low lung volumes are present . the heart size is mildly enlarged . mediastinal and hilar contours are unchanged with similar fullness of the superior mediastinum attributable to mediastinal fat . there is no pulmonary vascular congestion . no focal consolidation, pleural effusion or pneumothorax is identified . there are multilevel degenerative changes in the thoracic spine . low lung volumes . otherwise no acute cardiopulmonary process .	No Finding	19028690	50034238	96ea3d09-e928fb3b-dc086815-e0a3d015-45d3b08a
2532	right picc is no longer visualized . the lungs are clear of consolidation or effusion . cardiac silhouette is enlarged but stable . all left posterior th rib fracture is identified . atherosclerotic calcifications noted at the aortic arch . no acute cardiopulmonary process .	No Finding	13353878	54783326	1a81259c-493d3b3c-de7e0965-b13a0f4c-d813d91d
2533	the newly placed dobhoff tube reaches till the lower esophagus and loops back all the way up to the cervical esophagus . consider repositioning the dobhoff tube . since , there are no relevant changes in the lungs . minimal left lower lung atelectasis has improved . no new lung opacities concerning for pneumonia . top normal heart size, mediastinal and hilar contours are stable in appearance . no pleural effusion . on at pm .	Atelectasis&&Lung Opacity&&Pneumonia&&Support Devices	15338518	50410691	a69bfb99-6db10b12-ba4c0c04-51f5d6ea-ecddb834
2534	there is ill-defined opacity in the left upper lobe . there has been interval resolution of the left lower lobe consolidation . heart and mediastinal contours are within normal limits . no pneumothorax is seen . biapical pleural thickening is present . underlying emphysematous changes are noted . left upper lobe pneumonia . recurrent infection in an area that is chronically abnormal may be due to atypical mycobacterial infection . by dr . by telephone at pm . on at the time of discovery of these findings and at the time of wet read request . additional diagnostic consideration of atypical mycobacterical infection was discussed with dr . by dr . by phone at am . on after attending radiologist review .	Pneumonia	11052935	50367895	43b6f8f9-f0d77b57-b2603100-48f5611a-a7405f03
2535	the dobbhoff catheter was advanced . the tip now projects over the proximal parts of the stomach, there is no evidence of complication, notably no pneumothorax . otherwise, the radiograph is unchanged .	No Finding&&Support Devices	18079481	50139124	64c4f3ac-5b12f9d8-de62c4d5-1980be49-28cd96f9
2536	a nasogastric tube passes into the stomach . endotracheal tube terminates approximately cm from the carina . there is increased right mid lung atelectasis . bibasilar opacities were better demonstrated on prior radiographs . diffuse right lung opacity is compatible with layering pleural effusion as seen on subsequest ct of the neck .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Support Devices	12699874	52607450	ef172e96-8c4e23a8-160f096f-b5c584b5-f33c4c0b
2537	there has been interval intubation with the tip of the endotracheal tube positioned . cm above the carina . the right upper extremity access picc line is unchanged . there is increasing bibasilar atelectasis . as above .	No Finding	11022245	55490259	9ca1e240-842fe6d2-5b26c6f5-a9523752-6603498e
2538	right pic line can be traced as far as the junction of the right subclavian and jugular veins . transvenous right atrial and right ventricular pacer leads are unchanged in their respective positions . extensive consolidation in the left lower lobe and accompanying small-to-moderate pleural effusion have varied in size, no larger today than on . mild-to-moderate cardiomegaly and a generally enlarged thoracic aorta are also stable . borderline edema persists in the right lung . nasogastric tube ends in the upper stomach . no pneumothorax .	Cardiomegaly&&Consolidation&&Edema&&Pleural Effusion&&Support Devices	13649937	51183691	2d35647b-697aa705-d56cc89e-da6818b0-3ebe0b23
2539	as compared to the recent radiograph of earlier the same date, and endotracheal to tube has been placed with tip terminating . cm above the carinal . bibasilar opacities have rapidly worsened, particularly at the left lung base . a rapidly of the evolving aspiration or infectious pneumonia should be considered . moderate right and small left pleural effusions have slightly increased in size .	Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	19720782	52336902	916efce3-8ded2d22-21ca5070-3c1635b7-84c51396
2540	no appreciable pneumothorax or right pleural effusion following removal of the right basal pleural drain . mild pulmonary edema collected in the right lower lung . left lower lobe atelectasis is moderate-to-severe and small left pleural effusion is stable . normal post-operative cardiomediastinal silhouette including mild-to-moderate cardiomegaly, improved since pre-operative chest radiograph . nasogastric tube passes below the diaphragm and out of view . transvenous right atrial and right ventricular pacer leads are unchanged in their longstanding positions, including a more medial location than generally seen for the tip of the right atrial lead . swan-ganz or other pulmonary arterial line ends in the right pulmonary artery . no pneumothorax .	Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	10886362	55957472	b2b5a3a4-24b4dc24-84c9e1a5-98f8a217-8c89ba2a
2541	there is no change in position of the monitoring and support devices . unchanged volume loss at the right lung base . unchanged disruption of the right bronchial air column, suggesting mucoid impaction . unchanged borderline size of the cardiac silhouette . no pneumothorax . no pulmonary edema . no evidence of pneumonia .	Cardiomegaly&&Support Devices	11204646	52079096	3ed3a641-a4156d57-ea055912-baebd6d1-30ae3af9
2542	midline sternotomy wires and mediastinal clips are unchanged . the heart size continues to be mildly enlarged . the lungs show increasing opacity with worsening pulmonary vasculature engorgement as well as right lower lung consolidation with air bronchograms, all compatible with worsening pulmonary edema . neither costophrenic sulcus is distinctly sharp, suggesting small pleural effusions . worsening pulmonary edema findings discussed with at am on by over the phone .	Edema	17288844	54644366	adcf4325-aa59cd31-be329869-32fd0147-d3cd1387
2543	left lower lobe collapse andor consolidation and chf with possible small bilateral effusions, similar to at am .	Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Pleural Effusion	13031876	52519155	b7d847bc-3c2c9b05-dcc55b53-b7bd2a6c-f8496f99
2544	views of the chest the lungs are well expanded and show bilateral middle lobe opacities . the cardiomediastinal silhouette and hilar contours are normal . no pleural effusion or pneumothorax is present . bilateral pneumonia is in the right middle lobe and lingula .	Pneumonia	16662264	51773416	0d3c825a-9753f20e-bc1e0aa5-f14f69e5-eaa3adee
2545	there is persistent opacification of the right lower lung field, likely due to known pleural effusion and atelectasis . small left pleural effusion is again noted . overall, there has been no significant interval change . endotracheal tube, left internal jugular catheter, and esophageal catheter are again seen in similar positions with esophageal catheter tip out of view . no pneumothorax is detected . stable chest radiograph .	No Finding	11569093	51887095	7482f461-69260c1c-6d80e1ef-de9d3167-e122de4e
2546	right picc line ends at low svc . moderate right pleural effusion with adjacent lung atelectasis has decreased since . minimal left pleural effusion is unchanged . there are no new lung opacities of concern for pneumonia . heart size, mediastinal and hilar contours are stable . moderate right pleural effusion with adjacent lung atelectasis has improved since .	Atelectasis&&Pleural Effusion	11934114	52152296	67653b61-d4cdc144-670c5d2f-1d19f3a2-480d85a1
2547	there are low lung volumes without focal consolidation, effusion, or pneumothorax . the cardiac silhouette is moderately enlarged, there is stable widening of the mediastinum . pulmonary vasculature appears normal . low lung volumes, without pneumonia or chf . moderate cardiac enlargement is stable in appearance .	Cardiomegaly	19028690	59286076	3706cb8c-281ab1eb-f066978e-bce7d893-4b60bca9
2548	compared to the previous radiograph, the left ij catheter has been removed . there are persistent bilateral pleural effusions along with unchanged opacification of right lung base . this suggests right middle and lower lobe collapse . comparison is limited by patient rotation on current imaging . opacification at the left lung base is unchanged, and pneumonia cannot be excluded .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Pneumonia	11569093	56389746	395a7197-bac16c22-5e75d329-e014f2a8-5d6432e9
2549	portable ap radiograph of the chest was reviewed in comparison to prior study obtained the same day earlier at am . since the prior study, there has been some degree of improvement in the right upper lobe collapse which is still present . right hilar fullness is noted, consistent with post-radiation changes known from prior chest ct from . rightward deviation of the trachea is unchanged .	Atelectasis	12433541	51466579	dd006e88-448a1c0b-b26a6a12-d597b660-cb8279f5
2550	endotracheal tube has been removed . small bilateral pleural effusion left greater than right not appreciably changed . there is new atelectasis at the base of the right lung . left lower lobe has been consistently consolidated and obliteration of the bronchial lumen has been attributed to either aspirate or mucoid impaction . right pic line ends in the mid to low svc . no pneumothorax .	Atelectasis&&Consolidation&&Pleural Effusion&&Support Devices	16313531	55316723	c8432be1-b79e41da-834ae99a-c6cd0b0f-414d4eec
2551	lung volumes are low, leading to crowding of the bronchovascular structures . there is no evidence of focal consolidation, pleural effusion, pneumothorax, or frank pulmonary edema . the heart remains moderately enlarged, although this is accentuated by ap technique and low lung volumes . calcified ap window node is again noted . a right-sided port-a-cath terminates within the upper-mid svc, unchanged in position from the prior exam . low lung volumes without evidence for acute cardiopulmonary process .	No Finding	11413236	53155287	85487fb8-4d1bb78d-357fad99-bd6075d5-8b2da39c
2552	the nasogastric tube is likely coursing through the dilated esophagus and terminates near the gastroesophageal junction . the course is better appreciated on the lateral than on the frontal radiograph and best correlated with a ct torso examination from , to reflect abnormal anatomy .	No Finding&&Support Devices	11569042	56581797	4aeb5cd4-c071f14c-e4dcd046-420ce1ca-f6fedd70
2553	interval improvement in interstitial edema . small bilateral effusions . suture lines are noted in the region of the left upper hemithorax . the opacity in the right upper lobe corresponds to the mass demonstrated better on recent ct . no pleural effusion, pulmonary edema, or focal consolidation to suggest pneumonia . stable cardiomediastinal silhouette . incidental atherosclerosis in the left anterior descending artery . stable post-sternotomy changes . . interval improvement interstitial edema . . stable small bilateral effusions . . stable chronic changes which are followed on ct .	Edema&&Pleural Effusion	14851532	56249524	0fd2483e-20dd0ce1-75329782-17d1ddfd-e4e835a7
2554	cardiac size is top normal . new ill-defined opacity in the left lower lobe is consistent with an infectious process . the right lung is clear . there is no pneumothorax or pleural effusion . mild degenerative changes are in the thoracic spine . findings were discussed by phone with dr . on .	Pneumonia	18343726	54661616	57dd992a-c736b67a-5a1f24e1-fcef3aea-76faae84
2555	single frontal portable view of the chest right cvl and left chest tube are stable in position . bilateral pleural effusions, right greater than left, are unchanged . right lower lobe atelectasis is stable . left lower lobe atelectasis has mildly improved . post-operative cardiomediastinal widening is stable . there is no pneumothorax . previously seen pneumopericardium has resolved . findings were discussed with at am on , via telephone .	Atelectasis&&Pleural Effusion&&Support Devices	16875792	57849643	a466a1e2-24db4349-c068db9b-aae250f4-030ceb1e
2556	compared to the study from the prior evening, there is no significant interval change .	No Finding	13979643	55303241	d5219b78-e506682e-a67ffdcb-c315cb81-f0638101
2557	endotracheal tube has been withdrawn, tip now approximately . cm above the carina with the chin in neutral position . it could be withdrawn another mm to avoid inadvertent unilateral intubation when the chin and neck are in flexion mild pulmonary edema is continuing to improve, and previous left pleural effusion has virtually resolved . heart size normal . upper enteric drainage tube ends in the upper portion of a non-distended stomach but would need to be advanced at least cm to move all the side ports beyond the ge junction . right jugular line ends in the mid svc . no pneumothorax . heart size normal .	Edema&&Support Devices	16334516	55866927	e5ff06eb-15534151-f0889a9a-1ef2a26f-14945911
2558	diffuse interstitial opacities, predominantly in the right lung base and probably very mild in the left lung base are present . when compared to the prior chest ct from , these interstitial opacities appear new, and given the clinical history, likely represent lung infection atypical viral or asymmetric pulmonary edema . in view of history, a possibility of lymphangitic carcinomatosis also needs to be ruled out . compared with prior radiograph from , a dense opacity in the left perihilar region, likely radiation fibrosis has significantly improved over to , as demonstrated on series of chest cts . heart size is mildly larger and unchanged . irregularity of the hilar and mediastinal border is likely postradiation . ill-defined opacity in the left mid lung corresponds to scarring and atelectasis, as suggested on review of chest ct from . pleural effusion, if any, is minimal bilaterally . bilateral lower lung bases are remarkable for mild atelectasis . . diffuse interstitial opacities in the right lung and very mild in left lung base, in view of history most likely reflect lung infection or asymmetric pulmonary edema . a possibility of lymphangitic spread of malignancy also needs to be ruled out in view of clinical history . . irregularity of the mediastinal and hilar contours is attributed to the postradiation changes . . ill-defined opacity in the left mild lung is likely atelectasisscarring as suggested from a concurrent review of ct . follow-up radiograph is recommended at wks to monitor changes . above findings were discussed with dr . on at pm .	Atelectasis&&Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pneumonia	14722763	51766355	9e51895a-9f186f5a-4b0a5de3-44c03a40-204d048b
2559	the lung volumes have decreased . signs of chronic interstitial fluid overload . marked increase of the cardiac silhouette that is now moderately to severely increased . a central venous access line for dialysis has been placed over the right, the tip of the line projects over the right atrium . mild bilateral pleural effusions . no hilar or mediastinal lymphadenopathy . no pneumonia . no lung nodules or masses .	Cardiomegaly&&Pleural Effusion&&Support Devices	12963531	53443143	41d91119-e4864968-f736d803-6295f4df-29c302ea
2560	pa and lateral views of the chest there are low lung volumes . the heart size remains moderately enlarged . the aorta is tortuous but stable . there is mild pulmonary vascular congestion with perihilar haziness . more focal opacities in the lung bases may reflect atelectasis, though infection in these regions cannot be completely excluded . small left pleural effusion appears similar compared to the prior study . no pneumothorax is identified . mild loss of height anteriorly of an upper lumbar vertebral body is unchanged . mild pulmonary vascular congestion and small left pleural effusion . more focal opacities in the lung bases may reflect atelectasis, though infection in these regions cannot be completely excluded .	Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia	16853729	59219088	1fba2de2-36345a9e-ea2ef064-76c702c3-b80e6127
2561	the patient has received a right internal jugular vein catheter . the course of the catheter is unremarkable, the tip of the catheter projects over the mid svc . there is no evidence of pneumothorax or other complication . in the interval, mild pulmonary edema has developed . the known opacity at the lateral aspects of the left hemithorax is constant . constant position of the nasogastric tube and of the sternal wires . at the time of observation and dictation, am, the referring physician .	Edema&&Lung Opacity&&Support Devices	18906643	53157312	f461329d-d6c1fb63-1dbb6294-4837e58c-53a0b617
2562	compared with earlier the same day, a chest tube at the left lung base has been removed . no pneumothorax is identified . again noted is a right ij sheath over the proximal-most svc and a right subclavian central line with tip in region of svc-ra junction, unchanged . allowing for low inspiratory volumes, the cardiomediastinal silhouette is probably unchanged . left base collapse andor consolidation is stablesmall left pleural effusion is unchanged . there is also some increased opacity at the right base, with a small right effusion, which may be slightly worse . there is upper zone redistribution . i doubt overt chf . interval removal of left chest tube . no new pneumothorax or increase in left-sided effusion . equivocal slight increase in opacity at right base .	Lung Opacity&&Pleural Effusion&&Pneumothorax	12124741	53809636	1360763e-71ee973d-a29d16c9-9763397e-37844701
2563	frontal and lateral views of the chest there is no pleural effusion, pneumothorax or focal airspace consolidation . the cardiac silhouette is mildly enlarged . the aorta is tortuous and calcified . the pulmonary vascularity is normal . a linear opacity in the left mid lung is probably scarring from prior pneumonia demonstrated in this region . parenchymal distortion and apical bullous changes are consistent with underlying emphysema . bilateral pleural thickening is redemonstrated, most pronounced at the apices and right upper hemithorax laterally . no new areas of parenchymal consolidation are noted . a left-sided pacemaker is present with wires terminating in the right atrium and right ventricle . degenerative changes are seen in the thoracic spine .	Cardiomegaly&&Consolidation&&Lung Opacity&&Pleural Other&&Pneumonia&&Support Devices	14992360	50425233	d131f617-7810bf73-047f6e2e-16347ff4-e18183e6
2564	heart size is normal . again demonstrated within the right upper lobe and perihilar region is a chronic area of opacification compatible with radiation fibrosis . streaky right lower lobe consolidative opacity is also chronic . mediastinal contours are unchanged with atherosclerotic calcifications noted at the aortic arch . mild pulmonary vascular engorgement is re- demonstrated . small bilateral pleural effusions, right greater than left, are again noted . streaky left basilar opacity may reflect atelectasis but infection is not excluded . known spiculated nodule in the left upper lobe is better assessed on the previous ct . no pneumothorax is present . multilevel degenerative changes are again seen in the thoracic spine . no radiopaque foreign body identified . mild pulmonary vascular congestion with small bilateral pleural effusions, right greater than left . radiation fibrosis in the right upper lobe and right perihilar region and chronic consolidative opacity in the right lower lobe . streaky left basilar opacity may reflect atelectasis though infection cannot be completely excluded . no radiopaque foreign body identified .	Atelectasis&&Consolidation&&Edema&&Lung Opacity&&Pleural Effusion&&Pleural Other&&Pneumonia	19720782	53342490	82c1c97a-b5708e95-baa8ec84-c1237993-93b67d8b
2565	greater opacification at the right lung base since is probably a combination of slight worsening of pulmonary edema that has substantially improved since earlier on has worsened slightly since am . moderate right pleural thickening or loculated fluid is stable since and earlier post-operative study . in the mid portion of the left lung is a flame-shaped region of opacity that could be an early pneumonia . small left pleural effusion and moderate cardiomegaly are stable . no pneumothorax . findings supported by subsequent chest radiograph am . on available at the time of this review .	Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Pleural Other&&Pneumonia&&Support Devices	11474065	56372001	a57921f1-082e4298-c45f0a33-97a652fc-627f468e
2566	linear bibasilar opacity is likely atelectasis . blunting of the left lateral costophrenic angle is again seen, potentially due to additional atelectasis or potentially small effusion . elsewhere, lungs are clear . cardiomediastinal silhouette is stable . old healed right posterior rib fracture is again noted . no acute osseous abnormality . bibasilar atelectasis . possible trace left pleural effusion . otherwise no acute cardiopulmonary process .	Atelectasis&&Pleural Effusion	16853729	54925240	28286aca-22f060d1-344a3628-b2cd36f8-df90a34a
2567	ap upright and lateral views of the chest were provided . the lungs are clear . the heart is normal in size . superior mediastinum appears widened, which could be due to thyroidal enlargement as seen on prior ct . bony structures appear intact . there are prominent anterior spurs noted, however, in the mid t-spine .	Enlarged Cardiomediastinum	13353878	56510605	c5d72977-09300b2f-a22239ad-2c5d50c8-0cc06cf6
2568	chest pa and lateral radiograph demonstrates unremarkable mediastinal, hilar, and cardiac contours . lungs are clear . no pleural effusion or pneumothorax evident . there has been interval placement of a bravo ph capsule projecting in the expected location of the distal esophagus . surgical clips are seen in the upper abdomen . no acute intrathoracic process .	No Finding	15114531	53975458	4f1bb588-0dc670a4-6ec07af4-aa421e00-6bd3d8db
2569	comparison is made to previous study from . there is a left-sided picc line with distal lead tip in the distal svc, appropriately sited . heart size is enlarged but stable . there is a persistent left retrocardiac opacity and likely left-sided pleural effusion . there is prominence of the pulmonary interstitial markings suggestive of minimal fluid overload, slightly worse than on the prior study . no pneumothoraces are seen .	Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Support Devices	16855430	57834224	bf3a5411-5e10c67b-da46d4e3-89978035-8577d0fe
2570	comparison to prior study of at . single portable ap upper chest from at am . . the right costophrenic angle is not entirely included on the study . the lungs appear hyperinflated suggesting underlying emphysema . there are multiple post-surgical changes on the right side, and there is prominent bilateral pulmonary arteries suggestive of pulmonary arterial hypertension . no focal airspace consolidation is appreciated to suggest pneumonia . no pneumothorax is seen . no pleural effusions . overall, cardiac contour is stable and within normal limits . no pulmonary edema .	Cardiomegaly&&Enlarged Cardiomediastinum	16622813	52095390	5a90d178-7f241e16-96da79bd-735b668f-1f777ca8
2571	the patient is status post sternotomy . a dual-lead pacemakericd device appears unchanged with leads again terminating in the right atrium and ventricle, respectively . there is patchy left basilar opacity, also obscuring the left lateral costophrenic sulcus, but somewhat decreased . elsewhere, the lungs remain clear . there are no pleural effusions or pneumothorax . small osteophytes are present throughout the visualized thoracic spine . improving left basilar atelectasis .	Atelectasis	17163861	50065267	83502e58-5ada1fba-450984b0-07c9ec9e-2b5b91b4
2572	there is a -cm irregularly marginated mass in the lingula, which has grown since prior studies . other previous findings including the right lower lobe round atelectasis and bilateral pleural plaquespleural thickening appear similar to prior studies . the cardiac silhouette is stable and top normal in size . the aorta is slightly tortuous but stable in appearance . linear vertically oriented opacity seen in previous chest radiographs appears unchanged, most likely represent scarring adjacent to pleural plaques . lungs are hyperinflated suggesting copd . there is stable persistent blunting of the right costophrenic angle and stable interstitial opacities within the lower lungs . stable multilevel degenerative changes of the thoracic spine are noted . there are scattered areas of focal pleural thickening noted . irregularly marginated -cm mass in the lingula has grown since prior studies . although previously attributed to round atelectasis, its growth and margins raise the potential concern for a slowly growing lung adenocarcinoma . ct of the chest is recommended for further evaluation of this finding . these findings were discussed with dr . via phone at pm . by .	Atelectasis&&Lung Lesion	15809646	52660908	2f0868eb-1a137784-02208ca9-db04ed1a-dfd94665
2573	an endotracheal tube terminates . cm above the carina . in enteric tube terminates in the proximal stomach and could be advanced - cm for ideal positioning . the cardiomediastinal silhouette is stable . low lung volumes . minimal elevation of the right hemidiaphragm is also stable . the left lung base is not visualized . increased opacity at the base of the left lung may reflect atelectasis . there is mild vascular congestion with mild pulmonary edema . no pneumothorax . endotracheal tube . cm of the carina . enteric tube should be advanced - cm for ideal positioning . no pneumothorax . the left lung base is only partially imaged however opacity at the base of the left lung likely reflects atelectasis or aspiration . mild pulmonary edema .	Atelectasis&&Edema&&Lung Opacity&&Support Devices	14841168	54103570	1bc3bed7-2aa120b0-65805fec-266c7e92-f3eebc0a
2574	mild-to-moderate pulmonary edema is new . there is no pneumothorax . small-to-moderate left effusion has increased . small right effusion is stable . cardiomegaly and widened mediastinum are grossly unchanged . there is no pneumothorax .	Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Pleural Effusion	19454978	59405565	dfd72c95-382e12e2-f0574c76-793748ac-3dcf07f0
2575	the monitoring and support devices are constant . constant size of the cardiac silhouette . constant right basal opacity, consisting of a combination of atelectasis and parenchymal consolidation . no new opacities . no pneumothorax . no larger left pleural effusion the lateral parts of the left sinus are not included on the image .	Atelectasis&&Cardiomegaly&&Consolidation&&Lung Opacity&&Support Devices	11880923	54089797	ced4ad92-0b5bdd09-b67b83a8-8f155ad4-de399934
2576	small right pleural effusion, minimally larger than on . no pneumothorax . lungs essentially clear . marked enlargement and distortion of the cardiac silhouette by adjacent tumor is a longstanding phenomenon . there is no evidence of any hemodynamically significant pericardial involvement .	Cardiomegaly&&Lung Lesion&&Pleural Effusion	13023326	57583790	1cdaf07a-2bc25a95-58bb06b1-543156aa-39b0b6ef
2577	as compared to previous radiograph of , cardiomediastinal contours are stable in appearance . lungs are clear, with no new areas of consolidation to suggest the presence of pneumonia . there is no pleural effusion or pneumothorax .	Consolidation&&Enlarged Cardiomediastinum&&Pneumonia	15114531	52382860	bbe6ecaf-aac06564-603fea4c-3e3026e0-8a5cb7c8
2578	the monitoring and support devices are constant . moderate cardiomegaly with minimal fluid overload . retrocardiac atelectasis, combined to a small left pleural effusion . volume loss in the middle lobe . no newly appeared focal parenchymal opacities . no evidence of pneumonia .	Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices	11880923	52510525	c1bef603-3b1cf540-5d36a766-606c560d-9a61f31c
2579	available for comparison is the next preceding similar study obtained six hours earlier during the same day . the patient remains intubated, the ett in unchanged position . diffuse hazy densities over the right hemithorax appear unchanged . the previously described right-sided pleural chest tube remains, but has changed its position, it points more towards the mediastinum at the level of the hilum . no evidence of residual or newly developed pneumothorax . as before, there is some soft tissue emphysema in the axillary area and right lower neck . these findings are unchanged .	Enlarged Cardiomediastinum&&Support Devices	17112432	56192054	d9a018f0-efb2820b-ed7a64b7-c05b8be3-12124812
2580	portable ap upright chest radiograph was obtained . low lung volumes noted . allowing for this, the lungs appear clear . no large effusion or pneumothorax is seen . the cardiomediastinal silhouette appears normal . a calcified granuloma projects over the right lateral mid lung . bony structures are intact . no acute findings in the chest .	No Finding	19928916	54375943	7022a121-c39c1e71-7fc1c7f7-d24120be-62decb00
2581	a frontal upright view of the chest was obtained portably . interval removal of the right pigtail catheter with replacement with a right chest tube within the loculated right basilar pneumothorax, which is unchanged . volume loss in the right lung with surrounding pleural fluid is unchanged . the left lung is well expanded and clear without pneumothorax or effusion . surgical clips project over the epigastrium . aortic contour and left heart border are unchanged . unchanged right basilar pneumothorax .	Pneumothorax	11569093	56084617	68a9dec9-436c84d0-572f0df9-18929544-6b237d3b
2582	portable upright ap chest radiograph left basilar opacities likely represent subsegmental atelectasis . the lung volumes are low but otherwise clear . there is no pneumothorax . no vascular congestion or large pleural effusions are evident . cardiomediastinal and hilar contours are within normal limits . the colon is distended below the left hemidiaphragm .	Atelectasis	17897339	57667222	13c8c746-5d1d71f5-af021e53-041a96c3-710e3730
2583	since , there has been continued progressive consolidation involving the left lung with asymmetric opacification distributed throughout the right hemithorax most compatible with multifocal pneumonia . there are superimposed areas of bibasilar atelectasis . there are no pleural effusions or pneumothorax . the cardiomediastinal and hilar contours are stable, with the heart borderline enlarged . there is tortuosity and atherosclerotic calcification within the thoracic aorta . increased asymmetric opacification involving the left lung compatible with worsening multifocal pneumonia .	Lung Opacity&&Pneumonia	17206933	57571408	42ca3426-3c2dc573-7e2d42fe-aa2b9627-d888b47b
2584	there is increasing bilateral pulmonary opacifications consistent with worsening effusions, consistent with volume loss, and worsening pulmonary vascular congestion . the possibility of supervening pneumonia must be seriously considered in the appropriate clinical setting, and is difficult to evaluate due to the substrate of extensive pulmonary changes . dual-channel catheter, presumably due for hemodialysis ends in the right atrium .	Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	15259244	54912258	2241b085-d8b05d1d-b5f91fce-e5b5e662-4e27dbc6
2585	no relevant change as compared to the previous image . sternotomy wires and pacemaker in unchanged correct position . mild elongation of the descending aorta . status post valvular replacement . mild cardiomegaly . no pneumonia, no pulmonary edema .	Cardiomegaly&&Support Devices	16043637	59044123	c055e51a-f8fe191f-bc7f8dd3-78c1727e-d50f9a14
2586	ap view . there is evidence for increased density in the retrocardiac area in the left hemidiaphragm is indistinct . the lung bases are partially obscured by extensive costochondral calcification . the costophrenic sulci are blunted . bronchovascular markings are mildly increased, as before . the heart and mediastinal structures are unchanged as well . a double-lumen right internal jugular catheter has been inserted and terminates in the region of the lower superior vena cava . continued evidence of mild pulmonary vascular congestion and small pleural effusions . there is a suggestion of increased density in the retrocardiac area . this region could be better assessed by a lateral view if clinically indicated . a double-lumen right internal jugular catheter is in central position .	Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	13881772	54247614	669b4965-be67a9dd-0ba00b96-3ed4d288-597c3f17
2587	right internal jugular sheath ends at upper svc . a single mediastinal drain tube is present on the right side . the appearance of the post operative widened mediastinum is unchanged since . bilateral, confluent, lung opacities suggesting moderate pulmonary edema has improved asymmetrically on the left side, but unchanged on the right . pleural effusions, if any, is mild bilaterally .	Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Support Devices	10715477	51185902	b079d6bd-55655ce2-25867c4e-0deba6a1-8a159d08
2588	single portable chest radiograph demonstrates dobbhoff tube coiled within the stomach with tip terminating within the mid esophagus . exam is otherwise unchanged . discussed these findings including those of the prior radiographs with , pa, at on at the time of discovery who reports the third and final radiograph demonstrated a well-positioned dobbhoff tube .	No Finding&&Support Devices	17770657	52971146	486dfea4-dc27bc78-a4e9effa-c328c0ab-a8c3285e
2589	portable ap upright chest radiograph shows improved aeration at the right lung base, presumably status post right-sided thoracentesis . no pneumothorax is visible . the left hemidiaphragm remains obscured and there appears to be increased haziness of the mid and upper lung zone compared to the study from eight hours earlier . some of this may be exaggerated because of increased rotation . left-sided picc line tubing may be slightly pulled back and now is at the level of the mid superior vena cava . conclusion no visible pneumothorax status post thoracentesis presumably on the right .	No Finding	14851532	53992179	bf704123-a17d33d9-d80aaea8-665e04f1-11a14368
2590	dual lead left-sided pacemaker is again seen extending to the expected positions of the right atrium and right ventricle . no focal consolidation is seen . there is slight blunting of the posterior costophrenic angles which may be due to very trace pleural effusions . there is slight prominence of the interstitium which may be due to minimal interstitial edema . the cardiac and mediastinal silhouettes are stable . right proximal humerus hardware is seen but not well evaluated . possible trace pleural effusions and minimal interstitial edema .	Edema&&Pleural Effusion	19075045	59306733	74728f75-0a018add-11c546f2-e847b4e1-25501802
2591	the right subclavian picc line extends to the mid-to-lower portion of the svc . bibasilar opacification has slightly decreased and the costophrenic angles are more sharply seen . tracheostomy tube remains in place, though the esophageal stent is no longer appreciated . of incidental note is residual contrast material within the colon .	Lung Opacity&&Support Devices	13964474	52265716	7fae50dc-e842fd35-6c58a208-ebb5638e-085450e9
2592	the tip of the endotracheal tube projects cm above the carina . the tube could be advanced by cm . unchanged moderate-to-severe cardiomegaly with signs of mild-to-moderate pulmonary edema and a moderate right-sided pleural effusion . bilateral areas of atelectasis at the lung bases . no pneumothorax . right picc line in unchanged position .	Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	14841168	52759314	9b89dbe0-e7cb624a-a28136ca-4e93fa28-46f66f22
2593	pa and lateral chest radiographs were provided . there is a subtle opacity in the right lower lobe that is concerning for early pneumonia . there is linear scarring in the left upper lobe from area of prior pneumonia that has resolved . the lungs are hyperinflated and the diaphragms are flattened, consistent with copd . there is no pleural effusion or pneumothorax . the cardiomediastinal silhouette is unremarkable . there is no free air under the right hemidiaphragm . there are no acute osseous lesions . . possible early right lower lobe pneumonia . . left upper lobe scarring from prior pneumonia . . findings consistent with copd .	Lung Opacity&&Pneumonia	11052935	51882937	727f555b-ca31baa2-5a5d16fd-ca9b8960-5a9ce4e0
2594	right picc terminates in the lower superior vena cava . right internal jugular catheter has been removed, with no visible pneumothorax . otherwise, similar radiographic appearance of the chest since recent study .	No Finding&&Support Devices	19454978	57883497	8b277408-532884e8-ea3f5ba6-e619ee5e-8c820c0c
2595	pa and lateral views of the chest there are low lung volumes . the heart size is mildly enlarged . the aorta is unfolded . there is mild pulmonary vascular congestion, with small amount of fluid seen within the fissures . additionally, patchy opacities in the lung bases likely reflect atelectasis . a small left pleural effusion is relatively unchanged compared to prior . no new areas of focal consolidation are present . there is no pneumothorax .	Atelectasis&&Edema&&Pleural Effusion	13979643	52481248	c6264595-96860b66-fd1dfa5b-4697f3ba-214d913a
2596	compared to the prior exam, there is no significant interval change .	No Finding	16751749	50090559	9756bc1b-1827e912-16df6958-c6ddb9e7-17098cf1
2597	multifocal pneumonia including dense right lower lobe consolidation with abscess has not really changed much since . a pigtail catheter in the right lower lobe abscess is unchanged in position and presumably within the abscess cavity . residual stent is present . tracheostomy tube is in standard position .	Consolidation&&Pneumonia&&Support Devices	13964474	55723242	c6fc2f03-81a6bf53-7ffb417f-7915891d-dbe2945c
2598	frontal and lateral chest radiographs consolidations within the right middle lobe and lingula are again seen, improved since . a focal right upper lobe consolidation is also less conspicuous . no new consolidation, effusion, or pneumothorax is seen . there is associated right middle lobe volume loss with elevation of the right hemidiaphragm . a left-sided picc terminates at the cavoatrial junction .	Pneumonia	16662264	53078182	a86e243b-eb7c225e-ad44bbf8-9125ef98-3d02d669
2599	there is unchanged evidence of bilateral parenchymal opacities, constant on the right and minimally improving on the left . unchanged cardiomegaly and small bilateral pleural effusions . subsequent areas of basal atelectasis . unchanged position of the endotracheal tube and right-sided central venous access line .	Atelectasis&&Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Support Devices	10975446	53835190	32ddd325-e5d324e2-d240150b-5c00c3f0-fadd7c83
2600	a single, frontal, pa radiograph of the chest was taken with the patient in upright position . there is mild interstitial edema and pulmonary vascular engorgement . no focal airspace consolidation is seen . moderate cardiomegaly is unchanged . there is no pneumothorax or large pleural effusion . . no evidence of pneumonia . . mild congestive heart failure .	Cardiomegaly&&Edema	15131736	50083620	a652c914-9dee6fe8-96a798f8-8450007c-69a5592a
2601	the patient is status post coronary artery bypass graft surgery and apparently mitral valve replacement . the heart is mildly enlarged . the mediastinal and hilar contours appear unchanged . there is a slight interstitial abnormality, suggestive of a state of very mild congestion, but no new focal opacity . a left-sided pleural effusion has resolved although mild scarring or atelectasis persists . bones are probably demineralized . findings suggesting mild pulmonary congestion . resolution of small left-side pleural effusion .	Edema	15259244	53203970	42fd3d74-fe3267e7-82ffa036-96225174-327660f6
2602	a new heterogeneous opacity is seen in the retrocardiac posterior left lower lobe suggestive of early infiltrate . the right lung is clear . the heart size is unchanged . there is no pulmonary edema, pleural effusions or pneumothorax . the cardiac, mediastinal, and hilar contours are normal . the mild compression deformities of two mid thoracic vertebral bodies are stable . no new fractures . new left lower lobe early pneumonia . these findings were discussed with dr . on by telephone .	Pneumonia	19765968	59876822	ab062fe2-bf183eec-059ed8b1-b3b1917c-26fe6fdc
2603	the et and ng tubes have been removed . a right picc line terminates in the low svc . calcified left lung nodules are unchanged . the lungs are otherwise clear except for left basilar atelectasis . a small left pleural effusion has developed . moderate cardiomegaly is unchanged . no evidence of pulmonary edema . increased small left pleural effusion . stable moderate cardiomegaly .	Cardiomegaly&&Pleural Effusion	12185775	57910301	a7d5115b-c9749937-8502636c-ce1d2580-57e370dc
2604	frontal and lateral chest radiographs the heart is mildly enlarged . again seen are widespread reticular opacities, denoting chronic interstitial disease, better seen on the ct examination from . no superimposed consolidation, pneumothorax, or pleural effusion is seen .	No Finding	13475033	55966450	488be5c1-df6c98d6-5a8ab963-a827d34e-5a25ccc3
2605	ap and lateral chest radiographs demonstrate stable bilateral low lung volumes with persistent elevation of the left hemidiaphragm with air distended bowel beneath . mediastinal contours are stable . the cardiac contour is not well evaluated due to elevation of the diaphragm . compared to prior study, there is increased pulmonary vascular congestion . no focal opacification concerning for pneumonia identified . no pleural effusion or pneumothorax evident . low lung volumes . no focal opacification concerning for pneumonia . mild prominence of the pulmonary vasculature may indicate mild volume overload .	Pneumonia	18338007	50094334	ad2d9faa-b8c9c2ee-833f7217-e4abe541-ffbe0f8f
2606	the right pneumothorax has resolved . however, there has been continued increase in the pleural effusion which is now large and leaving only the right upper lobe aerated . there is no shift of mediastinal structures . there is no focal consolidation . the visualized portions of the cardiomediastinal silhouette are within normal limits . large right pleural effusion replacing the prior right pneumothorax seen on . results were relayed to by phone at pm .	Pleural Effusion&&Pneumothorax	14387068	58911568	1b1b23db-a13b7b1e-1cdeca0e-a6d035c6-a4699be0
2607	single ap semi-erect portable view of the chest was obtained . moderate-to-severe pulmonary edema is again seen . difficult to exclude underlying pleural effusions . the cardiac and mediastinal silhouettes are stable . there has been interval placement of a large-bore left-sided catheter, distal tip not optimally seen, but likely terminates in the cavoatrial junctionright atrium .	Edema&&Enlarged Cardiomediastinum&&Support Devices	17340686	57032496	f12f4aff-464794a0-43804b4b-647ac047-cc14b671
2608	interval removal of a right-sided internal jugular central venous line . multiple metallic clips overlying the superior mediastinum are unchanged in position . lung volumes remain low leading to crowding of the bronchovascular structures . there is no evidence of focal consolidation, pleural effusion, pneumothorax, or pulmonary edema . the cardiomediastinal silhouette is within normal limits . no evidence of acute cardiopulmonary process .	No Finding	19907884	55036801	6a92203f-216df921-4fce7d2a-acd7f2ac-ff08b6bf
2609	there is little change and no evidence of acute cardiopulmonary disease . no plain radiographic evidence of interstitial lung disease . no hilar or mediastinal lymphadenopathy to radiographically suggest sarcoidosis . no acute focal pneumonia .	No Finding	13448574	59329945	e8878eba-69ed4f98-5a498583-69912c0d-cf6a7773
2610	appearance of the median sternotomy wires are unchanged . again noted is the biventricular icd implant one lead is seen in the right atrium, a second lead within the right ventricle but the tip of the third lead is not well visualized . there is slight improvement of underlying pulmonary edema compared to . again noted is a small left pleural effusion . the heart is enlarged . no evidence of pneumothorax . . interval biventricular icd placement . no evidence of pneumothorax . . slight improvement in pulmonary edema .	Edema&&Support Devices	13896515	50498379	6a7ae1e7-25818d8d-e2aaca48-19d5034e-df932bae
2611	a port-a-cath terminates in the upper right atrium . the cardiac, mediastinal and hilar contours appear unchanged . fine reticulation associated with pulmonary fibrosis appears very similar within each lung in extent and distribution with no significant superimposed change . the lung volumes are low . there is no pleural effusion or pneumothorax . multiple compression deformities including lower thoracic vertebroplasties appear unchanged . no evidence of acute disease . severe pulmonary fibrosis, not significantly changed .	Pleural Other	10439781	56925922	bf36414d-6c371df9-7c7106e2-8b9991bc-f24f52d1
2612	the patient has undergone right thoracocentesis . the right pleural effusion has almost completely been drained . there is no evidence for the presence of a right pneumothorax . the scars at the level of the right lung base and the left perihilar area and the left lung periphery are constant . the size of the cardiac silhouette is also unchanged . unchanged position of the right picc line .	Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Pneumothorax&&Support Devices	14851532	55391861	db947f2f-6fecfd69-1ed4dbf2-6e7c6fb8-a395c1b6
2613	re- demonstrated is enlargement of the cardiomediastinal silhouette . there is elevation of the right hemidiaphragm . evaluation of the left lung base is less than optimal due to underpenetration from overlying body habitus although no definite focal consolidation is seen . pulmonary edema persists . no large pleural effusion seen . pulmonary edema and enlargement of the cardiac silhouette . no definite focal consolidation to suggest pneumonia .	Cardiomegaly&&Edema&&Pneumonia	15131736	52718973	de92b434-5ef9d4ce-61d1d2b2-1b3efd95-949c6123
2614	comparison is made to the patients prior study of , at . a single portable erect chest film at am . . right-sided internal jugular dual-lumen catheter is unchanged in position . there is worsening bilateral airspace and interstitial process, which most likely reflects worsening pulmonary and interstitial edema, possibly superimposed on underlying chronic interstitial changes . overall cardiac and mediastinal contours are difficult to assess given patient rotation on the current examination . no evidence of pneumothorax . probable small left layering pleural effusion .	Edema&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	18855147	57304510	6c24203f-eb2ae77d-f8dc8d4b-8ca91798-a6dddd76
2615	ap single view of the chest has been obtained with patient in sitting semi-upright position . as before, the patient is status post sternotomy, aortic valve replacement and bypass surgery . cardiomegaly as before . a right internal jugular approach central venous line remains in unchanged position and terminates in a location compatible with the upper portion of the right atrium . the diaphragmatic contours are bilaterally obscured and the lateral pleural sinuses are blunted . this is indicative of increasing pleural effusion in comparison with the previous portable postoperative chest examination . pulmonary vasculature remains congested with considerable perivascular haze . no pneumothorax is seen . the comparison is extended to multiple previous postoperative examinations, signs of pleural effusion and pulmonary congestion existed already earlier . on the preoperative chest examination of , significant cardiomegaly existed already at that time . the pleural spaces are practically free . continuing postoperative chf with bilateral pleural effusion apparently increasing slightly during latest examination interval . was informed via page .	Cardiomegaly&&Edema&&Pleural Effusion	12952223	52149367	89af9a9c-8f769cde-04b1cfb3-5ad98100-9e25d3a6
2616	comparison is made to the patients prior study of at am a single portable semi-erect chest film at is submitted . the patient is markedly rotated to his left limiting evaluation of the cardiac and mediastinal contours . the heart remains enlarged . there has been interval removal of the endotracheal tube with placement of a tracheostomy tube, which has its tip at the thoracic inlet . the right subclavian picc line still has its tip in the distal svc . a nasogastric tube is seen coursing below the diaphragm with the tip projecting over the expected location in the stomach . patchy opacity in the retrocardiac region may reflect an area of atelectasis, although pneumonia cannot be entirely excluded . no evidence of pulmonary edema . no pneumothorax . probable small layering left effusion .	Atelectasis&&Cardiomegaly&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	10268877	53883066	878341cc-7587aff2-e1f70246-3a29413e-36f37ddb
2617	compared with the recent radiographs, there has been interval improvement in the degree of pulmonary edema . the heart remains enlarged . no focal consolidation or pleural effusion . left-sided pacemaker remains in place . continued improvementresolution of pulmonary edema . no focal consolidation concerning for pneumonia .	Edema&&Pneumonia	13896515	54879730	d974aeb8-59d6b3c0-b7dec6c1-a25cf20c-541f88c0
2618	the lungs are clear . there is no focal consolidation, effusion, or edema . there is mild cardiomegaly and prosthetic valves . dense atherosclerotic calcifications noted in the thoracic aorta . no acute cardiopulmonary process .	No Finding	18224196	59857884	832a229c-642318e5-0b042be6-fc394a0a-c8c99a46
2619	previous pulmonary edema has not recurred . mild-to-moderate cardiomegaly is stable, and there is no change in the configuration of the thoracic aorta to suggest dissection, although that diagnosis is not excluded by the stable appearance on conventional chest radiographs . no pneumothorax or pleural effusion is present .	Cardiomegaly&&Edema	12185775	52400146	4fe86d2a-a88e414b-d58dd0c1-51340b76-e7353509
2620	the lateral images show that the right pleural effusion does not layer, which would be consistent with loculation . also, there is an increase in adjacent atelectasis .	Atelectasis&&Pleural Effusion	13263843	52399735	d7a25de4-e2d563e2-93017e5e-4127bd89-0d081f33
2621	the lungs are clear without focal consolidation . no pleural effusion or pneumothorax is seen . the cardiac and mediastinal silhouettes are unremarkable . the patient is status post median sternotomy with the superior most sternotomy wires again seen to be fractured . no acute cardiopulmonary process .	No Finding	15518538	59999362	fb713bef-44a802dc-179def5b-4baaedb7-991610c2
2622	cardiomediastinal contours are normal . right lower lobe opacities have resolved . opacities in the lingula adjacent to a healed rib fractures are grossly unchanged . the lungs are hyperinflated . there is no pneumothorax or pleural effusion . resolved opacities in the right lung ill-defined opacities in the lingula likely correspond to scarring, this is adjacent to healed rib fractures better seen in prior ct .	Fracture&&Lung Opacity	16435402	56971397	9867f9b8-833b5f7f-18a67bac-b62caa15-7a215a2b
2623	single ap view of the chest . right chest wall port is again seen, catheter tip not clearly identified due to motion . the lungs are grossly clear . mild left basilar atelectasis versus scarring again noted . cardiomediastinal silhouette is within normal limits . calcified ap window nodes are seen . osseous and soft tissue structures are unremarkable . no acute cardiopulmonary process .	No Finding	11413236	52164077	a17a8e28-46038399-4f9764d7-2338ca4c-6234bf11
2624	in addition to previously discussed new right lower lobe opacity most likely representing atelectasis, there is interval development of pulmonary edema, moderate-to-severe, associated with bilateral pleural effusions . heart size and mediastinum are unchanged .	Atelectasis&&Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion	12185775	50630947	ce406dad-094f4f88-1aa935f8-6d57f41b-219a6543
2625	pa and lateral chest radiograph a right lower lobe lung nodule measuring mm is stable dating back to ct scan of . biapical post-radiation changes are unchanged . mediastinal and cardiac contours are stable . there is no pneumothorax . trace right pleural effusion cannot be excluded . bony coalition between the posterior arch of the sixth and seventh right ribs is congenital . vague opacity within the right middle lung is similar to findings of and may represent recurrent pneumonia .	Cardiomegaly&&Enlarged Cardiomediastinum&&Lung Lesion&&Lung Opacity&&Pleural Effusion&&Pneumonia	14295224	55257496	7fb0f54f-a18826e9-05962b2b-66a603ac-a0991889
2626	the lungs are well expanded and clear . area of increase density overlying the right hilum with a sharp lower margin is of unclear clinical significance . severe cardiomegaly is reidentified . the hilar contours are unremarkable . there is no pleural effusion or pneumothorax . . area of increase density overlying the right hilum with a sharp lower margin is of unclear clinical significance . chest ct is recommended for further assessment . . severe cardiomegaly, unchanged . the impression was entered as an urgently flagged wet read on the ed dashboard by dr on at am after discussion with the attending as the patient was still in the ed .	Cardiomegaly	12963531	58929701	db56399e-4f04b226-d9773c85-a6d565a6-04fe3904
2627	the heart is mildly enlarged . the mediastinal and hilar contours are within normal limits . there is an area of increased density which projects over the left cardiac border . otherwise, remaining lungs are clear . there are no pleural effusions, pulmonary edema, or pneumothorax . increased density along the left cardiac border for which further evaluation is recommended with oblique views . these findings were discussed with dr . by dr . via telephone on at pm, at time of discovery .	Lung Opacity	18767957	50753069	5c8c0263-8d94687e-2a7896c8-5682bae9-6aeefbc4
2628	there is a right pleural effusion, the size of which is difficult to ascertain . there is unchanged bilateral lower lobe and right middle lobe collapse . the small left pleural effusion is unchanged . there is no pulmonary vascular congestion or pneumothorax . the cardiac and mediastinal contours are not well visualized . stable large right pleural effusion and increasing left pleural effusion . feasibility of of thoracentesis would best be evaluated with decubitus films . ultrasound guidance can also be considered .	Pleural Effusion	10410641	56031350	74ab0576-165250aa-5fedc1a0-3f75f2c6-9f87fa70
2629	there are low lung volumes . cardiomegaly and widened mediastinum are stable . extensive interstitial reticular abnormalities larger in the left perihilar and left lower lobe region are grossly unchanged allowing the difference in inspiratory effort of the patient without evidence of new abnormalities pneumothorax or effusion .	Cardiomegaly&&Enlarged Cardiomediastinum&&Pleural Effusion&&Pneumothorax	10867202	57033562	b7af070d-78068621-15eff16b-a70624dd-db393d15
2630	there is a further improvement in extent and severity of the pre-existing pulmonary edema . edema is now mild . moderate cardiomegaly persists . no pleural effusions . no pneumonia, no pneumothorax .	Cardiomegaly&&Edema	18767957	55238104	92c32c82-12a62f9c-f28ef1de-aa6bdc04-c6946e9e
2631	there again is enlargement of the cardiac silhouette with pulmonary edema and bilateral pleural effusions with compressive atelectasis, worse on the right . ij catheter remains in place .	Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	12952223	58565744	f7444698-77590d7a-c6202efc-7ebaf856-eb1ee866
2632	comparison to . the lung volumes remain relatively low and the cardiac silhouette is still substantially enlarged . however, the lung parenchyma has increased in transparent see, notably due to a decrease in extent of the pre-existing right pleural effusion and basilar atelectasis as well as an increase in radiolucency of the left upper lobe . no other relevant change is noted .	Atelectasis&&Cardiomegaly&&Pleural Effusion	14851532	55544509	ec82f84b-cccfc6e5-fa5fe314-b10d2e0f-0d272479
2633	moderate pulmonary edema with small bilateral pleural effusions and areas of atelectasis at the lung bases . moderate-to-severe cardiomegaly . overall, low lung volumes . no newly appeared parenchymal opacities . no pneumothorax .	Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion	15131736	59112340	e7f7234c-b9fe8996-8a54370a-0914218c-055c2477
2634	the lungs are hyperinflated . an esophageal stent is in place . a right basilar opacity is significantly improved from . mild residual opacity may be scarring . no new opacity . cardiac and mediastinal silhouettes and hilar contours are stable . blunting of the right costophrenic sulcus is unchanged . no left effusion or pneumothorax . loss of vertebral body height in the mid thoracic spine is unchanged . substantial clearing of the right lower lobe opacity . mild residual opacity is likely scarring rather than new pneumonia . no new opacity .	Lung Opacity&&Pneumonia	19016834	53458025	f3baaf80-a55a5d5c-780ab97b-5fade2b1-80096e7e
2635	dual-lead left-sided pacemaker terminates with leads in the proper position . chain sutures along the right lung base are again noted and appear stable . again visualized is a loculated small left pleural effusion as well as a small right pleural effusion, appearing stable in comparison to prior study . there is a new confluent patchy opacity in left lower lobe in comparison to the prior study, which may be representative of developing pneumonia . otherwise, the remainder of the lungs is clear . the cardiomediastinal silhouette remains stable . the visualized osseous structures are stable . . stable small loculated left and small right pleural effusions . . heterogeneous opacity in the left lower lobe may be representative of developing pneumonia in the appropriate clinical setting .	Lung Opacity&&Pleural Effusion&&Pneumonia	13067703	59507972	2a04d342-b9a115ec-6a14561e-678580c9-d2feb9ec
2636	ap upright and lateral views of the chest provided . lung volumes are low with bibasilar atelectasis noted . perihilar bronchovascular crowding is also noted . the heart is likely within normal limits of size . no large effusion or pneumothorax . no convincing signs of pneumonia . bony structures are intact . limited, negative .	No Finding	17147859	56619225	8146d764-df8a61cc-05eee7e7-2a09b0ca-af854e29
2637	chest, single ap portable view the carina is not well delineated . allowing for this, the et tube lies approximately - . cm above the carina . an ng tube is present -- the tip extends beneath diaphragm, off film . additional tubing is looped over the upper abdomen in the midline . a right ij sheath is present, tip over distal ij, proximal to its point of confluence with the subclavian vessel . of note, a stent is present in this location . an additional stent is seen along the expected course of the left innominate vein . the lungs are hyperinflated . the heart lies to the left of midline, raising the question of some volume loss on the left side . there is increased retrocardiac density . there are prominent interstitial markings in both lungs, of uncertain etiology or significance . the hila are obscured by the interstitial markings . no gross effusion . innumerable calcific densities in the spleen suggest prior granulomatous disease . two calcified nodes are also seen along the expected course of the splenic artery . question also a calcified node in the neck . the bones appear diffusely dense . compared to , no definite change is detected . increased retrocardiac density consistent with left lower lobe collapse andor consolidation is again seen . . right ij sheath position appears slightly proximal to the right subclavian vein at the site where a stent is seen . there is also kinking of the sheath at the skin . correlation with specifics of clinical presentation is requestedtargeted review of the report from a chest ct refers to occlusion of the left subclavian vein stent . . left lower lobe collapse andor consolidation and minimal patchy opacity at the right base, unchanged . . extensive calcified granulomas, similar to prior . . diffusely increased osseous density . there is an extensive differential, which should be correlated with the clinical presentation . the differential includes changes due to osteodystrophy . in the appropriate clinical setting, osteosclerosis could have a similar appearance .	Atelectasis&&Consolidation&&Lung Opacity	19061282	58645463	ac9317c6-52379372-d9464c93-abdb2215-2daad9f1
2638	there has been no significant interval change . the cardiac and mediastinal silhouettes are stable . hilar contours are stable with possible minimal central vascular engorgement . no significant interval change .	No Finding	18767957	56233609	9c67a2e3-68620391-2e5a5578-0433f757-1eba00c6
2639	dual lead of left-sided pacemaker is again seen with leads extending to the expected positions of the right atrium and right ventricle, unchanged . patient is status post median sternotomy and aortic valve replacement, grossly stable . again seen is blunting of the left costophrenic angle suggesting pleural effusion with overlying atelectasis . underlying consolidation cannot be excluded . there is slight increase in opacity at the right lung base which may be due to atelectasis, although the appropriate clinical setting, early aspiration or pneumonia are not excluded . surgical clips are again seen projecting over the lateral right upper hemithorax .	Atelectasis&&Consolidation&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	10850815	58393560	1bc3d3de-cd13c1cd-ce13e61d-5191632c-e3ae7b5c
2640	the heart is at the upper limits of normal size . linear calcification projects over the right lung apex . the lungs appear otherwise clear . there are no pleural effusions or pneumothorax . vascular calcifications are widespread . no free air is demonstrated . there are moderate to severe degenerative changes involving each glenohumeral joints . mild degenerative changes are present along the visualized lower thoracic spine . no evidence of acute disease .	No Finding	12074041	54973829	f430ec0f-40b790de-a5178baf-9dd6c108-9fc32de6
2641	the left chest wall pacemaker generator obscures portions of the left hemi thorax . no left chest tube is definitively visualized . lung volumes are lower with persistent retrocardiac opacity likely reflecting combination of effusion and atelectasisconsolidation . mild pulmonary edema appears stable . no chest tube visualized in the left hemithorax, possibly obscured by the pacemaker generator . recommendations consider repeat radiograph with pa and lateral technique . with dr .	No Finding&&Support Devices	13896515	58088717	4f4c1ed7-5e3e7b32-534f3142-60dfa8a1-b5350381
2642	there is continued enlargement of the cardiac silhouette . pulmonary vascularity is mildly engorged but less prominent than on the previous study . opacification at the bases with obscuration of the hemidiaphragms is consistent with bilateral layering effusions, more prominent on the left, with underlying compressive atelectasis . central catheter tip again extends to the upper to mid portion of the svc .	Atelectasis&&Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Support Devices	12185775	51826366	f9b1c946-2770d2d6-e7a89dc5-0e3d42e2-77117240
2643	patient is known to have lymphangiomyomatosis . coarsened interstitial markings are compatible with known cystic lung disease . there is no superimposed consolidation to suggest pneumonia . no effusion or pneumothorax . cardiomediastinal silhouette is normal . bony structures are intact . no free air below the right hemidiaphragm . stable chronic lung disease compatible with . no superimposed pneumonia .	No Finding	12303667	52329768	ab5d8429-a48d1b05-af73d020-ef1f6e53-30f8ae8d
2644	portable semi-upright radiograph of the chest demonstrates low lung volumes with resultant bronchovascular crowding . bibasilar consolidations may represent atelectasis or pneumonia in the appropriate clinical setting . the cardiomediastinal and hilar contours are unchanged . there is a new lucency beneath the right hemidiaphragm concerning for intra-abdominal free air . right-sided picc line and to the mid svc . unchanged position of the aicd . no pneumothorax . . bibasilar consolidations may represent atelectasis or pneumonia in the appropriate clinical setting . . new lucency beneath the right hemidiaphragm is concerning for intra-abdominal free air . clinical correlation recommended . additional evaluation could be performed with repeat upright radiograph or left lateral decubitus radiograph . notification these findings were discussed with dr . by dr . telephone at on , minutes after discovery .	Atelectasis&&Consolidation&&Pneumonia	12595991	58585557	036272e9-9052e7c2-444e59fd-86a7f36d-9dfe191a
2645	redemonstration of moderate-to-severe cardiomegaly is noted . there is pulmonary vascular congestion consistent with edema . there is vague increased opacity at the left costophrenic angle which may reflect atelectasis versus a small pleural effusion . redemonstration of a left subclavian venous stent is again noted . there is no evidence of pneumoperitoneum . osseous structures are unchanged . . opacity at left costophrenic angle likely reflects atelectasis vs . pleural fluid . . pulmonary edema .	Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion	13473495	52412265	a6aad5da-2b346586-e6b4b977-d71b3973-925a1eb1
2646	et tube tip is . cm above the carinal . ng tube tip is in the stomach . cardiomegaly is substantial . vascular enlargement is severe with border lining interstitial pulmonary edema, unchanged . bilateral pleural effusions are most likely present .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	15131736	52062934	f014bbdd-d959187e-caba9ce3-18da1106-ed34d3bc
2647	cardiac size is top normal . mediastinal contours are unremarkable . the lungs are clear . there is no evidence of pneumothorax or pleural effusion . spinal hardware is in place .	No Finding&&Support Devices	15114531	57624554	cc20a4e8-45bd956d-683185d2-3f0e8eef-1e3d8993
2648	left-sided pacer is again seen with three leads terminating over the expected location of the right atrium and right ventricle, respectively . overall, cardiac and mediastinal contours are stable . there is diffuse air space process with more focal consolidation again seen in the left mid lung and at the lung bases . this is concerning for bilateral pneumoniaaspiration . in addition, the lungs remain hyperinflated and there is parenchymal distortion and apical bullous changes consistent with underlying emphysema . no pneumothorax is seen . there is blunting of the costophrenic angles which may represent chronic pleural thickening or small effusions . heart remains enlarged most likely representing cardiomegaly . in addition, the perihilar vasculature is somewhat more prominent and indistinct which suggests a component of superimposed perihilar edema .	Cardiomegaly&&Consolidation&&Edema&&Enlarged Cardiomediastinum&&Pleural Effusion&&Pleural Other&&Pneumonia&&Support Devices	14992360	58503033	32c1d55b-e82e8109-857245af-c7f729c8-050f2e67
2649	frontal and lateral radiographs of the chest is limited by underpenetration which is likely secondary to body habitus . the lungs appear clear, however it is not possible to exclude a consolidation in the lateral inferior costophrenic angles . the cardiomediastinal and hilar contours are unchanged . there is no pneumothorax . the lungs appear clear, however it is not possible to exclude a consolidation in the lateral inferior costophrenic angles .	No Finding	11928692	53222889	d1b9813f-08d920a6-85c9bb6f-c516c1ee-a56f9d38
2650	there is no appreciable pneumothorax or pleural collection in the left chest following removal of the left pleural tube . right pleural tube still in place . left basal atelectasis is mild to moderate but unchanged . post-operative enlargement of the cardiomediastinal silhouette which improved between and is stable . no appreciable right pleural effusion . right subclavian line ends in the upper svc . transvenous right atrial and right ventricular pacer leads unchanged in their respective positions . no pulmonary edema .	Atelectasis&&Enlarged Cardiomediastinum&&Support Devices	15144601	54398860	600bdfe3-0d53440d-a74bdb21-e9faee00-958ca49f
2651	heterogeneous left basilar opacities do not have a correlate on the lateral radiograph and are likely minimal atelectasis . the lungs are otherwise clear . mild pulmonary vascular congestion is not accompanied interstitial edema or pleural abnormality . mild to moderate cardiomegaly is chronic . the thoracic aorta is generally enlarged, very tortuous and moderately calcified but neither focally aneurysmal nor changed since at least . the patient has had midline sternotomy and cabg . a right cervical rib is seen . multilevel degenerative changes of the thoracic spine include unchanged wedging of a lower thoracic vertebral body . . mild left basal atelectasis no pneumonia . . chronic mild to moderate cardiomegaly and pulmonary venous hypertension, but no pulmonary edema . . chronically enlarged atherosclerotic thoracic aorta, with no focal aneurysm .	Atelectasis&&Cardiomegaly	16957952	57798090	3a8c9fa9-90b94fc1-484469e2-d0316be1-245e5d13
2652	there is increasing left pleural effusion . in addition, there is increasing parenchymal opacity at the left lung base, potentially reflecting developing pneumonia . the pre-existing signs of mild pulmonary edema are constant in appearance . unchanged position of the sternal wires and the postoperative clips . unchanged left pectoral pacemaker . at the time of dictation and observation, am, on the , the referring physician, . findings were discussed minutes later over the telephone .	Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	18615099	50024272	fa9c8854-7c936fd0-4432d579-5cc2dc60-c78d9525
2653	reference to prior studies is made . when compared to the most recent study, there is probably less overall congestive change, but this has revealed the lower lobe bronchial wall thickening . this is nonspecific, may reflect either failure or a bronchial infection . there is no pneumonia . the left lower lobe effusion may be marginally bigger than on the prior study .	Lung Opacity&&Pleural Effusion&&Pneumonia	16772702	50295031	8842c8de-2368b8c6-9d83207c-ccfaecfe-7ae284e6
2654	interval placement of endotracheal tube terminating . cm above the carina, and a nasogastric tube terminating in the stomach . right internal jugular central venous catheter terminates in the proximal superior vena cava, with no visible pneumothorax . stable cardiomegaly accompanied by mild pulmonary vascular congestion . questionable small left pleural effusion .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	14727722	57078645	8ead2e2f-a4d30f0e-d6091305-a771d78b-09e4f06d
2655	single frontal view of the chest demonstrates a left pectoral paceraicd with leads terminating in the right atrium, right ventricle, and coronary sinus . there has been interval removal of a right picc . prominent cardiac silhouette is unchanged . the mediastinal and hilar contours are unremarkable . aortic arch calcifications are redemonstrated . the lungs are clear . no radiographic evidence of acute cardiopulmonary process .	No Finding	12595991	52076561	bd31fe67-ad4d5454-2cfd7c09-13c04383-d38297ac
2656	there has been reaccumulation of pleural fluid at the right base with underlying compressive atelectasis following apparent thoracentesis . no evidence of pneumothorax . the remainder of the heart and lungs are unchanged .	Atelectasis&&Cardiomegaly&&Pleural Effusion	12658295	57053848	32a7d189-41a4b4a2-2cbe2e58-67f6823b-94d7cb9b
2657	the cardiac, mediastinal and hilar contours appear unchanged including stable cardiomegaly . there is no definite pleural effusion or pneumothorax . each hilum is mildly prominent, as before . prominence of each hilum is probably due to mild enlargement of central pulmonary arteries, not significantly changed . the lungs appear clear . similar enlargement of central pulmonary arteries, but no definite evidence for acute disease .	No Finding	15131736	58470850	1b9a76c5-24e784cb-4a768979-edd5e575-042c91a0
2658	right picc terminates in mid svc . left pectoral pacemaker has its leads terminating in right atrium and right ventricle . cardiac silhouette is mildly enlarged . prosthetic heart valve and median sternotomy wires are in unchanged position . there is no consolidation, pleural effusion, or pneumothorax . right picc terminates in mid svc . no radiographic evidence of pneumonia .	No Finding&&Support Devices	16043637	51017703	5764a70f-234a5a0d-42ae4b8f-b130f5c4-63dac3a1
2659	bilateral lung volumes are lower . since yesterday, mild-to-moderately severe pulmonary edema has significantly improved . however, moderate right pleural effusion associated with right lower lung atelectasis and left lower lung atelectasis and small left pleural effusions are unchanged . the lung effusions and atelectasis obscuring the mediastinal border, thus assessment of the cardiomediastinum was limited . over last hours, mild pulmonary edema has significantly improved, moderate right and small left pleural effusion as well as bilateral lower lung atelectasis are unchanged .	Atelectasis&&Edema&&Pleural Effusion	12952223	56354797	5c3a891f-05d81eb0-c4ade60a-d0b2c55e-b6856098
2660	there is mild-to-moderate interstitial pulmonary edema . the heart is moderately enlarged but not significantly changed in size compared to . no definite pleural effusions are seen . there is no pneumothorax . mild-to-moderate pulmonary edema, likely cardiogenic .	Edema	13473495	55153576	92ca8ae9-3cd416c1-c8b97c65-2d1a7560-3a11ae68
2661	moderate cardiomegaly with tortuosity of the aorta and slight enlargement of the right hilus . this is likely due to pulmonary artery enlargement in the context of clinically evident pulmonary hypertension . minimal right pleural effusion . no left pleural effusion . no evidence of pulmonary edema or pneumonia . minimal areas of atelectasis at the right lung base .	Atelectasis&&Cardiomegaly&&Pleural Effusion	13978244	54843628	d1530705-a5f69e98-247896ff-71e118db-5ed1694c
2662	left upper lobe has collapsed again rendering the entire left lung airless . right lung is grossly clear . heart size is indeterminate . right pic line ends in the upper svc . stomach is moderately-to-severely distended .	Atelectasis&&Cardiomegaly&&Support Devices	16313531	56699078	efc15848-2e4788fd-35891eca-87c4c2a8-e9d28d15
2663	there is little change in the substantial enlargement of the cardiomediastinal silhouette and moderate pulmonary edema with bilateral pleural effusions . monitoring and support devices remain in place .	Edema&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	10715477	50563564	8671643b-f06c27c8-91a43c5d-85161fe5-a1eb95b0
2664	right internal jugular central venous catheter tip terminates in the mid svc . no pneumothorax is present . moderate cardiomegaly is again noted . the mediastinal and hilar contours are unchanged . there is mild pulmonary vascular congestion, new since the prior study . there continued bibasilar patchy airspace opacities, not substantially changed in the interval . no large pleural effusion is present . right internal jugular central venous catheter tip in the mid svc . no pneumothorax . mild pulmonary vascular congestion .	Edema&&Support Devices	17398573	52640725	6722c21a-9a65dc03-dbc8707e-83f326f7-09e1768c
2665	the cardiac, mediastinal and hilar contours appear unchanged . the lungs appear clear . there are no pleural effusions or pneumothorax . a vascular stent, presumably within the right brachiocephalic vein, again projects over the medial right lung apex . no evidence of acute disease .	No Finding	14744884	50906117	3f80bbda-1c82f45d-788d2535-2c56bc02-94651d15
2666	persistence of right middle lobe opacities obscuring the right heart border since is concerning for pneumonia . the rest of the lungs appear unchanged since . moderate bibasilar atelectasis is slightly improved . the heart size is exaggerated by compressive atelectasis . no pneumothorax . note is made of partial resection of the posterior rib . persistence of right middle lobe opacities since is concerning for pneumonia .	Lung Opacity&&Pneumonia	11474065	50955371	835047f2-adf49b86-e80c6954-330c111c-da7aeea9
2667	the left-sided pacemaker leads terminate in right atrium and right ventricle . heart size and mediastinum are unchanged . the right picc line tip is at the mid svc . minimal right basal atelectasis is unchanged .	Atelectasis&&Cardiomegaly&&Enlarged Cardiomediastinum&&Support Devices	19075045	51863226	afdc6101-9180ad47-d33f6956-0417a220-bd8284be
2668	the multifocal opacities on the current study appear to be progressed as compared to prior examination concerning for multifocal infection . there is small amount of right pleural effusion, slightly increased since the prior study . no definitive evidence of pulmonary edema is present, but it cannot be entirely excluded and reassessment of the patient after diuresis is recommended . the position of the pacemaker is slightly unclear, and although unchanged since prior examinations, still most likely is in the right ventricle .	Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	13291370	57012952	13def5d7-feb09fc8-8219055b-5a1e8e13-789ecfcc
2669	comparison is made to the patients prior study of at am . a portable semi-erect chest film at is submitted . . interval placement of an intraaortic balloon pump, which has its tip within the aortic knob . pullback by approximately cm would be recommended to place the tip in the proximal descending aorta . the patients nurse, , was notified of this recommendation by phone on at pm . endotracheal tube, right internal jugular swan-ganz catheter, right internal jugular central line, right-sided pacemaker, and nasogastric tube are unchanged in position . the patient is status post median sternotomy with aortic valve replacement and the heart remains stably enlarged . there has been interval improvement in bilateral pulmonary edema with residual mild-to-moderate edema and layering bilateral effusions . there is retrocardiac opacity likely representing partial lower lobe atelectasis . no pneumothorax is appreciated .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	13606683	59371598	e0c01c42-2132558f-c787b79d-98ea70a0-a03aeca7
2670	large right and small-to-moderate left pleural effusions with adjacent atelectasis are unchanged . mild cardiomegaly and tortuous aorta are stable . the patient has been extubated . right ij catheter tip is at the cavoatrial junction . sternal wires are aligned . the patient is status post cabg .	Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices	12736592	53757292	b8991dd1-b02017c1-0315cf5a-47b0351c-5dc44ccc
2671	the right picc line tip is at the level of superior svc . heart size and mediastinum are unremarkable . right lung volume is relatively low, unchanged . the patient is after right upper lung surgery with unchanged appearance of the right hemithorax . no new consolidations to suggest interval development of infectious process is seen . there is no pleural effusion or pneumothorax .	Consolidation&&Pneumonia&&Support Devices	19907884	58347871	8b9346c1-14e39176-24f6eec8-c0ab7ae7-df0ce0c9
2672	the lateral radiograph is essentially nondiagnostic due to underpenetration likely due to patient body habitus . on frontal radiograph, lung volumes are low with bibasilar atelectasis . evaluation is somewhat limited due to patient body habitus . the cardiac silhouette is enlarged . double-lumen central venous catheter appears similarly positioned . mild interstitial edema persists . no pneumothorax is seen . limited study with persistent mild interstitial edema and cardiomegaly . bibasilar opacities, atelectasis, can not exclude infection .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pneumonia	13473495	59702344	d52c36ac-6e608971-bbafb23d-06547ea6-1979d9e3
2673	left picc tip is seen terminating in the region of the distal left brachiocephalic vein . tracheostomy tube is in unchanged standard position . the heart is moderately enlarged . marked calcification of the aortic knob is again present . mild pulmonary vascular congestion is similar . bibasilar streaky airspace opacities are minimally improved . previously noted left pleural effusion appears to have resolved . no pneumothorax is identified . percutaneous gastrostomy tube is seen in the left upper quadrant . . left picc tip appears to terminate in the distal left brachiocephalic vein . . mild pulmonary vascular congestion . . interval improvement in aeration of the lung bases with residual streaky opacity likely reflective of atelectasis . interval resolution of the left pleural effusion .	Atelectasis&&Edema&&Lung Opacity&&Support Devices	10268877	50239281	0c69d156-6f5f3a89-7d361367-57f8c979-583ef198
2674	the monitoring and support devices remain in place without definite pneumothorax . the left lung remains essentially clear except for some atelectatic changes at the base . extensive subcutaneous emphysema again persists along the right lateral chest wall . opacification along the mediastinal border on the right again could reflect collection of pleural fluid . the development of hematoma cannot be excluded in the appropriate clinical setting .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Support Devices	19991135	54602632	715d0cdc-ddee4d9b-b5a28b77-350e1063-bc606f0d
2675	bilateral lung volumes remain low . pulmonary vascular congestion has significantly decreased . over the last hours, the right lower lung opacity likely from atelectasis and effusion has significantly decreased . left retrocardiac opacity due to a left lower lung volume loss and probably associated small effusion is unchanged . mediastinal and hilar contours are stable . orogastric tube is seen to course below the diaphragm into the stomach and is appropriate .	Atelectasis&&Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Support Devices	18079481	52227426	18538733-4a1be639-4094697f-10affe45-2dcbc4f7
2676	no focal opacities are noted in the right lung . chain sutures in the right upper lung region are from prior resection . there is a . cm nodule in the left mid lung is unchanged compared with prior exam . otherwise, there are no new focal opacities . the cardiomediastinal and hilar contours are unremarkable . there is no pleural effusion or pneumothorax . the sternotomy wires are intact and multiple surgical clips are noted in the lower thorax . external monitoring devices are noted . stable appearance of left lung nodule better characterized on ct chest dated .	Lung Lesion	16334516	53602937	4e978740-b97d9a2c-f97c4610-4dd52d72-5cb121ef
2677	portable ap semi-upright view of the chest was provided . patient is quite rotated to the left which limits the evaluation . the heart is enlarged which could in part reflect leftward rotation . there is a left pleural effusion which is small in size . there is a small area of consolidation in the left upper lobe which could represent a small focus of pneumonia . mild pulmonary edema is present . atherosclerotic calcifications at the aortic knob noted . bony structures are intact . pulmonary edema, left upper lobe focal consolidation could represent pneumonia . small left pleural effusion . cardiomegaly .	Cardiomegaly&&Consolidation&&Edema&&Pleural Effusion&&Pneumonia	15541869	50553646	912e2ddc-d5d8cb35-d2736bcd-4a25d08f-ee68cba1
2678	overlying trauma board limits evaluation . endotracheal tube tip terminates approximately cm from the carina . orogastric tube is noted within the stomach and the tip projects off the inferior borders of the film . bilateral chest tubes are noted terminating near the lung apices . left subclavian central venous catheter tip terminates within the upper svc . the heart size is normal . the superior mediastinum is widened . small bilateral pneumothoraces are present . minimal streaky opacity is noted in the left lung base, which could reflect atelectasis . more focal opacity is also seen within the left mid lung field, which is nonspecific . no pleural effusion is identified . there are multiple bilateral rib fractures noted . . lines and tubes in standard positions . . widened superior mediastinum . subsequent ct of the torso demonstrated an extensive type a aortic dissection . . small bilateral apical pneumothoraces . . streaky opacity left lung base may reflect atelectasis . more focal opacity in the left mid lung field is nonspecific but could reflect an area of aspiration or contusion .	Atelectasis&&Enlarged Cardiomediastinum&&Lung Opacity&&Pneumothorax&&Support Devices	19914761	56042355	43fd9f86-bafca6c3-8e89eb75-eccccb60-bdf29257
2679	feeding tube tip in the distal stomach . central line, endotracheal tube have been removed . sternotomy, valve replacements . small bilateral pleural effusions have worsened . left basilar atelectasis or infiltrate, worsened . right basilar atelectasis, worsened . increased heart size, more prominent . mildly prominent pulmonary vascularity . feeding tube tip in the distal stomach . worsened pulmonary findings .	No Finding&&Support Devices	18224196	59144799	ba021d0f-a80b547a-f46e1b2b-5b0a8ce9-3507868f
2680	the monitoring and support devices, including the temporal right pacemaker, have all been removed . the patient is in unchanged moderate pulmonary edema, with moderate cardiomegaly but without pleural effusions . no newly appeared parenchymal opacities . unchanged mild atelectatic changes at the lung bases . no other relevant changes .	Atelectasis&&Cardiomegaly&&Edema&&Support Devices	11893091	53794474	f0e71e50-eb720bc4-ed412179-8b07b163-cd37195b
2681	frontal and lateral views of the chest demonstrate low lung volumes, which accentuate bronchovascular markings . marked elevation of bilateral hemidiaphragms is longstanding . there is near-complete resolution of small bilateral pleural effusions seen on exam . there is no pulmonary edema . hilar and mediastinal silhouettes are unchanged . heart size is top normal . no focal consolidation or pneumothorax . in comparison to exam, there is interval near-complete resolution of bilateral pleural effusion . no pulmonary edema .	No Finding	18338007	54013815	703e42a5-6b45dc45-ddce2dde-27e08236-58af4c95
2682	continued enlargement of the cardiac silhouette with pulmonary vascular congestion and bilateral pleural effusions with compressive atelectasis . central catheter remains in place .	Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	12185775	56143620	b529320a-394d7b79-a3e8c3da-c28c6b94-7ec08b51
2683	the patient has undergone right thoracocentesis . the extent of the pre-existing pleural effusion has substantially decreased . there is no evidence of pneumothorax . the signs indicative of mild-to-moderate interstitial pulmonary edema are also improved, but the heart continues to be large and the contours of the left hilus continue to be bulging outwards . atelectasis at the left and right lung bases are unchanged . no evidence of pneumonia .	Atelectasis&&Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Pleural Effusion	12847817	58371032	3c920897-9646c09a-68473fee-614861c4-7a9780f1
2684	the monitoring and support devices are unchanged . slight progression of the bilateral basilar areas of atelectasis . minimal further enlargement of the cardiac silhouette . otherwise, the lung parenchyma is unchanged . no pneumothorax, no larger pleural effusions .	Atelectasis&&Cardiomegaly&&Support Devices	18322589	52428827	f4adee4b-4f00cc47-63f9ed2a-b4432064-a81ec91c
2685	the patient remains intubated with the et tube tip being approximately . cm above the carina . the left internal jugular line tip is at the junction of brachiocephalic vein and svc . the right internal jugular line tip is at the level of superior svc . ng tube tip passes below the diaphragm terminating in the stomach . heart size and mediastinum are stable in appearance including cardiomegaly . minimal interstitial pulmonary edema is unchanged . bibasal left more than right areas of atelectasis associated with small bilateral pleural effusions are noted .	Atelectasis&&Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	18906643	50566099	155bc756-c4c5c4a9-5db23266-7de1babe-65b89b7b
2686	again seen are chronic interstitial changes predominantly in the right lower and left mid and lower lungs . however, there is increased density of opacification in the right lower hemithorax concerning for developing infection . considerations include atypical infection, though asymmetric pulmonary edema is possible . given history of lung malignancy, lymphangitic carcinomatosis is also a consideration . underlying fibrotic changes are grossly similar with predominantly paramediastinal and lingular distribution . no pneumothorax or significant pleural effusion is seen . the heart size is enlarged, however, unchanged . of note, on the ct of , there was a small pericardial effusion . there are atherosclerotic calcifications of the aortic arch . diffuse interstitial opacities increased predominantly in the right lower lung, concerning for developing infection . given history of lung carcinoma, however, lymphangitic spread of carcinoma as well as asymmetric pulmonary edema are possibilities .	Edema&&Lung Lesion&&Lung Opacity&&Pneumonia	14722763	56753518	ab680048-8257c201-858ba25c-718b230c-186cf3f4
2687	compared to most recent prior exam, there has been little interval change . no new consolidation, pleural effusion, or pneumothorax is appreciated on this single frontal view . heart size is enlarged . the aorta is calcified . right-sided hemodialysis catheter terminates in the right atrium, as seen previously . stable chest radiograph . no significant edema .	No Finding	17340686	55469953	6ff741e9-6ea01eef-1bf10153-d1b6beba-590b6620
2688	the heart is again mildly enlarged . the mediastinal and hilar contours appear unchanged . pleural effusions have more fully resolved . there is persistent patchy opacification of the right mid upper and left upper lungs, which are background findings . streaky left basilar opacity also has improved . pulmonary edema has more fully resolved . a picc line again terminates in the superior vena cava . no evidence of acute disease .	No Finding	14851532	50821093	f0c7fed9-f0dd13bd-29757304-7d67a895-423549b2
2689	the evidence of pulmonary edema, of moderate severity, is unchanged . the patient has been extubated and the nasogastric tube has been removed . only the right internal jugular vein catheter persists . the ventilation at the left and right lung base is improved . there is unchanged evidence of scarring in the left mid lung and evidence of right basal pleural calcifications . no newly appeared focal parenchymal opacity suggesting pneumonia .	Edema&&Lung Opacity&&Pneumonia&&Support Devices	17838301	57255382	e5382fdb-74985bc4-2fb7ed30-c1708f5c-3f136ee4
2690	cardiac silhouette is enlarged and accompanied by pulmonary vascular congestion . persistent moderate right and small left pleural effusions with adjacent basilar lung opacities, which probably reflect atelectasis, although coexisting pneumonia is possible in the appropriate clinical setting .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia	12952223	50551136	2ff42829-e2419fdc-267d447a-f0ece038-e2161c61
2691	as compared to the prior study, there is redemonstration of the expected left mediastinal shift on this pa and lateral view . there is interval increase in the amount of fluid content of the left hemithorax with elevated air-fluid level as expected . several loculated air collections are still seen within the left hemithorax . right lung is clear . there is no right pleural effusion or pneumothorax . continued surveillance is recommended .	No Finding	12410066	57525852	07a02d8b-728a76a1-cb80919e-78d7a90f-cf5a5fb2
2692	heart size is normal . mediastinal widening is unchanged compatible with mediastinal lipomatosis with a tortuous aorta again noted . the hilar contours are unremarkable . pulmonary vasculature is normal . linear opacity within the lingula is compatible with subsegmental atelectasis . no focal consolidation, pleural effusion or pneumothorax is present . no acute osseous abnormality is identified . no acute cardiopulmonary abnormality .	No Finding	17337033	57289014	a30e7a85-23910be3-967d6653-109accd7-e4101dcf
2693	there is interval progression of left mid-lower lung opacities that appear to be more pronounced than on the prior chest ct from . in conjunction with severe emphysema, they most likely represent interval development of infectious processaspiration . there is minimal vascular engorgement, but no overt pulmonary edema . small amount of left pleural effusionpleural thickening is unchanged . heart size is enlarged, unchanged . post-sternotomy wires are unremarkable . the pacemaker defibrillator leads terminate in the expected location of right atrium, right ventricle, and left ventricle epicardial leads .	Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Pleural Other&&Pneumonia&&Support Devices	13606683	55496973	b3024f42-1bf6d070-0df335f6-854c6de4-e8edb406
2694	there again is enlarged of the cardiac silhouette in a patient with intact midline sternal wires and pacemaker device in place . engorged and indistinct pulmonary vessels are consistent with increasing pulmonary venous congestion .	Cardiomegaly&&Support Devices	13896515	50010747	77e614cb-6c987153-793f83ce-20c1f507-f6a49f49
2695	since the prior examination, interstitial pulmonary edema is resolved . there are no focal opacities concerning for pneumonia . there is a trace left pleural effusion . there is no right effusion . there is no evidence of pneumothorax . the cardiomediastinal and hilar contours are stable demonstrating mild tortuosity of thoracic aorta and cardiomegaly . pulmonary vascularity is within normal limits . . no evidence of focal pneumonia . . interval resolution of interstitial pulmonary edema .	No Finding	13484161	51009376	e120ed69-a974706b-30acf181-38be212f-48eb872d
2696	pa and lateral views of the chest comparison is made to . in comparison to prior exam, there is increase in the vascular markings consistent with cardiac failure . no sizeable pleural effusion . cardiomediastinal silhouette is top normal in size . the lungs show no focal opacities concerning for an infectious process . compression deformity at approximate t vertebrae .	Edema	10449297	54773340	c030b6d3-bd30c805-6a5b4a1c-43939f5d-e533cace
2697	left lung lavage was recently done, explaining probably the increased density of left middle lung . there is a small left pneumothorax measuring to mm . mild pulmonary edema is new . pleural effusions are small, if any . minor fissure on the right side is slightly thickened with an atelectatic band in right lower lung . mediastinal and cardiac contours are moderately enlarged . aortic knob calcification is unchanged . patient had prior sternotomy for aortic valve, mitral valve and tricuspid valve repair . conclusion . left middle lung increased density is probably related to recent lavage . . left apical pneumothorax is small . . pulmonary edema is also mild . this has been discussed with .	Edema&&Lung Opacity&&Pneumothorax	19182863	55145381	bce5d9b0-6d67ccea-45044d9d-e4136b2d-643464ce
2698	the monitoring and support devices are constant . low lung volumes . moderate cardiomegaly . mild to moderate pulmonary edema . no larger pleural effusions . retrocardiac atelectasis . no new focal parenchymal opacities .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Support Devices	15131736	53481305	374a4a0d-c236bc19-25ea8b17-2f7f41cb-2b323110
2699	median sternotomy wires are again seen with fractures of the superior most wires . the cardiomediastinal and hilar contours are within normal limits . lungs are well expanded and clear . there is no focal consolidation, pleural effusion or pneumothorax . no acute cardiopulmonary process .	No Finding	15518538	59504476	70ad5a5e-35834f2a-a5619c1e-5deaac58-b6657063
2700	the lung volumes are low . there is similar mild relative elevation of the right hemidiaphragm . the heart is at the upper limits of normal size . the lungs appear clear . there are no pleural effusions or pneumothorax . there has been little if any change . no evidence of acute disease .	No Finding	13202100	51265278	0d5def63-8ca29ddc-bf6bde42-fab8887f-19a6e96c
2701	there has been interval placement of a right ij approach tunneled hd catheter, the tip of which projects over the expected location of the right atrium . lung volumes remain somewhat low, and there is interval increase in bibasilar airspace opacity, right greater than left, concerning for right lower lobe pneumonia . small-moderate right greater than left pleural effusions are increased . there is no pneumothorax . the cardiac silhouette is top normal for size, and unchanged from prior . mediastinal contours remain normal . . interval hemodialysis catheter placement, the tip of which projects over the expected location of the right atrium . . new development of bilateral lower lobe atelectasis andor pneumonia, with moderate right and small left pleural effusions .	Atelectasis&&Pleural Effusion&&Pneumonia&&Support Devices	11880923	53367019	226379d0-ea16df78-cc85e54b-2f773a4c-8afb5ba2
2702	the lungs are clear without focal consolidation . no pleural effusion or pneumothorax is seen . the cardiac and mediastinal silhouettes are unremarkable . no acute cardiopulmonary process .	No Finding	15659181	56440919	7358c522-a008ba73-ad82f64d-377361fe-34cb3b0a
2703	low lung volumes and elevation of the left hemidiaphragm are similar to prior . pulmonary vascular markings are indistinct, compatible with mild pulmonary edema . left base atelectasis is present . no substantial pleural effusion or pneumothorax . cardiomediastinal contours are stable . mild pulmonary edema with low lung volumes .	Edema	18338007	58003864	20973f59-31a0c792-a3f0870b-bebcadce-934a76f3
2704	there is no focal consolidation . there is no pleural effusion or pneumothorax . the heart is mildly enlarged . the mediastinal contours are normal . the median sternotomy wires are again seen, three of which are fractured . the wire located third from the top has a fracture fragment oriented posteriorly . the mediastinal clips are stable . . no acute cardiopulmonary process . . three fractured median sternotomy wires . the wire located third from the top has a fracture fragment oriented posteriorly .	Fracture	19499595	58099159	cf85ad05-11574785-5d5c24bc-5931200b-df7f068a
2705	mild pulmonary edema is improved from prior exam . dilated main pulmonary artery is seen, compatible with pulmonary arterial hypertension . no large effusion is seen on this supine film . there is no pneumothorax . the cardiac silhouette is moderately enlarged but stable . left-sided double lumen central venous catheter is seen with tip in the right atrium . degenerative changes are seen in the right humeral head, better characterized on the dedicated exam . surgical sutures are noted in the right upper quadrant . . mild pulmonary edema, improved from the prior study . . dilated main pulmonary artery, compatible with pulmonary arterial hypertension .	Edema	17340686	52918822	b9b1f6e8-15e667f7-ded64b1b-841d8028-ebf79954
2706	since the previous radiograph, there has been continued improvement in the previously described pulmonary edema . there are moderate bilateral effusions, which are unchanged . there are small bibasilar hazy opacities consistent with atelectasis . the cardiomediastinal silhouette is normal . cervical hardware is again noted . . continued improvement in pulmonary edema . . moderate bilateral pleural effusions .	Edema&&Pleural Effusion	13586204	54073075	06da0b0e-ad407abe-e199913d-e079da96-22a7c445
2707	the patient has taken a better inspiration . the heart is normal in size and there is again evidence of intact mediastinal wires and aortic valve replacement . specifically, no pneumonia, vascular congestion, or pleural effusion .	No Finding&&Support Devices	16043637	59826977	9844f097-34ee5bca-c0ab33dd-1b830d21-0df9b00d
2708	compared with , at pm, the radiographic appearance is stable . again seen is background copd, with extensive parenchymal scarring, cardiomegaly, and moderately large right effusion with underlying collapse andor consolidation . increased opacity in the right infrahilar region and pleural thickening and scarring with retraction in the left upper zone as well as blunting of the left costophrenic angle and scarring at the left base . left vascular stent noted . prior old right-sided rib fractures again noted . copd with extensive pleuralparenchymal scarring, right effusion with underlying collapse andor consolidation, and right infrahilar opacity are unchanged compared with . the right-sided changes should be followed to conclusion to exclude underlying mass . the left apical scarring should also be followed over time to exclude an underlying neoplasm .	Atelectasis&&Consolidation&&Lung Opacity&&Pleural Effusion	13849733	51947909	bc8db468-b178d3ba-03bdb07d-16e95e5f-775875b8
2709	there is increased prominence of opacification adjacent to the right lateral chest wall . it is unclear whether this could merely reflect change in degree of obliquity of the patient or whether there is a reason to suggest increased fluid within the pleural space . the right hemidiaphragm remains sharp and there is nothing to indicate layering pleural effusion . this information has been telephoned to dr . , was covering for dr . .	Lung Opacity&&Pleural Effusion	19389547	55499601	47168ca2-46fb63bc-f859ecb2-d1a48369-fbc2f3cf
2710	bilateral perihilar and right basal parenchymal opacities have completely resolved . the lung parenchyma is now free of infectious changes or atelectasis . no pulmonary edema . no pleural effusions, valvular calcifications . no pulmonary nodules or other neoplastic or infectious lesions .	Pneumonia	16508811	52215519	9367b100-a7a0afff-943d155e-be050317-86dce692
2711	no relevant change is seen of the sternal wiring . monitoring and support devices are constant in appearance . constant low lung volumes with bilateral small pleural effusions and subsequent areas of atelectasis . moderate cardiomegaly . no new parenchymal opacities .	Atelectasis&&Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Support Devices	14851532	54726507	018a20b6-6f0efbba-f043405f-e1af115c-a30fa5ed
2712	comparison to prior study dated . portable erect chest film at is submitted . . right internal jugular dual-lumen large-bore catheter unchanged in position with the tip in the right atrium . overall, cardiac and mediastinal contours are stably enlarged given patients rotation . lung volumes are diminished . there is perihilar fullness and indistinctness of the pulmonary vasculature which would favor pulmonary edema rather than an acute infectious process . however, clinical correlation would be advised as this could reflect an atypical infection . no large effusions . no pneumothorax .	Edema&&Enlarged Cardiomediastinum&&Pneumonia&&Support Devices	14841168	57693388	0ac866f1-b3bfe12a-db469934-8e3130a5-407a9e34
2713	the ng tube tip passes below the diaphragm, most likely terminating in the stomach . there is no change in the appearance of the right chest tube, left subclavian line and et tube . extensive subcutaneous air collections are widespread throughout the entire chest . bilateral focal consolidations within the lungs appear unchanged .	Consolidation&&Support Devices	16751749	57787040	3d1d93b1-6b91fadd-c1b40a43-382aef3b-639c3488
2714	and moderate to severe pulmonary edema is increased from the prior examination . no focal consolidation to suggest pneumonia is seen . no significant pleural effusion or pneumothorax is present . there is moderate cardiomegaly . a left-sided port is unchanged . there are multiple vertebroplasties .	Cardiomegaly&&Edema	10439781	52737492	eae4f18b-52b36d2b-1d522da3-36dfb123-0de8cd13
2715	bilateral pleural effusions of mild-to-moderate extent, left more than right, have newly appeared . bilaterally, these leads through mild basal areas of atelectasis . overall, the lung volumes have decreased . the tracheostomy tube, the nasogastric tube and the ecg leads are constant . on the right, the pre-existing right internal jugular vein catheter in the subclavian catheter has been replaced by a right-sided picc line . the tip of the picc line projects over the mid-to-lower svc . there is no evidence of pneumothorax . at the time of observation and dictation, am, the referring physician, . , was paged for notification, .	Atelectasis&&Pleural Effusion&&Support Devices	13135946	56200127	b0ac58d9-2a6c6e67-a28d32ad-e75154c0-4a90359a
2716	the heart size is normal . the mediastinal and hilar contours are within normal limits . the pulmonary vascularity is normal . diffuse increased interstitial markings are similar when compared to the prior study and compatible with the patients known history of lymphangiomyomatosis . no focal consolidation, pleural effusion or pneumothorax is present . no acute osseous abnormalities are visualized . partially imaged is fusion hardware within the lumbar spine . widening of the right acromioclavicular interval likely reflects remote trauma . no acute cardiopulmonary abnormality . chronic lung changes compatible with lymphangiomyomatosis .	No Finding	12303667	51202805	f13c668b-a7cbd8c4-3de552f9-4c0921fe-7c8b4a12
2717	previous mild pulmonary edema has cleared, moderate left and small-to-moderate right pleural effusion and substantial bibasilar atelectasis are still present and moderate enlargement of the postoperative cardiac silhouette which decreased from through is stable . no pneumothorax . right internal jugular sheath ends at the origin of the svc and a feeding tube passes into the stomach and out of view . no pneumothorax .	Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices	18224196	50425819	845cab57-7175f1f2-caf520b2-83bdf74a-434a7206
2718	as compared to prior radiograph of day earlier, subcutaneous emphysema and pneumomediastinum are again demonstrated . bilateral pneumothoraces are not clearly identified on todays exam . heterogeneous opacities in the right lung are similar, and exam is otherwise remarkable for worsening left basilar atelectasis with adjacent small left pleural effusion .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Pneumothorax	11474065	59648796	370db7dd-bdd6ffce-5e0e6b83-bc6f534f-61ce5045
2719	a left pectoral dual-lead pacer with trans-subclavian lead extending to the right atrium and right ventricle is in unchanged position . there is no pneumothorax or pleural effusion . hyperexpansion suggests underlying chronic obstructive pulmonary disease . new from prior study, there are multifocal lower and middle lobe parenchymal opacities . given the provided history and the apparent lack of infectious symptoms, these could represent amiodarone toxicity . this suggestion is supported by the increased density of the liver from to . the hilar and cardiomediastinal contours are unchanged . there is no pulmonary vascular congestion or pulmonary edema to suggest congestive failure . new multifocal parenchymal opacities in the lower and middle lobes bilaterally, which given concurrent increased hepatic density from to , could represent amiodarone-induced pulmonary toxicity . differential would includes infectious processes in the proper clinical setting or organizing pneumonia . ct could be considered for further evaluation . this was discussed with dr at noon by dr on via phone .	Lung Opacity&&Pneumonia	10754184	54594848	36d187c2-a2f1c238-25e77d89-19d5e8b8-ca837472
2720	lines and tubes stable right ij line tip position . lungs low lung volumes with mild worsening of pulmonary edema . pleura small left pleural effusion . mediastinum stable cardiomegaly . bony thorax no change mild interval worsening of pulmonary edema with unchanged left pleural effusion and cardiomegaly .	Cardiomegaly&&Edema&&Pleural Effusion	16508811	59842151	430e6100-bae3aa34-d72132a7-2c61b505-8d2056bb
2721	multiple right rib deformities are noted along the right lateral rib cage . areas of pleuroparenchymal scarring are noted in the underlying lung . otherwise, the lungs appear clear bilaterally without focal consolidation, effusion, or pneumothorax . cardiomediastinal silhouette is normal . bony structures appear stable without definite signs of an acute fracture . no free air below the right hemidiaphragm is seen . stable deformity along the right lateral rib cage . no acute findings .	No Finding	12136799	51835810	03da26e7-8b50eef0-1b7ebc08-6a620d75-b320cbc4
2722	tip of the wire in the left pic line ends at the junction of brachiocephalic veins, and the catheter extends at least cm beyond that point into the upper svc . large bullae at the lung bases are responsible for atelectasis . heart is mildly enlarged, unchanged . lungs are otherwise clear, and there is no pulmonary vascular engorgement or edema .	Atelectasis&&Support Devices	18512911	54657707	a93cd149-9d1bdad3-ca3f7d1d-1e6235b5-9cde6b9c
2723	frontal and lateral chest radiographs the patient is slightly rotated . the heart size is normal . the hilar and mediastinal contours are within normal limits . there has been interval increase in central pulmonary vessel prominence and interstial opacities, representing mild edema . increased linear atelectasis at the left base is seen . there is no pneumothorax or large pleural effusion . no free intrabdominal air is detected on this upright study .	Edema	19028690	55086195	7b9c311b-b511e83b-75a5a6cf-d46efb9d-ac034314
2724	comparison to . no relevant change . moderate cardiomegaly . low lung volumes . mild to moderate pulmonary edema . the right basilar atelectasis . retrocardiac atelectasis . no larger pleural effusions .	Atelectasis&&Cardiomegaly&&Edema&&Support Devices	14841168	58881734	05497016-015d9fb6-1dcbc401-ad586ed8-ff4595d4
2725	pa and lateral chest views have been obtained with patient in upright position . there is evidence of sternotomy and previous bypass surgery with moderate cardiac enlargement . the pulmonary vasculature demonstrates an upper zone redistribution pattern, but no conclusive evidence for interstitial or alveolar edema is present . bilateral pleural space thickenings are seen along the lateral lower chest walls measuring up to and cm at the bases . the pleural densities extend into the posterior compartments as identified on the lateral view . there is no evidence of new acute pulmonary parenchymal infiltrates . no evidence of pneumothorax exists in the apical area . when comparison is made with the next preceding portable chest examination of , the described mostly basal located pleural thickenings were similar and appear rather stable . the pulmonary vasculature appears, however, now slightly more congested . review of previous pa and lateral chest examinations from , and demonstrated that the pleural thickenings existed already at that time . considering the rather stable pleural thickenings could consider that they are at least in part organized and represent scar formations in this patient with history of end-stage renal disease .	Cardiomegaly&&Lung Opacity&&Pleural Other	16360107	52578881	535db340-f9e90089-14252bfc-a0e9b1d2-7b3b4baa
2726	the patient is status post sternotomy and both mitral and aortic valve replacements . moderate cardiomegaly is unchanged . the mediastinal and hilar contours appear stable . there is new mild-to-moderate relative elevation of the right hemidiaphragm which suggests volume loss and a patchy opacity in the right lower lobe has increased and is worrisome for pneumonic consolidation . there is probably also some degree of new opacification in the right middle lobe . a vague opacity is also new in the right suprahilar region in the right upper lobe, potentially an early focus of pneumonia . there is no definite pleural effusion . findings suggest multifocal pneumonia involving the right lung .	Pneumonia	19182863	52786632	6a7b83c9-7b7c6ba9-09d85de8-a76f1aa7-4fd0e047
2727	frontal and lateral views of the chest a dominant right cavitary lesion is stable in size but demonstrates slightly less fluid and more gas than on the study . the smaller cavitary lesion at the right lung apex is stable in appearance . the left upper lobe consolidation has slightly decreased in size although the small area of central lucency is stable in size . bilateral areas of ground-glass and patchy opacities appear overall stable in appearance and distribution . observed findings are consistent with widespread pulmonary infection . there are no new areas of consolidation . there is no pleural effusion or pneumothorax .	Consolidation&&Lung Lesion&&Lung Opacity&&Pneumonia	17270742	59121133	9ec0cfcc-56c60789-9ba97090-78a9c166-1429115f
2728	lung volumes low with bibasilar atelectasis and increased bilateral alveolar opacities and bilateral pleural effusions . ng tube has been advanced now terminating in the stomach although the side port is difficult to visualize . other indwelling monitoring and support devices are stable and appropriate position . moderate pulmonary edema and small bilateral pleural effusions worse from .	Edema&&Pleural Effusion	15131736	56536391	108c4783-1499c826-2bf7748a-8beb06c1-d8a2c88f
2729	there is a mild-to-moderate left pneumothorax with rightward mediastinal shift more apparent than on portable chest radiograph at pm . the small right pneumothorax is stable . there is also a moderate left pleural effusion . bilateral pigtail catheters are in place . the heart size remains normal . there is no focal consolidation . . new mild-to-moderate left pneumothorax with mild rightward shift of the mediastinum . . stable right pneumothorax . . moderate left pleural effusion . the case was discussed by dr . with dr . .	Enlarged Cardiomediastinum&&Pleural Effusion&&Pneumothorax	10410641	59980986	380fda55-d2283afd-511dcad7-803d3b6a-ed8c6b64
2730	a port-a-cath type catheter is present, with lead tip over svcra junction . a right ij central line is present, replacing the previou sheath, with tip over proximal svc . the patient is status post sternotomy . there is enlargement of cardiomediastinal silhouette, unchanged compared with . there is upper zone redistribution and mild interstitial edema, improved . there is increased retrocardiac density, consistent with left lower lobe collapse andor consolidation, also slightly improved . hazy opacity at the right base is also slightly improved . probable small bilateral effusions .	Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion	12124741	55477134	b057552d-dcaef0e0-258a2453-37c600b2-d8d2b31f
2731	the patient has been extubated . the nasogastric tube has been removed . there are moderate bilateral pleural effusions with relatively substantial areas of atelectasis . size of the cardiac silhouette cannot be determined . no evidence of new parenchymal opacities suggesting pneumonia . a left internal jugular vein catheter remains in situ .	Atelectasis&&Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	11569093	54670469	a238199b-93d2aa00-f4451329-26e4438c-e170ad89
2732	lung volumes are low which somewhat limits evaluation . fluid is noted tracking along the fissural surfaces . mild interstitial pulmonary edema is noted . there is no focal consolidation to suggest pneumonia . no pneumothorax . cardiomediastinal silhouette is stable with an unfolded thoracic aorta . bony structures are stable with multiple lower thoracic and upper lumbar compression fractures better assessed on a prior ct torso from . ivc filter is partially visualized in the upper abdomen on the lateral view as well as surgical clips in the upper quadrant . interstitial pulmonary edema .	Edema	13979643	57005451	a3ebe8b0-1678004d-48fa1d7d-c4d3b940-5f7a57d2
2733	the lungs are clear of consolidation, effusion or pulmonary vascular congestion . cardiomediastinal silhouette is stable in configuration . vascular coronary stent is also notednodular opacity projecting over the right mid lung laterally is compatible with callous from prior rib fracture . chronic changes noted at the proximal left humerus suggestive of prior trauma . no acute osseous abnormality detected . no acute cardiopulmonary process .	No Finding	19549821	55593187	318e2d2a-cd564b66-987b939f-2b0ded80-8fc82ad2
2734	the bilateral areas of atelectasis at the lung bases, left more than right, are present in unchanged manner . minimal postoperative opacity at the left lung base that should receive attention on further followups . the right internal jugular vein catheter is unchanged . no overt pulmonary edema . no evidence of pneumothorax . borderline size of the cardiac silhouette .	Atelectasis&&Cardiomegaly&&Lung Opacity&&Support Devices	14851532	51478052	f9a786b3-b5473ac8-3f0d1596-bc19198f-2a6ccc1c
2735	the inspiratory lung volumes are decreased from the most recent prior study . increased opacification of the bilateral bases is likely reflective of atelectasis in the post-operative setting of low lung volumes . prominent lung markings raise the possibility of chronic lung disease . small bilateral pleural effusions are present . no pneumothorax is detected . the cardiac silhouette is likely within normal limits allowing for low lung volumes . no overt pulmonary edema is present . calcified hilar and mediastinal lymph nodes are re-demonstrated, compatible with sequela of known sarcoidosis . multiple healed right posterior rib fractures are again noted . . bibasilar opacities most likely represent atelectasis in the post-operative setting of low lung volumes . small pleural effusions . . stable calcified hilar and mediastinal lymph nodes compatible with known sarcoidosis . . suggestion of chronic lung disease .	Atelectasis&&Lung Opacity&&Pleural Effusion	15776774	55775814	8c9f9878-cdf131fc-776baece-6baeb337-8c4c2b2a
2736	the lung volumes have slightly decreased, which could potentially be caused by decreased ventilatory pressures . as a consequence, the bilateral parenchymal opacities appear slightly denser than on the previous image . the size of the cardiac silhouette is unchanged . no new parenchymal opacities have newly occurred . no pleural effusions are seen . the monitoring and support devices are constant .	Cardiomegaly&&Lung Opacity&&Support Devices	15378103	55410841	93b9fbec-d0096ef4-0f25a638-a44849a5-58844ba5
2737	there are lower lung volumes . engorgement and indistinctness of pulmonary vessels is consistent with worsening pulmonary vascular congestion . no definite acute focal pneumonia .	Edema	11213613	52190468	70cdba5b-2e0ec97d-779d4d58-23a484e4-02ec1b1c
2738	the dobbhoff tube tip passes below the diaphragm . cardiomediastinal silhouette is unchanged . there is unchanged appearance of left perihilar mass . patient continues to be in mild interstitial edema . small bilateral pleural effusions are most likely present . overall no substantial change since the prior radiograph demonstrated .	Edema&&Enlarged Cardiomediastinum&&Lung Lesion&&Pleural Effusion&&Support Devices	15185305	58478940	dbdd8fb8-dce8cc76-b74aa4de-722deb19-bdcfe5ca
2739	there is complete resolution of the pre-existing pleural effusions . unchanged moderate cardiomegaly without evidence of pulmonary edema . small basal parenchymal scars but no evidence of recent pneumonia . moderate tortuosity of the thoracic aorta . calcified bronchial walls .	Cardiomegaly&&Lung Opacity	10650001	56172325	edfd806e-5c672eea-1119d9d0-44c282a8-7c3d9730
2740	there is again prominence of the superior mediastinum, which apparently reflects exuberant mediastinal fat on a prior ct of the chest . the atelectatic change at the left base seen previously is essentially cleared . no acute pneumonia at this time .	Atelectasis&&Enlarged Cardiomediastinum	17337033	58080029	3f88d0d6-bcbb5cb4-27d9e806-7b3903f8-2645e762
2741	the patient has received a new nasogastric tube . the tube now shows a normal course . the tip of the tube is located in the proximal parts of the stomach . no repositioning is necessary . no evidence of complications, notably no pneumothorax . otherwise, the image is unchanged .	Pneumothorax&&Support Devices	18855147	56550578	3fb9a12d-133444d3-6e328120-7dc4d6ef-d0b6b9fd
2742	compared to the prior study there is no significant interval change .	No Finding	16751749	58820049	a8be9459-c3237ba1-f460add2-4b61c40c-bcdfd92c
2743	a left upper extremity picc line is seen extending into the distal left brachiocephalic vein . lung volumes are markedly low . the heart is stably enlarged . there is no overt evidence for pneumonia or chf . no large effusion or pneumothorax is seen . bony structures appear grossly intact . limited, negative . left upper extremity picc line terminates in the distal left brachiocephalic vein .	No Finding&&Support Devices	15131736	59175350	a3f94558-fcb3a66f-7b6f0be2-1c09857b-168fb462
2744	the patient is status post left pneumonectomy procedure with expected leftward shift of cardiomediastinal contours . left chest tube has been removed . pneumonectomy space remains predominantly air-filled with a small amount of fluid in the lower left hemithorax . right lung is overexpanded and demonstrates linear atelectasis at the base . subcutaneous emphysema in the left chest wall has slightly decreased from the prior study .	Atelectasis&&Enlarged Cardiomediastinum	12410066	50100756	a6a7fb04-b48fccde-ae205333-f958732f-5ef1f1ee
2745	residual stellate left upper lobe opacity is most compatible with scarring . left mid lung granuloma is unchanged . otherwise, the lungs remain hyperexpanded compatible with chronic obstructive pulmonary disease without new opacity . there is no pleural effusion or pneumothorax . the heart is normal in size and cardiomediastinal contours . residual left upper lobe stellate opacity may reflect scarring after pneumonia . however, followup radiograph in weeks is recommended . findings were entered in the radiology departments online record for notification of critical results on .	Lung Opacity&&Pneumonia	11052935	53792271	f1af4079-d3abad02-2bdd2d45-9f43ee98-bb00dc90
2746	patient is status post median sternotomy . left-sided pacer device is grossly stable in position . there is a moderate left pleural effusion with overlying atelectasis, left base consolidation is not excluded . similar pulmonary edema persists, possibly asymmetric on the left . no right pleural effusion is seen . there is no pneumothorax . cardiac and mediastinal silhouettes are stable . moderate left pleural effusion with overlying atelectasis, underlying consolidation not excluded . similar pulmonary edema .	Atelectasis&&Consolidation&&Edema&&Pleural Effusion	13896515	59828891	ac8313a2-9e5439a8-e287d978-72c66b71-8d91da34
2747	there is moderate to severe pulmonary edema . there is a small left pleural effusion with overlying atelectasis . small right pleural effusion may also be present . subtle patchy right upper lobe opacity, underlying the ekg lead, may be due to developing consolidation or confluence of vessels . repeat with removalrepositioning of the ekg lead may be helpful for further evaluation . the cardiac silhouette is enlarged . no pneumothorax .	Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Lung Opacity&&Pleural Effusion	16508811	53943140	8ca45b1d-11e7b3c4-81d757ce-5fa29549-4efce674
2748	comparison to prior study dated at . single portable ap upright chest film at is submitted . . cardiac and mediastinal contours are stable given patient rotation on the current study . lungs are well inflated . there are minimal residual linear opacities at the left base and interval improvement in patchy opacity at the medial right base consistent with resolving atelectasis . no pulmonary edema . no pneumothorax .	Atelectasis&&Enlarged Cardiomediastinum&&Lung Opacity	19389547	55212349	76bdc5c2-cca422ab-3223abe7-7b01baa8-cca25210
2749	as compared to prior chest radiograph from , there has been interval placement of a swan-ganz catheter with the tip slightly beyond the mediastinum . mild cardiomegaly is unchanged . irregular bilateral lung opacities are stable . chronic pleural thickening is unchanged . there are no pleural effusions or pneumothorax . interval placement of swan-ganz catheter with tip slightly beyond the mediastinum, for which consideration of withdrawing a few centimeters is recommended . these findings were discussed with dr . by dr . telephone on at pm, at time of discovery .	Enlarged Cardiomediastinum&&Support Devices	15809646	56431482	495e73be-71f5ed15-35bbd67d-363dfe60-32f375b6
2750	there has been slight interval increase in size of bilateral pleural effusions which are now moderate to large . there is mild interstitial pulmonary edema again noted . the heart size remains enlarged, the mediastinal contours are normal with note of calcification of the aortic knob . a left chest pacemaker is stable in position . chf, with slight interval increase in size of bilateral pleural effusions, now moderate to large .	Cardiomegaly&&Edema&&Pleural Effusion	15109122	59599357	e1a199d2-0a67b663-57e4049b-c809b2ac-789cce80
2751	progressive moderate pulmonary edema, best appreciated in the perihilar left lung, is accompanied by increased vascular caliber in the upper lobes and new small left pleural effusion . bibasilar consolidation has also increased, due either to worsening pneumonia or edema deposited in the pneumonia . the possibility that this consolidation is due to dependent edema alone should not be discarded . heart size top-normal unchanged . no pneumothorax .	Cardiomegaly&&Consolidation&&Edema&&Pleural Effusion&&Pneumonia	16508811	52785638	927bc2f0-02ccbb86-23fd266d-6890d7ff-8a0a2ce5
2752	there remains small residual consolidation in the lingula, which continues to decrease in size as compared to the prior studies . no definite focal consolidation is seen on the right . there is no pleural effusion or pneumothorax . the cardiac and mediastinal silhouettes are stable and unremarkable . lingular consolidation persists but continues to decrease in size as compared to the prior study .	Consolidation	16662264	56951123	0e20294a-a19790ed-687b001e-481e4273-f89dd2c4
2753	on this study, the lungs are better expanded and the lungs appear clear . a right upper lobe granuloma is unchanged . no pneumothorax or pleural effusion is present . the cardiac silhouette, hilar and mediastinal contours appear normal . no acute cardiopulmonary findings .	No Finding	19609215	59285132	8bedfff2-8d66e0f5-e4b03459-1e0fd124-b7efed95
2754	the lungs appear hyperexpanded . there is mild increased pulmonary vascular congestion from . a small right pleural effusion is likely present with mild right basilar atelectasis . right base consolidation is not entirely excluded . no significant left pleural effusion or pneumothorax is detected . suture chain material and scarring in the left upper-to-mid lung zone is not significantly changed . multiple mediastinal surgical clips are compatible with history of cabg surgery . the cardiac silhouette is top normal in size but unchanged . the mediastinal and hilar contours are within normal limits with moderate tortuosity of the descending thoracic aorta . lobulation at the apex of the left hemi thorax along the mediastinal border is stable, residual of slowly resolving hematoma . . increased mild pulmonary vascular congestion from with small right pleural effusion and right basilar atelectasis . right basilar opacity may be combination of above, but underlying consolidation due to infection is not excluded . . staple, suture material and scar in the left upper-to-mid lung .	Atelectasis&&Consolidation&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia	14851532	51844819	5dfffffd-68cbd012-f3428c65-ebd2ffd8-57793a0c
2755	lung volumes are low . no pleural effusion or pneumothorax is detected . bibasilar atelectasis is present . there is mild left ventricular enlargement . bilateral rib fractures are noted . low lung volumes without acute findings .	No Finding	18079481	56618763	ac34d85d-8a18bdb4-6a76e6b3-63e71de7-dd331e6c
2756	in comparison with the study of earlier in this date, there is increasing indistinctness of engorged pulmonary vessels, consistent with worsening vascular congestion . continued elevation of the right hemidiaphragmatic contour . it is unclear whether this represents a subpulmonic effusion or an intrinsic diaphragmatic abnormality or enlarged liver . left lung is essentially unchanged except for worsening pulmonary vascular congestion .	Edema&&Enlarged Cardiomediastinum&&Pleural Effusion	11569093	52805540	ac8eedd7-c5de2735-141b666d-540b2d92-243ec57d
2757	the heart is of normal size with normal cardiomediastinal contours . the lung volumes are low . there are diffusely increased interstitial markings bilaterally, compatible with known lymphangioleiomyomatosis . no pleural effusion, pulmonary consolidation, or pneumothorax . the osseous structures are unremarkable . no radiopaque foreign body . no acute cardiopulmonary process . chronic interstitial changes compatible with known lymphangioleiomyomatosis .	No Finding	12303667	58981887	be82eebb-cd25c088-b3c1ddfa-6ccf0b10-880a3a77
2758	pa and lateral chest radiographs the cardiomediastinal and hilar contours are normal . in comparison to the prior study, a nodular opacity in the right upper lobe measuring approximately mm, is new . the left lung appears relatively clear . no focal consolidation, pleural effusion, or pneumothorax is seen . no acute osseous abnormality is detected . surgical clips are seen in the left paraspinal region in the abdomen, consistent with prior nephrectomy . new nodular opacity in the right upper lobe, concerning for metastatic disease, less likely infection in this patient with known history of rcc . a chest ct is recommended for further evaluation .	Lung Lesion&&Lung Opacity&&Pneumonia	14794396	54917064	feab557c-84c132e2-a4172ea5-87289e6b-4c74334d
2759	no previous images . there is hyperexpansion of the lungs suggestive of chronic pulmonary disease . prominence of engorged and ill-defined pulmonary vessels is consistent with the clinical diagnosis of pulmonary vascular congestion, though in the absence of previous images it is difficult to determine whether any this appearance could reflect underlying chronic pulmonary disease . the possibility of supervening consolidation would be impossible to exclude on this single study, especially without a lateral view . no evidence of pneumothorax .	Consolidation&&Edema	14081759	53482917	4d69cce1-fecc3019-ee62f6c0-dc12a81e-ae02844a
2760	no significant interval change . the lungs remain hyperinflated . no focal consolidation, edema, or pneumothorax . bilateral pleural effusions are small . the heart is normal in size . retrocardiac opacity on the right is consistent with neo esophagus . no acute osseous abnormality . small bilateral pleural effusions are unchanged . no evidence of pneumonia .	Pleural Effusion	14295224	55139599	b85ad152-d351373d-9b33bc0d-584cf132-a45e2d7a
2761	as compared to recent radiograph from a few hr earlier, the patient has reportedly undergone a tracheobronchial stent placement . extensive pneumomediastinum is new, and accompanied by subcutaneous emphysema in the supraclavicular, cervical and chest wall regions . small bilateral pneumothoraces are also demonstrated . cardiac silhouette demonstrates left ventricular configuration is accompanied by pulmonary vascular congestion . asymmetrically distributed heterogeneous opacities in the right mid and lower lobe could reflect asymmetrical edema, aspiration, or hemorrhage in the post procedural setting . pneumomediastinum and bilateral small pneumothoraces following tracheobronchial stent placement . the findings are concerning for tracheobronchial rupture . notification see documentation of notification in the wet read below .	Pneumothorax	11474065	52522246	dd86cc8c-ae1e2c39-3bc3e62b-b15de0ae-652648de
2762	cardiomediastinal contours are unchanged . there is no evident pneumothorax . a chest tube remains in place . right perihilar opacity is unchanged, likely fluid in the fissure, unchanged from prior . right lower lobe atelectasis has improved . small right pleural effusion has improved . left lower lobe atelectasis is unchanged . left ij catheter tip is in unchanged position . ng tube tip is out of view, below the diaphragm .	Atelectasis&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Support Devices	17770657	56170958	7f3d04fc-eb235975-0821b32d-fbb6dbbb-2261f682
2763	ap upright and lateral views of the chest provided . there has been no significant change in the appearance of the chest . there is persistent interstitial opacity noted diffusely throughout both lungs likely representing interstitial pulmonary edema . no large effusion or pneumothorax . cardiomediastinal silhouette appears stable . no acute osseous abnormalities . chronic left midshaft clavicle deformity . no significant change in diffuse interstitial opacity likely reflecting interstitial pulmonary edema .	Edema&&Lung Opacity	13475033	56833050	b73bf324-b73f2173-694c520e-85a82ce2-93e7be3d
2764	ap single view of the chest has been obtained with patient in sitting semi-upright position . comparison is made with the next preceding similar study of the prior day . during the examination interval, the patient has received a permanent pacer capsule now seen in left anterior axillary position being connected to two intravascular electrodes terminating in right atrial appendage and right ventricular apical portion position . the heart size is unchanged and remains within normal limits . the metallic structure of an aortic valve prosthesis is seen in place as before . pulmonary vasculature is not congested, there are no new acute infiltrates and no pneumothorax is identified on either side . status post sternotomy and aortic valve replacement, newly implanted permanent pacer, unremarkable position of electrode termination and no pneumothorax .	No Finding&&Support Devices	16043637	52726859	2c8df100-4309e350-7d82cb04-094d8978-ce88debf
2765	ap and lateral radiographs of the chest were acquired . the heart is massively enlarged, as before . small bilateral pleural effusions are not significantly changed . diffuse interstitial opacities with perihilar predominance are likely secondary to mild interstitial pulmonary edema, increased compared to radiographs from . no focal consolidations concerning for pneumonia . there is no pneumothorax . the mediastinal contours are stable . . mild interstitial pulmonary edema . . massive cardiomegaly, not significantly changed . . small bilateral pleural effusions, not significantly changed .	Cardiomegaly&&Edema&&Pleural Effusion	12963531	59505688	0fecd070-24b67744-93fe3cdb-429860a4-386b63f5
2766	comparison to prior study of at . . the heart remains enlarged and there is unfolding and prominence to the aorta . there are subtle patchy opacities at both lung bases which may represent atelectasis in the setting of somewhat diminished lung volumes, although an early pneumonia cannot be entirely excluded . no pleural effusions . no pneumothorax . no evidence of pulmonary edema . calcification at the aortic knob consistent with atherosclerosis .	Atelectasis&&Cardiomegaly&&Lung Opacity&&Pneumonia	15393401	52969022	fed84864-f68bc255-fce404b6-c38c836c-08a9985d
2767	there is a dialysis catheter in unchanged position with its tip extending into the right atrium . there is stable cardiomegaly with severe pulmonary edema . there are likely bilateral small effusions though these are poorly assessed . no pneumothorax . bony structure is intact . interval development of pulmonary edema .	Edema	17340686	52923540	26429055-6f36df1c-a048f115-c1f04dc8-d04f9b02
2768	normal cardiomediastinal and hilar contours . lungs are mildly hyperinflated and clear . there has been interval resolution of the opacity in the right cardiophrenic sulcus . pleural surfaces are normal . right clavicular hardware appears intact . there is severe anterior osteophytosis of the thoracic spine . no evidence of pneumonia . notification the findings were communicated to dr . by dr . text on at pm, minutes after discovery of the findings .	No Finding	15881535	58215117	5fdb7189-ead5e2fd-71a6d19b-3862ce63-28bc762e
2769	ap and lateral chest radiographs the cardiomediastinal and hilar contours are stable, with stable enlargement of the left pulmonary artery superimposed over the left upper lung . streaky opacities and volume loss in the right lower lobe, likely atelectasis, have been stable since the prior studies . no new consolidation, pulmonary edema, pleural effusion or pneumothorax is seen . there is stable volume loss in the left lung secondary to prior lobectomy .	Atelectasis&&Lung Opacity	10885696	52937462	f1e6712c-61dabae0-6691539a-039dcbb7-6c467216
2770	a portable frontal chest radiograph demonstrates low lung volumes, with exaggeration of the cardiac silhouette and bronchovascular crowding . even allowing for this, there is at least moderate cardiomegaly . bilateral opacities are likely related sella mild to moderate vascular congestion and pulmonary edema, as well as atelectasis . this is similar to slightly increased compared to . dense retrocardiac consolidation is likely related to edema, but superimposed consolidation cannot be excluded . there is no appreciable pneumothorax . the visualized upper abdomen is unremarkable . mild to moderate vascular congestion and pulmonary edema . possible bilateral pleural effusions with atelectasis . retrocardiac opacity which may be due in part to pulmonary edema and atelectasis limits evaluation of the left lower lung, and superimposed pneumonia cannot be excluded .	Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia	15131736	55610477	676f47c0-d614cf37-78b5c5d0-274cd2aa-9d6211ac
2771	pa and lateral radiographs of the chest were acquired . there is volume loss on the right with associated elevation of the right hemidiaphragm, consistent with the provided history of prior right upper lobectomy . pleural densities along the right upper lateral chest wall are not significantly changed . similarly, opacity at the right apex along the superior mediastinum is not significantly changed, possibly loculated fluid in the pleural space . there is no focal consolidation concerning for pneumonia . there is no left pleural effusion . no definite pneumothorax is seen . there is evidence of prior right thoracotomy, involving the right posterior sixth rib . cervical fusion hardware is incompletely assessed . . no significant interval change . . post-surgical changes on the right, as described above .	No Finding	19991135	51777681	7cdd0c6e-d0263417-262f1fce-bd3d2712-99409e00
2772	aside from granulomatous lymph node calcifications in the aortopulmonic window node, cardiomediastinal silhouette is normal . linear scarring in the left mid lung is longstanding . lungs are otherwise clear . infusion port catheter tip projects over the region of the superior cavoatrial junction . no pleural abnormality .	Lung Opacity&&Support Devices	11413236	50494220	741811fe-d3a0f32c-0f5c16f2-5ab6eace-f84f5233
2773	low lung volumes account for bronchovascular crowding however mild fluid overload would be difficult to exclude . no focal opacities are identified . cardiac size is in the upper limits of normal . there is no pleural effusion or pneumothorax . a new right ij line ends in the lower svccavoatrial junction . increased vascular markings may be due to mild fluid overload although assessment is limited due to low lung volumes . new right ij line ends in the lower svccavoatrial junction .	No Finding&&Support Devices	14727722	56659228	46e392dd-8bae92bc-05e946e4-dad0f6d9-5866b783
2774	in comparison with study , there is continued hyperexpansion of the lungs consistent with chronic pulmonary disease . the pulmonary vascular congestion has substantially decreased . much of the prominence of interstitial markings most likely represents chronic lung disease . atelectatic changes are seen at the left base with possible small effusion .	Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion	16772702	54896233	5cd0800c-77280a87-980a1cf6-b7765304-288d0a38
2775	comparison to . moderate cardiomegaly . low lung volumes . areas of atelectasis at both the left and the right lung basis . no pleural effusions . no pneumonia .	Atelectasis&&Cardiomegaly	19075045	52355113	0126b395-890302f7-05e04391-5fdff456-bda0a891
2776	there are substantially lower lung volumes which may account for much of the prominence of the transverse diameter of the heart . obliquity of the patient makes interpretation difficult . there is opacification silhouetting the outer aspect of the left hemidiaphragm, suggesting volume loss in the lower lobe with pleural effusion . no definite vascular congestion . specifically, there is no evidence of pneumothorax on this somewhat limited study .	Cardiomegaly&&Lung Opacity&&Pleural Effusion	17439310	58060878	2ddeb88d-f8a15dea-6de598cd-b07bef82-d26381d6
2777	there has been some interval clearing of the left upper lung which may reflect a component of edema however, infiltrative pulmonary abnormality of the right lung and left lower lung persist . heart size remains large but indeterminate because heart borders are obscured by the lung abnormality . likely small to moderate left pleural effusion unchanged .	Cardiomegaly&&Edema&&Pleural Effusion	12475198	58891388	0c0e838d-f104a134-1cb0290a-1d03cf65-de502b0c
2778	two frontal images of the chest demonstrate improved atelectasis in the right upper lung and left lower lung from previous imaging . a hazy opacity over the left lung base suggests a layering pleural effusion . a small area of hazy opacity at the right costophrenic angle may represent a small layering pleural effusion . bilateral pulmonary vascular congestion is again seen, essentially unchanged . cardiomediastinal silhouette is unchanged . interval improvement in atelectasis . persistent vascular congestion and bilateral pleural effusions, left greater than right .	Atelectasis&&Edema&&Pleural Effusion	16334516	50121027	2687e47d-96929b39-f0f102b3-d5e17213-31865ec4
2779	lung volumes are reduced . the left internal jugular central venous catheter has been removed . the heart size is borderline enlarged, but accentuated due to low inspiratory lung volumes . there is crowding of the bronchovascular structures with probable mild pulmonary vascular congestion . worsening consolidative opacity in the right upper lung field as well as focal opacities within the left upper and bilateral lower lung fields are concerning for multifocal pneumonia . no pleural effusion or pneumothorax is seen . no acute osseous abnormalities visualized . clips are demonstrated within the left upper quadrant of the abdomen . worsening multifocal opacities concerning for pneumonia . probable mild pulmonary vascular congestion . low lung volumes .	Edema&&Lung Opacity&&Pneumonia	10933609	55736427	1a734389-4bcb9234-220a253e-c22386fd-4f018ada
2780	there is moderate cardiomegaly which is unchanged compared to previous studies . the left hilum is enlarged but stable . no pleural effusion or pneumothorax are seen . there is an opacity of left lower lobe that likely reflects developing pneumonia versus atelectasis . left lower lobe opacification that represents developing pneumonia versus atelectasis .	Atelectasis&&Lung Opacity&&Pneumonia	14841168	54062940	23e4102f-653bff1f-e3b35573-f3e54b6a-472f2c8a
2781	normal heart, lungs, hila, mediastinum and pleural surfaces . a right picc line ends in the region of the superior cavoatrial junction . patient has had a stabilization surgery of the lower cervical spine .	No Finding&&Support Devices	15114531	53033654	92d9fd50-81412806-b71e4d05-9ef38071-6b25204c
2782	comparison is made with prior study performed seven hours earlier . there has been no interval change in low lung volumes, standard position of lines and tubes, mild cardiomegaly, widened mediastinum and mild vascular congestion . there is increase in bibasilar opacities, consistent with increasing atelectasis . small left pleural effusion is unchanged allowing the difference in positioning of the patient . right upper lobe opacity is likely atelectasis . there is no pneumothorax .	Atelectasis&&Cardiomegaly&&Lung Opacity&&Pleural Effusion	19565388	54071126	00c905b2-337d5baa-2245ccaa-481b833c-f647e07a
2783	no focal consolidation, pleural effusion, or pneumothorax is seen . lung volumes are slightly low . there may be an azygous lobe . pulmonary vascular prominence is again seen with interval improvement in mild interstitial edema . heart size is mildly enlarged . persistent pulmonary vascular prominence with interval improvement in mild interstitial edema .	Edema	19028690	58640644	88599fd0-57288634-2d77f19e-73726d34-90158ecc
2784	the lungs are low in volume, but clear . the cardiac silhouette is enlarged . the mediastinal silhouette is normal . hilar and pulmonary vessels are chronically enlarged, but previous pulmonary edema has cleared . a left dialysis catheter ends in the right atrium . no pneumothorax or pleural effusion is present .	Cardiomegaly	17340686	57971060	77911e4a-fb35c2ec-cd17f417-a514b2d2-47244970
2785	comparison to . no relevant change is noted . stable alignment of the sternal wires . left pectoral port-a-cath in stable position . no pleural effusions . no pneumonia, no pulmonary edema .	No Finding	18487334	50226423	e20fecce-83e539b8-cb06143a-49ca3124-35dd992d
2786	there is continued substantial enlargement of the cardiac silhouette with diffuse bilateral pulmonary opacifications consistent with worsening pulmonary edema and bilateral pleural effusion . an endotracheal tube is now in place with its tip approximately cm above the carina . nasogastric tube extends at least to the antrum of the stomach where it crosses the lower margin of the image .	Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	13078497	55331519	5e868309-d66225ba-ff4f44dc-5e9aa433-7712e15d
2787	lung volumes are low . the heart is top-normal size given the lung volumes . there is crowding of the bronchovascular structures with probable mild pulmonary vascular congestion . patchy opacities in lung bases may reflect atelectasis . there are no large pleural effusions or pneumothorax . right brachiocephalicsubclavian stent is again demonstrated . low lung volumes which limits assessment of the lung bases . patchy opacities at the lung bases likely reflect atelectasis . mild pulmonary vascular congestion .	Atelectasis&&Edema&&Lung Opacity	14744884	53896301	3fb53bea-f1dad119-d26160af-4b106702-04691d32
2788	the right and left chest tubes have been removed . lung volumes have increased, likely reflecting improved inspiration . the pre-existing miniscule right apical pneumothorax is no longer clearly visible . unchanged mild air collections in the left and right perithoracic soft tissues . minimal atelectasis at the right lung base . borderline size of the cardiac silhouette, no pulmonary edema . normal hilar and mediastinal structures . unchanged proximal right clavicular fracture .	Atelectasis&&Cardiomegaly&&Fracture&&Pneumothorax	12736592	57146595	d7203332-f3c8731e-27d35dc0-3cacfa03-24d07da7
2789	moderate right pleural effusion is new, obscuring some of the right lower lung, but changing the contour of the lung base substantially since . postoperative left hemithorax is unchanged following left upper lobectomy . heart is partially obscured by postoperative contour changes . right middle lobe collapse seen on lateral chest films, and and on chest ct, , presumably unchanged .	Atelectasis&&Enlarged Cardiomediastinum&&Pleural Effusion	10885696	51545557	b83a98a1-69ae5692-5fc5b2eb-140a525a-abf289ab
2790	low lung volumes result in bronchovascular crowding . the left pectoral pacemaker leads end in the expected locations of the right atrium and right ventricle . there is no focal consolidation, pleural effusion or pneumothorax . bibasilar atelectasis is seen . the known fdg-avid nodules seen on recent pet-ct are below the threshold of detection on chest radiograph . heart size is within normal limits allowing for lung volumes . mediastinal silhouette and hilar contours are stable . blunting of the right costophrenic sulcus is similar to , although no effusion is seen on ct . no acute intrathoracic process .	No Finding	15370732	59990602	2d5f73c2-9a6138e2-d33b6539-067b7734-2b55b088
2791	single ap portable view of the chest . no prior . the lungs are clear of large confluent consolidation . cardiac silhouette enlarged but could be accentuated by positioning and relatively low inspiratory effort . calcifications noted at the aortic arch . degenerative changes noted at the glenohumeral joints bilaterally . osseous and soft tissue structures otherwise unremarkable . no definite acute cardiopulmonary process . enlarged cardiac silhouette could be accentuated by patients positioning .	Cardiomegaly	10268877	51513702	053e0fdd-17dbee89-17885e49-08249a30-7f829c9c
2792	the cardiac silhouette size is top normal . mediastinal and hilar contours are unchanged . focal opacities within the superior segment of the left lower lobe and right lung base are relatively unchanged compared to the previous exam and remain concerning for areas of multifocal pneumonia . small left pleural effusion may be present . there is no pulmonary edema or pneumothorax . clips are seen projecting over the right neck . there are no acute osseous abnormalities . persistent left lower lobe and right basilar opacities concerning for pneumonia . possible trace left pleural effusion .	Lung Opacity&&Pleural Effusion&&Pneumonia	16508811	56179563	dbb3e7c3-35a17f99-7bcd2d4c-57f5a932-d79a20cd
2793	there is increasing opacification at both bases with silhouetting of the right heart border and left hemidiaphragm . this is consistent with pneumonia involving the middle lobe and the left lower lobe . there is some indistinctness of pulmonary vessels, which could reflect some overhydration . monitoring and support devices remain in place .	Edema&&Lung Opacity&&Pneumonia&&Support Devices	13979643	55901932	f4c4784b-31b99106-b81f1b06-5297ab3a-8cc7ddaf
2794	mild interstitial pulmonary abnormality is new, and there is hazy opacification in the juxtahilar left mid and lower lung zones which could be due to pneumonia . heart size is normal . there is no appreciable pleural effusion .	Lung Opacity&&Pneumonia	13135946	51924292	849c8a62-044aeedd-d82807e1-77d0a8f3-b9d0e893
2795	one portable ap view of the chest . the swan-ganz catheter through a right internal jugular approach ends in the region of the main pulmonary artery . the left internal jugular catheter ends in the left brachiocephalic vein just before the svc . endotracheal tube ends cm from the carina . the previously seen moderate-to-severe pulmonary edema has slightly improved . the right upper lobe parenchymal opacity is unchanged . mild cardiomegaly is stable . mediastinal and hilar contours are normal . no pneumothorax . . slightly decreased pulmonary edema compared to most recent study, however right upper and lower lobe parenchymal opacities are more prominent and may represent pneumonia . . lines and tubes are in standard position .	Edema&&Lung Opacity&&Pneumonia&&Support Devices	11022245	51656138	64988a4a-7c2cfce5-4e93b5ca-d55602d6-94c83006
2796	there is no left subclavian line . an indwelling right subclavian line ends in the mid svc . there is no pneumothorax or appreciable pleural effusion . pulmonary vascular engorgement has improved, mild right lower lobe atelectasis has recurred . heart size is moderately enlarged, but improved since earlier study .	Atelectasis&&Cardiomegaly&&Support Devices	11474065	58409843	c1d5b4f7-c4ed16c1-202cd868-0f06cd8a-25de3389
2797	dual-lumen left-sided central venous catheter is seen with distal tip in the right atrium . given differences in technique, there has been no significant interval change in the degree of pulmonary edema when compared to prior . the cardiomediastinal silhouette is unchanged . atherosclerotic calcifications again noted at the arch . no acute osseous abnormality is identified . pulmonary edema, unchanged from prior .	Edema	17340686	59672442	67486f3c-a4ef806f-47d7541c-c1f00d2e-9c2f09fe
2798	compared with , a right-sided subclavian picc line has been placed . the tip overlies the svcra junction or upper right atrium . no pneumothorax is detected . there are slightly low inspiratory volumes . the heart is not enlarged . there are patchy interstial markings predominantly in both upper lobes, similar to findings on several prior ct scans and unchanged compared with cxr . ill-definition of both hila is likely secondary to obscuration by the interstial markings . there is minimal blunting of both costophrenic angles . no frank consolidation or gross effusion . no obvious pneumothorax . clips noted in the upper abdomen near the ge junction . picc line tip over svcra junction or upper right atrium . if clinically indicated, this could be retracted by approximately cm . chronic patchy interstial opacities both upper lobes, unchanged . no new infiltrate identified .	Lung Opacity&&Support Devices	10933609	56304327	b9c18cbb-323135fb-0118b586-6d8846f0-a1099863
2799	ap upright portable views of the chest were obtained . per the radiology technologist, x-ray was repeated due to patient kyphosis . the patients chin overlies the lung apices . again seen are increased interstitial markings, worse at the lung bases in this patient with history of known chronic interstitial pulmonary disease . opacity at the right lung base appears increased compared to the prior study and superimposed infectious process is not excluded . no large pleural effusion or pneumothorax is seen . cardiac and mediastinal silhouettes are unremarkable . known chronic interstitial disease with increased interstitial markings seen at the lung bases . interval increase in right base opacity raises concern for a superimposed infectious process .	Lung Opacity&&Pneumonia	19640059	58087032	f517acaa-8c49752c-968ae55b-9b6530f1-4dacc503
2800	lungs are well expanded . blunting of the right costophrenic angle is unchanged and may reflect chronic pleural thickening . retrocardiac opacity is likely due to bochdalek hernia on previous ct . cardiomediastinal silhouette is otherwise unremarkable . retrocardiac opacity is likely due to atelectasis and posterior pleural fatsmall bochdalek hernia seen on ct of the chest from . please see subsequently obtained cta chest for further details .	Atelectasis&&Lung Opacity	13978244	55719726	e2355bc9-8bf0bfaf-605c4222-bf3592b9-e1259f5b
2801	no relevant change in appearance of the lung parenchyma and the cardiac silhouette is seen . the position of the tip of the picc line remains difficult to determine, given that the line parallels the radiodense pacemaker leads .	Cardiomegaly&&Support Devices	16043637	55611959	2e0ac0a9-c4f5e463-bfc3a350-8515448c-2f9a7358
2802	pa and lateral views of the chest patient is status post median sternotomy and cabg . left-sided pacemaker device is noted with leads terminating in the right atrium and right ventricle, unchanged . the heart remains mildly enlarged but stable . the aorta is unfolded . there is mild pulmonary vascular congestion, which is improved when compared to the prior exam . no new focal consolidation, pleural effusion or pneumothorax is present . there are mild degenerative changes in the thoracic spine .	Edema	18615099	54265960	a0578edb-12a640ca-1ddab351-089c4d4c-00bb6f19
2803	again seen are bibasilar and right perihilar atelectatic changes, similar compared to and also seen on the ct abdomen and pelvis from . there is mild cardiomegaly and mild vascular congestion, but no pulmonary edema . tortuous vessels widen the uppper mediastinum . chronic right rib fractures . unchanged atelectatic changes . no acute cardiothoracic process .	Atelectasis	16853729	57605154	d5aa0315-53869b6c-10151e97-c12a5f0f-d369e178
2804	portable supine ap chest radiograph the endotracheal tube terminates . cm above the level of the carina . there are multiple areas of increased radiodensity most severe in the right upper lung, but also within the medial right lower lung and in the retrocardiac region . findings are most concerning for multifocal pneumonia . there is no overt pulmonary edema or large pleural effusions . there is apparent mild widening of the mediastinal contours secondary to the supine technique . the cardiac silhouette is mildly enlarged . there is no pneumothorax . please see concurrent chest ct report for additional details . . endotracheal tube in standard position . no pneumothorax . . multifocal opacities, most severe in the right upper lung, concerning for multifocal pneumonia .	Lung Opacity&&Pneumonia&&Support Devices	12966004	57399078	85904052-28d3a26a-9a756f5e-03c7a51b-3a9f5f19
2805	a cardiac conduction device is contiguous with a lead which terminates in the right atrium . there is no focal consolidation . there is no pneumothorax . the cardiomediastinal silhouette is unremarkable . no acute cardiopulmonary abnormality .	No Finding	18893199	50170739	bb42be73-33be1577-a742e6e6-9c47b56b-95a9659e
2806	again seen is hyperinflation of the lungs consistent with emphysema . the previously seen pulmonary edema has resolved . the right-sided pleural effusion is stable . the small left pleural effusion is also stable . a cluster of elliptical opacities in the left lower lobe that were present on study on . there are linear opacities in the left lower lobe and lingula consistent with atelectasis that have improved compared to prior study . cardiomegaly is stable . . no focal consolidation . . resolution of pulmonary edema . . stable right and left pleural effusions . . cluster of elliptical opacities in the left lower lobe that were present on study in , recommend followup with conventional cxr when acute issues have resolved .	Lung Opacity&&Pleural Effusion	18224196	57907009	060219ba-448fe7d4-8a19694c-92b20db5-74035416
2807	there are low lung volumes, but the lungs are clear . the heart is top-normal in size . there is no pneumothorax or pleural effusion . no acute cardiopulmonary process .	No Finding	13700088	59646245	8ce33378-337bc3e6-2915b9bf-0ea16f16-2c986cfe
2808	a right internal jugular catheter tip projects within the mid svc . a right basilar pleurx catheter is in stable position . since the prior examination, there is increased apparent lucency demonstrated in the left aspect of the aortic knob, that though may be projectional, pneumomediastinum cannot be excluded . there is improvement in bibasilar opacification, likely atelectases . in addition, there is improvement in pulmonary vascular engorgement . there is no evidence of pneumothorax . the cardiomediastinal and hilar contours are stable . . apparent lucency demonstrated in the left aspect of the aortic knob, that though may be projectional, pneumomediastinum cannot be excluded . if of clinical concern, chest ct can be performed . . interval improvement in interstitial edema and bibasilar atelectasis . on via telephone by dr . .	Atelectasis&&Edema	13755940	54060800	9678dc02-54a05e84-f5efffa5-bc62e0a2-83dac014
2809	portable ap chest radiograph moderate bibasilar opacities persist, likely reflecting a combination of atelectasis and pleural effusions . the left-sided effusion is moderate and the right effusion is small both are unchanged compared to prior examination from . mild pulmonary edema is improved in the interval . there is no pneumothorax . a coarse linear opacity in the right upper lung is unchanged dating back to , and likely reflects vascular calcifications . grossly stable bibasilar opacities, likely a combination of atelectasis and bilateral pleural effusions, left greater than right . improving mild pulmonary edema .	Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion	15380734	58155125	2bc6a85c-e37491cd-8408dde1-e5061580-b890fc2f
2810	comparison is made to prior study performed a day earlier . there has been interval marked enlargement of left pleural effusion that is layering and probably moderate . there is also increase in size in moderate right pleural effusion . cardiac size cannot be evaluated . it is obscured by pleural parenchymal abnormalities . et tube is in standard position . ng tube tip is in a distended stomach . left ij catheter tip is in the mid svc . there is no evident pneumothorax . there is worsening of bibasilar atelectasis larger on the right side . there is persistent elevation of the right hemidiaphragm . there is mild pulmonary edema .	Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	11569093	54969173	ef7be867-0fa87b48-e5f67e5f-81dc3391-c2b7a900
2811	frontal and lateral radiographs of the chest demonstrate well expanded lungs . there is obscuration of the left border, which may represent early lingular pneumonia, and is not definitely seen on the lateral view . the cardiomediastinal and hilar contours are unremarkable . there is no pleural effusion or pneumothorax . obscuration of the left heart border which may represent early lingular pneumonia, and is not definitely seen on the lateral chest x-ray . comments these findings were submitted to the critical results dashboard at pm on .	Pneumonia	16662264	55866796	4f39f3cc-21398fd5-98bdb9b6-55653602-c53fc011
2812	there is slightly better inspiration . the left hemidiaphragm is not sharply seen and there is hazy opacification at the left base . this suggests a possible atelectasis and effusion . monitoring and support devices are unchanged .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Support Devices	11880923	50720959	6aff92fc-a55af9c9-b11a0394-d2d62191-122cdf01
2813	severe cardiomegaly and widened mediastinum are unchanged . pulmonary edema has markedly improved . retrocardiac opacities have improved consistent with improving atelectasis and small left effusion . there is no pneumothorax . lines and tubes are in standard position . calcified granulomas in the left upper lobe are again noted .	Atelectasis&&Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Support Devices	12185775	56494283	957c26f1-18da168e-71c98f71-7f791b2a-4cb759cb
2814	mild pulmonary edema is less severe today than it was on . small pleural effusions and moderate cardiomegaly are comparable . there is no pneumonia . very small right upper lobe lung nodule may be present projected over the intersection of the right first anterior and fifth posterior ribs . findings were discussed by dr . with dr . by telephone at the time of this dictation .	Cardiomegaly&&Edema&&Lung Lesion&&Pleural Effusion	19844485	50240427	8830e4fd-71e68c81-f6292cf4-2a931e58-be84168d
2815	pa and lateral views of the chest demonstrate well-expanded lungs . in comparison to the prior study, there is interval obscuration of the right heart border and the medial right hemidiaphragm . correlation with the lateral view suggests that this is likely due to interval development of small bilateral pleural effusions . underlying consolidation is not excluded . no pneumothorax . cardiomediastinal silhouette is otherwise stable . of note, an air fluid level in a tubular structure posterior to the trachea on the lateral view is consistent with a dilated fluid-filled esophagus . . interval development of small bilateral pleural effusions . underlying consolidation not excluded . . dilated fluid-filled esophagus . comment discussed with dr . by dr . at am on .	Consolidation&&Pleural Effusion	13881772	50019396	1908e913-d3051cf7-34f98451-4ed66f58-15582c1d
2816	there is increasing opacity in the left hemithorax, likely reflecting post-surgical changes . extensive gas collection in the soft tissues on the left is unchanged . unchanged position of the left chest tube . the right lung and the cardiac silhouette are constant in shape, the right lung remains normal .	Cardiomegaly&&Lung Opacity&&Support Devices	12530259	58704662	8f427f0a-04f15d74-7d27eb04-930290b5-286d1642
2817	in the interval, the patient has been intubated . the tip of the endotracheal tube projects approximately . cm above the carina . in addition, the patient has received a nasogastric tube . the course of the tube is unremarkable, the tip of the tube is not included in the image . there is no evidence of complications, notably no pneumothorax . moderate cardiomegaly with signs of minimal fluid overload . no pleural effusions .	Cardiomegaly&&Support Devices	13700088	52081127	9f5e6fe5-3058dc34-5fb44a44-687509a4-af7f886f
2818	the patient has now received a right-sided picc line . the course of the line is unremarkable, the tip of the line projects over the mid svc . in the interval, the patient has developed a relatively widespread left middle and lower lung parenchymal opacity with air bronchograms, likely reflecting pneumonia . there is no evidence of complicating pleural effusions . at the time of dictation and observation, , , the referring physician . the referring physician was also sent an urgent email .	Lung Opacity&&Pneumonia&&Support Devices	16508811	52761853	444dfa8e-bb3ce9c4-55126266-43629bc2-fce21515
2819	single frontal view of the chest cardiac and mediastinal contours are normal . the heart remains moderately enlarged . there is mild blunting of the left costophrenic angle, again seen, which may reflect pleural thickening or small pleural effusion . vague opacities within the right-mid lung may represent atelctasis or early pneumonia . there is no pneumothorax or findings for pulmonary edema .	Lung Opacity&&Pneumonia	16853729	55797023	c9af77d2-fad3eeed-901b28fb-003041ad-d1ad165e
2820	feeding tube with a wire stylet in place passes into the stomach and out of view . comparing todays examination with many chest radiographs since , it looks like there is a mild degree of pulmonary edema superimposed on chronic interstitial lung disease . specifically, on the interstitial abnormality is comparable to that on , whereas at other times there has been at least a component of acute pulmonary edema . today, the findings are very similar to . severe cardiomegaly and pulmonary vascular plethora are chronic . left subclavian infusion port ends in the mid-to-low svc . pleural effusion, if any, is minimal and there is no pneumothorax .	Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	10439781	50277921	397252c6-f7b6111e-367341df-b8fc523c-599cfcbd
2821	analysis is performed in direct comparison with the next preceding portable chest examination of . heart size is unchanged . previously described moderate pulmonary congestive pattern with some upper zone re-distribution has normalized . presently no evidence of pulmonary interstitial alveolar edema and the lateral as well as posterior pleural sinuses are free from any fluid accumulation . no pneumothorax in the apical area . no acute infiltrates . lateral and posterior pleural sinuses are free . a previously described old calcified granuloma in the left upper lobe area is unchanged . no evidence of new acute pulmonary infiltrates .	Lung Opacity	12185775	50953777	c9bd6dd6-c8328950-4f61c412-81766efb-2d9c193f
2822	moderate pulmonary edema unchanged since . emphysema, right pleural thickening and pleural calcification have been discussed on prior and subsequent radiographic reports . heart size is normal . et tube in standard placement .	Edema&&Pleural Other&&Support Devices	17032538	58656783	e426b51e-f7222833-d8ee3136-30f0df83-872a415e
2823	the tracheal air column is not well defined and the etiology for this opacification remains uncertain . the appearance is similar to at pm . an ng tube is present, tip beneath diaphragm overlying stomach . a mediastinal drain is present . a right ij central line is present, tip over distal svc . a linear opacity overlies the upper cardiac silhouette to the right of the spine, unchanged compared with . multiple rings and surgical clips overlie the mediastinum . there is mild cardiomegaly, unchanged, with slight ill-definition of the mediastinal contours . there is patchy opacity at both lung bases . known bullous changes likely account for the rounded lucency at the left cardiac apex . allowing for this, no pneumothorax is detected .	Cardiomegaly&&Enlarged Cardiomediastinum&&Lung Opacity&&Support Devices	17770657	58353310	650aa0be-b9a59492-190d3ed4-96eb75e2-08bb0cb8
2824	there is slightly less opacification at the left base . this is most consistent with atelectasis and effusion, though in the appropriate clinical setting, supervening pneumonia would have to be considered . specifically, no evidence of pneumothorax . no acute focal pneumonia .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Pneumonia	13586204	50830952	68e78cda-4586bb4f-29822ae6-fbe7ad84-af842685
2825	extensive infiltrative pulmonary abnormality in the right lower lobe, and overlying pleural calcification are longstanding, but previous pulmonary edema in this location has improved if not resolved, leaving behind a small residual right pleural effusion . the left lung base was relatively clear on and also developed some edema, which has decreased since . given the severe scarring in these lungs, some pneumonia could be present and not appreciated, for example, just projecting over the right hilus, but in the left lung, there is no evidence of pneumonia . et tube is in standard placement . feeding tube ends in the upper stomach . the heart is not enlarged . right pleural thickening is most extensive at the apex and unchanged . no pneumothorax .	Edema&&Lung Opacity&&Pleural Effusion&&Pleural Other&&Pneumonia&&Support Devices	17032538	57983519	c620517c-54116688-14dadd50-6b22f911-d5812c38
2826	the patient has received an endotracheal tube . the tip of the tube projects cm above the carina and should be pulled back by approximately - cm . there is no evidence of complications . the patient has also received a nasogastric tube, the course of the tube is unremarkable, the tip of the tube projects over the middle parts of the stomach . unchanged appearance of the lung parenchyma, the heart and the chest wall .	Cardiomegaly&&Support Devices	12952223	54870443	4e2ae929-40713138-9d6a757e-deeed0b1-8062cd72
2827	interstitial opacities in the right lung have minimally increased, likely due to edema . in the right upper hemithorax several air-fluid levels are more conspicuous than in prior studies . right perihilar opacity is grossly unchanged, allowing the difference in position of the patient . the left lung is clear . the right chest tube remains in unchanged position . right chest wall subcutaneous emphysema has improved .	Edema&&Lung Opacity&&Support Devices	19991135	56217968	ffefdc2e-52afbd37-6ec4e225-f67b3576-9b0d7c4e
2828	since , right chest and mediastinal drain tubes have been removed . there is no appreciable pneumothorax . left lower lung opacity obscuring the left cardiomediastinal border and the left lung base has minimally worsened since and is combination of moderate left effusion and left lower lung atelectasis . riight basal atelectasis and presumed small right pleural effusion is unchanged . there is no significant change in the upper mediastinal . right internal jugular sheath has its tip ending at the upper svc . there is evidence of prior median sternotomy and sternal sutures are intact .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Support Devices	18224196	58094975	fb85016a-bff648ee-d64f0e6d-8bf72ac1-ce274815
2829	there is no focal consolidation, pleural effusion or pneumothorax . streaky opacities at the left lung base is most likely due to atelectasis . cardiomediastinal silhouette is within normal limits . median sternotomy wires are intact . known compression deformities of l and l are partially imaged . . no acute cardiopulmonary process . . known l and l compression deformities .	No Finding	16957952	59502822	737016db-c820a9cb-11c8e000-a5eef752-c1d20274
2830	one ap portable upright view of the chest . a previously seen cavity in the left lung is no longer present . in that location, there are linear interstitial opacities likely from fibrosis from scarring in that area or may represent pneumonia . mild bibasilar atelectasis . the mediastinal and hilar contours are normal . there is no pneumothorax . there are low lung volumes . . linear opacities in the left mid lung may represent residual scarring from prior cavitary lesion or could represent new pneumonia . . right basilar atelectasis .	Atelectasis&&Lung Lesion&&Lung Opacity&&Pneumonia	15186992	50894711	adbfc9ce-b82d1181-fce57c7d-f71a436a-708693b0
2831	there is persistent right base atelectasis scarring . no new focal consolidation is seen . there is no large pleural effusion or pneumothorax . cardiac and mediastinal silhouettes are stable . no significant interval change .	No Finding	11474065	56451222	408936b5-77f25bee-8f73cc21-251fc7bc-013094dc
2832	the left pectoral pacer is unchanged in position, with leads terminating in the right atrium and right ventricle . median sternotomy wires are intact . the prostatic aortic valve is re-demonstrated . no evidence of pneumonia, pulmonary edema or pleural effusions . cardiomediastinal silhouette is within normal limits . no evidence of pneumonia .	No Finding	16043637	53154034	5cecf989-3c537ad2-d38c50a6-2ca6b9d1-743a7756
2833	a right picc has been placed with the tip terminating in the proximal right atrium, which should be retracted cm to place in the low svc . the inspiratory lung volumes are decreased . there is mild right basilar atelectasis . calcified pulmonary granulomas are unchanged . there is no focal consolidation concerning for pneumonia, significant pleural effusion or pneumothorax . the pulmonary vasculature is not engorged . the cardiomediastinal and hilar contours are stable . no acute osseous abnormality is detected . right picc terminating in the proximal right atrium should be retracted cm to place in the low svc . with dr . telephone on at pm, during discovery of the findings .	No Finding&&Support Devices	12185775	56043671	d616d0a0-41025591-43cd391a-ee10bd11-29c865b3
2834	comparison to . feeding tube and right internal jugular vein catheter are in correct position . unchanged moderate cardiomegaly with moderate right pleural effusion and mild to moderate pulmonary edema . no new focal parenchymal opacities . no pneumothorax .	Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	14851532	59794465	e6250467-5024835a-ee6e25b1-59ef82bc-d2a286a5
2835	moderate left and small right pleural effusions are again noted . left basilar opacity could be due to pleural fluid noting that underlying consolidation cannot be completely excluded . elsewhere the lungs are clear of consolidation . cardiomediastinal silhouette is stable . prosthetic valve and median sternotomy wires are noted . osseous and soft tissue structures are unchanged . bilateral effusions, larger on the left . underlying consolidation at the left lung base would be difficult to exclude .	Pleural Effusion	15259244	59649088	32f9d0a6-a71c3e37-8285ac35-90d110a9-d3f838cf
2836	new picc line on the right is projecting with its tip somewhere in the mediastinum . appears to cross the midline, there is concern for potential arterial location . the initial line concerns were communicated over the telephone at the time of the wet read . repeat pa and lateral radiograph, taken approximately an hour after the radiograph demonstrated the picc line in the mid svc . potential small right pleural effusion . stable moderate cardiomegaly .	Cardiomegaly&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	10715477	55878458	77961fbc-766a38fd-e7b726ed-43313009-06ed55d4
2837	the lungs are clear, the cardiomediastinal silhouette and hila are normal . there is a tiny right pleural effusion . there is right hemidiaphragm eventration . nodular, rounded opacity at the left lung base likely represents nipple shadow . tiny right pleural effusion .	Pleural Effusion	11880923	57045176	20826cb6-21536aea-251f6984-7d353fb1-029fb362
2838	there are diffuse predominantly perihilar airspace opacities with slightly nodular appearance, which are new from prior studies . superimposed hilar adenopathy is difficult to exclude . no pleural effusion or pneumothorax is seen . the cardiomediastinal contours are within normal limits . no acute osseous abnormality is detected . diffuse perihilar opacities raise concren for widespread pneumonia, superimposed pulmonary edema may be present . differential diagnosis includes atypical pneumonia and pneumocystis jiroveci pneumonia . immune status of patient .	Edema&&Lung Opacity&&Pneumonia	18309149	52145612	2f04b963-317903c2-c937a1b3-84194e4c-5ce01852
2839	et tube tip is . cm above the carinal . ng tube tip passes below the diaphragm terminating in the stomach . cardiomediastinal silhouette is unchanged . left the area hilar opacity is slightly more conspicuous and might be consistent with progressing infectious process . left lower lobe atelectasis is unchanged .	Atelectasis&&Enlarged Cardiomediastinum&&Lung Opacity&&Pneumonia&&Support Devices	14841168	50382908	661a83d2-e84a4cd7-d05d7218-a81de999-15a66bea
2840	the esophageal stent, the tracheostomy tube and the right picc line are in unchanged position . the extensive right and moderate left parenchymal opacities are unchanged in extent and severity . unchanged is the size of the cardiac silhouette . no newly appeared focal parenchymal opacities . no evidence of pneumothorax .	Cardiomegaly&&Lung Opacity&&Support Devices	13964474	59003925	b642c012-d253de87-93e521f3-9bd69ba7-d7827b8e
2841	the cardiac silhouette appears slightly increased in size and is accompanied by pulmonary vascular congestion and minimal interstitial edema . a new more confluent opacity in the left lower lobe could reflect atelectasis, aspiration, or developing infectious pneumonia . small left pleural effusion is also demonstrated .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia	13881772	52186853	b68a7d7b-d7e76417-af2376cd-215c9620-c3934be4
2842	heart size is normal . the mediastinal and hilar contours are normal . the pulmonary vasculature is normal . lungs are clear . no pleural effusion or pneumothorax is seen . there are no acute osseous abnormalities . no acute cardiopulmonary abnormality . no acute fracture identified . if there is continued clinical concern for a rib fracture, a dedicated rib series is suggested .	Fracture	14147380	55599778	e5c7d198-f0d2cb5b-1ad03a2c-33b67f48-db2dd55d
2843	there is no focal consolidation, effusion, or vascular congestion . the cardiomediastinal silhouette is within normal limits . no acute osseous abnormalities identified . no acute cardiopulmonary process .	No Finding	19748558	53919021	6eaf56a0-ded30052-29edb3ad-20da2133-db0cf728
2844	again noted is eventration of the right hemidiaphragm . an old left clavicular shaft deformity is unchanged . there is stable widening of the mediastinum likely secondary to fatty infiltration . there has been an interval increase in pulmonary vascular engorgement and mild bilateral interstitial edema . there also may be a subtle increase in bibasilar atelectasis . there is no evidence of pneumothorax . the cardiac silhouette is stable . interval increase in pulmonary vascular engorgement and mild bilateral interstitial edema .	Edema	13475033	54900154	3cf29b0e-f67cd860-ae12f2a8-622ccc27-2195ca85
2845	the patient is status post median sternotomy and cabg . the cardiac and mediastinal silhouettes are stable with the cardiac silhouette persistently enlarged . two lead left-sided pacemaker is again seen, unchanged in position . there are slightly low lung volumes and there is persistent mild elevation of the right hemidiaphragm . slight blunting of the right costophrenic angle is stable . stable right base scarring is again seen . there is no evidence of pneumothorax . no overt pulmonary edema is seen . there may be mild pulmonary vascular congestion . stable cardiomegaly with possible mild pulmonary vascular congestion, without overt pulmonary edema .	Cardiomegaly&&Edema	12110863	55498995	e538135c-ebad1b7e-5f239803-3d6bcf94-7c5fddc4
2846	no focal consolidation or pulmonary edema . moderate cardiomegaly . no pleural effusions or pneumothorax . prior median sternotomy and cabg . no acute cardiopulmonary process .	No Finding	19150427	56013922	c874667d-3a322fbd-378b624c-a8b7113e-491c9160
2847	patient has had median sternotomy and aortic valve replacement . sternal wires are aligned . cardiomediastinal silhouette is normal . emphysema is moderate to severe and apical predominant . a mm nodular opacity projecting over the right second anterior rib could be a pleural calcification shown on the chest ct, or a new lung nodule a lordotic view might be definitive . lungs are otherwise clear of focal opacities . there is no pleural effusion or evidence of central adenopathy . cement and fusions are present in two lower thoracic vertebral bodies, with only minimal loss of height, unchanged since . findings were posted to the online record of critical radiology findings for direct notification of the referring physician, at the time of this dictation .	Lung Lesion&&Lung Opacity&&Support Devices	11016935	54381763	d7455c33-4a0f90a6-565ee283-906f14b4-c737ba31
2848	dual-lead left-sided pacemaker is again seen with leads extending to the expected positions of the right atrium and right ventricle . the lungs are hyperinflated, with flattening of the diaphragms, suggesting chronic obstructive pulmonary disease . no pleural effusion or pneumothorax is seen . slight increased opacity at the right lung base, best seen on the frontal view may relate to atelectasis, although in the appropriate clinical setting, infectious process is not excluded . no overt pulmonary edema is seen . chest radiography is inappropriate for evaluation of pulmonary embolism . the aorta is calcified and tortuous . the cardiac silhouette is top normal to mildly enlarge . . hyperinflated lungs suggest chronic obstructive pulmonary disease . . slight increase in opacity at the right lung base may relate to atelectasis, although in the appropriate clinical setting, infectious process is not excluded .	Atelectasis&&Lung Opacity&&Pneumonia	18929056	58958987	0d6db000-b7832a09-4e80e472-89242ef5-20701513
2849	cardiomediastinal contours are stable . lungs are clear except for linear bibasilar areas of atelectasis . no pleural effusion or pneumothorax .	Enlarged Cardiomediastinum	16043637	50065890	fb45550c-b18bc286-c44ccc22-7ef82df9-02181d75
2850	evaluate for interval change . comparisons chest radiographs from dating back to . portable supine radiograph of the chest the small right pleural effusion and associated atelectasis is unchanged . there is suggestion of a new small left pleural effusion with persistent atelectasis obscuring the hemidiaphragm . mild cardiomegaly and pulmonary vascular congestion are unchanged . the lungs are otherwise clear . there is no pneumothorax . a right ij central venous line terminates in the svc . there are subtle linear irregularities of several left ribs and at least one right rib which may indicate the presence of nondisplaced fractures . . persistent small right pleural effusion and probable new left effusion with associated atelectasis . . mild pulmonary vascular congestion and cardiomegaly unchanged . . possible rib fractures for which evaluation with a chest ct is recommended . findings were communicated to dr . by dr . by telephone on at .	Atelectasis&&Cardiomegaly&&Edema&&Fracture&&Pleural Effusion	15338518	59124380	8d15d949-caaa05f3-1811c857-a95fc3d0-6bf995b2
2851	there is a chronic diffuse interstitial abnormality, as seen on the ct from . mild cardiomegaly is unchanged . unchanged widening of the superior mediastinum is due to both mediastinal lipomatosis and tortuous vessels, as seen on the ct from . there is a small unchanged right-sided morgagni hernia . there are no pleural effusions . no pneumothorax . the tracheal configuration is unchanged . loss of height of a mid thoracic vertebral body is not significantly changed dating back through . . no acute cardiopulmonary findings . . unchanged mild cardiomegaly .	Cardiomegaly	13475033	59669144	41411ed9-2c9f6f41-b31a45f2-2ac7bb8f-2e25c279
2852	again seen is right-sided volume loss with right pleural scarring seen, particularly at the right lung apex . patient is status post esophagectomy and again presumably radiation to the midline in the upper chest . fullness along the right cardiac border, slightly more prominent as compared to the prior study, likely relates to patients gastric pull-through as seen on ct . no definite new focal consolidation is seen . there is no new pleural effusion or pneumothorax . calcified hilar and mediastinal lymph nodes again seen . no new focal consolidation . postoperative changes in this patient status post esophagectomy with gastric pull-through .	Consolidation	14295224	56348727	2c61f550-b2cf13d5-7166fc86-c7e9e336-2d1f9ae7
2853	the lungs are clear . there is no focal consolidation or pneumothorax . there is no vascular congestion or pleural effusions . mediastinal and hilar contours are within normal limits . moderate enlargement of the cardiac silhouette is unchanged from prior . a moderate hiatal hernia is unchanged from prior . . no acute cardiopulmonary process . . stable moderate cardiomegaly . . unchanged moderate hiatal herni .	Cardiomegaly	13131470	53887723	f822bf04-bb6d44c7-d992163b-54e7d6ac-9355a7aa
2854	the lungs are clear, the cardiomediastinal silhouette and hila are normal . there is no pleural effusion and no pneumothorax . a replaced mitral valve is seen . no acute cardiothoracic process .	No Finding	16116557	56362705	64613c7b-ce9fb911-c2eb42ab-41a905ea-97ce9a9d
2855	mild pulmonary edema has slightly increased . there is no significant pleural effusion . there is no pneumothorax . mediastinal and cardiac contours with moderate enlargement and stable . conclusion mild pulmonary edema has increased .	Edema	14841168	51115444	da9e3e67-02622466-3838d301-ca677b26-64a2bee0
2856	the inspiratory lung volumes are slightly decreased from the most recent prior study . the lungs are otherwise symmetrically expanded and clear without focal consolidation concerning for pneumonia . no pleural effusion or pneumothorax is detected . mild biapical pleural thickening is noted . the pulmonary vasculature is not engorged and there is no overt pulmonary edema . the cardiac silhouette is normal in size allowing for slightly decreased lung volumes . the mediastinal and hilar contours are stable . the trachea is midline . there is no evidence of free air beneath the right hemidiaphragm . . no acute cardiopulmonary process . . no free air beneath the right hemidiaphragm .	No Finding	19623993	57012563	839682a6-30ec6c4c-12520bec-1825e8a9-d6a263d4
2857	the heart is normal in size . the mediastinal and hilar contours appear within normal limits . pleural effusions have resolved . there is a patchy new opacity in the lateral segment of the right middle lobe, worrisome for pneumonia . however, elsewhere, the lungs appear clear . the osseous structures are unremarkable . new opacity in the right middle lobe suggesting pneumonia in the appropriate clinical setting .	Lung Opacity&&Pneumonia	16662264	56847326	42c0684d-a2f6f499-1215efe0-496a6638-f805c597
2858	supine positioning . the carina is not well-delineated . the et tube lies between . and . cm above the carina . an ng tube is present, tip extending beneath diaphragm off film . a right ij sheath is present . left subclavian picc line tip overlies distal svc, unchanged . cardiomediastinal silhouette is unchanged . there are small to moderate bilateral effusions with underlying collapse andor consolidation . allowing for differences in patient position supine today, erect on the prior film, there is no definite interval change .	Atelectasis&&Consolidation&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	16319601	58752096	29741a10-fb3651ef-e1e30f35-43a96b90-7aef2f9b
2859	low lung volumes . two calcified granulomas in the left lung are unchanged . no focal consolidation or pneumothorax . there are small bilateral pleural effusions . cardiomediastinal and hilar contours are stable . degenerative changes are again seen in the spine . small bilateral pleural effusions .	Pleural Effusion	12185775	54133721	91ba091c-cee12c63-ff22dde9-147ea7bb-418900c4
2860	there is a new right ij central line with tip in the mid svc . there is no pneumothorax . the lungs remain clear . azygous fissure again noted . cardiomediastinal silhouette is stable noting prominence of the upper mediastinum due to fat, unchanged . new right ij line . no pneumothorax .	No Finding	19028690	57456610	51f5ce00-6a5bde30-814d9207-cc5f7a52-ceb3502a
2861	there has been interval placement of a right central dialysis catheter . bilateral hilar vascular prominence is re- demonstrated with subtle nodularity in the left upper lung likely representing confluence of vasculature though a true nodule difficult to exclude . there is no convincing sign of pneumonia or overt edema . small left effusion is present with basilar atelectasis . the cardiomediastinal silhouette is unchanged . new hd catheter in place . prominent perihilar vascular markings with subtle nodularity in the left upper lobe requiring ct on a nonemergent basis to further assess . small left pleural effusion with basal atelectasis .	Atelectasis&&Pleural Effusion&&Support Devices	16553329	50112134	7ddd8e36-8b7ad07a-2157c5f0-e30755e5-e0a8ad3f
2862	a right picc is present with distal tip in the mid svc . the heart size is top normal . calcification in aortic knob is again seen . there are small bilateral pleural effusions with bibasilar atelectasis . there is moderate pulmonary edema . there is no new focal consolidation concerning for pneumonia . scarring projecting over the left mid lung is likely related to prior rib fractures . new small bilateral pleural effusions with mild-to-moderate pulmonary edema .	Edema&&Pleural Effusion	14851532	57850217	2d53d7a6-952779d8-cf36815b-c0de03a5-65207ded
2863	with study of , there is little overall change . again there is substantial enlargement of the cardiac silhouette with essentially normal pulmonary vasculature . this discordance suggests cardiomyopathy or possibly even pericardial effusion . no evidence of acute focal pneumonia .	Cardiomegaly	19731864	57876331	a1e78eb5-72f569fd-f5c8c795-887b8a35-97d007e1
2864	nasogastric tube terminates in the proximal stomach . cardiac silhouette remains enlarged, and aorta is tortuous and calcified . left perihilar and basilar opacities are again demonstrated, and likely represent a combination of pneumonia and atelectasis . improving atelectasis is noted at right lung base . small pleural effusions, left greater than right, are again demonstrated .	Atelectasis&&Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	13649937	55303396	0a9230c4-21071085-666dec7b-8a690910-28b3502c
2865	leftward mediastinal shift suggests that the persistent consolidation in the left lower lobe is due to collapse, not pneumonia, accompanied by small increasing left pleural effusion . right lung is grossly clear . perihilar opacification in the left could be pneumonia but is more likely atelectasis as well . moderate enlargement of the cardiac silhouette is stable . right jugular introducer ends at the junction of brachiocephalic veins . no pneumothorax .	Atelectasis&&Cardiomegaly&&Consolidation&&Lung Opacity&&Pleural Effusion&&Pneumonia	19565388	52949410	a443aa83-1d05b68f-6c199039-85500391-ea4904a1
2866	pa and lateral views of the chest the right picc has been removed in the interval . there is moderate enlargement of the cardiac silhouette which is not significantly changed from the prior exam . the mediastinal and hilar contours are unchanged, with continued widening of the mediastinum and aortic knob calcifications redemonstrated . mild pulmonary vascular congestion persists, and is not significantly changed in the interval . left basilar atelectasis is also noted, with a small right pleural effusion . no pneumothorax is identified .	Atelectasis&&Edema&&Pleural Effusion	14841168	59299448	db46fb79-5ef144b5-a30257dc-a364a08f-731905ea
2867	portable ap chest radiograph was compared to . as compared to the prior study, there is interval minimal increase in vascular congestion . cardiomediastinal silhouette is stable . there is no change in the appearance of the dialysis catheter . small bilateral effusions are most likely present . there is no pneumothorax . no new consolidations to suggest infectious process demonstrated .	Consolidation&&Edema&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	15259244	52794954	52e6e293-df5b1b69-a7d263ca-5400f4b2-f5c41027
2868	single frontal view of the chest is obtained . large area of consolidation in the right lung base is highly worrisome for pneumonia . the left lung is clear . bilateral brachiocephalic stents are stable in position . no pleural effusion or pneumothorax is seen . cardiac and mediastinal silhouettes are stable . innumerable rounded calcifications projecting over the spleen are again seen in this patient with history of prior granulomatous disease . right lower lung consolidation worrisome for infectionpneumonia . recommend followup to resolution to exclude underlying mass .	Consolidation&&Pneumonia	19061282	55058349	429fa17a-9886b777-b604dcc3-2aa91a9f-3963b43a
2869	swan-ganz catheter has been advanced beyond the right hilum, and should be withdrawn for standard positioning, as discussed by telephone with dr . new airspace opacity distal to the catheter tip could potentially represent pulmonary hemorrhage, but other etiologies such as atelectasis or aspiration are also possible . improving atelectasis in left lower lobe and persistent small left pleural effusion . incidental calcified granulomas within the left upper lobe .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Support Devices	12185775	59751598	a6ad44a0-61a41d41-a06153a4-5873c31d-f35069fa
2870	mediastinal and cardiac structures are unchanged . thus, no evidence of cardiac enlargement . the pulmonary vasculature is not congested . right-sided status post decortication procedure as before . unchanged moderate degree of diaphragmatic elevation . the previously described two pleural drainage chest tubes remain in position . comparison shows that both tubes have been withdrawn by up to cm, but basically, the position is unaltered . no pneumothorax has developed . no remaining pneumothorax is seen in the apical areas . satisfactory findings on followup examinations . minor change in chest tube positions as expected .	No Finding&&Support Devices	13352405	53273158	384b766e-a666fc50-5510a97f-c615a43c-1bfebe33
2871	there is unchanged evidence of free intra-abdominal air . the esophageal stent is placed . no visible peg device on the current image . the monitoring and support devices are constant . unchanged massive right parenchymal and moderate left parenchymal opacities .	Lung Opacity&&Support Devices	13964474	52444360	e5d70de7-1db12ea3-95e5fb41-d5ac6e5d-a9c5b917
2872	a small right apical and basal pneumothorax persists but is significantly decreased than on the prior study . a right pleurx catheter is in place and right pleural effusion has significantly decreased . there is no left pleural effusion . again seen is opacity in the left lung peripherally which corresponds to findings seen on recent chest ct . there is no focal consolidation . opacity at the right base is likely atelectasis . cardiomediastinal silhouette is stable . improved right pneumothorax which is now small . resolved right pleural effusion .	Pleural Effusion&&Pneumothorax	12699874	54282937	7d02f691-c9e983ff-b7685488-825c036a-ebf5e8eb
2873	low lung volumes exaggerate the cardiomediastinal contours, however the heart size is top normal . there is mild bibasilar atelectasis . no focal consolidations concerning for pneumonia are identified . there is no pleural effusion or pneumothorax . the visualized osseous structures are unremarkable . mild bibasilar atelectasis . no focal consolidations concerning for pneumonia identified .	Atelectasis&&Pneumonia	18767957	59366677	67d864d4-d51e968e-6523ea3d-51098156-ed3ea015
2874	near complete opacification of the right lung with multiple air bronchograms that has neither increased nor decreased in the interval . unchanged widespread but less severe opacities on the left . unchanged monitoring and support devices . no newly appeared parenchymal opacities . the regions of the costophrenic sinuses are not included on the image .	Lung Opacity&&Support Devices	19757720	58495629	41015709-991752ad-b8bf5519-0dd588fd-dec4d029
2875	swan-ganz catheter tip appears to be in the more distal aspect of the right main pulmonary artery . there are persistent low lung volumes . moderate cardiomegaly is stable . pacer leads are in standard position . there is no pneumothorax . if any there is small left effusion . bibasilar opacities have minimally improved . right perihilar opacity has almost completely resolved .	Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Support Devices	19075045	50645297	c3271fa5-173bb62f-8507daf0-46005d57-ba663779
2876	the lungs are well expanded . right mid and lower lung opacities persist, but are much improved from . no pleural effusion or pneumothorax with interval resolution of the right apical pneumothorax . the heart size is normal . mediastinal silhouette and hilar contours are normal . fractures of the anterior first, and lateral right third and seventh ribs are seen on this study . a vagal nerve stimulator is in place . . interval resolution of right apical pneumothorax . . right rib fractures as above .	Fracture	17112432	52349735	7e7b19ac-d29aedbe-10d9f138-4037688a-57615f21
2877	single, ap, upright, portable view of the chest was obtained . there are increased interstitial marking . given history of pulmonary fibrosis on prior ct, although increased interstitial markings have significantly increased since the prior and there may be superimposed pulmonary edema . the cardiac and mediastinal silhouettes are stable . there is slight blunting of both costophrenic angles, felt most likely be due to overlying soft tissues, but a trace pleural effusions be difficult to exclude . no right pleural effusion is seen . there is no pneumothorax . increased markings bilaterally may be due to the combination of underlying pulmonary fibrosis and moderate pulmonary edema, superimposed infectious process cannot be excluded .	Edema&&Pleural Other&&Pneumonia	16562430	51972257	03e4f490-80c314d6-8e4e9cee-cfdf8702-faac4644
2878	moderate cardiomegaly is stable . large bilateral pleural effusions, larger on the left side, associated with bibasilar atelectasis are grossly unchanged . there is no pneumothorax . right subclavian catheter tip is at the cavoatrial junction .	Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices	13135946	50356977	56cd4d0c-6480b613-33c96d36-ccd182ef-7ab9891a
2879	combination of moderate right pleural effusion and probable right middle and lower lobe collapse is unchanged over the past several days . chronic cardiomegaly is severe . pulmonary vasculature is minimally engorged in the left upper lobe but there is no pulmonary edema . left pleural effusion is small . no pneumothorax . swan-ganz catheter ends in the right descending pulmonary artery but has been withdrawn since . no pneumothorax .	Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices	14851532	57281227	44272033-b5295be7-f0373b0f-729ae692-1e1a3ba0
2880	the right-sided pleural effusion has minimally decreased . on the left, however, the effusion has substantially increased and leads to a near total opacification of the left hemithorax . subsequently, severe atelectatic changes are present . the swan-ganz catheter has been removed, the right internal jugular vein catheter has also been removed, a nasogastric tube, the endotracheal tube and a venous introduction sheath remains in situ .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Support Devices	11022245	57185571	c2ace888-d3f68f82-2d5b5dd6-07dc85c9-327c4bce
2881	severe scoliosis again noted, limiting evaluation of the lung parenchyma . the lungs are grossly clear . there is no pneumothorax or pleural effusion . cardiac size is top normal . ng tube tip is in the stomach . right picc tip is in the lower svc .	No Finding	18110020	59716296	7c499c84-2b72bcf9-4271a344-f85a3488-f06eca31
2882	new endotracheal tube in standard placement . edema in the left lung appears less radiodense but this may be a function of better inflation following tracheal intubation . severe right lung scarring and concurrent emphysema make it difficult to determine if a concurrent pneumonia is present . heart size is normal . right pleural thickening is more pronounced now than it was in suggesting either a component of pleural effusion or pathologic pleural involvement .	Edema&&Lung Opacity&&Pleural Effusion&&Pleural Other&&Pneumonia&&Support Devices	17032538	58760787	a66051d0-9ed3a477-30455196-064ccf0d-b667f74e
2883	no relevant change as compared to the previous examination, moderate cardiomegaly . mild pulmonary edema . swan-ganz catheter in correct position . small right pleural effusion .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	14851532	56614061	bd63a995-5035baef-7f63c277-92915a7a-253995c5
2884	the central venous catheter from a right ij approach tip is at the cavoatrial junction . the heart size is at the upper limits of normal . the mediastinal contours are within normal limits . mild pulmonary vascular congestion is seen . the lungs demonstrate improving consolidation of the retrocardiac space, either representing improving atelectasis or pneumonia . additionally, a new left upper lobe opacity is seen, concerning for a developing pneumonia . there is no large pleural effusion or pneumothorax . degenerative changes are seen in the spine . new left upper lobe opacity which may represent a developing pneumonia in the appropriate clinical setting . improving retrocardiac consolidation may represent improving atelectasis or pneumonia .	Atelectasis&&Consolidation&&Lung Opacity&&Pneumonia	15840907	50031776	3309c1ea-ab3bd4ee-d7677769-da248132-c26d7c02
2885	the lungs are low in volume but clear . the cardiac silhouette is unchanged compared to the previous examination . the mediastinal silhouette and hilar contours are normal . no pleural effusion or pneumothorax is present .	No Finding	16875792	52998783	66b2b4e8-470a1e57-77371a47-f3e6f263-0b7d1783
2886	bilateral upper lobe scarring is seen with superior retraction of the hila . the lung volumes are relatively low . there is no evidence of superimposed acute process . cardiomediastinal silhouette is stable . surgical clips in the upper abdomen again noted . osseous structures are essentially unremarkable noting probable right glenoid orthopedic hardware . bilateral upper lobe scarring unchanged without evidence of superimposed acute process .	Lung Opacity	10933609	51002383	5668d9ef-e5b61aae-8a38e823-b668e8ba-837392e7
2887	the cardiac, mediastinal and hilar contours are unchanged, with the cardiac silhouette size at the upper limits of normal . right subclavian vascular stent is unchanged . the lungs are clear and the pulmonary vascularity is normal . no pleural effusion or pneumothorax is identified . there are no acute osseous abnormalities . no acute cardiopulmonary abnormality .	No Finding	14744884	53605259	60565158-58324362-cca18ef0-bb2bc393-750737fd
2888	the left subclavian catheter tip now lies probably within the right atrium . long intestinal tube remains in place . there is increased opacification of the right hemithorax with preservation of pulmonary markings, consistent with substantial right layering pleural effusion . underlying compressive atelectasis . the left lung is essentially clear .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Support Devices	16319601	52726134	c20654e3-3f4f8322-d732af7e-f214d42f-c16264fc
2889	there is little interval change . again, there is a left hilar mass with volume loss and opacification in the left upper lobe, consistent with a post-obstructive pneumonia or collapse . the right lung is essentially clear .	Atelectasis&&Lung Lesion&&Lung Opacity&&Pneumonia	18067737	57632806	837cc5b5-e15e87de-3fc53c74-c391e8b0-c7e53396
2890	the intestinal catheter has been removed . the right picc line again extends to the lower portion of the svc . continued bilateral basilar opacification is consistent with substantial effusions, more prominent on the left, and underlying compressive atelectasis . moderate cardiomegaly persists . no definite vascular congestion .	Atelectasis&&Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Support Devices	18224196	51463307	0bef8ba1-43fc24e0-70fdb6e1-979af2ea-5243f4b6
2891	since the prior exam, there is increasing opacification at the right base, which is most likely due to aspiration, given the acute change . otherwise, remaining lung fields are stable, including right lower lobe bronchiectasis and scarring . there is continued diffuse interstitial prominence . there is no definite pulmonary edema . there is no pleural effusion or pneumothorax . the heart is severely enlarged . post-cabg changes are stable . a pacemaker is in place . the wires are in appropriate position . increasing opacity in the right lower lung zone is worrisome for aspiration . stable interstitial prominence and right lower lobe scaring .	Lung Opacity	12110863	50751429	7568a044-7f2b130e-9af97f69-17cda54e-cb366755
2892	single supine ap portable view of the chest was obtained . again seen, there are increased diffuse interstitial opacities bilaterally, may be due to pulmonary edema, although appears less severe than on the prior study . slight blunting of the bilateral costophrenic angles may be due to small bilateral pleural effusions . cardiac and mediastinal silhouettes are stable . left subclavian stent is again seen .	Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion	16772702	54541565	021c6321-4fe21bcf-a5fc07b5-10da56bf-8436fc83
2893	as compared to prior chest radiograph from , right pleurx catheter remains in position and there is still substantial layering of pleural effusion with compressive atelectasis at the right base . there appears to be interval engorgement of pulmonary vessels, particularly on the left . the left hemidiaphragm is not as sharply seen, which could represent a small pleural effusion . stable cardiomegaly . unchanged right pleural effusion . stable cardiomegaly with pulmonary vascular congestion . possible small left pleural effusion .	Cardiomegaly&&Edema&&Pleural Effusion	16826047	59395427	540bedcf-8202c1a0-6499b7ab-c43d0c66-a287c997
2894	there is again enlargement of the cardiac silhouette with elevation of pulmonary venous pressure . opacification at the right base again is consistent with collapse of the right middle and lower lobe .	Atelectasis&&Cardiomegaly&&Lung Opacity	14851532	54414101	d4c3eb06-68dcce85-81bae663-853a3883-288dc307
2895	single supine portable view of the chest was obtained . the patient is rotated to the right . cardiac and mediastinal silhouettes are stable . there is mild elevation of the right hemidiaphragm . no definite focal consolidation is seen . mild pulmonary vascular congestion is improved . patchy opacity at the left lung base is seen nonspecific, but could be due to infection or aspiration . dedicated pa and lateral views if and when patient able, would be helpful for further evaluation . no large pleural effusion or pneumothorax . . patchy left base opacity could be due to aspiration or infection . . mild pulmonary vascular congestion has improved in the interval . stable cardiomediastinal silhouette .	Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pneumonia	14841168	51613553	41ac266f-165c8df4-32f6976e-54066ffd-f078337c
2896	ap and lateral views of the chest are compared to previous exam from . postoperative changes of right upper lobectomy are again noted . there are new small bilateral pleural effusions . parenchymal opacity in the right upper lung and perihilar region have not significantly changed and could be in part due to post radiationtreatment changes . superiorly, the left lung is clear . cardiomediastinal silhouette is unchanged . degenerative changes of the right shoulder and post-thoracotomy changes on the right again noted . interval development of small bilateral pleural effusions . otherwise, no significant change .	Pleural Effusion	13263843	55876844	eddb9933-b3f09de6-7a247c23-5008736e-5f1faba5
2897	since , multifocal pneumonia has resolved and there is no new consolidation or other evidence of active intrathoracic infection . persistent blunting of the right posterior pleural sulcus could be due to scarring or a small chronic pleural effusion . the heart is no longer mildly enlarged and the neo esophagus, after esophagectomy, is no longer distended . mild pulmonary hyperinflation reflects emphysema . healed fractures of the posterior right sixth and seventh ribs should not be mistaken for a lung or pleural lesion . previous pneumonia resolved since . no evidence of current infection . emphysema . small right pleural effusion or pleural scarring, clinically insignificant . with dr . on the telephoneon at pm, minutes after discovery of the findings .	Pleural Effusion&&Pleural Other&&Pneumonia	14295224	52124829	8a6b0550-8fa3b54b-4703a676-db84baf7-e4fe2d48
2898	the patient was intubated in the meantime interval with the et tube tip being . cm above the carina . additional right internal jugular line has been inserted with its tip at the level of superior svc . the right picc line tip is low in the right atrium and should be pulled back approximately cm . heart size and mediastinum are grossly unchanged . bilateral, right more than left pleural effusion is seen, but most likely moderate to large on the right and small on the left, potentially slightly increased since the prior study .	Cardiomegaly&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	11204646	55868782	2e1fb168-5279d839-de9821a0-45e5c887-44bbf786
2899	there is no evidence of pneumothorax . little change in the appearance of the heart and lungs with continued low lung volumes, moderate cardiomegaly, elevated pulmonary venous pressure, and bilateral pleural effusions, more prominent on the left .	Cardiomegaly&&Pleural Effusion	13473495	56526400	a960626f-d83c011c-0418381e-d4cf2323-e82c0290
2900	vascular stents are again seen and stable from . there is no focal opacity, pleural effusions or overt signs of pulmonary edema . the cardiac and mediastinal contours are stable . the bones are diffusely sclerotic, likely secondary to renal osteodystrophy . no acute cardiopulmonary process .	No Finding	19061282	55793283	e4803482-51fd078d-b1b0c75c-e66487fe-0e881cdc
2901	the lungs are well expanded with little vascular engorgement . the heart size is normal . the minimal bibasilar atelectasis is unchanged . there is suggestion of a new mm left upper lobe nodule . additionally, the aortopulmonary window is bulging, new since . there is no apical pneumothorax or large pleural effusion . . there is no pulmonary edema and little vascular engorgement . . bulging of the aortopulmonary window, new since , and a newly identified mm left upper lobe nodule can be initially better evaluated with routine pa and lateral chest radiographs, and an additional lordotic view . was informed at on by dr . .	Lung Lesion	17720924	56426152	a17b5dc8-d644c07f-3d06ab54-851e9dee-b8643fad
2902	the lung volumes have slightly increased . the pre-existing, predominantly perihilar opacities have substantially decreased in extent and severity . the remaining opacities are now predominating in the upper lobes and are located around the upper aspects of the left and right hilus . no newly appeared opacities . the left internal jugular vein catheter has been removed, the lateral radiograph shows evidence of a small left effusion, obliterating the dorsal aspects of the costophrenic sinus .	Lung Opacity&&Pleural Effusion	10933609	59885828	f52047f3-b0ba5171-755f7044-afcf59b8-62848096
2903	the right picc line is at the level of cavoatrial junctionproximal right atrium . in comparison to the prior study the appearance of the cardiac silhouette is increased, although it might reflect different rotation of the patient . the mediastinum is slightly widened . there is minimal vascular engorgement that might reflect mild degree of interstitial edema . right pleural effusion is unchanged, small to moderate . minimal amount of left pleural effusion cannot be excluded . atelectasis at the left lower lung is noted, linear, mild .	Atelectasis&&Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	11204646	52157373	9f006813-48c1cfef-f8053cc6-7cf6f90b-b38379a0
2904	cardiac silhouette remains enlarged and is accompanied by pulmonary vascular congestion and mild pulmonary edema . as compared to the recent study, there has been improved aeration at both lung bases . small pleural effusions persist .	Cardiomegaly&&Edema&&Pleural Effusion	15207316	59143676	eb01562e-2c2a238a-fe9ab06f-74e7bb4d-a3352724
2905	cardiomediastinal contours are normal . the lungs are hyperinflated suggesting the presence of copd . the hemidiaphragms are flattened . there is a small left pleural effusion . there is evidence of bronchial wall thickening in the lower lobes bilaterally, more so in the left consistent with bronchitis . of note, in ct, there was evidence of an infection process in the lower lobes bilaterally this has not worsened, probably improved . the comparison is difficult due to the difference in technique .	Lung Opacity&&Pleural Effusion&&Pneumonia	10402372	52316568	e7179674-98666bd0-3463ad83-fb1cc95d-7a584b37
2906	there is little interval change . post-surgical changes are again seen on the right with chest tubes in place and no evidence of pneumothorax . the left lung remains clear with evidence of prior rib fractures .	Fracture&&Support Devices	13352405	54113050	9cafa042-7e42acc5-4e291de3-bf7be788-ef54e6cc
2907	a picc line ends in the mid-to-low svc . small bilateral pleural effusions seen only on the lateral view have decreased since . aside from minimal atelectasis at the posterior left lung base, the lungs are clear . the aorta is tortuous but not dilated . heart size is normal . . minimal left basal atelectasis . . small bilateral pleural effusions, decreased in size compared to . . no evidence of aspiration .	Atelectasis&&Pleural Effusion	13135946	52546073	1ec07497-ec6f4ace-baa95464-3ff6c941-6418e970
2908	a new area of consolidation has developed in the left lower lobe, and is concerning for developing pneumonia considering the clinical suspicion for this entity . additional nonspecific patchy opacity at the periphery of the right lung base could reflect focal atelectasis, or an additional site of infection . severe upper lobe predominant emphysema is again demonstrated . cardiomediastinal contours are normal . no pleural effusion or pneumothorax is evident .	Atelectasis&&Consolidation&&Lung Opacity&&Pneumonia	11052935	50457087	f3686ece-bb54acba-7f3b1ce4-b9166b5f-cd9b52c2
2909	chest pa and lateral radiographs redemonstrate mild interstitial edema and mild cardiomegaly . no signs of aspiration and no change from prior cxr .	Cardiomegaly&&Edema	11293517	57774874	6eaa4765-962aa2b7-3cc2112a-79abf7d4-36999ea4
2910	mild cardiomegaly is stable . mild-to-moderate pulmonary edema is new . there has been interval worsening in left perihilar consolidation, most likely consistent with pneumonia . continued followup is recommended until resolution . small bilateral pleural effusions, left greater than right, have increased . there is no evident pneumothorax .	Cardiomegaly&&Consolidation&&Edema&&Pleural Effusion&&Pneumonia	13353878	56538372	38fd10a6-9bc66421-6001dcd9-d1906370-18d01e97
2911	compared with the immediate prior study of earlier on the same day there has been new or right middle lobe and right lower lobe collapse . there is likely trace associated layering right pleural effusion . the endotracheal tube terminates . cm from the carina . a left subclavian central venous catheter terminates the junction of the svc with the brachiocephalic vein . an enteric tube courses below the diaphragm and outside of the field of view . an inferior approach central venous catheter terminates in the ivc, unchanged . there is no left-sided pleural effusion or consolidation . . interval right middle lobe and right lower lobe collapse . . endotracheal tube terminates . cm from the carina .	Atelectasis&&Support Devices	14841168	55926507	e3e6cc59-4cfa69f0-eb73c903-0346145f-f6ae821f
2912	midline sternotomy wires and mediastinal clips are again noted . heart is mildly enlarged, though this appears stable . the aorta is tortuous, also unchanged . there is mild interstitial edema without large effusions or pneumothorax . no definite signs of pneumonia . bony structures are demineralized . a mild wedge deformity of a vertebra at the thoracolumbar junction is noted . there is stable from prior . mild cardiomegaly with interstitial edema .	Cardiomegaly&&Edema	16957952	56849860	8e067d88-2ea4ee8d-21db2c6b-f78701cb-91ad53f9
2913	comparison is made with prior study performed seven hours earlier . there is no pneumothorax or pleural effusion . there is a new right pigtail catheter in the right hemithorax . large known anterior air- fluid collection is not longer visualized, though would be better evaluated with a lateral radiograph to assess any residual air or fluid . cardiac size is top normal . small right perihilar and bilateral opacities largely on the right side are grossly unchanged consistent with infectious process . patient has known emphysema . there are no other acute interval changes .	Lung Opacity&&Pneumonia&&Support Devices	17770657	52743281	7d360199-6d44109c-6aa33603-caf75a5d-941bd6b2
2914	upright ap view of the chest left-sided pacemaker device is noted with leads terminating in the right atrium, right ventricle, and coronary sinus . the heart size is mildly enlarged . the aortic knob is calcified . there is mild pulmonary edema with perihilar haziness and vascular indistinctness, new from the prior study . focal opacities at lung bases may reflect areas of atelectasis though infection cannot be excluded . small bilateral pleural effusions may be present . no pneumothorax is identified . mild pulmonary edema with probable small bilateral pleural effusions . more focal opacities at lung bases may reflect atelectasis but infection cannot be completely excluded .	Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia	12595991	51615087	29f643b7-e5408002-2f731ee3-cb5b8634-0d438145
2915	pa and lateral views of the chest the patient is status post median sternotomy, cabg, and aortic valve replacement . the cardiac silhouette size and configuration is unchanged, as is the mediastinal and hilar contours . there are low lung volumes, which results in minimal bibasilar atelectasis and crowding of the bronchovascular structures . no focal consolidation, pleural effusion, or pneumothorax is present . there are mild degenerative changes of the thoracic spine . cholecystectomy clips are noted in the upper abdomen .	Atelectasis	16773796	56605773	5f058986-c0a46f7a-7d175c3e-c40f1bd2-e71884bf
2916	compared with at pm, i doubt significant interval change . again seen is the left sided tube, left lung hyperlucency, and left-sided volume loss, with compensatory slight hyperextension of the right lung, leftward shift of the mediastinum, and elevation of the left hemidiaphragm, consistent with pneumonectomy . minimal atelectasis or scarring at the right base is unchanged . epidural catheter again noted .	Atelectasis&&Enlarged Cardiomediastinum&&Lung Opacity&&Support Devices	12410066	56130174	4f5bc759-411e9f5e-1bde471f-2d8e0359-d15caa34
2917	there is marked scoliosis with convexity to the right, similar to prior examinations and with increased patient rotation to the right . in the interval from the prior examination, obscuration of the left hemidiaphragm may be due to pleural effusion and atelectasis, though a consolidation or pneumonia cannot be entirely excluded . there may be mild interstitial edema . patchy right lower lobe opacity may be due to infection or aspiration . no pneumothorax is seen . the heart is mildly enlarged . an endotracheal tube is in standard position with tip near the inferior margin of the clavicular heads . an esophageal catheter has been placed, coursing inferior to the diaphragm with side port within the stomach and tip out of view of the radiograph . a left-sided dual-lead pacemaker is in standard position .	Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	13649937	53966692	019dff97-dd885742-7be6fc52-dfd21808-8513ba6d
2918	subtle increased density adjacent to the cardiac apex, with obscuration of the lower left cardiac border, has been present on multiple prior studies, and is thus likely chronic . no corresponding abnormality was identified on the lateral view performed one day prior . there is no further parenchymal opacity identified . there is no pleural effusion or pneumothorax . the cardiomediastinal contours are unchanged . there is no pulmonary vascular congestion or edema . there are no acute osseous abnormalities . no evidence of lobar pneumonia . opacity adjacent to the cardiac apex at the left base appears to be chronic, though if there is concern for developing pneumonia radiographic follow-up would be appropriate .	Lung Opacity&&Pneumonia	16662264	58701930	463d2a28-b411bb98-f7bda38e-7030ebb9-74a8a1e0
2919	lateral view somewhat limited due to overlying motion artifact . the lungs are low in volume . there is no focal airspace consolidation to suggest pneumonia . a -cm calcified granuloma just below the medial aspect of the right hemidiaphragm is unchanged from prior study . no pleural effusions or pulmonary edema . there is no pneumothorax . the inferior sternotomy wire is fractured but unchanged . surgical clips and vascular markers in the thorax are related to prior cabg surgery . no evidence of acute cardiopulmonary process .	No Finding	10046166	50051329	abea5eb9-b7c32823-3a14c5ca-77868030-69c83139
2920	the lungs are low in volume but clear . the cardiac silhouette is possibly mildly enlarged . low lung volumes may be responsible for mild widening of the mediastinal silhouette . the hilar contours and pleural surfaces are normal . no pleural effusion is present . a left-sided pacer terminates with its leads in the right atrium and right ventricle . non-standard placement of the right atrial lead is unchanged . mild cardiomegaly . no acute intrathoracic process .	Cardiomegaly	18487334	56858524	70da9ce8-660f957c-cff2916f-1e067a32-1f7149f9
2921	the lungs are clear of consolidation or effusion . the cardiac silhouette is enlarged but unchanged . no acute osseous abnormality is detected . right brachiocephalic venous stent is again noted . no acute cardiopulmonary process .	No Finding	14744884	59332553	165711e8-c8b71f3b-2d2cbf76-dca067bc-f2ba9089
2922	the lung fields are clear without focal consolidation, pleural effusion, or pneumothorax . heart and mediastinal contours are within normal limits . sternal wires and mitral valve replacement hardware are again seen . no radiographic evidence for acute process .	No Finding	16116557	51951386	0bb60711-8098a084-5f12d2bb-e8739a70-870e72a1
2923	comparison is made to the prior study from . an endotracheal tube has been placed and the distal tip is at the level of the aortic knob, cm above the carina . the swan-ganz catheter is unchanged . there is a persistent cardiomegaly . there is a right-sided pleural effusion . there is prominence of the pulmonary interstitial markings . no pneumothoraces are identified .	Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Support Devices	13135946	58348130	d1a588ba-df69fa21-41d67ef8-6ae29c22-17544175
2924	frontal and lateral radiographs of the chest were obtained . lung volumes are slightly low . a moderate right pleural effusion has increased compared to the prior study from , likely with a subpulmonic component . a concomitant consolidative process at the right lung base cannot be excluded . there is mild pulmonary vascular congestion without frank interstitial edema . mild cardiomegaly is unchanged . the mediastinal contours are normal . there is no pneumothorax . a right port-a-cath ends in the mid-to-low svc . . moderate right pleural effusion with a likely subpulmonic component . a concomitant infectious process at the right base cannot be excluded . . unchanged mild cardiomegaly . . mild pulmonary vascular congestion without interstitial edema .	Cardiomegaly&&Edema&&Pleural Effusion&&Pneumonia	16826047	56712342	a9c772ae-200934a7-b6e1a70f-b42f3c60-9ddecf2b
2925	with the patients neck in flexed position, the endotracheal tube ending approximately cm above the carina is highly placed . consider advancing the endotracheal tube by additional cm for better seating . new left internal jugular line ends at the left vertebral margins and is likely within the left brachiocephalic trunk . considering advancing by additional . cm to cm . left picc line ends at lower svc . both lung volumes are low and remarkable for minimal bibasal atelectasis . no oacities concerning for pneumonia . a thin, curved, radioopaque structure is seen extending from right medial basal lung till right hypochrondriac region . its clinical significance was discussed with dr by phone on at pm, but my discussion led to conclude this as of uncertain nature . i recommend a lateral radiograph for further evaluation to see if this is a artifact or real . orogastric tube is seen coursing below the diaphragm into the stomach and is adequately placed . an abdominal drain tube is seen in the left upper abdomen . above findings were discussed with dr . by phone on at pm .	Atelectasis&&Pneumonia&&Support Devices	19907884	55906329	c76592b7-dc16f6ee-eddffb4d-e872e85b-672e7d59
2926	removal of dialysis catheter with no evidence of pneumothorax . heart is mildly enlarged and is accompanied by vascular engorgement and new septal lines consistent with interstitial edema . small pleural effusions have increased in size in the interval .	Edema&&Pleural Effusion&&Support Devices	15259244	50243155	3920cf42-8cd1362b-cbe6eaee-518b1fa6-a7358a5b
2927	ap upright and lateral views of the chest were obtained . elevated right hemidiaphragm is again noted . mild cardiomegaly is also stable . there is no focal consolidation, effusion, or overt signs of chf . mediastinal contour is stable . bony structures are intact . a mild scoliosis is again noted with a superior end plate compression deformity at the thoracolumbar junction . no acute intrathoracic process .	No Finding	10449297	52837403	609ca0e0-3dcbf65f-38322c64-03e4fea0-3faa3a90
2928	volume of the postoperative right lung has improved considerably, and the volume of the persistent right apical pleural space has decreased, though now it contains more fluid than air . subcutaneous emphysema has increased . two right pleural drains remain . left lung is clear . heart size is normal . greater fullness in the right lower tracheobronchial angle could be due to paramediastinal pleural fluid, but should be carefully followed to exclude a developing hematoma . in the interim, the patient has been extubated . heart size is normal .	Pleural Effusion	19991135	50498205	d9661ff6-877ac981-a20a8810-92309d46-173008ad
2929	the patient is status post median sternotomy . right-sided port-a-cath is again seen without significant change in position, terminating at the cavoatrial junction . again, there are low lung volumes and minimal bibasilar atelectasis . ovoid calcification projecting over the left mediastinum is again seen . subcentimeter left lower lung rounded calcification is stable and may represent a calcified granuloma . no focal consolidation, pleural effusion, or evidence of pneumothorax is seen . the cardiac and mediastinal silhouettes are stable . there is no overt pulmonary edema . no significant interval change .	No Finding	11413236	57332361	11bf7fcd-96d58d34-49415fcc-c20c2b7d-1f340544
2930	a single-lead left-sided aicd is again seen with lead extending to the expected position of the right ventricle . there has been interval removal of a right internal jugular central venous catheter . there is minimal interstitial edema . no large pleural effusion or pneumothorax . the cardiac silhouette remains mildly enlarged . the aorta is tortuous . no focal consolidation seen . minimal interstitial edema and mild cardiomegaly .	Cardiomegaly&&Edema	12074041	51988570	a2f93b13-6b7f3079-3610454c-347f5e93-ad8f103b
2931	one view of the chest the lungs are hyperexpanded and show hyperlucency of the upper lobes consistent with known emphysema . asymmetric density is noted in the left lower lobe . the cardiomediastinal silhouette, hilar contours and pleural surfaces are normal . no pleural effusion or pneumothorax is present .	Pneumonia	11052935	57214202	4859ca51-f9aec9f3-e0959b5c-a6342b33-28811875
2932	feeding tube, now without the wire stylet ends in the same place, upper stomach . the apex and lateral right lower hemithorax are excluded from this examination . remaining pleural surfaces are normal and the imaged lungs show no pneumonia or edema, but there are several small nodules and bronchiectasis in the right lower lobe .	Lung Lesion&&Support Devices	10402372	57949791	080eb78a-c3c3f369-1eaacd39-7f6cc416-8810586c
2933	when compared to prior, there has been interval progression of the opacity in the left upper lobe . hazy opacity in the left lung base corresponds with lingular atelectasis versus scarring and superimposed left lower lobe ground-glass seen on prior chest ct . additional nodules previously described are not as clearly delineated by x-ray . the cardiomediastinal silhouette is within normal limits . no acute osseous abnormalities . surgical clips in the right upper quadrant suggest prior cholecystectomy . left upper lobe consolidation has progressed since prior . this could be due to an infection however underlying malignancy cannot be excluded . follow-up by chest ct is suggested and can be performed as previously recommended in .	Consolidation&&Pneumonia	16435402	58864570	218c9927-cdee34db-c4b93920-adfa83cb-cfb580c5
2934	moderate to severe cardiomegaly is stable . pacer leads are in standard position . et tube is in standard position . left ij catheter tip is in the mid svc . right picc is in unchanged position . ng tube tip is out of view below the diaphragm . vascular congestion has improved . bibasilar atelectasis have improved . bilateral effusions right greater than left are unchanged improved pulmonary edema .	Edema	12595991	50749866	9df33cee-a5533c4d-56048d41-edb2923b-6b01ac1f
2935	monitoring and support devices remain in place . widespread airspace opacities, more prominent on the right, are consistent with diffuse pneumonia . the known abscess in the right lower lobe is seen in better detail on recent ct . right pigtail catheter is seen at the base of the lung, presumably within the abscess cavity . little change in the moderate pleural effusion .	Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices	13964474	54413465	929b5959-0c447f88-a4f24482-1fa6681b-06dd8ec4
2936	frontal and lateral views of the chest demonstrate a left pectoral dual-lead paceraicd with leads terminating in the right atrium and right ventricle . the heart is normal in size . there is mild thoracic aortic unfolding . atherosclerotic calcifications are seen in the arch . suspected right middle lobe mass is present since at least and previously evaluated on ct . right basilar fibrosis is also better demonstrated on prior ct . aerated upper lungs are clear . there is no pneumothorax, vascular congestion, or pleural effusion . . no acute cardiopulmonary process . . probable right middle lobe mass, better assessed on prior ct . right bibasilar pulmonary fibrosis .	Lung Lesion&&Pleural Other	15378103	55048387	7a56c5a4-63fabea2-e65cd08b-42dd34c4-a1867f86
2937	new consolidation at the base the left lung could be either atelectasis or pneumonia, accompanied by stable small left pleural effusion . chest is otherwise unchanged, including normal size heart, minimally dilated upper lobe pulmonary vessels, but no pulmonary edema .	Atelectasis&&Consolidation&&Pleural Effusion&&Pneumonia	16553329	56936171	8ad111d7-bd7f226a-d10f242f-59b1df46-5defb013
2938	the lungs are clear without focal consolidation, effusion, or edema . left chest wall single lead pacing device is noted . mild cardiomegaly is noted . median sternotomy wires and mediastinal clips are seen . prior endotracheal and enteric tubes are no longer visualized . mild cardiomegaly without superimposed acute cardiopulmonary process .	Cardiomegaly	11540283	58773579	4a6b6a7c-83ed2cdc-41c74d6e-ed8815a2-84ed02ff
2939	there is a right-sided picc line with distal lead tip at the cavoatrial junction . there are low lung volumes with atelectasis at the lung bases and a left retrocardiac opacity . this is unchanged . surgical clips within the left axilla are again seen . there are several healed old right-sided rib fractures . no pneumothoraces are seen .	Atelectasis&&Fracture&&Lung Opacity&&Support Devices	18978682	54392033	aa20f78f-53dce569-e7263012-3c4ab839-7abbabd4
2940	the cardiac silhouette is enlarged with somewhat globular configuration, which may be due to pericardial effusion or cardiomyopathy . there is mild bibasilar atelectasis . no definite focal consolidation is seen, although a small retrocardiac consolidation is difficult to exclude . no large pleural effusion or pneumothorax . the superior mediastinum remains prominent as it did on the prior study from . there is mid lung linear atelectasisscarring, best seen on the lateral view . the posterior costophrenic angles are not well seen which may be due to overlying soft tissue, though trace pleural effusions are not excluded .	Atelectasis&&Cardiomegaly&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion	14727722	53818162	8c410469-6d0fe4ba-0b72128d-15095daa-3e1623e9
2941	cardiac size is top normal . the lungs are grossly clear . there is no pneumothorax or pleural effusion . moderate degenerative changes are in the thoracic spine .	No Finding	15840907	53731827	d89e6f21-a446eef4-a01c2b56-b8c103af-64774131
2942	on the previous radiograph, extent of the known right pleural effusion has increased . the right pleural drain seems to be in unchanged position . the effusion now occupies a little bit more than of the right hemithorax . unchanged appearance of the cardiac silhouette . unchanged normal appearance of the left lung .	Cardiomegaly&&Pleural Effusion&&Support Devices	16826047	59368305	c4043075-ef0f5e86-98cd490f-353abc47-c25c3a5f
2943	there is no change or evidence of acute cardiopulmonary disease . the lungs are clear and there is no vascular congestion or pleural effusion . of incidental note is dilatation of the trachea consistent with the patients known tracheomalacia . the esophageal capsule is no longer present and there are surgical clips in the upper abdomen .	No Finding	15114531	51762961	550025f0-fb28013b-e174e563-a9c2dc35-c3f0b4d0
2944	the right pleural effusion is moderate in size, loculated and unchanged in appearance or minimally decreased since the prior study . the left mediastinal shift is persistent, unchanged . architectural distortion, bronchiectasis, and pleural thickening in the left upper lobe is unchanged .	Pleural Effusion&&Pleural Other	13849733	50947446	0add49e8-ece420fd-0cb46263-87fad39f-10abd60b
2945	the heart is mildly enlarged with a left ventricular configuration . there is similar unfolding of the thoracic aorta . the mediastinal and hilar contours appear unchanged including a convexity along the right upper mediastinal contour . particularly since it appears stable over time, it can probably be attributed to tortuosity of the great vessels . at both lung bases, but more extensive on the right than left, there are patchy opacities, fairly streaky in nature but extensive . these are increased since the earlier examination and are accompanied by peribronchial cuffing . there is no pleural effusion or pneumothorax . suspected mild loss in mid thoracic vertebral body heights appears unchanged and probably coincides with demineralization . the lower thoracic spine shows mild rightward convex curvature . there is wedging of an upper lumbar vertebral body which may be increased somewhat, although the apparent difference may be due to differences in orientation . . increasing bibasilar opacities which could be seen with lower airway inflammation or infection, although developing bronchopneumonia is not entirely excluded . . mild anterior wedge compression deformity of a vertebral body at the thoracolumbar junction, likely l although probably chronic, potentially increased somewhat .	Lung Opacity&&Pneumonia	16853729	55420918	10b653ab-46de5007-fc3c0784-46a5a718-df7713ba
2946	in comparison with the study in on, the hemodialysis catheter is been removed and replaced with a right subclavian picc line that extends to almost the junction of the brachiocephalic vein superior vena cava . otherwise, little change in the appearance of the heart and lungs except for lower lung volumes .	Cardiomegaly&&Support Devices	16508811	54040548	e57f1292-5588d57d-2a9585b6-09d738a5-16b9c9f6
2947	heart size remains mildly enlarged with a left ventricular predominance . the aorta is unfolded and diffusely calcified, with the hilar contours appearing stable . the lungs are clear without evidence of pulmonary vascular engorgement . a trace left pleural effusion may be present, but no right pleural effusion is seen . no pneumothorax is identified . an inferior vena cava filter is noted within the abdomen . there are no acute osseous abnormalities . no radiographic evidence for pneumonia .	No Finding	13484161	55812727	0f3b10cd-b3e6a500-20370ada-6e3ab8b3-ad1019c5
2948	as compared to prior chest radiograph from , there has been interval improvement of opacities along the right lower lung . there is bibasilar atelectasis . mild cardiomegaly is unchanged . there are no pleural effusions or pneumothorax . an et tube ends . cm above the carina . right jugular line is unchanged in position . interval improvement of opacities along the right lower lung with bibasilar atelectasis .	Atelectasis&&Lung Opacity	15809646	52673752	2cdf54d6-df90d07a-cbaaa135-454278cd-ffe7eb4e
2949	there is persistent bibasilar atelectasis . no new focal consolidation, large pleural effusion, or evidence of pneumothorax is seen . the cardiac and mediastinal silhouettes are stable . no other significant interval change aside from possible decrease in small left pleural effusion noted on the prior study .	Pleural Effusion	15393401	54128006	ba3fb88d-d17476f9-7e265acc-3818caee-7fe0f04e
2950	the endotracheal tube has been removed . the right ij catheter tip again lies at the level of the mid portion of the svc . streaks of atelectasis are seen at the left base, but the lungs are otherwise essentially clear and there is no evidence of vascular congestion . of incidental note is post-surgical or post-traumatic changes involving the distal right clavicle and several rib fractures on the right .	Atelectasis&&Fracture&&Support Devices	17439310	59138498	0b5f3585-a53ebe18-3930e02f-271b3e7d-836cdf4a
2951	median sternotomy wires, aortic valve replacement, mediastinal surgical clips are again noted, no change in alignment . there is persistent opacity at the left lung base, though aeration is improved from two days prior . persistent linear opacities likely represent atelectasis . left pleural effusion is small . trace right pleural fluid is also present . lungs are otherwise well aerated . there is no focal consolidation to suggest pneumonia . there is no vascular congestion or pulmonary edema . there is no pneumothorax .	Atelectasis&&Pleural Effusion	12733339	53736575	946ab43b-aafbeb4c-99c6b132-43bf9624-4c09a5f4
2952	the study of , the swan-ganz catheter has been removed and there is no evidence of pneumothorax . continued substantial enlargement of the cardiac silhouette with pulmonary vascular congestion that appears to be decreasing . the hazy opacification at the right base has substantially cleared and the hemidiaphragm is more sharply seen . this could represent improved pleural effusion, though it could merely be a manifestation of a more erect position of the patient . poor definition of the right heart border with basilar opacification is again consistent with substantial volume loss in the right middle and lower lobe .	Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	14851532	52296776	8b5044a8-1b105a82-35dfd08e-befc2e5f-b2df474a
2953	the pre-existing left pleural effusion has massively increased in extent . the effusion occupies approximately half of the left hemithorax and causes substantial basal atelectasis . on the right, a small-to-moderate pleural effusion has newly occurred . in the ventilated parts of the lung parenchyma, there is no evidence of pneumonia . no pneumothorax .	Atelectasis&&Pleural Effusion	12433421	51235553	222087fc-b3297c5c-72502065-cf9f3e90-6839efc7
2954	comparison is made with prior study performed four hours earlier . new et tube is in the standard position . the tip is . cm above the carina . change in the density and opacities in the lungs bilaterally are consistent of shifting of pleural effusions . mild pulmonary edema is unchanged . there are no other interval changes .	Edema&&Lung Opacity&&Pleural Effusion&&Support Devices	17669276	58567017	05a2607c-496ddc11-835abb3e-f87f6687-b2f581c7
2955	ap portable semi upright view of the chest . lung volumes are low limiting assessment . the patients chin obscures the lung apices . allowing for limitations, the heart is enlarged with mild to moderate pulmonary edema noted . no large effusion . no gross bony abnormalities . mild to moderate pulmonary edema, mild cardiomegaly . limited exam .	Cardiomegaly&&Edema	15131736	55827546	6961188b-c38e2a5b-a99c020f-7b1d396a-86da5f49
2956	the radiopaque portion of the dobbhoff tube overlies the ge junction and upper stomach . residual contrast again noted . an additional ng tube type tube is present, tip extending beneath diaphragm, off film . et tube in satisfactory position approximately . cm above the carina . right subclavian central line tip over distal svc . cardiomediastinal silhouette appears smaller . sternotomy wires and prosthetic valve noted . there is chf with interstitial edema . allowing for technical differences, this is fairly similar to the most recent prior film . there is a small-to-moderate left effusion, with underlying collapse andor consolidation . hazy density at the right base also likely reflects layering effusion, with some underlying atelectasis .	Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	13135946	58778519	a7c40dad-a0c662b4-98da13ed-35ffc92a-4862b305
2957	large right pleural effusion persists following removal of the right pleural drain . there is no appreciable pneumothorax . large fissural fluid collection should not be mistaken for right lung mass . left lung is grossly clear . heart size normal .	Lung Lesion&&Pleural Effusion	13352405	52426022	dbc771b6-00a9d1dc-3d5f7a54-acb63200-cc010192
2958	thereis hyperinflation, consistent with background copd . there is increased diffuse parenchymal opacities bilaterally, more prominent at the bases consistent with mild pulmonary edema . there are small bilateral pleural effusions layering posteriorly, left greater than right . there is fluid in the major fissure seen on the lateral view . there is moderate cardiomegaly . no pneumothorax . the left hemidiaphragm is elevated laterally . moderate cardiomegaly, mild pulmonary edema and small bilateral pleural effusions consistent with chf .	Cardiomegaly&&Edema&&Pleural Effusion	11052273	53702175	e35b1970-3dfc9412-ec657374-09990870-561ca892
2959	low inspiratory volumes . there is a small left effusion and possibly a small right effusion . there is increased retrocardiac density and right infrahilar density consistent with lower lobe collapse andor consolidation . the superior mediastinum is not well demonstrated on this view due to lordotic positioning . there is upper zone redistribution, likely accentuated by low lung volumes . the degree of retrocardiac opacity is greater and the left effusion is new, compared with the film dated at pm . chondroid calcifications in the diaphysis of the right proximal humerus are noted, extending beyond the infeiror edge of this film, over a length of at least cm . in the absence of atypical upper arm pain, this likely represents a benign enchondroma . . bibasilar opacities, worse on the left, with possible new left effusion . . limited assessment of superior mediastinum due to lordotic positioning . . probable right humeral diaphysis enchondroma . when the patient is stable, recommend clinical correlation to exclude any right humeral atypical pain and baseline right humerus radiographs to include the entire lesion .	Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion	11569042	58093109	737fe166-1d61ed17-45d7d04d-b55e438d-4f23f221
2960	endotracheal tube terminates . cm above the carina and right internal jugular line ending at mid svc are appropriate . no interval changes in the lungs since . bibasal atelectasis, left side more than right side, is unchanged . top normal heart size, mediastinal and hilar contours are stable in appearance . no new lung opacities of concern . pleural effusion, if any, is mild on the left side and similar .	Atelectasis&&Lung Opacity&&Pleural Effusion&&Support Devices	19454978	50520166	7a61d475-697617d7-8f7bacca-80d56a97-5a83bbd7
2961	there is a single-lead pacemakericd device whose lead terminates in the right ventricle as before . the tricuspid and aortic valves has been replaced . hazy opacities that are predominantly central within each lung suggest mild pulmonary edema . a persistent pleural effusion with loculated character appears unchanged on the right, with probable atelectasis opacifying a substantial portion of the right lower hemithorax, as before . there is probably a trace pleural effusion only on the left . no pneumothorax is demonstrated . findings suggesting mild pulmonary edema . similar moderate-sized right pleural effusion, probably loculated to some extent, with persistent lung opacification that can probably be attributed to associated atelectasis .	Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion	19182863	54811277	89853b2a-bf88984c-37910d68-2401fca9-884951db
2962	the patient is status post sternotomy and aortic valve replacement . the cardiac, mediastinal and hilar contours appear unchanged . the heart is at the upper limits of normal size . aside from band-like opacity in the left mid lung suggesting minor atelectasis, there is no focal abnormality, but a mild diffuse interstitial abnormality suggests slight congestion . there is no pleural effusion or pneumothorax . the patient is also status post posterior fusion of the lower thoracic spine and vertebroplasty findings suggesting mild vascular congestion .	Edema	14434800	54259878	2ff8144f-c833baaa-899af187-89dbc6ce-3adfc088
2963	there is diffuse increase in opacifications bilaterally . although some of this could represent volume overload, much of the opacification, especially on the left, is consistent with superimposed pneumonia .	Lung Opacity&&Pneumonia	16508811	58890549	ee316aaf-4836b322-7a19300e-e45cd9fd-b0399146
2964	there are low lung volumes . bibasilar atelectases have increased on the left side . small left pleural effusion is minimally increased . mild pulmonary edema has increased . right lower lobe consolidation has improved . ng tube tip is out of view below the diaphragm . left picc tip is in the upper-to-mid svc . cardiomediastinal contours are unchanged .	Atelectasis&&Consolidation&&Edema&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices	13979643	55490963	0a69cc34-5b2f951d-97d57989-4fc060c7-52b94812
2965	the pre-existing partly pleural partly parenchymal opacities on the right have completely resolved . there is an obviously post-surgical rib defect on the right at the level of the fifth rib . minimal scarring in the region of the middle lobe, but no acute changes . no pleural effusions . no pneumonia . normal size of the cardiac silhouette .	Lung Opacity	19389547	53414987	d7fd94c9-c495c1e6-cfc0ccec-60cc9251-6dfbb8ff
2966	ap and lateral views of chest demonstrate a right upper lobe consolidation with some areas of air bronchogram . background multifocal opacities with volume loss and chronic scarring are unchanged . there is no large pleural effusion . cardiac size is normal . new right upper lobe consolidation worrisome for infection on background chronic scarring .	Consolidation&&Lung Opacity&&Pneumonia	10933609	54422699	53c18304-54fac49c-cabe4615-c2a37b60-8555c705
2967	severe bilateral infiltrative pulmonary abnormality continues to worsen . small bilateral pleural effusions and moderate cardiomegaly suggest that at least some of this abnormality is due to pulmonary edema, but the widespread recurrent infiltrative pulmonary abnormality present to varying degrees on chest ct scans since suggests an underlying process such as chronic pulmonary drug toxicity .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	13078497	51021074	956ec432-03e9c40c-ff58e74d-db0b9443-71042da1
2968	normal size of the cardiac silhouette . vertebral fixation device is in the cervical spine . no pneumonia, no pleural effusions . normal size of the cardiac silhouette . no pulmonary edema .	No Finding&&Support Devices	15114531	50613163	705d8098-599ee69b-ab0b9267-00def4fb-b2410a5d
2969	left-sided pacer is re- demonstrated with leads terminating in the right atrium and right ventricle . the patient is status post median sternotomy, aortic valve replacement, and cabg . heart size is mildly enlarged, unchanged . mediastinal and hilar contours are similar . mild upper zone pulmonary vascular redistribution is likely chronic without overt pulmonary edema . lung volumes remain low with streaky opacities in the lung bases suggestive of atelectasis . no large pleural effusion or pneumothorax is present . fusion hardware within the lumbar spine is partially imaged as well as hardware within the right humeral head . chronic mild pulmonary vascular congestion without overt pulmonary edema . bibasilar atelectasis .	Atelectasis&&Edema	19075045	52690612	d9804d7c-635ee55c-7df369a2-fad70e3c-4b5af3fb
2970	portable ap chest radiograph is obtained with the patient in the semi-erect position . tracheostomy noted . cardiomediastinal silhouette is unchanged bulging of the pulmonary outflow tract reflects enlargement of pulmonary arteries and suggests underlying pulmonary arterial hypertension . pulmonary edema has slightly improved compared to the prior study . small right pleural effusion is unchanged . again bibasilar opacifications are noted and are suggestive of atelectasis or consolidation . . unchanged bibasilar opacities are consistent with atelectasis or consolidation and pneumonia should be considered in the appropriate clinical context . . improved pulmonary edema .	Atelectasis&&Consolidation&&Edema&&Lung Opacity&&Pneumonia	10268877	57765703	2f8ca5e2-5a1e02ab-e84f7547-069743e9-0f08d9e0
2971	interval worsening of subcutaneous emphysema accompanied by persistent pneumomediastinum and small bilateral pneumothoraces . heterogeneous opacities in the right lung have worsened in the interval, and note is also made of a new small right pleural effusion and persistent small left pleural effusion .	Lung Opacity&&Pleural Effusion&&Pneumothorax	11474065	53308168	d6b1f3db-eed8e0db-3a5d58a2-bfb0290f-f04dd972
2972	nasogastric catheter is seen coursing through the dilated esophagus, consistent with achalasia, and appears to terminate in the esophagus at the level of the posterior costophrenic sulcus . otherwise, the exam is unchanged with unremarkable mediastinal, hilar and cardiac contours . lungs are clear . no pleural effusion or pneumothorax is evident . enteric catheter coursing through dilated esophagus, ending in the distal esophagus at the level of the right posterior costophrenic angle .	No Finding&&Support Devices	11569042	57778607	aac431c4-71ce2760-10747748-4fd37654-0f440dd6
2973	no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is detected . heart and mediastinal contours are within normal limits . aortic calcifications are again noted . a shunt catheter courses along the right neck, right medial chest, and right abdomen, incompletely imaged . mid-thoracic vertebral body compression deformity is again noted . old right rib fractures are noted . hardware projecting over the lumbar spine at the inferior margin of the image is incompletely evaluated . stable chest radiographs without evidence for acute process .	No Finding	11906222	52008677	59a291bb-a5b73755-8efc4039-1a4e13f2-887e46d2
2974	the endotracheal tube ends approximately . cm above the carina . moderate cardiomegaly, is unchanged since the prior study . patchy consolidation of the right upper lobe along the mediastinal border is seen . pleural effusions, if any, are small . bilateral calcified pleural plaques are present . moderate pulmonary edema is noted . the gastric tube courses through the stomach, and out of view . . et tube ends . cm above the carina, and could be withdrawn a few cm for optimal positioning . . moderate pulmonary edema . right upper lobe paramediastinal consolidation, which may represent acute infection or asymmetric edema .	Consolidation&&Edema&&Pneumonia&&Support Devices	17838301	50394941	bf2bacd5-b94c49e9-68a69f71-b5d6c169-1078cd4b
2975	the assessment of the position of the esophageal stent demonstrates minimal change as compared to the prior radiograph . right chest tube is in place . the right internal jugular line is in place . there is interval improvement in the left base aeration that is most likely consistent with resolution of aspirationatelectasis . no pneumothorax is appreciated . the et tube tip is in place .	No Finding&&Support Devices	19016834	58876378	6bf94769-48631939-de27a1af-91b05e66-e770045a
2976	frontal radiograhs shows diffuse bilateral lung opacities, most pronounced in the left upper lobe in the perihilar region likely due to chf, less likely multifocal pna . postdiuresis films should be obtained . left retrocardiac opacity likely represents atelectasis .	Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity	17206933	57141526	ec72dd86-36c802f0-20a909ca-8cbcc950-58733cd5
2977	a vascular stent is seen in the left brachiocephalic vein and svc, unchanged in appearance from the prior examination . the cardiomediastinal silhouette is stable . subtle opacities seen throughout both lungs, most notable at the base of the right lung obscuring the right heart border, are suggestive of multifocal infection . an area of focal opacity projected over the left mid lung could represent an additional area of consolidation . in addition, there is increased vascular congestion, that should be -re-assessed after diuresis . there is no large pleural effusion or pneumothorax . bilateral opacities as described above concerning for multifocal pneumonia . increased vascular congestion, that should be -re-assessed after diuresis . notification updated findings communicated dr . telephone on by dr . .	Edema&&Lung Opacity&&Pneumonia	14236258	55782151	95d5ba34-c754c542-a7da4947-9dce8e85-e0668736
2978	there has been interval placement of an endotracheal tube, which is low lying with tip approximately . cm above the carina . an esophageal tube is in place coursing inferior to the diaphragm however, tip out of view of the radiograph . lung volumes remain low with mild pulmonary edema . no significant pleural effusion or pneumothorax is identified . the cardiomediastinal silhouette is enlarged, however, unchanged . interval placement of endotracheal tube with tip low lying, approximately . cm above the carina . mild pulmonary edema . distal tip of esophageal tube not within the field of view of radiograph . at pm, .	Edema&&Support Devices	15131736	52404879	25bf2edc-f6ba2b7c-b60cce3d-7f3ba548-0606e88a
2979	there is increased retrocardiac density consistent with left lower lobe collapse andor consolidation . there is also atelectasis at the right lung base . no gross effusion . mild pulmonary vascular plethora, without overt chf .	No Finding&&Support Devices	13881772	58739295	d581d98c-1d55ec95-27066557-bcd43551-e1ff2218
2980	the cardiac silhouette remains mildly enlarged . in the interval since the prior study, there is increase in interstitial markings bilaterally, particularly centrally, worrisome for worsening pulmonary edema . right basilar opacity is again seen, which may be due to fluid overload, although an underlying consolidation is not excluded . small right pleural effusion was better seen on ct as was left lower lobe opacities . surgical clips are noted overlying the left upper mediastinum . aortic knob calcifications again seen . interval increase in interstitial markings bilaterally since the prior study raises concern for worsening pulmonary edema . small right pleural effusion, better assessed on preceding ct . left lower lobe opacities better seen on ct .	Edema&&Lung Opacity&&Pleural Effusion	14851532	55167068	8137d98b-e8a60482-a158cc07-096a8d02-978fa0cc
2981	compared to the prior film, i doubt significant interval change . again seen is a pacemaker, sternotomy wires, enlarged cardiomediastinal silhouette, patchy opacity in left upper zone, increased retrocardiac density consistent with left lower lobe collapse andor consolidation, and a small-to-moderate layering left effusion . the right lung is grossly clear, with minimal vascular plethora, but no overt chf . patchy cardiophrenic opacity is slightly improved . no frank consolidation or effusion .	No Finding	19075045	53104217	62e9edcc-50892c5b-d1908c61-edfdb644-33f323c6
2982	the et tube tip is relatively low, cm above the carina but note is made that the patients neck is in flexion . there is no change in the extensive left lower lobe atelectasis and potential partial atelectasis of the left upper lobe . mild vascular engorgement is present . small-to-moderate amount of bilateral effusion is most likely present .	Atelectasis&&Pleural Effusion&&Support Devices	14841168	50133146	badff6d2-5cf4b0e2-87a2fc81-ec99b751-425d490a
2983	as compared to the previous exam, the patient has been extubated and the nasogastric tube has been removed . the extent of the pre-existing pleural effusions have bilaterally increased . there is moderate-to-extensive cardiomegaly with bilateral extensive areas of atelectasis . mild-to-moderate fluid overload . no focal parenchymal opacity suggest pneumonia .	Atelectasis&&Cardiomegaly&&Pleural Effusion&&Pneumonia	11022245	56603583	777626de-a55fbd7d-e30f8359-db74c619-80afa62d
2984	right picc is seen with tip best delineated on the lateral view within the lower svc . retrocardiac opacity persists but is improved since exam days prior . superiorly, the lungs are clear . the cardiomediastinal silhouette is within normal limits . no acute osseous abnormality is identified . surgical clips project over the left upper quadrant . cervical fixation hardware is identified . resolving left lower lobe opacity compared to exam from four days prior . right picc tip in the distal svc .	Lung Opacity&&Support Devices	15114531	52117264	78abcbc7-6b5aa7c5-013f4e3b-2fd7d3b6-6a5986ee
2985	endotracheal tube terminates cm above the carina . orogastric tube terminates in the stomach . right internal jugular catheter terminates in the mid svc . lungs are low in volume with stable right upper lung opacities which are better assessed on the recent chest ct but suspicious for pneumonia . there is no pneumothorax or pleural effusion . heart is normal in size . normal cardiomediastinal silhouette . . satisfactory position of monitoring and support devices . aside from et tube which is cm above the carina and can be slightly withdrawn . this finding was discussed with icu rn at by phone on by dr . . . unchanged right upper lung pulmonary opacities which could reflect pneumonia .	Lung Opacity&&Pneumonia&&Support Devices	12966004	59842808	bbdcb05c-156dd562-ae7470ee-946facfc-07efcfcd
2986	the heart continues to be moderately enlarged, and a left cardiac device is again seen with its leads in appropriate position . the mediastinal contours are stable, and the patient is status post median sternotomy . there is no focal consolidation, pleural effusion or overt pulmonary edema . moderate cardiomegaly without acute cardiopulmonary process .	Cardiomegaly	15144601	56094879	b785c793-aaed777d-bf9e5f46-51f74f6e-d5c76d2d
2987	mild pulmonary edema is clearing . mild cardiomegaly stable . pleural effusions small if any . no pneumothorax . swan-ganz catheter still ends in the right pulmonary artery . left jugular line tip in the region of the superior cavoatrial junction . transvenous right atrial right ventricular pacer leads follow their expected courses from the left pectoral generator .	Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices	19075045	50174434	a84bccbe-728dfb05-43811a78-46904061-d629b3bb
2988	single portable upright ap image of the chest . the right ij central line terminates in the right atrium . the lungs are well expanded and clear . there is no pleural effusion or pneumothorax . the cardiomediastinal silhouette is unchanged from prior exam . . right ij central line terminates in right atrium . pullback of - cm could be performed to have the tip located in the superior cavoatrial junction, if desired . no pneumothorax . . no acute cardiopulmonary process . little cephalization edema supine positioning is repsonsible in part for distenstion vasculatrue makes it difficult to eval for pulm edema - just last one this way .	Edema&&Support Devices	19454978	54844678	5180e323-2f458dd9-ed09ecb3-6528c63a-6b9b4f1f
2989	heart size and mediastinum are unremarkable . right lower lobe and left lower lobe bronchiectasis with bronchial wall thickening and endobronchial impaction overall appear unchanged since the prior examination with no evidence of interval progression of the infectious process . note is made that the left costophrenic angle was not included in the field of view . there is no appreciable pleural effusion or pneumothorax . the dobbhoff tube tip is in the stomach . substantial hyperinflation is redemonstrated .	Lung Opacity&&Support Devices	10402372	52470229	91957a55-d594678a-9799fb94-c27276d6-17ecf65f
2990	the tip of the dobbhoff tube extends to about the level of the ligament of treitz . endotracheal tube has been removed and the right ij catheter extends to the lower svc or upper right atrium . there is some increased opacification in both lower zones . some of this reflects volume loss in the left lower lobe with probable vascular congestion . in the appropriate clinical setting, possibility of supervening pneumonia would have to be seriously considered .	Edema&&Lung Opacity&&Pneumonia&&Support Devices	13881772	53198721	b32da72c-ae689a0b-86c6297f-a34fb19e-fafd4351
2991	evaluation limited due to underpenetration and low lung volumes . there is cardiomegaly with hilar congestion and mild pulmonary edema . no large effusion is seen the small effusions difficult to exclude . no overt signs of pneumonia though lung bases are suboptimally assessed . no large pneumothorax . cardiomegaly with hilar congestion and mild pulmonary edema . somewhat limited exam .	Cardiomegaly&&Edema	15131736	50016102	b57face8-df2c3c57-2a99e6b1-4919f774-c8c3e93c
2992	pa and lateral images of the chest demonstrate interval worsening of left lung opacity . the entire left hemithorax is now again opacified . opacification is likely due to a large left pleural fluid collection in the setting of lobectomy versus less likely left lung collapse . there is persistent significant elevation of the left hemidiaphragm . the right lung is clear . there is no right pleural effusion . cardiac size cannot be assessed due to obscuration by the left hemithorax opacification . the mediastinum is not shifted . interval increase in the opacification of left hemithorax, likely consistent with large left pleural effusion . right lung is clear .	Lung Opacity&&Pleural Effusion	12530259	51972716	02cab5e2-32c693a1-f28fc960-a42cc4a2-4d8d7c44
2993	lateral views are limited due to motion despite repeat image . relatively low lung volumes are seen with secondary crowding of the bronchovascular markings . there is superimposed interstitial edema . there is no large effusion or definite consolidation . linear atelectasis seen in the mid lungs bilaterally . the cardiac silhouette is enlarged but not significantly changed . right-sided central venous catheter tip seen within the right atrium . left subclavian vascular stent is noted . interstitial edema .	Edema	13473495	51300469	6cb983aa-64b252ae-99834c29-3233ef10-ba21f892
2994	compared the prior study, there is increase in opacity at the right mid to lower lung difficult to exclude small left pleural effusion . pneumonia pneumothorax is seen . the cardiac and mediastinal silhouettes are stable . chronic deformity of the posterior right fourth rib . increase in opacity at the right mid to lower lung is nonspecific, could be due to infection and or aspiration .	Lung Opacity&&Pneumonia	11474065	56896759	3b31865b-b41244e4-c46dbdca-c33ad6e4-3cca5768
2995	lung apices are excluded on the frontal view limiting assessment . left chest wall pacemaker is again seen with intact appearance of leads - extending to the region of the right atrium and extending to the region of the right ventricle, unchanged in position . cardiomegaly is mild and stable . the aorta is mildly unfolded . mildly increased prominence of the interstitial markings with minimal hilar engorgement raises potential concern for mild congestionedema . no convincing signs of pneumonia . a nodular opacity in the left mid lung is stable from radiograph . right upper lobe scarring is also stable . no bony abnormalities are detected . findings consistent with mild pulmonary edema .	Edema	14992360	52206840	9b21566f-2fa02275-f08686bc-4b67b21b-5dc922fb
2996	in comparison to chest radiograph, cardiomegaly is accompanied by pulmonary vascular congestion and mild edema, with increasing small right and new small left pleural effusions . worsening left retrocardiac opacification could reflect atelectasis or infectious consolidation .	Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia	15131736	57458228	344efa4b-02fb5b16-9db4229a-51955f21-7522b595
2997	ap portable erect ap view of the chest . diffuse bilateral mainly basilar parenchymal opacities consistent with moderate pulmonary edema . small bilateral pleural effusions . cardiomegaly is stable . mediastinum is still slightly widened due to mediastinal venous engorgement . moderate pulmonary edema and small bilateral pleural effusions and cardiomegaly consistent with congestive heart failure .	Cardiomegaly&&Edema&&Pleural Effusion	19844485	53984746	f138d1b9-51f16615-50213e4d-c67d164b-78ea6c15
2998	the cardiac and mediastinal contours appear stable . although less striking than on the last study, there is perihilar congestive change above that of an earlier baseline study from . there are also patchy opacities at both lung bases, more prominent in the retrocardiac area than at the right lung base, decreased from but retrocardiac opacity was not present in so is not necessarily chronic . findings suggest mild vascular congestion . opacities at the lung bases, particularly the left lower lobe, which are indeterminate as to etiology and chronicity .	Edema&&Lung Opacity	16508811	51780323	93f1cff6-36f3e02f-d36cdf6d-ee6f284b-c618d6fd
2999	the nasogastric tube is now visible . it is coiled in the stomach but the tip is located in the middle parts of the stomach . no evidence of complications, notably no pneumothorax . otherwise unchanged chest radiograph . unchanged cardiac silhouette .	Cardiomegaly&&Pneumothorax&&Support Devices	11204646	59627448	79c87d15-f10d7ef5-8935e2df-e2ed9032-32668f44
3000	an ng tube is present -- the tip is not well seen but probably overlies the lower mediastinum . an additional right-sided chest tube is present, unchanged . allowing for differences in positioning, the cardiomediastinal silhouette is probably unchanged . there is upper zone redistribution and mild chf, which appears improved compared with earlier the same day at am . irregular opacity over the right lung is slightly improved and the amount of pleural fluid on the right appears less . increased retrocardiac opacity and blunting of the left costophrenic angle is probably unchanged . no supine film evidence of pneumothorax is detected . leads overlie the left neck and upper chest . compared with earlier the same day, improvement in chf findings and in the right pleural effusion . patchy opacities throughout the right lung slightly improved, but persistent . left lower lobe collapse andor consolidation and small left effusion unchanged .	Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Lung Opacity&&Pleural Effusion	16848073	54330319	f87d7943-a25e6d95-2b683eb7-c03c1ff4-587591bc
3001	pulmonary edema is mild . large triangular opacity in the left mid lung is more likely malignant or infectious than traumatic . there is no appreciable pleural effusion or any pneumothorax . heart is normal size . multiple rib fractures are better displayed by the torso ct scan, most readily appreciated on the conventional chest radiograph in posterolateral and anterolateral aspects of right middle ribs .	Edema&&Fracture&&Lung Opacity&&Pneumonia&&Support Devices	15185305	58286219	7c2b70be-625cb0d4-aaf7b0f6-84685c72-50a04089
3002	left-sided consolidation involving the left upper lobes and possibly portions of the lingula and left lower lobe is seen . there is a trace left pleural effusion . subtle opacity at the right lung base of is more likely due to atelectasis bone additional site of infection is not excluded . prominence of the right hilum is stable . the cardiac and mediastinal silhouettes are stable . no pneumothorax is seen . large area of consolidation involving the left lung, worrisome for pneumonia . recommend followup to resolution . possible trace left pleural effusion . right base opacity may be due to atelectasis, of additional site infection is not excluded in the appropriate clinical setting .	Atelectasis&&Consolidation&&Lung Opacity&&Pleural Effusion&&Pneumonia	16508811	53183813	e07fa786-650ff653-81675db1-7d20a8f0-b4a5b8f3
3003	cardiac silhouette remains moderately enlarged slightly increased from prior exam . there has been interval increase in central pulmonary vascular engorgement as well as interstitial edema . a focal right lower lung consolidation has increased in severity and is worrisome for pneumonia . there is no large pleural effusion or pneumothorax . a right internal jugular central venous catheter is unchanged in position . worsening pulmonary congestion and edema as well as worsening right lower lung consolidation worrisome for pneumonia . results were discussed over the telephone with dr . by at on at time of initial review .	Consolidation&&Edema&&Pneumonia	19182863	53608469	1385f4a5-f1a65c0d-03e20ca7-6c7c7812-681c33fe
3004	the nodular opacity at the bases of the right upper lobe, that was clearly present at the last examination, has completely cleared . there currently is no evidence of lung nodules or lung masses suggestive of metastatic lung disease . the pleural surfaces are even . there is no evidence of pleural effusions . no evidence of rib abnormalities . clips are seen projecting over the medial aspect of the left lung apex, cranially to the aortic knob . normal size of the cardiac silhouette . normal hilar and mediastinal contours . clips projecting over the left upper quadrant .	No Finding	14794396	58352022	ad690f59-42c11dc9-609bb394-37809e1b-d91c2652
3005	the patient is status post median sternotomy and cabg . there is mild cardiomegaly which is unchanged . the mediastinal and hilar contours are relatively stable with tortuosity of the thoracic aorta again noted . there is mild diffuse calcification of the thoracic aorta . mild pulmonary vascular congestion is slightly increased when compared to the prior study . no focal consolidation, pleural effusion or pneumothorax is identified . there are no acute osseous abnormalities . degenerative spurring is seen within the left acromioclavicular joint as well as within the thoracic spine . mild pulmonary vascular congestion, slightly worse in the interval .	Edema	17318449	55265250	9bfe49ac-87087878-1110949f-335e751c-ddc3d7fe
3006	mild pulmonary edema has worsened . whether perihilar consolidation in the upper lungs increased increase since is asymmetric pulmonary edema in a pattern patient has previously displayed or concurrent pneumonia is radiographically indeterminate . moderate cardiomegaly is chronic . an earlier focus of consolidation in the right lung base has not cleared, and a small region in the lingula partially obscuring heart border is more pronounced today .	Cardiomegaly&&Consolidation&&Edema&&Pneumonia	13921768	53517180	a680547a-378dc1fb-a9fa6a3d-6713949e-e0b69f0a
3007	there is persistent prominence of the hila suggesting vascular engorgement with possible mild increase in vascular congestion as compared to the prior study . no new focal consolidation is seen . there is no large pleural effusion or pneumothorax . the cardiac and mediastinal silhouettes are stable . persistent prominence of the hila suggesting pulmonary vascular engorgementenlargement of the central pulmonary arteries, similar to prior, with possible mild increase in vascular congestion as compared to prior study .	Edema	15131736	50165831	467886fc-bdd148bc-96415ce2-3ea24428-0ee1d9a1
3008	ap single view of the chest has been obtained with patient in sitting semi-erect position . there exists extensive thickening and calcified scar formations in both apical areas . no evidence of pneumothorax is present . in comparison with the next preceding chest examination of , no significant interval change can be identified . the left-sided hilar mass is present as before .	Lung Lesion&&Lung Opacity	19389041	56852226	6211c262-9d3215ef-c9ecc9be-dab821ad-94ac069f
3009	comparison is made with the next preceding ap chest examination of . heart size remains normal . unremarkable appearance of aortic contours . similar as identified on the previous examination, there is a wide caliber -mm diameter stent occupying the esophagus and reaching from the upper thorax clavicular level down into the hiatus see also report on barium examination of neoesophagus of same day . there is a right-sided pleural effusion that blunts the right-sided lateral pleural sinus but extends into the posterior pleural spaces, occupying the area posterior to the stent prosthesis along the right posterior chest wall . the amount of pleural effusion has increased in comparison with the preceding ap single view chest examination of . the left-sided hemithorax demonstrates unchanged findings with regard to pulmonary vasculature and absence of any new acute infiltrates . no pneumothorax is identified in the apical area .	Lung Opacity&&Pleural Effusion	19016834	53124891	cd63e875-f4edd5c0-6b3cb2eb-aa774713-24cec640
3010	bilateral moderate size pleural effusions are increased with increased interstitial markings and vascular congestion compatible with moderate to severe pulmonary edema . mid and lower lung right greater than left pulmonary opacities, may reflect atelectasis in this setting of effusions and pulmonary edema, however a in multifocal infectious process or aspiration cannot be excluded . moderate cardiomegaly persists unchanged . patient is status post median sternotomy and cardiac valve replacement . moderate to severe congestive failure with bilateral moderate-sized pleural effusions, increased . as these findings could mask an underlying infectious process, if clinical concern persists repeat imaging after diuresis is recommended .	Pleural Effusion&&Pneumonia	15259244	54756918	641cc7ad-8d3dc0c6-ee97f6e1-7bf62c19-d12ac7bd
3011	ap single view of the chest has been obtained with patient in supine position . comparison is made with a previous similar examination of , which also was performed with the patient in supine position . moderate cardiac enlargement as before . heart size may have increased slightly . however, portable technique in supine position does not allow precise assessment . comparison with the next previous study clearly identifies a new parenchymal density in the left hemithorax in perihilar position extending into the left upper lobe . the previously identified left lower lobe linear densities suspicious for atelectasis persist . no new pulmonary abnormalities in the right hemithorax and no pneumothorax identified on either side . the patient is intubated and the ett terminates in the trachea some cm above the level of the carina . new parenchymal infiltrates in mid and left upper lung field . as patient apparently was in supine position during the last ten days, consider possibility of aspiration pneumonitis in this unusual location .	Lung Opacity	14841168	56670181	5c6e01e3-164c30db-22196724-376748a3-d299a9eb
3012	a pacemaker defibrillator with right atrial and biventricular leads is again noted in unchanged position . a right internal jugular approach dialysis catheter present with tip in the right atrium . an aortic valve replacement is also noted . the patient is status post cabg . there is moderate cardiomegaly . the mediastinal and hilar contours are stable with aortic calcifications there is no pleural effusion or pneumothorax . the lungs are well-expanded with increased interstitial markings, consistent with mild edema . there is no focal consolidation concerning for pneumonia . moderate cardiomegaly with mild edema . with dr . on the telephone on at am .	Cardiomegaly&&Edema	19759491	50882471	283df983-fd666130-de72e26e-a2fb9b59-88a371f7
3013	no additional line or monitoring devices visible on the current examination . the pre-existing swan-ganz catheter is in unchanged position . as on the previous report, it is noted that the the device needs to be pulled back by approximately cm, as it is located too far in the right pulmonary system . unchanged evidence of vascular stents and the right pleural effusion distributes in a different manner, but is overall unchanged in extent . the left lung appears unchanged .	Pleural Effusion&&Support Devices	12847817	57348805	8967b4f7-73cc1f85-64b133a1-6fe7a386-01716d9f
3014	comparison is made with prior study of . there are persistent low lung volume . mild right pleural effusion is probably unchanged allowing the difference in position of the patient . small left pleural effusion is also unchanged . bilateral atelectases, larger on the right side, have increased on the right . there is no pneumothorax . the cardiac size cannot be evaluated, is obscured by the pleural parenchymal abnormalities . left picc tip can be followed to the mid svc .	Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices	12952223	50702561	b7fbe6c5-f2486f77-e2ba42aa-5ad58645-6f620be5
3015	portable chest radiograph demonstrates unremarkable mediastinal, hilar, and cardiac contours . minimal stable atelectasis noted in the bilateral lower lungs, right greater than left . bilateral chest tubes projecting over lung bases with no reaccumulation of pleural effusions or pneumothorax . other lines and tubes in appropriate position . no pleural effusions bilaterally .	No Finding	16319601	51150576	bb664e62-f26a58fb-f3f6515a-0cb91fa0-2638766f
3016	the patient has received a right-sided picc line . the course of the line is unremarkable, the tip of the line projects over the mid-to-low svc . there is no evidence of complications, notably no pneumothorax . unchanged appearance of the cardiac silhouette . moderate tortuosity of the thoracic aorta . small bilateral pleural effusions .	Cardiomegaly&&Pleural Effusion&&Support Devices	19454978	57475408	f7d18e0b-557566af-9339243f-a8b26e9f-c974e2de
3017	previous multiple loculated right pleural effusions have not changed, and the intrafissural right pleural drainage catheter is stable in position . the cardiac silhouette continues to be mildly enlarged without pulmonary edema . tiny linear and nodular opacities have appeared in the left upper lobe since . multiloculated right pleural effusion unchanged since . new linear and nodular opacities in the left upper lobe may represent carcinomatosis . findings were relayed to dr . by dr . following review on at approximiately via telephone .	Lung Lesion&&Lung Opacity&&Pleural Effusion	16826047	50448867	7e6b2f67-75c969ed-bbc30375-abddcfdb-1f16d824
3018	the picc line appears to be in the mid to lower portion of the svc . the overall appearance of the heart and lungs is essentially unchanged, though there is an artifact overlying a portion of the right lung . continued hyperexpansion of the lungs consistent with emphysema . atelectatic changes are seen at both bases . the possibility of supervening consolidation in the posterior aspect of one of the lower lobes would be difficult to unequivocally exclude in the appropriate clinical setting .	Atelectasis&&Cardiomegaly&&Consolidation&&Support Devices	17770657	52175266	6e436657-6f0023be-60aed3c6-bdcf88c4-bb1c2ffc
3019	again there is substantial cardiomegaly with bilateral opacifications that most likely represent pulmonary edema . more focal opacification at the right base medially could represent a developing consolidation .	Cardiomegaly&&Consolidation&&Edema&&Lung Opacity	10439781	52831202	d43639b5-bec0c47c-8415bea0-3a2f74e5-627c89d4
3020	ap and lateral upright chest radiographs were reviewed in comparison to and multiple prior radiographs dating back to , for example . the patient is after right chest surgery, radiation and most likely lobectomy . there is interval gradual progression of left basal opacity, concerning for infectious process that was previously obscured by pleural effusion and currently appears to be gradually progressing . the appearance of the right hemithorax is stable . no new additional abnormalities have been demonstrated . the right picc line tip is at the level of mid svc .	Pneumonia	13263843	53450140	8d5ad6ce-5614528c-96b4dc9c-90955e74-7a3a722b
3021	in addition to the clear peribronchovascular infiltration and fibrosis in the upper lungs, less severe micro nodulation and early fibrosis is present in the lower lungs laterally and has progressed slightly since . although this could be a community acquired lung infection, i suspect sarcoid or other granulomatous infection . there is no pleural effusion or evidence of central lymph node enlargement in the heart is normal size . i do not see a focal opacity corresponding to the described lesion described in the requisition . if there is particular concern for a pulmonary nodule, other than sarcoidosis, ct scanning would be the only way to investigate it .	Lung Lesion&&Lung Opacity&&Pleural Other&&Pneumonia	14147787	55240854	ba892f90-88618ff7-28ff47ef-ffe24fdc-ede9c315
3022	since prior radiograph from , the mediastinal drain tube has been removed . there is no pneumothorax . both lung volumes are very low . bilateral, right side more than left side, moderate pulmonary edema has improved . widened cardiomediastinal silhouette is more than it was on however, this appearance could be exacerbation from low lung volumes . patient is status post median sternotomy with intact sternal sutures .	Edema&&Enlarged Cardiomediastinum&&Support Devices	10715477	53818026	264b773c-cd573e36-8b42c4fd-971c4302-1946ed5a
3023	frontal and lateral views of the chest previously seen basal consolidations and diffuse abnormalities in the upper lungs have improved when compared to the study . however, moderate-sized bilateral pleural effusions have worsened from although appear stable from the chest ct of . there are no new areas of consolidation or evidence of pulmonary edema . cardiomediastinal contours are unchanged .	Consolidation&&Enlarged Cardiomediastinum&&Pleural Effusion	16662264	59606790	dfde1118-f8d0acbf-f1edeee7-1d568beb-a983654d