0 there is a moderate-sized left pleural effusion which is increased in size from the prior exam in . there is no right pleural effusion . the lungs are clear without pulmonary edema, consolidation, or pneumothorax . a small calcified granuloma in the right mid-to-lower lung zone is unchanged from prior exams . the cardiac size is mildly enlarged, unchanged from prior exams . mediastinal contours are normal . the aorta is tortuous with mild calcifications . degenerative changes of the lower thoracic and upper lumbar spine are unchanged . . enlarging moderate left pleural effusion . . stable right calcified granuloma . . stable mild cardiomegaly . Cardiomegaly&&Pleural Effusion 10003502 57812613 1efa55e3-0a3856d9-421024b8-408fa7e5-81d83c1e 1 the left picc line tip is at the level of mid svc . heart size and mediastinum are stable . bibasal atelectasis, right more than left is unchanged with no new consolidations demonstrated . no appreciable pleural effusion is seen . lung volumes remain low . Atelectasis&&Cardiomegaly&&Consolidation&&Enlarged Cardiomediastinum&&Support Devices 10013502 54857277 c81b70dd-6e74dfbc-dad34592-ddacfe2d-3c3a5d4c 2 low lung volumes, no pleural effusions . no parenchymal abnormality, in particular no evidence of pneumonia . borderline size of the cardiac silhouette without pulmonary edema . no hilar or mediastinal abnormalities . Cardiomegaly 10013502 59527128 bb160b54-83b69413-d51367dd-c267210b-fbad7ccd 3 as compared to the previous radiograph, there is no relevant change . normal lung volumes . normal size of the cardiac silhouette . normal hilar and mediastinal structures . minimal scarring at the lateral aspects of the right lung . no lung nodules or masses suggesting metastatic disease . no pleural effusions . no diffuse or focal lung parenchymal disease . Lung Opacity 10072167 50281931 822ea266-47279ea1-f37382a9-0e32ce11-fc3d643a 4 heart size is normal . aorta is tortuous . lungs are clear . there is no pleural effusion or pneumothorax . No Finding 10072167 53625240 dfc90a8a-8c3ddac2-d97b03d5-33d87b92-cba96991 5 heart size is normal . aorta is tortuous . decrease in lung volume . however, the lungs are clear . there is no pleural effusion or pneumothorax . no evidence of metastatic disease in the thorax, within the limitations of chsst radiograph . No Finding 10072167 53950117 0f3224d0-b72c37a0-b9d8b5e4-ec922787-44f841ac 6 in comparison with the study of , there is little change and no evidence of acute cardiopulmonary disease . no pneumonia, vascular congestion, or pleural effusion . specifically, at the limits of plain radiography, there is no evidence of pulmonary or skeletal metastasis . No Finding 10072167 55283974 250a78d4-af5baabd-28ba3b84-13941316-dc3f1d7d 7 mild pulmonary vascular congestion with mild to moderate interstitial pulmonary edema are new compared with the prior study . mild cardiomegaly has increased compared with the immediate prior study . there is no pleural effusion, pneumothorax, or focal consolidation . the cardiomediastinal contour is stable the osseous structures and upper abdomen are unremarkable . new mild pulmonary vascular congestion with mild to moderate interstitial pulmonary edema and increased mild cardiomegaly . no focal consolidation . Cardiomegaly&&Edema 10075925 51010496 2d783c8a-492984b7-28aaf571-bfc30156-61ab26f6 8 lungs are clear without consolidation, effusion, or pneumothorax . the cardiomediastinal silhouette is within normal limits . no displaced fractures . no acute cardiopulmonary process . No Finding 10174198 51856263 dbd34ffe-85795554-0531cdd9-ac757c62-46a7e259 9 comparison to . no relevant change . minimally increased atelectasis at the left lung bases . unchanged known elevation of the left hemidiaphragm and moderate cardiomegaly as well as signs of generalized fluid overload . no new focal parenchymal opacities . no evidence of pneumonia on the frontal and lateral radiograph . Atelectasis&&Cardiomegaly&&Lung Opacity 10190940 50438069 2aafe5ea-12d26b26-972e16c4-ff3d0f9a-ae75d498 10 the left hemidiaphragm is elevated . cardiomegaly is stable . there is bibasilar atelectasis . no pleural effusion or pneumothorax is seen . the left-sided port terminates at the distal svc . no evidence of pneumonia . no acute cardiopulmonary process . No Finding 10190940 51351116 f48effa0-ca35986f-95efd353-3ba4e8a2-3ec3c9ca 11 moderate cardiomegaly is accompanied by pulmonary and mediastinal vascular engorgement but no pulmonary edema or consolidation . elevation of the left lung base posteriorly reflects scarring or linear atelectasis . there no findings to suggest acute chest syndrome or pneumonia and the cardiovascular findings could be chronic, but we have no priors studies with which to compare . a left central venous infusion pump catheter ends close to the superior cavoatrial junction . Atelectasis&&Cardiomegaly&&Lung Opacity&&Pneumonia&&Support Devices 10190940 51877987 e1b3bcbc-dc7e3b4d-cf3958a9-8357851c-6ec58b21 12 lungs are fully expanded and clear . no pleural abnormalities . severe cardiomegaly and cardiomediastinal hilar silhouettes are unchanged . pacemaker and icd leads are unchanged in position . no evidence of displaced rib fracture . no evidence of rib fracture . pacemaker and icd leads are unchanged in position . Fracture&&Support Devices 10198310 53321855 52051de6-12f425a6-7e6e8a6e-8b8c4176-b5d56a2b 13 comparison to . the pacemaker leads are in correct position . no complications, notably no pneumothorax . stable moderate cardiomegaly . stable mild elongation of the descending aorta and minimal retrocardiac atelectasis . no pneumothorax . no larger pleural effusions . Atelectasis&&Cardiomegaly&&Pneumothorax&&Support Devices 10198310 54296371 c4231749-4328dd96-eabe1197-d473f365-9b6602bc 14 pa and lateral views of the chest provided . left chest wall aicd is again seen with leads extending into the right atrium and right ventricle . the heart is moderately enlarged . hila appearing or urged . there is no overt pulmonary edema . no large effusion or pneumothorax . no focal consolidation concerning for pneumonia . the mediastinal contour is stable . bony structures are intact . no free air below the right hemidiaphragm seen . moderate cardiomegaly with pulmonary vascular congestion . Cardiomegaly&&Edema 10198310 57420501 a94f823a-d1f6f5aa-de10d9b8-37f6c6c1-e9631495 15 subtle patchy opacity along the left heart border on the frontal view, not substantiated on the lateral view, may be due to atelectasis scarring or epicardial fat pad, less likely consolidation . no focal consolidation seen elsewhere . there is no pleural effusion or pneumothorax . cardiac and mediastinal silhouettes are stable . hilar contours are stable . no overt pulmonary edema is seen . chronic changes at the right acromioclavicular joint are not well assessed . subtle patchy opacity along the left heart border on the frontal view, not substantiated on the lateral view, may be due to atelectasis scarring or epicardial fat pad, less likely consolidation . Atelectasis&&Consolidation&&Lung Opacity 10199765 51438218 121773ed-56eae249-ca58c72b-26c66aae-88b837e5 16 no focal consolidation is seen . there is elevation of the mid to posterior left hemidiaphragm with minimal blunting of the left costophrenic angle without a definite pleural effusion seen on the lateral view . no evidence of pneumothorax is seen . the cardiac and mediastinal silhouettes are unremarkable . evidence of dish is seen along the spine . no displaced fracture is seen . elevated left hemidiaphragm and blunting of the left costophrenic angle although no definite evidence of pleural effusion seen on the lateral view . 10248673 51023457 1f199273-2f4b7e8c-9041b5c2-18e7ca21-26142e3c 17 the lungs are clear without consolidation or edema . the 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 10269181 53799929 51051faa-2f20e284-0d88407b-8415e95b-9767e74e 18 pa and lateral views of the chest . no prior . the lungs are clear . cardiomediastinal silhouette is normal . osseous structures are unremarkable . no acute cardiopulmonary process . No Finding 10295064 59266404 c558a43e-149445ab-fd0ae407-39c70cca-a8a63ddf 19 ill-defined patchy opacities are seen in the right lung base with an associated small right pleural effusion, which is also confirmed in the lateral view . a dense left-sided retrocardiac opacity abutting the left hemidiaphragm is unchanged since at least compatible with a bochdalek hernia . a small left pleural effusion is also likely present . there is biapical pleuro-parenchymal scarring, more conspicuous in the left apex . no other focal opacities are identified . mild cardiomegaly is unchanged from prior . there is no pneumothorax . right lower lobe pneumonia . small bilateral pleural effusions . Pleural Effusion&&Pneumonia 10308375 57023953 aa29a8f7-ec260779-8cb37967-7d5bb1e6-a623e93f 20 frontal and lateral views of the chest were obtained . new subtle opacity at the right lung base in the setting of similar lung volumes with increased opacity on the lateral view may be atelectasis, but could represent early or developing pneumonia in the appropriate clinical setting . cardiac and mediastinal silhouettes are normal . no acute osseous abnormality is identified . right basilar opacity is probably atelectasis, but could represent early or developing pneumonia in the appropriate clinical setting . Atelectasis&&Lung Opacity&&Pneumonia 10377744 54647674 658a8ccf-a63adc9e-66351e99-f15af5f2-8e2e00b1 21 pa and lateral views of the chest cardiac, mediastinal and hilar contours are normal . the lungs are clear and the pulmonary vascularity is normal . no pleural effusion or pneumothorax is present . there are no acute osseous abnormalities . No Finding 10401591 58549367 f30d9e52-566bca1d-3ae8578d-0996d890-bc076486 22 frontal and lateral views of the chest demonstrate normal lung volumes without pleural effusion, focal consolidation or pneumothorax . hilar and mediastinal silhouettes are unremarkable . heart size is normal . patients known bilateral sub--mm pulmonary nodules are better assessed in ct . partially imaged upper abdomen is unremarkable . no evidence of acute cardiopulmonary process . No Finding 10401700 57541861 cf1dab72-e09f8f17-73f1e925-ffb70fe0-e8b878fa 23 heart size is normal . a small hiatal hernia is demonstrated . mediastinal and hilar contours are otherwise unremarkable . no focal consolidation, pleural effusion or pneumothorax is seen . multiple clips are noted in the upper abdomen . multilevel degenerative changes are present in the thoracic spine . no acute cardiopulmonary abnormality . No Finding 10425463 53709854 6887e2d1-fbfd6066-7306286f-87e5d3bc-3ded14e7 24 in comparison with the study of , there is no change or evidence of acute cardiopulmonary disease . no pneumonia, vascular congestion, or pleural effusion . there has been interval placement of multiple surgical clips in the lower neck, presumably from thyroid surgery . No Finding 10462870 52339870 aa81a761-dbc13def-538949eb-6aefd90c-12a85e54 25 frontal and lateral views of the chest are obtained . no focal consolidation, pleural effusion, or evidence of pneumothorax is seen . the cardiac and mediastinal silhouettes are unremarkable . no acute cardiopulmonary process . No Finding 10503161 55818165 f5d855de-88ff9fae-f82e34bc-c80b59f6-1f79d117 26 frontal and lateral views of the chest were obtained . the lungs are clear without focal consolidation . no pleural effusion or pneumothorax is seen . there appears to be a right-sided aortic arch . the cardiac silhouette is not enlarged . clear lungs without focal consolidation . probable right-sided aortic arch . No Finding 10521109 55380352 ede0b529-6cdb009c-7768be87-b40bb244-7ff29b19 27 pa and lateral views of the chest provided . there are subpleural reticular opacities as seen on prior ct compatible with early interstitial lung disease . the heart size appears mildly enlarged . the mediastinal contour is normal . no pleural effusion or pneumothorax . bony structures are intact . subpleural reticular opacities better assessed on the recent ct of the chest likely representing early interstitial lung disease . mild cardiomegaly . Cardiomegaly&&Lung Opacity 10543994 58473321 1216f943-00196c3a-c41ea739-788f8d83-9571731c 28 frontal and lateral views of the chest . the lungs are clear . there is no pneumothorax nor effusion . cardiomediastinal silhouette is within normal limits . radiopaque densities seen in the mid to distal esophagus with additional focus just past the ge junction . this may represent patients esophageal ph probe . no acute cardiopulmonary process . radiopaque densities in the region of the mid to distal esophagus and stomach which may correlate with patients ph probe placement . 10552670 51104115 eb6725c5-05997634-42fc628d-001242ba-5ab3fe83 29 moderate enlargement of the cardiac silhouette persists . the mediastinal and hilar contours are normal . pulmonary vasculature is normal . no focal consolidation, pleural effusion or pneumothorax is identified . no acute osseous abnormality is detected . no acute cardiopulmonary abnormality . No Finding 10569231 51507599 3ef83336-7f67850f-4c481312-ec7c99d2-a874836a 30 moderate enlargement of the cardiac silhouette persists . the lung bases are underpenetrated due to overlying soft tissue . increased opacity projecting over the inferior thoracic spine on the lateral view may be due to atelectasis although an early consolidation due to aspiration or infection is not excluded in the appropriate clinical setting . no pleural effusion or pneumothorax is seen . mediastinal contours are stable . no pulmonary edema is seen . persistent enlargement of the cardiac silhouette . no pulmonary edema . the lung bases are underpenetrated due to overlying soft tissue . increased opacity projecting over the inferior thoracic spine on the lateral view may be due to atelectasis although an early consolidation due to aspiration or infection is not excluded in the appropriate clinical setting . Atelectasis&&Cardiomegaly&&Consolidation&&Lung Opacity&&Pneumonia 10569231 54463242 c9537d32-fb8e976f-0128f837-6f009881-56b28f56 31 the heart size is mildly enlarged, slightly increased compared to the prior exam . the mediastinal and hilar contours are unremarkable . there is mild pulmonary vascular congestion with trace amount of fluid tracking within the fissures . no large pleural effusion or focal consolidation is seen . there is no pneumothorax . no acute osseous abnormalities identified . findings likely reflective of mild pulmonary vascular congestion . Edema 10575262 51022437 f6aafba9-9cacdf7c-73268cf5-74b96292-7b81a593 32 no pleural effusion or pneumothorax . no parenchymal consolidation is seen . the heart is mildly enlarged . on the lateral, the posterior heart border overlies the anterior aspect of the lower thoracic vertebral bodies implying lv and . there is decreased retrosternal space implying mild right ventricular enlargement . no radiographic cause is identified for the patients cough . mild cardiomegaly is seen . notification the findings were discussed by dr . with , md on the telephone on at am, minutes after discovery of the findings . Cardiomegaly 10575262 54255491 16e57afa-63382843-a3a5c024-e1af2c42-96184334 33 cardiac silhouette size remains mildly enlarged but unchanged . mediastinal and hilar contours are stable . pulmonary vasculature is normal . lungs are clear without focal consolidation . no pleural effusion or pneumothorax is present . no acute osseous abnormality is identified . unchanged mild cardiomegaly . otherwise no evidence of congestive heart failure or pneumonia . Cardiomegaly 10575262 55987322 e283e6ee-1e78a429-c05396b5-19ed705f-5de5210a 34 heart size is normal . the mediastinal and hilar contours are normal . mild atherosclerotic calcifications are noted at the aortic knob . the pulmonary vasculature is normal . lungs are clear . no pleural effusion or pneumothorax is seen . there are no acute osseous abnormalities . no subdiaphragmatic free air is present . no acute cardiopulmonary abnormality . no subdiaphragmatic free air identified . No Finding 10592002 51728482 20907810-b1ab5c94-cb4fbcf4-09c10590-05321eb1 35 no previous images . no evidence of acute cardiopulmonary disease . there is some the apical sub pleural thickening with mild fibrous scarring bilaterally, consistent with old healed tuberculous disease . Lung Opacity&&Pleural Other&&Support Devices 10592002 58910893 2a4ad985-4a6d5b92-11a8cc7b-046220f5-188ce7c8 36 frontal and lateral chest radiographs the heart size is normal . the hilar and mediastinal contours are within normal limits . there is no pneumothorax, focal consolidation, or pleural effusion . No Finding 10595724 56038252 3e690aea-3a937250-0a43c974-010eeb6a-f84953b2 37 frontal and lateral chest radiographs demonstrate a normal cardiac silhouette . slightly unfolded aorta with otherwise unremarkable mediastinal and hilar contour . the lungs are well-aerated without focal consolidation, pleural effusion, or pneumothorax . the visualized upper abdomen is unremarkable without evidence for sub- diaphragmatic free air . no acute cardiopulmonary process . No Finding 10617538 52366630 5e4ec3e6-eff5ccaf-92e6f524-90e868e2-3d2c2772 38 the heart size is normal . the hilar and mediastinal contours are normal . the lungs are clear without evidence of focal consolidations concerning for pneumonia . there is no pleural effusion or pneumothorax . no focal consolidations concerning for pneumonia . Pneumonia 10625954 52666674 e4b6639a-addc6e70-3931f176-25766a17-95a40103 39 left-sided picc tip terminates in the mid svc, in unchanged position . heart size is normal . the mediastinal and hilar contours are normal . the pulmonary vasculature is normal . minimal subsegmental atelectasis in the left lung base is noted . the remainder of the lungs are otherwise clear . no pleural effusion or pneumothorax is seen . there are no acute osseous abnormalities . left picc tip in unchanged position . no acute cardiopulmonary abnormality . No Finding&&Support Devices 10738077 58146073 50d7481e-a17d3334-1639b695-43ac984e-46ccec4f 40 the lungs are well expanded and clear . there is no pleural abnormality . the cardiac and mediastinal silhouettes are unremarkable . no acute cardiopulmonary process . No Finding 10767172 59509278 e6a7f3ac-fb2965d9-da384ee3-023cf138-7b74ab23 41 the right lung is unremarkable . on the left, there is an increase in pleural effusion and, with limitation of different techniques, an increase in extent of the pleural based parenchymal consolidation, as compared to the ct from . only a minimal portion of the left lung continues to be ventilated . the right hemithorax is unremarkable . Consolidation&&Pleural Effusion 10773739 50392431 12c35222-67523ce4-b206cd0f-7ae4b5c5-cffd8b0f 42 the left upper chest tube is been removed . the lower chest tube is still in place . there is interval improved appearance of the lungs with decreased effusions bilaterally . there continues to be volume loss infiltrate in the left lower lung and a layering left effusion . Lung Opacity&&Pleural Effusion&&Support Devices 10773739 52243706 03a0e671-6ed112db-cd729147-e75e4c14-8b10b571 43 the tiny volume of residual air in the left pleural space laterally and anteriorly, in the small, stable volume of loculated left pleural fluid or pleural thickening, reflects recent removal of the left thoracostomy tube . the left hemidiaphragm is more elevated now than it was several days ago, an indication of greater volume loss in the left lower lobe . the right lung and pleural space and visible mediastinal contours and structures are normal . . small amount of thoracostomy related air and residual pleural fluid loculation, unchanged . . mild volume loss at the left lower lobe . Pleural Effusion 10773739 53225875 7ce067b7-43b86b45-28974414-6f1c4688-b7f94e66 44 the left-sided chest tube is been removed . there is a small left apical lateral pneumothorax . the volume lossa atelectasiseffusion on the left is similar compared to prior compared to the prior study there is no significant interval change small left pneumothorax . Pneumothorax 10773739 56346242 1ded0fc6-dc59870e-c054eea2-5b6cceee-6151983d 45 cardiomediastinal contours are normal . the right lung is clear . there is no pneumothorax or right pleural effusion . there is mild elevation of the left hemidiaphragm unchanged from prior . opacities in the left lower hemithorax have markedly improved with residual probably scarring . blunting of the left costophrenic angles could represent a small effusion or pleural thickening . the osseous structures are unremarkable no acute cardiopulmonary abnormalities . minimal residual linear opacities in the left lower lung likely scarring and small left effusion and or pleural thickening . Lung Opacity&&Pleural Effusion&&Pleural Other 10773739 59278582 0c04004a-a36c9c30-f869bd3d-e4497073-49914c51 46 the lungs are clear . the cardiomediastinal silhouette is normal . no acute osseous abnormalities identified . no acute cardiopulmonary process . No Finding 10785610 51475084 864c32b8-9a203655-831c5b9a-f9adadcb-767da6bb 47 pa and lateral chest views were obtained with patient in upright position . analysis is performed in direct comparison with the next preceding similar study of . the heart size remains normal . no configurational abnormality is seen . unremarkable appearance of thoracic aorta . 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 . no evidence of pneumothorax in the apical area on the frontal views . as already seen on the preceding study, there is a mild degree of right-sided convex scoliosis in the thoracic spine with moderate degree of degenerative changes, but no other skeletal abnormalities are identified . stable chest findings, no cardiomegaly, pulmonary congestion or interstitial abnormalities suspicious for amiodarone toxicity . Edema 10803114 53790841 3bcd0d92-81373a0a-8fb28e74-2cac5886-c8fd319b 48 a large subpulmonic effusion is present on the right with associated atelectasis . the heart size is at the upper limits of normal and the visualized mediastinal and hilar contours are within normal limits . the left lung is clear . there is no pneumothorax . two locules of gas in the left upper abdomen represent the gastric bubble and splenic flexure of the colon . large right pleural effusion with associated atelectasis . Atelectasis&&Pleural Effusion 10803114 54240463 b8a69006-58500ba5-3ae8ca5c-e3c7bbde-d18e3034 49 the cardiac, mediastinal and hilar contours appear unchanged . there is no shift of mediastinal structures . there is a large right-sided pleural effusion, which has increased since the earlier radiographs and perhaps slightly since the more recent ct . there is no pneumothorax . the left lung remains clear . similar to increased right-sided pleural effusion, large in size . no evidence of pneumothorax . Pleural Effusion 10803114 56199877 ffc73da5-5e52ccfd-028a2711-ae2702af-ad87c455 50 frontal and lateral views of the chest demonstrate similar configuration as a right basal approach pleural catheter in place . there is a persistent small right pleural effusion with associated atelectasis and a small perifissural component . previously seen pneumothorax component in the right basal hydropneumothorax is no longer visible . the right upper lung and left lung appear well aerated . there is no pulmonary edema or left pleural effusion . the heart is normal in size . the mediastinal and hilar contours are within normal limits . multilevel upper thoracic anterior spondylosis is present . stable small right pleural effusion with associated atelectasis and pleural chest catheter in place . Atelectasis&&Pleural Effusion&&Support Devices 10803114 56915281 d4eb74b1-f44ac0fc-aaaa580a-ebd12892-d8aef5e2 51 pa and lateral views of the chest demonstrate a right-sided pleural catheter in unchanged position . the pleural effusion has decreased in size, now only a small amount remains, but there is now air within the pleura . the chest is otherwise unchanged, including right basal atelectasis, and clear left lung . cardiac size remains stable . interval decrease in the amount of fluid but increase in the amount of air within the right pleura compatible with a small hydropneumothorax . Pneumothorax 10803114 58469461 e29f99dd-1ecf184b-8a7a3240-781f606a-b37061da 52 pa and lateral views of the chest provided . 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 10807361 56869570 e5fe40d3-47686c41-bd3deb46-bff9a8dd-60e1fc04 53 the lungs are clear without focal consolidation . no pleural effusion or pneumothorax is seen . the heart is top-normal in size . there is mild unfolding of the thoracic aorta . the cardiac and mediastinal silhouettes are otherwise unremarkable . no acute cardiopulmonary process . No Finding 10862054 50702835 bb1e3b63-37b0c06b-9ee2551f-b2d7cf01-ed2f7d8b 54 frontal and lateral views of the chest were obtained . lungs are clear without focal consolidation . no pleural effusion or pneumothorax is seen . the cardiac and mediastinal silhouettes are stable and unremarkable . hilar contours are also stable . no acute cardiopulmonary process . No Finding 10862054 52442425 d0991e2b-409414c3-61292bfe-a7503b43-1683f5b1 55 normal heart, lungs, hila, mediastinum and pleural surfaces . Enlarged Cardiomediastinum 10862054 52877968 48c29455-ce143787-9c665645-6d085f76-c141b0f1 56 there is no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema . the cardiomediastinal silhouette is within normal limits . mild multilevel degenerative changes of visualized thoracic spine are noted . no acute cardiopulmonary process . No Finding 11045233 53261242 0ab98ebc-3e42c243-135283ca-41290b6b-639453bd 57 lungs are clear . the cardiomediastinal silhouette is within normal limits . no acute osseous abnormalities . no acute cardiopulmonary process . No Finding 11082901 56811276 1f6d1038-c6cffc09-b682f19e-854afec7-cef098a5 58 mild enlargement of the cardiac silhouette is present . the aorta is tortuous . the mediastinal and hilar contours are otherwise unremarkable . pulmonary vasculature is not engorged . lungs are clear . no focal consolidation, pleural effusion or pneumothorax is present . there are no acute osseous abnormalities . no acute cardiopulmonary abnormality . No Finding 11091816 51797846 4eb4be03-2765d772-09f40d82-96431de2-b7ca17e9 59 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 . there continues to be elevation of the right hemidiaphragm, similar to prior radiographs . no acute cardiopulmonary process . No Finding 11128012 57451515 b4a9606f-2d62a1a5-c7d2c5e1-7ca25c12-e1d2f15f 60 as compared to the previous radiograph, the right pleural effusion has been almost completely drained . there is no evidence of pneumothorax . otherwise unchanged radiograph . Pleural Effusion 11181748 53038461 a9f45db3-3320935c-32abfa1d-70c84639-f9d19d75 61 right-sided pleural effusion has minimally decreased . right-sided adjacent atelectasis and fluid along the fissure have also decreased . the left lung is clear . the cardiomediastinal silhouette is unchanged . numerous calcified lesions in the right chest wall are stable . slight interval decrease in right-sided pleural effusion and atelectasis . Atelectasis&&Pleural Effusion 11181748 53610077 c75317be-225faf00-b7bccd06-b199a930-a4ef45ff 62 cardiomediastinal silhouette is stable . moderate right pleural effusion has decreased in size with better aeration of the right lung . the left lung is clear . there is no left pleural effusion . no pneumothorax . interval decreased moderate right pleural effusion . Pleural Effusion 11181748 53956979 7a54f39f-f199adbd-22bd79bc-f9ef8f44-0ee9682f 63 new atelectasis right middle lobe probably due to increased small right pleural effusion . left lung clear . heart size normal . Atelectasis&&Pleural Effusion 11181748 54592417 589ad56b-158c86eb-cb95283c-8452b1ed-44503295 64 small right pleural effusion is stable . there is no evidence of pneumothorax, lobar consolidation, or pulmonary edema . no left-sided pleural effusion . the cardiomediastinal silhouette is unchanged from the prior examination . stable small right pleural effusion . Pleural Effusion 11181748 58227020 3b81672c-7380f29c-16a0623b-5e6342fc-243805ea 65 chest pa and lateral radiograph demonstrates unremarkable mediastinal, hilar and cardiac contours . the lungs are clear . no pleural effusion or pneumothorax is evident . no acute intrathoracic process or evidence of recurrent sarcoidosis . No Finding 11226572 51350911 0301c574-112ee0a8-1ccd9da9-2d579a55-b2f80210 66 focal opacity in the left lower lobe is not from nipple shadow and on retrospective review was imaged in the ct abdomen and pelvis on and likely represents atelectasis or focal scarring . no new focal opacity, pneumothorax, pleural effusion or pulmonary edema . heart size, mediastinal contour and hila are normal . no bony abnormality . focal opacity in the left lower lobe likely represents atelectasis or focal scarring . Atelectasis&&Lung Opacity 11226572 51860612 f2f96a77-ffa800e0-fe3c692c-487ed51b-87b84b10 67 the lungs are hyperinflated . multifocal bilateral opacities are concerning for multifocal pneumonia atypical infection or viral infection . no pleural effusion, edema, or pneumothorax . heart size is normal . hilar contours are unchanged . no mediastinal widening . multifocal pneumonia, atypical or viral . notification dr . was paged on at pm, minutes after discovery of the findings, but response was still pending at the time of this dictation . therefore, the impression and recommendation above was entered by dr . on at into the department of radiology critical communications system for direct communication to the referring provider . Pneumonia 11226572 53521127 48f65bd6-fd930f65-27b3123b-39cb33cc-049a89be 68 previously seen focal consolidation at the lingula is resolved and there is only minimal residual interstitial thickening . there is no consolidation, pleural effusion, or pneumothorax . cardiomediastinal and hilar silhouette are normal size and unchanged . there is no radiographic findings that suggests sarcoidosis . the lungs are mildly hyperinflated . no evidence of pneumonia . No Finding 11226572 53764194 c7524a34-034ad3d1-e934a59f-85f18631-6f81adad 69 the heart is normal in size . the mediastinal and hilar contours appear within normal limits . the chest appears somewhat hyperinflated . there is no pleural effusion or pneumothorax . there is no indication of lymphadenopathy or parenchymal interstitial disease that would be likely to reflect sarcoidosis . in the lingula, there is persistent minor opacification, but considerably reduced so possibly due to scarring from a prior process . persistent lingular opacity, but markedly reduced, so possibly due to scarring although perhaps unlikely recurrent pneumonia at the site is not entirely excluded, however . no radiographic findings particularly suggestive of active sarcoid . Lung Opacity&&Pneumonia 11226572 54348250 efa7ce32-9434194a-c88b2633-833bc1e5-4b39a4fc 70 there is o pacitiy at the left lung base, but is unchanged since when patient was asymptomatic . this suggests chronic scarring . otherwise, there are no focal consolidations, pleural effusions or pneumothorax . no evidence of hilar lymphadenopathy . cardiomediastinal silhouette is within normal limits . no acute osseous abnormalities . left lung base opacity, likely due to chronic atelectasis . no hilar lymphadenopathy . Atelectasis&&Lung Opacity 11226572 59178330 c468a266-8cdc345b-7830d55d-85f6be9c-42a47dc9 71 frontal and lateral views of the chest were obtained . no focal consolidation, pleural effusion, or evidence of pneumothorax is seen . mild left base and lingular linear atelectasisscarring is seen . the cardiac and mediastinal silhouettes are stable and unremarkable . no acute cardiopulmonary process . No Finding 11226572 59951875 1231dc8f-4cf6ae66-2754d2f7-db1abf04-fe0eb62b 72 the lungs are clear of focal consolidation, pleural effusion or pneumothorax . the heart size is normal . the mediastinal contours are normal . degenerative changes are noted in the thoracolumbar spine . no acute cardiopulmonary process . No Finding 11260884 59535336 55ba8d4b-a90e56a6-4209b8bf-e6950992-a13cab93 73 pa and lateral views of the chest provided . lungs are clear . 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 11285398 54116119 7b305795-f3816546-a9a8227a-013d0d53-47dec574 74 interval resolution of the right subpulmonic effusion . mild elevation of the left hemidiaphragm, most likely secondary to bowel distention and interposition of bowel between the spleen and left hemidiaphragm . no focal consolidation, pleural effusion, pulmonary edema, or pneumothorax . stable appearance of the cardiomediastinal silhouette . no sub-diaphragmatic intra-abdominal free air . . interval resolution of the right subpulmonic pleural effusion . . no acute cardiopulmonary process . No Finding 11287042 50043121 dc423670-4243d370-0917d0d7-e7ccb499-f9e256e6 75 small to moderate right subpulmonic pleural effusion has re accumulated, substantially smaller than its volume on . aside from mild right basal atelectasis lungs are clear . there is no left pleural effusion . there is no evidence of central lymph node enlargement . incidental note is made of a heavily calcified mitral anulus and possible left atrial enlargement, but there is no overall cardiomegaly or any pulmonary vascular congestion or pulmonary edema . Atelectasis&&Cardiomegaly&&Pleural Effusion 11287042 50391562 2cd661d7-82b0c37e-0db4c82f-d0b33edb-842bf86c 76 pa and lateral views of the chest provided . a small right pleural effusion is noted not significantly changed from the prior pet-ct allowing for differences in modality . otherwise, lungs are clear . cardiomediastinal silhouette is normal . bony structures are intact . small right pleural effusion, not significantly changed from prior pet-ct . Pleural Effusion 11287042 50657073 1ad21961-ee94488b-7fc68fbd-3a8a8100-9b71edfc 77 moderate subpulmonic right pleural effusion smaller today than on . there is probably mild right basal atelectasis . lungs are otherwise clear . no left pleural effusion . mediastinum is midline and contours are normal . stomach is moderately distended with air . no pneumothorax . Atelectasis&&Pleural Effusion 11287042 53208211 d3e2e4d5-85f72646-4f703a66-df6941af-3344c515 78 heart size and mediastinum are stable . lungs are clear . elevated right hemidiaphragm is re- demonstrated as well as calcified mitral anulus . there is no definitive pleural effusion seen and there is no pneumothorax . prior mediastinal lesions to the as seen on the previous chest ct are not clearly seen on the current examinatio . Cardiomegaly&&Enlarged Cardiomediastinum 11287042 56219888 579d3a5f-1e6911b4-307a3da3-6a8c84c8-27cfb985 79 pa and lateral views of the chest provided . there is new retrocardiac opacity consistent with left lower lobe pneumonia . mild elevation of the right hemidiaphragm is again noted with stable blunting of the right cp angle suggesting small right pleural effusion versus pleural thickening . no pneumothorax . no edema . cardiomediastinal silhouette is stable . no acute osseous abnormalities . left lower lobe pneumonia . Pneumonia 11287042 56969632 a19d711b-6c29af26-11883860-c9e6a00a-dd8b349c 80 small right pleural effusion is overall stable . there is new bandlike opacity in the right mid lung, concerning for atelectasis or developing infectious process . alternatively it might represent the fluid in the fissure major . lungs are essentially clear otherwise . no pleural effusion demonstrated on the left . Atelectasis&&Lung Opacity&&Pleural Effusion&&Pneumonia 11287042 58000103 ebff6ece-1b6243e8-1f3cd0af-af4824b5-3f629000 81 there is new left lower lobe opacity compatible with infection . elsewhere, lungs are clear . lobulated contour abutting the aortic arch and projecting over the ap window on the frontal view is compatible with thoracic aortic aneurysm with prior dissection . no acute osseous abnormalities . left lower lobe consolidation compatible with pneumonia . repeat after treatment suggested to document resolution . stable appearance of the mediastinum with abnormal aortic contour as seen on multiple priors . Consolidation&&Enlarged Cardiomediastinum&&Pneumonia 11307058 51697632 3f5dec1b-45644e70-ed34cbb0-1a80da55-77581541 82 in comparison with the study of , there is again a hyperexpansion of the lungs consistent with chronic pulmonary disease . cardiac silhouette is within normal limits and there is no vascular congestion, pleural effusion, or acute focal pneumonia . there is substantial prominence of the descending aorta, better characterized on the ct of the chest from . 11307058 53295563 ab25e52b-e8eebab5-500ce27e-c39b6376-71e6f3f1 83 patient is status post median sternotomy . the appearance of the cardiac and mediastinal silhouettes is stable patient has reported history of known thoracic aortic dissection and descending aortic dilatation . there is a likely hiatal hernia . no focal consolidation is seen . no large pleural effusion or pneumothorax . no overt pulmonary edema . no acute cardiopulmonary process . stable appearance of the mediastinum . Enlarged Cardiomediastinum 11307058 54070533 1b56958d-2db30a47-c149a47c-5161435f-f70948bd 84 in comparison with the study of , there is little change . the aneurysm and dilatation of the descending aorta is unchanged . no evidence of vascular congestion or acute focal pneumonia . No Finding 11307058 56032638 a0c5a980-ee72873e-6b8ab2e4-ccf5e1b7-56693b1b 85 compared to prior, there is opacity a partially obscuring the left heart border, concerning for pneumonia or atelectasis . the right lung is clear . no pleural abnormality is seen . mediastinal contour is consistent with patients known thoracic aortic dissection and descending aortic dilatation, unchanged from prior . possible lingular pneumonia vs . atelectasis . notification the findings were discussed by dr . with dr . on the at pm, minutes after discovery of the findings . Atelectasis&&Pneumonia 11307058 58044051 03270807-5e38a815-9e4f8720-08103828-f27bb4e4 86 the cardiac and mediastinal silhouette appear similar compared to the study from days ago . there small bilateral pleural effusions which have slightly increased in the interval . this is particularly apparent on the lateral films . otherwise no significant change . there is no focal infiltrate . small bilateral effusions, increased compared to prior . Pleural Effusion 11307058 58651071 2c1b8528-f39e96b9-54bb89a8-d99d2ec5-472472ce 87 lungs are fully expanded and clear . heart size top-normal . normal pulmonary vasculature . normal mediastinal and hilar contours and pleural surfaces . Cardiomegaly 11465247 54659794 01ef5d76-76b24ff8-e3bd287c-b62fa42a-fa7fe5ee 88 previous pneumonia in lingula has resolved . lungs are now clear . heart size is normal . there is no pleural abnormality or evidence of central lymph node enlargement . thoracic aorta is tortuous but not clearly aneurysmal . No Finding 11465247 54829511 5cd7a101-9ff0c026-fd16c237-8cdcd48d-3c4c342b 89 pa and lateral views of the chest provided . there is a vague consolidation in the lateral aspect of the left lung which localizes anteriorly which is concerning for pneumonia . no large effusion . right lung is clear . cardiomediastinal silhouette is stable . findings concerning for pneumonia within the left upper lobelingula . Pneumonia 11465247 56946073 e19abbe6-df472023-83481ac8-0a310178-3cdd22d2 90 frontal and lateral views of the chest demonstrate normal cardiomediastinal silhouette . there is no pneumothorax or pleural effusion . there is no consolidation . no acute cardiopulmonary process, including no evidence of pneumothorax . No Finding 11469724 50248902 0e252b44-7eeee514-f7db5565-5c69c644-9808eb6c 91 no focal consolidation is present . the cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal . there is no pleural effusion or pneumothorax . no acute intrathoracic process . No Finding 11483127 51499238 3b825e5c-972cf73b-c9e78f42-2ffb6f80-40fb7b5e 92 chest, pa and lateral . the lungs are clear . the hilar and cardiomediastinal contours are normal . there is no pneumothorax or pleural effusion . pulmonary vascularity is normal . no acute cardiopulmonary process . No Finding 11485848 55217119 e739c1f7-c8cb4da6-35a5b19c-c3c44f5c-bde78d3d 93 left-sided pacemaker device is noted with single lead terminating in the right ventricle, unchanged . the heart remains moderately enlarged . dense atherosclerotic calcifications are present at the aortic knob . mediastinal and hilar contours are unchanged . rounded opacity within the right upper lobe appears slightly increased in size compared to the previous exam, which again remains concerning for adenocarcinoma and now measures up to . cm . minimal patchy opacities are noted within the lung bases . no pleural effusion or pneumothorax is identified . multiple are demonstrated within the right upper quadrant of the abdomen . patchy bibasilar airspace opacities appear relatively unchanged, and may reflect atelectasis andor chronic changes . slight interval increase in size of right upper lobe rounded opacity which remains concerning for adenocarcinoma . Atelectasis&&Lung Lesion&&Lung Opacity 11520249 57610653 e7dd53db-aad223bb-65d21903-85c5d0b4-02e26850 94 heart size is normal . cardiomediastinal silhouette and hilar contours are normal . lungs are clear . pleural surfaces are clear without effusion or pneumothorax . normal chest radiograph . No Finding 11524266 59584536 2bd4b6f8-658cb9f5-939803a8-685c7ce3-356accb5 95 as compared to the prior examination dated , there has been no significant interval change . low lung volumes resultant crowding of the bronchovascular structures . there is no lobar consolidation, pleural effusion, or pneumothorax . the heart size is within normal limits . a large hiatal hernia is again seen . multiple known osseous metastases are poorly visualized on todays examination . stable appearance of the chest with low lung volumes and a large hiatal hernia . no evidence for superimposed acute cardiopulmonary process . 11529986 50677500 18f9a05f-f2cd30f5-bb92443e-a96e29a2-2d10374b 96 in comparison with the study of , there are even lower lung volumes . again there is a large hiatal hernia but no evidence of acute pneumonia or vascular congestion . sclerotic metastases again are seen from carcinoma the prostate . Lung Lesion 11529986 55864646 4e988876-de35584e-49fde4ca-bfa3f240-b99a8e3a 97 in comparison with the study of , there has been some decrease in the still substantial left pleural effusion . there is a small pleural effusion on the right extending into the minor fissure . the pulmonary vascular congestion has essentially cleared . bibasilar atelectatic changes are present . port-a-cath again extends to the cavoatrial junction or right atrium . the possibility of supervening pneumonia would be difficult to exclude in the appropriate clinical setting . Atelectasis&&Pleural Effusion&&Pneumonia 11614040 50995901 51bf1504-fd68a1ec-7f7ca477-9736040f-4167a6f0 98 as compared to prior chest radiograph from , there has been interval increase of moderate left pleural effusion and increased atelectasis at the left lower lung . there is a small right pleural effusion . minimal amount of apical left pneumothorax persists . a right port-a-cath catheter tip terminates at the cavoatrial junction . . minimal left apical pneumothorax . . interval increase of moderate left pleural effusion . these findings were discussed with by dr . via telephone on at pm, at time of discovery . Pleural Effusion&&Pneumothorax 11614040 54498314 cb4af14c-7c3258e3-157f685e-c1cc0471-fe3eb0ec 99 as compared to the previous radiograph, the patient has newly developed, moderate pulmonary edema . the changes manifest as increase in interstitial markings, a symmetrically increase in lung density and an increase in diameter of the pulmonary vessels and the heart . no pleural effusions . unchanged right pectoral port-a-cath . at the time of dictation and observation, am, on , the referring physician, . was paged for notification . Cardiomegaly&&Edema&&Lung Opacity 11614040 57726913 f7afb1fb-980babb9-17a967f1-4ab852ff-c8ecd2fa 100 ap and lateral chest radiographs demonstrate stable positioning of the right port-a-cath . there is no pulmonary vascular congestion, pleural effusion, or pneumothorax . left apical nodule is unchanged and has been further characterized on prior ct-torso . the cardiomediastinal silhouette is normal . no pneumonia . No Finding 11614040 58129550 bd9e45d8-e8d6d3fa-e8a8e094-a2a77b14-2b43fddb 101 previous pulmonary edema has nearly cleared . small right pleural effusion and moderate left pleural effusion, both stable . cardiac silhouette is obscured and its size cannot be assessed . right subclavian infusion port ends in the right atrium . Cardiomegaly&&Pleural Effusion 11614040 58602712 172f444a-38c985ed-c8457287-b660b135-cde87b37 102 heart size and mediastinum are stable in appearance . the lungs are essentially clear . no appreciable pleural effusion or pneumothorax is seen . overall, there is no definitive abnormality to explain patients symptoms demonstrated . Cardiomegaly&&Enlarged Cardiomediastinum 11641663 57340789 2240c7cc-db173077-a43c8610-b4ef4144-61d529f1 103 no previous images . mild streaks of atelectasis at the left base, but otherwise, there is no evidence of acute pneumonia, vascular congestion, or pleural effusion . there are low lung volumes and some tortuosity of the aorta . Atelectasis 11641663 57605743 36e2ba54-b3a43f54-fe19cfdd-d444c635-f67a3229 104 subtle left base streaky opacity most likely represents atelectasis, although in the appropriate clinical setting, an underlying consolidation is not excluded . the right lung is clear . no pleural effusion or pneumothorax is seen . the cardiac and mediastinal silhouettes are stable . mild degenerative changes are seen along the spine . no displaced fracture is seen . subtle left base streaky opacity most likely represents atelectasis, although in the appropriate clinical setting, an underlying consolidation is not excluded . Atelectasis&&Consolidation&&Lung Opacity 11668016 53288720 c28d6f89-4ca74a2d-2dac60f1-572eb1e1-651e43a4 105 the cardiomediastinal and hilar contours are within normal limits . the lungs are clear without focal consolidation, pleural effusion or pneumothorax . old healed left lateral rib fractures are noted . no acute cardiopulmonary process . No Finding 11669319 50335438 c681e756-278b3b38-0472808c-ce2344ce-743125ee 106 pa and lateral chest views have been obtained with patient in upright position . there is moderate cardiac enlargement and the thoracic aorta is generally widened and elongated . calcium deposits are seen in the wall, mostly at the level of the arch . the pulmonary vasculature demonstrates an upper zone redistribution pattern, but there is no sign of an advanced interstitial or alveolar edema . no evidence of acute infiltrates and the lateral pleural sinuses are free . in the apical area, thickened pleural structures are noted bilaterally and combined with old scar formations and irregular densities in the peripheral portions of the parenchyma in this territory . when comparison is made with the next previous examination of , these changes have not undergone any difference in appearance anf represent old inactive specific scars . comparison demonstrates on the other hand that the cardiac size has increased mildly and so has the upper zone redistribution pattern . acute infiltrates are not present . old stable, probably specific bilateral apical scar formations, moderate cardiac enlargement with mild degree of chronic chf but no evidence of acute pulmonary infiltrates or pleural effusions . Cardiomegaly&&Edema&&Lung Opacity 11686207 54673619 f33f365d-10d1ff5e-228007f3-863aa1cb-63c0c506 107 biapical scarring is again seen . the lungs are otherwise clear . cardiomediastinal silhouette is stable . no acute osseous abnormalities . no acute cardiopulmonary process . No Finding 11686207 58712687 c8d7cf11-95b640cd-48eceb73-02f4b390-b9d3f500 108 as compared to the previous radiograph, the cardiac assist device is in unchanged position . the lung volumes have substantially expanded and the pre-existing left pleural effusion is almost completely resolved . if new nineth in the colon i picc line on the left has been removed . the patient has received a left pectoral pacemaker with a single lead . the lead projects over the right ventricle . there is no evidence of pneumothorax . Pleural Effusion&&Support Devices 11717909 51326810 5fd8a518-4f42a2e8-6c946190-1901fd9e-b7fbcd08 109 heart size and mediastinum are stable . lungs are well aerated . there is interval resolution of right pleural effusion, almost complete . the right middle lobe atelectasis is minimal . effusion along the distal portion of the fissure my still being a present . no focal consolidation to suggest infectious process demonstrated . Atelectasis&&Cardiomegaly&&Enlarged Cardiomediastinum&&Pleural Effusion 11717909 51345024 74ada62d-569c8df3-d20cc6c4-27858ab1-6bf22d69 110 cardiomediastinal contours are stable . patient is status post heart transplant . the lungs are clear . there is no pneumothorax or pleural effusion . sternal wires are aligned . multiple clips in the mediastinum are noted . no acute cardiopulmonary abnormalities . No Finding 11717909 51409536 ea47c557-92fcaf75-13b7ed5c-c784b2b8-3d83111c 111 since the prior examination of , the lung volumes have improved . heart is mildly enlarged . heterogeneous linear opacities at the right base superimposed on the right hemidiaphragm probably represent residual atelectasis . there is no focal consolidation or pleural effusion . no pneumothorax . no evidence of pneumonia . No Finding 11717909 51595982 d7a84073-0d23e88e-5dbd44fd-4d8bee1f-5f53df8b 112 comparison to . the pre-existing right-sided parenchymal opacities have increased in extent and severity and are suggesting pneumonia . there is also is a new parenchymal opacity in the perihilar left lung areas . moderate cardiomegaly persists . status post cabg . no larger pleural effusions . Cardiomegaly&&Lung Opacity&&Pneumonia 11717909 52879897 df0b3ae5-a86fd93b-1d84dc76-01d14fb3-4837ad71 113 there is no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema . the cardiomediastinal silhouette is within normal limits . mild atelectasis is noted at the lung bases bilaterally . sternotomy wires and mediastinal clips are unchanged from prior studies . no acute cardiopulmonary process . No Finding 11717909 55248428 bbed68cb-2b0d6862-be4b2ad1-33830392-d1192f4b 114 the lungs are mildly hypoinflated with crowding of vasculature . there is a new heterogeneous right lower and right middle lobe opacities . no pleural effusion or pneumothorax . heart size, mediastinal contour, and hila are unremarkable . again seen are intact median sternotomy wires and mediastinal clips . right middle and right lower lobe pneumonia . Pneumonia 11717909 56671598 be35822b-d15d7251-57872f94-f8e5d649-b71aba02 115 heart size is normal . the patient is status post previous median sternotomy and coronary bypass surgery . right internal jugular catheter terminates in the lower superior vena cava, with no pneumothorax . the mediastinal and hilar contours are normal . the pulmonary vasculature is normal . lungs are clear except for linear scar in the lingula . no pleural effusion or pneumothorax is seen . there are no acute osseous abnormalities . no acute cardiopulmonary abnormality . No Finding 11717909 59535781 1645a8b3-a40b82da-8ea72c55-64a8dfe5-ce6efba4 116 no relevant change as compared to the prior image . sternal wires, pacemaker and a cyst device are in unchanged position . minimal left pleural effusion and left atelectasis . otherwise normal lungs . mild cardiomegaly that is unchanged in severity . Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices 11717909 59872440 427b4ab7-9ff413ad-27cb0c6a-12e7de89-7ab26654 117 frontal and lateral views of the chest . no prior . opacity at the left cardiophrenic angle would be compatible with a pericardial fat pad, especially given appearance on the lateral . lungs are clear and costophrenic angles are sharp . the cardiomediastinal silhouette is within normal limits . osseous and soft tissue structures are unremarkable . degenerative changes noted at the acromioclavicular joints and hypertrophic changes are seen in the spine . no acute cardiopulmonary process . no focal consolidation . No Finding 11724488 55960369 8a2d0c99-d9c16df8-af4a6670-03baa169-48086bb0 118 frontal and lateral views of the chest were obtained . lungs are clear without focal consolidation . no pleural effusion or pneumothorax is seen . cardiac and mediastinal silhouettes are unremarkable . no evidence of free air is seen beneath the diaphragm . degenerative changes are again seen along the spine . no acute cardiopulmonary process . no evidence of free air beneath the diaphragm . No Finding 11724488 57834148 9be6d2e9-c327b161-d0f2085f-bb403a9c-dfcb4b59 119 the lungs are clear . the cardiomediastinal silhouette is within normal limits . no acute osseous abnormalities . no acute cardiopulmonary process . No Finding 11778596 50523025 c3fd73cb-5e46b400-0cc3a1d2-8cd95b40-d8ce12df 120 no focal consolidation, pleural effusion, or evidence of pneumothorax is seen . the cardiac and mediastinal silhouettes are stable and unremarkable . no evidence of pneumomediastinum is seen . no significant interval change . no acute cardiopulmonary process . No Finding 11778596 51411261 b1013c9a-72cbbabf-f3f57999-0e872542-c493daa7 121 comparisons . the lung volumes are normal . normal size of the cardiac silhouette . normal hilar and mediastinal contours . no pneumonia, no pulmonary edema, no pleural effusions . No Finding 11778596 51454316 c8d5e710-a91b72a0-7854336c-d9636d1e-f30a45fe 122 pa and lateral views of the chest provided demonstrate no focal consolidation, effusion, or pneumothorax . the cardiomediastinal silhouette is normal . bony structures are intact . no free air below the right hemidiaphragm seen . no acute intrathoracic process . No Finding 11778596 51493045 9b3209a1-4f4f10b6-89d60e43-ae5ca330-58720ec8 123 pa and lateral chest radiographs the lungs are clear . there is no pleural effusion or pneumothorax . the cardiomediastinal silhouette is normal . No Finding 11778596 52620709 87c987cb-bf4d5e2a-f57b9ffb-a5d3f1b3-2a752ed8 124 the lungs are well expanded . there is no focal consolidation, pleural effusion or pneumothorax . the cardiomediastinal silhouette is normal . the bones are intact . no acute cardiopulmonary process . No Finding 11778596 55316910 4e2cdbbb-94042b25-3040684e-0c7ff67d-5616031e 125 as compared to the previous radiograph, there is no relevant change . normal lung volumes . no evidence of pneumonia or other parenchymal lung disease . normal size of the cardiac silhouette . normal hilar and mediastinal structures . No Finding 11778596 56643765 0557e604-9479496b-6839fa34-3dfa8788-846e8429 126 in comparison with the study of , there is no change or evidence of acute cardiopulmonary disease . no pneumonia, vascular congestion, or pleural effusion . No Finding 11778596 57138064 013e8b20-1dd181f6-4abba114-5ab4f096-e8a4d186 127 in comparison with the study of , there is little change and no evidence of acute cardiopulmonary disease . no pneumonia, vascular congestion, or pleural effusion . No Finding 11778596 58510004 9f68f784-5188d495-c5803627-37126944-42f904c6 128 in comparison with the study of , there is little change in the appearance of the cardiomediastinal silhouette and spinal hardware . the pulmonary vessels are less engorged, it consistent with improvement in pulmonary vascular status . bibasilar atelectatic changes are again seen with probable small pleural effusions on both sides . Atelectasis&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices 11842519 51164335 36997d16-4f0421af-656978c4-33b5be2d-4bd00de0 129 the heart is enlarged and there is engorgement of the pulmonary vasculature as well as mild pulmonary edema . there is thickening of major fissure on the right, which may represent fissural fluid . again seen are bilateral pleural effusions with atelectasis at the lung bases . there is no evidence of new focal consolidation . no pneumothorax is seen . again seen is thoracic spinal fusion hardware, unchanged in appearance . . mild pulmonary edema with no strong evidence of pneumonia . . bilateral pleural effusions and bibasilar atelectasis . Atelectasis&&Pleural Effusion 11842519 52278905 e044c941-2f2d494f-0a794f54-a64e76fe-70da04b2 130 the bilateral pleural effusions are again seen right greater than left . right lower lobe opacities are unchanged and may be chronic atelectasis related to persistent effusions . the previously seen pulmonary edema has resolved . there is mild cardiomegaly . orthopedic hardware is seen in the thoracic spine with adjacent surgical clips . . persistent bilateral effusions and likely chronic atelectasis . . resolution of previous pulmonary edema . Atelectasis&&Pleural Effusion 11842519 52435125 87c8d17c-efddd19d-6d6bdf4a-33ac06da-52d1f2ae 131 in comparison with the study of , there is little overall change . cardiac silhouette remains within normal limits and there is some hyperexpansion of the lungs . coarse interstitial markings process along with blunting of both costophrenic angles and atelectatic changes at the bases, more prominent on the right . Atelectasis&&Lung Opacity 11842519 52474377 b4b54fa6-a62cd7a9-4ba6082c-5534bec0-fab033bf 132 comparison is made with prior study, . large right and small-to-moderate left effusions have minimally increased on the right with increasing adjacent atelectasis . mild cardiomegaly is stable . hardware in the thoracic spine is again noted . Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices 11842519 52867251 50fbe1fa-ace6be47-082c1ac4-6be43489-25ee1f1a 133 stable cardiomegaly . there is worsening pulmonary vascular congestion and mild pulmonary edema . pleural effusions are stable . no pneumothorax is seen . right hilar fullness is a manifestation of mild heart failure . again seen is chronic posterior pleural thickening and nodulation at the right base . again seen is thoracic fusion hardware, unchanged . . worsening pulmonary vascular congestion and edema . mild chronic cardiomegaly . . chronic small pleural effusions, posterior pleural loculation . . recommend baseline chest ct to further evaluate chronic pleural thickening and nodulation at the right base . recommendation recommend baseline chest ct to further evaluate chronic pleural thickening and nodulation at the right base . Cardiomegaly&&Edema&&Pleural Effusion&&Pleural Other 11842519 54717070 463855e7-833cbc69-04a5abcb-dda8a693-e6e4e948 134 pulmonary vascular cephalization is chronic . moderate loculated right pleural effusion going into the fissure is stable . mm opacity projects at the left lung base unchanged since , but could not be clearly seen before that . mild-to-moderate cardiomegaly is unchanged . the patient is status post fusion with posterior screws at t through t levels . conclusion left lower lung opacity could either be a focal area of atelectasis or even a lung nodule . it could not be seen before the chest x-ray of . if warranted, ct scan could be done to assess this abnormality . there is no significant change since in chronic pulmonary vessel cephalization and loculated pleural effusion on the right . the results have been posted to radiology dashboard for direct notification to referring physician . Atelectasis&&Lung Lesion&&Lung Opacity&&Pleural Effusion 11842519 54806621 0fe43549-21617d5c-89c5f44b-affffc13-9409fa39 135 cardiomediastinal silhouette is unchanged . spinal hardware is unchanged . bibasal consolidations appear to be mildly progressed since the prior study as well as there is slightly more pronounced vascular congestion . right pleural effusion is small but increased since the prior study . Consolidation&&Edema&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices 11842519 55737976 5c411331-4bd0ce00-fa971a77-14b441a9-7988a9a4 136 pa and lateral chest views were obtained with patient in upright position . analysis is performed in direct comparison with the next preceding pa and lateral chest examination of . moderate cardiomegaly as before . upper mediastinal structures are obscured by the presence of two rods each with penetrating fixation screws stabilizing the mid portion of the thoracic spine . integrity of orthopedic devices appears preserved and is unchanged . similar as on the previous examination, there is evidence of bilateral pleural effusion blunting the lateral pleural sinuses . the pleural effusion is moderately more marked on the right side than the left . lateral view indicates extension of fluid into the posteriorly located dependent pleural sinuses . no evidence of new acute discrete pulmonary infiltrates indicating acute pneumonia . no pneumothorax seen in the apical area . bilateral small pleural effusions and moderate congestive pulmonary vascular pattern . in comparison with the next previous examination months ago, the patients pulmonary congestion and pleural effusions were markedly more pronounced than they are now . whether the present degree of chronic chf is related to fluid overload must be judged on clinical grounds . Cardiomegaly&&Edema&&Pleural Effusion 11842519 55933985 c8e45d42-826148f0-ecddc635-78da1bb8-218f17be 137 frontal and lateral views of the chest demonstrate normal lung volumes . no pleural effusion, focal consolidation or pneumothorax . there is no pneumomediastinum . hilar and mediastinal silhouettes are unremarkable . heart size is normal . mild pulmonary vascular congestion is seen on exam has resolved . insterstiail markings appear prominent which may reflect underlying small airways disease or interstitial disease . clinical correlation is advised . partially imaged upper abdomen is unremarkable . mild pulmonary vascular congestion seen on exam has resolved . No Finding 11888614 50536002 3f69336f-36ceec41-467c3490-22a37536-b48f30e3 138 there has been little interval change from the prior exam . the heart size is normal . the mediastinal and hilar contours are within normal limits . the pulmonary vascularity is normal without evidence of pulmonary edema . again noted are bilateral ill-defined hazy airspace opacities predominantly within a perihilar distribution, not significantly changed in extent compared to the recent chest radiograph and chest ct . no pleural effusion or pneumothorax is present . there are no acute osseous abnormalities . no significant interval change in bilateral predominantly perihilar ill-defined airspace opacities which may reflect a multifocal infectious process, but is nonspecific . Lung Opacity&&Pneumonia 11888614 50561566 f877eb30-e2155ec8-a0bdcfb3-494d60b8-a0e7c7b7 139 the lungs are well inflated and clear . no focal consolidations identified . the cardiomediastinal silhouette hilar contours are stable . there is no pleural effusion or pneumothorax . no evidence of acute cardiopulmonary process . No Finding 11888614 51017937 da356d52-522f4027-87bf71f9-a9ee4996-ea735f4e 140 the cardiomediastinal and hilar contours are normal . there is no pleural effusion pneumothorax . the lungs are expanded and clear without focal consolidation concerning for pneumonia . pulmonary vascularity is within normal limits . the upper abdomen is unremarkable . no acute osseous abnormalities are detected . no acute cardiopulmonary process . No Finding 11888614 51240157 25b1f581-32a8bccf-ddc5c8cd-f34d16a5-befd4bdc 141 there is no evidence of focal consolidation, pleural effusion, pneumothorax, or frank pulmonary edema . a rounded, nodular opacity overlies the right lower lung, and cannot be discreetly separated from the ninth posterior rib . the cardiomediastinal silhouette is within normal limits . . no evidence of acute cardiopulmonary process . . nodular opacity overlying the right lower lung and anterior right fifth rib . to determine whether this is a lung nodule or the right nipple or sclerosis in the anterior right fifth rib, shallow oblique views with nipple marker should be obtained . notification dr . reported the findings to qa nurses by receipted email on at am, minutes after discovery of the findings . Lung Lesion&&Lung Opacity&&Support Devices 11888614 52249249 cfa6f879-767cb5fe-cfb7acdf-144814b9-7e4fb170 142 frontal and lateral chest radiographs the heart size is normal . the hilar and mediastinal contours are within normal limits . there is no pneumothorax, focal consolidation, or pleural effusion . mild reticular denisities are again seen throughout both lungs, less prominent, suggestive of improved chronic interstitial disease . no bony abnormalities are seen . No Finding 11888614 52480192 9cbd3475-8f9f2464-1fbb6aca-f66b1b1e-6f5a46d8 143 the cardiac, mediastinal and hilar contours are within normal limits, and the heart size is normal . focal ill-defined opacities are demonstrated predominantly within the perihilar regions of both upper lobes, as was noted on the prior ct, but new when compared to the prior chest radiograph . no pleural effusion or pneumothorax is present, and there is no pulmonary vascular congestion . there are no acute osseous abnormalities . multifocal opacities in both lungs, predominantly within a perihilar distribution, as demonstrated on the prior chest ct . findings again are nonspecific, but concerning for a multifocal infectious process . Lung Opacity&&Pneumonia 11888614 53383243 f64e7f86-3a69ce7c-1bca8f45-3fb972a4-a7f54583 144 the heart is normal in size . the main pulmonary artery contour is slightly prominent, but stable . central pulmonary arteries are also mildly enlarged . the pulmonary interstitium has a mildly coarsened appearance bilaterally, but without significant change . there is no pleural effusion or pneumothorax . mild rightward convex curvatures centered along the mid thoracic spine appear similar . similar central pulmonary artery enlargement, for which the possibility of pulmonary hypertension should be considered in the appropriate clinical setting . 11888614 53774641 eaf346b2-804fccf1-7b8edede-5553e418-701f2e75 145 pa and lateral chest radiograph mediastinal and hilar contours are normal . both lungs are clear with no focal consolidation, pleural effusion, or pneumothorax . No Finding 11888614 56650370 06d06454-e679a2d4-05fcb986-27323b1b-a82e89c8 146 pa and lateral views of the chest are obtained . there is significant interval improvement in lung aeration . vague reticular opacities persist in the perihilar regions, possibly representing residual pneumonia . no definite signs of chf, pleural effusion, or pneumothorax . heart and mediastinal contours appear normal . interval removal of the endotracheal and nasogastric tubes . bony structures are intact . significant improvement in pulmonary aeration with persistent reticular perihilar markings, possibly representing residua of recent pulmonary infection . Pneumonia 11888614 57547663 8792030f-fa92ef26-20cc8462-d46e5176-1dd9ee64 147 the lungs are symmetrically well expanded and well aerated without focal consolidation concerning for pneumonia, pleural effusion or pneumothorax . there is no overt pulmonary edema . the cardiomediastinal and hilar contours are within normal limits . the trachea is midline . no acute osseous abnormality is detected . no acute cardiopulmonary process . No Finding 11888614 57933100 b2866e53-ffc2e916-fe99a48b-4d3622b6-df9fb5e7 148 frontal and lateral views of the chest were obtained . prominence of interstitial markings is similar to prior radiograph particularly that on . the cardiac, mediastinal, hilar contours are stable . no focal consolidation, pleural effusion, or evidence of pneumothorax is seen . no significant interval change . No Finding 11888614 58264635 971b4bd8-09f04bc5-e43b86b5-dde445a3-5cbfca46 149 pa and lateral chest radiographs the cardiomediastinal and hilar contours are within normal limits . the lungs are well expanded and clear, without focal consolidation, pleural effusion or pneumothorax . No Finding 11888614 58444156 1e9ce595-bdd1e282-474eb65a-4f0acade-2ed14cac 150 heart size is normal . the aorta is mildly tortuous, as seen previously . mediastinal and hilar contours are unchanged . pulmonary vasculature is not engorged . lungs are clear . small bilateral pleural effusions are new in the interval . no focal consolidation is present . there is no pneumothorax . no acute osseous abnormality is visualized . new small bilateral pleural effusions . no radiographic evidence for pneumonia . Pleural Effusion 11890444 52548540 6f942e01-0ff2a009-37a3ba1a-9ac8cfa7-43910a68 151 heart size is normal . the aorta is unfolded . the mediastinal and hilar contours are unchanged . pulmonary vasculature is not engorged . lungs are clear without focal consolidation . no pleural effusion or pneumothorax is visualized . no acute osseous abnormalities detected . no acute cardiopulmonary abnormality . No Finding 11890444 53685497 edf1e5ad-e7249deb-2d881608-aa2878c8-e22288bd 152 the heart is normal in size . the mediastinal and hilar contours appear unchanged . there is no pleural effusion or pneumothorax . the lungs appear clear . bony structures are unremarkable . there has been no significant change . no evidence of acute disease . No Finding 11917288 56893815 d4b90254-71776112-73f647e1-bf4f2291-54ff2751 153 pa and lateral views of the chest provided demonstrate no focal consolidation, effusion, or pneumothorax . the cardiomediastinal silhouette is normal . bony structures are intact . no free air below the right hemidiaphragm . no acute findings in the chest . No Finding 11925631 50794292 25651b13-d572c28c-5e501292-b096b253-6d6fb63a 154 improved aeration of the left lower lobe since with residual bibasilar opacities likely atelectasis . no pleural effusion or pneumothorax . normal cardiomediastinal silhouette . improving left lower lobe aeration with residual bibasilar atelectasis . dr . paged at on by dr . request . Atelectasis 11925631 51003988 4b17550c-25e0500e-c7f5e522-75da40cb-c6e5c492 155 cardiomediastinal contours are normal . the lungs are clear . there is no pneumothorax or pleural effusion . No Finding 11925631 51368660 b6d962de-3c13f291-b994fcea-8f43cab1-4d7bd9e9 156 pa and lateral views of the chest were obtained . there is an area of linear opacity representing plate-like atelectasis of the left lower lung . there is no focal consolidation, pleural effusion, or significant pulmonary edema . the cardiomediastinal silhouette is unremarkable . conclusion no acute cardiopulmonary disease . No Finding 11925631 52715722 00d187bc-46b2dcc4-dcc3029d-57dedba3-c026f807 157 compared with the most recent prior radiograph, there are new bibasilar opacities which could represent atelectasis, aspiration or consolidation . there are low lung volumes, which accentuates the cardiomediastinal silhouette . there is blunting of the left costophrenic angle which may be related to small pleural effusion . no pneumothorax is present . a dense round opacity in the left upper abdomen could be barium if the patient had a previous barium swallow however, none is documented our system . a drain is seen in the left upper abdomen . new bibasilar opacities could be atelectasis, aspiration or pneumonia . findings discussed with dr . by dr . at am . on , minutes after discovery . Atelectasis&&Lung Opacity&&Pneumonia 11925631 53086987 01b2e505-9d2a75bc-da0a86a7-cb2a2c42-9582f62b 158 there has been little change since except for decrease in previous small right pleural effusion . substantial atelectasis persists at the base of the right lung and the left lower lobe is still completely consolidated or collapsed . upper lungs are grossly clear . the extent of gaseous distention of the intestinal tract as seen in the upper abdomen has improved . Atelectasis&&Cardiomegaly&&Consolidation&&Pleural Effusion 11925631 54487320 9dbd6a42-6f6b8a99-892e0d7d-b0765810-57292428 159 pa and lateral views of the chest . the lungs remain clear . the cardiomediastinal silhouette is normal . osseous structures are unremarkable . surgical clips seen in the upper abdomen . no acute cardiopulmonary process . No Finding 11925631 56096550 5153eb4a-9454babf-5d463789-3f9111a6-547adedb 160 the lungs are clear without focal consolidation . no pleural effusion or pneumothorax is seen . the cardiac and mediastinal silhouettes are unremarkable . no evidence of free air is seen beneath the diaphragms . right upper quadrant surgical clips are noted . no acute cardiopulmonary process . No Finding 11925631 56871970 3e807ef1-89671fba-a42567b3-a1ceb0db-0c056a50 161 frontal and lateral views of the chest were obtained . there are relatively low lung volumes . there is mild left base atelectasis . there is slight increase in the interstitial markings bilaterally, which may relate to low lung volumes and minimal interstitial edema however, an atypical infectious process cannot be excluded . no pleural effusion or pneumothorax is seen . cardiac and mediastinal silhouettes are stable and unremarkable . Atelectasis&&Edema&&Lung Opacity&&Pneumonia 11925631 58651437 f075ce73-c9417eb6-96794bef-5c430ca4-d3026797 162 in comparison with the study of the right heart border is not as sharply seen . however, there is no evidence of a opacification overlying the cardiac silhouette on the lateral view, and therefore no evidence of acute focal pneumonia . no cardiomegaly or vascular congestion or pleural effusion . Cardiomegaly&&Pleural Effusion 11925631 59403702 44f46b9b-c9fa5d0e-60b6b805-910142d9-93721971 163 frontal and lateral views of the chest were obtained . the patient is status post left upper lobectomy with significant volume loss again seen on the left with suggestion of interval increase in volume loss as compared to the prior study . no definite pleural effusion is seen . in the visualized left lower lung field, there is a patchy opacity likely present on the prior study and most likely relates to underlying volume loss, although a superimposed infection is not entirely excluded . the right lung is clear . there is no pleural effusion or pneumothorax . cardiac and mediastinal silhouettes are grossly stable . surgical clips in the upper quadrant are from presumed prior cholecystectomy . status post left upper lobectomy with left-sided volume loss which is increased as compared to the prior study . 11932181 52153858 d593896e-25d268b0-0a8ededc-4a4c401c-c72b8357 164 frontal and lateral chest radiographs demonstrate a left chest tube, unchanged in position . there is persistent right upper lobe atelectasis with collapse of the right upper lobe and rightward tracheal deviation . the lungs are clear without focal consolidation or pulmonary edema . there is no pneumothorax . the cardiomediastinal silhouette is unchanged . persistent right upper lobe collapse . Atelectasis 11932181 52901971 274d8805-bc393e4a-269a1f8a-ee42d1ae-e8959ff7 165 pa and lateral radiographs were acquired of the chest . the lungs are clear . the cardiac and mediastinal contours are normal . there are no pleural effusions . no pneumothorax is seen . bilateral degenerative changes of the acromioclavicular joints are noted . no acute cardiac or pulmonary process . No Finding 11932181 53058995 a6bfecfe-281e20c1-3d9a3002-ebed7792-aa0c7f47 166 frontal and lateral views of the chest . there is volume loss in the left hemithorax with elevation of left hemidiaphragm and of the left hilum . findings are compatible with left upper lobectomy . the lungs are clear . the cardiomediastinal silhouette is within normal limits . deformity of the posterior left sixth rib is again seen . postoperative changes of left upper lobectomy . no superimposed acute cardiopulmonary process . No Finding 11932181 53371051 6e7d1634-c7ec6214-ab2d08c7-5f964d50-7fcebc90 167 the cardiomediastinal silhouettes are stable and within normal limits . the hila are within normal limits . there is volume loss of the left upper lung . the lungs are clear without focal consolidation . there is no pulmonary vascular congestion . there is no pneumothorax or pleural effusion . deformity of the left posterior sixth rib is again noted . no acute cardiopulmonary process . No Finding 11932181 53880874 57eb3bc1-e545c54d-119c0054-14d0f8cd-7d46d994 168 there is still considerable volume loss in the postoperative left hemithorax, with no pneumothorax or appreciable pleural effusion . right lung is clear . heart is normal size . extent of left suprahilar atelectasis and elevation of the left hemidiaphragm unchanged . Atelectasis 11932181 54197091 533e10b2-a8dcfde7-b7e21125-3adb9a2b-ddfde194 169 frontal and lateral chest radiographs demonstrate a left chest tube in unchanged position and normal cardiomediastinal silhouette . there has been interval re-expansion of the right upper lobe, with residual atelectasis adjacent to the fissure . there is no focal consolidation or pleural effusion . there is a small left apical pneumothorax . this pneumothorax is more obvious on todays exam and may be minimally bigger, but was likely present on prior radiograph . . small left apical pneumothorax . . interval re-expansion of the right upper lobe, with residual atelectasis adjacent to the fissure . these findings were communicated via telephone by dr . to dr . at on , min after discovery . Atelectasis&&Pneumothorax 11932181 54496719 01426485-8678cd3e-09df30bc-44f2929a-dcae524c 170 frontal and lateral chest radiograph again demonstrate a normal cardiomediastinal silhouette and a re-expanded right upper lobe with slight improvement of residual atelectasis adjacent to the fissure . the left apical pneumothorax is likely unchanged . minimal increase may be secondary to changes in patient position . there is no right pneumothorax . again seen are bilateral pleural effusions, the right effusion similar to slightly decreased and the left effusion increased . there is no focal consolidation . . likely unchanged small left apical pneumothorax . . increased left pleural effusion . unchanged to slightly decreased right pleural effusion . . redemonstration of a re-expanded right upper lobe with slight improvement of residual atelectasis adjacent to the fissure . Atelectasis&&Pleural Effusion&&Pneumothorax 11932181 55112740 8ddb63f4-106e50f8-38f5b05c-d7f17419-6515de90 171 pa and lateral images of the chest shows stable left lung asymmetry due to left upper lobectomy, the left lung base opacity is minimally improved since due to increased lung ventilation . there is no pneumothorax . cardiomediastinal silhouette is normal . the posterior left chest wall osteotomy is due to thoracotomy . stable left lung asymmetry in a patient who has had left upper lobectomy and thoracotomy . improvement of left lung base opacity with improved lung ventilation . Lung Opacity 11932181 55935470 9244882d-c90352d9-806e731d-e028242b-a619a04c 172 very small left apical and lateral pneumothorax unchanged since earlier in the day following removal of the left pleural drain . very small left pleural effusion has begun to reaccumulate . the right hemithorax segmental atelectasis adjacent to the minor fissure is stable . right lung otherwise clear . no right pneumothorax . tiny right pleural effusion is collected posteriorly . heart size normal . mediastinal contour is unremarkable . Atelectasis&&Pleural Effusion&&Pneumothorax 11932181 56531569 397e0897-311459aa-55923dc8-b8d44d58-0a3db1a0 173 frontal and lateral views of the chest were obtained . increased left basilar opacity has significantly increased likely large left pleural effusion with overlying atelectasis . small left pneumothorax persists . prominence of the left hilum may relate to left-sided pleural fluid however, underlying lymphadenopathy or consolidation is not excluded . left aspect of the cardiac silhouette is not well assessed due to the left basilar consolidation however, the remainder of the cardiac and mediastinal silhouettes are grossly stable . left hydropneumothorax . significant interval increase in left basilar opacity, likely left pleural effusion with overlying atelectasis, underlying consolidation not excluded . left perihilar opacity may relate to the above findings . however, underlying lymphadenopathy or additional consolidation is not excluded . air-fluid level seen in the left upper hemithorax, which appears longer in the frontal view than on the lateral view can be seen in bronchopleural fistula . Atelectasis&&Consolidation&&Lung Opacity&&Pleural Effusion&&Pneumothorax 11932181 59234160 83422dab-e3015272-fbf3df24-eb9e1d65-1da5c1dc 174 the heart is normal in size . the mediastinal and hilar contours appear within normal limits . there is no pleural effusion or pneumothorax . the lungs are clear . small anterior osteophytes are similar along the mid thoracic spine . one finding that is different since is a small ossification interposed between the coracoid process of the left scapula and the nearby clavicle, which may be post-traumatic, but does not appear to represent an acute finding . no evidence of acute disease . No Finding 11952678 50901945 a30106ce-242ee50e-4ce16bef-83e94bda-ce490f7d 175 previous marked postoperative widening of the cardiomediastinal silhouette has improved . moderate left pleural effusion has redistributed, now probably loculated and partially fissural . moderate bibasilar atelectasis has improved . no pneumothorax or pulmonary edema . right jugular line ends in the low svc . Atelectasis&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices 11989878 52887996 0c29ea1e-848c7739-b7f4844c-aac23b7c-cd7ec5f4 176 mild bibasilar atelectasis without definite focal consolidation seen . no pleural effusion or pneumothorax is seen . the cardiac and mediastinal silhouettes are stable . no pulmonary edema is seen mild basilar atelectasis without definite focal consolidation . Atelectasis 11989878 55750309 ac093f50-68e5995f-7d538f77-146f8bc4-7f6bd8a2 177 ap single view of the chest was obtained with patient in semi-upright position . comparison is made with the next preceding similar study of . in the interval, the right-sided pigtail end drainage catheter in the lower pleural space has been removed . aeration of the lung is unchanged and no evidence of increasing pleural effusion is present . again, however, a small up to cm wide apical pneumothorax cavity persists . no other new abnormalities . left-sided pleural effusion persists and is seen to extend in the posterior pleural space as well as identified on a lateral view in sitting position . Pleural Effusion&&Pneumothorax 12056668 58168751 c85fee28-66bb150d-3b065b0a-102fe76b-cbe662b0 178 pa and lateral views of the chest were provided demonstrating no focal consolidation, effusion or pneumothorax . the cardiomediastinal silhouette is normal . bony structures are intact . there is no free air below the right hemidiaphragm . no acute intrathoracic process . No Finding 12183320 59125943 6df82632-348a13df-d696e9ad-1f33b79e-86525aab 179 in comparison with study of , there is no change or evidence of acute cardiopulmonary disease . no pneumonia, vascular congestion, or pleural effusion . as on the previous study, there is mild hyperexpansion of the lungs, raising the possibility of some underlying chronic pulmonary disease . 12184969 51336149 4f22a5c8-9c123a46-7ddaa379-f478d129-ebfe7617 180 the lungs are clear without focal consolidation . no pleural effusion or pneumothorax is seen . the cardiac and mediastinal silhouettes are unremarkable . no pulmonary edema is seen . no acute cardiopulmonary process . No Finding 12184969 57098023 e00791c1-236f1162-299681bf-dc0ec9cf-db0b76ee 181 subtle opacity is seen projecting over the lateral right mid lung which may be due to overlap of structures, but underlying pulmonary opacity is not excluded . the lungs are relatively hyperinflated, suggesting chronic obstructive pulmonary disease . minimal left base atelectasis is seen . there is no pleural effusion or pneumothorax . the cardiac and mediastinal silhouettes are unremarkable . no displaced rib fracture is definitively identified . however, if clinical concern persists, dedicated rib series or chest ct is more sensitive . subtle opacity projecting over the lateral right mid lung may be due to overlap of structures, but underlying pulmonary opacity or even rib fracture is not excluded . findings could be further assessed with shallow oblique radiographs or chest ct . no displaced rib fracture definitively identified . however, if clinical concern persists, dedicated rib series or chest ct is more sensitive . Fracture&&Lung Opacity 12273883 51337781 7abed310-5c7341f5-b74d2b26-7880d896-1cd5cff0 182 the cardiomediastinal contours are normal . aside from atelectasis in the left lower lobe, the lungs are clear . there is no pneumothorax or pleural effusion . No Finding 12276724 57458073 ffb27aee-3c32e3d2-0ed50754-b3e3167e-faa80013 183 ap and lateral views of the chest were obtained . there is no focal consolidation, pleural effusion, pulmonary edema, or pneumothorax . the cardiomediastinal and hilar contours are unremarkable . there is no bony abnormality . no acute cardiopulmonary process . No Finding 12329950 50866812 53286e62-dc9dc056-5c468ac4-8d4b9a0d-747d77cd 184 in comparison with the study of , there is no interval change or evidence of acute cardiopulmonary disease . no pneumonia, vascular congestion, or pleural effusion . No Finding 12329950 53383140 371535d2-66f5cbc5-b9d8abfd-fadeca21-81b0e4a8 185 mild rotation . allowing for this, the heart size is probably at the upper limits of normal for size . lung bases not particularly well seen particularly the left costophrenic sulcus and effusion here cannot be immediately out ruled but this likely reflects a combination of poor respiratory effort and also perhaps some splinting from the multiple distended loops of bowel incidentally observed . there is no evidence of pneumonia . the visualized osseous structures appear grossly normal . respiratory effort, but likely no acute lung process . minimal left costophrenic sulcus is seen and minimal congestive changes are not excluded . incidentally noted are multiple distended loops of likely colon . please correlate clinically . No Finding 12365242 54341807 3ae2087f-a1f7a91f-91aa746d-514ea044-0864768e 186 the lungs are clear . the cardiomediastinal silhouette is within normal limits . no acute osseous abnormalities identified . height loss of several mid thoracic vertebral bodies is unchanged from prior . no acute cardiopulmonary process . No Finding 12371823 53550262 c58bc070-f7ebbe78-118de371-eb210cc8-fa6d8df7 187 the cardiomediastinal silhouettes are within normal limits . the bilateral hila are unremarkable . there is no pulmonary vascular congestion . there is no focal lung consolidation . there is no pneumothorax or pleural effusion . no evidence of acute cardiopulmonary process . No Finding 12390084 53379950 87d03f53-dd1465e8-d596008b-79e71d28-8211447b 188 the lungs are well inflated and clear . the cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal . there is no pleural effusion or pneumothorax . no acute cardiopulmonary process . No Finding 12424405 55900756 0031401d-0506c0cc-964f493e-c7e40618-2047871e 189 pa and lateral chest radiographs the cardiomediastinal and hilar contours are normal . the lungs are well expanded and clear, without consolidation, pleural effusion or pneumothorax . no displaced rib fractures are detected . No Finding 12458098 57011996 5ff8860b-fc277b55-da194e4b-22a5190d-6e95a1aa 190 sternal wires are intact except for the inferior most wire . heart size is normal . the lungs are clear and there is no pleural effusion or pneumothorax . aortic valve replacement is noted . central venous stent is noted . no acute cardiopulmonary process . No Finding 12502618 51389473 c3a1b629-9780bce6-f4039fd1-f3db7c19-55bbcdb7 191 the lungs are clear without focal consolidation . no pleural effusion or pneumothorax is seen . the cardiac and mediastinal silhouettes are stable . the patient is status post median sternotomy . vascular stenting appears stable in position . no acute cardiopulmonary process . no significant interval change . No Finding 12502618 51872919 e965c6fd-c7c9ed8a-313a8d01-e2761616-b0dda288 192 pa and lateral views of the chest provided . midline sternotomy wires again noted . there is no focal consolidation, effusion, or pneumothorax . the heart remains mildly enlarged . mediastinal contour is stable . imaged osseous structures are intact . no free air below the right hemidiaphragm is seen . no acute intrathoracic process . No Finding 12502618 52919818 00c5e8ac-78438bb0-ce44b225-9f9b777a-cb4e468e 193 as compared to the previous radiograph, there is no relevant change . the alignment of the sternal wires is constant . no change in position . normal appearance of the lung parenchyma . no pneumothorax . no pleural effusions . normal size of the cardiac silhouette . normal hilar and mediastinal contours . No Finding 12502618 53914388 4350f64d-aeb8882b-534177fb-fd203cf0-30c10a19 194 the patient is status post aortic valve replacement and left subclavian vein stent placement . there is a fracture through the inferior-most sternotomy wire, which is unchanged since . otherwise, the remaining sternotomy wires are intact and appropriately aligned . there is stable enlargement of the cardiomediastinal silhouette . lungs are well-expanded and clear . the pulmonary vasculature is normal . no pleural effusion or pneumothorax is seen . there are no acute osseous abnormalities . no acute cardiopulmonary abnormality . No Finding 12502618 55381986 1d4d38ca-ca23a788-10bb00aa-f4d15995-4fa7389c 195 assessment is slightly limited due to rotation . heart size remains mildly enlarged . elevation of the left hemidiaphragm is unchanged . atelectasis within the left lung base is noted, but no focal consolidation, pleural effusion or pneumothorax is present . mediastinal and hilar contours are unchanged, and no pulmonary vascular congestion is identified . scarring within the apices is unchanged . mild to moderate multilevel degenerative changes are present in the thoracic spine . chronic elevation of the left hemidiaphragm with left basilar atelectasis . no acute cardiopulmonary abnormality otherwise demonstrated . Atelectasis 12521573 58700633 2522581e-ac120282-c9568047-88e5dfff-2e19d8e4 196 right picc tip has been somewhat advanced into the upper-to-mid svc . the cardiomediastinal and hilar contours are normal . the lungs are clear . there is no pleural effusion or pneumothorax . right picc tip at upper-to-mid svc . No Finding&&Support Devices 12659391 56049214 1ed2756e-369a930f-ffff5e24-2435499b-1e4603e9 197 heart size is normal . mediastinum is stable in appearance including prominence of the main pulmonary artery that might be consistent with pulmonary hypertension . lungs are essentially clear with no pleural effusion or pneumothorax . no evidence of aspiration or pneumonia is demonstrated on the current study . repeated radiograph if patients symptoms persist might be considered . 12659391 56056686 06a83fd7-94ed1a00-8227ada6-da0b3c89-371cb132 198 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 Finding 12663605 58673717 88ccf610-b3c4e8b9-dc228355-6410ee87-1191a63b 199 compared to the prior radiograph of the lung volumes have improve . the left pleural effusion has decreased and is now small . linear opacities in the left lung base represents platelike atelectasis . there is no new opacity or pneumothorax . the cardiac and mediastinal contours are normal . nipple rings are noted . no new opacity concerning for pneumonia . interval improvement in lung volumes and decrease in size of a now small left pleural effusion and atelectasis . Atelectasis&&Lung Opacity&&Pleural Effusion&&Pneumonia 12671922 54253905 576ea30f-0b6d676e-4fb00e65-c319c423-7445e215 200 frontal and lateral chest radiograph demonstrates unremarkable mediastinal and hilar contours . lung volumes are low with mild bibasilar atelectasis . otherwise, lungs are clear . there is mild pleural thickening adjacent to the right fifth rib with suggestion of a cortical step-off however, the area of concern is obscured by a crossing sixth rib . no other fracture is identified . possible right fifth rib fracture with small amount of adjacent pleural fluid or hematoma . discussed with dr . regarding these findings at am . on at the time of discovery . Fracture&&Pleural Effusion 12706312 51746534 aecd487f-89650453-71139ac4-094e3790-910d705d 201 pa and lateral views of the chest were obtained . dual-lead pacer is unchanged with proximal lead in the expected location of the right atrium and distal lead in the expected location of the right ventricle . no focal consolidation, large effusion or pneumothorax . there is mild vascular redistribution which is likely suggestive of mild pulmonary vascular congestion . no frank pulmonary edema . cardiomediastinal silhouette is stable . bony structures appear intact . mild pulmonary vascular congestion . Edema 12749849 52178631 48137c2d-eb569f44-d59a0735-091e53b4-ea6f8a26 202 the cardiac silhouette is top-normal in size . no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema . normal mediastinal and hilar contours . unremarkable pleural . mild degenerative changes are noted in the thoracic spine . as above . No Finding 12751006 53972858 6731c06d-16bbcd4b-74834699-e8808d6b-6f7c74c6 203 heart size is normal . the mediastinal and hilar contours are normal . the pulmonary vasculature is normal . lungs are hyperinflated but clear . no pleural effusion or pneumothorax is seen . there are no acute osseous abnormalities . multilevel degenerative changes are noted in the thoracic spine with anterior bridging osteophytes . no acute cardiopulmonary abnormality . No Finding 12840185 54433456 b8fe3d66-623dd7f2-01a7c7a7-e3115bac-20b92cb8 204 heart size is normal . the mediastinal and hilar contours are unremarkable with atherosclerotic calcification of the aortic arch again noted . a fudicial seed is again seen within a posterior left lower lobe lesion, compatible with known malignancy status post cyberknife therapy . minimal streaky bibasilar opacities likely reflect atelectasis, though infection is difficult to exclude . there is no new focal consolidation, pleural effusion or pneumothorax . no pulmonary vascular congestion is present . multiple clips are again seen within the upper abdomen . there are no acute osseous abnormalities . left lower lobe lesion containing a fudicial marker, not significantly changed from the prior study . probable bibasilar atelectasis though infection is difficult to exclude . Pneumonia&&Support Devices 12932866 53816282 fadf202c-b58902f4-74479a47-d1cb4e1f-f67332ba 205 comparison is made with prior study, ct, . cardiac size is top normal . left lower lobe opacities with a marker and lung nodules are better seen in prior ct . patient has known emphysema . there is no pneumothorax . there is no evidence of displaced rib fractures, but this examination is not tailored to evaluate the osseous structures, and if clinically concerned, dedicated rib series can be performed . dense material projecting in the right upper quadrant liver reflects prior tace . a small left pleural effusion is stable . Lung Lesion&&Lung Opacity&&Pleural Effusion&&Support Devices 12932866 59914893 8f1eedc1-d6955632-09f93aa7-392775ca-cd76ca09 206 the lungs are well-expanded and clear . no focal consolidation, effusion, edema, or pneumothorax . cardiomediastinal silhouette is normal . hila are unremarkable . no acute osseous abnormality . upper abdomen bowel gas pattern is nonspecific . no pneumothorax . No Finding 12955039 54097156 c1e60b7d-0a4e5228-148af355-3f9fcb50-d501908b 207 frontal and lateral views of the chest were obtained . no focal consolidation, pleural effusion or evidence of pneumothorax is seen . the cardiac and mediastinal silhouettes are unremarkable . no pulmonary edema is seen . no acute cardiopulmonary process . please note that pcp may be radiographically occult . No Finding 12977138 50332797 ff3dc06f-f7a97800-fce2758f-0bbeccd1-463d4449 208 frontal and lateral views of the chest demonstrate normal lung volumes . right lung base opacities are slightly more conspicuous since prior, projecting over the spine on the lateral view . there is no pleural effusion, focal consolidation or pneumothorax . hilar and mediastinal silhouettes are unchanged . heart size is normal . there is no pulmonary edema . partially imaged upper abdominal visceral organs are unremarkable . right lung base opacities, slightly more conspicuous since , may represent atelectasis or infection in the appropriate clinical setting . Atelectasis&&Lung Opacity&&Pneumonia 12977138 55273228 2a1e777f-0b658cf0-64aafd5d-0a0d22f8-9bba06d0 209 no focal consolidation or pleural effusion currently pneumothorax is seen . the cardiac and mediastinal silhouettes are unremarkable . there is questionable mild prominence of the left hilum on the frontal view, which may be artifactual, but underlying lymphadenopathy is not entirely excluded . no focal consolidation . equivocal mild prominence of the left hilum on the frontal view may be artifactual but underlying lymphadenopathy is not excluded . this could be further evaluated with a nonurgent chest ct . 12985283 57852146 11e48232-807822de-087a2398-ff1998ec-ec7c263e 210 heart size and mediastinum are unremarkable . lungs are clear . there is no pleural effusion or pneumothorax . No Finding 12993646 54865950 e9757e74-70899027-2ed85472-de35ca54-d13398e0 211 the cardiomediastinal silhouette and pulmonary vasculature are unremarkable . the lungs are clear . there is no pleural effusion or pneumothorax . no acute intrathoracic abnormality . No Finding 12993646 57172548 3a296121-9fc2bc73-d081dd75-b9ea5164-f49fc528 212 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 Finding 12993646 58081122 0b2dd972-3c011bed-2c95c910-d16cc4da-65760e65 213 the cardiac, mediastinal and hilar contours appear within normal limits and unchanged . streaky opacities at the left lung base indicate mild atelectasis . a small calcification projecting over the right upper lobe and the course of the right anterior fourth rib as well as the posterior right seventh rib suggests a bone island or parenchymal granuloma but unchanged . mild pleural thickening appears unchanged at each lung apex . there is no pleural effusion or pneumothorax . the chest appears hyperinflated . no evidence of acute cardiopulmonary disease . No Finding 12998617 53111457 14ca8f98-3b8cc136-42e4fd22-e44b2da1-e390b60b 214 the lung volumes are normal and the lungs are clear . there is no pleural effusion, pneumothorax or focal airspace consolidation worrisome for pneumonia . bilateral apical thickening is symmetric and unchanged . heart is normal size . the mediastinal and hilar contours are unremarkable . no acute cardiopulmonary process . No Finding 13022116 59794043 bb2d16ed-83a9269c-7f1b2130-45116784-a9c8a430 215 the lungs are well inflated and clear . the cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal . there is no pleural effusion or pneumothorax . no acute cardiopulmonary process . No Finding 13034473 55433920 945ba47d-cb1ad056-168ac55e-9b9ba3b6-4b80d1f5 216 the lungs are clear without focal consolidation . no pleural effusion or pneumothorax is seen . the cardiac and mediastinal silhouettes are unremarkable . apparent linear lucency along the right heart border is felt to most likely be artifactual and is not substantiated on the lateral view . no acute cardiopulmonary process . apparent linear lucency along the right heart border is felt to be artifactual . No Finding 13097080 59273362 c3198910-fd888ca2-0e1c5a82-8e318b2f-9901e350 217 as compared to the previous radiograph, the right internal jugular vein catheter has been removed . the small right pneumothorax is no longer visible . neither the frontal nor the lateral radiograph show evidence of pleural effusions . unchanged clips and sternal wires of the cabg . no pneumonia, no pulmonary edema . normal size of the cardiac silhouette . Pleural Effusion&&Pneumothorax 13171410 51969259 3077d18e-520b03ab-15ec5dd1-21c42a96-58bb1a22 218 a right-sided central venous catheter projects along the right internal jugular vein and its tip is seen proximal to the cavoatrial junction . surgical clips are projecting along the heart and sternotomy wires are intact . as compared to prior chest radiograph from , there has been interval removal of a right-sided chest tube . there is scattered atelectasis and there are tiny bilateral pleural effusions . a residual right apical pneumothorax is identified . cardiomediastinal silhouette is stable . . residual tiny right apical pneumothorax . . bilateral tiny pleural effusions . these findings were discussed with dr . by dr . telephone on at pm, time of discovery . Pleural Effusion&&Pneumothorax 13171410 52850524 e436cfc0-fc21c094-9d4ddd86-bbf65f19-70a2c641 219 as compared to the previous radiograph, the patient is substantially improved . normal size of the cardiac silhouette . status post cabg with correct alignment of the sternal wires . status post right shoulder surgery . there currently is no evidence of pneumonia or other acute lung disease . the frontal and the lateral radiographs show normal appearance of the lung parenchyma . no pulmonary edema . normal postoperative appearance of the mediastinum and hilar structures . No Finding 13171410 55330429 3a8d14bb-e7b82dd7-5dad553b-e6eb2c41-7a0e3118 220 there is no focal consolidation, pleural effusion or pneumothorax . cardiomediastinal silhouette is within normal limits . no acute osseous abnormalities are identified . no acute cardiopulmonary process . No Finding 13238497 50643047 34c2aa16-f1f5bd4a-29eb1957-6c3c1668-854aa214 221 blunting of the bilateral costophrenic angles may be due to small bilateral effusions andor pleural thickening . mild bibasilar atelectasis is also seen . there is no definite focal consolidation . the aorta is somewhat tortuous . the cardiac silhouette is top-normal . there may be very minimal pulmonary vascular congestion . bilateral pleural thickening with possible small pleural effusions . bibasilar atelectasis and possible minimal pulmonary vascular congestion . Atelectasis&&Edema&&Pleural Effusion&&Pleural Other 13260103 53169484 5cbd768e-5bd7bc33-aff08070-8a3a2de3-bd826608 222 the lungs are moderately well inflated . no pleural effusion or pneumothorax . heart size and mediastinal contour are unremarkable . mild prominence of the right hila is unchanged since . atherosclerotic calcifications of the aortic arch are noted . limited assessment of the osseous structures are notable for multilevel degenerative changes of the thoracic spine . no acute cardiopulmonary process . specifically, no pneumonia . No Finding 13299965 51469366 f1e70f28-5a6e30a4-7f2d7942-6753668e-d6f2ba56 223 pa and lateral views of the chest provided . 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 13303439 53885176 837c2769-c747eb79-c73923fc-29fa11a1-7954345d 224 heart size and mediastinum are stable . there is a right upper lobe opacity, concerning for right upper lobe pneumonia . questionable paramediastinal opacity in the left upper lobe is noted as well . there is no pleural effusion or pneumothorax . Cardiomegaly&&Enlarged Cardiomediastinum&&Lung Opacity&&Pneumonia 13312840 55034479 a1a5ef58-0de8e5da-bc54d948-c5fcfe48-3232203b 225 the lungs are normally expanded with exception of mild platelike atelectasis in the right mid lung . there is no focal airspace opacity worrisome for pneumonia . there is no pleural effusion or pneumothorax . the size of the cardiomediastinal silhouette is within normal limits . mild platelike atelectasis in the right lung . no evidence of pneumonia . Atelectasis&&Support Devices 13312840 57765466 00b5589c-f5097caa-1b9fc64a-3cbd40d1-aac5eb42 226 frontal and lateral views of the chest were obtained . the lungs are clear without focal consolidation . no pleural effusion or pneumothorax is seen . the cardiac and mediastinal silhouettes are stable and unremarkable . no displaced fracture is seen . no acute cardiopulmonary process . No Finding 13313381 50050632 9f3c1525-622b3786-d4ec71b4-0ce69eb7-b8ebd96a 227 comparison to . in the interval, the right picc line was removed . lung volumes remain low but both the cardiac silhouette and the lung parenchyma are of normal appearance . no pneumonia, pulmonary edema or pleural effusions . No Finding&&Support Devices 13313381 56614637 438de949-b994cd81-3e038daa-dfe2c09c-e5a3461b 228 the lungs are clear . the hilar and cardiomediastinal contours are normal . there is no pneumothorax . there is no pleural effusion . pulmonary vascularity is normal . normal chest . No Finding 13313381 59987091 799a1e79-6391085d-5116aa00-483b59b4-8a776a15 229 in comparison with study of , the cardiac silhouette remains within normal limits and there is no evidence of vascular congestion or pleural effusion . no convincing evidence of acute focal pneumonia . Pneumonia 13314609 52837363 81893a7b-25e3ed4b-8debe6d3-38e925f6-ebeb46c7 230 the lungs are clear . the hilar and cardiomediastinal contours are normal . there is no pneumothorax or pleural effusion . pulmonary vascularity is normal . no displaced rib fracture is seen . no displaced rib fracture is seen . if there is further clinical concern, a dedicated rib series with the location of the patients pain marked with a skin marker is recommended . No Finding&&Support Devices 13328038 56402902 68d8c74c-b5c3c405-4232a5db-964916b5-a79a6594 231 frontal and lateral views of the chest were obtained . low lung volumes results in bronchovascular crowding . the lungs are clear without focal consolidation, pleural effusion or pneumothorax . heart size is normal . mediastinal silhouette and hilar contours are normal . no acute intrathoracic abnormality . specifically, no pneumothorax . No Finding 13332630 50457687 9eacee09-f3a00feb-1129b788-b9127605-94b95329 232 heart size is normal . mediastinal and hilar contours are within normal limits . lungs are clear . pulmonary vascularity is normal . no pleural effusion or pneumothorax is present . no acute osseous abnormalities are present . no acute cardiopulmonary abnormality . No Finding 13332630 53854807 c5d04cda-5902b0d3-962ad8a5-23e1fcb3-013d913f 233 the cardiomediastinal and hilar contours are within normal limits . the lung fields are clear . there is no pneumothorax, fracture or dislocation . limited assessment of the abdomen is unremarkable . no acute cardiopulmonary abnormality . No Finding 13332630 58340245 d26f1288-1dbca978-9e778e54-d1b738cd-ee48b9dd 234 pa and lateral views of the chest provided . 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 13335223 57911302 7a30c54e-efd24c40-62ebd58f-010424a9-6a7200a8 235 diffuse peribronchial abnormalities in the right upper lobe as well as the area of consolidation on the lateral margin of the left and right lungs have improved since chest radiograph and chest ct and are likely due to bronchiectasis on the left and pneumonia or possible radiation injury in the left lung . no new opacification concerning for pneumonia identified . multiple calcified granulomas identified . cardiomediastinal and hilar contours are normal . no pleural effusion or pneumothorax . no evidence of new infection . chronic mild bronchiectasis improved radiation or organized pneumonia . Pneumonia 13340246 56424846 c3faa797-8ce7ca41-dfd7d4f1-977729ad-c02062b6 236 the cardiomediastinal and hilar contours are stable . the aorta is tortuous . the lungs are mildly hyperexpanded suggestive of underlying emphysema . there has been interval development of a right lower lobe opacity which would be concerning for pneumonia or aspiration, less likely atelectasis . no pneumothorax or pulmonary edema . note is made of severe degenerative change involving the right glenohumeral joint . interval development of probable right lower lobe pneumonia or aspiration . clinical correlation is advised . Pneumonia 13356814 52613722 b9e0794f-128bc11f-687abd02-c3068507-8bd8cb3e 237 pa and lateral views of the chest are reviewed and compared to the prior study . normal heart, lungs, pleural and mediastinal surfaces . normal chest radiograph without evidence of all-trans retinoic acid syndrome . No Finding 13376876 51080370 42fa5a10-17856f17-da125a25-87062ee3-f9e4c296 238 a right subclavian port-a-cath is unchanged in position with the tip terminating in the mid svc without any kinks or breaks in the line . cardiomediastinal silhouette and hilar contours are normal . lungs are clear . there is no pleural effusion or pneumothorax . no acute cardiopulmonary process . right subclavian port intact and unchanged in position . No Finding 13376876 53410013 72b75c31-c89b5e3c-f2a6d852-a3982477-96334886 239 pa and lateral views of the chest redemonstrates a right subclavian port-a-cath, unchanged in position, terminating in the mid svc . there is no evidence of pneumothorax, focal consolidation, pleural effusion or pulmonary edema . the lungs are well expanded and clear . the cardiomediastinal silhouette is unremarkable . no acute cardiopulmonary process . right-sided port-a-cath terminates in the mid svc . No Finding 13376876 56009674 0b15a853-44ea4dcc-e9dcc745-dc75e138-94628837 240 a right picc line ends in the mid svc . no focal consolidation, pleural effusion or pneumothorax . normal heart size, mediastinal and hilar contours . new right picc ends in the mid svc with no evidence of complication, particularly no pneumothorax . notification telephone notification to , iv nurse, . at am . on . No Finding&&Support Devices 13376876 56885460 d510b0bf-95986115-d0440448-4733c4af-00c420aa 241 pa and lateral views of the chest . no prior . the lungs are clear of focal consolidation . left apical calcified scarring is seen as well as a calcified ap window node suggestive of previous granulomatous disease . there is no effusion or pneumothorax . cardiomediastinal silhouette is within normal limits . osseous and soft tissue structures are unremarkable . no acute cardiopulmonary process . No Finding 13378971 53474190 08029b60-763ac6a5-53ccfd4e-3b593a21-cf78ad88 242 as compared to the previous radiograph, the pre-existing opacity in the left lung has completely resolved . on todays image, there is no evidence of infectious changes or other acute lung abnormality . borderline size of the cardiac silhouette without pulmonary edema . minimal tortuosity of the thoracic aorta . Cardiomegaly 13380841 58063777 e830b6f7-d74485cf-a5ab6855-8063ff88-edd2313f 243 again, there is no evidence of primary or mediastinal abnormality . there is no radiographic evidence of adenopathy on this study please refer to recent ct of the chest dated , which demonstrates left hilar findings . the lungs are well expanded bilaterally with no areas of focal consolidation, masses, lesions, pleural effusion or pneumothorax . the cardiomediastinal silhouette and hilar silhouettes are within normal limits . the pleural surfaces are unremarkable . no evidence of infection or malignancy . No Finding 13381744 50880023 ce503ee9-43932a5f-76cf3fc3-77fc0303-686fb5c2 244 pa and lateral views of the chest dated at are submitted and compared to a prior study of at . cardiac and mediastinal contours appear stable . lungs are well inflated . there is a subtle patchy opacity in the left base which is somewhat linear in configuration which favors partial lobar atelectasis rather than pneumonia . however, clinical correlation is advised and followup imaging should be performed based on the clinical assessment . no pleural effusions or pneumothoraces are seen . the left hilum superiorly remains mildly prominent but is stable and this is known to correspond to the area of a previous malignancy first imaged in . no acute bony abnormality is appreciated . Atelectasis&&Enlarged Cardiomediastinum&&Lung Opacity 13381744 51165747 e50a0991-3848adb7-ad6f8944-80c7d026-4124cf2f 245 the lungs are clear, there is no evidence of pneumonia and there are no pleural effusions . the cardiomediastinal shilhouette and hila are normal . there is no pneumothorax . no evidence of pneumonia . known malignancy not really appreciated . No Finding 13381744 54475799 5094d0a0-f07c9eb2-b85c310a-d6e1335b-ca4efd83 246 the right lung is clear without consolidation . the previously seen equivocal opacity was likely from superimposed normal vessels in the setting of low lung volumes . the left hilum remains mildly prominent due to patients known tumor, but is much improved from the previous chest radiograph on . there is no pleural effusion or pneumothorax . the size of the cardiac silhouette is at the upper limits of normal and unchanged . no evidence of pneumonia . No Finding 13381744 55522316 8d4c9eb2-984e5879-a822d017-56d518a7-0a75fbd5 247 projecting over the anterior aspect of the right rib along the midclavicular line in the right upper lung is an ill-defined heterogenous opacity approximately . x . cm, more readily visible now than it was on . the lungs are otherwise clear . cardiomediastinal silhouette is normal . pleural surfaces are unremarkable . adenopathy is not appreciated on this study . likely, small, right upper lung pneumonia . Pneumonia 13381744 55571313 e84c83d4-f03872ee-5fe8ec3b-076ce17a-f7b4f861 248 the left hilum remains prominent and is due to the patients known tumor, and appears stable . otherwise, the lungs are clear with no evidence of a consolidation, effusion, or pneumothorax . cardiomediastinal silhouette is at the upper limits of normal and stable . no acute fractures are noted . no evidence of acute infection . No Finding 13381744 58561597 4bb0a233-9c375594-652f647f-64f5080f-30112b80 249 frontal and lateral views of the chest are obtained . the left hilum is prominent . no additional areas of consolidation are seen . the right lung is clear . no pleural effusion or pneumothorax is seen . the cardiac silhouette is not enlarged . mediastinum is unremarkable . enlarged left hilum per patients ed notes, the patient had an outpatient ct revealing a left lung mass . reference to that ct recommended . Lung Lesion 13381744 59597249 482d52f7-7c113961-9abdb524-09269248-cef6708c 250 no previous images . the cardiac silhouette is within normal limits and there is no vascular congestion, pleural effusion, or acute focal pneumonia . No Finding 13409440 55534282 f82c8dce-08b4a4f3-7e31a017-5d79c194-88f6bf9d 251 the heart and mediastinum are normal . the lung fields are clear . no infiltrates are present . No Finding 13421580 51827027 312bb0ed-2dafb619-a0da3729-5dc19055-53169588 252 in comparison with the study of , there again are relatively low lung volumes . areas of increased opacification is seen at the bases, suggestive of atelectatic change . there is evidence of a right pleural effusion . no definite acute focal pneumonia, though this could be well hidden on the radiographs are presented . Atelectasis&&Lung Opacity&&Pleural Effusion 13453133 50285647 448e62e9-12a35130-5cc19fc9-f7d8b729-5751bf9c 253 lung volumes are low . bibasilar atelectatic changes are stable . bilateral pleural effusions, right greater than left, are unchanged since . there is no pneumothorax . the mediastinum and heart are within normal limits . no acute osseous abnormalities . no significant change in bilateral pleural effusions, right greater than left . Pleural Effusion 13453133 51079737 669d85b2-5453dc2b-a961b4a5-afa296a7-06a77cd8 254 in comparison with the earlier study of this day, there has been a thoracentesis with removal of a substantial amount of pleural fluid . small residual process . specifically, there is no evidence of appreciable pneumothorax . remainder of the study is essentially unchanged . 13453133 52354768 386e8915-c0072f29-206ebd92-18525c1d-07c487f4 255 there are bilateral pleural effusions, right greater than left . the right effusion is larger than the prior radiograph on . there is also opacification of the left lung base, which likely represents compression atelectasis, but pneumonia cannot be excluded in the appropriate clinical setting . no pneumothorax . there is minimal calcification of the aortic arch . cardiomediastinal silhouette is within normal limits . no acute osseous abnormalities . there are bilateral pleural effusions, right greater than left . right effusion is worse compared to . Pleural Effusion 13453133 58917692 3ff7aa6a-fcc94e00-adc8df6a-de85a781-27c9f662 256 on todays examination, no suggestion of mediastinal widening . the mediastinal reflections are all visualized . the mild peripharyngeal soft tissue thickening described on a ct examination from is not visible on the current image . borderline size of the cardiac silhouette . no pneumomediastinum . normal appearance of the lung parenchyma . no pleural effusions . no pneumothorax . Cardiomegaly 13548796 52791306 96734a31-b38490e1-f61e9e78-5db8c8f5-ded5e1df 257 right-sided picc terminates in the upper svc . cardiac silhouette size is normal . mediastinal and hilar contours are unchanged . no pulmonary vascular congestion is seen . the lungs are clear . no focal consolidation, pleural effusion or pneumothorax is present . there are no acute osseous abnormalities . no acute cardiopulmonary abnormality . No Finding 13548796 58768886 0d393050-8caaa760-f81a0bdb-da31d259-43e27146 258 frontal and lateral views of the chest were obtained . the lungs remain hyperinflated with flattening of the diaphragm, suggesting chronic obstructive pulmonary disease . evidence of bilateral pleural and diaphragmatic plaques are again seen consistent with prior asbestos exposure . no focal consolidation is seen . there is no pleural effusion or pneumothorax . the cardiac and mediastinal silhouettes are stable and unremarkable . bilateral calcified pleural plaques again seen, consistent with the prior asbestos exposure . no acute cardiopulmonary process . 13565877 50132992 f635620c-c59587a0-ea69a0e8-2b68825f-8a5e281f 259 multiple calcified pleural plaques are similar to prior studies suggesting prior asbestos exposure . there is no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema . the cardiomediastinal silhouette is within normal limits . no acute intrathoracic process . unchanged bilateral calcified pleural plaques consistent with prior asbestos exposure . 13565877 50756406 e49ba178-a7c83425-3d9c730c-7e693dba-8ad83e82 260 the heart size is normal . the aorta is mildly unfolded . the mediastinal and hilar contours are unchanged . calcified bilateral pleural plaques are re- demonstrated . the lungs are hyperinflated but clear . no focal consolidation, pleural effusion or pneumothorax is seen . the pulmonary vasculature is normal . there are no acute osseous abnormalities . bilateral calcified pleural plaques compatible with prior asbestos exposure . no acute cardiopulmonary abnormality . 13565877 58461129 d7148302-06967b0d-b0842ffe-a02c5032-4b7d26d6 261 the lungs are well expanded . an ill-defined nodular opacity projecting over the periphery of the lingula is noted, not seen clearly on the lateral view . right lung is clear . the cardiomediastinal silhouette, hilar contours and pleural surfaces are normal . no pleural effusions or pneumothorax is present . ill-defined opacity projecting over the periphery of the lingula is concerning for pneumonia . Lung Opacity&&Pneumonia 13571108 50920453 e9c7e41a-39669be4-ef06a00c-98608201-df448387 262 heart size is top normal with mild tortuosity of the thoracic aorta . hilar contours are unremarkable . there has been interval development of small bilateral right greater than left pleural effusions with mild adjacent bibasilar atelectasis . remainder of the lung fields are clear . there is no pneumothorax . a dobbhoff tube remains in place in the very proximal stomach and should be further advanced . small right greater than left bilateral pleural effusions . dobbhoff tube ends in the very proximal stomach and should be further advanced . Pleural Effusion&&Support Devices 13571108 53069779 08f26428-11618c66-d31e30be-bb3cdba9-7246cdef 263 pa and lateral views of chest demonstrate an extensive left -sided pleural effusion with compressive atelectasis an underlying pneumonia cannot be excluded . a tiny right pleural effusion may also be present . the cardiac silhouette also appears enlarged, but it is difficult to completely assess the left border given the large pleural effusion . the right lung is clear of focal opacities worrisome for pneumonia . there is no pneumothorax . . large left-sided pleural effusion with underlying atelectasis, underlying consolidation is not excluded . . difficult to assess, but possibly enlarging cardiac silhouette query underlying pericardial effusion . Atelectasis&&Cardiomegaly&&Consolidation&&Pleural Effusion 13571108 54975015 efd6cb09-2f2d04d4-41f75c29-c95e86ac-5aba4006 264 comparison is made with prior study . cardiomediastinal contours are normal . lingular opacity has decreased . faint opacity remains . otherwise the lungs are clear . there is no pneumothorax, pleural effusion or new lung abnormalities . Lung Opacity 13571108 58671472 fa4948aa-878365c3-6dc676a8-9265b2d0-a3a529f4 265 the heart is normal in size . the mediastinal and hilar contours appear within normal limits . there is no pleural effusion or pneumothorax . the bony structures are unremarkable aside from minimal degenerative changes . there has been no significant change . no evidence of acute disease . No Finding 13653377 58111167 b55480c5-35f5035f-99072f8f-e543d1e6-5ac76f23 266 there is a left-sided dual-lead pacemaker with leads terminating in appropriate position in the right ventricle and atrium . the heart size is normal . the lungs are clear . hilar contours are normal . there is no pleural effusion or pulmonary edema . descending thoracic aorta is tortuous with no suggestion of aneurysm . no evidence of acute cardiopulmonary process . appropriate lead positioning . No Finding 13671677 50457804 b57e2fd5-e8efb1d9-46533dc5-2d856c3d-19ab41b4 267 left cardiac pacemaker with intact leads ending in the right atrium and right ventricle is seen . heart size is upper limit of normal with no signs of pleural effusion or pulmonary congestion . no focal consolidation is seen, and no complications of the procedure including pneumothorax are seen . pacemaker with leads ending in the right atrium and right ventricle seen . No Finding&&Support Devices 13671677 54728992 7707c2f5-2b806bbd-3f906fe9-e476a733-223553d7 268 dual lead left-sided pacemaker is seen with lead extending the expected positions of the right atrium and right ventricle . the lungs are clear without focal consolidation . no pleural effusion or pneumothorax is seen . the cardiac and mediastinal silhouettes are stable . no acute cardiopulmonary process . No Finding 13671677 59005527 cdbffb1b-b48fd807-aadb1f9f-0acda7ba-dd92b80a 269 heart size and mediastinum are stable . lungs are clear . there is no pleural effusion or pneumothorax . overall no evidence of metastatic disease within the limitations of the study technique demonstrated . if clinically warranted, correlation with chest ct is to be considered . Cardiomegaly&&Enlarged Cardiomediastinum 13714536 57144065 794533ad-f257d046-041dd56e-181a50d3-b5643cd0 270 heart size is top-normal is stable . apical scarring right more than left as well as right lower lobe linear opacities are stable . no definitive evidence of new infectious process demonstrated on the current study with similar to known chronic findings seen . no pleural effusion or pneumothora . Cardiomegaly&&Lung Opacity 13722528 50871707 f74bcb32-9100c0a3-afef824e-a1485ea6-f990aa2a 271 heterogeneous opacification in the right upper lobe in is most readily explained by pneumonia . that has largely resolved, but there is still irregular opacification, best appreciated on the lateral view as well as the possibility of a -mm wide nodule projecting just anterior to the ascending thoracic aorta . for that reason, i would recommend chest ct scanning if nothing else to establish baseline appearance of hyperinflated lungs, probably due to emphysema . heart size is top normal, but there is no pulmonary or mediastinal vascular engorgement, edema or pleural effusion . Lung Lesion&&Lung Opacity&&Pneumonia 13722528 52066292 8fc640a2-1d6e4787-685d3061-db38a40a-ad7c2e6c 272 the assessment of the radiograph demonstrates substantial improvement in the right upper lobe consolidation with current appearance being similar to . based on that reflects the presence of subpleural interstitial opacities that might potentially reflect interstitial lung disease . lungs are hyperinflated but no new abnormalities are demonstrated . the heart size is enlarged but stable . mediastinal contours are stable . still slightly more pronounced opacity in the right apex is present and reassessment in four weeks for documentation of complete resolution is suggested . there is no pleural effusion or pneumothorax . Cardiomegaly&&Consolidation&&Enlarged Cardiomediastinum&&Lung Opacity 13722528 52515651 ac41d67c-103ee28a-0efb6f93-85a812d9-6bdf13c6 273 interval resolution of the left upper lobe pneumonia . no new areas of airspace consolidation . the cardiomediastinal shadow is unchanged . no pleural effusions . mild coarsening of the interstitial markings persist . interval resolution of the left upper lobe pneumonia . No Finding 13722528 53126282 bcfdab4a-41f56a9d-969a736a-88b92d25-0b313cc1 274 increased interstitial markings seen at the periphery of the lung, right greater than left compatible with previously noted subpleural fibrotic changes . there is no new focal consolidation, effusion, or edema . cardiomediastinal silhouette is stable . no acute osseous abnormalities . chronic changes in the lungs without superimposed acute cardiopulmonary process . No Finding 13722528 53966206 da1e8877-ddaa6388-3f825099-88a1ca8d-da46da3f 275 large airspace opacity in the left upper lung is grossly unchanged . patchy opacities in the right lung are stable as well . no pleural effusions or pneumothorax . the hila and cardial mediastinal silhouette are otherwise unchanged . persistent severe left lung opacity . no new consolidation . Consolidation&&Lung Opacity 13722528 54403374 cd910d90-c7ce8292-427f0761-508b8be8-83629e20 276 pa and lateral chest radiographs show a subtle opacity in the left lung base compatible with pneumonia . there is no pleural effusion or pneumothorax . mild cardiomegaly is unchanged . the cardiac, hilar, and mediastinal contours are unremarkable . right lower lung opacity compatible with pneumonia . Lung Opacity&&Pneumonia 13722528 54669301 e6828d47-61cbfa6e-0213c719-e6864bd1-2bd635b9 277 mild cardiomegaly is stable compared to multiple prior exams dating back at least to . the previously noted subtle opacity in the right lung base is not seen on this exam . there are no new focal consolidations, pleural effusions or pneumothorax . the hilar and mediastinal contours are unremarkable . no evidence of pneumonia . No Finding 13722528 55504230 55a14268-88a2935c-2da0561c-338a49af-e83b75cd 278 frontal and lateral views of the chest . there is new consolidation in the right upper lobe and likely within the right middle lobe as well . the left lung is grossly clear . there is no effusion . cardiac silhouette is enlarged, unchanged . atherosclerotic calcifications noted at the aortic arch . no acute osseous abnormality . right upper and potentially middle lobe pneumonia . recommend repeat after treatment to document resolution . Pneumonia 13722528 57880555 3454e89a-58e3895d-8af07967-2786fcd9-72c8fe21 279 in comparison with the study of , there is little interval change . postoperative changes are seen on the left with no evidence of pneumothorax . bibasilar atelectatic changes are again seen with the right hemidiaphragm not as well visualized on the current study . Atelectasis 13736401 51531649 96c0d4a5-051e3fc3-f672b6ff-77c9b55c-0d6ca4d4 280 compared to chest radiographs through . normal postoperative appearance following left lower lobectomy, including anterior herniation of the right upper lobe . lungs essentially clear . heart size top-normal . no pleural abnormality . Cardiomegaly 13736401 59148466 a55585df-edd0377a-0ec6bd01-2ecabdc0-109d0e9c 281 the heart size is borderline enlarged . the aorta is tortuous . mediastinal and hilar contours are otherwise unremarkable and the pulmonary vasculature is normal . no focal consolidation, pleural effusion or pneumothorax is seen . there are no acute osseous abnormalities . no acute cardiopulmonary process . No Finding 13740705 54045900 d4d8ed91-d54929b5-a7e9fd6e-063cc534-089ceaab 282 frontal and lateral views of the chest were obtained . no focal consolidation, pleural effusion, or evidence of pneumothorax is seen . the cardiac and mediastinal silhouettes are stable and unremarkable . no displaced fracture is seen . no acute cardiopulmonary process . no significant interval change . please note that dedicated imaging of the spine was not obtained . No Finding 13761822 57708460 7db3c46c-7de7d596-bf39fadf-cb34f915-6fcdd3c0 283 the heart is mildly enlarged . the mediastinal and hilar contours appear unchanged . patchy calcification is similar along the aortic arch . there is a vascular stent projecting adjacent to the aortic arch . there is no pleural effusion or pneumothorax . the lungs appear clear . slight degenerative changes are similar along the thoracic spine . there is a prior non-displaced right sixth rib fracture with remodeling . mild cardiomegaly . no evidence of acute disease . Cardiomegaly 13799343 53343064 b90f926b-309e71d5-d3572c48-dc0744ec-8b4c6a5e 284 the lungs are relatively hyperinflated, with flattening of the diaphragms, which can be seen in chronic obstructive pulmonary disease . there is mild left base atelectasis . no focal consolidation, large pleural effusion or evidence of pneumothorax is seen . the aorta is calcified and tortuous . the cardiac silhouette is top-normal to mildly enlarged . no overt pulmonary edema is seen . the bones are diffusely osteopenic . a drain is partially imaged overlying the upper abdomen . mild left base atelectasis . hyperinflated lungs suggests chronic obstructive pulmonary disease . no focal consolidation . top normal to mildly enlarged cardiac silhouette . Atelectasis 13837849 57210057 a1a11577-09c2a5a2-93a505de-55c0dcb7-cb35e605 285 frontal and lateral chest radiographs the heart size is normal . the hilar and cardiomediastinal contours are within normal limits . there is no pneumothorax, focal consolidation, or pleural effusion . no bony abnormalities are detected . No Finding 13853261 50832976 f42d7dbd-d192327f-ba7c9e5c-8ef226b5-87f58720 286 the cardiac, mediastinal and hilar contours are normal . both lungs are clear with no focal consolidation, pleural effusion or pneumothorax . No Finding 13863916 54170949 762a4f20-66c7bb78-c7ed6020-a23e9f73-e13cb70a 287 the lungs are clear . the cardiomediastinal silhouette is within normal limits . no acute osseous abnormalities identified . no acute cardiopulmonary process . No Finding 13863916 55385188 984ccf69-a2dacdd1-6ec13d35-3af17fd5-5c583dfa 288 comparison to . normal lung volumes . normal size of the cardiac silhouette . normal hilar and mediastinal contours . no pneumonia, no pulmonary edema, no pleural effusions . no lung nodules or masses . No Finding 13863916 56979658 e851b139-e2d48dc6-f6d066cb-47cc6c01-1be04ae0 289 at the level of the middle lobe, on both the frontal and the lateral radiograph, findings indicating pneumonia are seen . the right heart border is obliterated, there is increased density in the middle lobe on the lateral radiograph . no pleural effusions . no other pathologic findings . borderline size of the cardiac silhouette, normal hilar and mediastinal contours . a wet read was delivered at the time of image acquisition, , pm . Cardiomegaly&&Lung Opacity&&Pneumonia 13866250 56868936 cd93f5ed-8955a049-e8718dc7-1ed931f6-00410869 290 the lungs are clear without evidence of focal consolidation, effusion or pneumothorax . the cardiomediastinal silhouette is normal . there is no evidence of pulmonary vascular congestion . a focal calcification appears to be within the right breast, unchanged . surgical clips are noted projecting over the right upper quadrant . no displaced rib fractures are seen . . no acute intrathoracic process . . no displaced rib fractures seen if continued concern for rib fracture, consider a dedicated rib series . Fracture 14028959 57718488 193b6fbc-20817b64-62a0329b-67b74188-7e664d39 291 compared with the prior radiograph, cardiomediastinal silhouette is grossly unchanged . lungs are hyperinflated, but clear, without evidence of focal consolidation, pleural effusion, or pneumothorax . small area of parenchymal sparing in the left upper lobe is unchanged . mild degenerative changes of the thoracic spine again seen . no acute cardiopulmonary process . No Finding 14062229 55856355 c32f537b-1e531bdf-dc94439f-516792e2-c4933220 292 frontal and lateral views of the chest . the lungs are clear of focal consolidation or effusion . the cardiomediastinal silhouette is within normal limits . no acute osseous abnormalities detected . no acute cardiopulmonary process . No Finding 14083729 58210381 ca4f0e35-a2b35596-46ff395e-f8b1d162-2d199a8f 293 the lungs are clear . the cardiomediastinal silhouette is within normal limits . no acute osseous abnormalities . no acute cardiopulmonary process . No Finding 14136683 51969834 9de35640-255ad38e-8307196e-74d8e70f-ad7df48a 294 the lungs are well-expanded and clear . no pleural effusion or pneumothorax . heart size, mediastinal contour, and hila are unremarkable . no pneumonia . No Finding 14136683 58108137 a55632d0-66917d00-a02a2d21-db611a0e-baeed86e 295 as compared to the previous radiograph, there is no relevant change . relatively low lung volumes without evidence of pneumonia or pulmonary edema . neither the frontal nor the lateral radiographs show evidence of pleural effusions . borderline size of the cardiac silhouette . no abnormal hilar or mediastinal contours . no pneumothorax . Cardiomegaly&&Pleural Effusion 14158492 55003488 a0f5a683-e287a03c-6fa57c7c-0e9ea9bb-a7ee872f 296 frontal and lateral chest radiographs the heart size is normal . the hilar and mediastinal contours are within normal limits . a right middle lobe opacity is most compatible with consolidation . there is no pneumothorax or pleural effusion . Pneumonia 14226251 56011861 66da37b9-cee79ad9-575d0c12-3258f935-5b252c22 297 cardiomediastinal contours are normal . aside from minimal atelectasis in the right upper lobe . the lungs are clear . there is no pneumothorax or pleural effusion . No Finding 14232420 57317305 e859a1ab-98acc65b-d8bfb3fd-ae04e11e-f3317290 298 moderate cardiomegaly persists . the mediastinal and hilar contours are within normal limits . lungs are clear . no focal consolidation, pleural effusion or pneumothorax is present . calcified granuloma in the left lower lobe is unchanged . there are no acute osseous abnormalities . no acute cardiopulmonary abnormality . No Finding 14235184 51611847 22d4b5a3-c6744296-d4c6b985-335ebb8a-47b33809 299 frontal and lateral views of the chest the lungs are clear . there is no pleural effusion, pneumothorax or focal airspace consolidations . the heart is mildly to moderately enlarged but unchanged . there is no evidence for pulmonary edema . the mediastinal and hilar structures are unremarkable . No Finding 14235184 53464266 38d09978-1abbe4ef-2d0291f6-b956da6f-733ce57c 300 frontal and lateral chest radiographs demonstrate mild-to-moderate cardiac enlargement, unchanged compared with prior . the lungs are clear . there is no pleural effusion or pneumothorax . the mediastinal contours appear normal . the pulmonary vasculature is mildy engorged . mild-to-moderate cardiomegaly with borderline cardiac decompensation . Cardiomegaly 14235184 54857381 a1debf16-716b5f40-b15944a1-79c490ee-129dff0e 301 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 . no acute cardiopulmonary abnormality . No Finding 14235841 51533854 5908d07a-1a8c8602-444efbb2-1fdd7481-5810665b 302 in comparison with the study of mid , there is little change and no evidence of acute cardiopulmonary disease . given the limitations of plain radiography, there is no evidence of parenchymal or skeletal metastases . No Finding 14235841 52062026 eb4d38d4-5a42a2ac-f3c8a44d-e78fe3d8-20354de3 303 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 . bony structures are unremarkable . no evidence of acute disease . No Finding 14235841 57231052 809478a0-89ff6933-f8530e59-3f6f75d2-1fc0bb55 304 frontal and lateral chest radiographs demonstrate a normal cardiomediastinal silhouette and well-aerated lungs which are clear . there is no focal consolidation, pleural effusion, or pneumothorax . the visualized upper abdomen is unremarkable, without evidence of intraperitoneal free air . no acute cardiopulmonary process . No Finding 14235841 57325562 25e1fea3-63c087dd-adb27176-a70687be-f0954a3b 305 the lungs remain mildly hyperexpanded reflecting copd . mild bibasilar atelectasis has progressed . the heart is not enlarged . the mediastinal and hilar contours are normal . there is no pleural effusion or pneumothorax . . slight worsening of bibasilar atelectasis . . copd . no acute cardiopulmonary abnormality . Atelectasis 14255450 50698639 0973ab55-e2d9ddb3-e7c364fe-137b0308-177b4795 306 frontal and lateral views of the chest were obtained . the lungs are hyperinflated, with flattening of the diaphragms, consistent with chronic obstructive pulmonary disease . there is mild left basilar atelectasis . no focal consolidation is seen . there is no pleural effusion or pneumothorax . the cardiac and mediastinal silhouettes are unremarkable . degenerative changes are seen along the spine . copd and left basilar atelectasis . otherwise, no acute cardiopulmonary process . Atelectasis 14255450 58031591 df3e97d7-fd77aab4-5efdb12d-111b9a8c-e9569b7c 307 there to prior chest radiographs since , most recently and . mild left lower lobe atelectasis and small left pleural effusion persists . upper lungs clear . normal postoperative cardiomediastinal silhouette . no pneumothorax . Atelectasis&&Pleural Effusion 14290919 51170595 3da8fb2d-0e0a1796-4b98b571-78e0bad7-04a32511 308 in comparison with the study of , the swan-ganz catheter has been removed . there is a moderate left effusion and minimal right effusion . no vascular congestion or acute focal pneumonia . Pleural Effusion 14290919 54487013 cf93eaa8-246c2d54-99361712-29f491cb-b5dc78fb 309 a dual-chamber pacemaker is present, with one lead in the right ventricle, the other in the right atrium . no pneumothorax is present . the lung fields are clear . No Finding&&Support Devices 14293935 54660460 d3f96d98-36e89d3a-4b18fd6f-979c1f4d-0c81b93e 310 frontal and lateral views chest were obtained . 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 14319319 52885023 a7ae0c27-73fe32bb-6d9fd821-4b8a0d03-0ced0365 311 in comparison with the study of , the patient has taken a better inspiration . there again is some increase in opacification in the perihilar and infrahilar region on the left . this again could reflect an area of consolidation . the area of subtle opacity in the right lower lung is again seen, which also could reflect an infectious focus . Consolidation&&Lung Opacity&&Pneumonia 14319319 52924184 809c72b2-39df536d-93ec5dbf-ac5f8f71-95414ea7 312 heart size, mediastinal and hilar contours are stable compared to prior studies dating back to . lungs are clear, and there are no pleural effusions or acute skeletal findings . no radiographic evidence of pneumonia . No Finding 14319319 53967898 80d9b2ed-78a45dda-a5de2d9e-64e077c3-9c07a278 313 pa and lateral views of the chest were provided . there is vague opacity in the left perihilar region, which is concerning for pneumonia . in addition, there is subtle increased opacity in the right lower lobe, which also may represent a focus of pneumonia . no large effusion or pneumothorax . cardiomediastinal silhouette is stable . a screw is partially imaged in the right humeral head . left perihilar and right lower lobe opacities concerning for pneumonia . Lung Opacity&&Pneumonia 14319319 54489741 2ae82330-8aa965f5-a811c7b7-73cf5c80-f2006ab9 314 cardiomediastinal contours are normal . the lungs are clear . there is no pneumothorax or pleural effusion . right picc tip is in the cavoatrial junction . No Finding 14319319 55468075 c1227be3-f510adf2-23e88c3f-8cbe4a6d-9b42b6ac 315 normal heart size, mediastinal and hilar contours . no focal consolidation, pleural effusion or pneumothorax . no displaced rib fracture . no acute process . No Finding 14319319 59650920 f834a63d-bdcd3d6a-6a87cf3f-a7a890c2-5cda7d0e 316 the lungs, mediastinum, hilar contours, pleural surfaces and heart are all normal . normal chest x-ray . No Finding 14323502 51790365 62ada9ed-7166dd46-94661d49-c4fbabd2-b47e7fb7 317 opacity projecting over the anterior left first rib is likely due to overlapping structures however, this could be confirmed with apical lordotic view . no focal consolidation is seen elsewhere . no pleural effusion or pneumothorax is seen . the cardiac and mediastinal silhouettes are unremarkable . no pulmonary edema is seen . opacity projecting over the anterior left first rib is likely due to overlapping structures however, this could be confirmed with apical lordotic view . no focal consolidation seen elsewhere . Lung Opacity 14376938 51293946 9a973abe-4bfabaca-59bc4d9f-e8f497d9-a4a3c9a9 318 pa and lateral views of the chest were obtained . cardiomediastinal silhouette is within normal limits . lungs are clear . there is no pleural effusion or pneumothorax . no evidence of pneumonia . No Finding 14437159 58711037 4ec320f1-f6ed092b-c749d300-8124dd63-d98d10c4 319 pa and lateral views of the chest are provided . the lungs are clear bilaterally without focal consolidation, effusion, or pneumothorax . the heart appears top normal in size . mediastinal contours are normal . bony structures are intact . no free air below the right hemidiaphragm is seen . top normal heart size . otherwise, unremarkable . clinical correlation is advised given patients age . No Finding 14501307 51916515 34ea4862-69b56c27-eea2acfb-63230bb2-63c5d575 320 there is no focal consolidation, pleural effusion or pneumothorax . the cardiomediastinal and hilar contours are normal . no acute cardiopulmonary process . No Finding 14501307 52575559 f12aeb4b-97ac02a5-ca00f34c-0eba166e-714a951e 321 the lungs are clear . cardiomediastinal silhouette and hilar contours are unremarkable . there is no pleural effusion or pneumothorax . no fractures are noted . no acute cardiopulmonary process . No Finding 14528802 55170845 f9b94529-baeec146-110c6f2c-ac0f07c8-2bf2a00b 322 frontal and lateral views of the chest . the lungs are clear of focal consolidation or effusion . opacities at the cardiophrenic angles bilaterally are thought to represent prominent fat pads . cardiomediastinal silhouette is within normal limits . descending thoracic aorta is tortuous . atherosclerotic calcifications noted at the aortic arch . no acute osseous abnormality is detected . no acute cardiopulmonary process . No Finding 14538897 56333260 0296c965-747a37f9-3ac114b7-bbbc8820-43ca361b 323 comparison is made with prior study of . large necrotic cavitating right upper lobe mass with air-fluid level has more air component and less fluid component, still soft tissue is seen medially . right lower lobe pneumonic opacities have improved . left lower lobe opacities are grossly unchanged . there is no pneumothorax . right hemidiaphragm is elevated . cardiomediastinal contours are obscured by the pleural parenchymal abnormalities . Enlarged Cardiomediastinum&&Lung Lesion&&Lung Opacity 14544801 52058445 f6b773a4-96bacd3b-eafdaf27-b55f141b-30fbf197 324 non-displaced anterior fifth left rib fracture is new . necrotic cavitating right upper lobe mass with air-fluid level was better assessed in previous chest ct . bibasilar opacities are mostly compatible with aspiration or pneumonia . pleural effusion is small if any . there is no pneumothorax . conclusion . the patient is known with right upper lobe lung cancer that has cavitated with bilateral basal opacities that could be compatible with aspiration or pneumonia . . left fifth anterior rib fracture is new . Fracture&&Lung Opacity&&Pneumonia 14544801 58798839 d44811b4-e337ad4c-3db89276-a24ae31a-5364e1fb 325 frontal and lateral views of the chest were obtained . there are relatively low lung volumes, which accentuate the bronchovascular markings . minimal left base atelectasis is seen which is less apparent on the second image . the aorta is calcified and tortuous . the cardiac silhouette is not enlarged . there may be minimal anterior wedging of a thoracic vertebral body at the thoracolumbar junction, of indeterminate age . very minimal pulmonary vascular congestion may be present . there is gaseous distention of what appears to be the stomach under the left hemidiaphragm . possible minimal pulmonary vascular congestion . no definite focal consolidation seen . gaseous distention of what appears to be the stomach vs represent splenic flexure . correlate clinically . Edema 14632685 58334557 ccae2064-e531c70c-adac2f88-9bb93c07-f67c5607 326 the heart is normal in size . the mediastinal and hilar contours appear within normal limits . the lungs appear clear . there are no pleural effusions or pneumothorax . bony structures appear normal . no evidence of acute disease . No Finding 14650196 51971463 0c62a8e0-fa47177a-d5a6df96-e1bb986f-bafebb7c 327 pa and lateral chest radiographs demonstrate clear lungs bilaterally . the lungs are symmetrically expanded . cardiomediastinal and hilar contours are within normal limits . there is no evidence of pulmonary edema, pneumothorax, or pleural effusion . no acute cardiopulmonary process . No Finding 14702127 59853610 b16c6c8b-37296ed9-9ea6fb0b-c9f5c94a-2026dfc3 328 frontal and lateral views of the chest were obtained . lungs are clear without focal consolidation, pleural effusion, or pneumothorax is seen . cardiac and mediastinal silhouettes are unremarkable . no acute cardiopulmonary process . No Finding 14720011 57096268 707adba4-b7367857-642b3047-ed140bd8-5a905de2 329 lower lung volumes seen on the current exam with bibasilar atelectasis . the lungs are otherwise clear . there is no effusion or pneumothorax . cardiomediastinal silhouette is within normal limits . atherosclerotic calcifications are noted at the aortic arch . thoracolumbar s-shaped scoliosis is noted . no acute cardiopulmonary process . No Finding 14725077 55315754 8abf5ff4-0a62823f-8bd0c4f8-3bdf0dd9-69c2e270 330 frontal and lateral radiographs of the chest were acquired . the lungs are clear . the heart size is normal . the mediastinal contours are normal . there are no pleural effusions . no pneumothorax is seen . the bony thorax is grossly intact . . no acute cardiac or pulmonary findings . . no definite rib fracture identified . if there is continued clinical concern for a rib fracture, further evaluation can be performed with a dedicated rib series, including an appropriately positioned radiopaque skin marker . Fracture&&Support Devices 14764320 51496052 f9631c4d-13fad799-9c72bca5-c380fc8b-59d730ed 331 there is a large opacity within the right lung base which is at least partly due to a moderate pleural effusion . there may be underlying consolidation or atelectasis . there is also an opacity within the left lung base with air bronchograms concerning for consolidation . minimal septal thickening seen within the peripheral aspect of the left lung base suggests mild pulmonary vascular engorgement . upper lungs are clear . mediastinal and hilar contours are within normal limits . there is no pneumothorax . heart size is difficult to assess given the presence of the right pleural effusion . remote right sided rib fractures are noted . . moderate right pleural effusion with possible underlying consolidation or atelectasis . . consolidation within the left lung base concerning for pneumonia in the appropriate clinical circumstance . . mild pulmonary vascular congestion . Atelectasis&&Consolidation&&Edema&&Pleural Effusion&&Pneumonia 14783430 56024419 10183281-0e48a980-d8b20af2-8fb2878b-86f14605 332 the lungs are clear without focal consolidation . no pleural effusion or pneumothorax is seen . the cardiac and mediastinal silhouettes are unremarkable . no displaced fracture is seen . no acute cardiopulmonary process . No Finding 14790859 57078506 61e6ad42-674b9c48-684abad1-83ce16d3-0188f603 333 frontal and lateral views of the chest demonstrate normal lung volumes without pleural effusion, focal consolidation, or pneumothorax . hilar and mediastinal silhouettes are unremarkable . heart size is normal . there is no pulmonary edema . no evidence of acute cardiopulmonary process . No Finding 14793590 58364828 7bf046f9-18898711-4375498f-1c2a8724-dda1c2ff 334 the lungs are clear . there is no focal consolidation, effusion, or pneumothorax . the cardiomediastinal silhouette is normal . no acute osseous abnormalities . no acute cardiopulmonary process . No Finding 14795241 51735069 e5cf035a-e203a9f5-8d1942e2-e8b87b94-68462325 335 mild mediastinal widening on the right side is from an air-filled neoesophagus which has an unchanged appearance since . both lungs are well expanded and clear . no evidence to suggest aspiration or pneumonia . there is no pneumothorax . heart size is normal, mediastinal and hilar contours are unremarkable . stable appearance of the mediastinum with the neoesophagus . lungs are clear . no pneumoniaaspiration . Enlarged Cardiomediastinum 14798972 50078606 79632435-0693e0d0-9f3a1293-1663b451-127421df 336 right port-a-cath tip is in the right ij . there is no pneumothorax . cardiomediastinal contours are normal . the lungs are clear . there is no pleural effusion . team is aware of the location of the catheter . No Finding&&Support Devices 14798972 50159062 504de268-91f03481-436102fe-75388785-f4e49e10 337 comparison is made with prior study performed hours earlier . small-to-moderate right pneumothorax has minimally decreased in size . right basal pigtail catheter is still in place . right chest wall and neck subcutaneous emphysema is unchanged . cardiomediastinal contours are stable . right port-a-cath is in standard position . bibasilar atelectasis has improved on the right . Atelectasis&&Enlarged Cardiomediastinum&&Pneumothorax&&Support Devices 14798972 50198128 6346e738-92b54005-4fc6d87e-9037f956-6495dd34 338 in comparison with study of , the port-a-cath has turned on itself so that it extends into the right jugular and then has its tip pointing downward . lungs are clear . No Finding 14798972 51217938 5c2bc160-a56ea402-02315775-00bb383c-8df68576 339 compared to the previous radiograph, the right-sided pigtail catheter has been removed . there is an unchanged right apical pneumothorax without evidence of tension and a relatively extensive soft tissue air collection right laterally . the position and course of the right port-a-cath is unchanged . unchanged appearance of the left lung with areas of basal plate-like atelectasis . Atelectasis&&Pneumothorax&&Support Devices 14798972 52353675 e6b4ccd3-0795f625-2acad01a-72101d69-4ade2ad7 340 the current study demonstrates moderate-to-large pneumothorax despite the presence of the pigtail catheter that appears to be larger than on the original chest radiograph from obtained at pm . there is no appreciable pleural effusion seen . the port-a-cath catheter tip is at the level of low svc . findings were discussed with dr . the phone by dr . at pm . on . Pneumothorax&&Support Devices 14798972 53111950 34a847c0-1064f7be-7174acc7-f552794e-b7b8fbc2 341 the cardiac and mediastinal silhouette appears stable with expected widening of the right mediastinum due to the neoesophagus . right chest tube is in place . there is no appreciable pneumothorax . no appreciable pleural effusion is demonstrated as well although small amount of fluid cannot be excluded . lungs are essentially clear . there is no evidence of pulmonary edema . Enlarged Cardiomediastinum&&Support Devices 14798972 53282277 e9bb2e99-4208de3e-59bacad5-8e02e55c-42955bad 342 as compared to the previous radiograph, pre-existing right pneumothorax appears to have completely resolved . no pneumothorax is seen on todays image . unchanged course and position of the right port-a-cath, decreasing extent of the pre-existing right lateral soft tissue air collection . the cardiac silhouette and the left lung are normal . No Finding 14798972 53979892 f353557c-c5c77676-0355d9f8-f6ec8a6a-15084cd3 343 comparison is made with prior study performed a day earlier . small right pneumothorax has decreased in size . cardiomediastinal contours are unchanged, right picc line catheter tip is in the cavoatrial junction . platelike atelectasis in the left lower lobe and left upper lobe are unchanged . aeration of the right lower lobe has improved, there is no pleural effusion, right basal pigtail catheter is in unchanged position . right chest wall subcutaneous emphysema has improved . Atelectasis&&Enlarged Cardiomediastinum&&Pneumothorax&&Support Devices 14798972 55075981 5c2bd6fe-31eb3d79-ac068cea-ef620dc5-26402554 344 comparison is made with prior study performed the same day earlier in the morning . cardiomediastinal contours are unchanged with evidence of neoesophagus . there is no pneumothorax or pleural effusion . the lungs are grossly clear . right chest wall subcutaneous emphysema is unchanged . Enlarged Cardiomediastinum 14798972 55291399 587fd33f-4367cbc5-87ec6abe-7a88e214-03367eac 345 moderate-to-large right pneumothorax has increased over the past five hours, now surrounds the entire right lung, previously basal . new leftward mediastinal shift despite persistent right lower lobe collapse, which would be expected to move the mediastinum rightward, suggests the pneumothorax is accumulating under pressure . left lung grossly clear . heart size normal . findings were discussed by dr . with dr . at pm . on . Atelectasis&&Enlarged Cardiomediastinum&&Pneumothorax 14798972 57788036 7c43e78d-ab1bda95-4c4e1601-f5dbfd62-b4890b04 346 there is a new left mid and lower lung zone parenchymal opacity which is highly suggestive of an infectious process . there is also a small left-sided pleural effusion . the right basilar opacity present on prior chest x-rays is not as extensive on todays chest x-ray . there is retrocardiac atelectasis . the mediastinal and hilar contours are normal, and the heart size is normal . . new left mid and lower lung zone opacity with small left pleural effusion consistent with pneumonia . . improved right basilar opacity . . retrocardiac atelectasis . wet read was called to by dr . telephone at , minutes after the time of discovery . Atelectasis&&Lung Opacity&&Pleural Effusion&&Pneumonia 14798972 58049883 72550433-6fe53947-edefc714-62955b1d-5210cb16 347 comparison is made with prior study, . there are low lung volumes . cardiac silhouette is unchanged . right paramediastinal opacity is due to the neoesophagus . bibasilar atelectasis that are minimal and larger on the left side are unchanged . there is no pneumothorax or pleural effusion . right chest wall subcutaneous emphysema has decreased . right apical chest tube remains in place . Atelectasis&&Cardiomegaly&&Lung Opacity&&Support Devices 14798972 59492394 ccda45e0-517df94b-12cabece-0accc381-8622980c 348 heart size is normal . cardiomediastinal silhouette and hilar contours are normal . lungs are clear . pleural surfaces are clear without effusion or pneumothorax . no overt traumatic abnormality . . no acute cardiopulmonary abnormality . . no overt traumatic abnormality . No Finding 14880886 50743847 588def2d-500ceb2b-4f6ba7d2-538d584d-1b6e3093 349 heart size is normal . the mediastinal contour is unchanged with mild atherosclerotic calcifications noted at the aortic arch . hilar contours are similar compared to the prior chest ct with an infrahilar opacity re- demonstrated . the lungs are hyperinflated with severe emphysematous changes again seen . while scarring within the lung apices is again noted, there is a new patchy opacity seen within the left upper lobe concerning for an area of infection . no pleural effusion or pneumothorax is identified . no acute osseous abnormality seen . . new patchy opacity in the left upper lobe concerning for an area of pneumonia . . severe emphysema with scarring within the lung apices . . right infrahilar opacity is re- demonstrated, and previously characterized on chest cta as an area concerning for possible malignancy . again bronchoscopy of this area is recommended if not done in the interval . Lung Opacity&&Pneumonia 14930750 53267993 272ca8f3-c19b4186-d9b66363-3b20f14f-a6cec2b6 350 cardiac silhouette size is top normal . the mediastinal and hilar contours are unremarkable . pulmonary vasculature is not engorged . moderate size right pleural effusion is new from the previous radiograph with associated right basilar atelectasis . left lung is clear . no pneumothorax is present . there are no acute osseous abnormalities . moderate size right pleural effusion with right basilar compressive atelectasis . Atelectasis&&Pleural Effusion 14954732 53597344 a45898be-7a277064-b3338345-c2044677-1b9cffa4 351 cardiomediastinal contours are normal . the lungs are clear . there is no pneumothorax or pleural effusion . the osseous structures are unremarkable no acute cardiopulmonary abnormalities . No Finding 14954732 53957652 8e719f66-0c603da9-c93cc5c7-41574b5d-7e6cf099 352 the lungs are well expanded and show an opacity inferior to the right main stem bronchus . the cardiomediastinal silhouette, hilar contours and pleural surfaces are normal . no pleural effusion or pneumothorax is present . the previously reported right lower lobe abnormality is not visualized on the current examination and it was noted to have been resolved by report of a ct chest performed with contrast on at . no acute intrathoracic process . an opacity inferior to the right mainstem bronchus could represent resolving changes secondary to superior segmental abnormality, however direct comparison with the chest ct from atrius is recommended . these findings were communicated to md via telephone at am on . Lung Opacity 14971109 58838012 d00fb5d5-88c9a0f0-4d9224af-01793823-97ad452a 353 no focal consolidation, pleural effusion or pneumothorax . the cardiomediastinal and hilar contours are normal . no acute cardiopulmonary process . No Finding 14995285 53482463 2aea6da8-c43d911f-f1ffde22-323a0ea8-ae72787f 354 there are bibasilar opacities that may reflect atelectasis or aspiration in the appropriate clinical setting . no other focal consolidation . there is no pleural effusion or pneumothorax . mild cardiomegaly . no acute osseous abnormalities are identified . subcutaneous emphysema is partially imaged along the right lateral chestupper abdominal wall . . bibasilar opacities may represent atelectasis or aspiration . . subcutaneous emphysema along the right lateral chestupper abdominal wall, which should be correlated with site of recent surgeryinstrumentation . Atelectasis&&Lung Opacity 14998555 55294938 cf47d683-e828be31-85e2c295-1ee43e48-9663dfba 355 the lungs are well expanded and clear . there is no pleural effusion or pneumothorax . the cardiomediastinal silhouette is unremarkable . no acute cardiopulmonary process . No Finding 15020971 52434635 68eb5585-b507f6a7-22aec032-5da34d2f-86b95ee6 356 the lungs are clear without focal consolidation, effusion, or edema . cardiac silhouette is top normal . no acute osseous abnormalities . there is no free intraperitoneal air . no acute cardiopulmonary process . No Finding 15020971 54651539 9edfbe81-f4663dcd-3a8cef29-c4ae3ebf-34eaf330 357 extremely low lung volumes without definite consolidation . heart size is likely normal, allowing for low lung volumes . the mediastinal and hilar contours are normal . the pulmonary vasculature is normal . no pleural effusion or pneumothorax is seen . there are no acute osseous abnormalities . there are multilevel degenerative changes of the visualized thoracolumbar spine . no acute cardiopulmonary abnormality . No Finding 15020971 59195119 2e44f83c-54689c28-6a55b93e-8d0b1498-dbbd97b9 358 cardiac, mediastinal and hilar contours are normal . lungs are clear . pulmonary vascularity is normal . no pleural effusion or pneumothorax is seen . no acute osseous abnormalities are visualized . normal chest radiograph . No Finding 15051804 56870153 b2d5d5d0-0f2ce3c9-7c098cea-a08ae5c5-c4c9c1c1 359 frontal and lateral radiographs of the chest demonstrate normal heart size, mediastinal and hilar contours . clear lungs . no pneumothorax or pleural effusion . normal chest radiograph . No Finding 15072866 50137061 f2a8d6d9-5425eaf4-1261d395-319e1538-edf854d9 360 the cardiomediastinal and hilar contours are normal . there is no pleural effusion or pneumothorax . lungs are well-expanded and clear without focal consolidation concerning for pneumonia . pulmonary vasculature is within normal limits . there is no abnormality in the visualized upper abdomen . no focal consolidation concerning for pneumonia . Pneumonia 15127156 53513169 2be53082-f806f1da-98837406-6ee69de5-63b79cad 361 pa and lateral views of the chest . no prior . the lungs are clear . there is no effusion or pneumothorax . the cardiomediastinal silhouette is normal . osseous and soft tissue structures are unremarkable . no acute cardiopulmonary process . no pneumothorax . No Finding 15153582 50281282 7524e142-0147cd8b-c4f41ff3-0d8d5792-49a48a77 362 frontal and lateral chest radiographs the lungs are clear . there is no confluent opacity or consolidation . no pneumothorax is evident . no pulmonary edema or pleural effusions are identified . cardiomediastinal and hilar contours are within normal limits . No Finding 15153582 50588876 9fdcee0b-ef15f145-db2edbc3-861be20f-d5e27c80 363 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 cardiopulmonary disease . No Finding 15153582 53105805 7dbb4b71-725cf08f-15105e66-93510dff-fa62ea4f 364 the cardiomediastinal and hilar contours are within normal limits . the lungs are clear without focal consolidation, pleural effusion or pneumothorax . no acute cardiopulmonary abnormality . No Finding 15153582 56121507 3cbdb4bd-f8ea5752-da55affe-f3e77959-40803c29 365 frontal and lateral chest radiographs the heart size is normal . the hilar and mediastinal contours are within normal limits . there is no pneumothorax, focal consolidation, or pleural effusion . No Finding 15153582 57311421 2b53c5b4-6a087c8d-3e66def7-7fd6604a-77eb0287 366 in comparison with the study of , there is no change or evidence of acute cardiopulmonary disease or old tuberculous disease . No Finding 15153582 57783859 72d57d0a-8b8b1b36-e930bc66-8244f92c-a8c8e5c3 367 pa and lateral chest radiographs were obtained . the lungs are clear and well expanded . there is no consolidation, effusion, pneumothorax . cardiac and mediastinal contours are normal . no acute cardiopulmonary process . No Finding 15153582 59088085 2d2ff304-3025174d-ae262933-da20379a-0b089143 368 frontal and lateral chest radiographs demonstrate a normal cardiomediastinal silhouette . low lung volumes somewhat limit evaluation, resulting in bronchovascular crowding and bibasilar atelectasis without focal consolidation . no pleural effusion or pneumothorax is seen . marked degenerative changes of the thoracic spine are unchanged . no acute cardiopulmonary process . No Finding 15154281 51537676 405c64d9-2764c738-5d6c101d-4670fc09-119dbe6e 369 pa and lateral views of the chest are obtained . low lung volumes somewhat limit evaluation . likely mild atelectasis or bronchovascular crowding accounts for subtle opacities in the lower lungs . there is no definite sign of pneumonia, chf, pleural effusion, or pneumothorax . cardiomediastinal silhouette appears normal . bony structures are intact . there is no free air below the right hemidiaphragm . no acute intrathoracic process . subtle opacities in the lower lungs likely atelectasis or bronchovascular crowding . if needed, a repeat study with more optimized inspiratory effort may be performed to confirm . Atelectasis&&Lung Opacity 15154281 58371143 a3de483f-15711cf1-0123d198-14a34d08-69b4eca8 370 in comparison with the study of , allowing for the pa and lateral projections, the right mediastinal border of the heart is slightly less prominent . no evidence of acute focal pneumonia or vascular congestionthere is loss of height of several vertebral bodies in the thoracic region, not appreciated on the most recent available study in . Cardiomegaly 15167936 52093968 3d94f5e0-24d15a0d-03dfa926-7bab6be7-90cc1c34 371 frontal and lateral chest radiograph demonstrates hypoinflated lungs with crowding of vasculature and bilateral lower lobe atelectasis . no pleural effusion or pneumothorax . no pneumomediastinum . subtle blunting of the left cardiophrenic angle is most consistent with scarring . prosthetic valves are noted, most likely mitral and aortic . intact median sternotomy wires . a mildly calcified, tortuous aorta is present . the heart is mildly enlarged . limited assessment of the upper abdomen is within normal limits . no acute cardiopulmonary process . no pneumomediastinum or pneumoperitoneum . No Finding 15175883 57698298 e0f060fd-48f99877-e59be55f-f3ff2bba-0228b638 372 the lungs are hyperinflated with linear streaky opacities at the lung bases, likely representing atelectasisheart size is moderately enlarged but stable . aortic and tricuspid valve prostheses are in unchanged location . moderate calcification of the aortic knob is again noted . no focal consolidation concerning for pneumonia . no evidence of pulmonary edema, pleural effusion, or pneumothorax . median sternal wires are intact . moderate cardiomegaly and bibasilar atelectasis are stable from . no evidence of pulmonary edema or pneumonia . Atelectasis&&Cardiomegaly 15175883 58119115 f56565b1-4dff7a18-f696ea91-96947d34-0faf11b6 373 there has been interval placement of a left-pectoral cardiac device with one lead terminating in the right ventricle . lung volumes are low and there is a small amount of right middle lobe atelectasis . otherwise, no significant interval change . stable prominence of the cardiomediastinal silhouette, which may be secondary to slight apical lordotic technique and low lung volumes . stable appearance of the hila and pleura . no focal consolidation, pleural effusion, pulmonary vascular congestion, or pneumothorax . no acute intrathoracic process . No Finding 15187487 50734654 bdf52938-8cefb7d7-cfd86285-f8f1537b-7224f6fe 374 left-sided pacer defibrillator and single lead are in unchanged position . cardiomediastinal and hilar contours are within normal limits unstable . lung volumes are low . there is no focal consolidation, effusion or pneumothorax . left costophrenic pleural thickening is stable . no acute cardiopulmonary abnormality . No Finding 15187487 53945155 ce90119b-f1d03bb8-42218616-235c6432-9277af77 375 in comparison with the study of , there are again low lung volumes that accentuate the transverse diameter of the heart and tortuosity of the aorta . no evidence of acute focal pneumonia, vascular congestion, or pleural effusion . Cardiomegaly 15187487 59454021 c5a0eb3d-8ed144a5-5a58bf8f-4bb89eaf-e4557889 376 heart size is normal and without change . mediastinal and hilar contours are also normal . lungs and pleural surfaces are clear . no acute skeletal findings . stable radiographic appearance of the chest with no acute cardiopulmonary radiographic abnormalities . No Finding 15195289 52317337 2694726b-b64f21d1-40b204a6-b4106d63-e6e4af86 377 in comparison to the chest radiographs obtained , no significant changes are appreciated . lungs are fully expanded and clear without consolidations or suspicious pulmonary nodules . no pleural abnormalities . heart size is top normal . cardiomediastinal and hilar silhouettes are normal . cervical fusion hardware is incompletely evaluated on this study . no radiographic evidence of pneumonia or other significant cardiopulmonary abnormalities . No Finding 15195289 52950410 89db0697-aa26530a-d451eb99-319b8e78-39a6aeb0 378 heart size is at upper limits of normal or slightly enlarged, similar to . aorta is minimally unfolded . possible minimal upper zone redistribution, but no overt chf . no focal infiltrate or effusion . no pneumothorax detected . mild eventration of the right hemidiaphragm is unchanged . borderline low inspiratory lung volumes . in the extreme upper aged these films, the lower portion of his cervical spine fixation hardware is noted . heart size at the upper limits of normal or slightly enlarged, unchanged compared with . mild upper zone redistribution, also similar to prior, without overt chf . otherwise, no acute intrathoracic process . No Finding 15195289 58574233 ca6270f2-04c17d88-cd4d219a-ba2ce815-f95b4e51 379 in comparison with the study of , there is little change and no evidence of acute cardiopulmonary disease . cardiac silhouette is at the upper limits of normal in size and there is no vascular congestion, pleural effusion, or acute focal pneumonia . cervical fusion device is again seen . No Finding&&Support Devices 15195289 59968677 97665b53-8da96eef-00829a6c-105f445c-be77a88d 380 as compared to the previous radiograph, no relevant change is seen . normal size of the cardiac silhouette . normal hilar and mediastinal structures . no pleural effusions . no pneumonia, no pulmonary edema . No Finding 15275519 55387859 9299fa90-c463e69b-c74b271b-8e905160-ed906c51 381 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 15295867 52226505 cff48e01-d2db0222-9bbd6a26-6d30a9ba-b91e3ffa 382 frontal and lateral chest radiographs demonstrate unremarkable cardiomediastinal contours . the lungs are clear . no pleural effusion or pneumothorax identified . no osseous abnormality . normal chest radiograph . no evidence of active tuberculosis . No Finding 15303282 55911809 b2dcef8d-c2328b84-d47a7ecc-042df2f7-4aab73c7 383 linear right upper lung opacity most likely represents atelectasis . no definite focal consolidation is seen . no pleural effusion or pneumothorax is seen . the cardiac and mediastinal silhouettes are unremarkable . linear right upper lung opacity most likely represents atelectasis rather than consolidation due to pneumonia . Atelectasis&&Lung Opacity&&Pneumonia 15343139 58133024 91b36d79-326b86ae-773d6a6f-2d9a9401-bfe405dc 384 frontal and lateral views of the chest were obtained . there is no focal consolidation, pleural effusion or pneumothorax . heart size is normal . mediastinal silhouette and hilar contours are normal . normal chest radiographs . dr . a preliminary report to dr . by phone at pm on . No Finding 15413165 50319609 4b900027-eae3a3b7-e4d8b930-1b7322f7-2efeef42 385 pa and lateral views of the chest . no prior . the lungs are clear of focal consolidation or effusion . cardiomediastinal silhouette is within normal limits . osseous and soft tissue structures are unremarkable . no acute cardiopulmonary process . . No Finding 15413165 58171899 127bf93a-197127b6-f778134c-daa7bac1-f104f57e 386 the cardiomediastinal contours are within normal limits . the bilateral hila are unremarkable . there is a right lower lobe opacity which is concerning for developing infection . the remainder of the lungs are clear . there is no evidence of pulmonary vascular congestion . there is no pneumothorax or pleural effusion . right lower lobe pneumonia . Pneumonia 15436594 56734350 2bf97d91-aeecb635-55ed5060-aea787be-5271de06 387 heart size is normal . the mediastinal and hilar contours are unremarkable . pulmonary vasculature is normal . scarring within the lung apices is unchanged . no focal consolidation, pleural effusion or pneumothorax is present . mild degenerative changes are again noted in the imaged thoracic spine . no acute cardiopulmonary abnormality . No Finding 15456033 51937974 ccbd2311-fc323e32-01acc861-6baf59d1-7fac2f5b 388 the lungs are well expanded and clear . cardiomediastinal and hilar contours are unremarkable . there is no pleural effusion or pneumothorax . no evidence of acute cardiopulmonary process . No Finding 15457431 57184085 952a19af-b73f31e5-ea3c88bc-315847ec-97e78512 389 the lungs are clear without focal consolidation . no pleural effusion or pneumothorax is seen . the aorta is calcified and tortuous . the cardiac silhouette is top-normal . mild biapical pleural thickening is seen . no focal consolidation to suggest pneumonia . Pneumonia 15461483 57395944 cfce55c4-645f48d5-67d2eb78-e6c3fe6e-9489f536 390 heart size, mediastinal and hilar contours are within normal limits and without change . lungs are clear except for a small linear focus of atelectasis of scar at the left lung base . no pleural effusion or acute skeletal findings . no radiographic findings to suggest the presence of sarcoid or tuberculosis . No Finding&&Support Devices 15479108 50384009 d8b7273b-a7fcc609-c3282bbb-34e43194-ff77283e 391 no focal consolidation is seen . small pulmonary nodules reported on prior chest ct from were better assessed on that more sensitive study and follow-up recommendation per that study remains . no pleural effusion or pneumothorax is seen . the cardiac and mediastinal silhouettes are stable . no acute cardiopulmonary process . no focal consolidation to suggest pneumonia . small pulmonary nodules reported on prior chest ct from were better assessed on that more sensitive study and follow-up recommendation per that study remains . Lung Lesion&&Pneumonia 15585360 52078228 cdbb816d-5149649c-ae5f5de6-9c97c843-aeb02508 392 pa and lateral chest radiograph demonstrate clear lungs bilaterally . there is no pleural effusion or pneumothorax . cardiomediastinal and hilar contours are within normal limits . no overt pulmonary edema . a large hiatal hernia is again identified . osseous structures are without an acute abnormality . large hiatal hernia . no acute intrathoracic abnormality . 15658321 50006562 643dcfc3-df3d87ec-c5b390e2-4483ada9-b37c922f 393 chest, pa and lateral . the lungs are clear . nodular opacities over the lung bases most consistent with nipple shadows . a large hiatal hernia is redemonstrated . otherwise, the hilar and cardiomediastinal contours are normal . there is no pneumothorax or pleural effusion . pulmonary vascularity is normal . . no acute cardiopulmonary process . . large hiatal hernia . 15658321 53093195 eea74349-5461aadf-23d886d2-2d1cc279-a753eb82 394 a very large hiatal hernia is again demonstrated, unchanged in configuration since the radiographs . the heart size remains within normal limits . the hilar and mediastinal contours are normal . there is no focal consolidation, pneumothorax, or pleural effusion . no acute intrathoracic process . unchanged large hiatal hernia . notification the findings were discussed by dr . with dr . on the telephone on at pm, minute after discovery of the findings . 15658321 54415831 2334929e-1e2a581e-82ff2163-5a51b1f9-316bc604 395 there is no focal consolidation, pleural effusion or pneumothorax . cardiomediastinal silhouette is within normal limits . a large hiatal hernia is noted . no acute fractures are seen . no free air under the right hemidiaphragm . . no acute intrathoracic process . . large hiatal hernia . 15658321 58254317 593ece09-48ef4c41-fea2a357-67004038-0e886e64 396 the cardiomediastinal and hilar contours are normal . there is no pleural effusion or pneumothorax . there is no focal consolidation concerning for pneumonia . pulmonary vasculature is within normal limits . the upper abdomen is unremarkable . no acute cardiopulmonary process . No Finding 15659017 54417884 787e7af6-b1d3f2a1-81b39649-9ac3a846-1380d48f 397 heart size and mediastinum are stable . pacemaker leads terminate in right atrium and right ventricle . the patient is after right hemithorax surgery . diffuse interstitial opacities overall are unchanged except for right mid lung, where there is a concern of new consolidation . left basal opacity appears to be overall stable . concern for developing right upper lobe and unchanged left lower lobe opacities concerning for multifocal infectious process . Lung Opacity&&Pneumonia 15693523 51055127 ce085ac9-380a3af0-26189a25-67e34038-82954f13 398 better delineated on recent ct scan is a left hilar mass compatible with patients known malignancy with complete left lower lobe collapse is again seen . scattered opacity in the aerated left upper lobe are compatible with opacity seen on recent ct . the right lung is grossly clear . mediastinal shift to the left is as seen on prior . left chest wall dual lead pacing device and right port-a-cath are again seen . widespread metastatic disease is better seen on prior ct scan . no significant interval change noting left perihilar mass with subsequent left lower lobe collapse and opacities in the aerated left upper lobe . Atelectasis&&Lung Lesion&&Lung Opacity 15693523 52654474 116fcb38-1309dd16-16643cd1-262b2801-bcc0a0bf 399 left-sided pacemaker device with leads terminating in the right atrium and right ventricle is noted . heart size is normal . mediastinal and hilar contours are unremarkable . apical predominant emphysema is noted . there is no pulmonary edema . linear scarring within the left upper lobe is seen . left lower lobe ill-defined opacity is concerning for pneumonia . no pleural effusion or pneumothorax is seen . scarring within the apices is demonstrated . several clips are demonstrated within the posterior mediastinum superiorly . additionally there appears to have been prior resection of the right posterior rib . left lower lobe ill-defined opacity concerning for pneumonia . followup radiographs after treatment are recommended to ensure resolution of this finding . Lung Opacity&&Pneumonia 15693523 57108434 39623822-10ce4ab6-684d8f03-25ca8526-4136f1fb 400 the heart is mildly enlarged but not significantly changed since earlier examinations . the cardiac, mediastinal, and hilar contours appear similar . the lungs are clear . there are no pleural effusions or pneumothorax . mild-to-moderate degenerative changes are similar along the thoracic spine . no evidence of acute disease . No Finding 15718331 52552455 2475d419-36bd3605-ce47decf-c2d3ebce-4f860c29 401 the lungs remain hyperinflated consistent with patients history of underlying emphysema . areas of calcified pleural plaques previously demonstrated on ct account for the focal calcific densities overlying bilateral lungs . there are no focal consolidations, effusions, or pneumothoraces . the cardiomediastinal silhouette is normal . no acute fractures are identified . no acute cardiopulmonary process . No Finding 15732468 53441107 bca22183-8c2b4234-3bb8fbcf-d0f4efb0-678b48ae 402 heart size is normal . cardiomediastinal silhouette and hilar contours are unremarkable . multiple scattered calcified pleural plaques are suggestive of prior asbestos exposure . lungs are otherwise clear . there is no pleural effusion or pneumothorax . the bony structures are grossly unremarkable with fracture . . no acute intrathoracic process, specifically no evidence of rib fracture . . asbestos-related pleural plaques . 15732468 53686865 a9e93c6f-04f9e839-999c9508-6890b550-8f0ee880 403 stable small calcified granuloma in the right lower lung . the lungs are hyper-expanded with associated flattening of the diaphragms . no focal consolidation, pneumothorax, pleural effusion, or pulmonary edema . stable normal-appearing cardiomediastinal silhouette and hila . calcified pleural plaques are unchanged from the prior exam . no acute rib fracture . . hyper-expanded lungs, consistent with emphysema . . no definite rib fracture on chest radiograph . . no acute cardiopulmonary process . Fracture 15732468 53862674 8d8a83b1-f5d26f88-bf5fc2bc-b3dd668b-33861d97 404 pa and lateral views of the chest . the lungs are clear without consolidation, effusion or pulmonary vascular congestion . cardiomediastinal silhouette is normal . no acute osseous abnormality is identified . no acute cardiopulmonary process . No Finding 15768537 52545368 c066c96c-0ea2a9d9-9583c8f7-e770d3f7-2c120854 405 as compared to the previous radiograph, the pre-existing parenchymal opacities have slightly decreased in extent and severity but are still clearly visible, notably in the region of the right apex . the bilateral pleural effusions, better visualized on the lateral than on the frontal radiograph, persist . unchanged normal hilar structures and normal size of the cardiac silhouette, with minimal calcification of the aortic wall and minimal tortuosity of the aorta . no pneumothorax . mild degenerative right shoulder disease . Lung Opacity&&Pleural Effusion 15780880 52459455 77d12f34-7559e3b5-ca659cda-05d2e515-b0726d99 406 pa and lateral views of the chest . the lungs are clear without consolidation, effusion, or pneumothorax . cardiomediastinal silhouette is within normal limits . no acute osseous abnormalities detected . no acute cardiopulmonary process . No Finding 15791567 58410337 b7067dad-3c9c3cc2-595cc8fc-fc6e7efa-6f3eaece 407 the lungs are hyperexpanded . there are bullous emphysematous changes in the lower lobes increased since . there is no focal consolidation, pleural effusion or pneumothorax . the ascending aorta is dilated and tortuous but unchanged since . the imaged upper abdomen is unremarkable . . bullous emphysematous changes in the lower lobes increased since . consideration to alpha-- antitrypsin deficiency should be given . 15793456 52887977 328c4898-15a54df3-c97f1134-fd048ae3-d95c0107 408 compared to chest radiographs since , most recently . bullous emphysema is extremely severe, with basal predominance raising possibility of panacinar emphysema due to alpha one antitrypsin deficiency . there is a very small region of possible peribronchial opacification projecting over the lower pole of the left hilus on the frontal view, and over the descending thoracic aorta on the lateral . this could be a very small pneumonia . oblique views would be helpful in evaluation . blunting of the pleural sulci is due to inversion of the displaced diaphragm, not pleural effusion . cardiomediastinal silhouette is normal . Lung Opacity&&Pneumonia 15793456 54148272 86b7942d-6aafab5f-acb47e68-1fff0868-437f35ea 409 the heart is normal in size . the mediastinal and hilar contours appear within normal limits . mildly prominent opacity in the right infrahilar region appears unchanged and is suspected to represent normal descending vascularity, which is unchanged and associated with slight leftward rotation of the heart . there are no pleural effusions or pneumothorax . no evidence of acute disease . No Finding 15846912 55127146 189951de-c5c0b41a-d14bcfd4-1e257166-1f89b5d0 410 the lungs are clear . there is no pleural effusion, pneumothorax or focal airspace consolidation . the cardiac and mediastinal contours are normal . the hilar structures are unremarkable . no acute cardiopulmonary process . No Finding 15846912 56587661 61d53449-02330de6-e967c099-549e42a6-3346afad 411 left transvenous pacemaker leads appear intact . the tips are in standard position in the right atrium, right ventricle and through the coronary sinus . there is moderate-to-severe cardiomegaly . there is moderate right and small left pleural effusion with associated adjacent atelectasis . Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices 15911529 52748820 011b341a-aa4cf984-beef2741-bca288fe-598f5273 412 the heart is again mild-to-moderately enlarged . the mediastinal and hilar contours appear unchanged, again noting calcifications along the aortic arch . the lungs are clear . there are no pleural effusions or pneumothorax . mild rightward convex curvature is centered along the mid thoracic spine with mild degenerative anterior osteophyte formation . no evidence of acute disease . No Finding 15911529 55296778 f58ceea9-b65ddd7a-210c3c5d-64f6f523-e898d9d7 413 in comparison with the study of , the patient has taken a better inspiration . pacer leads are essentially unchanged and there is no evidence of pneumothorax . No Finding&&Support Devices 15911529 58807131 196485f6-66508452-3f992f30-5e0c4182-53d9d2d0 414 in comparison with study of , there is little change and no evidence of acute cardiopulmonary disease or old granulomatous disease . No Finding 15914007 58123697 c46a9297-9c4fae50-d9821fee-6a6d4d13-2111948e 415 the heart size is top normal . the mediastinum is stable in appearance . there is redemonstration of the neoesophagus contour . there has been interval increase in bilateral pleural effusions compared to the most recent prior exam from . there is adjacent mild compressive atelectasis . there is no evidence of a pneumothorax . post-sternotomy wires are unremarkable . surgical rib fracture of the right th rib is again noted . slight interval increase in known bilateral pleural effusions, right greater than left . compared to the prior exam from , there is adjacent mild compressive atelectasis a superimposed infectious process cannot be excluded . Atelectasis&&Pleural Effusion&&Pneumonia 16029766 55454745 c03267f8-f0900e7f-f768fa2d-8ba19ccf-5d5cbc99 416 no previous images . low lung volumes accentuate the transverse diameter of the heart . no evidence of acute pneumonia or old tuberculous disease . Cardiomegaly 16030469 53444094 f5749890-f4250cdd-2292cfd3-615f2be0-8af3bc3a 417 frontal and lateral chest radiographs demonstrate a dual-lumen right chest wall dialysis line, terminating in the right atrium . the cardiomediastinal silhouette is normal and the lungs fairly well-aerated, without focal consolidation, pleural effusion, or pneumothorax . the visualized upper abdomen is unremarkable . no acute cardiopulmonary process . No Finding 16030469 55136339 66e97c1d-0fa3fcaf-2a0046b8-80ee76c8-99993f04 418 frontal and lateral radiographs of the chest show a left pectoral pacemaker with a single lead unchanged in position within the right ventricle . bilateral apical pleural thickening is unchanged . a right lower lung granuloma is stable from the preceding radiograph . the lungs are otherwise clear without pleural effusion, focal consolidation or pneumothorax . no new pulmonary nodule is detected by radiography . the pulmonary vasculature is not engorged . the cardiac silhouette is top normal in size but stable . the mediastinal and hilar contours are within normal limits and unchanged from . . no evidence of intrathoracic malignancy by radiography . . stable right lower lung granuloma . 16033763 52447787 36b80f83-181f47f3-7f54839c-4f80a1f3-60de306a 419 frontal and lateral chest radiograph demonstrate new large left pleural effusion with diffuse bilateral pulmonary nodules better seen on ct dated . there is additional shift of the mediastinum to the right with an enlarged heart . question pleural effusion . no evidence of tamponade . there is collapse of the left lower lobe . there is no pleural effusion on the right . there is no pneumothorax . a single chamber pacemaker is identified with its tip terminating in the right ventricle in standard position . new left large pleural effusions with pulmonary nodules bilaterally . question enlarged heart with pleural effusion . no evidence to suggest tamponade . these findings were communicated to the ordering physician . by dr . at on . Cardiomegaly&&Lung Lesion&&Pleural Effusion 16033763 53913303 0c7700b8-19401338-187bcaf9-bf35ab7d-5ffed660 420 frontal and lateral radiographs of the chest demonstrate diffuse bilateral pulmonary nodules which are unchanged from . there has been interval increase in the size of the large left pleural effusion, now with some adjacent atelectasis in the left upper lung zone . there is no pleural effusion in the right lung . again seen is a single-chamber pacemaker with tip terminating in the right ventricle, in the standard position . no pneumothorax . right-ward shift of the mediastinum is unchanged . interval increase in size of large left-sided pleural effusion with adjacent atelectasis . Atelectasis&&Pleural Effusion 16033763 55332727 a6c52f01-34a7d3e3-2a99de86-82d9a4b5-e07086f7 421 small left pleural effusion has decreased since , basal pleural tube still in place . very large cardiac silhouette may have decreased slightly in size . there is also the suggestion that some of the lung nodules in the right lung may be slightly smaller, but this determination is better made, particularly if there is substantial clinical significance, by ct scanning measurements . transvenous right ventricular pacer lead unchanged in position . no appreciable pneumothorax . Cardiomegaly&&Lung Lesion&&Pleural Effusion&&Support Devices 16033763 57627815 91148fbd-f4022f33-a996798f-03c3a1fe-69f478ce 422 there is a new . cm nodule within the left lower lobe, abutting the heart border on the ap view . the lungs are otherwise clear . there is no effusion, or pneumothorax . there is unchanged hyperexpansion of the lungs . the cardiac silhouette is unchanged in size, top normal . a left pectoral pacemaker is unchanged in appearance, with a single ventricular lead remaining intact . new . cm nodule in the left lower lobe, in a patient with history of melanoma is concerning for metastasis . findings were discussed with at am . by phone . Lung Lesion 16033763 57701612 6127f936-4c93476d-3d0cb4aa-85926f79-3d24a610 423 comparison is made with prior study, . moderate cardiomegaly is stable . left pacemaker lead tip is in the right ventricle . there is no evident pneumothorax . bilateral pleural effusions are smaller, larger on the right side and unchanged . left chest wall subcutaneous emphysema has increased . bibasilar opacities, larger on the left side, are likely atelectasis . Atelectasis&&Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Support Devices 16033763 58051243 4dfea441-2774fd50-63f81051-acc09f94-4fa2fe80 424 frontal and lateral radiographs of the chest demonstrate persistent massive left-sided pleural effusion, occupying at least two-thirds of the left hemithorax . minimal aeration of the left upper lobe . slight interval increase in rightward shift of the mediastinum . trace pleural effusion at the right base . again seen are diffuse bilateral pulmonary nodules which are unchanged from the prior study . a single-chamber pacemaker is present with the tip terminating in the right ventricle . no pneumothorax . large left pleural effusion with minimal aeration of the left upper lobe, and slight interval increase in rightward shift of the mediastinum . Enlarged Cardiomediastinum&&Pleural Effusion 16033763 58499222 81549ff4-37400bfe-77ebb7f7-9bf5005b-2a9a6381 425 pa and lateral chest views were obtained with patient in upright position . there is moderate cardiac enlargement . the configuration suggests prominence of the left ventricular contour to the left and posteriorly as well as a moderate enlargement of the left atrium with some right-sided intracardiac double contour straightening of the left heart border . a permanent pacer is in left anterior axillary position, seen to be connected to a single intracavitary electrode terminating in a position compatible with the right ventricle . the pulmonary vasculature shows a mild upper zone redistribution pattern however, no interstitial or alveolar edema is identified . on the other hand, the marked irregular distribution of the pulmonary vessels in the periphery, coinciding with local areas of increased translucency and low position, flattened diaphragms is suggestive of copd . acute parenchymal infiltrates, however, cannot be identified . there is no pneumothorax in the apical areas . in comparison with the next preceding chest examination of , the at that time postoperative existing left-sided chest wall emphysema has absorbed . also, the left basal postoperative linear small atectatic densities have normalized . also, noteworthy in comparison with the previous study is that the, at that time existing more marked cardiac enlargement and the bilateral small amount of pleural effusions have disappeared . Cardiomegaly&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Support Devices 16033763 59137251 dedbcf5c-540d2883-d85fbcfd-dfec626d-9621d11b 426 interval improvement in pulmonary edema with residual interstitial edema remaining . cardiac silhouette is stable in size, and note is made of a moderate hiatal hernia . bilateral small pleural effusions are also present . increased lung volumes are suggestive of copd . . improving pulmonary edema with residual interstitial edema remaining as well as small bilateral pleural effusions . . moderate hiatal hernia . Edema&&Pleural Effusion 16034181 53395975 77e5731e-4cd67ee6-56cf33fa-772c6c6b-4e25a333 427 there is slight increase in interstitial markings involving the right lung, particularly the right lung base, to a lesser extent the left lung base which may be due to chronic lung disease however, atypical infection is not excluded . no lobar consolidation is seen . there is no large pleural effusion or pneumothorax . the cardiac silhouette is top normal . aortic knob calcification is again seen . mediastinal contours are relatively stable . Enlarged Cardiomediastinum&&Lung Opacity&&Pneumonia 16034181 56963809 7692121e-81594620-38286eb8-1059dec5-06a3d2b9 428 comparison is made to prior study from . heart size is upper limits of normal but is stable . there is no focal consolidation, pleural effusion or signs for acute pulmonary edema . there is likely a small pleural effusion on the left side, best seen on the lateral view . Cardiomegaly&&Edema&&Pleural Effusion 16034181 58564406 95f4c351-08ade2e1-786e44a0-8d53ac86-c22dc8c7 429 there appears to be slight interval increase in opacification overlying the right lower lobe . there is stable mild-to-moderate cardiomegaly with mild pulmonary vascular engorgement . there is no evidence of pulmonary edema . there are small bilateral pleural effusions . there is a stable hiatal hernia . there is no evidence of pneumothorax . the visualized osseous structures are unremarkable . slight interval increase in consolidation overlying the right lower lobe concerning for pneumonia . Consolidation&&Pneumonia 16034181 59599710 b399bd52-4c8c5e61-6bb23031-5843f7ed-c1134475 430 heart size is normal . tortuous aorta is noted . mediastinal contours is unremarkable . lungs are hyperinflated . no definitive evidence of lobectomy demonstrated . questionable right upper lobe opacity might represent asymmetric emphysema or potentially other lung abnormality . left basal linear opacity most likely represent atelectasis . sclerotic lesion in the left humeral s is partially imaged . compression fractures in the thoracic spine and lumbar spine are multiple . no pleural effusion or pneumothorax is seen . comparison to previously images as well as assessment with dedicated left shoulder and left humerus radiographs is required . Atelectasis&&Fracture&&Lung Opacity 16126373 56784795 e04746db-68c79c74-d16fbc0d-489249c6-aa7df779 431 the lungs are clear . there is no effusion, consolidation, or pneumothorax . the cardiomediastinal silhouette is normal . no acute osseous abnormalities identified . normal chest x-ray . No Finding 16136825 56242356 f0cf07bf-52eaa447-3c2c74a7-55295a62-a962b099 432 cardiomediastinal contours are normal . small bilateral effusions are associated with adjacent atelectasis left greater than right . there is no pneumothorax . no evidence of pneumonia . small bilateral effusions with adjacent small atelectasis . Atelectasis&&Pleural Effusion 16139394 57198860 befedeee-9f8df55c-4957be6a-81c9d6ff-3f641e1c 433 the lungs are well inflated and clear . heart size is normal and mediastinal contours are unremarkable . no pleural effusion or pneumothorax . osseous structures are intact . no acute cardiopulmonary process . No Finding 16143638 57800025 f2d4b82f-bbc3f47a-ffa13252-797ba37a-e52591b3 434 cardiomediastinal silhouette is normal . there is no pleural effusion or pneumothorax . there is no focal lung consolidation . no evidence of pneumonia . No Finding 16145265 52402962 6c4ce28b-408c6a59-f54ae6fe-dc6b0ebf-c5c1cc34 435 cardiac silhouette is upper limits of normal in size . mediastinal and hilar contours as well as pulmonary vascularity are within normal limits . lungs and pleural surfaces are clear . no acute skeletal findings . no acute cardiopulmonary radiographic abnormality . No Finding 16145265 55123749 964b2018-3d3a8dc6-c637225e-16e9a8f8-dabd5c4c 436 there is a persistent nodular opacity projecting over the right mid lung measuring approximately x mm for which ct is recommended to further assess . in addition, there is right basal atelectasis . the possibility of additional nodules is difficult to entirely exclude . there is subtle opacity adjacent to left heart border on the frontal projection which could represent a prominent fat pad versus a very early pneumonia . no large effusions are present . calcified pleural plaque is noted on the lateral projection along the posterior pleural surface . the cardiomediastinal silhouette is stable . bony structures are intact . . nodular opacity projecting over the right mid lung, as seen previously and chest ct is again recommended to further assess . . additional subtle opacities in the right and left lower lungs which could represent atelectasis though the possibility of pneumonia is difficult to entirely exclude . Atelectasis&&Lung Lesion&&Lung Opacity&&Pneumonia 16159370 52514999 b8d59f8b-a58efaf2-9c361139-8ce4f7c1-6f948185 437 comparison is made with prior study . right pleural effusion is small . there are low lung volumes . mild-to-moderate cardiomegaly is stable . the aorta is tortuous . right lower lobe opacities are persistent including more lateral rounded opacities from , the growth cannot be assesed due to different inspiration and position of the patient . right mid lung scarring is stable . right lower lobe lung nodules . ct is recommended . Lung Lesion&&Pleural Effusion 16159370 59479332 9f1b0e81-d1968ae2-d78e5c31-fb737c29-9ef07a21 438 the lungs are well expanded and clear . cardiomediastinal and hilar contours are unremarkable . there is no pleural effusion or pneumothorax . no evidence of acute cardiopulmonary process . No Finding 16172396 50937713 6f4705d9-33c6c0d9-d5c126c5-2710e4b6-1738c4bb 439 no focal consolidation, pleural effusion, pneumothorax or pulmonary edema is seen . heart and mediastinal contours are within normal limits . no radiographic evidence for acute cardiopulmonary process . sensitivity of routine chest radiography for rib fracture is low . this study is not tailored for evaluation of the left shoulder . Fracture 16172396 51932011 fe24eab1-ee7ade48-c989c10b-512e9081-036b7c17 440 heart size and cardiomediastinal contours are normal . lungs are clear without focal consolidation, pleural effusion, or pneumothorax . chronic left rib fracture is stable . no acute cardiopulmonary process . No Finding 16172396 54875360 088e81ed-7922aa11-c825f648-1b390ce3-e6f8b18f 441 the heart is normal in size . the mediastinal and hilar contours appear within normal limits . there is no pleural effusion or pneumothorax . minimal left basilar opacity suggests minor atelectasis . otherwise, the lungs appear clear . small osteophytes are noted along the lower thoracic spine . no evidence of injury . No Finding 16172396 55812319 69993378-c937a43f-67393866-a501ac76-1a78ed84 442 since prior, there is no significant interval change . heart size and cardiomediastinal contours are normal . the lungs are clear without focal consolidation . there is no pneumothorax or pleural effusion . chronic left rib fracture, again seen . no radiographic explanation for chest pain . No Finding 16172396 58362071 f7dc11e5-43c374d7-48d89864-86815a5f-388045ef 443 lung volumes are somewhat low but clear . the cardiomediastinal silhouette and contour are within normal limits . there is no pleural effusion or pneumothorax . old lateral left eighth rib fracture is again noted . there is atelectasis at the left lung base . no acute cardiopulmonary process . No Finding 16172396 59945120 2a8b4162-428841d5-78833596-19ea5555-bfe4701b 444 pa and lateral views of the chest are obtained . the lungs are clear bilaterally without focal consolidation, effusion, or pneumothorax . heart and mediastinal contours appear normal . the imaged osseous structures are intact . bony structures are intact . no free air below the right hemidiaphragm . no signs of pneumonia or other acute intrathoracic process . No Finding 16185004 50957128 604f38a3-9910dd87-7fff1923-fd7b0ea5-228ab209 445 the mediastinum appears widened especially comparatively to the most recent prior chest x-ray however some of this may be due to low lung volumes . the lungs are clear . there is no evidence of pneumonia, pneumothorax, or pleural effusion . widened mediastinum which could be secondary to many factors including low lung volumes however acute aortic pathology cannot be ruled out on the basis of this radiograph . on attending readout comment is also noted that the tissue posterior to the sternum was thickened . all these findings are probably due to low lung volumes and a repeat pa and lateral radiograph with full inspiration would be able to better assess the situation . updated findings after attending readout discussed with at am via telephone . initial findings discussed with at am via telephone . Enlarged Cardiomediastinum 16197098 52663873 ad7d1cde-f67b3e6f-3420f812-641b1b2f-b2441e48 446 the lungs are clear without focal consolidation . no pleural effusion or pneumothorax is seen . heart size is normal . heart size is normal . No Finding 16265536 59563273 94559fca-c712619f-88d28bb4-241c950e-94d1d4a5 447 frontal and lateral views of the chest were obtained . the lung volumes are slightly low . no focal consolidation, pleural effusion or evidence of pneumothorax is seen . cardiac and mediastinal silhouettes are unremarkable . no acute cardiopulmonary process . No Finding 16287857 50092703 918b3685-2e9bcd30-3df57797-5bff4c65-4437c8b5 448 lungs are clear . cardiac silhouette is normal . there is no pleural effusion or pneumothorax . no evidence of acute cardiopulmonary process . No Finding 16288388 50020535 c78c0eb4-e2192739-b11564a9-fdd1ae3b-2041db15 449 left pectoral pacemaker has a lead terminating in the right ventricle . there are small bilateral pleural effusions and right lung base atelectasis . cardiomediastinal silhouette is normal size . no evidence of pulmonary edema is identified . small bilateral pleural effusions and right lung base atelectasis . Atelectasis&&Pleural Effusion 16289688 50432710 88848743-c43a0962-5d8b16f5-85267238-f8d9cd7e 450 cardiac size is top normal . the aorta is tortuous . the lungs are grossly clear . there is no pneumothorax or effusion . severe degenerative changes are present in the thoracic spine . No Finding 16289688 56891018 9b254c46-2e16d5a7-6017b84a-9c1de7d5-43037945 451 pa and lateral views of the chest . moderate cardiomegaly is unchanged . calcification in the aortic knob is unchanged . compared to study of , the pulmonary edema has resolved . there is no focal consolidation or pleural effusion or pneumothorax . there is mild scarring at the apices . no acute cardiopulmonary process . moderate cardiomegaly . Cardiomegaly 16319384 51991869 374b061d-8ac364d9-175a127c-5c6cff5a-98e8a57c 452 in comparison with study of , there is now a dual-channel pacer device in place with leads extending to the right atrium and region of the apex of the right ventricle . cardiac silhouette is within normal limits and there is no vascular congestion, pleural effusion, or acute focal pneumonia . No Finding&&Support Devices 16319384 52386935 804b8d22-6d1eb472-77b4a9b3-2a62bd27-a1d390a9 453 pa and lateral views of the chest . left-sided pacemaker wires are stable . there is no focal consolidation, pleural effusion or pneumothorax . the cardiomediastinal and hilar contours are normal . no acute cardiopulmonary process . No Finding 16319384 59369376 4a0e4892-05ce6193-0cd30bb3-2ab7b697-539ea57d 454 the lungs are hyperinflated . blunting of the right lateral costophrenic angle is chronic and likely due to component pleural scarring . superimposed trace effusions are also possible . streaky left basilar opacities are likely atelectasis . there is mild pulmonary vascular congestion without overt edema . cardiac enlargement is stable compared to prior . atherosclerotic calcifications noted at the aortic arch . no acute osseous abnormalities . cardiomegaly with mild vascular congestion without overt edema or focal consolidation . Cardiomegaly&&Edema 16346354 50825553 680b5549-8b23749a-6d908684-c364b8db-473d4e7e 455 mild cardiomegaly is present with left ventricular configuration of the heart . aorta is tortuous, and pulmonary vascularity is normal . focal linear scar in the lingula is present as well as localized appear pleural and parenchymal scarring at the right base, with latter unchanged since the prior study . there is no pleural effusion cardiomegaly without evidence of congestive heart failure . Cardiomegaly 16346354 55299733 92a5d6c1-3f56ede1-91a82ea3-97a0a28c-b540ac54 456 the cardiac and mediastinal silhouettes are stable . hilar contours are stable . there is persistent blunting of the right costophrenic angle . there is mild increased interstitial markings bilaterally suggesting interstitial edema . left mid lung atelectasis is linear . no pneumothorax is seen . cardiomegaly and interstitial pulmonary edema . persistently prominent hila may be due to pulmonary are partial hypertension . . Cardiomegaly&&Edema 16346354 55956507 4dd14141-717a2a23-ca41af2c-d7723505-840e9c37 457 the cardiac, mediastinal and hilar contours appear stable including mild to moderate cardiac enlargement including a left ventricular configuration . the aorta is mildly tortuous and calcified . the cardiac, mediastinal and hilar contours appear stable . streaky scarring in the lingula is unchanged . fissures are slightly thickened, which is somewhat increased suggesting mild vascular congestion . there is a new trace pleural effusion on the left . slight pleural thickening of the right is probably unchanged . increased interstitial opacity in the right lower lung, although regional, may represent vascular congestion . there is no pneumothorax . no definite fracture is seen . findings suggest mild vascular congestion . no definite rib fracture identified . dedicated rib series would be more sensitive to detect rib fracture if needed clinically . Edema&&Fracture 16346354 56181168 f58f13fc-5e0dd5d2-eb74ea1e-e45cb8dd-be5cda6e 458 an icd is in place . lead overlies right atrium and an other overlies the right ventricle . the third lead courses posteriorly and lies in the expected location of the coronary sinus . there is a small effusion at the right costophrenic angle . there is probable atelectasis with a small curvilinear sliver of air in between . this is less likely to represent a right lung base pneumothorax, as there is no corresponding abnormality on the lateral view . left costophrenic sulcus is clear . no overt chf or focal infiltrate identified . no apical pneumothorax detected . background hyperinflation likely present, similar to prior icd leads over right atrium, right ventricle, and in region of coronary sinus . probable atelectasis and small right pleural effusion new or more pronounced than on . right lung base pneumothorax is considered much less likely . attention to this area on followup films is requested . Atelectasis&&Pleural Effusion&&Pneumothorax&&Support Devices 16346354 59889283 81352ea3-46dd9764-71a8e980-798f84b0-45f4f3e5 459 the lung volumes are somewhat low, accentuating retrocardiac vascular markings . no discrete consolidation, pleural effusion, pneumothorax, or pulmonary edema is identified . the heart size is normal . suggestion of a slight impression upon the right aspect of the trachea at the level of the thoracic inlet is noted . no acute cardiopulmonary process . suggestion of slight fullness at the right thoracic inlet may be due to a thyroid nodule or thyroiditis . correlation with clinical exam is recommended . Lung Lesion 16456728 52571563 cfaacd99-7ac63214-6b328e63-b94c98af-9872e989 460 pa and lateral views of the chest were obtained . cervical fixation hardware is again noted in the lower cervical spine . the lungs are clear bilaterally without focal consolidation, effusion, or pneumothorax . the heart and mediastinal contours are normal . bony structures are intact . no acute intrathoracic process . No Finding 16465340 55965016 dc37af08-8279822c-2a010ca6-ddf93db7-69abdb4e 461 cardiac size is top normal . the lungs are clear . there is no pneumothorax or pleural effusion . there are mild degenerative changes in the thoracic spine . No Finding 16466095 55834788 f340d494-fb8d53ea-c889abd7-3e0ded96-3211d305 462 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 Finding 16469493 51880113 2868887b-fff9f2f7-a10ff53d-11548e39-4332837d 463 the lungs are clearthe cardiac, hilar and mediastinal contours are normalno pleural abnormality is seen . radiopaque density overlying the left heart border is external to the chest wall . no acute cardiopulmonary process . No Finding 16476300 51687670 e33fa528-3c176030-592d4d75-9395739d-2f4c25a2 464 the lungs are hyperinflated . there are no focal opacities suggestive of pneumonia . cavitary lesion with adjacent scarring is seen in the right upper lobe periphery, unchanged from . cardiomediastinal and hilar contours are unremarkable . there is no pleural effusion or pneumothorax . mild pectus excavatum is redemonstrated . hyperinflated lungs . no evidence of pneumonia . 16529785 56625524 6d896995-e8f0c6a9-33a67c60-4e7b80f4-9e94ac30 465 post left lobectomy with slight increased prominence of postsurgical scarring from previous examination . interval increased reticular infiltrate and honeycomb appearance of the right lung base . pectus excavatum deformity . interval increased right reticular infiltrate could represent pneumonia or interstitial lung disease . noncontrast chest ct is recommended for further characterization . recommendations interval increased right reticular infiltrate could represent pneumonia or interstitial lung disease . noncontrast chest ct is recommended for further characterization . Lung Opacity&&Pneumonia 16615572 54982764 eace0477-37c4a4fd-a3506e90-640be36b-33ed8594 466 patient is sp left upper lobectomy . cardiomegaly is mild . the ascending aorta is tortuous . the pulmonary vasculature is normal . no focal consolidation, pleural effusion, or pneumothorax . pectus excavatum but no evidence of acute abnormality or intrathoracic malignancy . no evidence of acute abnormality or intrathoracic malignancy . No Finding 16615572 56371656 845caf2b-a844a1eb-7e01fbc3-43aac027-d0d17998 467 the cardiomediastinal and hilar contours are normal . the lungs are clear . there is no pleural effusion or pneumothorax . examination of the thoracic spine shows no compression deformity and no changes compared to the chest radiograph . additionally, subtle contour irregularities at the costovertebral junctions of the posterior aspect of the right upper ribs suggest old healed injury, also unchanged from chest radiograph . no acute cardiopulmonary process no evidence of acute thoracic spine or rib fracture . No Finding 16617702 50577627 8516b7c2-bc3304e9-1feaa3ac-b755f740-eef350d8 468 since the prior film, there is a new small left-sided pleural effusion with a left lower lobe consolidation . the right lung remains clear . the cardiomediastinal silhouette is difficult to evaluate secondary to pleural effusion and consolidation . the bones are intact . consolidation likely pneumonia in the left lower lobe with associated small pleural effusion . Consolidation&&Pleural Effusion&&Pneumonia 16617702 58848750 102f4ba7-1322e8d6-a5776e75-ccf4447a-7d64aa0c 469 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 Finding 16643695 50835299 f212b3f4-b1b8e805-038e1a42-b7593ac7-f038a750 470 the cardiac and mediastinal silhouettes demonstrate calcification of the aortic arch but otherwise appear grossly unremarkable . there is slight blunting of the right costophrenic angle, probably representing changes of atelectasis . no definite consolidative process is seen . no other focal pulmonary opacity, pleural effusion, or evidence of pneumothorax . examination of osseous structures demonstrate mild anterior shortening of a mid thoracic vertebral body, but are otherwise unremarkable . probable atelectasis at the right lung base . no definite consolidation . Atelectasis 16683757 54335653 85075912-24fd6f93-372dd618-02e8b4b1-acf0b956 471 the lungs are clear without focal consolidation . no pleural effusion or pneumothorax is seen . the cardiac silhouette is top-normal to mildly enlarged . mediastinal contours are unremarkable . no pulmonary edema is seen . top-normal to mildly enlarged cardiac silhouette . no pulmonary edema . no focal consolidation . Cardiomegaly 16686190 59889763 49af2ff8-ff268b7f-50035a5b-237ad933-2159c08d 472 pa and lateral views of the chest there is moderate enlargement of the cardiac silhouette . the aorta is mildly tortuous and calcified . pulmonary vascularity is not engorged . ill-defined opacity is noted within the right lung base, which is concerning for an infectious process . there is no large pleural effusion or pneumothorax . mild degenerative changes are noted in the thoracic spine . multiple clips are seen within the upper abdomen . ill-defined opacity within the right lung base which is concerning for pneumonia . followup radiographs after treatment are recommended to ensure resolution of this finding . Lung Opacity&&Pneumonia 16698318 50289779 85b47dcf-a5b619d4-60c3593d-76bf6fec-02ea2a87 473 pa and lateral chest radiographs were obtained . there is an ill-defined opacity in the right lower lobe that does not obscure the right heart border . a right-sided pleural effusion is small . there is no pneumothorax . cardiomegaly is mild . aortic calcifications are minimal . right lower lobe pneumonia and small right pleural effusion . discussed with dr phone at . Pleural Effusion&&Pneumonia 16698318 55141338 c34ed3e3-bb96ed94-9a7e3ce0-7e06cff2-ced55bdc 474 right picc tip terminates in the mid lower svc, unchanged . heart size is normal . mediastinal and hilar contours are normal . lungs are clear . pulmonary vasculature is normal . no pleural effusion, focal consolidation or pneumothorax is present . there are no acute osseous abnormalities . no acute cardiopulmonary abnormality . right picc tip is in unchanged position, within the midlower svc . No Finding&&Support Devices 16768418 51878253 894066e5-5d358d23-4a0565ac-ebb2bd92-c882bc27 475 the cardiomediastinal and hilar contours are within normal limits . the lung fields are clear . there is no pneumothorax, fracture or dislocation . limited assessment of the abdomen is unremarkable . no acute cardiopulmonary abnormality . No Finding 16768418 57997493 cabbbf75-3fd892e6-697cd8ee-d77563dd-a174163f 476 no previous images . the cardiac silhouette is within upper limits of normal and there is no vascular congestion, pleural effusion, or acute focal pneumonia . No Finding 16771913 55520420 ef10ae5c-310b2986-3dd67831-1efa31c7-f4d1dcae 477 the cardiomediastinal and hilar contours are within normal limits . the aorta is unfolded . the lungs are clear without focal consolidation, pleural effusion or pneumothorax . no acute intrathoracic process . No Finding 16821122 51675967 d8215900-2a751f2f-0b74c0f8-0d436922-94f8738d 478 the cardiomediastinal silhouettes are stable allowing for differences due to a suboptimal inspiratory effort . there is a tortuous thoracic aorta, as on prior exam . the hila are within normal limits . there is evidence of prior right rotator cuff repair . slightly increased opacity projecting over the right mid lung on ap view likely represents crowding of normal structures . otherwise the lungs are clear . there is no pulmonary vascular congestion or pulmonary edema . there is no pneumothorax or pleural effusion . subtle right lower lobe opacity likely represents crowding of normal bronchovascular structures in the setting of low lung volumes . no pneumothorax or effusion . Lung Opacity 16821122 52076228 e230a3a1-23446c9b-9196940b-ffe3a2de-5591ac72 479 pa and lateral views of the chest provided . subtle basal opacities likely represent minimal atelectasis . no definite signs of 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 . minimal basal opacities likely represent atelectasis . Atelectasis&&Lung Opacity 16823449 58480596 4685452c-c8859fa5-a7250c35-3d46984c-9234a600 480 normal heart size, mediastinal and hilar contours . clear lungs . no pleural effusion . no acute cardiopulmonary radiographic abnormality . No Finding 16833957 56214826 8820705c-97b6153e-de30a8e7-051cd9d2-cebb4f99 481 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 Finding 16833957 59565191 047d2fd6-38d8ef84-728afc5d-09bf059d-a8694a24 482 ap upright and lateral views of the chest were provided . metallic fragments are seen projecting over the left lower lung, question retained foreign body . there is no central venous catheter identified . the lungs appear clear of consolidation, effusion or pneumothorax . cardiomediastinal silhouette is normal . bony structures appear intact . on the lateral view, there is a metallic stent projecting over the region of the axilla, though it is unclear if this is in the left or right . dialysis catheter not visualized . metallic fragmentation in the left lower lung . No Finding&&Support Devices 16851119 51129693 92f6680e-05166498-698d6769-130f7edf-4bbc67d4 483 no previous images . cardiac silhouette is within normal limits and there is no evidence of vascular congestion, pleural effusion, or acute focal pneumonia . No Finding 16862598 55607212 d6162608-9c0f3d91-70648859-d4e77cdb-4aee3538 484 the lungs are clear of airspace or interstitial opacity . the cardiomediastinal silhouette is unremarkable . no pleural effusions or pneumothorax . no acute or aggressive osseus changes . no acute radiographic intrathoracic pulmonary disease . No Finding 16921932 52048896 14b22777-f4431fac-5af907ae-36abcace-32885dba 485 heart size is normal . mediastinal and hilar contours are within normal limits . lungs are clear . pulmonary vascularity is normal . no pleural effusion or pneumothorax is present . no acute osseous abnormalities are present . no acute cardiopulmonary process . No Finding 16942853 52933933 d24a8ab9-9016718b-9c276753-154be4bb-d8a94ed2 486 the lungs are clear without focal consolidation . no pleural effusion or pneumothorax is seen . cardiac silhouette is top-normal . no overt pulmonary edema is seen . no acute cardiopulmonary process . No Finding 16959871 55173284 afa7b0ef-ab36331f-40216eed-b9cb4a50-b937d72b 487 heart size is normal . mediastinal and hilar contours are unremarkable . pulmonary vasculature is normal . an x mm nodule is demonstrated projecting over the left upper lobe . remainder of the lungs are clear without focal consolidation . no pleural effusion or pneumothorax is seen . there are no acute osseous abnormalities . mm pulmonary nodule projecting over the left upper lobe . further assessment with chest ct is recommended as this could reflect a malignancy . Lung Lesion 17002995 53093135 68061713-5fff1c59-90ebb853-44566d77-ae9fe3c9 488 there are bibasilar opacities, left greater than right, likely corresponding to findings on recent ct which were felt to most likely represent atelectasis . the dominant left upper lobe pulmonary nodule is re-demonstrated . no other areas of focal consolidation suspicious for pneumonia . no pleural effusions or pneumothorax . cardiomediastinal silhouette is within normal limits . no free air under in the hemidiaphragms . left greater than right bibasilar opacities, felt to most likely represent atelectasis on the recent ct . re-demonstration of dominant left upper lobe pulmonary nodule . Atelectasis&&Lung Lesion&&Lung Opacity 17002995 57260304 f428c50b-ff3f758f-7ec7be0b-831ee404-7190d0ed 489 frontal and lateral views of the chest were obtained . mild cardiomegaly is new since . there is calcification of the aortic knob . increased interstitial lung markings are compatible with mild pulmonary edema . patchy opacities at the lung bases may represent atelectasis, but infection cannot be excluded . minimal costophrenic blunting on lateral view suggests small bilateral pleural effusions . there is no pneumothorax . osseous structures are unremarkable . no radiopaque foreign bodies are seen . . patchy bibasilar opacities may represent atelectasis but cannot exclude infection . . new mild cardiomegaly with mild pulmonary edema and small bilateral pleural effusion . Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia 17052080 51182510 f6903ec6-d68cd572-11a44700-84d1d724-3af57b2a 490 the lungs are clear without focal consolidation . no pleural effusion or pneumothorax is seen . the cardiac and mediastinal silhouettes are normal . there is a rounded radiopaque structure with the appearance of the ring seen projecting over the left upper quadrant on the frontal view, not included on the lateral view . rounded radiopaque structure with the appearance of a ring projects over the left upper quadrant on the frontal view, not seenincluded on the lateral view . 17063660 51468217 e8d69f7c-a0a4aaaf-1fffa003-792382cb-c70f248e 491 pa and lateral chest radiographs demonstrate no focal consolidation, pleural effusion, pneumothorax, or radiopaque foreign body . the cardiomediastinal silhouette is normal . No Finding 17063660 53103953 581bd51a-61e5b86c-e90de29e-d6f1eaf5-f42cd0ff 492 there is mild-to-moderate cardiomegaly stable from . blunting of the right costophrenic angles could be due to a tiny effusion or pleural thickening . surgical clips project in the right upper paramediastinal region . the lungs are grossly clear . there is no evidence of pneumothorax . there are moderate degenerative changes in the thoracic spine . elevation of the right hemidiaphragm is stable . Cardiomegaly&&Pleural Effusion&&Pleural Other 17079101 54858608 a5db0a40-c2be39ee-96979e87-489a534d-a85b3ffe 493 compared to chest radiographs through . small bilateral pleural effusions are new or larger . moderate left basal atelectasis still present . no pneumothorax . no pulmonary edema . moderate cardiomegaly unchanged . normal postoperative mediastinum, including small retrosternal air collection appreciated on the lateral view . this also shows small volume of pre sternal subcutaneous emphysema, probably not clinically significant . Atelectasis&&Cardiomegaly&&Pleural Effusion 17093296 57108303 0aa50d1d-a705af1d-2ae94264-d816f57d-7bf020dc 494 as compared to the previous radiograph, no relevant change is seen . left pectoral port-a-cath . moderate cardiomegaly with tortuosity of the thoracic aorta and slightly enlarged aortic knob . the lung parenchyma is unchanged in radiographic appearance . no pneumonia or other parenchymal opacities . no pleural effusions . Cardiomegaly 17096560 51658352 0615d7dd-3b5b225b-dfe7b687-a299a0e3-7dcfae33 495 low lung volumes are noted with secondary bibasilar atelectasis, more so on the left . the lungs are otherwise grossly clear . the cardiomediastinal silhouette is within normal limits . no acute osseous abnormalities . no acute cardiopulmonary process . No Finding 17223574 53855769 b058bdb1-6a9896e5-00708569-5736cf87-151a9cd3 496 comparison to . no relevant change . relatively low lung volumes . borderline size of the cardiac silhouette . minimal retrocardiac atelectasis . no overinflation, no pneumonia, no pulmonary edema, no pleural effusions . Atelectasis&&Cardiomegaly 17223574 57443673 0310ac4a-6a3d539e-8a9a8d70-191de66a-68379772 497 lung volumes are low which accentuates bronchovascular markings . there is pulmonary vascular congestion and mild pulmonary edema . a more focal consolidation at the base of the right lung could reflect an area of infection in the appropriate clinical setting . no pleural effusions are seen . there is no pneumothorax . mild pulmonary vascular congestion and pulmonary edema . more focal consolidation at the base of the right lung may reflect an area of infection though is likely related to pulmonary edema . Consolidation&&Edema&&Pneumonia 17223574 59919455 32669e3a-7cb50378-471dabe1-a85d90ce-332159a5 498 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 Finding 17230915 53874691 cef536f7-4e642cbb-62068854-95acc1eb-ff276ffa 499 cardiomediastinal contours are normal . the lungs are clear . there is no pneumothorax or pleural effusion . the osseous structures are unremarkable no acute cardiopulmonary abnormalities . No Finding 17230915 58226444 07455488-3fc54c14-ee5c25d1-ce6e6897-03ddef23 500 heart size is normal . the mediastinal and hilar contours are unremarkable . the pulmonary vasculature is normal . lungs are clear . no pleural effusion or pneumothorax is seen . there are no acute osseous abnormalities . moderate degenerative changes are seen in the thoracic spine . no acute cardiopulmonary abnormality . No Finding 17257394 51500297 620e390e-9859fe21-06a3d4f4-5234159a-3a7615ba 501 lungs are clear . there is no focal consolidation, effusion, or edema . the cardiomediastinal silhouette is within normal limits . no acute osseous abnormalities . no acute cardiopulmonary process . No Finding 17257394 51686968 428c7b1c-097b77b2-e92655c6-0fba9227-1ad7dafe 502 the lungs are hyperinflated and clear . the cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal . there is no pleural effusion or pneumothorax . degenerative changes are seen in the thoracic spine . no acute cardiopulmonary process . No Finding 17257394 57891982 d1943b3d-7739ba1b-6774964a-990c66a8-9e0db49e 503 frontal and lateral views of the chest were obtained . the lungs are clear without focal consolidation . no pleural effusion or pneumothorax is seen . cardiac and mediastinal silhouettes are stable and unremarkable . no overt pulmonary edema is seen . no displaced fracture is identified . no acute cardiopulmonary process . No Finding 17257394 58095545 1f74f7c8-d728f398-72d444e8-2d41431b-e5678e43 504 cardiac, mediastinal and hilar contours are normal . mild atherosclerotic calcifications are seen at the aortic knob . the pulmonary vasculature is normal . lungs are hyperinflated but clear . no focal consolidation, pleural effusion or pneumothorax is present . moderate multilevel degenerative changes are present in the thoracic spine . no acute cardiopulmonary abnormality . No Finding 17257394 58216412 ec080570-5a1cbee6-0f62cc62-5b4bcf5e-da1a8c2c 505 lung volumes are low . the cardiac, mediastinal and hilar contours appear stable including stable cardiomegaly and tortuosity of the thoracic aorta . there is again mild relative elevation of the right hemidiaphragm . calcified nodule in the right lower lobe is again visible . the lungs appear otherwise clear . there are no pleural effusions or pneumothorax . surgical clips project over each axillary region . there has been no definite change . no evidence of acute cardiopulmonary disease . No Finding 17266832 54668084 09e51f9b-6149243e-70660f6d-66092f8e-b5342668 506 cardiomegaly is unchanged, predominantly involving left ventricle . the right basal opacity appears to be similar to the prior study . minimal amount of pleural effusion versus pleural thickening on the left is unchanged . surgical clips are projecting over the right hemithorax . there is no pneumothorax . for precise details, please review ct chest obtained the same day as well as the corresponding report . Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Pleural Other 17266832 56719925 c9e8a32b-fcefd4e7-f21032e8-020e03e5-ec6d4534 507 frontal and lateral views of the chest were obtained . lungs are clear without focal consolidation . no pleural effusion or pneumothorax is seen . cardiac and mediastinal silhouettes are unremarkable . a chronic-appearing deformity is seen at the distal right clavicle, correlate for site of pain . . no acute cardiopulmonary process . . chronic-appearing deformity at the distal right clavicle . correlate with site of pain . 17290008 51281091 3ddb84d9-7f9422cf-299f2e01-d271cb45-0de2ed3d 508 pa and lateral chest radiographs demonstrate clear lungs . the heart size is normal . the cardiac, hilar, and mediastinal contours are normal . normal chest radiographs . No Finding 17313406 54407863 dda541da-8ccc3f68-97aa6c6a-6d7a5498-db3ca231 509 the lungs are clear . there is no pleural effusion or pneumothorax . lobulation of the mediastinal contour of the main pulmonary artery and the left hilus could be due to mild adenopathy . any prior radiographs should be obtained to see if this is a new finding . if stability cannot be determined, i recommend repeat cxr in weeks . no pneumonia . possible mild central adenopathy requires follow was paged . No Finding 17346035 59048448 c72f3502-8d982413-ca2511b6-441e719e-a0c293c9 510 frontal and lateral chest radiographdemonstrates well expanded lungs . no chf, focal infiltrate, pleural effusion or pneumothorax detected . heart size, mediastinal contour, and hila are unremarkable . limited assessment of the upper abdomen is within normal limits . normal chest radiograph . no pneumothorax or pneumomediastinum . No Finding 17528941 54238531 f9f2ec75-f28ac7f6-8e57221d-248fc115-82a9a1e0 511 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 Finding 17614057 53572658 f762bf98-b2141d3c-a5c0a0b1-4fb662f7-fce29b8d 512 chest, pa and lateral . the lung volumes are low causing crowding of the pulmonary vasculature at the bases . the hilar and cardiomediastinal contours are normal . there is no pneumothorax or pleural effusion . pulmonary vascularity is normal . crowding of vasculature at the bases due to low lung volumes makes it difficult to differentiate between microatelectasis and mild interstitial abnormality . Atelectasis 17622916 57478580 30d0c13b-a8dcf71f-618ddb30-3d8864d7-491b08e1 513 frontal and lateral views of the chest are obtained . a right-sided central venous dialysis catheter is again seen without significant change in position, terminating in the right atrium, without evidence of pneumothorax . the patient is status post median sternotomy and mitral valve repair . curvilinear structure projecting over the left hilum has been present since at least , unchanged . no new focal consolidation, pleural effusion, or evidence of pneumothorax is seen . the cardiac silhouette remains enlarged . the aorta is calcified and tortuous . . no acute cardiopulmonary process . persistent cardiac silhouette enlargement . central dialysis catheter terminates in the right atrium . Cardiomegaly&&Support Devices 17660889 54535542 0c83ebb9-3b2d3376-23088ab5-17419c9b-b7f42c1f 514 pa and lateral views of the chest provided . left chest wall pacer device is seen with leads extending into the right heart . midline sternotomy wires are also noted . the lungs are clear . 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 . pacemaker in place . No Finding&&Support Devices 17665558 52103847 f5acc5b4-1e6fd282-3453001f-e9d68af4-af0a8782 515 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 17667438 58897524 6096e9b5-86463a35-ae11e747-b6c244b6-e79d1436 516 heart size is prominent and unchanged . there is a persistent right sided basilar pleural effusion . there is no pulmonary edema . there is some atelectasis at the left lung base, stable . there are no pneumothoraces . Atelectasis&&Cardiomegaly&&Pleural Effusion 17680905 51149106 e0355e24-3d8b8030-c4db843f-a7f08492-b9b58e2c 517 pa and lateral radiographs demonstrate clear lungs . markedly dextroconvex s-shaped scoliosis of the thoracolumbar spine is noted . heart size is normal . there is no pneumothorax or pleural effusion . pulmonary vascularity is normal . no acute cardiopulmonary process . No Finding 17691303 53404686 e63c6663-176a47bc-a0c8f2b2-68d9fe3f-a02b4dfa 518 pa and lateral views of the chest the cardiac, mediastinal and hilar contours are normal . the lungs are clear and the pulmonary vascularity is normal . no pleural effusion or pneumothorax is seen . there are no acute osseous abnormalities . No Finding 17709047 50218097 440953b1-efb8e185-cb50c4a5-18e15241-4b1a4941 519 the cardiac, mediastinal and hilar contours are normal . the pulmonary vascularity is normal . the lungs are clear . no pleural effusion or pneumothorax is present . no acute osseous abnormality is seen . surgical sutures are demonstrated within the left upper quadrant of the abdomen . no acute cardiopulmonary abnormality . No Finding 17709047 58802826 1f7ba140-b003ee99-5b0b5d7d-af4aa6b4-a212ee2d 520 pa and lateral views of the chest the lungs are clear . there is no pleural effusion, pneumothorax, or focal airspace consolidation . the heart size is normal . the mediastinal silhouette is unremarkable . No Finding 17778323 51450693 9dbec9b8-85e97046-6ed0693b-0756a0c9-2d7d42ea 521 the lungs are clear . there is no consolidation or pneumothorax . the cardiomediastinal silhouette is within normal limits . no acute osseous abnormalities . no acute cardiopulmonary process . No Finding 17797518 55621374 bb7b1e88-c2f3b1bd-8d48cc78-62117964-b18a89aa 522 frontal radiographs of the chest demonstrate normal heart size . the aorta is tortuous . there is an mm round opacity projecting over the right lower lung, which was further evaluated on subsequent chest ct and found to be a nipple shadow . the lungs are otherwise clear . no pleural effusion or pneumothorax . no displaced rib fracture identified . no evidence of acute process . No Finding 17802612 57652627 0927598f-e24da99d-ec445ee7-e5470dfc-978d2780 523 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 focal consolidation to suggest pneumonia . Pneumonia 17847770 53304221 e1ce5809-b1cbeb24-fde041d3-54a42f81-043462f0 524 the lungs are clear without focal consolidation . no pleural effusion or pneumothorax is seen . the cardiac and mediastinal silhouettes are unremarkable . hilar contours are stable . no acute cardiopulmonary process . No Finding 17847770 56451780 a200c4d9-39de37d9-f20906a3-87b342f8-59b476da 525 cardiomediastinal contours are stable with moderate cardiomegaly . the lungs are clear . there is no pneumothorax or pleural effusion . there are moderate degenerative changes in the thoracic spine no acute cardiopulmonary abnormalities . No Finding 17933711 51201285 27a25899-ff86a8aa-e4233c75-794e0118-c17d38ea 526 there are relatively low lung volumes . mild pulmonary edema is seen . no definite focal consolidation is seen . there may be trace pleural effusions posteriorly, but no large pleural effusion is seen . cardiac and mediastinal silhouettes are stable . . low lung volumes and mild pulmonary edema . no focal consolidation to suggest pneumonia . possible trace pleural effusions but no large pleural effusion . Edema&&Pleural Effusion&&Pneumonia 17933711 59614080 c9490237-d2939ebb-637bda9a-e5a0039f-284b489b 527 marked rotary levoscoliosis slightly limits assessment . the cardiac and mediastinal contours are unchanged, with the heart size within normal limits . pulmonary vasculature is normal . no focal consolidation, pleural effusion or pneumothorax is seen . mild bronchial wall thickening is noted in the right lung base, compatible with bronchiectasis as seen on the prior chest ct . no acute cardiopulmonary abnormality . No Finding 17934731 50363621 d67a6a39-f7d74ca8-28b47ca7-cb8e9364-284bebd3 528 compared with most recent prior radiographs, pleural effusions and associated atelectasis have resolved . there is no change in severe leftward thoracic scoliosis and hiatal hernia . lungs are clear . no pleural effusion or pneumothorax . no evidence suspicious for intrathoracic metastatic disease . No Finding 17934731 54358600 ac273887-927e791a-6efc8cbb-9e16bd27-f2fc65cc 529 pa and lateral upright chest radiograph demonstrates severe scoliosis of the thoracic spine, convex to the left . as demonstrated on ct obtained on the same day, there is a large hiatal hernia accounting for retrocardiac opacity . no focal opacities identified concerning for pneumonia . when compared to prior chest radiograph obtained on a , there is been little interval change with stable appearance of cardiomediastinal contour, allowing for differences in patient positioning . no convincing opacity concerning for pneumonia . Pneumonia 17934731 54981405 dbb5d5c8-c8b687af-eb581dc3-69916e4d-16dcdc9e 530 in comparison with the study of , there is no change in the appearance of the heart and lungs and the severe scoliosis of the thoracic spine convexed to the left . specifically, no evidence of pulmonary metastases . Cardiomegaly 17934731 56305857 1c493af8-170d3211-d1a0da94-92ced558-f2b893d8 531 the lungs are hyperinflated . there is no pneumothorax . bilateral effusions are small . retrocardiac opacity correlates with postoperative changes seen on concurrent cta chest . the cardiomediastinal silhouette is normal . imaged osseous structures are intact . no free air below the right hemidiaphragm is seen . no acute intrathoracic process . faint nodules throughout the lungs are better seen on concurrent cta chest . Lung Lesion 17971994 51958471 7aebfaa7-d5a1f4ed-24dfd06b-e5e86c5c-5850e00f 532 the left-sided chest tube is been removed . there is a small left pleural effusion and volume loss in the left lower lobe better new compared to prior . there is no pneumothorax . there is a small right effusion as well worsened appearance to the left lung . No Finding 17971994 58301819 9eaa5798-a1f9ce99-1756bdf0-83b81c43-45840f0f 533 mild cardiomegaly and a calcified aorta are again seen . the lungs remain hyperinflated, and central pulmonary arteries remain prominent . thin linear opacities at the lateral left base on the pa view are similar to prior, compatible with atelectasis or scarring . there is no evidence for pulmonary consolidation, pulmonary edema, pleural effusion, or pneumothorax . there are degenerative changes and dextroconvex scoliosis in the thoracic spine . stable appearance of the chest without evidence for acute abnormalities . No Finding 17978047 52381069 10012b3a-50cadc6b-2c7edc30-cd4462d7-94cc5a75 534 chest, pa and lateral . lung volumes are low . the hilar and cardiomediastinal contours are within normal limits . no chf, focal infiltrate, effusion or pneumothorax is detected . no acute pulmonary process identified . No Finding 18001816 54309228 ba03cd17-84ef8c6e-04903ede-41a75c34-165e5c44 535 heart size and cardiomediastinal contours are normal . lungs are clear without focal consolidation, pleural effusion, or pneumothorax . normal chest radiographs . No Finding 18016444 56399172 61370059-4f1745cc-d3636639-4b9629ce-bb9b8467 536 pa and lateral chest radiographs were obtained . lung volumes remain low with right basilar atelctasis as well as enlargement of main pulmonary artery and cardiac silhouette . there are small bilateral pleural effusions . no pneumothorax is identified . surgical clips are again noted in the left upper quadrant . exam unchanged with bilateral small pleural effusions and right basilar atelectasis and stable cardiomegaly . Atelectasis&&Cardiomegaly&&Pleural Effusion 18057037 50572999 5139b8e5-f1349775-39057827-046ed642-60133e35 537 in comparison with study of , there is continued enlargement of the cardiac silhouette without evidence of pulmonary edema . small left effusion is seen . again, there is substantial elevation of the right hemidiaphragmatic contour, as clearly demonstrated on the ct of . Cardiomegaly&&Enlarged Cardiomediastinum&&Pleural Effusion 18057037 53058109 ed9cb7d3-e541763d-995f4deb-46c21698-b3f3f780 538 heart size is top normal . mediastinum is unremarkable . lobulation of right hemidiaphragm is unchanged . multiple clips projecting over the left upper abdomen . there is no appreciable pleural effusion or pneumothorax . No Finding 18057037 53861968 129f413f-93ad3c02-078798e4-098743e5-4749e33b 539 comparison is made with prior studies . moderate cardiomegaly is stable . patient has known mediastinal small lymph nodes and lymph nodes in the hilum bilaterally, better seen in prior ct . the lungs are clear . there is no evidence of pneumonia, pulmonary edema or pleural effusion . there is no evidence of pneumothorax . elevation of the right hemidiaphragm is chronic . multiple surgical clips project in the left upper quadrant . Cardiomegaly 18057037 54977618 1b866cfc-75e5f12e-334afb5f-883d5e06-c36184c8 540 pa and lateral views of the chest . there is mild bibasilar atelectasis . persistent slight elevation of the right hemidiaphragm . there is no focal parenchymal opacities concerning for pneumonia . there is no pleural effusion or pneumothorax . the cardiac and mediastinal silhouettes are stable . multiple surgical clips in the left upper quadrant . . no evidence of pneumonia . . mild bibasilar atelectasis . Atelectasis 18057037 56203584 b5c48946-bd1838f7-c09076f9-1427ea90-d701bf5d 541 lungs the lungs are well inflated . there is no consolidation . pleura her hemidiaphragm is elevated as it was in the past . this is likely due to hepatic enlargement or diaphragmatic paresis . heart the heart is not enlarged . mediastinum and hila there is no mediastinal mass . osseous structures the osseous structures are normal for age . other findings none lungs clear . elevated right hemidiaphragm . No Finding 18088902 56895618 68ad0229-fbf719ec-6407d47e-398368ac-1c4ffe02 542 the inspiratory lung volumes remain low in comparison to the prior study . there is no focal consolidation concerning for pneumonia . no pleural effusion or pneumothorax is present . the pulmonary vasculature is not engorged . the cardiac silhouette is normal in size . the mediastinal and hilar contours are within normal limits . the osseous structures are grossly unremarkable, although evaluation is limited secondary to body habitus . no acute cardiopulmonary process . No Finding 18088903 51635143 4d0125e1-1cc299af-9d2fccd0-d04efd8a-8f0d7220 543 lungs are clear without focal consolidation, effusion or vascular congestion . the cardiomediastinal silhouette is within normal limits . no acute osseous abnormalities identified . no acute cardiopulmonary process . No Finding 18088903 55137528 31cbe120-34a6c3e2-c1b2549f-22f5ce48-a57db40d 544 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 Finding 18095293 58140208 ee8009d0-8d39c5ea-7834a7a0-14647847-d9dd7ef1 545 pa and lateral views of the chest . low lung volumes . there is a small left pleural effusion . heart size is normal . there are no focal opacities concerning for pneumonia . the mediastinal and hilar contours are normal . no pneumothorax . small left pleural effusion . otherwise, unremarkable examination of the chest . Pleural Effusion 18137951 58918762 82c84432-ff11fe52-0064b58c-b7bc2f43-ef86e88b 546 lungs are well-expanded and clear . cardiomediastinal and hilar contours are unremarkable . there is no pneumothorax, pleural effusion, or consolidation . no acute cardiopulmonary process . No Finding 18156346 50091256 fdbe2f56-f0015477-75607dcd-5c56304a-5d8c699e 547 pa and lateral views of the chest . the lungs are clear without focal consolidation, effusion or pulmonary vascular congestion . calcified granuloma again seen at the right lung base . there is no pneumothorax . the cardiomediastinal silhouette is within normal limits . pneumomediastinum identified on prior chest ct is not definitively identified by this chest x-ray . there is no subcutaneous gas identified in the neck . there is no free intraperitoneal air . osseous structures are unremarkable . known pneumomediastinum identified on chest ct from one day prior is not clearly identified by this plain film . 18162895 51908330 5d5a7606-5db82e01-30ed2d70-68cf2b3e-01014d34 548 heart size is normal . mediastinal and hilar contours are within normal limits . lungs are clear . pulmonary vascularity is normal . no pleural effusion or pneumothorax is present . no acute osseous abnormalities are present . oral contrast material is seen within the left colon . no acute cardiopulmonary abnormality . No Finding 18162895 53273716 af3990fd-dd3e3ef2-b30e6f3b-3e3db1fa-025c0d4f 549 the lungs are hyperexpanded with increased opacification of the right upper and middle lobes with silhouetting of the right cardiac border and retrocardiac opacification on lateral view suggests pneumonia . the mediastinal silhouette and bilateral hemidiaphragms stable . the left lung is clear . no pneumothorax or pleural effusion is present . retrocardiac opacification concerning for pneumonia . repeat radiograph weeks after completion of treatment is recommended to ensure resolution . recommendations repeat chest radiograph weeks after completion of treatment is recommended to ensure resolution . Lung Opacity&&Pneumonia 18166102 57478248 74148346-3344cf5f-1ce06a31-e433d994-9e1fabd5 550 heart is normal size and mediastinal contours are within normal limits . calcifications are noted in the aortic arch . lungs are symmetrically expanded and clear . there is no pleural effusion . no pneumothorax . bones are grossly unremarkable . . no acute intrathoracic abnormality . . although no acute fracture or other chest wall lesion is seen, conventional chest radiographs are not sufficient for detection or characterization of most such abnormalities . if the demonstration of trauma to the chest wall is clinically warranted, the location of any referrable focal findings should be clearly marked and imaged with either bone detail radiographs or chest ct scanning . No Finding 18167484 53300045 f8080681-868cdc36-e7ccdf1d-570e4c42-ef04d221 551 pa and lateral views of the chest provided . lung volumes are low which limits assessment . there is mild left basalretrocardiac opacity which could represent atelectasis versus an early pneumonia . the right lung appears clear . no large effusion is seen . no pneumothorax . no signs of congestion or edema . the heart appears mildly enlarged . mediastinal contour appears normal . imaged bony structures are intact . no free air below the right hemidiaphragm . as above . No Finding 18172293 57657192 5495cf03-882d6e53-523d1ccc-3ac2643f-f294b347 552 there is no focal consolidation, pleural effusion, or pneumothorax . the cardiomediastinal and hilar contours are normal . no foreign bodies identified . no foreign body identified . no evidence of trauma . No Finding 18194501 58393728 b83da8c3-f89f1640-af7d7c50-231b3560-b1313ec6 553 the cardiomediastinal and hilar contours are within normal limits . the lungs are well expanded and clear . there is no focal consolidation, pleural effusion or pneumothorax . there are mild degenerative changes within the shoulders, right greater than left . note is made of inferior spurring of the glenohumeral joint on the right . no radiographic evidence of an acute cardiopulmonary process . No Finding 18232123 55748803 707a7540-cb3bf051-5a339e77-d0bf7c09-1031feb5 554 frontal and lateral radiographs of the chest demonstrate low lung volumes . the heart is top normal in size, which is exaggerated by the low lung volumes . there is no evidence of tuberculosis . aeration of the right lung base is suboptimal as compared to the left, and some crowding versus atelectasis is seen in this region . there is no pleural effusion or pneumothorax . . no evidence of tuberculosis . . low lung volumes, with possible crowding versus atelectasis at the right lung base . consider repeat chest x-ray examination with increased inspiratory volumes for additional evaluation . Atelectasis 18380327 53660780 1df86c6a-c5308f87-4dae24bf-5acfe642-c5e79dd4 555 pa and lateral chest views were obtained with patient in upright position . analysis is performed in direct comparison with the next preceding similar chest examination . heart size remains within normal limits . no typical configurational abnormality is identified . thoracic aorta is unchanged and unremarkable . pulmonary vasculature is not congested and there is no evidence of pneumothorax on the frontal view in the apical area . the patient is rather heavyset and able to elevate the arms on the lateral view allegedly related to shoulder discomfort . the pulmonary vasculature is not congested . the lateral and posterior pleural sinuses are free from any fluid accumulation . no acute pulmonary parenchymal infiltrates can be identified . mild degree of degenerative changes are noted in the thoracic spine but appear unchanged in comparison with the previous study of . no evidence of acute infiltrates or chf . stable chest findings since . No Finding 18408427 57343186 c9da4948-05264240-eb4ff71e-f2c88106-f3c8cf60 556 in comparison with the study , the patient has taken a much better inspiration . cardiac silhouette remains mildly enlarged an there is an appearance of the left hemidiaphragm and costophrenic angle the could reflect pleural fluid or chronic thickening . no evidence of acute focal pneumonia . Cardiomegaly&&Pleural Effusion 18411490 50317024 64cc948a-2c477474-c2629ba4-d9cc0822-1ec6d0f7 557 pa and lateral views of the chest provided . lung volumes are low . mild cardiomegaly is noted . there is subtle blunting of the left cp angle suggesting a tiny effusion or pleural thickening . the lungs appear clear without focal consolidation or edema . no pneumothorax . mediastinal contour is normal . bony structures are intact . partially imaged spinal hardware is again noted in the lumbar spine . cardiomegaly with tiny left pleural effusion versus pleural thickening . no findings to account for acute chest pain . Cardiomegaly&&Pleural Effusion&&Pleural Other 18411490 50523107 d58d0e27-e1c60eac-ce1656c7-d7b99a45-484b6ea5 558 frontal and lateral chest radiographs demonstrate an ill-defined opacity projecting over the lateral posterior left rib, not seen on lateral views . for this, additional imaging with chest ct is recommended . the lungs are otherwise well expanded and clear without focal consolidation, pleural effusion, or pneumothorax . the cardiomediastinal and hilar contours are unremarkable . . ill defined opacity projecting over the lateral posterior left rib not seen on lateral views for which additional imaging with ct is recommended . . no findings to suggest lymphadenopathy . these findings were communicated to the ordering physician via critical findings website at the time findings were reviewed . Lung Opacity 18429449 58984392 3063fefa-19c17307-b873e001-4512111f-8a620446 559 there is no evidence of focal consolidation, pleural effusion, pneumothorax, or frank pulmonary edema . blunting of the left costophrenic angle on the lateral view suggests chronic pleural thickening rather than small effusion . the cardiomediastinal silhouette is within normal limits . no evidence of acute cardiopulmonary process . No Finding 18465343 51903210 66d13817-333439e1-2134a531-fed0a9cb-579956fd 560 cardiac, mediastinal and hilar contours are normal . lungs are clear and the pulmonary vascularity is normal . no pneumothorax or pleural effusion is seen . there are multilevel degenerative changes in the thoracic spine . no acute cardiopulmonary process . No Finding 18465343 59362958 98938972-36f72211-d3e34220-54a0a0bc-18bc8bb8 561 no definite focal opacity to suggest pneumonia is seen . no pleural effusion, pulmonary edema or pneumothorax is present . the cardiomediastinal silhouette and pleural surface contours are normal . No Finding 18480741 50216176 9c1262ca-2e73d948-e988de44-6da23bff-79ef4e19 562 frontal and lateral views of the chest were obtained . the lungs are well expanded and clear without focal consolidation, pleural effusion or pneumothorax . heart size is normal . mediastinal silhouette and hilar contours are normal . normal chest radiographs . dr . was paged at am . per request . No Finding 18480741 54584844 418573f9-e9d1de26-ef5715f9-5d7c0434-177c5b61 563 pa and lateral views of the chest are obtained . lungs are clear and well expanded . a nodular hyperdensity in the right upper lung is unchanged and likely reflects a calcified granuloma . no large effusion or pneumothorax is seen . the heart and mediastinal contours are normal . the bony structures are intact . no free air below the right hemidiaphragm . no acute intrathoracic process . No Finding 18482407 55144227 1e0fedfe-9bcbb335-3fe84f33-734baf67-40b747ef 564 pa and lateral views of the chest the heart size is normal . the mediastinal and hilar contours are unchanged with minimal tortuosity of the thoracic aorta . pulmonary vascularity is normal . a calcified granuloma in the right upper lung field measuring mm is unchanged . lungs are clear . no pleural effusion or pneumothorax is present . there are no acute osseous abnormalities . there is no free air under the diaphragms . No Finding 18482407 59225584 ec4a1322-8a9bf09f-33fbd390-0a0943c8-11b3c889 565 pa and lateral views of the chest provided . there is no focal consolidation, effusion, or pneumothorax . the cardiomediastinal silhouette is top-normal . no pulmonary edema . imaged osseous structures are intact . no free air below the right hemidiaphragm is seen . no acute intrathoracic process . No Finding 18520122 57630819 85d0b656-71639eb3-56a3068f-a6adcea9-b539fb4b 566 the lungs are hyperinflated consistent with the given history of asthma . there is no evidence of focal consolidation worrisome for pneumonia . no pleural effusion or pneumothorax . the cardiac size is normal . the hilar contours are unremarkable . there is slight loss of height anteriorly of a mid thoracic vertebral body seen on the lateral views . . no evidence of pneumonia . . hyperinflation consistent with asthma . . slight height loss anteriorly ~ of a mid thoracic vertebral body of unknown chronicity . 18528269 51037397 832bc387-3c9cf25c-7fb73452-7a6ee080-80be4aa8 567 pa and lateral views of the chest were provided . the lungs are hyperinflated and clear . no effusion or pneumothorax is seen . the heart and mediastinal contours are normal . bony structures are intact . no free air below the right hemidiaphragm . no acute intrathoracic process . No Finding 18528269 54998180 a7b11686-430bd527-08172ee1-1bd780f3-551fb77a 568 as compared to the previous examination, the miniscule left pneumothorax has completely resolved . the pre-existing right pneumothorax is smaller but still clearly visualized . there is no evidence of tension . improved transparent see of the lung parenchyma reflect improved ventilation . the size of the cardiac silhouette has decreased . increased density at the lateral aspect of the seventh right rib is unchanged . Cardiomegaly&&Lung Opacity&&Pneumothorax 18536624 53931664 ceb961ba-2ced940d-471b2b09-087e5b3f-b9118db0 569 the lungs are clear without focal consolidation, pleural effusion or pneumothorax . there is no pulmonary edema . minimal atelectasis is noted in the lung bases . the heart is normal in size, and the mediastinal contours are normal . no acute cardiopulmonary process . No Finding 18548611 52534188 7a7f9061-9eef6733-e94cb29b-c4088494-9177b82f 570 pa and lateral views of the chest were provided . midline sternotomy wires are again seen along with mediastinal clips . there is a tiny right pleural effusion . otherwise, the lungs are clear . no signs of edema or pneumonia . the cardiomediastinal silhouette is normal . bony structures are intact . no free air below the right hemidiaphragm . small right pleural effusion . otherwise, normal . Pleural Effusion 18573829 57755274 078eec80-ef37c7df-f352dd0a-ad6da42a-370e6a41 571 pa and lateral views of the chest provided . 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 18577540 56782686 08fd4c57-e13761d9-96132981-e2878469-e4018317 572 the cardiac, mediastinal and hilar contours appear stable . there is no pleural effusion or pneumothorax . the lungs appear clear . bony structures are unremarkable . there has been no significant change . no evidence of acute cardiopulmonary disease . No Finding 18577540 58531102 04dd2d3b-b0cf87a9-bb364724-243aefcf-5facd320 573 ap and lateral views of the chest . the innumerable bilateral nodular densities, better appreciated on recent chest cta from , appear slightly worse compared to study done on but this may be exaggerated by difference in technique and superimposed edema . the cardiomediastinal and hilar contours are normal . there is no pleural effusion or pneumothorax . innumerable bilateral nodular opacities, better seen on recent chest ct from , appear slightly worse compared to study done on but this may be exaggerated by difference in technique and possibly superimposed edema . Edema&&Lung Lesion&&Lung Opacity 18580594 56562091 6abe4ea4-169e4ba1-a84d3279-9d50d94c-f5eea071 574 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 18581076 55703291 05ff4e34-05d8cfb5-a89bc7fa-e2f28c07-5b9f190f 575 pa and lateral chest radiographs were obtained . the lungs are well expanded and clear . there is no focal consolidation, effusion, pneumothorax . cardiac and mediastinal contours are normal . no acute cardiopulmonary process . No Finding 18619672 50605041 5ebc8d35-a5ece81f-8e1833b8-9605b2d7-688ef3e9 576 heart size is normal . mediastinal and hilar contours are within normal limits . lungs are clear . pulmonary vascularity is normal . no pleural effusion or pneumothorax is present . no acute osseous abnormalities are present . no acute cardiopulmonary abnormality . No Finding 18619672 55152029 696a7413-9343a3f1-4d2a119b-8b6bbf79-599b2c4c 577 pa and lateral views of the chest provided . chronic scarring in the left lower lobe accounts for retrocardiac opacity . no new consolidation is seen . no evidence of edema, large effusion or pneumothorax . cardiomediastinal silhouette is stable . bony structures are intact . no free air below the right hemidiaphragm no acute findings . stable retrocardiac opacity compatible with scarring in the left lower lobe . Lung Opacity 18711952 50263751 6a1dcdef-77f285f3-0dc88baa-e1241adf-0eba3f6b 578 the cardiac silhouette is enlarged with mild interstitial edema . pulmonary artery is enlarged . lung volumes are low, and there is a left retrocardiac opacity . a left axillary vascular stent is again noted . cardiomegaly with mild interstitial edema . suspected pulmonary hypertension . Cardiomegaly&&Edema 18711952 51452692 089ab3b5-4b7f0a82-24c89f6a-d876a8f0-34b46929 579 pa and lateral chest compared to . previous small-to-moderate left pleural effusion is smaller, although there is residual pleural thickening . lateral view shows a region of peripheral atelectasis, where previously there was a posteriorly collected pleural effusion . there may be a tiny right pleural effusion in the posterior sulcus . heart is mildly enlarged, larger today than in , but the pulmonary vasculature is unremarkable and there is no edema . a supraclavicular dual-channel central venous catheter ends in the upper right atrium . Atelectasis&&Pleural Effusion&&Pleural Other&&Support Devices 18711952 51736713 cf6a4352-a09fe502-cedb583d-cf8a12af-f09a5c62 580 in comparison with the study of , the the elevated pulmonary venous pressure is no longer appreciated . there is continued small left effusion with basilar atelectatic changes . no definite acute focal pneumonia . Atelectasis&&Pleural Effusion 18711952 52019235 a6eaf07c-7d11c9e6-cbf92b96-72eb5709-8e9f4163 581 frontal and lateral radiographs of the chest . the moderate right pleural effusion is unchanged with associated atelectasis . there is interval improvement in pulmonary edema . stable mildly enlarged cardiac silhouette . no right pleural effusion . no pneumothorax . persistent moderate right pleural effusion with associated atelectasis and resolving pneumonia . improved pulmonary edema . Atelectasis&&Edema&&Pleural Effusion&&Pneumonia 18711952 52152687 cdc9c3fc-2c1de092-1ff45e6d-12accd18-918c173c 582 since there been substantial changes moderate enlargement of the cardiac silhouette is new, borderline interstitial edema has developed, small left pleural effusion is larger, and new heterogeneous opacification at the right base could be dependent atelectasis and edema . overall findings indicate cardiac decompensation . possibility of acute pulmonary embolism should be considered from a clinical standpoint, particular given . Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion 18711952 52575467 901bb0dd-fdfda3ed-2d96b0f4-d803b7bb-9e4b3bd8 583 comparison is made with prior study . moderate cardiomegaly is stable . small right and moderate left effusions are unchanged . pulmonary edema has resolved . there is no pneumothorax . Cardiomegaly&&Pleural Effusion 18711952 52755969 6769fd0c-b51ad36a-54e19d93-66fec455-aa13b0da 584 small left pleural effusion, slightly smaller today than on . at least two left juxtahilar lung nodules are still visible . a right supraclavicular dual-channel hemodialysis catheter ends in the right atrium . mild cardiomegaly stable . no pulmonary edema . Cardiomegaly&&Lung Lesion&&Pleural Effusion&&Support Devices 18711952 54064544 ac1c8deb-4d1a48db-00b1f8e6-74207e6d-aca12386 585 frontal and lateral views of the chest . there is a large left pleural effusion . the right lung is clear of consolidation . trace blunting of the posterior costophrenic angles suggest trace effusion . there is mild pulmonary vascular congestion . cardiomediastinal silhouette cannot be assessed given silhouetting the left heart border . no acute osseous abnormalities . large left pleural effusion with probable underlying atelectasis noting infection cannot be excluded . pulmonary vascular congestion . Atelectasis&&Edema&&Pleural Effusion&&Pneumonia 18711952 55724407 ee82f2ad-31d58c5b-8760e53b-07c17cf2-7ebebc97 586 comparison to . . persistent left-sided pleural effusion which may have slightly increased in size with some associated patchy opacity most likely reflecting patchy atelectasis, although pneumonia could also have this appearance . there is increasing prominence to the interstitium suggesting a component of superimposed interstitial edema . a smaller right effusion is likely . overall cardiac and mediastinal contours are unchanged . no pneumothorax . Atelectasis&&Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Pneumonia 18711952 55943354 8918e0bb-74e205be-380e930e-9217a419-27d4eab0 587 there has been interval placement of a left axillary stent . lung volumes are low, and the cardiac silhouette is enlarged . there is mild central vascular congestion, and small pleural effusions are noted . no focal consolidation or pneumothorax is seen . cardiomegaly with mild central vascular congestion . small bilateral pleural effusions . Cardiomegaly&&Edema&&Pleural Effusion 18711952 57803827 44fbc6d0-0c39e6ef-e9181984-728748c3-7d42ff10 588 a moderate-sized left pleural effusion has partially reaccumulated following recent thoracentesis procedure . cardiac silhouette is upper limits of normal in size and accompanied by pulmonary vascular congestion and peribronchial cuffing . additionally, a widespread reticular and nodular pattern has developed diffusely as well as more confluent opacities in the left mid and lower lung regions . . partial reaccumulation of left pleural effusion, now moderate in size . . diffuse reticulonodular opacities, possibly due to pulmonary edema, but atypical or opportunistic infection is an additional consideration given the nodular appearance . if persistent after diuresis, consider a ct scan for further characterization to exclude a miliary nodular infection . . patchy and linear opacities in left mid and lower lung may be due to atelectasis or infectious consolidation . Atelectasis&&Consolidation&&Edema&&Lung Lesion&&Lung Opacity&&Pleural Effusion&&Pneumonia 18711952 57885425 9a0a7c9d-1d812343-2d53c9b4-bc13998e-a629c3e5 589 cardiac silhouette size is normal . mediastinal and hilar contours are unremarkable . pulmonary vasculature is normal . lungs are clear . no pleural effusion or pneumothorax is demonstrated . clips are seen in the right upper quadrant of the abdomen . there are no acute osseous abnormalities identified . no acute cardiopulmonary abnormality . No Finding 18713335 50314735 16e01908-f73fd063-90006332-eb5aeba7-50b4fe00 590 the lungs are well expanded . there is no focal consolidation, pleural effusion or pneumothorax . cardiomediastinal silhouette is normal . the imaged upper abdomen is unremarkable . no acute cardiopulmonary process . No Finding 18776448 56089705 1c009226-64474f8f-8f47e3e0-01640769-ae6bc0ae 591 pa and lateral chest views were obtained with patient in upright position . the heart is mildly enlarged . the configuration demonstrates a prominence of the left ventricular contour to the left and posteriorly but no evidence of marked left atrial enlargement . thoracic aorta is mildly widened but does not show any local contour abnormalities . a right-sided internal jugular vein approach port-a-cath system is noted and the line terminates in mid-to-lower svc . no pneumothorax is present . the pulmonary vasculature is not congested . there is no evidence of new acute parenchymal infiltrates . there is mild blunting of the lateral and posterior pleural sinuses, but in the absence of acute pulmonary congestion, these findings are most likely related to patients past medical history, which includes a liver transplant, probably represent pleural scar formations . there is no evidence of pneumothorax on either side . skeletal structures of the thorax grossly unremarkable . mild cardiac enlargement with left ventricular prominence, but absence of acute pulmonary congestion or left atrial enlargement . no acute infiltrates . bilateral pleural scar formations, probably related to past history . thus, presently no evidence of acute pulmonary infiltrates or significant chf . Cardiomegaly&&Edema&&Lung Opacity&&Pleural Other 18783450 53467295 024cc0c3-67fb5ac5-621d954e-656314f7-e8ceed76 592 there are streaky bibasilar opacities likely due to atelectasis in the setting of low lung volumes . there is no other region of consolidation, effusion, or edema . the cardiomediastinal silhouette is within normal limits . no acute osseous abnormalities identified . surgical clips in the right upper quadrant suggest prior cholecystectomy . bibasilar opacities which are most likely atelectasis . lungs are otherwise clear without acute cardiopulmonary process . Atelectasis&&Lung Opacity 18788733 54610506 43a98704-16eea15d-90d9ddae-e5ce78e7-7321540c 593 there is a subtle opacity in the left lung base adjacent to the left heart border on the frontal projection . there is no other focal consolidation, pleural effusion, pulmonary edema, or pneumothorax seen . the heart and mediastinal contours are normal . subtle opacity within the left lower lung suggestive of pneumonia . Lung Opacity&&Pneumonia 18824826 56093039 ea824a78-8cbd68db-cdc27d64-6ecd71ac-4000879e 594 the lung volumes are normal . the patient shows bilateral small pleural effusions seen on both the frontal and the lateral radiograph . there are signs of mild pulmonary edema . in addition, both in the retrocardiac lung region and at the bases of the right lung, subtle ill-defined parenchymal opacities are seen that could reflect pneumonia . no abnormal hilar contours . Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia 18914641 57480718 9ed7d647-e4937ff7-83b5ba6d-6e6b0565-04722acd 595 the heart is normal in size . the mediastinal and hilar contours appear within normal limits . there is retrocardiac opacity, probably referring to opacity in the left lower lobe, although best seen on the pa view, suggesting pneumonia . the lungs appear otherwise clear . there is no pleural effusion or pneumothorax . findings suggest pneumonia in the left lower lobe . Pneumonia 18920143 56495618 fbe115e8-ec164702-1ef97452-fd82e502-5ea6806a 596 left lower lung opacity is re- demonstrated . known small hemothorax blunts the left costophrenic sulcus . heart size is normal . known small left pneumothorax is not well seen . non-displaced rib fractures are better seen on concurrent ct of the chest . known small left pneumothorax seen on ct is not appreciated on the radiograph . left lower lobe contusions are also better seen on ct . Pneumothorax 18926499 53494114 c5e42130-348838fa-de1e5517-65edefb9-a57952c4 597 lungs are well-expanded and clear . thickening of the tracheal wall is better seen on recent ct of the neck . the heart appears mildly enlarged with mild prominence of the bilateral hila consistent with mild congestive heart failure . no pneumothorax, pleural effusion, or consolidation . findings consistent with mild congestive heart failure . no acute cardiopulmonary process seen . Cardiomegaly&&Edema 18969267 53255510 eed7debf-292679cb-a89b7580-25336d55-4e0d77ef 598 the heart remains mildly enlarged but unchanged . the aorta is tortuous . the mediastinal and hilar contours are within normal limits . pulmonary vascularity is not engorged . no focal consolidation, pleural effusion or pneumothorax is identified . no acute osseous abnormalities detected . no acute cardiopulmonary process . No Finding 18969267 57377879 f72a9857-c7f18038-73f34ab0-7f977374-d544ac69 599 frontal and lateral views of the chest were obtained . lungs are clear without focal consolidation . no pleural effusion or pneumothorax is seen . cardiac and mediastinal silhouettes are unremarkable . no overt pulmonary edema is seen . no acute cardiopulmonary process . No Finding 19001503 56011616 5d6c57bc-d3142da8-3564fd8f-d31a2032-4720945c 600 pa and lateral views of the chest provided . midline sternotomy wires and left chest wall pacer device appear unchanged . the pacer leads extending to the region of the right atrium and right ventricle . the lungs are clear . there is no focal consolidation, effusion, or pneumothorax . the cardiomediastinal silhouette is unchanged . imaged osseous structures are intact . no free air below the right hemidiaphragm is seen . no acute intrathoracic process . No Finding 19001598 50830008 7add735d-68204a28-3c833b2f-90d5f57f-3055ca58 601 rotated positioning . a left-sided pacemaker present, with lead tips over right atrium right ventricle . an ng tube is present, tip extending beneath diaphragm, off film . surgical are noted over the upper abdomen in the midline . linear density overlying the left lung could represent an epidural catheter, best correlated clinically . the patient is status post sternotomy . note is made that the lower most sternotomy wire is fractured . there is probable mild cardiomegaly . there is increased retrocardiac density with a probable small left effusion and partial obscuration the left hemidiaphragm . there is minimal atelectasis in the right cardiophrenic region . no pneumothorax is detected . there is pleural parenchymal thickeningscarring at the left lung apex . the right first rib may be truncated, but is unchanged . aside from right base atelectasis, the right lung is grossly clear . no gross right effusion, though minimal pleural fluid could be present on the right . suspect background hyperinflationcopd . note made of old rib fractures seen in lower right chest, similar to . compared to the heart size is larger . left effusion and left lower lobe collapse andor consolidation is new and right cardiophrenic atelectasis is more pronounced . . small to moderate left effusion with underlying collapse andor consolidation of the left base . . atelectasis in the right cardiophrenic region . . cardiac silhouette larger compared with . . clinical correlation is required for full assessment . . fractured inferior sternotomy wire, unchanged compared with . Atelectasis&&Cardiomegaly&&Consolidation&&Fracture&&Pleural Effusion 19001598 56307251 cb6c796c-9671f70e-c1a3ebb2-cc1a326b-ed83cfa1 602 there is no focal consolidation, pleural effusion, pulmonary edema, or pneumothorax . the cardiomediastinal contour is normal . normal chest radiographs . No Finding 19017542 54985891 28a5d454-4f6e8afe-c96281bb-c685dc86-984117dc 603 the cardiomediastinal silhouette is normal . there is bronchovascular crowding in the left lower lobe consistent with atelectasis . otherwise the lungs are clear . no pleural abnormalities . no pneumothorax . the visualized bones and soft tissues are normal . the new right port tip is in the right atrium . . no pneumonia . . atelectasis in the left lower lobe . Atelectasis 19109135 51197801 ae4d45fc-815b6cd8-d29c078f-ad849410-cbb8cf47 604 multifocal areas of consolidation are present, mostly in the right lower lobe, with a lesser degree of involvement in the right middle lobe and posterior segment left lower lobe . heart size, mediastinal and hilar contours are normal . there are questionable small pleural effusions on the lateral view . multifocal pneumonia . recommend followup chest x-ray weeks after completion of antibiotic therapy . findings entered in radiology communications dashboard on date of study . Pneumonia 19128767 59202016 49fbba93-49346260-5c3cc7e9-ad087106-f84c1739 605 there are right lower lobe and left lower lobe consolidations as well as bilateral mild pleural effusions, suggestive of an infectious process . the heart size is normal . the mediastinal and hilar contours are unremarkable . there is no evidence of pneumothorax . the osseous structures are unremarkable . right lower lobe and left lower lobe pneumonia . Pneumonia 19144092 58485003 eee03001-19c73647-bfb514b6-dd1597b1-3379cbc6 606 in comparison with study of , there is little change in the degree of left pneumothorax . persistent atelectatic changes are seen at the left base . on the lateral view, there is an air-fluid level posteriorly, consistent with some degree of hydropneumothorax, possibly loculated . dilatation of gas-filled loops of bowel is consistent with adynamic ileus . Atelectasis&&Pneumothorax 19175595 50127791 f120c01c-111b4b69-2583a40d-de1f181d-72de42e0 607 the heart size is normal . mediastinal and hilar contours are normal . the pulmonary vascularity is normal . there is minimal streaky opacity within the left lower lobe, likely reflective of atelectasis . blunting of the left costophrenic angle on the lateral view posteriorly suggests a small left pleural effusion . no right-sided pleural effusion or pneumothorax is definitively seen . there are mildly displaced fractures of the left lateral and likely th ribs . mildly displaced fractures of the left and likely lateral ribs . mild left lower lobe atelectasis and probable trace left pleural effusion . Atelectasis&&Fracture&&Pleural Effusion 19175595 52014921 6136ff46-3dfea390-1639cd6f-50dc91c7-f1069f7b 608 consolidation at the base of the left lung which worsened from through at am . is unchanged . this could be atelectasis alone or aspiration . a small amount of fluid has accumulated in the left hemithorax with persistence of the moderate left pneumothorax, unchanged in volume since it was first detectable radiographically on . heart size is top normal . the fractures of the right middle ribs laterally are probably chronic . Atelectasis&&Consolidation&&Fracture&&Pneumothorax 19175595 52445151 468a1675-344a56da-7cf12651-0344086a-8454a87a 609 heart size is normal . mediastinum is normal . there is left-sided pneumothorax, small . there is also small amount of pleural effusion and basal opacity that might reflect atelectasis . right lung is unremarkable . findings were discussed with dr . over the phone by dr . at pm . on . the findings were made on pm . Atelectasis&&Lung Opacity&&Pleural Effusion&&Pneumothorax 19175595 52576095 409e8ad6-2a430b33-c5e09174-8cd5eec3-453eb611 610 there is no longer an apical component to the previously described left pneumothorax . a small-to-moderate left pleural effusion persists on the left with few areas of streaky associated atelectasis . an air-fluid level best seen on the lateral view indicated some degree of hydropneumothorax . there is no evidence of diaphragmatic flattening or mediastinal shift . right mid rib fractures are nondisplaced, not well appreciated on the current exam . resolution of apical portion of left pneumothorax with lower left hydropneumothorax no evidence of tension . Pneumothorax 19175595 52873579 756771db-5805a998-08667cd8-f505ae42-22e2414b 611 in comparison to earlier study of this date, there are lower lung volumes with little change in the degree of small-to-moderate left pneumothorax . opacification in the retrocardiac region is consistent with atelectasis . right lung is clear and there is no evidence of vascular congestion . Atelectasis&&Lung Opacity&&Pneumothorax 19175595 54079675 f9e9f170-19e813d2-a7c0fbe9-2610a969-b3913c3c 612 the 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 19245983 56562756 daad30b9-976a0ab4-d4b667cf-38d005b1-ec3a483a 613 the left pneumothorax, best seen on the lateral film appears unchanged since the prior film, it has not changed significantly . marked atelectasis at the left lung is again noted . opacification in the left mid zone is noted, probably representing a loculated effusion posteriorly . the right lung shows some atelectasis, but is otherwise clear . Atelectasis&&Pneumothorax 19254322 51170210 48003dc6-c6038610-25596c4c-016c4acd-3d08f408 614 since the prior study, there is almost complete resolution of subcutaneous air . there is also improvement in the aeration of left lower lobe . present atelectasis and pleural effusion are noted . there is no evidence of pneumothorax . cardiomediastinal silhouette and left lung are clear . Atelectasis&&Pleural Effusion 19254322 56629750 f14d047c-4743b199-64f60407-dfd3531f-42186adb 615 cardiac, mediastinal and hilar contours are normal . lungs are clear . pulmonary vasculature is normal . no pleural effusion or pneumothorax is present . there are mild multilevel degenerative changes in the thoracic spine . no acute cardiopulmonary abnormality . No Finding 19303480 52617198 01751cc7-4bb8333e-14073a53-1c074d9c-32d10cd5 616 pa and lateral views of the chest show interval clearing in bilateral airspace consolidation with no increased size in spiculated common nodular pleural thickening at the right lung apex compared to . marker of on ill volume loss in the left hemithorax related to the patients surgery for pancoast tumor is a chronic finding and occludes upper rib resections . bones are demineralized . interval clearing of bibasilar consolidation compared to . No Finding 19358609 51748246 d25bbe23-d111ed9c-d5ff0630-42378992-62fb128c 617 the multifocal bilateral opacities have essentially completely resolved since . left pleural effusion has also completely resolved . residual background emphysematous changes most prominent in the right upper lung with scarring and pleural thickening as well as background post-left upper lobectomy changes with elevation of the left hemidiaphragm are unchanged compared to . blunting of the left costophrenic angle reflects thickeningscarring . a calcified perihilar node is unchanged . the heart is normal in size . the descending thoracic aorta is slightly tortuous, unchanged . dextroconvex scoliosis of thoracic spine is overall similar with similar distortion of thoracic cage . prominent degenerative changes in the thoracic spine are also overall unchanged . interval resolution of pneumonia . No Finding 19358609 53320690 5a0fbb50-16fcbb3c-b43ab7db-64bdd2fa-0d3ba8ae 618 frontal and lateral views of the chest demonstrate a stable postoperative appearance of the left hemithorax status post thoracoplasty . right apical scarring persists . right lung base opacity partially obscuring right hemidiaphragm is new since prior exam . ill-defined left lung base opacity is also noted . no pleural effusion is seen . there is no pulmonary edema . emphysema predominantly involving upper lung zones is unchanged . hilar and mediastinal silhouettes are stable . heart size is normal . partially imaged upper abdomen is unremarkable . bibasilar opacities are new since exam, possibly atelectasis, aspiration, or infection in appropriate clinical setting . Atelectasis&&Lung Opacity&&Pneumonia 19358609 59002259 c278f0af-bf6b18eb-2e0a01ad-3d3a4fbd-68d440cc 619 the lung volumes are increased . there is increased sagittal diameter of the thorax as well as an increase of the retrosternal space . together with flattening of the diaphragm these findings are highly suggestive of severe functional obstruction, for example caused by copd . no evidence of pneumonia or pulmonary edema . normal size of the cardiac silhouette . moderate elongation of the descending aorta . minimal right apical thickening . 19365784 52111228 cf12c942-00f9c4e0-d2a23250-9d3bb177-19775339 620 pa and lateral views of the chest provided . port-a-cath over the right chest wall is again seen with catheter extending into the region of the mid svc . in this patient with known pulmonary nodules better seen on the a recent ct exam, nodules are poorly visualized on radiograph . there is a small right pleural effusion which appears unchanged from the recent ct exam . no evidence of superimposed pneumonia or edema . cardiomediastinal silhouette is stable . the imaged bony structures are intact . . no acute findings . . small right pleural effusion stable from recent pet-ct . . pulmonary nodules better assessed on recent pet-ct . Lung Lesion&&Pleural Effusion 19423061 50829350 641c0bab-e8835ec0-a9953bda-359a9381-a8bc717a 621 a port-a-cath is in place, with tip over distal svc . there is background hyperinflation, consistent with copd . the cardiomediastinal silhouette is not enlarged . mild aortic calcification noted . there is slight blunting of the right cardiophrenic angle, consistent with a small amount of pleural fluid or thickening . on the lateral view, there is suggestion of focal nodular density in the lower lobe posteriorly on side . additional patchy density projects over the cardiac silhouette . indistinct opacities are seen laterally in both right and left lower zones . these small opacities likely correspond to opacities seen on the chest ct . no chf or large consolidation is identified . oral contrast is noted within the bowel . . port-a-cath tip over distal svc . . bibasilar focal opacities, likely corresponding to opacity seen on an outside the chest ct . correlation with clinical history is requested for further assessment . . small right effusion . Lung Opacity&&Pleural Effusion 19423061 59322832 4f168bc8-3e6328a5-313a3636-4e952ac6-a0ae095f 622 pa and lateral chest radiographs demonstrate a normal cardiomediastinal silhouette . there is no focal consolidation, pleural effusion, or pneumothorax . a convex, linear opacity in the right lung base is stable from and may represent an area of scarring . the pulmonary vasculature is normal . no cardiopulmonary process . No Finding 19442226 55802076 a229d223-937a556a-7a395dbc-951be366-22d9e940 623 as compared to the previous radiograph, there is no relevant change . loss in volume of the left hemithorax, associated with juxtaphrenic peak at the left lung bases . no pleural effusion . no masses or consolidations . unremarkable right lung . No Finding 19486351 51851862 a38ab00a-694908eb-0e3cac94-ff0635c9-41d52d82 624 no consolidation . left hilar and mediastinal regions have normal postoperative appearance unchanged from prior . no pleural effusion or pneumothorax . the cardiomediastinal silhouette is normal . no pneumonia . notification the findings were discussed with , md . by , md . on the telephone on at am, minutes after discovery of the findings . No Finding 19486351 54810204 98b0f854-2f8c7b87-0750ac8e-5001cfd3-4449e97b 625 the examination is compared to . there is no relevant change . known left hydropneumothorax with both left basal and left apical component . unchanged post-surgical opacities at the right lung apex and right lung base . unchanged size of the cardiac silhouette . no newly appeared focal parenchymal opacities . no increase in extent of left pleural fluid . Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Pneumothorax 19486351 54816507 0340106c-4c4810c8-0b3a0be3-779cf0c7-d6185cf2 626 the right lung is clear . post-surgical changes are noted in the left lung with elevation of the left hemidiaphragm and rightward deviation of normally midline structures as expected after completion left upper lobectomy . tiny left pleural effusion may be present . cardiac silhouette is unremarkable . tiny left pleural effusion with expected post-surgical appearance to the left lung . Pleural Effusion 19486351 55981228 3f2efd86-6d2f7dd3-13733c06-96512585-461537e4 627 pa and lateral chest radiographs demonstrate clear lungs . there is no pleural effusion, pneumothorax, or pulmonary vascular congestion . the cardiomediastinal silhouette is normal . no acute cardiopulmonary process . No Finding 19519113 54655842 cfad9518-e9155e36-b7ddfe25-0756fe5d-a11405f1 628 the lungs are clear . cardiac silhouette is normal in size . no pleural effusion, pneumothorax or pulmonary edema . no evidence of acute cardiopulmonary process . No Finding 19521888 59627220 1abba9e2-b59f090a-f83d8ef2-43c94615-46bfa1cf 629 left basal platelike atelectasis . otherwise lungs are clear . no signs of pneumonia or edema . no effusion or pneumothorax . cardiomediastinal silhouette is stable . bony structures are intact . no free air below the right hemidiaphragm . no acute intrathoracic process . No Finding 19550692 51242161 4a9c54a9-b2e611eb-c5682312-61c0f546-64baeb2f 630 the cardiomediastinal and hilar contours are within normal limits . lungs are clear . there is no focal consolidation, pleural effusion or pneumothorax . no acute cardiopulmonary process . No Finding 19550692 52125718 c72e02f0-f6fddd10-c238dc43-3bc253ad-d86b0f72 631 frontal and lateral views of the chest . the lungs are clear . cardiomediastinal silhouette is within normal limits . mild mid thoracic dextroscoliosis is noted . no acute cardiopulmonary process . No Finding 19550692 59756917 b2cbf182-9d259151-0bab637e-69dece8f-be889649 632 moderate cardiomegaly, mediastinal silhouette and hilar contours are unchanged from prior exam . there is persistent mild pulmonary edema and in this setting is difficult to discretely identify pneumonia . bibasilar patchy opacities are relatively unchanged compared to prior exam . there is no pleural effusion or pneumothorax . unchanged pulmonary edema with no change in appearance of bibasilar patchy opacities . infection is not excluded given the correct clinical circumstance . Lung Opacity&&Pneumonia 19553042 51763977 9878db3c-76b9d4df-5665d4e6-1cfd1b57-819c2daf 633 frontal and lateral views of the chest were obtained . cardiomediastinal silhouette is stable . slight prominence of the right hilum is also stable . there are relatively low lung volumes . given this, patchy bibasilar opacities are seen, which while could relate to underlying edema, raises a concern for multifocal infection . there is also mid lung atelectasis . there is prominence of interstitial markings bilaterally . this may be due to underlying edema . no large pleural effusion or pneumothorax is seen . low lung volumes accentuate the bronchovascular markings . stable prominence of the right hilum . bibasilar opacities may be due to multifocal infection superimposed on mild interstitial edema depending on the clinical scenario . Edema&&Lung Opacity&&Pneumonia 19553042 55426590 f5ff8576-31d96895-75ed689c-6b8204ea-fb3fd185 634 patient is status post median sternotomy and cabg . there is cardiomegaly . prominence of the main pulmonary artery raises concern for pulmonary arterial hypertension . fluid is seen along the right major fissure, likely loculated . there are small bilateral pleural effusions . right perihilar opacity may be due to vascular congestion andor atelectasis, although focal consolidation is difficult to exclude . no evidence of pneumothorax is seen . bilateral pleural effusions with likely loculated component along the right major fissure . pulmonary vascular congestion . cardiomegaly . Cardiomegaly&&Edema&&Pleural Effusion 19560275 57248462 ed75f13d-51f62718-7271bf99-9086d33c-c72f7f23 635 ct torso lungs are fully expanded and clear . no pleural abnormalities . mild cardiomegaly . cardiomediastinal and hilar silhouettes are normal . a left pectoral pacemaker with right atrial and right ventricular leads is unchanged . recommendations no evidence of intrathoracic metastasis . Cardiomegaly&&Support Devices 19580750 52799543 31c50e15-4a244cac-11d33a37-6e57019b-63c5858f 636 a left chest wall pacemaker generator and leads are unchanged . the lungs are clearthe cardiac, hilar and mediastinal contours are stable, and the heart size is top normalno pleural abnormality is seen . mild cardiomegaly with no evidence of pulmonary edema, or metastatic disease . Cardiomegaly 19580750 53527021 e58282c4-fc8a5bed-aab4317b-f3dff9c8-40e5c04c 637 no relevant change . left pectoral pacemaker, no pulmonary edema . mild cardiomegaly . no pleural effusions . no lung nodules or masses suspicious for metastatic or malignant disease . Cardiomegaly&&Support Devices 19580750 57163769 efca036a-26a1899f-b388658f-da334861-32dba3c3 638 heart size is normal with mild tortuosity of the thoracic aorta . hilar contours are unremarkable . the lungs are mildly hyperinflated but otherwise clear . pleural surfaces are clear without effusion or pneumothorax . no acute cardiopulmonary abnormality . mild hyperinflation . 19580789 53737218 4ebe2c0c-2050b7f6-43722c9e-600d983c-63487359 639 moderate cardiomegaly is re- demonstrated, unchanged . the aorta remains tortuous . mediastinal and hilar contours are similar . pulmonary vasculature is not engorged . no focal consolidation, pleural effusion or pneumothorax is seen . lungs are hyperinflated . mild degenerative changes are noted in the thoracic spine . no acute cardiopulmonary abnormality . No Finding 19580789 54896273 3c46dc4f-b658b25f-8697ada5-6ef38005-825d9235 640 heart size is normal . the aorta is mildly tortuous . there are mild atherosclerotic calcifications along the aorta . the hilar contours are normal . pulmonary vascularity is normal . minimal blunting of the left costophrenic angle suggests a trace pleural effusion . lungs are otherwise clear . no focal consolidation or pneumothorax is seen . there are no acute osseous abnormalities . tiny left pleural effusion . otherwise no acute cardiopulmonary abnormality . Pleural Effusion 19580789 58022905 02b4c25f-5d1b8bd0-38c29e2a-cd861d6f-92f7175b 641 no focal opacities concerning for infection although enlargement of the cardiac silhouette as well as the azygos vein is noted . no large effusions . stable tortuous aorta . no pneumothorax . mild cardiomegaly, new since the prior study, and enlargement of the azygos compatible with volume overload without frank pulmonary edema . Cardiomegaly 19580789 59211846 ad6d1465-2d48c76e-d3452db0-f0146bfd-54f5fdad 642 frontal and lateral views of the chest were obtained . lungs are clear without focal consolidation . no large pleural effusion or evidence of pneumothorax is seen . the aorta is calcified and tortuous . the cardiac silhouette is top normal . no overt pulmonary edema is seen . some degenerative changes are seen along the spine . no acute cardiopulmonary process . No Finding 19580789 59237725 64647c0c-e9b324f5-de4e864d-0dede615-1c4d854a 643 the heart and mediastinum are normal . the lung fields are clear . the costophrenic angles are sharp . no infiltrates are present . there is no evidence of a pneumothorax . No Finding 19586697 50637770 efb2c222-0fe78b2f-2bd67556-d10e01d8-72e87669 644 the lungs are moderately well inflated and clear . no pleural effusion or pneumothorax . heart size, mediastinal contour, and hila are unremarkable . no acute cardiopulmonary process . specifically, no pulmonary edema, effusion or pneumonia . No Finding 19586697 58804043 48548736-8e298f5f-e35f834e-eb62c604-3202d283 645 frontal and lateral chest radiographs demonstrate linear opacities at the bilateral bases, likely reflecting scar . lung volumes are slightly decreased compared with years prior . there is no significant effusion, or pneumothorax . the cardiac silhouette remains normal in size, the mediastinal contours are notable only for tortuosity of the aorta . pulmonary vasculature is normal . no acute chest abnormality . No Finding 19587538 51209548 bbff4e3f-5c4c00dd-c356f902-530cb15d-9e6663a9 646 the lungs are clear of focal consolidation, pleural effusion or pneumothorax . flattening of the diaphragms likely reflects chronic pulmonary disease . the heart size is normal . the mediastinal contours are normal . there are no signs of latent or active tuberculosis . no signs of latent or active tuberculosis . No Finding 19636128 57207094 1834a247-2913b335-13a0d5d6-a20329be-26d3a2bd 647 pa and lateral views of the chest . the lungs are clear . cardiomediastinal silhouette is normal . osseous and soft tissue structures are unremarkable . no acute cardiopulmonary process . No Finding 19796957 57051557 b0cda8a3-ddffb15c-e8d7fdb8-00fbf9fa-a5b1a60d 648 severe cardiomegaly is stable . pacer leads are in standard position in the right atrium, right ventricle and through the coronary sinus . there is no pneumothorax . there is no pleural effusion . patient is status post aortic valve and mitral valve repair no pneumothorax . No Finding 19837705 52255420 174d1efe-f7714d0c-f1f99de2-c6e25477-48635320 649 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 pneumothorax seen . No Finding 19845866 54018390 a03600e3-6f4ea6f0-c413be5b-1dade32a-4447a53f 650 cardiac silhouette size is normal . mediastinal and hilar contours are unchanged . pulmonary vasculature is normal . lungs are clear . no pleural effusion or pneumothorax is present . no acute osseous abnormalities are visualized . no acute cardiopulmonary abnormality . No Finding 19890966 52385709 9d752539-c8aeb9f8-049a169c-1605c54e-90634c71 651 the lungs are clear without focal consolidation . no pleural effusion or pneumothorax is seen . the cardiac and mediastinal silhouettes are stable . no acute cardiopulmonary process . no focal consolidation to suggest pneumonia . Pneumonia 19890966 52643889 35fe6db8-9b1e2b47-acbac4cf-7c7be2b0-4e63a836 652 the lungs are clearthe cardiac, hilar and mediastinal contours are normalno pleural abnormality is seen . no acute cardiopulmonary process . No Finding 19890966 55753415 499b08f0-eadc74b7-e72cbb9c-48acb229-95d39e5f 653 pa and lateral views of the chest provided . 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 19890966 57024988 94d1cb3d-d73778f9-54fd1b3c-a3db8e00-ac37feda 654 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 . no acute cardiopulmonary abnormality . No Finding 19932024 52421327 a9e13b36-9f15b5ec-c6da8ece-3f40651b-6efa91f1 655 heart size is normal . mediastinum is normal . lungs are clear . there is no pleural effusion or pneumothorax . No Finding 19932024 55032644 94cfab5d-c84c24dc-ebd79acf-b51bfecb-df30081b 656 the cardiac, mediastinal and hilar contours appears unchanged . there is no pleural effusion or pneumothorax . parenchymal abnormalities appear unchanged and reflect emphysema with mild accompanying interstitial disease . subpleural scarring and a small hyperdense nodules at the right lung apex appear unchanged . scarring and bullous changes are also stable at the base of the left chest . the chest is hyperinflated . there has been no significant change . no evidence of acute cardiopulmonary disease . No Finding 19950864 50986956 6895d4bc-d096ea6d-b0c6fcba-6b5fe802-4ce2705e 657 there is mild interstitial edema, and the heart is normal in size . a left basilar opacity may reflect atelectasis versus pneumonia . there is no pleural effusion or pneumothorax . mild interstitial edema . left basilar opacity may reflect atelectasis though infection can be considered in the appropriate clinical setting . Atelectasis&&Edema&&Lung Opacity&&Pneumonia 19950864 52815959 61b2e5b3-5192e298-d28244ef-a46613e7-13ff9c2e 658 frontal and lateral views of the chest show no acute intrathoracic process . flattened diaphragms and pulmonary blebs are consistent with obstructive lung disease . the mediastinum and pleural structures are unremarkable . calcifications are seen within the aortic arch . the shoulders are not fully evaluated, however, there are no suspicious osseous lesions . degenerative changes are seen within the thoracic spine . no acute intrathoracic process . No Finding 19950864 58368837 dbd9097b-81b68048-faf162d2-5ecda5ea-5d893d73 659 compared to chest radiographs since , most recently . large right and moderate left pleural effusions and severe bibasilar atelectasis are unchanged . cardiac silhouette is obscured . no pneumothorax . pulmonary edema is mild, obscured radiographically by overlying abnormalities . Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion 10003502 50084553 70d7e600-373c1311-929f5ff9-23ee3621-ff551ff9 660 no evidence of consolidation to suggest pneumonia is seen . there is some retrocardiac atelectasis . a small left pleural effusion may be present . no pneumothorax is seen . no pulmonary edema . a right granuloma is unchanged . the heart is mildly enlarged, unchanged . there is tortuosity of the aorta . Atelectasis&&Cardiomegaly&&Pleural Effusion 10003502 51180958 1fa79752-9ddaf5b5-2120ae82-9fec50d6-51f48d1f 661 there are moderate bilateral pleural effusions with overlying atelectasis, underlying consolidation not excluded . mild prominence of the interstitial markings suggests mild pulmonary edema . the cardiac silhouette is mildly enlarged . the mediastinal contours are unremarkable . there is no evidence of pneumothorax . bilateral pleural effusions, cardiomegaly and mild edema suggest fluid overload, however, given the clinical history, underlying consolidation due to pneumonia cannot be excluded at the lung bases . Cardiomegaly&&Consolidation&&Edema&&Pleural Effusion&&Pneumonia 10003502 52139270 550e6f3b-f008c1d0-8d2dee2a-649b30f4-101a98cc 662 moderate to large bilateral pleural effusions are again seen, likely right greater than left . there is suspected superimposed pulmonary edema may have slightly improved since prior although detailed evaluation is limited given layering pleural effusions . vasculature appears less engorged . cardiac silhouette cannot be assessed . mild to large bilateral, right greater than left pleural effusions . degree of pulmonary edema may have slightly improved since prior exam although detailed evaluation is limited . Edema&&Pleural Effusion 10003502 52309364 e0275ad1-1e6a7451-c3960f5f-1267a188-547b73a1 663 heart size is difficult to assess given the presence of moderate to large bilateral pleural effusions, but appears at least moderately enlarged . the mediastinal contours are grossly unremarkable . perihilar haziness with vascular indistinctness and diffuse alveolar opacities are compatible with moderate pulmonary edema . bibasilar compressive atelectasis is demonstrated . no pneumothorax is seen . moderate multilevel degenerative changes are noted in the thoracic spine . moderate pulmonary edema with moderate to large bilateral pleural effusions and bibasilar atelectasis . Atelectasis&&Edema&&Pleural Effusion 10003502 53282957 eb2fabb7-4bbc8aab-d7371282-08e5bcb5-de2e430a 664 the bilateral pleural effusions, lower lobe volume loss, and dense lower lobe opacity compatible with a combination of volume lossinfiltrateeffusion . the heart continues to be moderately enlarged . there is mild vascular redistribution . chf, slightly worse than on the prior study . Cardiomegaly&&Edema 10003502 53836463 371aaea8-195e21b2-ba5a2856-54803ecf-1b72d88b 665 frontal and lateral views of the chest . size of the bilateral effusions, left greater than right has slightly decreased in size since prior exam . there is less pulmonary vascular congestion on the current exam as well . cardiac silhouette which appears enlarged, is unchanged . no acute osseous abnormality is detected . persistent small bilateral effusions, larger on the left which have decreased in size . decreased pulmonary vascular congestion . no evidence of superimposed acute cardiopulmonary process . Edema&&Pleural Effusion 10003502 57641661 b410634d-0e4278d7-9c9b3561-8f5e5fc4-34a6aac8 666 cardiomegaly is severe, unchanged . pacemaker leads are unchanged . there is interval progression of vascular congestion and interstitial pulmonary edema . no pneumothorax . no atelectasis . subcutaneous air within the left chest wall is minimal . Cardiomegaly&&Edema&&Support Devices 10198310 52908323 ff7d1ad3-f6e1cd09-288ac039-d69f45d4-8ebbacf3 667 compared to chest radiographs since , most recently and postoperative radiographs . since , pulmonary vascular congestion has improved, mild pulmonary edema has resolved, but severe cardiomegaly is stable . pleural effusions are small if any . no pneumothorax . transvenous atrioventricular pacer leads, at least of which are or found are unchanged in their respective positions since . new epicardial leads project over the left heart border . new left pleural thickening partially hidden by the new left pectoral generator is a probably a small amount of bleeding associated with lead placement . there is no mediastinal widening or pneumothorax . lungs are low in volume but clear of any focal abnormality . Cardiomegaly&&Edema&&Pleural Effusion&&Pleural Other&&Support Devices 10198310 55018013 769fd8c6-0c20f1bf-86fa9850-b0b58e74-054967d1 668 in comparison with the study of , there appears to be a new pacer generator in place with what appear to be epicardial leads in the region of the left ventricle . no evidence of post procedure pneumothorax . there are lower lung volumes that may be accentuating the pulmonary vascularity . No Finding&&Support Devices 10198310 59538225 3971a847-5fdaeaec-226d2538-7ef67cf3-d5955a86 669 no relevant change as compared to the previous image . moderate cardiomegaly . mild central enlargement of the pulmonary arteries . no pleural effusions . no parenchymal opacities . no pneumothorax . Cardiomegaly 10199765 56226668 53875428-43e38b4f-4474877c-8f58e8c1-9a189004 670 as compared to the previous radiograph, no relevant change is seen . moderate cardiomegaly . mild tortuosity of the descending aorta . no pleural effusions . no pneumonia, no pulmonary edema . Cardiomegaly 10199765 56874598 b7b5e3b9-d55d332f-ebd0edf9-b48553d6-376f7a96 671 ap upright and lateral views of the chest provided . 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 10244947 58927269 d98a4431-acba5ef8-f0c5fe0c-b1b0900e-13276d61 672 comparison is made to the patients previous study dated at . a portable ap upright chest film at is submitted . . interval extubation . right internal jugular central line and left basilar chest tube remain in place . lung volumes are lower on the current examination . there is patchy opacity at the left base with an associated effusion, likely reflecting compressive atelectasis . no evidence of pulmonary edema . cardiac and mediastinal contours are difficult to assess due to the low lung volumes and patient rotation on the current study, although the mediastinal contours are likely unchanged . status post median sternotomy for cabg . no pneumothorax . Atelectasis&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Support Devices 10248673 55182796 5af7f675-13339075-9c8b61d4-bf098f85-30636763 673 comparison to prior study of at . a portable ap upright chest film, at is submitted . . interval removal of the left chest tube . no evidence of pneumothorax . right internal jugular central line has its tip in the distal svc near the cavoatrial junction, unchanged . status post median sternotomy for cabg with stable postoperative cardiac and mediastinal contours . there is elevation of the left hemidiaphragm with some adjacent streaky opacities, suggestive of atelectasis . blunting of the left costophrenic angle likely reflects a small effusion . there is also possibly a tiny right pleural effusion . no evidence of pulmonary edema . Atelectasis&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Support Devices 10248673 55680175 81d06e6f-8036e3cb-2cc3e83e-53754192-6adfd7ae 674 the lungs are clear . the cardiomediastinal silhouette is within normal limits . no acute osseous abnormalities . no acute cardiopulmonary process . No Finding 10253119 57118642 24386f31-41e447f6-dd0abcfa-ac74f2fe-431699ec 675 no previous studies for comparison . the heart size is within normal limits . lungs are grossly clear without definite consolidation, pleural effusions, or signs for acute pulmonary edema . there are no pneumothoraces . Edema 10261230 54512270 46583e03-f42311f4-87dca60a-c4c12f22-0fe13c7f 676 as compared to , there is unchanged evidence of mildly displaced right rib fractures . the right pneumothorax . visualized on the ct examination from , is not visualized on the radiograph . no pleural effusions . no pulmonary edema . no pneumonia . Fracture&&Pneumothorax 10287742 58092224 f2c7b3a4-c8299236-db971a34-5b06646b-233f91ae 677 comparison is made to the patients preoperative study of . portable semi-erect chest film, at is submitted . the heart remains enlarged . there is opacity along the medial left hemidiaphragm, which is known to correspond to a bochdaleks hernia containing portion of the left kidney . the right bochdalek hernia is not as well visualized on todays examination . there is patchy bibasilar opacity with likely associated layering effusions . these findings could reflect compressive atelectasis, although aspiration pneumonia should also be considered . there is also an asymmetric airspace process involving the left apex, which likely is not significantly changed dating all the way back to and therefore would favor a benign process . no pulmonary edema . no pneumothoraces . mediastinal contours are stable . Atelectasis&&Cardiomegaly&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Pneumonia 10308375 52139824 53f5b331-b246e0f1-f7e1d461-eb3139a0-caf707e0 678 interval increase in moderate-sized right pleural effusion, and right lower lobe opacity with new right upper lobe heterogeneous opacity . unchanged left apical pleural thickening and scarring . no interval change in the dense retrocardiac opacity obscuring the left hemidiaphragm which represents a bochdalek hernia . no pneumothorax or pulmonary edema . heart size is partially obscured by the pleural parenchymal process . mediastinal contour and hila are normal . no bony abnormality . . interval increase in moderate-sized right pleural effusion . . worsening right lower lobe opacity and new right upper lobe opacity are likely due to evolving pneumonia or aspiration . results were conveyed via telephone to primary team by dr . on at pm . within minutes of observation of findings . Lung Opacity&&Pleural Effusion&&Pneumonia 10308375 55091382 42fb9144-0cd336f1-4e3ecd64-a3e859ef-2647d4b0 679 allowing for differences in technique and projection, there has been minimal change in the appearance of the chest except for apparent slight increase in bilateral pleural effusions, now moderate on the right and small to moderate on the left . Pleural Effusion 10337896 50223793 5aab99c5-9eddcc03-d82c31f8-f7578391-c74b9f65 680 ap portable upright view of the chest . extensive intrathoracic calcifications are again seen, better localized on the chest ct examination from . the heart size is top normal . a tracheostomy tube is appropriately positioned . a right picc terminates at the caval atrial junction . again seen are bilateral pulmonary parenchymal opacities, with interval improvement along the right mid and lower zones since the radiograph . opacities across the left lung are unchanged . there is no pneumothorax . small bilateral pleural effusions are stable . , interval decrease of right pulmonary parenchymal opacities, reflecting improvement since . unchanged small bilateral pleural effusions . Lung Opacity&&Pleural Effusion 10337896 50519407 47dd9117-4908216e-6fa039c8-2d7a1454-74151fad 681 findings on the chest ct showed probable multi focal pneumonia, predominantly in the right lung, and mild interstitial edema . edema improved between and , and then opacification in the right lung increased again accompanied by increasing moderate right pleural effusion . the progression of these associated findings this suggested that the interval change was primarily due to cardiac decompensation . today edema has worsened in both lungs, and the moderate right pleural effusion is larger, although the opacification in the left lower lung is heterogeneous enough to suggest concurrent pneumonia or large scale aspiration . . mild cardiomegaly and chronic mediastinal widening are chronic . Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia 10337896 50880103 e5cd4468-946415a5-4559575d-56536274-59b03c5d 682 the tracheostomy tube is unchanged in position and terminates approximately . cm above the carina . the right picc line terminates in the distal svc . there is no significant change in the lungs when compared to . there are several parenchymal calcifications which were characterized on the most recent ct scan . again noted are diffuse infiltrative parenchymal opacities, right worse than left this is largely due to pulmonary edema and the right-sided pleural effusion, but underlying pneumonia cannot be excluded . the mediastinum is wide, which was noted as far back as the outside hospital cxr from . no acute osseous abnormalities . . moderate pulmonary edema, unchanged . . interval improvement in right-sided pleural effusion . Edema&&Pleural Effusion 10337896 53275640 ac8d6143-a581f133-eafa59da-4f66bc75-4693997c 683 in comparison with the study of , there is little change . diffuse bilateral pulmonary opacification with areas of calcificationpersist with bilateral pleural effusions and no change in the monitoring and support devices . Lung Opacity&&Pleural Effusion&&Support Devices 10337896 53323373 15034ac9-409361f3-6164c82a-a854b0cb-06ae3a8d 684 endotracheal tube and right internal jugular central line are unchanged position . nasogastric tube is seen coursing to the level of the distal esophagus but the tip is not identified . multiple calcified lymph nodes, multiple bilateral calcified parenchymal opacities and pleural calcifications are unchanged consistent with prior granulomatous infection . given the extensive parenchymal abnormality, this does limit the sensitivity of plain radiography . bilateral apical pleural thickening, left greater than right, which is unchanged . there are stable bilateral layering effusions, left greater than right, with probable associated compressive atelectasis in the lower lobes . no overt pulmonary edema . heart remains stably enlarged . bilateral glenohumeral degenerative changes with deformity of the left humeral head . Atelectasis&&Lung Opacity&&Pleural Effusion&&Pleural Other&&Pneumonia&&Support Devices 10337896 53482443 e7f2ad9b-a5698623-14f87c8b-47a99b0b-31959f7a 685 multiple calcified pulmonary nodules and calcified lymph nodes within the neck . severe degenerative changes of the glenohumeral joints . bilateral pleural effusions with bibasilar atelectasis . developing bibasilar consolidation is difficult to exclude . no pneumothorax . small bilateral pleural effusions with passive atelectasis . developing bibasilar consolidations are difficult to exclude . redemonstrated densities within the lung parenchyma and neck, possibly secondary to prior granulomatous disease . Atelectasis&&Pleural Effusion 10337896 53778461 58ac68b5-24c8cb7d-62f38524-4c03808a-0329f3c6 686 interval placement of an endotracheal tube which has its tip approximately . cm above the carina . nasogastric tube appears to be coursing below the diaphragm with the tip not identified . right internal jugular central line is unchanged in position . overall stable cardiac mediastinal contours . no interval change in the bilateral multiple calcified lymph nodes and parenchymal and pleural opacities . unchanged layering bilateral effusions . asymmetric biapical pleural thickening, left greater than right, all is unchanged dating back to . no pneumothorax . Enlarged Cardiomediastinum&&Pleural Effusion&&Pleural Other&&Support Devices 10337896 53799148 c13cd8dd-8b083466-64564d12-69441e5d-7b8a2515 687 as compared to the previous radiograph, the parenchymal opacities notably on the left, have moderately decreased in severity . the monitoring and support devices are unchanged . unchanged moderate cardiomegaly . unchanged known intra and extra thoracic lymph node calcifications . Cardiomegaly&&Lung Opacity&&Support Devices 10337896 54031658 ffde91fb-1eb2b3c1-48e6008b-c16bd376-8a771f1b 688 ap portable semi upright view of the chest . multiple calcified lymph nodes again seen projecting over the chest and neck . the previously noted tracheostomy tube is no longer seen . calcified pleural plaque along the right hemidiaphragm noted along with multiple bilateral calcified pulmonary nodules . a small right pleural effusion is likely present . no convincing signs of pneumonia . the cardiomediastinal silhouette appears grossly within normal limits . severe degenerative disease at both shoulders is again noted . no convincing evidence for pneumonia . chronic changes as detailed above . Pneumonia 10337896 54346165 ad80e2eb-b3f466b2-05747a4a-6bceb507-5d3748ba 689 an et tube is present approximately . cm above the carina . the enteric tube is present the distal tip off the film . there is no pneumothorax . there are small bilateral effusions . dense calcified opacities in both upper lung fields and hila are noted, consistent with prior history of tuberculosis . atelectasis or consolidation of the lung bases are noted . reticular changes are also noted, which may be acute or chronic . Atelectasis&&Consolidation&&Lung Opacity&&Pleural Effusion&&Support Devices 10337896 54785280 1cf4fc4f-428e8580-055a5630-45455deb-5c72df9c 690 in comparison with the study of , there is little change . monitoring and support devices remain in place . diffuse bilateral pulmonary opacifications persist along with multiple dense calcifications . Lung Opacity&&Support Devices 10337896 54966187 aa75e710-aee0e27e-b996e245-8bb737da-caa4ea7a 691 in comparison with the earlier study of this day, the monitoring and support devices are unchanged diffuse pulmonary opacification is processed and may be more prominent in the left base, suggesting some layering pleural effusion . Lung Opacity&&Pleural Effusion&&Support Devices 10337896 55022783 8c563705-ea74b74f-c379e0f7-91cd0b0e-b7ed81d8 692 the ng tube not well visualized, but may pass into the abdomen . diffuse bilateral pulmonary opacifications are again seen, unchanged from prior exam . et tube and right ij central line are in stable position from prior exam . ng tube not well visualized, but may pass into the abdomen . if it is a better visualization is desired, repeat radiographs with abdominal technique can be performed . No Finding 10337896 55070875 44bec237-520a0e5b-80e20d64-2c0a9036-c8766a81 693 minimal interval improvement of the pre-existing right pleural effusion, with subsequent increase in transparency of the right lung base . in the interval, the nasogastric tube has been removed . no other relevant changes . Pleural Effusion 10337896 55705635 ce5750a7-68ea7a3c-9170b26c-f86bd4a4-dea2e2f2 694 endotracheal tube continues to have its tip approximately cm above the carina . a right internal jugular central line is unchanged in position . nasogastric tube appears to have pulled back into the mid esophagus . no interval change in appearance of the multiple calcified nodes, multiple calcified pleural plaques, and multiple calcified parenchymal opacities . layering effusions with retrocardiac opacity likely reflecting compressive atelectasis . no pneumothorax . asymmetric biapical pleural thickening unchanged . bilateral humeral head degenerative changes with remodeling on the left . Atelectasis&&Lung Opacity&&Pleural Effusion&&Pleural Other&&Support Devices 10337896 55929666 69edea97-d76e1e86-638a39dc-13ee8420-6f3385ef 695 as compared to the previous radiograph, there is a minimal increase in diameter of the vascular structures, likely reflecting increased fluid overload . no other changes . the multiple known calcifications are constant in appearance . in the interval, the patient has received a tracheostomy tube . there is no pneumothorax . Support Devices 10337896 56165736 7fef0afd-85293903-b15562d2-3b827aee-1405b065 696 there is an et tube which terminates . cm above the carina . the right ij central venous catheter is in stable position with tip projecting over the low svc . again seen is an enteric tube with distal tip projecting below the lower limit of film, not visualized . allowing for changes in differences in rotation, the cardiomediastinal silhouette is unchanged . the bilateral hila are not well visualized . there is again seen pulmonary vascular congestion and moderate pulmonary edema, possibly worsened in the left lung in comparison to prior radiograph . there is stable pleural thickening most notable in the left apex . there are at least small bilateral layering pleural effusions, stable in size . there is unchanged appearance of multiple bilateral calcified lymph nodes as well as pleural and parenchymal calcifications . there is no pneumothorax . moderate pulmonary edema, possibly worse in the left lung most prominently . otherwise stable chest x-ray . Edema 10337896 56271118 c81c9275-d9fbf1b0-d61f3278-28a1d56b-6fc5dec5 697 et tube is seen in stable position . cm above the carina . right ij central venous catheter is in stable position projecting over the mid to lower svc . enteric tube is again seen coursing inferiorly with distal tip projecting approximately over the stomach, however side port is most likely above the ge junction, in comparison to prior radiograph . the cardiomediastinal silhouette is unchanged in appearance . the bilateral hila are not well seen . there is unchanged appearance of the bilateral lung parenchyma, with pulmonary vascular congestion and moderate pulmonary edema . there are unchanged small bilateral layering pleural effusions . there are stable multiple bilateral calcified lymph nodes, pleural and parenchymal calcifications . there is no pneumothorax . . enteric tube with side port projecting above the ge junction . require advancement . otherwise stable support structures . . unchanged lung parenchyma and stable small bilateral layering pleural effusions . Pleural Effusion&&Support Devices 10337896 56329890 7a04d256-8236b272-b4ccee81-b556f1dd-9df7b98a 698 there has been interval placement of a right internal jugular line with tip terminating in the lower svc . there is no pneumothorax . there is no improvement in the lung fields since the recent prior study . No Finding&&Support Devices 10337896 56437767 b6a12938-a1f0ed52-bca8e3f0-728b69ec-d2bc0a92 699 interval extubation . nasogastric tube is seen coursing below the diaphragm with the tip not identified but at least within the stomach . right internal jugular central line is unchanged in position . multiple calcified lymph nodes, multiple bilateral calcified parenchymal opacities and pleural calcifications are unchanged consistent with prior granulomatous infection . bilateral layering effusions unchanged . overall cardiac mediastinal contours are stable . no pneumothorax . Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices 10337896 56539620 603d88d1-87fcfddd-63120bbc-0d84d3ff-c0793f3e 700 as compared to the previous radiograph, the right picc line has been pulled back . the tip of the line, however, still projects over the right atrium and should be pulled back by another - cm . no evidence of complications . otherwise unchanged appearance of the lung parenchyma and the cardiac silhouette . Cardiomegaly&&Support Devices 10337896 56623034 f06a566d-44137a23-0a4acf0e-15f9c10d-4fcffff2 701 as compared to the previous radiograph, the tip of the right picc line now projects over the mid svc . no other changes are noted . the right internal jugular vein catheter and the tracheostomy tube are in constant position . Support Devices 10337896 56887951 c6fc6685-e7a9723b-af0fd3b9-b27ab011-0cd0b383 702 the right ij central line, endotracheal tube and enteric tube remain in satisfactory position . moderate pulmonary edema and small layering pleural effusions are also unchanged . there is no pneumothorax . the heart and mediastinum are magnified by the projection . calcified lymph nodes, as well as pleural and parenchymal calcifications are again noted . no significant interval change in moderate pulmonary edema and small bilateral pleural effusions . lines and tubes in satisfactory position . Edema&&Pleural Effusion&&Support Devices 10337896 56902361 7aca64c9-d64297cc-102477f2-a8ca30e1-7b90cf8c 703 as compared to the previous image, tip of the right picc line still projects over the mid to lower parts of the right atrium . pulling back of the line should be performed, as indicated in the previous report . no relevant change in appearance of the lung parenchyma and the heart . No Finding&&Support Devices 10337896 57080785 3b2a9672-8cd9b992-a96c4d95-6a081155-fd543b5e 704 cardiomediastinal contours are unchanged . mild to moderate pulmonary edema has worsened . small to moderate right and small left effusions have increased . multiple calcified lymph nodes and granulomas are again noted . Edema&&Enlarged Cardiomediastinum&&Pleural Effusion 10337896 57554911 a9390c8a-a8ea6990-7b9e1035-281e4eee-754368be 705 the overall appearance of the chest is similar to the recent study except for worsening multifocal consolidation in the right lung and standard slight increase in size of moderate right pleural effusion . Consolidation&&Pleural Effusion 10337896 57814257 f65f9193-62ebcf82-99968803-f13a04d1-f2c529b5 706 in comparison with the study of , the monitoring and support devices remain in place . diffuse bilateral pulmonary opacification is processed, consistent with pulmonary edema, bilateral pleural effusions, and compressive atelectasis at the bases, as well as diffuse calcifications . Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices 10337896 58472100 837a3315-a9ccd709-59623363-1b86d9d7-0682317f 707 support and monitoring devices are unchanged in position, and cardiomediastinal contours are similar . interval worsening of pulmonary edema as well as slight increase in size of moderate bilateral pleural effusions . otherwise, no relevant short interval change . Edema&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices 10337896 59930189 56ba2b4a-a47cedaf-139af8c9-10d8a957-74ec4f4f 708 frontal and lateral views of the chest demonstrate normal lung volumes without pleural effusion, focal consolidation or pneumothorax . hilar and mediastinal silhouettes are unremarkable . heart size is normal . there is no pulmonary edema . partially imaged upper abdomen is unremarkable . no evidence of acute cardiopulmonary process . No Finding 10401700 50064627 acf8db28-7be06aa5-dec86122-ecb7e055-f198a3f8 709 mild to moderate pulmonary edema, with a basal predominance, is new probably accompanied by small pleural effusions . heart size is top-normal not appreciably changed . Cardiomegaly&&Edema&&Pleural Effusion 10522265 50421811 d5aedb5c-3e300b8e-4ab8aa68-066f67dc-cfe7bd84 710 pulmonary edema developed between and . edema has subsequently cleared from the upper lungs, but there is still substantial consolidation in the lower lungs, particularly the left accompanied by at least small bilateral pleural effusions . to what extent the abnormality represents combination of edema and residual atelectasis or pneumonia, is radiographically indeterminate, but if the patients respiratory status has recently declined that cannot be attributed to worsening edema either atelectasis or pneumonia is more likely . feeding tube passes into the stomach and out of view . left pic line ends in the low svc . Atelectasis&&Consolidation&&Edema&&Pleural Effusion&&Pneumonia&&Support Devices 10522265 52497746 17077b64-972ced4d-1dd026ac-595f3151-121e9520 711 an ng tube is present, tip overlies the gastric body . the sideport lies distal to the ge junction . the chest is incompletely evaluated, but note is made of left lower lobe collapse andor consolidation with a small effusion . incidental note is made of a small density along the right edge of the tl disc space - small clip or calcification . the differential includes an artifact outside of the patient . ng tube side port and tip distal to the ge junction . No Finding&&Support Devices 10522265 54528409 3b6ecb77-1f0b496f-0e7298e0-2805ed0e-616e6f35 712 in comparison with the study of , there again are low lung volumes . the endotracheal tube has been removed . no evidence of acute cardiopulmonary disease . what appears to be some apical pleural thickening is again seen at the right apex laterally . Pleural Other 10522265 55120315 a8326c4c-0f639e00-ca24c7c1-95d336f2-d9de521f 713 tip of the endotracheal tube projects over the mid thoracic trachea, approximately . cm from the carina . enteric tube terminates beyond the diaphragm, in the left upper quadrant . lungs are clear and cardiomediastinal silhouette is normal . appropriate position of endotracheal and enteric tubes . No Finding&&Support Devices 10522265 55255109 b9454df6-7f75440e-9f3f32d4-038f3447-0c48ce72 714 compared to at , the overall appearance is similar . enteric type tube extends beneath the diaphragm, off the film . left subclavian picc line tip overlies distal svc . inspiratory volumes are low, with left lower lobe collapse andor consolidation and faint hazy opacity at the lung bases . mild upper zone redistribution present . overall similar to day earlier . above . No Finding 10522265 55807323 88d07416-c595d584-b0eec579-babde77f-c3ce90be 715 as compared to the previous radiograph, the nasogastric tube was removed . the left picc line is in unchanged position . mild cardiomegaly with retrocardiac atelectasis . no overt pulmonary edema . no pneumonia, no pleural effusions . Atelectasis&&Cardiomegaly&&Support Devices 10522265 57136358 1dd6b552-6d7354f6-6087977b-ed48e39a-5eecc163 716 there are low lung volumes . bibasilar opacities have increased more so in the left side likely due to increasing atelectasis and a small left effusion . the upper lungs are clear . there is no pneumothorax . cardiomegaly is stable . left picc tip is in the lower sv . Atelectasis&&Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Support Devices 10522265 58007779 5112f0c8-88daad36-4b8ec976-5df44b65-9b6b621b 717 et tube tip is . cm above the carinal . ng tube tip is in the stomach . heart size and mediastinum are stable . lungs are essentially clear . there is no pleural effusion or pneumothorax . Cardiomegaly&&Enlarged Cardiomediastinum&&Support Devices 10522265 58814809 87c1098e-9c3bb6e3-a61f96b2-ee3edd92-93ac1cdf 718 in comparison with the study of from an outside facility, there has been substantial decrease in the bilateral pulmonary opacifications . monitoring and support devices have been removed . the cardiac silhouette is within normal limits . mild prominence of the ascending and descending aorta raise the possibility of underlying hypertension . some indistinctness of pulmonary vessels could reflect elevated pulmonary venous pressure . are mild focal areas of opacification suggested at the bases . in view of the relatively low lung volumes, these could merely reflect areas of atelectasis . however, in the appropriate clinical setting, superimposed pneumonia could be considered . Atelectasis&&Edema&&Lung Opacity&&Pneumonia&&Support Devices 10526217 55733884 de3b15c4-8ccd2746-09cb6b58-2c546177-5c7cc9f8 719 since the prior study there is no substantial change in widespread parenchymal opacities and no focal consolidation that would be neo wall concerning for aspiration . the rest of the findings are similar to previous examinatio . Lung Opacity 10543994 50135643 343111ee-6c14729f-63955176-bbc37b84-e1195f48 720 cardiomediastinal silhouette is unchanged . there is interval improvement in the left lung variation but unchanged appearance of the right lung . port-a-cath catheter tip is at the cavoatrial junction . a left pacemaker lead is in the right ventricle . interstitial opacities projecting over the lung bases, right more than left are consistent with known interstitial lung disease with most likely superimposed pulmonary edema . no focal consolidation to suggest pneumonia is can see i . Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pneumonia&&Support Devices 10543994 50269819 5ed42390-a6bef7ec-7a5f8cd0-59d4304d-6a85c880 721 as compared to radiograph, cardiomegaly is accompanied by pulmonary vascular congestion and worsening asymmetrical combined alveolar and interstitial pattern which remains more severe in the right lung than the left . observed findings may reflect asymmetrical edema, but followup radiographs after diuresis may be helpful to exclude secondary superimposed process in the right lung such as infection . small pleural effusions are present bilaterally . Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia 10543994 52321866 6227f675-2c12a350-9948a0bc-be0b2666-b1ba8954 722 since the prior radiograph, no significant change in the widespread parenchymal opacities and moderate cardiomegaly . no change in the left the port-a-cath, which terminates at the cavoatrial junction, and right pacemaker lead in the right ventricle . no new focal consolidation or larger pleural effusions . no significant change in the widespread parenchymal opacities and moderate cardiomegaly . no larger pleural effusions . Cardiomegaly&&Lung Opacity 10543994 52330535 b3d6304a-bf9f636f-6eba19df-d0e27e8d-4d62934b 723 the bilateral parenchymal opacities are likely secondary to edema but may be due to accelerated interstitial disease . there largely unchanged . moderate cardiomegaly is unchanged, as are the pulmonary vasculature and mediastinal contours . right port-a-cath terminating at the cavoatrial junction and left pacemaker continuous lead in the right ventricle are unchanged . largely unchanged bilateral parenchymal opacities, likely secondary to edema but may be due to accelerated interstitial disease . Edema&&Lung Opacity 10543994 53186992 cd184740-11930719-2a8fc04b-c1076a05-9009709a 724 portable ap upright chest film at is submitted . interval placement of a single lead left-sided pacing device with the lead terminating over the expected location of the right ventricle . the cardiac and mediastinal contours are stable with left ventricular prominence . interval placement of a right internal jugular port-a-cath with its tip in the distal svc . no pneumothorax . interval appearance of mild pulmonary edema . Edema&&Enlarged Cardiomediastinum&&Support Devices 10543994 53418566 78383c35-b9b27e1d-2f9fa023-af32c4bc-0e8f6a90 725 widespread parenchymal opacities have demonstrate no substantial change since the prior study . heart size and mediastinum are unchanged including moderate cardiomegaly . no pleural effusion or pneumothorax is seen . port-a-cath catheter tip is at the level of the cavoatrial junction . Cardiomegaly&&Enlarged Cardiomediastinum&&Lung Opacity&&Support Devices 10543994 54489908 7abd173d-1d1b5df7-ff08e42a-7d346b58-6e49dcec 726 as compared to the previous radiograph, no relevant change is seen . low lung volumes . relatively extensive bilateral parenchymal opacities, right more than left, combined with a moderately enlarged cardiac silhouette . no new parenchymal opacities . the left pectoral pacemaker and the right port-a-cath are in unchanged position . Cardiomegaly&&Lung Opacity&&Support Devices 10543994 57237894 95a1bd4e-c011b21e-36ba6f97-6683c294-5b0dd26d 727 in comparison with the study of , there again is prominence of the transverse diameter of the heart with a similar degree of elevated pulmonary venous pressure superimposed upon chronic interstitial lung disease . or fibrosis the tip of the right port-a-cath again extends to the upper portion of the right atrium . pacer device remains in place . Cardiomegaly&&Lung Opacity&&Pleural Other&&Support Devices 10543994 58585479 3d361f0b-af2b247b-955d1166-f1ae4ef9-b96b55db 728 the abdomen ct showed mild pulmonary fibrosis and severe aortic valvular calcification undoubtedly stenotic . interstitial abnormality has predominated in the right lung . this is probably asymmetric edema . it has improved today since . cardiomegaly is severe . pleural effusions are small if any . no pneumothorax . right jugular infusion catheter ends low in the right atrium . transvenous right ventricular pacer lead in standard placement . no pneumothorax . Cardiomegaly&&Edema&&Pleural Effusion&&Pleural Other&&Support Devices 10543994 58967663 e666163a-857953ec-9b3034d3-6020c1aa-12c0c11a 729 since the prior study there is minimal interval change in cardiomegaly, mediastinal contours, lines as well as parenchymal opacities . the right lung appears to be more involved than left . the consolidation is slightly more asymmetric than on the prior study and does either worsening of interstitial process or superimposed infection in the right lung are possibility . correlation with chest ct would be justified at this poin . Cardiomegaly&&Consolidation&&Enlarged Cardiomediastinum&&Lung Opacity&&Pneumonia&&Support Devices 10543994 59383182 b2093612-0ee94341-26838e2f-d6912ecd-14c5aa64 730 mild interstitial edema has minimally worsened . there are low lung volumes . patient has underline interstitial lung disease fibrosis . there is no pneumothorax . cardiomegaly and widened mediastinum are stable . right port catheter tip is in the upper right atrium . pacemaker lead tip is in the right ventricle . Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Other&&Support Devices 10543994 59627293 ef13f435-fe872e16-39f17cfe-50700e9c-c69a04d3 731 underpenetration of the lower chest, particularly on the left, is felt to be due to overlying soft tissue . no focal consolidation is seen on the lateral view . there is no pleural effusion or pneumothorax . the cardiac and mediastinal silhouettes are stable with persistent enlargement of the cardiac silhouette . no acute cardiopulmonary process . No Finding 10569231 53678530 f81a519e-734afad4-3d6c87f8-6434f949-a7676b82 732 ap upright and lateral views of the chest provided . large body habitus and underpenetrated technique limits assessment . allowing for technical limitations, the lungs are clear . heart is mildly enlarged . mediastinal contour is normal . no large effusion or pneumothorax . bony structures are intact . mild cardiomegaly . no overt signs of edema or pneumonia . Cardiomegaly 10569231 55488757 8bd08c70-fbb6e2dc-4a5730ee-8a7a80b5-c496867e 733 ap upright and lateral views of the chest provided . lung volumes are low . allowing for this, the lungs are clear . 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 10575714 59777295 c027d8f8-d7e3b702-251c84f4-f4630cbf-72e59727 734 moderately severe pulmonary edema has improved minimally in the mid and upper lung zones, not so in the lung bases where it is more severe, accompanied by moderate bilateral pleural effusion . severe cardiomegaly has improved slightly . there is no pneumothorax . transvenous right atrioventricular pacer defibrillator system in standard placement . thoracic aorta is heavily calcified and mildly irregular in shape, due to heavy atherosclerotic plaque . Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices 10580208 53675993 a7955cff-d2fccb0b-b49d4a97-71d64c98-d657a78b 735 ap and lateral images of the chest . a pacer is seen overlying the left anterior chest in a different location than on prior exam, with intact leads in appropriate position . increased interstitial markings are seen bilaterally, consistent with mild to moderate pulmonary edema . bilateral pleural effusions are seen, left greater than right . no pneumothorax is seen . the cardiomediastinal silhouette is incompletely assessed due to adjacent pulmonary effusion, but it appears to be enlarged . . mild-to-moderate pulmonary edema with bilateral pleural effusions, left greater than right . . cardiomegaly . Cardiomegaly&&Edema&&Pleural Effusion 10580208 54794964 43fe7b33-07803c3a-c3cdc4b6-7a8f7f94-e7e6e01a 736 right sided port-a-cath tip terminates in the mid svc . heart size is normal . mediastinal and hilar contours are unchanged . calcified bilateral hilar lymph nodes are re- demonstrated . pulmonary vasculature is not engorged . no focal consolidation, pleural effusion or pneumothorax is present . no acute osseous abnormality is detected . heterogeneous appearance of the t vertebral body is better seen on the prior ct . no acute cardiopulmonary abnormality . No Finding 10617538 59001230 cb19438f-641f1bf4-e5b7d045-351ae8c3-892e9013 737 ap view of the chest . there are low lung volumes . calcified nodules in the right lung base are unchanged from prior, likely sequelae of prior healed infection . there is bibasilar atelectasis . no focal consolidation, pleural effusion or pneumothorax . the cardiomediastinal silhouette is unremarkable . . no evidence of pneumonia . . stable calcified nodules in the right lung base, likely sequela of prior healed infection . Pneumonia 10649970 50196128 1d781883-bb2d3cf0-14fd56ff-c4d0e12f-1143d820 738 comparison to at . portable ap upright chest film at am . is submitted . . lung volumes remain somewhat low . there are multiple small calcified nodular opacities in the right mid and lower lungs, which are unchanged . no pulmonary edema or airspace consolidation to suggest an acute infectious process . no pneumothorax or pleural effusions . overall cardiac and mediastinal contours are stable . no pneumothorax . Enlarged Cardiomediastinum&&Lung Opacity&&Pneumonia 10649970 50701407 a1c8c7ce-7da30482-9513e5d6-e9c94ca0-4ce8696a 739 the ap portable chest radiograph demonstrates right picc which terminates in the axilla . there is no focal consolidation . there is bibasilar atelectasis . heart size is top-normal . mediastinal and hilar contours are within normal limits . there is no pneumothorax or appreciable pleural effusion . right picc with tip terminating in right axilla . these findings were communicated to surgical house staff officer by dr . telephone at on . No Finding&&Support Devices 10738077 52247104 df51559d-507712fb-fa6e2962-7da4f76b-a209ffe9 740 there is a new tracheostomy tube, turned to the left, tip facing the left tracheal wall . there is no pneumothorax or mediastinal widening . small right pleural effusion is new . heart size is normal . thoracic aorta is tortuous, but not focally dilated . right subclavian line ends low in the svc . Pleural Effusion&&Support Devices 10750092 51178141 6a83b24c-67c3269a-c2c1b295-6bde13b8-b9bab43c 741 comparison is made to previous study from . there is an endotracheal tube whose tip is . cm above the carina . this could be pulled back - cm for more optimal placement . there is a nasogastric tube whose side port is near the ge junction . this could be advanced several centimeters for more optimal placement . there is stable cardiomegaly and tortuosity of the thoracic aorta . there is some slight prominence of pulmonary vascular markings and some atelectasis versus developing infiltrate at the right base . no pneumothoraces are present . Atelectasis&&Cardiomegaly&&Lung Opacity&&Support Devices 10750092 52347962 f9f2994d-0072f6aa-32cf61c7-af016a0a-5e32b37a 742 portable upright chest radiograph demonstrates no change in aeration accounting for differences in positioning . the patient remains intubated, with the tip of the endotracheal tube positioned . cm from the level of the carina . an ng tube is in place with its tip projecting over the expected position of the stomach, and sidehole projecting over the expected position of the distal esophagus . there is mild pulmonary edema . cardiac and mediastinal contours are unchanged . . unchanged mild pulmonary edema . . ng tube sidehole in the distal esophagus, could be advanced several centimeters to decrease the risk of aspiration . Edema&&Support Devices 10750092 54397816 0467c521-bdba9798-87b7c0cf-b1e76b40-5fcd1444 743 portable supine chest radiograph endotracheal tube terminates . cm above the carina . nasogastric tube terminates in the proximal stomach slightly higher than on the prior study and as mentioned previously can be advanced for more optimal positioning . right subclavian catheter terminates in the mid svc . left basal opacity and mild vascular congestion are improved with calcified granuloma seen in the right apex . Edema&&Lung Opacity&&Support Devices 10750092 55121872 27da1774-c4b8d63b-55aa64ae-fd743cac-debd93de 744 ap and lateral views of the chest there is no focal consolidation to suggest pneumonia . there is no pleural effusion or pneumothorax . again seen in the right upper lobe is a calcified granuloma . the previously described multiple lung nodules are not as conspicuous on this study and are better characterized on the previous chest ct . an old right seventh rib fracture is present . a wedge compression fracture of the mid thoracic spine is unchanged . the heart size is normal . aortic calcifications are seen in an otherwise normal mediastinum . No Finding 10750092 55148571 791ef542-9bf794a8-96dd48ff-588a38ed-9b686f16 745 semi-upright portable chest radiograph was obtained . endotracheal tube terminates . cm above the carina . nasogastric tube is again seen with side hole at the level of ge junction . right subclavian catheter terminates in the mid svc . bibasilar left greater than right atelectasis is unchanged with slight decrease in edema . a right midlung opacity is more apparent given the decreased edema and may reflect an early pneumonia . cardiac size and tortuosity of the aorta is unchanged . finding was discussed by phone with dr . by dr . at on . Atelectasis&&Edema&&Lung Opacity&&Pneumonia 10750092 57870796 ce531719-78a6c8a0-6db6ac35-9786e10c-8ff62104 746 in the interim, the patient has been intubated, the endotracheal tube tip lies no less than . cm from the level of the carina . the lungs remain hyperexpanded, with no pneumothorax or pleural effusion . the cardiac silhouette remains normal in size, the mediastinal contours are notable for aortic ectasia . there is a healed fracture of the posterolateral right fifth rib . an ng tube remains in place with its tip and sidehole within the stomach . note is made of mitral annular calcifications . . interval intubation, endotracheal tube tip is at least . cm from the level of the carina . . hyperexpansion, with no acute chest abnormality . Support Devices 10750092 59472868 632aa920-047fa58d-57bb9ec3-53497e57-ab6df53a 747 left-sided chest tubes are again seen . there continues to be a moderate left effusion . there is left sided pulmonary vascular redistribution and alveolar edema that is slightly increased compared to the study from the prior day . the right lung is clear . Edema&&Pleural Effusion&&Support Devices 10773739 54534488 e6f661d0-3ef9f93a-c00603f2-8e7d049d-6a3a0581 748 interval increase in opacification of the left lung is probably a function of pleural restriction and had asymmetric edema, accompanying increase in the volume of pleural fluid at the base of the left hemi thorax . apical and basal pleural tubes are unchanged in position . right lung is clear . heart is mildly enlarged . elevation of the left hemi diaphragm is probably a function of left lower lobe atelectasis and pleural fixation . no pneumothorax . Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices 10773739 57343946 203fcaff-aaa7aa30-f1eeb9d0-d903b93f-b2bc1a10 749 following insertion of left apical and basal pleural drains, there has been a substantial decrease in the volume of left pleural effusion, small to moderate, and largely basal . left lower lobe is poorly aerated, so i cannot exclude pneumonia there . the upper lung is clear . there is mild re-expansion edema in the left midlung . right lung is clear . ct scanning would be helpful in assessing both the left pleural space an the lower lung, depending course upon the profile of the thoracentesis aspirate . no pneumothorax . Edema&&Pleural Effusion 10773739 58663163 4f3d57de-827269dc-785ac7cd-9b9c4f86-8366d5da 750 small right apical and basilar pneumothorax is not significantly changed compared to the most recent radiograph from . the previously seen small caliber right pleural catheter on the prior chest radiograph is no longer identified . there are two new larger bore pleural catheters projecting over the right lung base . there has been interval improvement of the small right-sided pleural effusion . the left lung is clear without evidence of focal consolidations . there is mild right basilar atelectasis . the hilar and mediastinal contours are normal . . sp placement of two new larger bore pleural catheters projecting over the right lung base . small right pneumothorax not significantly changed compared to the most recent radiograph . . mild right basilar atelectasis . Atelectasis&&Pneumothorax&&Support Devices 10803114 50512608 49910657-1f377f22-5cc20631-adab4e1a-1debb4b0 751 comparison to the most recent preceding radiograph, there is a slight reaccumulation of fluid in the right pleural space . two chest tubes are noted in that space . a tiny apical pneumothorax is present . right atelectasis is also present . the left lung is essentially clear . cardiac size is normal . Atelectasis&&Pneumothorax&&Support Devices 10803114 50901934 a239d4b6-5c88ad05-ed28dae6-22f93f18-4538a559 752 a pigtail catheter is present at the right base and a small residual effusion is still present . there is no evidence of a pneumothorax . some basilar atelectasis is seen . the left lung remains clear . Pleural Effusion 10803114 52569432 21b088f4-785d17f9-7d448101-6744c865-87dd790b 753 comparison is made to the patients prior study of at . portable upright chest film at is submitted . . there is a stable small right apical pneumothorax . two right basilar chest tubes remain in place and there is contiguous patchy airspace disease in this vicinity which is essentially unchanged . a small but stable right effusion is likely present . the left lung remains clear . overall, cardiac and mediastinal contours are stable . no evidence of pulmonary edema . Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Pneumothorax&&Support Devices 10803114 53287973 24dcc6bd-268da180-8371ae76-64cd7bcd-550a8701 754 in comparison with study of , there is little interval change in the appearance of the small residual effusion and atelectatic changes at the right base with pleurx catheter in place . no evidence of pneumothorax . Atelectasis&&Pleural Effusion&&Support Devices 10803114 53696310 dd5da479-b1000fad-3146bb1a-6a6c7244-25e07794 755 comparison is made to the patients prior study at . portable ap upright chest film at am . is submitted . . two right basilar chest tubes remain in place . there is a stable small right apical pneumothorax . contiguous patchy airspace disease at the right base is also seen and stable . there is a small residual right pleural effusion vs . pleural thickening, unchanged . left lung is clear . no evidence of pulmonary edema . heart remains enlarged . mediastinal contours are unchanged . Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Pleural Other&&Pneumothorax&&Support Devices 10803114 56530218 4e706237-7bfcb1f1-73ed2f42-d39a58df-de79389a 756 there has been no significant change since the prior chest x-ray of . a small residual right effusion is present . there is no evidence of a pneumothorax . the left lung fields are clear . No Finding 10803114 56814699 44a77474-9433858c-b46ea842-b78cbd76-b08fc180 757 the et tube tip is relatively high at the level of the thoracic inlet, approximately cm above the carina and might be considered to be advanced . heart size and mediastinum are unremarkable . lungs are essentially clear except for minimal bibasilar atelectasis . No Finding&&Support Devices 10817099 51966317 0f2ba928-9c1965d7-afbe3c98-6b530f76-f000ae54 758 interval extubation . cardiomediastinal contours are within normal limits and without change . improved aeration at the lung bases with residual subsegmental atelectasis at the left lung base . improving aeration at lung bases with residual left lower lobe subsegmental atelectasis . Atelectasis 10817099 59649487 30b12960-af4bffa5-615613dd-d0a3cdcc-f885a90f 759 the lungs are clear bilaterally . the heart may be at the upper limit of normal, however there are low lung volumes and magnification artifact present ap film . no pleural effusion or pneumothorax is seen . on the lateral, a thin-walled ring shadow unlikely be of significance is seen . no radiographic evidence for the patients leukocytosis . No Finding 10893584 53265978 e5ba8565-97cf1086-bd6674d6-78042027-ad400dce 760 pa and lateral chest radiograph the cardiac, mediastinal and hilar contours are normal and unchanged from . bilateral low lung volumes are again noted with crowding of bronchovascular markings . no focal consolidation or superimposed edema is noted . calcification of the aortic arch is noted . no definite effusion or pneumothorax is seen . 10893902 54173236 8a5f12a9-223bb9c6-bbd5b9fd-ca751b7a-ba6e910c 761 lung volumes are low and exaggerate pulmonary vascular markings . there are bibasilar atelectatic changes but the lungs are otherwise without a focal consolidation . the cardiac and mediastinal contours appears stable . left ventriculoperitoneal shunt is again visualized traversing through the chest into the upper abdomen . no acute fractures are identified . severe degenerative changes are noted at the right glenohumeral joint with moderate degenerative changes throughout the thoracolumbar spine . no acute cardiopulmonary process . No Finding 10924949 53623762 d1552af1-5b159d3e-4058cc59-8af87caf-375f46e7 762 frontal lateral views of the chest . tubing seen along the left anterior chest wall, presumably from a ventriculoperitoneal shunt . relatively low lung volumes are seen . the lungs however are clear of consolidation or effusion . cardiomediastinal silhouette is within normal limits . no acute osseous abnormality detected . no acute cardiopulmonary process . No Finding 10924949 58001725 f4ec1ae5-a9b3e696-9647c6e3-2518312e-e435cf0a 763 cardiomediastinal and hilar contours are stable demonstrating mild cardiomegaly . mitral annular calcifications are noted . bibasilar opacities, left greater than right are demonstrated and may represent infection or atelectasis . lower lung volumes on the current exam results in crowding of the bronchovascular markings . the aorta is tortuous and calcified . there is no pneumothorax . there is no pleural effusion . there is marked degenerative change involving the glenohumeral joints bilaterally . bibasilar opacities, left greater than right suggest infection or atelectasis . mild cardiomegaly is stable . Atelectasis&&Cardiomegaly&&Lung Opacity&&Pneumonia 10986871 53302173 171a4674-65e7ed96-c63bae1f-faa3fd7d-07ac9309 764 single portable upright view of the chest the lungs show minimal bilateral dependent atelectasis . the lungs are otherwise clear . cardiomediastinal silhouette and hilar contours are unremarkable . no pleural effusion or pneumothorax . no evidence of free air . No Finding 11001469 54076811 d0d2bd0c-8bc50aa2-a9ab3ca1-cf9c9404-543a10b7 765 since , substantial pulmonary edema is increased, bilateral layering pleural effusions, right greater than left, are increased with persistent bibasilar and retrocardiac atelectasis . lung volumes remain low . cardiomegaly is difficult to evaluate but also appears worse . no pneumothorax . substantial pulmonary edema is increased, bilateral layering pleural effusions, right greater than left, are also increased with persistent bibasilar retrocardiac atelectasis since . Atelectasis&&Edema&&Pleural Effusion 11068484 50986892 5baac073-ce7e3f3a-9ba21c8f-9237a435-845c26f6 766 compared to the prior study there is no significant interval change . no change . No Finding 11068484 52314386 9613d784-ef4fadd2-8b33b9c3-3db90fd4-6730c5d6 767 as compared to radiograph, cardiomegaly is accompanied by improved pulmonary vascular congestion and decrease in size of left pleural effusion, now small . a moderate right pleural effusion persists with adjacent basilar atelectasis and or consolidation . elevation of the right hemidiaphragm is a persistent finding since . Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Pleural Effusion 11068484 53544633 2c072c9e-42b8fab0-a0fd256c-780bc612-53941594 768 lung volumes remain low . silhouetting of the left hemidiaphragm and blunting of the left costophrenic angle is new compared to the prior exam and suggest presence of small pleural effusion . is probably also atelectasis . there is moderate pulmonary edema . heart size is probably a moderate to severely enlarged, even in the setting of low lung volumes and portable technique . elevation of the right hemidiaphragm is unchanged . severe pulmonary vascular engorgement is overall unchanged . right infrahilar opacity may reflect combination of atelectasis, edema . concurrent infection cannot be excluded . no pneumothorax . extensive aortic knob calcifications are unchanged . low lung volumes . findings most consistent with volume overload . however, concurrent infection cannot be excluded . this patient could benefit from a chest ct non-emergently . Pneumonia 11068484 54047608 5a686ceb-f01792db-cdba870c-da79a22f-f34265ea 769 portable semi-erect chest radiograph at is submitted . lung volumes remain low with crowding of the vasculature and bibasilar opacities likely representing atelectasis, although pneumonia or aspiration cannot be excluded . worsening mild perihilar edema . stable cardiac and mediastinal contours with calcification of the aortic knob . no pneumothorax . Atelectasis&&Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pneumonia 11068484 55945977 c4752408-15e8abd3-707ec66e-a1449931-5430926e 770 ap portable upright view of the chest . lung volumes are markedly low limiting evaluation . there is chronic elevation of the right hemidiaphragm . left mid to lower lung opacity could reflect the presence of pneumonia or aspiration . there is pulmonary vascular congestion with at least mild pulmonary edema . pleural effusions are likely present . heart size cannot be assessed . no pneumothorax . bony structures appear grossly intact . limited exam with left lower lung consolidation concerning for pneumonia or aspiration . mild pulmonary edema with bilateral pleural effusions . Consolidation&&Edema&&Pleural Effusion&&Pneumonia 11068484 55984935 4cac02f5-71a07948-2e40edb0-d546dcad-b3683965 771 ap upright and lateral views the chest were provided . lung volumes are low limiting assessment . elevation of the right hemidiaphragm is again noted . there is bibasilar atelectasis . hilar congestion and mild pulmonary edema is noted . no large effusions are seen . heart size cannot be assessed . mediastinal contour appears grossly unchanged with atherosclerotic calcifications of the aortic knob . bony structures are grossly intact . mild edema, bibasilar atelectasis . Atelectasis&&Edema 11068484 56360523 fadc81b1-9ea238c0-58b6e7a8-915e4bbc-34aee7b4 772 compared to the prior study there is no significant interval change . no change . No Finding 11068484 57395441 06e2fd1d-35c95f84-e6021f4a-4611a14e-a4b9a693 773 heart size is prominent but stable . there are calcifications of the thoracic aorta . there are very low lung volumes . there is atelectasis at the lung bases . there is a left retrocardiac opacity . there is prominence of the pulmonary interstitial markings suggestive of mild pulmonary edema . no pneumothoraces are seen . Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity 11068484 59455276 804c7e55-eb848216-fc96a88b-0e374004-dacbc260 774 severe cardiomegaly and pulmonary vascular engorgement are unchanged since . mild pulmonary edema on present on has resolved . atelectasis in the right middle lobe and atelectasis or consolidation in the infrahilar left lower lobe are unchanged . pleural effusions are small if any . no pneumothorax . chest ct scanning would be useful to determine the extent of pulmonary abnormality the size of right pleural effusion, and the presence if any pericardial effusion . chest cta would of course be diagnostic regarding pulmonary emboli . Atelectasis&&Cardiomegaly&&Consolidation&&Pleural Effusion 11068484 59971654 b0f9a42a-784e16e8-201986c2-ae91c454-6f5cbbd6 775 no focal consolidation is seen . biapical pleural thickening is noted . no pleural effusion or pneumothorax is seen . the cardiac silhouette is top-normal . the aorta is calcified and tortuous . old posterior lateral left ninth rib fracture was better seen on prior x-ray . no acute cardiopulmonary process . No Finding 11134683 51942946 30e1c508-1a2ca634-02f30afb-06fc43a9-d7eac519 776 since , the patient has been intubated, with tip of endotracheal tube terminating within cm of the carina . this can be withdrawn a few cm for standard positioning . additionally, the cuff of the tube is apparently over distended . cardiomegaly is accompanied by improved pulmonary vascular congestion and near resolution of interstitial edema . small pleural effusions have also decreased in size in the interval . Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices 11135350 50091414 9f4042d8-67b0cf43-edad00d1-e8a6f893-c8c3548c 777 compared to prior radiograph of day earlier, endotracheal tube remains relatively low, with tip terminating cm above the carina . cardiomegaly is accompanied by pulmonary vascular congestion and slight worsening of pulmonary edema . bilateral pleural effusions are a persistent finding, and left retrocardiac atelectasis or consolidation has improved . Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Pleural Effusion&&Support Devices 11135350 52432586 e2cc529b-ba7a0982-effc5cf0-662077a9-c2ce376f 778 assessment is somewhat limited due to marked patient rotation . the endotracheal tube tip is cm above the carina . a right internal jugular catheter terminates in the distal svc . there is persistent left lower lobe atelectasis . the heart remains enlarged . bilateral pleural effusions are similar in appearance when compared to the prior study . airspace opacity at the right lung base may reflect either atelectasis or infection . bibasilar atelectasis versus consolidation . otherwise no significant interval change when compared to the prior study . Atelectasis&&Consolidation 11135350 53036339 a49ebd3a-d86b070c-87256a4b-f5bb2b7e-f8ebaa00 779 since the chest radiographs obtained days prior, there has been a significant increase in left lung atelectasis with leftward mediastinal shift . patient positioning does not account for all apparent mediastinal shift . unable to assess for concomitant left pleural effusions or consolidation . the right lung is fully expanded and clear . subtotal left lung collapse with significant leftward mediastinal shift concerning for an airway obstruction such as an endobronchial lesion, foreign body, or mucous plug . notification the findings were discussed by dr . with dr . on the telephone on at pm, approximately minutes after discovery of the findings . Atelectasis 11135350 53277637 f3a27e2d-1d0d73bc-b7394f0c-7ed82c79-189ddee5 780 the tip of the endotracheal tube again is low and is . cm above the carina . this could be pulled back for more optimal placement . right ij central line has the distal lead tip in the distal svc, unchanged . heart size is enlarged but stable . there is a left retrocardiac opacity and bilateral effusions . there has been mild improvement of the pulmonary interstitial edema . Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices 11135350 53452058 317f2687-c3bf422b-70bb63ef-c094a677-6c81f799 781 ap upright and lateral views of the chest provided . tiny clips in the left axilla are again noted . the heart remains mildly enlarged . there is no focal consolidation, large effusion, or pneumothorax . a rounded density at the right pulmonary hilum likely represents a large vessel en face . no convincing signs of pneumonia or edema . imaged osseous structures are intact . no free air below the right hemidiaphragm is seen . mild cardiomegaly . otherwise unremarkable . Cardiomegaly 11135350 53762826 120e5b75-c3500201-4fcbcd62-51265bb3-e3371c84 782 as compared to the previous image, no relevant change is seen . the endotracheal tube and the right internal jugular vein catheter are constant position . moderate cardiomegaly . unchanged mild enlargement of the right hilus . . overall low lung volumes with mild fluid overload but no overt pulmonary edema . no evidence of pneumonia . Cardiomegaly&&Support Devices 11135350 53772313 cd3281a8-6fdf014d-d38263aa-913e7ac6-50920fae 783 as compared to , signs indicative of pulmonary edema have increased . there is now moderate pulmonary edema . moderate cardiomegaly . low lung volumes . minimal blunting of the costophrenic sinuses, potentially indicative of pleural effusions . Cardiomegaly&&Edema&&Pleural Effusion 11135350 54266284 2d945b0a-0962f1ea-b9f44bcd-83adc688-3a74a962 784 the study is suboptimal given patient head overlies lung apices . within those limitations, there is impression of overall unchanged cardiomediastinal silhouette . the bibasal areas of atelectasis are most likely present . infectious process in the lung bases cannot be excluded . small amount of pleural effusion is most likely present . no pneumothorax is seen . Atelectasis&&Enlarged Cardiomediastinum&&Pleural Effusion&&Pneumonia 11135350 56944245 578626a9-77b33b8d-b729cbff-72ed5102-152cf0e4 785 as compared to the previous radiograph, the patient has been extubated . the right internal jugular vein catheter remains in unchanged position . unchanged moderate cardiomegaly with new partial left lower lobe atelectasis . no change in appearance of the right lung . Atelectasis&&Cardiomegaly&&Support Devices 11135350 57156490 3dd5a5cf-d8a6dc19-0e4fbd9e-3c8cb517-68034727 786 et tube is seen with tip approximately . cm from the carina . enteric tube seen passing below the inferior field of view . lower lung volumes are noted on the current exam with bilateral parenchymal opacities which could be due to edema or infection . prominence of the right hilum is again noted . moderate cardiomegaly and appears to have progressed since prior could potentially be in part due to changes in positioning . no acute osseous abnormalities . surgical clips project over the left chest wallaxilla . et and enteric tubes as above . cardiomegaly with bilateral parenchymal opacities potentially infection or edema . Cardiomegaly&&Edema&&Lung Opacity&&Pneumonia&&Support Devices 11135350 57437729 0a7b4797-26061ea5-69f731ec-a45b9e8e-b4a66113 787 tip of endotracheal tube continues to terminate within . cm above the carinal with the neck in a flexed position . cardiomediastinal contours are stable . small to moderate right pleural effusion has apparently increased in size in the interval . no other relevant changes . Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices 11135350 57976096 e9151bd8-1aa6fa8b-d9bfa6c6-4035e4a5-e0e856bd 788 as compared to , the monitoring and support devices are constant . increasing right pleural effusion . unchanged moderate cardiomegaly with signs of mild to moderate pulmonary edema . increasing extent of a left retrocardiac atelectasis . Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices 11135350 57998601 7a9248b7-731f2e31-4c7a766b-902c1682-03ec67c8 789 since the chest radiograph obtained day prior, there is substantial improvement in aeration throughout the left lung . subtotal collapse has resolved with minimal residual atelectasis of the apex and lung base . right lung is fully expanded and clear . no obvious consolidations . moderate cardiomegaly is unchanged . pleural effusions small, if any . substantially increased left lung aeration with minimal residual atelectasis of the left apex and left lung base . Atelectasis 11135350 58767809 02ae05fc-ce6ab459-7561db4d-881fb85b-5a207608 790 ap and lateral views of the chest . the right lung is clear . there is obscuration of the left hemidiaphragm, which is clearly seen on prior and could be due to underlying left basilar atelectasis or pneumonia . increased opacity over the spine on the lateral view is likely in part due to degenerative, the tortuous descending thoracic aorta and hilar vasculature, although superimposed component of overlying consolidation is also possible in this region . atherosclerotic calcifications are noted at the aortic arch . there is a sliver of lucency projecting over the upper abdomen to the left of midline . this is of could be due to pneumomediastinum or potentially free intraperitoneal air . consider repeat examination with a chest x-ray with pa technique if possible . otherwise, ct scan may be necessary . findings were discussed with dr . at pm . on by dr . the phone minutes after time of discovery . Atelectasis&&Consolidation&&Lung Opacity&&Pneumonia 11135350 59122716 88877d10-188b5a1e-d99e6d09-75236a50-63e30ee8 791 consolidation in the left lower lobe is new since , without improvement since . previous moderate right pleural effusion is slightly smaller . severe cardiomegaly is not . there is no pulmonary edema . no pneumothorax . et tube is in standard placement . sharp definition of the upper margin of the cuff indicates secretions pooling above the . right jugular line ends in the low svc . Cardiomegaly&&Consolidation&&Pleural Effusion&&Support Devices 11135350 59746851 56291d00-a7244635-53aa8eb3-dce3a174-bc250ba0 792 frontal and lateral views of the chest were obtained . there is prominence of the hila raising concern for vascular engorgement, although underlying lymphadenopathy may be present and could be further evaluated for on chest ct . no focal consolidation is seen . there is minimal pulmonary vascular congestion . the cardiac and mediastinal silhouettes are unremarkable . there is no pleural effusion or pneumothorax . prominence of the hila could be due to vascular engorgement, although underlying lymphadenopathy not excluded . findings could be further evaluated on non-urgent chest ct . 11144972 51953245 a5c3470b-be30e581-14b6f2be-8eb54504-adeaa406 793 as compared to the previous radiograph, there is no relevant change . borderline size of the cardiac silhouette . no acute process, in particular no pneumonia or pulmonary edema . no pleural effusions . no pneumothorax . Cardiomegaly 11164575 56430288 1d6f62f9-adc5107d-e66dba67-28c879ec-bcf9e17a 794 single frontal view of the chest . heart size and mediastinal contours are stable . left lower lobe atelectasis persists . pulmonary vascular markings have increased and the hila appear indistinct and hazy, findings consistent with interval worsening of pulmonary edema . in addition, multiple widely distributed small rounded opacities were not seen on and, given the short time interval, likely represent vascular structures . slight interval worsening of pulmonary edema with persistent left lower lobe atelectasis . multiple bilateral small rounded opacities, new since , are most likely engorged vessels, but follow-up is recommended after resolution of pulmonary edema . Atelectasis&&Edema&&Lung Opacity 11177224 54099371 f9624358-214a129c-dc05b026-e49885ed-66224bdb 795 portable semi-upright radiograph of the chest demonstrates increased interstitial markings in the bilateral lungs concerning for pulmonary edema . increased opacification in the retrocardiac region raises concern for atelectasis versus pneumonia . there is a small left-sided pleural effusion . cardiomediastinal and hilar contours are unchanged . no pneumothorax . . interval increase in interstitial markings raises concern for pulmonary edema . . retrocardiac opacity is consistent with atelectasis or less likely pneumonia . Atelectasis&&Edema&&Lung Opacity&&Pneumonia 11177224 57718675 25a4da29-677dfc01-3c7bc2e9-ca5766ff-8910f5a1 796 a large right pleural effusion is new from the prior study . superimposed opacity likely represents compressive atelectasis, however infectious process could be considered the proper clinical setting . there is no left pleural effusion . there is mild pulmonary vascular congestion without overt pulmonary edema . . new large right pleural effusion . . superimposed opacity may represent compressive atelectasis or infectious process in the proper clinical setting . . mild pulmonary vascular congestion without overt pulmonary edema . Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia 11181748 55851177 c3badf14-8f90970e-8455cef5-6fe2eea4-6357ee71 797 the lung volumes are normal . the patient is intubated . the tip of the endotracheal tube projects . cm above the carinal . the course of the nasogastric tube is unremarkable . no pleural effusions . no pneumonia, no pulmonary edema . moderate tortuosity of the thoracic aorta . No Finding&&Support Devices 11197890 54514716 f2ed03fa-b7c00d7d-985f0cb3-dc9fb555-01c54c25 798 no focal consolidation, pleural effusion or pneumothorax is seen . prominent bilateral interstitial markings are stable from prior exam . the cardiac silhouette is normal in size . multiple bilateral rib deformities reflect prior fractures . no acute cardiopulmonary process . No Finding 11216230 57239326 cb6b6702-9109f7be-cb626f90-5de5b6ef-4f4c7ad9 799 comparison to . no relevant change . no pneumonia . mild overinflation . normal size of the heart . minimal bilateral apical scarring . Lung Opacity 11219382 58384629 34aad429-6b57597f-a1caa34d-d84cef06-3bc0c4ab 800 the cardiac, mediastinal and hilar contours appear stable . there is no pleural effusion or pneumothorax . the lungs appear clear aside from minor unchanged scarring in the lingula . no evidence of acute cardiopulmonary disease . No Finding 11226572 56558940 80ebdd2c-d387828d-89e90960-df690604-91bd8696 801 the lungs are clear . a small right pleural effusion is stable . the heart and mediastinum are within normal limits despite the projection . there is no pneumothorax . clear lungs with no evidence of pneumothorax . stable small right pleural effusion . Pleural Effusion 11287042 54197597 b8084cc6-129daa21-5e7278cf-1038961e-a964e354 802 up several lines are projecting over the chest, most of them are external except for central venous line terminating in the level of lower svc . heart size is unchanged, normal in size . severely dilated and tortuous descending thoracic aorta is consistent with known aneurysm i tip dissection . lungs are essentially clear with no evidence of focal consolidation to suggest infectious proces . Cardiomegaly&&Pneumonia&&Support Devices 11307058 50677909 9f2507a2-f8ed6c9f-657277ba-664fb54d-c23684b6 803 compared with the most recent radiograph, left lower lobe opacity compatible with infection is grossly unchanged . there is minimal right basilar atelectasis . lobulated contour abutting the aortic arch and projecting over the ap window is compatible with thoracic aortic aneurysm and prior dissection . intact median sternotomy wires . no pneumothorax . tiny, if any, right pleural effusion . persistent left lower lobe consolidation, compatible with infection . small right pleural effusion . Consolidation&&Pleural Effusion&&Pneumonia 11307058 51634516 cd8b3583-06cd4871-e09025fe-a2a60b90-348e7521 804 in comparison with the earlier study of this date, there has been placement of a nasogastric tube that extends into the lower body of the stomach with the side port distal to the esophagogastric junction . the remainder of the examination is unchanged, except for free gas beneath the hemidiaphragm related to the the recent abdominal procedure . No Finding&&Support Devices 11309915 51462743 ca55481f-3895ec03-76a040b8-d0fbd6ec-bcac13eb 805 no previous images . the cardiac silhouette is enlarged but there is no vascular congestion . opacification in the retrocardiac region is consistent with volume loss in the left lower lobe and small pleural effusion . however, in the appropriate clinical setting, it would be very difficult to exclude superimposed pneumonia, especially in the absence of a lateral view . Cardiomegaly&&Lung Opacity&&Pleural Effusion 11309915 52073508 09e634af-25dfbe2b-e54ba5f1-0b74a44a-bd670415 806 no previous images . cardiac silhouette is within normal limits and there is no vascular congestion, pleural effusion, or acute focal pneumonia . there is mild scoliosis of the thoracic spine convex to the right . 11442039 54889965 f086c561-9ee26e41-62786cc5-de4c7709-13df81fa 807 compared to chest radiographs . relative elevation of the right hemidiaphragm is more pronounced today, but unexplained . lungs are grossly clear . normal cardiomediastinal and hilar silhouettes and pleural surfaces . 11442039 59515380 d3a7a4ec-d8c2bf03-e0bd22f1-4c39d667-2b5dd849 808 low lung volumes on the ap projection causing crowding of bronchovascular structures . in addition, the apparent widened mediastinum is likely due to patient positioning and rotation . no focal consolidation concerning for pneumonia . no evidence of pneumothorax . cardiomediastinal and hilar silhouettes are grossly unremarkable . no evidence of dispalced rib fractures . low lung volumes causing crowding of bronchovascular structures . no evidence focal consolidation or pneumothorax . no evidence of dispalced rib fractures . please see the subsequent ct torso report from the same date for further findings . Consolidation&&Fracture&&Pneumothorax 11500818 56446166 c051db46-f8077330-028442f2-35bf5221-fda0ae4f 809 peripheral right upper lobe lung nodule has grown compared to the prior ct chest of and chest radiograph of . on the prior chest radiograph, it measured . cm in diameter and now measures . cm . as ap technique may magnify the nodule, dedicated chest ct may be considered for more accurate assessment of interval growth as well as possible development of lymphadenopathy in the right hilum . heart remains enlarged . low lung volumes accentuate the pulmonary vascular structures . minor bibasilar atelectasis is present . no definite pleural effusion . single-lead pacer remains in place, with lead terminating in right ventricle . . slowly growing peripheral right upper lobe lung nodule is concerning for primary lung adenocarcinoma . dedicated chest ct may be considered for more accurate assessment as well as to evaluate for possible right hilar lymph node enlargement warranted clinically . . low lung volumes limit assessment of the lung bases for pneumonia . given clinical suspicion for this entity, this could be further evaluated with repeat chest radiograph with improved inspiratory level . dr . was paged with these results at am . on , at the time of discovery . Lung Lesion&&Pneumonia 11520249 53036025 da4b16dc-70fac17f-f55577e8-6d7eb687-7777fa17 810 left-sided pacemaker device is noted with single lead terminating in the right ventricle . moderate cardiomegaly persists . aortic knob is densely calcified . mediastinal and hilar contours are unchanged . there is no pulmonary vascular congestion . left basilar opacity likely reflects atelectasis . no large pleural effusion is seen though assessment for left-sided effusion is somewhat limited due to overlying pacemaker generator pack obscuring this region . and ill-defined mm hazy nodular opacity within the right upper lung field is unchanged from . calcified granuloma in the left lung apex is unchanged . no pneumothorax is identified . degenerative changes are noted in the thoracic spine . . retrocardiac opacity likely reflects atelectasis . infection is difficult to exclude . . persistent mm subtle ill-defined nodular opacity in the right lung apex . finding are concerning for a neoplastic process, and further assessment with a chest ct is recommended . Atelectasis&&Lung Lesion&&Lung Opacity 11520249 53508597 046d4db0-ce1ff4f2-7995008c-6b054b3f-52e497a8 811 a left single lead pacemaker projects over the left lower chest and the lead likely terminates in the right ventricle . lung volumes are decreased, accentuating the cardiac silhouette which otherwise appears mildly enlarged . there is a left lower lobe opacity, which may reflect aspiration or pneumonia in the appropriate clinical setting . there is prominence of the right hilum . there is prominence of the pulmonary vasculature . no large pleural effusion identified, although limited examination of the left costophrenic angle . . left lower lobe opacity which could reflect aspiration or pneumonia . clinical correlation advised . . mild cardiomegaly with mild pulmonary vascular congestion . . prominent right hilum, concerning for lymphadenopathy . anterior shallow obliques or a chest ct can be obtained for further evaluation if clinically warranted . notification discussed with dr . by via telephone on at am . Cardiomegaly&&Edema&&Lung Opacity&&Pneumonia 11520249 56831678 47095b32-a853ea62-3c44a0f5-18ba6a9d-bf1ef6f9 812 ap upright and lateral views of the chest provided . a left chest wall pacer device is seen with catheter extending into the expected location of the right ventricle, unchanged . there is mild central pulmonary vascular engorgement which could indicate mild increased pulmonary pressures . the heart is stably enlarged . atherosclerotic calcification of the aortic knob noted . lung volumes are low, though there is no definite sign of pneumonia . bony structures appear intact . stable cardiomegaly with mild pulmonary interstitial edema . Cardiomegaly&&Edema 11520249 58466105 b22978a8-b5b4125a-08c7a341-112606a4-cbd852a9 813 ap and lateral views of the chest . there is a right upper lung, somewhat rounded opacity as seen on previous exam . again, this remains concerning for neoplasm . the lungs are otherwise grossly clear noting some right basilar atelectasis . left chest wall single lead pacing device seen with lead tip in the right ventricular apex . cardiac silhouette is enlarged but stable in configuration . atherosclerotic calcification is seen within the aorta . no definite acute cardiopulmonary process . right upper lung rounded opacity again concerning for malignancy . Lung Opacity 11520249 58792298 a54f4d38-f53d69a4-fe5bb1af-ec0c839c-ca1ea4cf 814 compared with the earlier film, an og tube has been placed . the tip extends beneath the diaphragm and overlies the expected site of the gastric fundus, looping slightly within the stomach . the et tube, right ij line, and right-sided port-a-cath catheter are largely unchanged . cardiomediastinal silhouette is unchanged . left lower lobe opacity is unchanged . parenchymal markings remain prominent, but appear to have improved compared with the earlier film, suggesting some interval improvement in the chf findings . . og tube placed, with tip over fundus . . slight interval improvement in chf findings . Cardiomegaly&&Edema&&Support Devices 11614040 52577959 3171e900-87eb21d0-8d960bcd-ae644198-073b1869 815 ap portable view of the chest was obtained . a right-sided port-a-cath is seen, distal aspect not well seen but likely terminates at the cavoatrial junctionright atrium . there is a large left pleural effusion with overlying atelectasis . underlying consolidation is not excluded . there may be a trace right pleural effusion . the cardiac silhouette is not well assessed due to the dense left mid-to-lower hemithorax opacity . the aortic knob is calcified . Atelectasis&&Cardiomegaly&&Consolidation&&Lung Opacity&&Pleural Effusion 11614040 52884720 77990ff0-f8347f9e-fa7dbb3d-d8c3086d-ef0f6f92 816 compared with the earlier film, an et tube has been placed . the tip lies in satisfactory position, approximately . cm above the carina . increased density overlying the trachea at the thoracic inlet is thought to represent artifact due to overlying material . a right ij central line is present, tip overlying distal svc . a right-sided port-a-cath is again seen, with tip overlying upper ra . hyperinflation raises the question of background copd . the cardiac silhouette is enlarged, but grossly unchanged . curvilinear density extending across the right mid lung could represent either plate-like atelectasis or fluid in the minor fissure, increased compared to the prior film . there is increased retrocardiac density, without obscuration of left hemidiaphragm, consistent with left lower lobe collapse andor consolidation and small left effusion . there is upper zone redistribution, asymmetrically more pronounced on the left side . equivocal minimal blunting of the right costophrenic angle . . stable cardiomegaly . . findings suggestive of chf with interstitial edema . this is likely superimposed on background copd . . small left effusion, with left lower lobe collapse andor consolidation . . new fluid or atelectasis in the right mid zone . no fluid seen in the right costophrenic sulcus . Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Pleural Effusion&&Support Devices 11614040 54015727 bdb97138-b120be67-8b9c2ad3-d5187876-17f2143d 817 ap single view of the chest is obtained with patient in sitting semi-upright position . analysis is performed in direct comparison with the next preceding similar study of . cardiac enlargement and right-sided port-a-cath system via internal jugular approach as before . there is now marked congestive pulmonary vascular pattern with distended vessels and perivascular haze . centrally located parenchymal densities are indicative of pulmonary edema . in comparison with the previous study, a sizeable left-sided pleural effusion has developed reaching up to the hilar level . the right-sided lateral pleural sinus, however, remains free . acute pulmonary congestion with central pulmonary edema and left-sided pleural effusion . report has been issued at pm . as the study remained non-verified for more than hours . Edema&&Pleural Effusion 11614040 54620855 003fd23c-264ac00a-8e8225c5-d7f3543f-6ba3ef81 818 as compared to the previous radiograph, the effusion on the left has minimally increased in extent . on the right, the small pleural effusion is constant . substantially improved are the signs previously indicative of interstitial lung edema . fluid marking of the fissures persists . unchanged evidence of moderate cardiomegaly with left basal atelectasis, unchanged position of the right pectoral port-a-cath . Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion 11614040 56045322 050b0481-40bac9ae-ecbb8c83-6251c674-f8dc69a7 819 moderately severe pulmonary edema, transiently improved on has recurred, more pronounced today than on . interval decrease in the volume of moderate left pleural effusions suggests thoracentesis . no pneumothorax . moderate cardiomegaly, not appreciably changed . small right pleural effusion stable . right supraclavicular central venous infusion port ends close to the superior cavoatrial junction . a small elliptical opacity projecting over the right mid lung is probably fissural pleural fluid . Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion 11614040 56082008 7fccf9d1-bf743f6f-504039f0-d2709205-699a13cc 820 in comparison with the earlier study of this date, there has been a thoracentesis on the left with removal of substantial fluid from the pleural space . specifically, no evidence of appreciable pneumothorax . 11614040 56418467 c81743fc-40348d42-c468e36f-0c9077e0-46d24e73 821 moderate left pleural effusion has slightly increased in the interval with overlying atelectasis . new right base opacity is seen, may represent combination of pleural effusion and atelectasis with overlying consolidation . fluid is seen tracking in the minor fissure on the lateral view . there is mild pulmonary vascular congestion . the cardiac silhouette difficult x-ray assessed due to the bibasilar opacities . the aorta is calcified . right-sided port-a-cath is seen, with distal tip in the expected location of the right atrium . moderate left pleural effusion slightly increased as compared to the prior study . interval increase in right base opacity may represent combination of pleural effusion and atelectasis, underlying consolidation is not excluded . pulmonary vascular congestion . Atelectasis&&Consolidation&&Edema&&Lung Opacity&&Pleural Effusion 11614040 57214129 551d7076-32d60564-745ab2a8-624b5317-c6f634f8 822 currently, there is minimal amount of apical left pneumothorax and there is interval decrease additionally in the left pleural effusion . loculation of pleural effusion is suspected along the lateral aspect . the basal opacities in the left base are unchanged . the port-a-cath catheter tip is at the cavoatrial junction, unchanged . Lung Opacity&&Pleural Effusion&&Pneumothorax&&Support Devices 11614040 57272076 a85adbf5-301650f6-e0861ceb-de58948f-66d1a9a4 823 as compared to the prior study from , there is a substantial interval decrease in left pleural effusion, currently small to moderate . no definitive pneumothorax is seen . the rest of the findings are unchanged . Pleural Effusion 11614040 59120011 d4591a06-8492548a-1b274424-ad732667-f57235a4 824 portable frontal chest radiograph a right approach picc terminates in the upper svc, unchanged from prior . there is no pneumothorax . linear opacities within the left lung base are likely due to subsegmental atelectasis . no confluent consolidation is identified . there is no pulmonary edema or pleural effusions . cardiomediastinal and hilar contours are within normal limits . No Finding&&Support Devices 11619788 50955531 7252d03a-a20f7bb6-f72983bd-0b4f5591-98efee5e 825 a right picc line has been retracted with the tip now terminating in the proximal right axillary vein . there is no pneumothorax . there are increased bibasilar patchy airspace opacities in the bilateral lung bases concerning for developing pneumonia and raising the possibility of aspiration . small left pleural effusion is difficult to exclude . the cardiac silhouette is unchanged in size . the mediastinum appears unchanged from the prior chest radiograph of . . right picc retracted with the tip terminating in the proximal right axillary vein . . bibasilar patchy airspace opacities new from the most recent prior study are concerning for developing pneumonia and raise the possibility of aspiration . Lung Opacity&&Pneumonia&&Support Devices 11619788 52904178 268224a0-f4db4bc6-9f5606f0-6a333f24-ace4e910 826 semi-upright portable frontal chest radiograph demonstrates interval withdrawal of right-sided picc line now terminating in the upper svc . cardiomediastinal and hilar contours are unremarkable . stable platelike atelectasis in the bilateral lung bases . no focal opacification concerning for pneumonia . no pleural effusion or pneumothorax . no osseous abnormality present . interval withdrawal of picc line now terminating in the upper svc . otherwise, unchanged exam . no fluid overload or pneumonia . No Finding&&Support Devices 11619788 55041813 a305262a-fc35773c-be68cd0d-b834e2ec-80646749 827 the cardiac silhouette size is mildly enlarged . the aorta is unfolded and calcified but unchanged . the mediastinal and hilar contours are otherwise unremarkable . minimal linear opacities in the lung bases are compatible with subsegmental atelectasis . no focal consolidation, pleural effusion or pneumothorax is present . there are no acute osseous abnormalities . minimal bibasilar atelectasis . Atelectasis 11619788 56461985 d04f293e-687f0e9d-4e5eb75c-5a6dbe57-eeb72c9b 828 ap and lateral chest radiographs lung volumes are low resulting in bronchovascular crowding . linear opacities in the lung bases likely reflect atelectasis . there is no overt pulmonary edema . no large pleural effusions are identified . there is no confluent consolidation or pneumothorax . calcifications of the aortic knob are again noted . cardiomediastinal and hilar contours are within normal limits . Atelectasis 11619788 58277756 ede7dee9-d9fff69d-6b18ffa5-ee83e334-d818bbaa 829 there is bilateral interstitial edema and pulmonary vascular congestion . the heart is moderately enlarged . small right and moderate left pleural effusions are seen . retrocardiac opacity may represent pneumonia in the appropriate clinical setting . moderate pulmonary edema, moderate cardiomegaly, and bilateral pleural effusions, small on the right and moderate on the left . superimposed pneumonia cannot be excluded . Cardiomegaly&&Edema&&Pleural Effusion&&Pneumonia 11644926 54913015 5b7be76e-a4c9feb1-8407dbe4-3d0e8436-c2b49b98 830 portable supine ap view of the chest obtained . there are low lung volumes with bronchovascular crowding . there are subtle lower lobe opacities, may reflect atelectasis, less likely pneumonia . no supine evidence of pneumothorax or effusion . the cardiomediastinal silhouette is unremarkable . the visualized osseous structures are unremarkable . Atelectasis&&Lung Opacity&&Pneumonia 11662490 51038639 5a32886d-a4653f96-53ae3fbd-4903075b-320b865d 831 as compared to the previous radiograph, there is unchanged evidence of mild fluid overload . in addition, there is an area of increased opacity around the right hilus, further monitoring is required to exclude the presence of perihilar pneumonia . no pleural effusions . borderline size of the cardiac silhouette . minimal retrocardiac atelectasis . Atelectasis&&Cardiomegaly&&Lung Opacity&&Pneumonia 11662490 51400794 127c8f18-778f317b-10bde8a4-fb02eba9-e1fcd511 832 the study is somewhat limited by motion . there is improved aeration at the lung bases with increasing consolidation of the right mid-lung . there is no pleural effusion or pneumothorax . cardiac and mediastinal contours are normal . improved aeration of the lung bases with increasing consolidation in the right mid-lung . these findings would be atypical for aspiration . Consolidation 11662490 51662547 b9ea020d-fe39c08b-1e6f557d-405aa7cb-ce016ba2 833 there is prominence of the vasculature which has increased from prior . additionaly, patchy opacities at the lung bases is more conspicuous on this study . there is no pleural effusion or pneumothorax . the cardiomediastinal contours are normal . the imaged upper abdomen is unremarkable . cervical orthopedic hardware is partially imaged . bibasilar patchy opacities are nonspecific but may be due to aspiration given clinical suspicion for this entity . worsened vascular congestion . Edema&&Lung Opacity 11662490 53401480 209d689e-f2bb226e-ab552d0d-9117b227-324c0ac6 834 right picc line tip is at the level of the right atrium and should be pulled back cm to secure it position at the cavoatrial junction or above . right basal atelectasis is unchanged associated with minimal amount of pleural effusion . there is no pneumothorax . no pulmonary congestion . Atelectasis&&Pleural Effusion&&Support Devices 11717909 50281684 dec3e055-ebb80e67-6fe65c6e-de8f0130-d39b8896 835 lungs continued parenchymal disease is seen in the right chest which has not altered significantly . there is also left basilar disease . pleura likely there is a right pleural effusion is well as a small left pleural effusion . mediastinum surgical clips noted in the mediastinum heart the heart is not enlarged . osseous structures the osseous structures are normal for age . additional findings endotracheal tube is in the region of the thoracic inlet . left-sided picc line terminates in the satisfactory position . a new right internal jugular catheter terminates in the right atrium . nasogastric tube some stomach . monitor leads noted . there is no pneumothorax . right internal jugular catheter terminates in right atrium . continued bilateral parenchymal disease much worse on the right than the left . probable bilateral effusions . Pleural Effusion&&Support Devices 11717909 50309094 edd6b83c-688ee075-7706abe7-8585945e-88b5d0c7 836 pulmonary edema has not recurred . moderate cardiomegaly including substantial left atrial enlargement is comparable to prior to removal of the intra-aortic balloon pump . pulmonary vasculature is unremarkable . projecting over the right second anterior rib, there could be a right juxta hilar nodules large as mm across . conventional radiographs are recommended when feasible . pleural effusion small if any . swan-ganz catheter ends in standard position at the upper pole of the right hilus . Cardiomegaly&&Edema&&Lung Lesion&&Pleural Effusion&&Support Devices 11717909 50703663 5dfe015d-040fa10d-c7519ab8-abd04b07-2013debb 837 comparison to . the endotracheal tube has been advanced by approximately cm . the tip of the tube is now cm above the carina . the pre-existing left retrocardiac and right perihilar parenchymal opacities are unchanged in extent and severity . no new parenchymal opacities . unchanged alignment of the sternal wires . normal size of the cardiac silhouette . no pneumothorax . Lung Opacity&&Support Devices 11717909 51107651 2d2c3c7d-5f951cb0-24e5522b-c233da94-349dc006 838 comparison to . the parenchymal opacities on the right are stable in extent and severity . no new parenchymal opacities . low lung volumes . mild cardiomegaly without pulmonary edema . unchanged normal alignment of the sterna . Cardiomegaly&&Lung Opacity 11717909 51110401 bc5a307e-a37c05c6-a1ef1917-721c48d7-ebdd2788 839 sternotomy . right ij central line tip low svc . small right pleural effusion, similar . stable right basilar, right perihilar opacities . surgical clips . shallow inspiration accentuates heart size . mild elevation right hemidiaphragm, may in part be related to subpulmonic component of effusion, stable . no pneumothorax . . stable exam . No Finding 11717909 51427132 b51fb695-3cf77ffd-0401b042-c7378e82-eca5ceed 840 in comparison with the study of , the monitoring and support devices are stable . there is increased opacification at the right base with extension along the right lateral chest wall, consistent with worsening pleural effusion . the areas of atelectasis and multifocal opacities on the right may have slightly decreased . the left lung is essentially clear except for blunting of the costophrenic angle and mild retrocardiac atelectasis . Atelectasis&&Lung Opacity&&Pleural Effusion&&Support Devices 11717909 51664703 fe9eaa7f-1b6e6971-5aae1fe2-1a9a732e-9a4f58e7 841 the endotracheal tube, nasogastric tube and right central line are unchanged . there is persistent density both bases more pronounced on the right than the left . there has been slight improvement in aeration as compared to the earlier study . there is no pneumothorax or chf . Support Devices 11717909 51977643 5cb341c8-aa49422d-40f3789c-39d15032-f20400d3 842 in comparison with the earlier study of this date, there is little changed . continued substantial enlargement of the cardiac silhouette with obscuration of the left hemidiaphragm consistent with substantial volume loss in the left lower lobe . the right lung is clear and there is no evidence of pulmonary vascular congestion . Cardiomegaly 11717909 52052474 fe2ff38c-680b5099-89541975-822dfa10-235feb53 843 as compared to , widespread areas of airspace consolidation have slightly improved and continue to involve the right lung to a greater degree than the left . moderate right and small left pleural effusions are again demonstrated, and no pneumothorax detected . Consolidation&&Pleural Effusion 11717909 52127446 65ef31a2-e080f853-c5c75be5-2246e4e8-105fffb1 844 portable semi-erect chest radiograph at is submitted . there is worsening airspace consolidation involving most of the right lower lung and possibly some of the right upper lobe concerning for pneumonia or possibly hemorrhage in the correct clinical setting . the left lung remains grossly clear . no pulmonary edema . heart remains stably enlarged status post median sternotomy for cabg . no pneumothorax . left subclavian picc line unchanged in position . Consolidation&&Pneumonia&&Support Devices 11717909 52264867 6fa38a39-b7c9d558-58dec4b3-9b6ae59b-d80805e8 845 in comparison to chest radiograph, cardiomediastinal contours are stable . poorly defined opacities in the right perihilar and basilar regions are similar as well as a small right pleural effusion . small left pleural effusion is apparently new . no other relevant change . Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion 11717909 52293076 09c44558-47920454-12da126b-06869468-7083d3b6 846 as compared to the previous radiograph, no relevant change is seen . the cardiac assist device is in constant position . constant extent of the known left pleural effusion, combined to retrocardiac atelectasis . the lung volumes remain low . moderate cardiomegaly persists . there is minimal fluid overload but no overt pulmonary edema . the sternal wires are in constant position . normal position of the left picc line . Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices 11717909 52362021 f3d88efb-8d1f70db-a2131320-90053712-cfd9a1bd 847 heart size is enlarged and stable . right internal jugular swan-ganz catheter is appropriately positioned . pulmonary edema has improved . small left pleural effusion is stable . intra-aortic balloon pump tip is . cm from the apex of the aortic knob . intra-aortic balloon pump is above the usual expected position . stable cardiomegaly and improvement in pulmonary edema . Cardiomegaly&&Edema 11717909 52435223 efb1eddb-0ef61d1a-e71c7c6a-9885a19f-d756d9ca 848 a right-sided picc terminates within the right atrium and should be pulled back approximately cm for appropriate positioning . median sternotomy wires and clips are again demonstrated . 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 . right-sided picc terminates within the right atrium and should be pulled back approximately cm for appropriate positioning . notification results communicated with the iv nurse at on by dr . via telephone . No Finding&&Support Devices 11717909 52620864 e3afe9cf-4fbc9089-8943fa0a-08a4af09-069a5605 849 swan-ganz catheter tip is in the main pulmonary artery or proximal right pulmonary artery . there is no pneumothorax . there is stable atelectasis or scarring in the right mid and lower lung zone . there is no new consolidation or chf . Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Lung Opacity&&Support Devices 11717909 52655610 c2bd0b48-ecc300dc-df118f3d-a82300cd-5e16b5bc 850 again seen is very extensive consolidation involving the right lung with relative sparing of the apex . an associated right pleural effusion is likely slightly decreased when compared to the prior study . opacities in the left lung are unchanged . monitoring and supportive equipment is unchanged in appearance . no definite left-sided pleural effusion . no pneumothorax seen . no significant interval change when compared to the prior study . No Finding 11717909 52755842 17a73741-1a329d9a-09f6f1af-1e66a860-43d74397 851 since , moderate right pleural effusion is mildly improved and bibasilar and retrocardiac atelectasis is increased with a possible new small left pleural effusion . a new opacity in the right mid lung may be atelectasis but could represent pneumonia in the right clinical setting . the left lung remains clear . enlarged appearing heart may be technical from persistence of low lung volumes . unchanged positioning of right internal jugular central line and feeding tube . median sternotomy wires are intact and aligned . no pneumothorax . . since , moderate right pleural effusion is mildly improved, bibasilar atelectasis is increased with possible new small left pleural effusion, and new opacity in the right mid lung may be atelectasis but could be pneumonia in the right clinical setting . Atelectasis&&Lung Opacity&&Pleural Effusion&&Pneumonia 11717909 52869267 f0bdf88f-f956d3d7-2ba2ed1c-b1a7bcab-4a9cf8eb 852 compared to the prior study there is no significant interval change . no change . No Finding 11717909 52970815 c1999cab-aab644aa-a8c530ff-347de8b1-4b8299ac 853 as compared to the previous radiograph, the lung volumes have decreased . the monitoring and support devices, including the cardiac support device, is in unchanged position . the extent of the opacity in the left lung, however, has not substantially increased . no evidence of pneumothorax . Lung Opacity&&Support Devices 11717909 52983911 9e212d56-0e1f18f3-63caba31-b94a0ec4-50aa339b 854 as compared to chest radiograph, a feeding tube is been advanced into the duodenum . overall appearance of the chest is not appreciably changed . No Finding&&Support Devices 11717909 53001361 e273ee90-02f2af87-c118ca0a-86222135-c38eb743 855 small to moderate left pleural effusion has recurred, despite persistent left pleural drainage catheter . no pneumothorax . persistent left lower lobe collapse . right lung cardiomediastinal silhouette clear . is large but unchanged . ventricular diversion device grossly unchanged in position . midline and left pleural drains, swan-ganz catheter, left pic line all in standard placements . tip of the nasogastric tube lies above the upper margin of the clavicles, no less than mm from the carina . Atelectasis&&Pleural Effusion&&Support Devices 11717909 53042347 843962d4-17729cc1-22b9d9ad-fd3f97b8-e78f8b56 856 prior chest radiographs through . extensive bilateral pneumonia, more pronounced in the right lung, has improved in the left lower lobe since , but is still considerable . heart size top-normal . no pulmonary edema . small right pleural effusion is likely, not appreciably changed since . no pneumothorax . Cardiomegaly&&Pleural Effusion&&Pneumonia&&Support Devices 11717909 53106161 c2bbad8a-13586101-c890f65a-eb483340-39f89263 857 in comparison with the study of , there is little change in the diffuse opacification involving most of the right hemithorax and the lower left lung . the monitoring support devices appear essentially unchanged . Lung Opacity&&Support Devices 11717909 53205436 7ee2c611-7652d0ee-f7552709-ffaf4671-7623d229 858 as compared to previous radiograph of day earlier, multifocal opacities in the right lung show slight interval improvement in the right lower lobe . left basilar opacities have slightly worsened . small left pleural effusion is unchanged, and a small right pleural effusion has apparently decreased in size . no other relevant changes . Lung Opacity&&Pleural Effusion 11717909 53534976 8e665747-30e84fad-114b57db-62a44a61-43ce1a8d 859 comparison to . decrease in extent and severity of a pre-existing right lower lobe parenchymal opacity . a small atelectasis in the retrocardiac lung area is constant . constant size of the cardiac silhouette . stable normal size of the monitoring and support devices . the tip of the endotracheal tube continues to project approximately cm above the carinal . Atelectasis&&Cardiomegaly&&Lung Opacity&&Support Devices 11717909 53651103 d6d51a18-a82e65e5-5faa935c-9054fe80-5c5545af 860 compared to radiograph, heterogeneous consolidation in the right middle and right lower lung have progressed, concerning for an evolving infectious pneumonia in the appropriate clinical setting . a possible new small right pleural effusion is also demonstrated . exam is otherwise unchanged . Consolidation&&Pleural Effusion&&Pneumonia 11717909 53722061 7c4ff21f-9a4daf55-86b77fbe-ca727f5f-3b43aeae 861 in comparison with the study of , the swan-ganz catheter has been removed . slightly improved lung volumes with continued cardiomegaly with left ventricular configuration . opacification at the right base persists, most likely reflecting a combination of pleural fluid and atelectatic changes . no evidence of pulmonary edema . no definite acute focal pneumonia . however, there is mild asymmetry in the mid to lower zones with opacification on the right . in the appropriate clinical setting, this could represent a developing consolidation . Atelectasis&&Cardiomegaly&&Consolidation&&Lung Opacity&&Pleural Effusion 11717909 53923822 d0ca3617-41955c1f-01c01461-5785bb86-ea5d99a9 862 compared to chest radiographs through . small right pleural effusion is new . no pneumothorax . very low lung volumes and subsegmental atelectasis right mid and lower lung zones unchanged . no pulmonary edema . stable and normal cardiomediastinal silhouette . swan-ganz catheter ends in the right pulmonary artery . Atelectasis&&Pleural Effusion&&Support Devices 11717909 54060552 efa94d5d-74a20d4d-31e24085-919dcc5d-f9e926ad 863 in comparison with the study of , the cardio mediastinal silhouette is stable and the right ij swan-ganz catheter extends to the right pulmonary artery . continued low lung volumes . there again is increased opacification in the right mid and lower lung zones, most likely related to atelectasis above the elevated hemidiaphragmatic contour . however, in the appropriate clinical setting, superimposed pneumonia would have to be considered . no evidence of pulmonary vascular congestion or pneumothorax . mild atelectatic changes are seen at the left base . Atelectasis&&Enlarged Cardiomediastinum&&Lung Opacity&&Pneumonia&&Support Devices 11717909 54130761 ca478dcf-175c3fb5-2c0d1d03-58bb12ac-8b86f479 864 portable supine radiograph of the chest demonstrates low lung volumes with resultant bronchovascular crowding . the left lower lobe has improved aeration and there has been interval clearing of mild interstitial edema . chest tubes project over the left hemithorax . severe cardiomegaly is stable . no pneumothorax . the endotracheal tube ends . cm from the carina . the left ventricular assist device is in unchanged position . swan-ganz catheter tip ends in the right pulmonary artery . . the left lower lobe has improved aeration and there has been interval clearing of mild interstitial edema . . no pneumothorax or pleural effusion . No Finding 11717909 54173931 54df276e-3a7668b9-583c36a0-d858ee7e-e7d57d25 865 comparison to . no relevant change . the extensive right and mild left parenchymal opacities are constant . constant size of the moderately enlarged cardiac silhouette . the monitoring and support devices are in stable position . Cardiomegaly&&Lung Opacity&&Support Devices 11717909 54350778 3d5c1b0f-46f03f74-eb5beae3-88ef8b4f-7e463c51 866 in comparison with these study of , the patient has taken a slightly better inspiration . the monitoring and support devices are stable . the degree of opacification in the right hemithorax appears to have decreased, though much of this could merely represent the better inspiration . poor definition of the hemidiaphragm on the right is consistent with layering pleural fluid . the opacification at the left base has decreased and most likely represents atelectasis . Atelectasis&&Lung Opacity&&Pleural Effusion&&Support Devices 11717909 54360882 68415db4-13599d5d-876aef44-c3907c31-1b429bba 867 right ij swan-ganz catheter has been removed and no pneumothorax seen . left-sided picc line and left ventricular assist device appear unchanged radiographically . cardiac silhouette is large with unchanged splayed carina . obscuration of the left hemidiaphragm and right cardiophrenic angle indicate associated basilar consolidation the findings do not suggest increase in pleural fluid on either side . no pneumothorax status post removal of right-sided swan-ganz catheter . no specific findings to account for new increase in tachycardia notification note patient had chest ct within a half an hr of this current study . No Finding 11717909 54369648 075c5fad-cfbf7397-05bfb8fc-55ed0999-6c4abf11 868 as compared to the previous radiograph, no relevant change is seen . the patient has been extubated and the nasogastric tube was removed . the other monitoring and support devices, including the cardio vascular assistance device and the left chest tube are in unchanged position . there might be minimal increase of a left pleural effusion, with subsequent areas of atelectasis at the basal and basal lateral left lung . no change in appearance of the right lung and of the cardiac silhouette . Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices 11717909 54405868 b780e69e-01fe1577-1c8d166a-40f8c788-8f9f1115 869 the swan ganz tip is in the right pulmonary artery . there is stable linear atelectasis in the right lung base . there is no pneumothorax or chf . Atelectasis 11717909 54458579 dd25eb4c-0385059d-450c8977-dd3049b5-5c1790be 870 multifocal pulmonary consolidation, most pronounced in the right lung, also at the left base, has not worsened . apparent improvement is probably due to decreased atelectasis and perhaps resolution of a component of pulmonary edema and decrease in moderate right pleural effusion . moderate cardiomegaly remains . Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Pleural Effusion 11717909 55096981 65c1567a-4a7ac3a5-cbd23877-d66c126e-7e188589 871 portable semi upright radiograph of the chest demonstrates well expanded lungs . increased opacification of the retrocardiac space is consistent with atelectasis . there has been interval resolution of pulmonary edema . the cardiomediastinal and hilar contours are unchanged . the heart remains enlarged . a left ventricular assist device is in the expected position . the swan-ganz catheter remains in place with the tip in the right pulmonary artery . there has been interval removal of the nasogastric tube, endotracheal tube, left-sided chest tube, and intra-aortic balloon pump . there is no pneumothorax or pleural effusion . no pneumothorax . No Finding 11717909 55357075 755a89e3-07c0c918-4be04b78-27526552-f2505932 872 compared to , there is suggestion of cavitation in lesions in the left mid lung measuring up to . x . cm . bilateral parenchymal opacities, right worse than left is unchanged . moderate right pleural effusion is likely . left retrocardiac atelectasis is unchanged . left upper lung is mostly clear . there is no evidence for pulmonary edema . moderate cardiomegaly is unchanged . monitoring and support lines are unchanged . sternal wires are aligned and intact . no pneumothorax is seen . possible cavities in the left lung . further evaluation with ct chest is recommended if clinically indicated . recommendations further evaluation with ct chest is recommended if clinically indicated . notification the findings were discussed by dr . with dr . on the at pm, minutes after discovery of the findings . No Finding 11717909 55385319 b337b63e-7e254de9-316afa13-f7d944d1-b69cbe1d 873 comparison is made to previous study from . there is a swan-ganz catheter which is unchanged . mediastinal drains and chest tube are also unchanged . lvad device is identified . there is an unchanged left retrocardiac opacity . there are no pneumothoraces . the right lung and left lung apex appear clear . overall, there has been no appreciable change . Lung Opacity&&Support Devices 11717909 55763521 462d17f7-8f916f40-15f994b1-a745df9d-44cc9f48 874 there is no consolidation, pneumothorax or large pleural effusion . cardiomediastinal and hilar silhouettes are normal size . sternotomy wires are intact . no radiographic evidence of pneumonia . if there is continued clinical concern for pneumonia, consider obtaining chest ct for better evaluation . notification the findings were discussed by dr . with dr . on the telephone on at am, at the time of the discovery of the findings . Pneumonia 11717909 55813066 4cd0e6e4-e486a052-5adcc162-6ea6ba64-f65c1a31 875 as compared to , cardiomediastinal contours are stable . heterogeneous opacities in the right upper lobe and a small right pleural effusion are not appreciably changed in the interval, but right basilar opacities have slightly improved . no other relevant changes since recent exam . Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion 11717909 55835350 437a988e-3de10dcb-fe6e16b3-eb4765eb-b5d5ca1b 876 in comparison with the study of , the right subclavian picc line is again in the right atrium . to be at or just above the cavoatrial junction, the tube could be pulled back about cm . the heterogeneous opacification in the right mid zone may be slightly improved . however, there is increasing opacification at the right base, consistent with pleural fluid and underlying atelectasis . Atelectasis&&Lung Opacity&&Pleural Effusion&&Support Devices 11717909 55912381 e189e2b0-2d38dabb-5a0273ad-39465f07-37d9141e 877 in comparison with the study , there is continued increased opacification at the left base with substantial enlargement of the cardiac silhouette . however, no evidence of pulmonary vascular congestion . Cardiomegaly&&Lung Opacity 11717909 55912597 1f19bc2a-ca226782-41cd1a10-2c3c3346-a73ba6b7 878 left picc tip is in thecavoatrial junction . moderate cardiomegaly is stable . lvad is in unchanged standard position . smaller catheter projecting over to the heart is also in unchanged position . mild to moderate left pleural effusion has increased with increasing adjacent atelectasis . mild vascular congestion is stable . there is no pneumothorax . Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices 11717909 55953262 488f88a2-0d2c244c-a15f605b-2cf68a06-cb42cd3b 879 again seen is heterogeneous ill-defined opacity in the right lower lobe with some central lucency, though not as well seen compared to the exam from the day before . small pleural effusion on the right is also likely . the left lung is mostly clear . heart size is large and have increased in size compared to the day beforemediastinal and hilar contours are unchanged . there is no evidence for pulmonary edema or pneumothoraxleft-sided picc terminates in the cavoatrial junction or right atrium, unchanged from prior . sternotomy wires and surgical clips are intact and unchanged . . right lower lobe pneumonia, cavitation suspected . small right pleural effusion . . increase in size of the heart . notification the findings were discussed by dr . with dr . on the at am, minutes after discovery of the findings . Cardiomegaly&&Pleural Effusion&&Pneumonia 11717909 56207647 ea32b0da-db8371b9-e24620b3-33e572f6-51a33032 880 compared to the prior study there is no significant interval change . no change . No Finding 11717909 56279353 072f7231-5cf47203-6fd7994e-ed9b5111-008da8c6 881 final addendum addendum due to a voice recognition system error, the incorrect report was is sign to this patient . the report below represents of the corrected report for this radiograph in comparison to chest radiograph, support and monitoring devices are unchanged in position and cardiomediastinal contours are stable . bilateral asymmetrically distributed airspace disease remains most severe in the right lung and shows some interval improvement in the left lower lobe . bilateral pleural effusions, right greater than left, are unchanged . Enlarged Cardiomediastinum&&Lung Opacity 11717909 56316715 c5987359-2e90a885-b3394108-de36dfa8-bd5bd43f 882 severe cardiomegaly improved slightly between and , subsequently unchanged . lungs are grossly clear, pulmonary and mediastinal vasculature are unremarkable . pleural effusions small if any . swan-ganz catheter ends in the right main pulmonary artery . no pneumothorax . Cardiomegaly&&Pleural Effusion&&Support Devices 11717909 56401108 2a8f24b1-1ece112d-0b423812-bc4b1305-91950820 883 compared to the study from at there is a new doboff tube with tip in this proximal stomach . there is also an ng tube with tip in the stomach . the remainder of the lines and tubes are unchanged from the study earlier the same day . No Finding&&Support Devices 11717909 56417700 a3bc4d65-3db9755b-661a9b86-fdfdb4cf-a04f944e 884 endotracheal tube tip is cm above the carina . nasogastric tube tip is in the stomach . right central line tip is in the svc right atrial junction . there is no pneumothorax . there is slight decrease in the bilateral basal consolidation . there are no new areas of consolidation present . there is no chf . Consolidation&&Support Devices 11717909 56447683 5c4c8b07-b9c2042c-256f2184-2dcf8b2d-86131204 885 since a recent radiograph from earlier today, a feeding tube is been placed within the stomach and a pre-existing nasogastric tube remains in place as well . exam is otherwise remarkable for persistent widespread airspace opacities with relative sparing of the left upper lobe . since a recent radiograph, this has slightly improved in the right upper lobe and worsened in the left lower lobe . bilateral pleural effusions are again demonstrated, right greater than left . Lung Opacity&&Pleural Effusion&&Support Devices 11717909 56453461 eb44dfa3-6e1ec3a7-87fcfad9-4b141aa7-889a0d2e 886 in comparison with the earlier study of this day, the endotracheal tube has been removed . the tip of the dobbhoff to appears to be in the distal stomach . otherwise little change . retrocardiac opacification with obscuration of the hemidiaphragm persists, consistent with substantial volume loss in the left lower lobe . Lung Opacity 11717909 56526568 bbeb657c-2c2bd6fe-ec787126-bc79a926-4d1122e9 887 the swan-ganz catheter inserted on the right side has its tip the right pulmonary artery . there is no pneumothorax or chf . there is persistent linear atelectasis or scarring in the right lung base and right perihilar region . the cardiac silhouette is unchanged . Atelectasis&&Cardiomegaly&&Lung Opacity&&Support Devices 11717909 56582554 0ab5e42c-b66dcafc-80e41036-0be28891-69da4244 888 there has been worsening of both extensive multifocal pneumonia, particularly in the lower lobes, and in moderate pulmonary edema now extending to the level of both hila, moderate right pleural effusion,, small left pleural effusion, and probably increase in moderate cardiomegaly as well . no pneumothorax . left pic line ends in the upper right atrium . Cardiomegaly&&Edema&&Pleural Effusion&&Pneumonia&&Support Devices 11717909 56647493 861996f7-f715090f-6fbfb34e-37a5f763-1e1ff6e7 889 very severe pulmonary consolidation in the right lung than accompanying moderate right pleural effusion have worsened and there may be more nodular areas of new infection in the left lung, compared to . moderate cardiomegaly is probably stable of right heart border is obscured by adjacent cardiopulmonary abnormalities . there is no pneumothorax . left pleural effusion is probably small . left pic line a right jugular line both end close to the superior cavoatrial junction . et tube is in standard placement . nasogastric drainage tube ends in the midportion of the nondistended stomach . Cardiomegaly&&Consolidation&&Pleural Effusion&&Pneumonia&&Support Devices 11717909 57022813 6d3458a1-7651b4c9-e3a4ca51-1483a45c-6a421d53 890 compared to most recent radiograph, there is more confluent appearance of previously seen right middle and lower lobe opacity, concerning for infectious pneumonia . right pleural effusion is likely increased since prior exam . the left lung is grossly clear . otherwise the exam is unchanged . sternotomy wires and surgical clips are again noted to be intact . worsening right middle and lower lobes pneumonia . increased right pleural effusion . notification the findings were discussed by dr . with dr . on the at pm, minutes after discovery of the findings . Pleural Effusion&&Pneumonia 11717909 57198522 2ee41fdf-c427ca61-d4dad2ce-68c8d635-55b20347 891 compared to prior chest radiographs, through . frontal chest radiographs show successive advancement of the esophageal feeding tube from the upper to the lower esophagus and finally into the upper stomach . final radiograph in the series shows clear left lung and mild cardiomegaly . right pleural abnormality in heterogeneous consolidation or atelectasis in the right lung are unchanged over the past several days . the final radiograph in the series shows repositioning of the right pic line from a right internal jugular vein to the estimated location of the right superior cavoatrial junction alongside the indwelling right internal jugular catheter . Atelectasis&&Cardiomegaly&&Consolidation&&Support Devices 11717909 57348180 8908c4da-5bd8a618-c158f213-e0942be7-73d112cb 892 ap upright and lateral views the chest provided . lung volumes are low which limits assessment . midline sternotomy wires and mediastinal clips again noted . airspace consolidation in the right lower lung is concerning for pneumonia . no large effusion or pneumothorax . cardiomediastinal silhouette appears normal . bony structures are intact . right mid to lower lung opacity likely pneumonia . low lung volumes limits assessment . Lung Opacity&&Pneumonia 11717909 57552532 679090b8-5b08a40b-e515db21-32f95ad4-624698c4 893 right internal jugular swan-ganz catheter is appropriately positioned . intra-aortic balloon pump tip is roughly . cm from the apex of the aortic arch . heart size is enlarged and bilateral parenchymal opacities likely represent pulmonary edema . small bilateral pleural effusions are noted . no pneumothorax . mild pulmonary edema with appropriately positioned swan-ganz catheter . intra-aortic balloon pump is above the usually accepted positioning . Edema&&Support Devices 11717909 57608934 c3ddf503-e6b16525-fd7a9015-9a50abe2-bef2b09e 894 compared to the prior study there is no significant interval change . no change . No Finding 11717909 57616637 b44fb02a-f784c183-f64902ef-a17d7453-69968006 895 left swan-ganz catheter tip is in themain pulmonary artery . cardiomegaly is enable . there is no pneumothorax . left pleural effusion has resolved . retrocardiac atelectasis have improved . vascular congestion has resolved . et tube is in standard position . new mediastinal and chest tubes are noted . lvad is unchanged . sternal wires are aligned . ng tube tip is out of view below the diaphragm . left picc tip is at the cavoatrial junction . Atelectasis&&Cardiomegaly&&Support Devices 11717909 57650038 3d448c7c-b9ba0614-6607cf2a-472022b9-c8f49a4a 896 severe consolidation, most of the right lung in the left lung base improved on the right since , unchanged since . bilateral pleural effusion, moderate on the right, small on the left, unchanged . mild cardiac enlargement stable . no pneumothorax . cardia is pulmonary support devices in standard placements unchanged, including esophagogastric feeding tube which retains a wire stylet . Cardiomegaly&&Consolidation&&Pleural Effusion&&Support Devices 11717909 57712518 2fb800a3-3eaf68d1-b83393d6-6c72f07a-fa520908 897 right picc tip is in thelower svc . cardiac size is top-normal . right mid lung and right lower lobe consolidations are stable . the left lung is grossly clear . there is no pneumothorax or pleural effusion there are low lung volumes . sternal wires are aligned . ng tube tip is out of view below the diaphrag . Cardiomegaly&&Consolidation&&Support Devices 11717909 57740453 87d740da-c8e188ac-af29818b-cadad040-6f3ef6ca 898 in comparison with the study , there is again substantial enlargement of the cardiac silhouette with retrocardiac opacification most likely reflecting substantial volume loss in the left lower lobe . no definite vascular congestion . the left subclavian catheter in again is at the level of the cavoatrial junction or upper portion of the right atrium . Cardiomegaly&&Lung Opacity&&Support Devices 11717909 57805143 25e2e3f7-350778cf-d7530deb-eb31e56c-8c2a8744 899 portable semi-upright radiograph of the chest demonstrates low lung volumes which results in bronchovascular crowding . the heart remains stably enlarged . there is dense left basilar opacification, which may represent atelectasis or pneumonia, but is not significantly changed from prior . median sternotomy wires and a left ventricular assist device are in place . a swan-ganz catheter is present with the tip ending in the right pulmonary artery, but its ifnerior loop in the right atium appears to be subluxing into the ivc . there is no pneumothorax . stable dense left basilar opacification may represent atelectasis, however pneumonia could be considered in the appropriate clinical setting . no pulmonary edema . Atelectasis&&Lung Opacity&&Pneumonia 11717909 57994301 6a0b14e0-582c0bb3-fe7625b9-7cd88c64-48f2a1db 900 comparison is made with prior study performed a day earlier . moderate-to-severe cardiomegaly is stable . vascular congestion is mild and stable . retrocardiac atelectasis has improved . there is no pneumothorax . sternal wires are aligned . left picc tip is in the cavoatrial junction . the amount of left pleural effusion is probably small and unchanged . new catheter projects over the left lower medial hemithorax . lvad is in unchanged position . Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices 11717909 58217958 f1120431-f40e3c5a-374851f6-49f45b94-5c996f47 901 patient is mildly rotated . compared to , there is worsening of right perihilar parenchymal opacities . left lung atelectasis is still present . bilateral pleural effusions are likely unchanged . sternotomy wires and surgical clips are well aligned and unchanged from prior . ett terminates less than cm from the carina, however this may be due to chin-tuck position of the patient . otherwise, support lines appear unchanged from prior . worsening consolidation in right perihilar region . Consolidation 11717909 58279613 f4caf2a7-cfab7dcf-4ed18148-2edc0c1d-ec22176f 902 severe cardiomegaly is stable . there is no pulmonary edema . no pleural effusion . no pneumothorax . right transjugular swan-ganz catheter ends in the right pulmonary artery in standard placement . Cardiomegaly&&Support Devices 11717909 58465039 b4c53279-dc6e8b39-fbc566fd-d4cb1bf9-41b39939 903 as compared to the previous radiograph, the swan- catheter was removed and the left chest tube was pulled . unchanged appearance of the cardiac silhouette . no not visible left-sided pneumothorax . the extent of the retrocardiac atelectasis and small left pleural effusion as well as of the right lung are unchanged . unchanged position of the cardiac support device . the second more basal positioned tube is also or removed . Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices 11717909 58480507 b57584cc-a29bd841-898af146-74374eab-42633a08 904 comparison to . the feeding tube is now in correct position . the right internal jugular vein catheter is stable . unchanged mild elevation of the right hemidiaphragm, with platelike atelectasis at the right lung basis . mild cardiomegaly without overt pulmonary edema . likely presence of a minimal right pleural effusion . Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices 11717909 58486262 1fb09915-c0059d07-e6cd2be9-857cd031-773f848a 905 comparison to . no relevant change . the widespread bilateral parenchymal opacities are constant . unchanged monitoring and support devices . unchanged size of the cardiac silhouette . the patient shows no new parenchymal opacities . Cardiomegaly&&Lung Opacity&&Support Devices 11717909 58613391 3a02fc54-25995479-f166cf7b-9bf0c201-fe0e3098 906 portable semi-upright radiograph of the chest demonstrates low lung volumes which results in bronchovascular crowding . left lower lobe collapse has recurred . the cardiomediastinal and hilar contours are unchanged . the endotracheal tube ends . cm from the carina . chest tubes project over the left hemi thorax . swan-ganz catheter ends in the right pulmonary artery . left ventricular assist device is in unchanged position . nasogastric tube courses into the stomach . left-sided picc line ends at the cavoatrial junction . . nasogastric tube courses into the stomach . . endotracheal tube ends . cm from the carina . . left lower lobe collapse has recurred . notification these findings were discussed with by dr . telephone at am on , minutes after discovery . Atelectasis&&Support Devices 11717909 58628303 83464977-3248cdf7-dabf04d4-71b78a27-306db131 907 portable upright chest radiograph at persistent right airspace disease and interval appearance of increasing opacity at the left base . findings are concerning for multifocal pneumonia or aspiration . the left upper and mid lung remain clear . no pulmonary edema . stable postoperative cardiac and mediastinal contours status post median sternotomy . left subclavian picc line unchanged in position with tip in the distal svc . no pneumothorax . Enlarged Cardiomediastinum&&Lung Opacity&&Pneumonia&&Support Devices 11717909 58663147 18696db7-7d416236-9375f9b1-cb09447c-cbfb9773 908 in comparison with study of , there has been placement of an iabp, which is somewhat high with the tip located only about . cm below the transverse arch of the aorta . swan-ganz catheter extends beyond the mediastinum into branches of the right pulmonary artery . enlargement of the cardiac silhouette persists, though the pulmonary vascularity is essentially within normal limits . some retrocardiac atelectasis is noted . Atelectasis&&Cardiomegaly&&Enlarged Cardiomediastinum&&Support Devices 11717909 58964089 4237ac38-158147e0-87b15115-b3ffc6e6-113d33a5 909 the right central line, endotracheal tube and nasogastric tubes are unchanged . there is persistent patchy density in both lung bases . there is no pneumothorax or chf . there is no significant interval change . Support Devices 11717909 59068375 083f7549-82faf4e6-b108e14f-e1d63399-5e5dc66d 910 the cardiomediastinal and hilar contours are within normal limits . the heart appears smaller in size compared to the prior examination on . right midlung and right lower lobe opacities are similar in appearance to multiple prior examinations . the left lung is clear . there is no pneumothorax or pleural effusion . sternal wires are aligned . there is no evidence of pulmonary edema . no evidence of pulmonary edema . persistent opacities involving the right midlung and base of the right lung are stable from multiple prior exams and likely reflect atelectasis or scarring . Atelectasis&&Lung Opacity 11717909 59105787 cd151804-3ba37dc7-1008641f-491929af-f37e6dc5 911 allowing for projection the heart is probably within normal limits in size . left lung is clear . increased small right effusion is seen . increased opacity in the right base may indicate the underlying atelectasis . infection cannot be excluded . right ij line in mid svc right base atelectasis opacity and small right pleural effusion . Atelectasis&&Lung Opacity&&Pleural Effusion 11717909 59231099 7798f90f-d4185983-5f262189-fe7879ae-df20ce5d 912 these are two views during dobhoff placement . on the second film the feeding tube tip is in the stomach . ng tube is been removed . the right ij line is unchanged . the appearance the lungs are unchanged . dobhoff tube in the stomach . No Finding&&Support Devices 11717909 59507971 a92dc43d-69675ba1-b327698d-39a479af-fd78fba4 913 bilateral lower lobe pneumonia, right greater than left, is stable since but improved since . the cardiac silhouette remains top-normal . no pneumothorax or pulmonary edema . the endotracheal to tip is seen . cm above the carina . right internal jugular central line placement is unchanged and transesophageal drainage tube is seen over the stomach and continues had a few . . unchanged bilateral lower lobe pneumonia, right greater than left, since . . all support devices are appropriately positioned . Pneumonia&&Support Devices 11717909 59549909 c25143a2-4277be3e-75e5e1e0-67b10cbb-2386d4ca 914 the left chest tube has been removed . there is no new large pleural effusion . there is no pneumothorax . there is a persistent left retrocardiac opacity which may be secondary to infection, pleural effusion, or atelectasis . cardiomegaly is unchanged . the left picc, right ij swan-ganz catheter, and lvad are unchanged in appropriate in position . persistent left retrocardiac opacity . no evidence of large volume left pleural effusion . no pneumothorax after removal of chest tube . Lung Opacity&&Pleural Effusion 11717909 59648901 9296d4e5-8c81e5dd-f08e6cfb-658feaeb-fe3cdfa5 915 swan-ganz catheter tip is at the level of right main pulmonary artery . heart size and mediastinum are stable . minimal bibasal atelectasis, right more than left are similar to previous study . there is no pneumothorax . Atelectasis&&Cardiomegaly&&Enlarged Cardiomediastinum&&Support Devices 11717909 59756989 c6e3ce13-2009d15c-22403934-c8b0ed0a-84811273 916 in comparison with the study of , the there may be even further opacification in the right hemithorax . persistent opacification in the retrocardiac region with blunting of the left costophrenic angle . monitoring and support devices are essentially unchanged . Lung Opacity&&Support Devices 11717909 59882746 78ed3ced-cd79570f-e1427410-e2202da1-75dd1584 917 portable semi-upright radiograph of the chest demonstrates low lung volumes with resultant bronchovascular crowding . dense retrocardiac opacification persists, consistent with left lower lobe consolidation and small pleural effusion . vague haziness projecting over the left upper lobe, in the region of recent chest tube, is stable . the cardiomediastinal and hilar contours are unchanged . left ventricular assist device is remains in similar position . left-sided picc line ends at the cavoatrial junction . no pneumothorax or pleural effusion stable retrocardiac opacification consistent with left lower lobe consolidation and small pleural effusion . Consolidation&&Lung Opacity&&Pleural Effusion 11717909 59956973 0df3e21f-5672d561-1479a9a6-bb24d13a-afd4f39e 918 comparison is made to previous study from . there is a swan-ganz catheter . there is a left-sided chest tube . there is an lvad device . there are mediastinal drains . there is a left-sided picc line . these are all stable . the heart size is upper limits of normal, but unchanged . there remains a left retrocardiac opacity . there are no signs for overt pulmonary edema . no pneumothoraces are identified . overall, there has been no change . Cardiomegaly&&Edema&&Lung Opacity&&Support Devices 11717909 59962763 321f3032-be0e27a3-89aaf76d-79b01d0b-1c4d5b9b 919 comparison to . no relevant change . mildly increased lung volumes with the subsequent decrease in radiodensity of the pre-existing right parenchymal opacities and consolidations . the left changes are constant . stable correct position of the monitoring and support devices . Consolidation&&Lung Opacity&&Support Devices 11717909 59982171 1c847671-bd632b77-11107efc-969f0d03-ffb45c06 920 volumes are quite low . heterogeneous opacification involves both lower lungs . heart is normal size and mediastinal vasculature is not engorged . findings include noncardiogenic as well as atypical cardiogenic edema and severe aspiration or diffuse pulmonary hemorrhage . dr . was paged at the time of dictation . Edema&&Lung Opacity 11724488 55651475 9f2d20e8-1c570228-e58b3e93-e6171fd9-2033b28a 921 lordotic positioning with low inspiratory volumes . compared with at pm, there has been improvement in chf findings . there is residual upper zone redistribution . there are also residual patchy opacities at both lung bases, with mild hilar prominence . no gross effusion . increased retrocardiac density is present . . suspect mild chf, though improved compared with . . bibasilar patchy opacities . the differential diagnosis includes infectious infiltrates and aspiration . these are similar to , allowing for considerable differences in technique . Cardiomegaly&&Edema&&Lung Opacity&&Pneumonia 11724488 58618080 3a83d7fe-a10cb175-c0015bff-dc7613f5-2ed928b2 922 the lungs are normally expanded and clear . the cardiomediastinal silhouette, hilar contours and pleural surfaces are normal . there is no pleural effusion or pneumothorax . there are few prominent loops of small bowel in the left upper quadrant . no evidence of acute cardiopulmonary abnormality . No Finding 11778596 59075390 571f6fe7-8dfc0bb4-1a799b61-088a701a-55a35ec7 923 in comparison with the study of , there again is mild enlargement of the cardiac silhouette with tortuosity of the aorta . no evidence of acute pneumonia, vascular congestion, or pleural effusion . Cardiomegaly 11805011 59624830 c0f09085-246fdee9-571d4688-2450db13-fb67b641 924 comparison to . minimal decrease in extent of the pre-existing right basal parenchymal opacities . moderate cardiomegaly . stable appearance of the vertebral fixation devices . a minimal right pleural effusion is unchanged in extent and severity . Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Support Devices 11842519 51581083 e9977922-0c45547e-2c72b894-91042335-31f132ea 925 the cardiac, mediastinal and hilar contours are relatively unchanged, with the heart size appearing top normal . there is mild pulmonary edema, minimally worse when compared to the prior study . moderate size right and small left pleural effusions are relatively unchanged . there are patchy bibasilar airspace opacities, likely reflective of atelectasis though infection cannot be completely excluded . no pneumothorax is identified . thoracic posterior spinal fusion hardware accomplished by two posterior rods and pedicle screws is unchanged . there are multiple clips also demonstrated within the mid back . mild congestive heart failure, with moderate size right and small left pleural effusion . bibasilar airspace opacities likely reflect atelectasis though infection is not completely excluded . Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia 11842519 55196530 293c8608-3a0f3cbd-cea33c07-ea8130b0-2b90fea4 926 portable ap radiograph of the chest was compared to and . the thoracic spine hardware as well as most likely mediastinal fiducial markers are redemonstrated, unchanged . heart size overall is stable with prominence of the right hilum . bilateral pleural effusions, right more than left are demonstrated with loculations suspected on the right, again with no substantial changes compared to the prior imaging . on the other hand, there is interval improvement of interstitial pulmonary edema, but new more focal opacity is demonstrated in the left upper and lower lobe that might be concerning for infectious process . Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices 11842519 56907723 a0cb7557-fa3d1d06-5f378c5a-b3cb4a26-f3af6c4f 927 pa and lateral views demonstrate dilation of the azygos, tiny pleural effursion, and faint interlobular septal thickening . there is no focal consolidation, pleural effusion, or pneumothorax . the heart size is normal . the cardiac, hilar, mediastinal contours are within normal limits . mild pulmonary edema . Edema 11888614 50160109 2b16b5f9-f1b0a358-5bd9e08e-e1f5a385-2a69e8dd 928 et tube tip is cm above the carinal . ng tube tip is in the stomach . pulmonary edema is substantial, bilateral associated with large bilateral pleural effusions . no evidence of pneumothorax expresse . Edema&&Pleural Effusion&&Support Devices 11888614 50703372 65a8e3b5-8552ea89-9bc2e215-fd42bed9-e469687f 929 there are nonspecific bibasilar opacities . the apices of the lungs are clear . there is no pulmonary edema, pleural effusion, or pneumothorax . the cardiomediastinal silhouette is normal . no fracture is identified on this limited supine view . nonspecific bibasilar opacities, right worse than left, which are concerning for pneumonia . notification the findings were text paged by dr . with dr . at am . the patient had already been started on antibiotics . Lung Opacity&&Pneumonia 11888614 50741129 c3a5cd3a-ef8d5ed2-e9185ad1-5ed385b0-b980a67e 930 since the prior study the endotracheal tube is been removed . heterogeneous bilateral opacities predominantly at the lung bases, are essentially unchanged . no pleural effusion or pneumothorax . cardiomediastinal silhouette is normal . unchanged bilateral parenchymal opacities since , concerning for multifocal pneumonia or aspiration . consider opportunistic infection given the atypical appearance . Lung Opacity&&Pneumonia 11888614 50746880 73e67ffa-4125674a-1c921135-faea72ee-d3a60267 931 again seen are nonspecific bibasilar opacities, which have increased from . the apices of lungs are clear . there is no evidence of pulmonary edema, pleural effusion, or pneumothorax . cardiomediastinal and hilar contours are unremarkable . no acute displaced rib fracture identified . nonspecific bibasilar opacities, right worse than left, are concerning for pneumonia . these appear progressed from . Lung Opacity&&Pneumonia 11888614 51840085 7f7f9559-e0020fe2-d818feea-fe3dfc5a-6fe1fdf3 932 in comparison with the study of , the monitoring and support devices are unchanged . the patient has taken a much poor inspiration . continued enlargement of the cardiac silhouette with pulmonary edema with pleural effusions and compressive basilar atelectasis . Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices 11888614 51853599 d761d23a-c91f3562-afa919b9-4296a1ca-18a90632 933 the patient is a currently intubated with the et tube tip being . cm above the carinal . ng tube tip is in the stomach . widespread parenchymal opacities are demonstrated, most likely representing pulmonary edema but reassessment after diuresis is recommended . underlying infection is a possibilit . Edema&&Lung Opacity&&Pneumonia&&Support Devices 11888614 52382255 436a33ef-05436b90-941301ea-3e5c29aa-85fa6307 934 there are some increased lung markings at both bases that have increased compared to the film from the prior day and could represent small infiltrates or areas of aspiration . Lung Opacity 11888614 53595687 5544bf5f-cd726bd8-5b0bd5ab-c8c4b0f3-f296c7e7 935 supine portable ap view of the chest was provided . there is an endotracheal tube which is seen terminating approximately . cm above the carina . an ng tube tip terminates in the left upper abdomen . there is mild prominence of the bronchovascular markings which could reflect technique though possibility of aspiration is not excluded . no definite pneumothorax or effusion is seen . cardiomediastinal silhouette appears normal . no bony deformities are seen . appropriately positioned et and ng tubes . mild bronchovascular prominence could reflect an element of aspiration . Edema&&Support Devices 11888614 53769263 c963fac4-7f414f76-1fe5eb83-2bd75a14-f2dcd77e 936 there is no focal consolidation, pleural effusion or pneumothorax . the cardiomediastinal silhouette is normal . the imaged upper abdomen is unremarkable . the bones are intact . no acute cardiopulmonary process . No Finding 11888614 54081752 394e4fc7-9c032c3f-1bf44214-594a112c-dbf00598 937 there has been interval improvement in aeration in the lower lobes . no focal infiltrate is identified . the cardiac and mediastinal silhouettes are unchanged . Enlarged Cardiomediastinum 11888614 55352995 cabb5fa9-d1acd957-85f5de3b-98fe2481-6ebf62bd 938 since prior, a left picc has been retracted and now ends at the confluence of the left brachiocephalic vein and superior vena cava . an endotracheal tube has been removed . there is no pneumothorax or pleural effusion . cardiac enlargement is unchanged . since prior, there has been increased right greater than left basilar opacity, compatible with worsening pulmonary edema . . retraction of the left picc now ending in the left brachiocephalic vein . . worsening pulmonary edema . notification findings were discussed with the iv nurse by dr . telephone on at , min after they were made . Edema&&Support Devices 11888614 55517450 ae6a9c3e-1994f6fc-566936f5-9b51a110-2fb8ea7e 939 portable upright chest radiograph demonstrates clear, well expanded lungs . there is no focal consolidation, pleural effusion, or pneumothorax . the cardiac silhouette is normal in size, the mediastinal contours are normal . normal view of the chest . No Finding 11888614 56043754 abca1a43-54c24a8a-52ed07b0-5cd250c5-afdc7061 940 ap portable upright view of the chest . interval intubation noted with the endotracheal tube tip residing approximately cm above the carina . the lungs are mostly clear aside from mild lower lung atelectasis . no large effusion or pneumothorax . cardiomediastinal silhouette appear stable . bony structures are intact . endotracheal tube in place with its tip cm above the carina . advancement of endotracheal tube by - cm may result in more optimal positioning . No Finding&&Support Devices 11888614 56703975 88e154a1-fd82784b-588fbc5a-0649ad57-b12ed9cb 941 no focal consolidation, pleural effusion, or pneumothorax is seen . mild pulmonary vascular redistribution persists . interstitial prominence is likely chronic . heart and mediastinal contours are within normal limits . pulmonary vascular congestion, a little more congested than his best recent chest radiograph on . Edema 11888614 56780883 3262a2af-cbec2cad-9cd5cba9-7d8623c0-9655977e 942 in comparison with the study of , the nasogastric tube has been removed . diffuse bilateral pulmonary opacifications are again seen, consistent with substantial pulmonary edema . the cardiac silhouette is within normal limits on this study . given the extensive pulmonary changes, superimposed pneumonia would be difficult to exclude, especially in the absence of a lateral view . the left spur picc line extends only to the brachiocephalic vein just before the junction with the svc . Edema&&Lung Opacity&&Support Devices 11888614 57247661 c7d68ac0-4b3a8241-8126525e-1868154e-bfe8aae3 943 ap upright and lateral views the chest . subtle prominence of the right hilar bronchovascular markings may reflect ap technique . no definite consolidation concerning for pneumonia . no effusion or pneumothorax . no overt edema . cardiomediastinal silhouette appears normal . no acute bony injuries . limited exam, no acute findings . No Finding 11888614 57386788 31716940-bbbe2182-3ed77c6c-2c4bb3d2-e2d71c0e 944 there is no focal consolidation, pleural effusion or pneumothorax . pulmonary edema has resolved . the cardiomediastinal silhouette is normal . the imaged upper abdomen is unremarkable . no acute cardiopulmonary process . No Finding 11888614 58240183 380bd914-1c234083-a59c609d-7ebce49b-0a9b6101 945 single ap portable view of the chest was obtained . low lung volumes persist . there is mild central pulmonary vascular engorgement . no focal consolidation, pleural effusion, or evidence of pneumothorax is seen . cardiac and mediastinal silhouettes are stable . Enlarged Cardiomediastinum 11888614 58813685 69eca2be-d1ce0c03-915414db-24d5cb14-1a5729b1 946 in comparison with the study of , the patient has taken a better inspiration . the cardiac silhouette is within upper limits of normal or mildly enlarged with continued substantial pulmonary edema . although there is no definite focal area of consolidation, superimposed pneumonia would be difficult to unequivocally exclude, in view of the pulmonary changes as well as the absence of a lateral projection . Edema 11888614 59174426 b200342e-9a78a04c-db63c0f7-725a09b8-0a4f31d5 947 comparison is made with prior study, . cardiac size is top normal . there are low lung volume with widened mediastinum due to distention of the vessels . bibasilar opacities have increased on the left . this could be due to increasing atelectasis andor aspiration . there is mild vascular congestion . there is no pneumothorax or pleural effusion . Atelectasis&&Edema&&Enlarged Cardiomediastinum&&Lung Opacity 11888614 59192793 8c6326e3-b3e4f913-8ee4674e-d82424f7-ee0e7d74 948 lung volumes are low . this accentuates the size of the cardiac silhouette which is borderline enlarged with a left ventricular predominance . the aortic knob is calcified . mediastinal and hilar contours are unremarkable . there is crowding of the bronchovascular structures without overt pulmonary edema . patchy opacities in the lung bases likely reflect atelectasis . no pleural effusion, pneumothorax, or focal consolidation is present . moderate multilevel degenerative changes with anterior osteophytic spurring are demonstrated in the thoracic spine . low lung volumes with patchy bibasilar airspace opacities, likely atelectasis . Atelectasis&&Lung Opacity 11891514 59741167 e5f0aa5a-be3e0f67-149b4619-3d110ca7-7f102361 949 lung volumes are low . there is a mild interstitial pulmonary edema and mild cardiomegaly . mediastinal wires appear intact numerous surgical clips project over the mediastinum . the aortic arch is calcified . there is no large pleural effusion or pneumothorax . mild cardiomegaly and interstitial pulmonary edema . Cardiomegaly&&Edema 11921090 51087989 26ee6ee4-e5bb799b-aa5f201b-b27779ab-636db2a4 950 in comparison with the earlier study of this date, there is suggestion of some increasing opacification at the left base that could represent atelectasis or, in the appropriate clinical setting, a developing consolidation . otherwise little change . Atelectasis&&Consolidation&&Lung Opacity 11921090 56456745 5448e34a-3c48a8c9-74c33e5b-2f85b885-6f094061 951 upright portable view of the chest demonstrates low lung volumes, which accentuates bronchovascular markings . there is no pleural effusion, focal consolidation or pneumothorax . hilar and mediastinal silhouettes are unremarkable . heart size is normal . evidence of free is is seen under the right hemidiaphragm, which may relate to patients reported recent cholecystectomy . evidence of free air under the right hemidiaphragm, may relate to patients reported cholecystectomy earlier today . No Finding 11925631 51690906 82c0e7ef-5760c746-e27a81ec-73b19b26-475e8d54 952 as compared to the previous radiograph, the patient has undergone left upper lobectomy . the patient now displays typical signs of right upper lobe atelectasis with consolidation of the right upper lobe and deviation of the trachea to the right . the left chest tube is in correct position . there is no postoperative pneumothorax . the postoperative rib defect is seen on the left . normal size of the cardiac silhouette . no pleural effusions . mild overinflation of the stomach . Atelectasis&&Consolidation&&Support Devices 11932181 51819903 01064b50-d0d421d9-6fad1834-798ed6d8-d2ef01ac 953 compared to the study from earlier the same day, there is no significant interval change . No Finding 11932181 54296756 4e25f2e7-4ab07975-e5a9f14c-acc20f75-9fa89750 954 there is a new left-sided chest tube with interval decrease in the left pleural effusion . on this upright film, the chest tube tip is located high in the thorax, much higher than the majority of the fluid . post-surgical lobectomy changes are again visualized . there has been interval decrease in the left pneumothorax . the right lung is clear . Pleural Effusion&&Pneumothorax&&Support Devices 11932181 55109095 9f4f2d43-83091dbe-aa72f47e-5d7d06a0-6512aa11 955 ap portable single view of the chest shows stable left lung base opacity due to moderate pleural effusion and left lower lobe atelectasis . left pleural drain is unchanged . right lung is clear . the cardiomediastinal silhouette is normal . there is a small left apical pneumothorax . Atelectasis&&Lung Opacity&&Pleural Effusion&&Pneumothorax&&Support Devices 11932181 55349973 e5058ddc-12914e19-41492f3b-9016f745-4333ebfe 956 left chest tube is again seen . there is moderate left effusion is slightly larger than on the study from the prior day . there is pulmonary vascular redistribution and mild cardiomegaly compatible with fluid overload . Cardiomegaly&&Pleural Effusion&&Support Devices 11932181 55392606 d82e22a0-b3ce3eec-22bf56ae-9a1fca51-556da100 957 portable semi-upright radiograph of the chest demonstrates well-expanded, clear lungs . there is a curvilinear structure in the upper left hemithorax which may represent the pleural surface, but vessels are seen extending superior to this line, making pneumothorax unlikely . cardiomediastinal and hilar contours are unremarkable . there is no pleural effusion . again seen is a nodular opacity in the left upper lung, consistent with area of biopsy today . left apical curvilinear structure may represent pleural surface, but vessels are seen coursing superior to this structure, making pneumothorax unlikely . Pneumothorax 11932181 55708104 8894a073-a8fc7130-d4c16a1a-200a8663-2f3577f8 958 ap and lateral views of the chest . the lungs are clear without focal consolidation, large effusion, or pulmonary vascular congestion . the cardiomediastinal silhouette is within normal limits for technique . no acute osseous abnormality is identified . no acute cardiopulmonary process . No Finding 11941487 57818787 666f0409-83c99213-aec854ff-03da11ef-e191743c 959 et tube and midline and pleural drains have been removed . left lower lobe collapse has worsened accompanied by increasing moderate left pleural effusion . cardiomediastinal silhouette is slightly wider, including mediastinal vascular engorgement . there is no pneumothorax or pulmonary edema . moderate right basal atelectasis is unchanged . right jugular line ends in the low svc . Atelectasis&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices 11989878 54526426 1a210276-bc14011e-b4575d45-690d73e9-5a5f4b36 960 final addendum addendum the ct from shows a large loculated left basilar pleural effusion that appears to remain on chest radiographs from and . it is likely that the new thoracostomy tube does not communicate with this loculation . as mentioned in the original report, the moderate free left effusion is decreased . frontal chest radiograph the patient is rotated rightwards . there is a new left thoracostomy pigtail catheter terminating at the left base, with decrease in size of a moderate-sized left pleural effusion . adjacent atelectasis is present . right pleural effusion and atelectasis have worsened . there is no pneumothorax . left basilar thoracostomy tube, with interval decrease of a moderate left effusion . worsening right basilar atelectasis and right effusion . Atelectasis&&Pleural Effusion&&Support Devices 12056668 50120531 218d1c93-0e3c7a85-76dca3b3-1b9ebcc9-e2b4c42d 961 comparison is made with prior study, . there has been interval decrease in size in still small-to-moderate left pleural effusion . there is probably a left lower lobe collapse . there is no pneumothorax . moderate right pleural effusion has decreased . vascular congestion has decreased . right picc remains in place . cardiomediastinum is obscured by pleuroparenchymal abnormalities . Atelectasis&&Edema&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices 12056668 50662142 62998cf2-402df6d5-0a4beadb-6220521b-ea8ed109 962 in comparison with study of earlier in this date, there has been placement of a right pigtail catheter at the base with some decrease in the degree of pleural effusion . opacification at the right base is consistent with persistent volume loss in the lower right lung and residual fluid . large left pleural effusion persists . Lung Opacity&&Pleural Effusion&&Support Devices 12056668 50674125 e63e4411-eb57a2b9-50bb9ef0-8f980310-c7fd6f0f 963 portable chest radiograph demonstrates slightly increased large bilateral pleural effusions . evaluation of the cardiomediastinal and hilar silhouettes is very limited due to pleural effusions but appears grossly unchanged . no focal opacification concerning for pneumonia identified . slight increase in large bilateral pleural effusions . Pleural Effusion 12056668 52167064 052e448b-2164ba7d-2a1a5625-94f5bdc2-34f732ab 964 in comparison with study of , there is again large left pleural effusion and a much smaller right pleural effusion with pigtail catheter in place . bibasilar compressive atelectasis . in the absence of a lateral view, the possibility of supervening pneumonia, especially at the left base, cannot be excluded . no evidence of vascular congestion . Atelectasis&&Pleural Effusion&&Pneumonia&&Support Devices 12056668 53195010 4861b3fb-a6f7f90a-54624d89-31cc606f-beab81a7 965 as compared to the previous radiograph, the monitoring and support devices are unchanged . unchanged bilateral pleural effusions, with a tendency to increase, and resultant areas of atelectasis . the air collection in the bilateral soft tissues is slightly decreased . unchanged right picc line . no definite evidence of pneumothorax . Atelectasis&&Pleural Effusion&&Support Devices 12056668 54161539 23a5cd3b-6bb29875-b1984d7c-7987bdb4-cff71cef 966 ap and lateral views of the chest are compared to previous exam from . when compared to prior, there has been no significant interval change in the size of the bilateral pleural effusions . there is no significant pulmonary vascular engorgement . cardiac silhouette is grossly unchanged but limited due to bibasilar abnormalities . hypertrophic changes are again seen in the spine . g-tube not clearly identified . no free air identified below the diaphragm . moderate bilateral pleural effusions, not significantly changed from prior . no free air below the diaphragm . Pleural Effusion 12056668 55757032 3c021d64-a606521a-b5070291-5ec59830-23aad4a7 967 comparison is made to the patients previous study dated at . portable ap supine chest film on at is submitted . . endotracheal tube has its tip cm above the carina . right subclavian picc line continues to have its tip in the mid svc . there has been interval appearance of extensive subcutaneous emphysema . there continues to be elevation of the left hemidiaphragm with lucency beneath it likely corresponding to distended bowel . no definite pneumothorax is seen on this supine film, although the sensitivity to detect a pneumothorax is diminished given supine technique . there are likely small layering effusions and bibasilar patchy opacity which may reflect partial lower lobe atelectasis . followup imaging in the upright or semi-erect position may be helpful to exclude an underlying pneumothorax . no pulmonary edema . Atelectasis&&Lung Opacity&&Pleural Effusion&&Pneumothorax&&Support Devices 12056668 59247330 0bf4ce04-1a1975cb-30d2e4c3-72803b59-f383d941 968 comparison is made with prior study performed seven hours earlier . there has been markedly interval decrease in size in left pleural effusions, now small . there is residual persistent large atelectasis in the left lower lobe . there is no evident pneumothorax . cardiomediastinal contours are unchanged with cardiomegaly . right small pneumothorax is unchanged . right pigtail catheter is in unchanged position . aeration of the right lower lobe and right middle lobe has improved . Atelectasis&&Cardiomegaly&&Enlarged Cardiomediastinum&&Pleural Effusion&&Pneumothorax&&Support Devices 12056668 59786298 ae2e7d80-ff33449e-b88a8013-66cff528-5fc0d503 969 large bilateral pleural effusions and moderate enlargement of the cardiac silhouette are continuing to increase . it could be a pericardial effusion . moderate pulmonary edema is exaggerated by low lung volumes, but also worsened . no pneumothorax . right pic line follows a course consistent with either the right internal mammary vein or upper right atrium . Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices 12056668 59819600 d57952c1-89986306-f483eb47-8dc115ff-36d4fb7b 970 overlying trauma board limits assessment . heart size is normal . mediastinal and hilar contours are unremarkable . there is minimal calcification of the aortic knob . pulmonary vascularity is normal and the lungs are grossly clear . no pleural effusion or pneumothorax is seen on this supine exam . eventration of the right hemidiaphragm is present . multilevel degenerative changes are noted in the thoracic spine . marked degenerative changes of both glenohumeral joints are also noted . no acute osseous abnormalities are seen . no acute cardiopulmonary abnormality . No Finding 12085050 52313236 daa9c2a1-691a861b-e52b5481-7f9bdd7b-7620fca2 971 ap and lateral views of the chest . the lungs are clear . cardiomediastinal silhouette is within normal limits . no acute osseous abnormality detected . no acute cardiopulmonary process . No Finding 12186603 54260087 b60f7b52-7c9856fa-65e8bf8a-92264fda-4be20437 972 as compared to the previous radiograph, there is no relevant change . moderate cardiomegaly without overt pulmonary edema . no pleural effusions, no interstitial abnormalities, in particular non-suggestive of chronic fluid overload . the hilar and mediastinal structures are unremarkable . no evidence of pneumonia . Cardiomegaly 12216053 55600141 2183d638-8f431548-7221c970-340325e1-fae35262 973 compared to most recent prior exam, mild pulmonary edema has improved . lung volumes are improved with minimal bibasilar atelectasis . no focal consolidation, pleural effusion, or pneumothorax is detected . there has been interval extubation . right internal jugular catheter is in similar position with tip projecting at the level of the cavoatrial junction . interval extubation and improved interstitial edema . Edema 12326452 53211019 e4527afd-9522899b-f0226c68-901dccb8-e2d4eff4 974 single portable view of the chest . lower lung volumes seen on the current exam . patchy region of opacity identified at the left lung base . elsewhere, the lungs are clear . the cardiomediastinal silhouette is within normal limits . tortuosity of the descending thoracic aorta is noted . partially visualized apparently chronic deformity of the proximal right humerus is also seen . left basilar opacity could be due to atelectasis, although infection cannot be entirely excluded and please correlate clinically . otherwise, no acute cardiopulmonary process . if desired, pa and lateral could be obtained to further characterize . Atelectasis&&Lung Opacity&&Pneumonia 12329950 57495790 6cc81092-d60dc980-f5c8dd41-cc44c43d-09b45cbf 975 the lung volumes are normal . normal size of the cardiac silhouette . normal hilar and mediastinal structures . no pulmonary edema . no pleural effusions . borderline size of the cardiac silhouette . elongation of the descending aorta . Cardiomegaly 12386201 54768912 f8e30069-9a0af2ef-8f97a61a-6081a0f9-043dbf76 976 patient is rotated to the left . the lungs are clear without focal consolidation, effusion, or pneumothorax . there is likely at least mild cardiomegaly although evaluation is limited due to patient positioning . there is no visualized pneumomediastinum . right humeral head orthopedic hardware is identified . cardiomegaly without definite superimposed acute cardiopulmonary process . Cardiomegaly 12388581 51553781 3f35c879-e0f325bf-a821d3d2-60eb7acd-9e2a28d9 977 the patient appears to be kyphotic in position . there are low lung volumes . prominence of the central pulmonary vasculature, pulmonary pulmonary arteries may be due to pulmonary arterial hypertension . left base streaky opacity is more likely due to atelectasis rather than consolidation . no large pleural effusion or pneumothorax is seen . cardiac silhouette is not well assessed due to patient position, but appears mildly enlarged . Atelectasis&&Cardiomegaly&&Lung Opacity 12503812 52811570 2cd5b0dd-527a6616-cb6ad62f-c8ee94df-0b7ffd5b 978 ap single view of the chest has been obtained with patient in semi-upright position . high positioned diaphragms indicate poor inspirational effort and obscure major portion of heart silhouette and result in crowded appearance of pulmonary vasculature . there is, however, no evidence of any pulmonary vascular congestion, acute infiltrate, or pneumothorax . the lateral pleural sinuses are free . no pneumothorax is observed in the apical area . no evidence of significant cardiovascular or pulmonary abnormalities, no pleural effusion reaching lateral pleural sinuses . single view cannot exclude minor pleural effusions and depending posterior pleural sinuses . Pleural Effusion 12508865 55747240 421ffb60-9a41bff9-c842e6e6-a31adcbc-d8e5ad64 979 ap upright and lateral views of the chest were provided . there is stable elevation of the left hemidiaphragm, unchanged from . no focal consolidation, large effusion or pneumothorax is seen . there is grossly stable appearance of the cardiomediastinal silhouette . imaged osseous structures are intact . degenerative changes in the mid thoracic spine are noted . stable appearance of the chest with elevated left hemidiaphragm . no overt failure . No Finding 12521573 59397743 d24b5355-c7b4a8cb-680e6185-0280353a-18bff492 980 cardiomediastinal silhouette is within normal limits . lung volumes are low . an endotracheal tube terminates approximately cm above the carina and an enteric tube projects over the stomach with tip excluded from the images . linear opacities at the bases likely represent atelectasis in the setting of low lung volumes . there is no focal consolidation, pleural effusion, or pneumothorax . appropriate positioning of endotracheal and nasogastric tubes . No Finding&&Support Devices 12536467 52709218 78675c97-3d574a7a-21454f9d-2487195b-496a7b4b 981 as compared to the previous radiograph, there is no relevant change . mild fluid overload . cardiomegaly, extensive right pleural effusion with subsequent right middle and lower lung consolidations, likely to represent atelectasis, pneumonia, or a combination of both . unchanged right picc line . no pneumothorax . Atelectasis&&Cardiomegaly&&Consolidation&&Pleural Effusion&&Pneumonia&&Support Devices 12548159 56957928 54dc0bb7-ef174450-8314a8e5-b94f3c64-748fd4a3 982 compared to the prior exam, there is no significant interval change . No Finding 12548159 57004106 0108e1ef-f190341b-932868ab-83d242f0-e56c7beb 983 there is moderate cardiomegaly and mild pulmonary edema as well as bilateral small pleural effusions . the mediastinum and hila are normal . no focal consolidation . mild-to-moderate pulmonary edema, progressed since . Edema 12548159 59548661 b8a96dfd-924e5707-1009e1ac-9f767236-ff131cd4 984 as compared to the previous radiograph, there is status post resection of the eighth right-sided rib . moreover, the local pleura is minimally thickened . the lung parenchyma shows no evidence of acute changes . no pneumonia, no pulmonary edema . normal size of the cardiac silhouette . normal hilar and mediastinal contours . No Finding 12598684 54952803 766b651a-bf318a3c-a6e00002-e595f99a-1a97ffae 985 feeding tube with the wire stylet in place is curled in the upper stomach . right pic line ends in the mid svc heart is normal size . low lung volumes exaggerate mild pulmonary vascular congestion but there is no pulmonary edema or pleural effusion . Edema&&Support Devices 12641488 51383617 c211b75b-8161910e-f2e25176-8b940c43-41776603 986 the ng tube tip is in the stomach . the . left tube is been removed . there is volume loss at both bases . there is no focal infiltrate . ng tube tip in the stomach . No Finding&&Support Devices 12641488 51982061 76c189dd-c9cae85a-af7009fe-25471b3e-172f291c 987 lung volumes are low which leads to bronchovascular crowding . there may be mild pulmonary vascular congestion exaggerated by supine positioning . no focal consolidation is identified . the cardiomediastinal silhouette and hilar contours are normal . there is no pleural effusion or pneumothorax . mild pulmonary vascular congestion . no focal consolidation . Edema 12641488 55748860 14f68fc5-ae8a53c1-5b35d96f-1fb5d709-e09abe35 988 as compared to the previous radiograph, the previously well-positioned picc line has been pulled back . the tip of the line now projects over the confluence of the brachiocephalic in the superior vena cava . the line should be advanced by approximately - cm to ensure safe position in the superior vena cava . no evidence of complications, notably no pneumothorax . Pneumothorax&&Support Devices 12659391 56143095 3bd7086b-893fe462-f1699be8-dce553d3-1459991d 989 the et tube terminates in the mid trachea . a nasogastric tube terminates in the stomach . mild pulmonary edema with small bilateral pleural effusions are unchanged . moderate cardiomegaly despite the projection is also unchanged . there is no pneumothorax . stable mild pulmonary edema, small bilateral pleural effusions, and moderate cardiomegaly . Cardiomegaly&&Edema&&Pleural Effusion 12669344 51358230 7b4211fe-def2de24-c6991efa-026a3d44-2e4082f8 990 as compared to previous radiograph of day earlier, endotracheal tube now terminates about cm above the carinal and could be advanced a few cm for standard positioning . cardiomegaly is accompanied by pulmonary vascular congestion and improving pulmonary edema . small bilateral pleural effusions are persistent findings . Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices 12669344 53588397 d88bc850-2681d230-e2d3bc84-ba0996c2-078fe63b 991 portable semi-erect chest film at is submitted . nasogastric tube is seen coursing below the diaphragm with the tip not identified . endotracheal tube has its tip approximately cm above the carina . the heart remains enlarged . interstitial edema has slightly improved . small right pleural effusion . no pneumothorax . Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices 12669344 55077682 c3dccd75-321d490b-d282ea11-4da8be1c-6f83adb4 992 pulmonary vascular congestion improved between and , and has remained subsequently stable . there is no pulmonary edema but there is residual small bilateral pleural effusion unchanged . heart is mildly enlarged given the extent of pulmonary hyperinflation, but it has improved since . et tube is in standard placement . nasogastric tube passes into the stomach and although the tip is not seen, the most proximal side port lies above the ge junction . it would need to be advanced cm to move all of the drainage ports into the stomach . Edema&&Pleural Effusion&&Support Devices 12669344 55678624 7062c579-507738d9-ccbbac4a-bcbb9596-7fbc4f31 993 there is moderate cardiomegaly along with widening of the vascular pedicle as well as mild to moderate pulmonary edema . there are probable bilateral pleural effusions, right greater left along with right-sided atelectasis . an endotracheal tube is in appropriate position . an ng tube is seen coursing into the stomach and off the view of the film . cardiomegaly and pulmonary edema . Cardiomegaly&&Edema 12669344 57264873 d54a965f-9fb1b27f-8a1b45a8-87d31707-45c1feb1 994 compared with the prior chest radiograph, there is a new focal consolidation involving the right lower lobe, concerning for pneumonia . the heart is persistently enlarged, and there is persistent mild interstitial edema . left basilar opacity is likely due to atelectasis . . new right lower lobe consolidation is concerning for pneumonia . . persistent mild cardiomegaly and interstitial edema . left basilar opacity is likely due to atelectasis, as seen on the prior study . Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Lung Opacity&&Pneumonia 12669344 58561179 efa1c4d4-c6b83e76-71107d37-015f4c79-24aa9e68 995 as compared to chest radiograph, cardiomegaly and pulmonary vascular congestion are accompanied by worsening interstitial edema and persistent small bilateral pleural effusions . Cardiomegaly&&Edema&&Pleural Effusion 12669344 58890484 8c740b46-36733ece-3c0cf641-1644df78-0219c847 996 as compared to the previous radiograph, there is an increase in interstitial markings surrounding the medial aspect s of the right lower lung and the lower aspect of the right hilus . in the appropriate clinical setting, these changes could reflect pneumonia . increasing retrocardiac atelectasis . moderate cardiomegaly persists . the monitoring and support devices are in correct unchanged position . no pulmonary edema . Atelectasis&&Cardiomegaly&&Lung Opacity&&Pneumonia&&Support Devices 12669344 59437027 edd99c90-fa96205f-04b2900c-127c69bd-d632e5c5 997 there has been interval removal of an endotracheal tube and enteric tube . the heart is persistently enlarged but stable in size from the prior exam . mild interstitial edema persists . opacities involving the right middle lobe and left lower lobe are again demonstrated and may represent atelectasis or infection in the appropriate setting . persistent mild edema . multifocal opacities could represent areas of atelectasis or infection in the appropriate setting . Atelectasis&&Edema&&Lung Opacity&&Pneumonia 12669344 59881207 59b7e3c4-05bcf819-da6417fa-60f5b61a-38711e5c 998 there is a left-sided picc line with distal tip in the mid svc . heart size is prominent, stable . there has been increase in the bibasilar opacities . previously felt to represent atelectasis, this may represent developing infiltrate as well . there is a left retrocardiac opacity and left-sided pleural effusion which are stable . there are no pneumothoraces . Atelectasis&&Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Support Devices 12671922 56711844 b7c818c2-bf5dde12-748d7913-48366cba-d787cb7b 999 in comparison with study of , there again are low lung volumes that accentuate the transverse diameter of the heart . mild indistinctness of pulmonary vessels is consistent with elevated pulmonary venous pressure . on frontal view common there is suggestion of some asymmetry of opacification at the bases, more more prominent on the left . in the appropriate clinical setting, this could represent a developing area of pneumonia . Cardiomegaly&&Edema&&Lung Opacity&&Pneumonia 12749849 53502580 e2d8fc47-6b718166-13b4771b-3194dbf7-48168537 1000 right picc line tip terminates at the level of superior svc . heart size and mediastinum are stable . vascular congestion is demonstrated . there is no pleural effusion . there is no pneumothorax . Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Support Devices 12749849 58796142 059f665a-5889b37e-e7cbf507-8afc0524-28836769 1001 the lung volumes are low . there is a hazy linear opacification at the right base, which is new from the prior exam, and concerning for pneumonia, aspiration, or atelectasis . there is persistent blunting of the right costophrenic angle, without definite pleural effusion . there is a moderate left pleural effusion . the upper lungs are clear . there is no pneumothorax . the cardiomediastinal silhouette is unchanged with stable mild cardiomegaly . . new right lower lung zone opacity, which is nonspecific, and could be due to aspiration, pneumonia andor atelectasis . . moderate left pleural effusion . . stable mild cardiomegaly . Atelectasis&&Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Pneumonia 12772476 50730815 96ac5d23-fc7ee66f-45c92058-4edaeaf3-87204a92 1002 there is moderate-to-severe cardiomegaly accentuated by the projection . there appears to be a hiatal hernia . faint opacities in the right perihilar region and right lower lobes represent aspiration given the clinical concern . opacities in the left retrocardiac region are likely atelectasis . there is no pneumothorax or pleural effusion . there are low lung volumes . Atelectasis&&Cardiomegaly&&Lung Opacity 12772476 57466319 e22a2371-3096bd1f-9b775197-baaddad6-eea8f9d7 1003 mild pulmonary edema, moderate bilateral pleural effusions are new since , increased slightly since . there are no findings strongly suggestive of pneumonia . a large gastrointestinal hernia or defect in the left hemidiaphragm is responsible for considerable left lower lobe atelectasis . heart is not particularly enlarged . no pneumothorax . Atelectasis&&Edema&&Pleural Effusion 12772476 58409499 9cda5d38-795b0046-56155ec6-1f51e537-3f6beee4 1004 as compared to the previous radiograph, all monitoring and support devices, including the left chest tube, are in unchanged position . on todays image, there is no evidence for the presence of a left-sided pneumothorax . the appearance of the right lung apex and of the heart is constant . Cardiomegaly&&Pneumothorax&&Support Devices 12906762 51485705 3a6d5658-ef16be63-d3d6c7b6-9da40249-74eb97ed 1005 allowing for differences in technique and positioning, there has not been a relevant change in the appearance of the chest since the recent study of day earlier . No Finding 12906762 51923417 ec551da7-a02ee2e5-7d9d36c0-ec4ed8c9-d6dee4e5 1006 no relevant change as compared to the previous radiograph, the fibrotic and potentially cavitary changes in the right and left lung apex are of similar appearance . no new focal parenchymal opacities . normal size of the cardiac silhouette . no pleural effusions . no pulmonary edema . the monitoring and support devices are constant . Lung Opacity&&Support Devices 12906762 52126280 699a2526-5b07de66-ef9bc72a-8995b427-76074026 1007 since the prior study there has been no change in the left chest wall subcutaneous air, pigtail catheter in overall appearance of the lung . No Finding&&Support Devices 12906762 53644354 8ab6990c-a800bfc0-d5f5ae92-26f3a84f-cfb69e0a 1008 small left pneumothorax with apical and basal lateral components, unchanged . left pigtail pleural drainage catheter unchanged projecting over the left lateral chest . moderately extensive subcutaneous emphysema left chest wall is unchanged . heart size normal . hyperlucency in the right lung due to emphysema, and to compensatory overinflation due to severe upper lobe scarring . Lung Opacity&&Pneumothorax&&Support Devices 12906762 54899102 cbd96006-a4b14669-614de320-ba15c1d5-71250057 1009 left pigtail catheter is in place . left subclavian line tip is at the level of mid svc . ng tube tip is in the stomach . second left pigtail catheter has been removed with no interval development or increase in pneumothorax of subcutaneous air . right apical scarring is unchange . Lung Opacity&&Support Devices 12906762 55236071 5871f846-5b267431-2d13d3d5-0c59f8d1-7cebfb38 1010 as compared to previous radiograph of day earlier, left pleural catheter remains in place, with hyperlucency at the left lung base suggestive of a basilar pneumothorax . exam is otherwise remarkable for slight improved aeration at the lung bases, with no other relevant changes . Pneumothorax&&Support Devices 12906762 55779897 c8d25759-11bea40b-02429e0d-4657a4d5-af5a6411 1011 endotracheal tube tip terminates approximately . cm from the carina . an enteric tube courses below the left hemidiaphragm, off the inferior borders of the film . heart size is mildly enlarged . atherosclerotic calcifications are seen in the aortic arch and descending thoracic aorta . both hila are slightly enlarged, which can be seen with pulmonary hypertension . emphysema is noted . scarring within the lung apices is present, with bullous disease in the right apex . patchy opacities within the lung bases, more so on the left, may reflect atelectasis though aspiration is not excluded . no pleural effusion or pneumothorax is clearly noted on this supine exam, though the left costophrenic angle is not completely included in the field of view . . standard positioning of the endotracheal and enteric tubes . . bibasilar patchy opacities, likely atelectasis though aspiration or infection cannot be excluded . . scarring within the lung apices with bullous formation in the right apex . Atelectasis&&Lung Opacity&&Pneumonia&&Support Devices 12906762 56802169 21e904a4-539c24eb-be580554-4d15ddda-3546386c 1012 left pigtail catheter is in place . ng tube tip is in the stomach on the last radiograph . rest of the findings are unchanged except for mild interval increase in the opacity in the right apex . Lung Opacity&&Support Devices 12906762 57147053 f539e030-ad3235bb-bf9f3afc-e2076d14-ddb0c511 1013 et tube tip is . cm above the carinal . left subclavian line tip is at the level of mid svc . apical scarring is unchanged but there is interval development of right lower lobe opacity that potentially might reflect interval development of infectious process . left pigtail catheter is in place . subcutaneous air is extensive . minimal basal pneumothorax might potentially be presen . Lung Opacity&&Pneumonia&&Pneumothorax&&Support Devices 12906762 57213444 ca1ee5db-fd901beb-4e89749e-da081003-404b404f 1014 endotracheal tube tip is nearly cm from the carina an should be advanced mm for more secure seating . nasogastric tube ends in the upper portion of a nondistended stomach . heart is top-normal size . there is no evidence of cardiac decompensation . a cluster of cystic spaces in a severely retracted right lung apex is presumably the residual of tuberculosis . comparison with recent prior radiographs would be necessary to confirm that the area is inert . No Finding&&Support Devices 12906762 57315471 4095996e-f8e2d9b1-6d25ee5b-ba56f785-8cc0eca0 1015 left pigtail catheter is in place . subcutaneous air within the left chest wall is demonstrated . apical scarring on the right is unchanged . cardiomediastinal silhouette is unchanged as well as the position of tubes and lines . Enlarged Cardiomediastinum&&Lung Opacity&&Support Devices 12906762 57713214 a8cf2392-a1e39009-f5b6a7ba-7803adc3-0ec7f268 1016 left pleural pigtail catheter has been removed . there is no consolidation, pleural effusion, or pneumothorax . right apical parenchymal and pleural scarring is unchanged . et tube is approximately - cm above the carina . cardiomediastinal silhouette is normal size and unchanged . dobbhoff tube terminates in the stomach . left subclavian venous line terminates at superior svc . no pneumothorax . No Finding 12906762 58695208 5ce424e3-7e50c3a2-f36da4c7-bc25a2d1-a37fca4f 1017 as compared to the prior radiograph of earlier the same date, a feeding tube has been advanced or repositioned, now coursing below the diaphragm with tip outside of the field of view of the radiograph . no other relevant changes since the recent study . No Finding&&Support Devices 12906762 59091002 a50abdea-4d26d980-2f94499a-cfa66e08-00087752 1018 with the left pigtail catheter on water seal, there is no definite pneumothorax . decreasing subcutaneous gas along the left lateral chest wall . suggestion of an area of increased opacification at the right base, which could represent aspiration . extensive opacifications at the right apex are essentially unchanged . Lung Opacity&&Support Devices 12906762 59338798 b6712b07-679e0714-dd203abe-15144208-07b33056 1019 single portable frontal chest . the lungs are well expanded . there are subtle bibasilar opacities which raise concern for bilateral lower lobe pneumonia . there is no pleural effusion or pneumothorax . cardiomediastinal silhouette is unremarkable . subtle bibasilar opacities which raise concern for bilateral lower lobe pneumonia . Lung Opacity&&Pneumonia 12937037 53814100 b6d528ca-2adc0b92-747b8c36-a0e0887d-6b962cec 1020 there is an asymmetric left lower lung opacity, which could be due to infection in the correct clinical setting . the right lung is clear . the cardiomediastinal and hilar contours are normal . no pneumothorax or large effusions . left lower lung opacity may be due to pneumonia in the correct clinical setting . notification the above findings were communicated via telephone by dr . to dr . at on , min after discovery . Lung Opacity&&Pneumonia 12998617 54582114 4213580d-ac255044-99dbadbe-876a28fe-69c13044 1021 borderline heart size, similar . mildly increased pulmonary vascularity, more prominent . segmental elevation left hemidiaphragm . no effusion . no pneumothorax . tortuous calcified aorta . minimal basilar atelectasis . probable scarring right costophrenic angle . minimal bibasilar atelectasis . Atelectasis 12998617 55575107 67cde0b0-055d8347-2a99b426-f30ad9ca-db0ade30 1022 in comparison with study of , there is again substantial elevation of the left hemidiaphragmatic contour with mild atelectatic changes at the left base . no evidence of acute pneumonia or vascular congestion . Atelectasis&&Enlarged Cardiomediastinum 13055950 51222490 f2948447-484794a5-6fb5339c-38ea0630-f00b4d11 1023 heart size and mediastinum are stable . lungs are clear . there is no pleural effusion or pneumothorax . there is questionable nodular opacity projecting over the right cardiac border . correlation with pa and lateral views recommended and anterior shallow obliques . Cardiomegaly&&Enlarged Cardiomediastinum&&Lung Lesion&&Lung Opacity 13071559 58452624 a4d9f542-e5d79dcd-595c393c-1abb2504-53b539fd 1024 supine portable ap chest radiograph there is expected mild postoperative cardiomediastinal silhouette widening . there is mild left basilar atelectasis . no large effusion, pneumothorax or consolidation . mild pulmonary vascular congestion, without edema . an endotracheal tube tip terminates approximately . cm above the carina . a swan-ganz catheter terminates in the right main pulmonary artery . Atelectasis&&Support Devices 13171410 50557253 58597ddf-5c95d260-4911eef3-5907f696-f132c629 1025 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 marked pulmonary congestive pattern including bilateral pulmonary edema seen on the preceding examination has improved markedly . still pleural densities are present along the lateral walls of the chest, particularly on the left side . no new infiltrates are seen . no pneumothorax has developed . status post sternotomy and bypass surgery as well as position of right internal jugular approach central venous line unchanged . some improvement of pulmonary edema . no new abnormalities . Edema 13171410 50794886 ed41d65f-590e0bfb-eb73d35c-3096e02f-e29daec8 1026 comparison with the earlier study of this date, there is no change . no evidence of acute cardiopulmonary disease . monitoring and support devices remain in place following cardiac surgery . no evidence of substantial effusion . No Finding&&Support Devices 13171410 51053791 08c57c30-cc28a132-c83ff0b6-eb8367f2-8c2eeb06 1027 small -mm right apical pneumothorax is unchanged in this patient who still has a right chest tube . left fissural loculation has completely resolved . the right jugular line ends in upper atrium . conclusion . unchanged small right apical pneumothorax . . resolution of left fissural loculation . Pneumothorax 13171410 51163175 abbc56f7-3569a197-33b68a76-2649b730-79cbcd28 1028 in comparison with study of , there is increasing opacification bilaterally . this most likely represents a combination of multifocal pneumonia as well as elevated pulmonary venous pressure in this patient who has undergone a prior cabg procedure . Lung Opacity&&Pneumonia 13171410 51796411 57007272-9df31ade-7ab87e66-6edccc37-48b62a32 1029 comparison is made with prior study performed a day earlier . cardiomediastinal silhouette is unchanged . mild pulmonary edema is stable . moderate bilateral pleural effusions, larger on the left side, have decreased in amount . bibasilar opacities, larger on the right side, have improved on the left . right ij catheter tip is in the mid-to-lower svc . sternal wires are aligned . patient is status post cabg . Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Support Devices 13171410 53888975 5f64b9e7-1cf1f315-28b9eab7-0b2da5bd-d5b1bd6d 1030 as compared to the previous radiograph, there is evidence of a newly appeared parenchymal opacity at both the right lung base and in the left lung, notably in the perihilar areas in the retrocardiac space . the distribution suggests pneumonia rather than pulmonary edema, notably given the absence of pleural effusions and the absence of other findings indicative of fluid overload . borderline size of the cardiac silhouette . status post cabg . no hilar or mediastinal changes . at the time of dictation the referring physician, . , was paged for notification at am, on . findings were subsequently discussed over the telephone . Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Pneumonia 13171410 54238302 1a93c3ba-b683fe20-b0710462-cf40c34d-136cf408 1031 severe pulmonary edema and moderate-to-large bilateral pleural effusion are all increasing, obscuring what might have been an earlier pneumonia in the left lung laterally . heart is mildly enlarged . no pneumothorax . right jugular line ends low in the svc . Edema&&Pleural Effusion&&Pneumonia&&Support Devices 13171410 55806461 d9db020c-127f5d05-0b15114d-f9441c91-1080c498 1032 in comparison with the study of , the right hemidiaphragm is more sharply seen . this could reflect some decreasing effusion or merely be a manifestation of change in patient position . remainder of the examination is essentially unchanged, and the right ij catheter tip remains in good position . Pleural Effusion&&Support Devices 13171410 58511483 b141bf84-f515c0d9-96113b11-9349f481-567cb70e 1033 right chest tube remains in place with a persistent small right apicolateral pneumothorax . cardiomediastinal contours are stable in the postoperative period . bibasilar atelectasis persists and is slightly worsened in the left lower lobe . moderate partially loculated left pleural effusion has slightly decreased in size, and a small right pleural effusion is unchanged . Atelectasis&&Enlarged Cardiomediastinum&&Pleural Effusion&&Pneumothorax&&Support Devices 13171410 59848394 01913fe9-f0448eac-8f439832-dc05486f-95545a64 1034 interval improvement in mild bibasilar atelectasis . small left-sided pleural effusion is new . there is a trace amount of fluid tracking in the right minor fissure . no evidence of pulmonary edema . the degree of cardiomegaly is slightly more than expected after surgery . median sternotomy wires are intact . slightly more than expected cardiomegaly after surgery . follow-up radiographs are recommended . small left pleural effusion is new . Cardiomegaly&&Pleural Effusion 13184933 51891743 379b4718-fca565b4-9fc2566d-ecc473aa-00e09bdd 1035 compared to chest radiographs through . there is no pneumothorax and previous small left pleural effusion has decreased since following removal of bilateral thoracostomy tubes . mild cardiomegaly has increased mild to moderate bibasilar atelectasis is stable . there is no pulmonary edema . Atelectasis&&Cardiomegaly&&Pleural Effusion 13184933 51905928 651c4169-94a729d0-c106e57b-c9c4864f-da822a8c 1036 the patient has been extubated . the patient is status post cabg with intact sternotomy wires . bilateral chest tubes are visualized, which are unchanged in positioning in comparison to the prior examination . there has been interval removal of the pa catheter . there are bibasilar opacities, which are largely unchanged in comparison to prior and likely represent a combination of pleural fluid and atelectasis . the cardiomediastinal silhouette is stable . the pulmonary vasculature is normal . no pneumothorax is seen . . interval extubation and removal of pa catheter . . status post cabg with intact sternotomy wires, and unchanged positioning of the bilateral chest tubes . . bibasilar atelectasis and bilateral small pleural effusions . Atelectasis&&Pleural Effusion&&Support Devices 13184933 55419902 9771b7cd-8a87ee8d-bf9e4546-ec002991-5580c62b 1037 catheters are seen projecting over the inferior aspect of the heart . there is a right sided central venous line with the distal lead tip at the cavoatrial junction . svc stent is also seen . there are low lung volumes due to poor inspiratory effort . there is some elevation of the left hemidiaphragm . there is again seen numerous parenchymal nodules better assessed on the prior ct scan . Cardiomegaly&&Lung Lesion&&Support Devices 13196707 50564703 1ad7b193-ec7866e0-b028d0ab-58e2fd05-8da28ddd 1038 dobhoff tube terminates in the body of the stomach . right subclavian line has been removed in the interim . svc stent appears unchanged in position . bibasilar consolidations may represent a combination of pneumonia and or atelectasis, not significantly changed . multiple bilateral pulmonary metastases are known to the patient . small right pleural effusion has decreased . no pneumothorax . cardiomediastinal contours are stable . right hemidiaphragm is persistently elevated . . slight interval decrease in size of a small right pleural effusion, with persistent bibasilar pneumonia andor atelectasis . . multiple bilateral pulmonary metastases . Atelectasis&&Pleural Effusion&&Pneumonia 13196707 53814539 2d271bb0-b719bae0-a9361b1b-16706831-41fc9798 1039 ap upright and lateral views of the chest provided . elevation of the right hemidiaphragm is again noted . the heart appears top-normal in size . there is a svc stent in place . known right suprahilar mass is better assessed on recent prior ct exam . multiple pulmonary nodules are also better assessed on prior ct . there is no new consolidation, large effusion or pneumothorax seen . bony structures appear intact . no convincing signs of pneumonia . No Finding 13196707 54072113 bdd0f372-e708b3b0-e9328838-c9a7f29f-f68971d0 1040 central line in cavoatrial juncture as previously . increased haziness over the right hemithorax and suggesting increased pleural effusion . left lower lobe atelectasis . there may be a small left effusion . no pneumothorax . cardiomegaly as before . increased right effusion . Pleural Effusion 13196707 55984720 ca7d8827-ea1c412d-b6a0a594-12d32534-52028738 1041 the dobbhoff tube terminates in the stomach . the right ij central venous catheter terminates in caval atrial junction . lung volume is small . the right atelectasis and pleural effusion has increased . the left atelectasis is unchanged . the left costophrenic angle is out of view . the lungs are otherwise clear . the cardiac silhouette is enlarged and unchanged . the mediastinum is unchanged . the dobbhoff tube terminates in the stomach . . worsening right atelectasis and pleural effusion . Atelectasis&&Pleural Effusion&&Support Devices 13196707 56377178 be18562e-74237b2c-c9ebfcb8-ba1b5c02-7b949433 1042 compared to chest radiographs through . worsening opacification at the base of the left lung with slight ipsilateral mediastinal shift is probably new lower lobe collapse . elevation right lung base and multiple right lung nodules due to carcinoma andor complications . previous mediastinal widening has improved . no pneumothorax . mild enlargement of cardiac silhouette has decreased . right central venous catheter ends in the region of the superior cavoatrial junction . Atelectasis&&Cardiomegaly&&Lung Lesion&&Lung Opacity&&Support Devices 13196707 56558687 75872755-7b9a13ad-1980114f-743ec5a7-064e7ac0 1043 stent is seen projecting over the svc . there is a new right subclavian central line with the distal lead tip in the cavoatrial junction . there are low lung volumes . there is elevation of the right hemidiaphragm and a small right-sided pleural effusion . numerous bilateral parenchymal nodules are again seen and better assessed on the prior ct scan . Lung Lesion&&Pleural Effusion&&Support Devices 13196707 59638386 ea657c75-4d5d227a-c3adf2dc-0bf06970-bfa15f60 1044 comparison is made to ct scan from . there is a nasogastric tube whose tip is in the fundus of stomach however, the side port is above the ge junction . the catheter could be advanced an additional cm for more optimal placement . heart size is within normal limits . the visualized lung fields are grossly clear . No Finding&&Support Devices 13270675 55403615 ecb75c7e-8737e1e1-a77376ea-c4b1aea9-7021ccac 1045 the lung volumes are low which causes crowding of the bronchovascular structures . no focal opacity, pleural effusion or pneumothorax is identified . the aortic knob is calcified . the heart size is normal . no acute cardiopulmonary process . No Finding 13299965 50046465 edc6ce1c-fc4f414b-85d4b348-397ef133-0cd52d48 1046 pa and lateral views of the chest provided . right paratracheal opacity likely represents prominent vascular structures and is unchanged from . no new focal consolidation, effusion or pneumothorax . the hilar contours are stable . cardiac and mediastinal silhouettes are stable . no acute intrathoracic process . No Finding 13299965 51119268 a4e3640a-d1ed5982-b24f0c58-60e77e47-0256fe41 1047 single ap upright portable view of the chest was obtained . there is bibasilar atelectasis without definite focal consolidation . right paratracheal opacity likely relates to prominent vascular structures and has been stable as compared to . the cardiac and mediastinal silhouettes are stable also compared to . no overt pulmonary edema is seen . no definite fracture is identified . no acute cardiopulmonary process . no displaced fracture is seen . No Finding 13299965 52804736 bc3c796e-6d0d50cb-bbda3fad-e5317feb-9129e16e 1048 the lungs are clear without focal consolidation . no pleural effusion or pneumothorax is seen . the cardiac and mediastinal silhouettes are unchanged . prominence of the inferior right hila is similar to prior . no acute cardiopulmonary process . No Finding 13299965 56837754 17d61d08-38d54e3f-a90d2a5a-cc0735ca-16f7c8a9 1049 heart size and mediastinum are stable . lungs are clear . there is no pneumothorax . the evidence of recent spinal surgery is present as surgical clips projecting over the mid spine . Cardiomegaly&&Enlarged Cardiomediastinum 13306067 51241123 253a953d-7bebbd7b-cd68e5bc-7c48ae74-fb8a2ccd 1050 cardiac size is normal . the lungs are clear . there is no pneumothorax or pleural effusion . skin are again noted no acute cardiopulmonary abnormality . No Finding 13306067 53942433 3d973084-61d4b944-76a7f29f-472d0b0e-74563711 1051 there are surgical in place . the lungs are clear . normal heart size, pulmonary vascularity . lungs are clear . No Finding 13306067 57848022 0a13521e-6acfb42d-704d4596-c983baab-5227fbea 1052 the lungs are only partially visualized on this study . lower lungs appear unchanged without wall focal consolidations or pleural effusions . the partially visualized cardiomediastinal contours appear stable . the ng tube is visualized in the thorax likely coiled in the mid esophagus . the ng tube is in the midesophagus . the subsequent film dictated prior to this study shows the ng tube was advanced to the appropriate position . No Finding&&Support Devices 13312840 54249174 b29bb966-45c209b8-1dee89af-5f791df9-481fe9f4 1053 ng tube tip is in the stomach, with its tip being below the inferior margin of the film . heart size and mediastinum are stable . lungs are overall clear . there is no appreciable pleural effusion . there is no pneumothorax . Cardiomegaly&&Enlarged Cardiomediastinum&&Support Devices 13312840 54588794 8950f771-ba1f85b9-43178d85-6143c89f-ee7be17d 1054 shallow inspiration . bibasilar opacities, likely atelectasis . tiny right pleural effusion . no pneumothorax . borderline heart size, pulmonary vascularity, accentuated by shallow inspiration . bibasilar opacities, likely represent atelectasis pneumonitis cannot be excluded radiographically . Atelectasis&&Lung Opacity 13312840 57623556 222de94a-617f5cad-684d59ce-8ddd536c-aa8aa84a 1055 in comparison with the study of , there is little overall change . again there are low lung volumes with bibasilar opacifications most likely representing atelectasis . in the appropriate clinical setting, superimposed pneumonia could be considered . Atelectasis&&Lung Opacity&&Pneumonia 13312840 57625868 ad553034-c4992e1a-b1833fab-e0ca9b5c-472e3a59 1056 the proximal end of the left picc line is seen approaching the left chest cage, however, the distal end of the picc line is not clearly visualized within the chest cavity and as such, placement cannot be assessed . the mediastinal silhouette, hilar contours, and pleural surfaces are normal . no pneumonia or pneumothorax . the left picc line is seen approaching the left chest cage, however, the distal end of the picc line is not clearly visualized within the chest cavity, and placement cannot be assessed . recommendations recommend conventional ap and lateral chest radiographs to fully assess picc line positioning . notification the findings were discussed with , np . by , md . on the telephone on at am, minutes after discovery of the findings . No Finding&&Support Devices 13313381 51193877 e87f90e6-bce5fca4-f56f7269-9dda5b46-e2413c48 1057 the left picc line is again seen approaching the chest wall and enters into a smaller axillary vein . the lungs are clear . the heart size is unchanged . there is no pneumothorax, pulmonary edema, pneumonia, or pleural effusion . . the tip of the left picc line is seen in a small axillary vein . recommendations recommend the left picc line be replaced or readjusted . notification the findings were discussed with , md . by , md . on the telephone on at pm, minutes after discovery of the findings . No Finding&&Support Devices 13313381 54976328 edf0798f-b3a2fdbf-00c812b0-c8d3b152-10d90abf 1058 the tip of the right internal jugular central venous catheter projects over the right atrium . low bilateral lung volumes and . there is a new retrocardiac opacity likely reflective of atelectasis . no pleural effusion or pneumothorax identified . the size the cardiac silhouette is enlarged, likely exaggerated by the low lung volumes and ap technique . the tip of the right internal jugular central venous catheter projects over the right atrium . low bilateral lung volumes . retrocardiac opacity likely reflects postop atelectasis . Atelectasis&&Lung Opacity&&Support Devices 13318908 54656635 c3a30ee6-a23b54c0-6b4d9444-3703233d-1f7a5a46 1059 the tip of the right internal jugular central venous catheter extends to the upper svc . a retrocardiac opacity may reflect atelectasis or fullness of the left hilum . no pleural effusion or pneumothorax identified . the size of the cardiac silhouette is enlarged but unchanged . interval retraction of the right internal jugular central venous line, now projecting over the upper svc . No Finding 13318908 55751350 cf34b8b8-d4e13fb9-2d589730-6f402164-0ef8ffdd 1060 compared to prior chest radiographs through at . left lower lobe collapse between and and is still airless . right middle lobe collapse between and venous partially re-expanded . most likely explanation is mucous retention, but ct scanning would be required for confirmation or other explanation . upper lungs are clear . moderate cardiomegaly stable . small pleural effusions are likely, but these are secondary to the atelectasis, not the cause . no pneumothorax . Atelectasis&&Cardiomegaly&&Pleural Effusion 13356814 52553174 56c0b824-617a7edf-7ad7a6d7-c02e5088-5a22aaa6 1061 mild cardiomegaly is a stable . the aorta is tortuous . small bilateral effusions larger on the right have increased . bibasilar atelectasis have increased . there is no evident pneumothorax or pulmonary edema . the and moderate degenerative changes in the thoracic spine increasing bilateral effusions with adjacent atelectasis . Atelectasis&&Pleural Effusion 13356814 52595455 bf216517-21b42ccc-627f8812-5d889362-f5e78c59 1062 there is new complete collapse of the right middle lobe . atelectasis in the lower lobes have increased . small bilateral effusions are probably unchanged . cardiomegaly cannot be assessed . there is no evident pneumothorax . Atelectasis&&Cardiomegaly&&Pleural Effusion 13356814 53743846 54ab854c-ec14b27b-d554c385-73da5922-3ea3d6ed 1063 final addendum addendum dr . reported the findings to dr by telephone on at am, minutes after discovery of the findings . Atelectasis&&Cardiomegaly&&Pleural Effusion 13356814 58392527 643b5892-d5755e02-7054a915-f33776d7-b2859fa1 1064 in comparison with the study of , the patient has taken a somewhat better inspiration . no evidence of acute cardiopulmonary disease . tip of the right subclavian catheter again is in the mid portion of the svc . No Finding&&Support Devices 13376876 51235024 53f3ebc2-eccf07d6-246e623d-a4b102ff-79e5b202 1065 as compared to chest radiograph, left chest tubes have been removed with development of a very small left apical pneumothorax . cardiomediastinal contours are stable in the postoperative . small bilateral pleural effusions are new and accompanied bibasilar atelectasis, right greater than left . Atelectasis&&Enlarged Cardiomediastinum&&Pleural Effusion&&Pneumothorax 13409440 53692338 7db6c381-43097f53-27747acf-fdd4adc3-1d479213 1066 et tube is cm below the level of the carina, and is in appropriate position . ng tube enters in to proximal stomach and is out of field of view . left picc tip is in mid svc and right ij tip is in low svc . mild interval decrease in size of multiple bilateral rounded opacities suggestive of septic emboli . lung volumes remain low . no new focal opacity, pneumothorax, pleural effusion, or pulmonary edema . heart size, mediastinal contour and hila are normal . no bony abnormality . mild interval decrease in size of bilateral rounded opacities suggestive of septic emboli . Lung Opacity 13421580 50001612 089b48e3-21dd2256-41eb2c07-e7ac0494-da51c1b8 1067 consolidation in the left lower lobe improved between and , and has not changed since . small right pleural effusion has decreased in that period of time . new opacification at the right lung base could be either atelectasis or developing pneumonia . the heart is normal size . mild interstitial pulmonary edema persists . et tube, right internal jugular line are in standard placements and a feeding tube passes into the stomach and out of view . no pneumothorax . Atelectasis&&Consolidation&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices 13421580 50391444 e7d5b98a-6610a0fe-de38fcf4-1d68c85e-30f96ae0 1068 portable ap radiograph of the chest was reviewed in comparison to . the ap radiograph of the chest demonstrates et tube being . cm above the carina . the right internal jugular line tip is at the level of low svc . the left picc line tip is at the level of mid svc . heart size and mediastinum are unchanged . there is interval additional progression of parenchymal opacities and potentially increase in pleural effusion . Cardiomegaly&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Support Devices 13421580 50553653 9440df05-7c68c259-e576f624-576a1add-8cd42eba 1069 as compared to the previous radiograph, there is minimally improved ventilation at the lung apices . otherwise, the lung parenchyma has an unchanged appearance . unchanged size of the cardiac silhouette . unchanged presence of extensive bilateral pleural effusions and subsequent areas of atelectasis . unchanged appearance of the cardiac silhouette . Atelectasis&&Cardiomegaly&&Pleural Effusion 13421580 50575681 4c20cd93-cbf30533-1459577c-278ce3b2-46750f47 1070 moderate-to-large bilateral pleural effusions and severe, relatively asymmetric pulmonary consolidation, probably due to pulmonary edema, unchanged over the past hours . heart size, however, is normal . tip of the endotracheal tube is at the upper margin of the clavicles, no less than . cm from the carina with the chin down . it should be advanced cm for more secured seating . left pic line ends at the origin of the svc and a right internal jugular line in the mid-to-low svc . no pneumothorax . dr . was paged at am . Consolidation&&Edema&&Pleural Effusion&&Support Devices 13421580 51749027 c6fe33ff-7cbd847a-01c9e864-447ae08c-a3e2ac73 1071 as compared to the previous radiograph, there is a slight increase in lung volumes, likely reflecting increased ventilatory pressures . the pre-existing parenchymal opacities are slightly less severe than on the previous image, but still relatively advanced and diffuse . unchanged presence of a left pleural effusion is likely . no pneumothorax . Lung Opacity&&Pleural Effusion 13421580 52546898 4912b8ce-70f296a3-b9137775-5da5c93b-74948b5e 1072 large bilateral pleural effusions have increased, generally obscuring most of both lungs, where it is possible, particularly on the left, there is a large pneumonia . if pleural effusions are not to be drained, i would recommend ct scanning to examine the lungs . heart size is normal . mediastinum is not widened . et tube is in standard placement, bilateral central venous catheters end in the low svc and a feeding tube passes into the duodenum and out of view . no pneumothorax . Pleural Effusion&&Pneumonia&&Support Devices 13421580 53340313 be3cdb3c-7f8e24b7-df00a412-c41181eb-44d18ada 1073 bilateral pleural effusion, moderate on the right has improved, slightly less on the left has increased since . mediastinal and pulmonary vascular congestion suggests interstitial abnormalities due to mild edema . left lower lobe remains consolidated medially, either atelectasis or pneumonia . heart size is normal . et tube, right internal jugular line, feeding tube, and left pic line are in standard placements respectively . no pneumothorax . Atelectasis&&Consolidation&&Edema&&Pleural Effusion&&Pneumonia&&Support Devices 13421580 53500287 743258cc-ba82e88d-ec2100af-3da6c655-7afe0682 1074 ap single view of the chest has been obtained with patient in semi-upright position . analysis is performed in direct comparison with the next preceding similar study obtained four hours earlier during the same day . during the interval, the patient has been extubated . previously described right-sided internal jugular approach central venous line remains . again noted is a feeding tube traversing the entire esophagus terminating in the abdomen . the present image covers the line only about inches below the hiatal area . the more distal portion of the line could be followed further on the previous chest examination, still the tip of the dobbhoff line was never included in the image . precise location of the line is essential for patients management . it is recommended to perform the study under fluoroscopic control . comparison of the chest examinations does not reveal any new acute infiltrate . however, the pulmonary vascular pattern appears to be crowded, probably related to the high positioned diaphragms . termination point of dobbhoff line not identified on this film . No Finding&&Support Devices 13421580 53672228 60999807-e9c65537-0be33d31-e1f2eb09-329bb2a8 1075 comparison is made to previous study from . there has been placement of a left-sided picc line with distal lead tip in the mid svc . there is a nasogastric tube with tip of the side port below the ge junction . there are low lung volumes . there is prominence of the pulmonary vascular markings with atelectasis at the lung bases . no overt pulmonary edema is seen . there are no pneumothoraces . Atelectasis&&Support Devices 13421580 53870146 0b336535-040e4914-3827c41e-c9f96093-d6f5d54a 1076 pa and lateral chest radiographs a prominant azygous vein is noted . infrahilar opacity on the lateral view may represent left infrahilar lymphadenopathy or consolidation . a dedicated chest ct may be considered if there is clinical concern . no pleural effusion or pneumothorax is noted . the cardiac silhouette is within normal limits . dr . was notified of the results at am on via telephone . Consolidation&&Lung Opacity 13421580 55026521 976d5e24-dbf376ab-9966d398-5632fd4a-09cb1d19 1077 as compared to the previous radiograph, there is no relevant change . the monitoring and support devices are in constant position, except for the endotracheal tube that has been advanced by approximately cm . the extent of the pleural effusion is constant . atelectasis at both lung bases . unchanged size of the cardiac silhouette . Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices 13421580 55493597 3e0c30fb-983b2a9f-80136b8d-f7949f7d-4ee24f04 1078 comparison is made with prior study . cardiac size is top normal . large bilateral pleural effusions have markedly increased with increasing bibasilar atelectasis, right greater than left . et tube is in standard position . left picc tip is in the mid to lower svc . right ij catheter tip is in the lower svc . right upper lobe opacity could be due to asymmetric edema but superimposed infection cannot be excluded and attention in followup studies is recommended . ng tube tip is out of view below the diaphragm . Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices 13421580 55643821 ed3c0f15-aaabaecf-fc06b5d9-e2679337-1bb8fe87 1079 indwelling support and monitoring devices are in standard position, and cardiomediastinal contours are similar to the prior study . pulmonary vascular congestion is again demonstrated, with overall improvement in extent of perihilar edema, but a new peripheral focus of airspace opacity in the right upper lobe is demonstrated, and could reflect either shift of asymmetrical pulmonary edema, or a new process such as localized aspiration or developing infection or infarction . moderate-to-large right and moderate left pleural effusion appear slightly larger than on the prior study, but positional differences could potentially contribute to this apparent change . Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices 13421580 55692270 d7f886e4-10b9a3b0-c1cd0403-c6ec2f94-2dfc32db 1080 ap single view of the lower chest was obtained covering the upper abdomen . a dobbhoff line is seen to have passed well below the diaphragm and curling up in the left upper abdominal quadrant presumably located in the fundus of the stomach . if the purpose of the line placement was to pass through the pylorus into the duodenum, further advancement would be necessary . as the patient has a markedly distended abdomen presumably related to ascites, supervision of these manipulations with fluoroscopy may be helpful . No Finding&&Support Devices 13421580 55749095 b5cd5972-6de1d0a8-65f54917-02fd239c-37171ea6 1081 in comparison with the earlier study of this date, the dobbhoff tube extends at least to the junction of the second and third portions of the duodenum, where it crosses the lower margin of the image . the tip of the endotracheal tube measures approximately . cm above the carina . low lung volumes with little overall change in the appearance of the heart and lungs . Cardiomegaly&&Support Devices 13421580 56004726 83239aeb-423f4884-3030d0a9-5c624588-7b8dca07 1082 the large bilateral pleural effusions have increased substantially over the past four days and may account entirely for greater opacification in both hemithoraces, without any real abnormality in the lungs . the heart is normal size . et tube in standard placement . right internal jugular line ends low in the svc . Lung Opacity&&Pleural Effusion&&Support Devices 13421580 56608606 840781fb-1fe8a6de-7bd6d463-9943d21f-7716fb40 1083 interval re-positioning of left picc, now terminating in the proximal superior vena cava . other devices are unchanged in position . heart size remains normal . multifocal pulmonary opacities in the mid and lower lungs appear relatively similar to the prior study allowing for patient rotation . moderate-to-large pleural effusions are again demonstrated, with apparent slight improvement on the right . diffuse haziness of upper abdomen is suggestive of ascites . Lung Opacity&&Pleural Effusion&&Support Devices 13421580 56979948 ca37ce49-8fdec0d6-4dc2466b-44543962-762cad72 1084 all the monitoring and support devices are unchanged and in standard position, in particular right ij catheter and in lower svc . left subclavian picc ends in lower svc . et tube ends at cm from carina . ng tube ends in gastric cavity, but the tip is not visualized . as compared to yesterday, lung volumes are persistently low with left retrocardiac consolidation and multiple bilateral nodules in the mid and upper lungs . the largest in the right upper lobe of mm . these bilateral nodules are consistent with septic emboli or new opportunistic infection . the left lower lobe consolidation is suspicious for pneumonia . persistent small pleural effusion on the left base . cardiomediastinal silhouette is normal . there is no pneumothorax . bilateral multifocal nodules with left lower lobe consolidation and small left base pleural effusion . these bilateral nodules are consistent with septic emboli or new opportunistic infection, while the left lower lobe consolidation might be penumonia . findings were discussed with dr at pm by dr . Consolidation&&Lung Lesion&&Pleural Effusion&&Pneumonia 13421580 57044212 05c6f437-00c5dd3e-2c78d21e-40683522-8e9ff770 1085 the et tube tip is . cm above the carina . the dobbhoff tube passes below the diaphragm terminating in the stomach . the left picc line tip terminates at the level of svc . right internal jugular line tip is at the level of cavoatrial junction . the left retrocardiac consolidation is unchanged and most likely represents atelectasis and pleural effusion combination . widespread parenchymal opacities involving the entire chest unchanged as well with no new consolidations currently seen . Atelectasis&&Consolidation&&Lung Opacity&&Pleural Effusion&&Support Devices 13421580 58355979 dacef393-c3ecc055-b15828f6-6e51ba4e-724b20a7 1086 portable ap radiograph of the chest was reviewed in comparison to . the et tube tip is cm above the carina . the right internal jugular line tip is at the level of mid svc . the left picc line tip is at the level of superior mid svc . the feeding tube passes below the diaphragm . heart size and mediastinum are stable and there is additional interval progression in bibasilar consolidations and potentially bilateral pleural effusions . on the other hand, there may be minimal interval improvement in vascular engorgement . Cardiomegaly&&Consolidation&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices 13421580 58836158 edddb068-c24f12b6-084654d9-533d402a-a74f074a 1087 an et tube is present -- the tip lies at the level of the upper clavicular heads approximately . cm above the carina . right ij central line tip overlies the distal svc . a left subclavian picc line overlies the proximal svc . no pneumothorax is detected . there are moderate-sized bilateral effusions with underlying collapse andor consolidation . there is upper zone re-distribution and vascular plethora, suggesting mild chf . compared with , the overall appearance is quite similar . Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Pleural Effusion&&Support Devices 13421580 59027014 da4a05e0-883101fe-b029b869-6baa6722-62c01efd 1088 comparison made to prior study of at . a portable semi-erect chest film at is submitted . . endotracheal tube, right internal jugular central line, and feeding tube and left picc line do not appear to be significantly changed, although the tip of the nasogastric tube is not identified on the current study . there continue to be bilateral layering effusions with bibasilar airspace disease, and these findings likely reflect bilateral pleural effusions with compressive atelectasis and superimposed moderate pulmonary edema . a superimposed infectious process cannot be excluded . overall, however, there has been no significant interval change . cardiac and mediastinal contours are stable . no pneumothorax . Atelectasis&&Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices 13421580 59377628 b9d3c16c-c812c4bf-c62245c0-d8eabccb-5df44b6e 1089 an et tube is present -- the tip lies approximately . cm above the carina . right ij central line tip overlies the distal svc . a left subclavian picc line overlies the mid svc . no pneumothorax is detected . compared with the prior film and allowing for technical differences, there is more confluent alveolar opacity in the right mid and upper zones and in the left perihilar region . again seen are moderate right and small left effusions, with underlying collapse andor consolidation . although the current film is slightly rotated, the appearance raises the question of diffuse narrowing of the left main stem bronchus . findings consistent with pulmonary edema, slightly worse compared with . the possibility of an underlying infectious infiltrate cannot be excluded . mild diffuse narrowing of the left main stem bronchus . attention to this area on followup films is requested . Edema&&Lung Opacity&&Pneumonia 13421580 59568253 40f27d37-e6a130c7-a8f437de-a7caafc0-1f106075 1090 et tube, dobbhoff tube, right jugular catheter, left subclavian picc are all unchanged and in standard position . mild pulmonary edema is redemonstrated, stable since prior chest x-ray . persist bilateral moderate to large pleural effusion and bibasilar atelectasis . cardio mediastinal silhouette is unchanged . there is no pneumothorax . all the monitoring devices are unchanged, persist mild pulmonary edema and moderate to large bilateral pleural effusion with atelectasis . Atelectasis&&Edema&&Pleural Effusion&&Support Devices 13421580 59694374 8ed65ad6-239bbf7b-5e6858f2-f00269d0-41305065 1091 interval placement of right-sided chest tube with apparent resolution of right pleural effusion but development of a small pneumothorax . otherwise, no relevant short interval change since recent study performed earlier the same date . please see recently dictated ct torso of for more complete description of cardiothoracic findings, including a pericardial effusion . Pneumothorax&&Support Devices 13453133 51829071 b01ddc40-b80fa234-3533e014-3b0fdf7b-e8c67c6c 1092 as compared to the previous radiograph, the right chest tube has been removed . there is mild elevation of the right hemidiaphragm but no evidence of right pneumothorax . unchanged appearance of the cardiac silhouette . a pre-existing small retrocardiac atelectasis has resolved . Cardiomegaly 13453133 54560211 d79ce993-34d446c9-a42868d4-53ecd790-f07cb168 1093 as compared to the previous radiograph, the right chest tube is in unchanged position . there is unchanged evidence of a small right apical pneumothorax . the lung volumes have slightly decreased, with development of basal areas of atelectasis . borderline size of the cardiac silhouette . no pulmonary edema . please see recent ct torso examination for a more detailed description of the findings, in particular the pericardial effusion . Atelectasis&&Cardiomegaly&&Pneumothorax&&Support Devices 13453133 59808069 1096d9fd-e71aefb9-50874d07-29cb8e86-2da35512 1094 in comparison with the study of , the monitoring and support devices remain in place . cardiac silhouette is somewhat prominent with mild tortuosity of the aorta . bibasilar atelectatic change without definite vascular congestion or acute focal pneumonia . Atelectasis&&Cardiomegaly&&Support Devices 13558665 58636898 664198f0-e4b3fbb9-c7a6f117-980a1fc1-f6fa9a2f 1095 portable supine view of the chest demonstrates low lung volumes, which accentuates bronchovascular markings . there is no pleural effusion, focal consolidation or pneumothorax . hilar and mediastinal silhouettes are unremarkable . heart size is top normal . endotracheal tube terminates cm above the carina . the patients known sternal and rib fractures are better seen on the ct exam of same date . no evidence of acute cardiopulmonary process . No Finding 13558665 59315283 7b232609-e63c02a4-28b79e05-fb02ed28-1facf2f2 1096 vague opacities projecting over the mid upper lungs laterally are compatible with calcified pleural plaques seen on prior ct . no obvious underlying consolidation . there is no effusion or edema . the cardiomediastinal silhouette is within normal limits . no acute osseous abnormalities . no acute cardiopulmonary process . No Finding 13565877 55639373 6f550224-a23be693-b5f671c6-843ca075-5b25df1f 1097 lung volumes are lower, accounting in part but probably not entirely for slight increase in pulmonary vascular and mediastinal venous caliber . the poor ventilation at the base of the right lung is most likely due to atelectasis . heart is normal size . asbestos-related calcified pleural plaques are more readily appreciated on the conventional chest radiograph performed . no pneumothorax . Atelectasis 13565877 55895988 0eca4744-28e28df7-0a6c3a98-dee33b2a-4041ba77 1098 lung volumes are lower compared to the prior study . this accentuates the size of the cardiac silhouette which is likely mildly enlarged . the aorta is slightly tortuous . there is crowding of the bronchovascular structures, with mild possible mild pulmonary vascular engorgement likely present . diffuse calcified pleural plaques limits assessment of the pulmonary parenchyma . there are likely patchy opacities in the lung bases reflective of atelectasis . minimal blunting of the right costophrenic angle appears new compared to the prior study and may be due to a small pleural effusion . no pneumothorax is identified . no acute osseous abnormalities seen . . bilateral calcified pleural plaques compatible with prior asbestos exposure . . low lung volumes with probable bibasilar atelectasis and possible mild pulmonary vascular congestion . blunting of the right costophrenic angle suggests a trace pleural effusion . Atelectasis&&Edema&&Pleural Effusion 13565877 56299234 0c59944b-dbd8302b-4562d004-5868ec7a-d84395ad 1099 in comparison with the study of , there may be small improvement in the degree of pleural effusions since the intervening procedure . no definite pneumothorax . right lung remains clear . Pleural Effusion 13571108 50393864 7ece76d5-4de53231-dc9bc951-c27b8a9c-00694cc8 1100 cardiac size is top normal . moderate right and large left pleural effusions with associated passive atelectasis are unchanged from prior study . there is new mild vascular congestion . right picc is in the low svc new mild vascular congestion . Edema 13571108 51737323 e5f491e8-7492e07c-44f7e6b7-01e90cc8-5242f410 1101 as compared to the previous radiograph, there is unchanged evidence of a relatively extensive left pleural effusion that occupies approximately half of the left hemithorax . the true extent of the effusion is, overall, grossly unchanged, although the effusion is distributed in a slightly different way . unchanged relatively extensive left lower lung atelectasis and moderate cardiomegaly . on the right, there is no evidence of pathological changes such as effusions, pneumonia or pneumothorax . Atelectasis&&Cardiomegaly&&Pleural Effusion&&Pneumonia&&Pneumothorax 13571108 52526223 80e656ba-2e0b73a5-6252aa35-12c0df92-f0d566b9 1102 dobbhoff tube tip is in the right at the gastroesophageal junction and should be further advanced . there is substantial distention of the stomach . No Finding&&Support Devices 13571108 54496880 f418559d-05aff24a-246e401f-9575cf4e-de484f2a 1103 moderate right and small left pleural effusions, both increased since . persistent consolidation at the right lung base, which developed between , and , persistent, could be pneumonia . heart size is top normal . no pneumothorax . feeding tube ends in the stomach . Consolidation&&Pleural Effusion&&Pneumonia&&Support Devices 13571108 56217740 65cbc543-f6cef27d-ecffe71b-7a1cab1e-28e47ee2 1104 the lung volumes are low . the heart size is normal . mediastinal and hilar contours are unremarkable . the pulmonary vasculature is normal . lungs are clear . no pleural effusion or pneumothorax is seen although the left costophrenic angle is excluded from the field of view . there are no acute osseous abnormalities . no acute cardiopulmonary process . No Finding 13571108 58074550 29db2a67-c5b93d1b-9c1638a1-673fda55-77f3d8ba 1105 as compared to the previous radiograph, the lung volumes continue to be low . there is mild hyperexpansion of the stomach and a newly appeared retrocardiac atelectasis . no pleural effusions . no pulmonary edema . the cardiac silhouette continues to be at the upper range of normal . Atelectasis&&Cardiomegaly 13571108 58633058 ffd81c9c-a7f1e1b9-eb6fb574-0066af97-9d20f9a9 1106 the lungs are clear without consolidation or edema . there is no pleural effusion or pneumothorax . the cardiomediastinal silhouette is normal . no acute cardiopulmonary process . No Finding 13653377 55712456 730ac1ff-f9317f93-3bb0bb75-18942eab-a90c43a3 1107 pa and lateral views of the chest provided . there is left lung volume loss with increased left upper lung opacity concerning for pneumonia . scarring in the right apex is noted . the heart is mildly enlarged . no large effusion is seen . no pneumothorax . mediastinal contour is within normal limits . aortic calcification is present . bony structures are intact . copd with left upper lobe opacity concerning for pneumonia . please note, follow-up to resolution is strongly recommended to exclude underlying malignant process . Lung Opacity&&Pneumonia 13722528 55960864 bb3f07a8-beb19591-79af0942-6ba135e7-d3e24bb7 1108 portable upright ap views . there are low lung volumes . exam appears stable from prior . there is a subtle opacity in the right inferior cardiac margin, consistent with known epicardial fat pad . the lungs are otherwise clear . cardiomediastinal silhouette is stable . there is no pneumothorax or pleural effusion . visualized osseous structures are unremarkable . no acute cardiopulmonary process . No Finding 13731472 51901233 7fb879bd-f49e00bd-91609953-bf71e17f-5a419295 1109 the heart size is moderately enlarged but is less prominent than on the study from years prior . there is mild pulmonary vascular redistribution . there is increased opacity at both bases compatible with volume lossearly infiltrate . mild fluid overload . compared to the study from years prior the amount of chf is less . Cardiomegaly&&Edema 13731472 59665820 7a12e8a5-770ebdb4-2304e41d-535a3f1c-7409884f 1110 in comparison with the earlier study of this date, there has been removal of the left chest tube with no definite pneumothorax . little change in the appearance of the heart and lungs . Cardiomegaly 13736401 50023807 ae55293e-607959ee-bf6ea683-731aaf2c-7974ce2c 1111 in comparison with the study of , there has been a left lower lobectomy with placement of a chest tube . no definite pneumothorax . there are lower lung volumes with streaks of atelectasis at the bases . the cardio mediastinal silhouette is stable and there is no evidence of vascular congestion . Atelectasis&&Enlarged Cardiomediastinum&&Support Devices 13736401 57362963 7077f691-0bb23d05-5205c77a-f3361d79-90cccad8 1112 compared to chest radiographs in . pulmonary vascular congestion, borderline pulmonary edema and slight increase in mild cardiomegaly are new . otherwise normal postoperative appearance left hemi thorax following lower lobectomy . pleural drainage tube in place . no pneumothorax or appreciable pleural effusion . Cardiomegaly&&Edema&&Support Devices 13736401 57950218 12b37691-c36ee41a-5e187544-72273a32-86c10904 1113 the lungs are clear without focal consolidation . no pleural effusion or pneumothorax is seen . the cardiac and mediastinal silhouettes are stable . no acute cardiopulmonary process . No Finding 13740705 51992242 38c6b526-4a53ddea-3c236e8b-2761544c-90f1c42b 1114 frontal and lateral views of the chest are obtained . there are low lung volumes, which accentuate the bronchovascular markings, particularly at the lung bases . mild bibasilar atelectasis is seen . no focal consolidation, pleural effusion, or evidence of pneumothorax is seen . the cardiac silhouette is top normal . the aorta is calcified and tortuous . degenerative changes are again seen along the spine . no significant interval change . low lung volumes with no focal consolidation seen . No Finding 13740705 55924803 b88c89c2-6422d672-c5ec4f6a-afb43481-31f62b0d 1115 low lung volumes accentuate the cardiac silhouette and bronchovascular structures . calcified lymph nodes are present in the right hilar region as well as a calcified granuloma in the right upper lobe . patchy opacity in left retrocardiac region is new, and may reflects patchy atelectasis in the setting of low lung volumes . acute aspiration is an additional consideration in the appropriate clinical setting . note is also made of apparent rightward deviation of the trachea, at the level of the thoracic inlet . this is difficult to evaluate on a portable radiograph, particularly as the patients neck appears to be turned towards the right on this exam . apparent rightward deviation of trachea . repeat radiograph with the neck in neutral position may be helpful to differentiate the effects of rotation from tracheal displacement from a fixed abnormality such as an adjacent thyroid mass . Lung Lesion 13770664 53622016 0a10435e-e43147f5-c4986cba-35836a58-b4b70cd6 1116 new left middle and lower lung opacities are concerning for pneumonia . there is also new mild cardiac congestion . cardiac contour is mildly enlarged with tortuous aorta . there is no pleural effusion or pneumothorax . conclusion . new middle and lower lung consolidation on the left side is consistent with pneumonia . . mild cardiac congestion . this was discussed verbally with dr . . Consolidation&&Pneumonia 13837849 51619708 69b9e772-540d070d-5e5e948f-cf7cbf37-020b9a69 1117 frontal and lateral chest radiographs 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 rib fracture or compression deformity of the thoracic spine is evident on this radiographic examination . No Finding 13866250 53527138 b8d4de5a-4676a6b1-01f6df7f-f0b072c6-e951dffc 1118 small left pleural effusion is new . lungs are clear . heart size is normal . Pleural Effusion 13866250 56260436 78ed0647-df6522bd-879ef182-28259d9d-79106b33 1119 mild to moderate pulmonary edema has minimally increased . moderate bilateral effusions are again noted . cardiac size is top-normal . there is no evident pneumothorax . lines and tubes are in standard positio . Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices 13894716 50227217 7ab5ab83-8d6ebc13-5e5217da-8063ac02-612d1066 1120 right middle lobe atelectasis has markedly improved . large area of retrocardiac loss of volume and consolidation persist . lines and tubes are in unchanged standard position . cardiomediastinal contours are stable . small left pleural effusion is unchanged . no other interval change from prior study . Atelectasis&&Consolidation&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices 13894716 50404152 b992d83f-9b14d160-93965b3d-de9488c3-3ec16f91 1121 there are persistent bilateral interstitial infiltrates likely representing edema . in addition, there is increased density in the retrocardiac area consistent with atelectasis and possibly consolidation . streaky density consistent with subsegmental atelectasis in the middle lobe is no longer apparent . an endotracheal tube nasogastric tube and right internal jugular catheter remain in place . mediastinal structures are stable . bilateral interstitial infiltrates most consistent with edema . continued evidence of left lower lobe atelectasis or consolidation . Atelectasis&&Consolidation&&Edema&&Lung Opacity 13894716 50640883 b9c5fa7a-09bd7ea7-3a8d70e1-294c2963-340a8244 1122 comparison to . the endotracheal tube was removed and has been replaced by a tracheostomy tube . stable low lung volumes with moderate bilateral pleural effusions and mild to moderate pulmonary edema . moderate cardiomegaly persists . no pneumothorax . the right-sided central access lines are stable . Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices 13894716 50659512 f41dc470-8bfd45a8-dd5a735a-b5eeb061-901d46fa 1123 widening mediastinum with the right paratracheal opacity has minimally improved . left lower lobe collapse is new . mild vascular congestion is grossly unchanged . right perihilar atelectasis is unchanged . right middle lobe collapse has improved . lines and tubes are in unchanged standard position . there is no pneumothorax . . bilateral effusions are grossly unchanged . right perihilar opacity is grossly unchanged . Atelectasis&&Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Support Devices 13894716 50731650 f524f43e-5a71f3ed-652266ed-dedcd67f-b062298b 1124 a right internal jugular tunneled dialysis catheter is unchanged in position compared to the prior study . a right internal jugular vascular access catheter is also unchanged . in the interval since the prior study the tracheostomy has been removed in obtained for an endotracheal tube . the tip is positioned approximately . cm above the level the carina . there is a veil like opacity over the right lung likely representing a layering pleural effusion, this appears to have increased slightly in size compared to the prior study . left lower lobe atelectasis persists . mild to moderate pulmonary edema again noted . moderate cardiomegaly . no pneumothorax seen . probable mild increase in the right-sided pleural effusion . Pleural Effusion 13894716 50814385 20fd8602-76e94ccd-74b97075-b4acc96c-22816e41 1125 the tip of the endotracheal tube projects over the mid thoracic trachea . the gastric tube courses below the level the diaphragms but beyond the field of view of this radiograph . the tube right internal jugular central venous lines are unchanged in position . please note the right costophrenic angle and right lateral hemithorax are not included on this x-ray . there are persistent bilateral layering pleural effusions with bibasilar atelectasis . no pneumothorax identified . the size the cardiomediastinal silhouette is enlarged but unchanged . the right lateral aspect of the chest is not included on this radiograph . the visualized thorax demonstrates no significant interval change since the prior study . No Finding 13894716 50825078 0fd8eb66-17575650-50cd8c8c-11dcb1fe-a35ee055 1126 et tube tip is . cm above the carinal . right internal jugular line tip is at the level of mid svc . central venous line tip is at the level of lower svc . interval improvement in pulmonary edema is substantial with small bilateral pleural effusion is present . Edema&&Pleural Effusion&&Support Devices 13894716 51062436 5ba240af-dffc7803-22ba7344-9658b496-9e0ce127 1127 large bilateral pleural effusions right larger than left shows interval increase in size . suspected associated atelectasis . transverse cardiomegaly . dialysis catheter in situ at the cavoatrial junction . no new airspace consolidation . worsening large bilateral pleural effusions with associated atelectasis . no new airspace consolidation . Atelectasis&&Consolidation&&Pleural Effusion 13894716 51334425 d6aabaed-583edc36-625b39fd-3dc3bdeb-4e46bb0b 1128 comparison to . no relevant change is seen . the venous introduction sheet on the right has been removed . the other monitoring and support devices are stable . extensive bilateral pleural effusions with subsequent areas of atelectasis . moderate cardiomegaly . mild to moderate pulmonary edema . no pneumothorax . Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices 13894716 51424614 f7bf88df-2734c8dd-dbe15ebe-58fa37e4-329b9d59 1129 mild pulmonary edema is stable . bilateral pleural effusions with adjacent atelectasis have improved . cardiomegaly is accentuated by the low lung volumes . right ij catheter tip is in the upper svc . et tube is high above the clavicles and should be advanced for more standard position at least cm . ng tube tip is out of view below the diaphragm . Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices 13894716 51850136 3cdf934e-b0ece0aa-1c13aaf6-b9518f53-7e7eae10 1130 in comparison with the study of , there is now a tracheostomy tube instead of the endotracheal tube . other monitoring and support devices are unchanged . continued enlargement of the cardiac silhouette with little change in the degree of pulmonary edema and layering bilateral pleural effusions with compressive basilar atelectasis . Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices 13894716 52221435 ee9ef4b3-71184595-eb3b6ec8-8f9f5577-3ab80ed8 1131 compared to the prior study there is no significant interval change . no change . No Finding 13894716 52444140 dfe7902d-7f50fd3a-34f95cfb-3aeeea63-20d6aa4f 1132 compared to chest radiographs through . there has been no change since earlier in the day moderate pulmonary edema, moderate to large right and small to moderate left pleural effusions all unchanged . there is quite possibly substantial lower lobe atelectasis, perhaps even collapse . heart size mildly enlarged . no pneumothorax . cardiopulmonary support devices in standard placements, unchanged . Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices 13894716 52923479 e301cf49-ca4e1f54-2aab6551-5bed4849-1cbf5bcf 1133 comparison to . all monitoring and support devices, including the endotracheal tube and the to central venous access lines inserted over the right internal jugular vein, are in stable position . stable appearance of the bilateral pleural effusions and the moderately enlarged cardiac silhouette . mild pulmonary edema is present in unchanged manner . no pneumothorax . Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices 13894716 53010838 eca90488-10582fe3-bd30e11d-cca0f4a3-4a7f7367 1134 et tube is approximately . cm above the carina . right ij central venous catheter terminates in mid svc . the enteric tube loops around and terminates in the stomach . moderate pulmonary venous congestion has slightly improved and no pulmonary edema . left lower lobe atelectasis is unchanged . no new consolidation . no pleural effusions or pneumothorax . heart size is top normal but unchanged . mediastinal silhouette is unchanged . . ett is . cm above the carina . . improved pulmonary venous congestion . recommendations the findings were discussed with , rn by , md . on the telephone on at am, minutes after discovery of the findings . No Finding 13894716 53160255 1530fc93-5d8daf6b-2fe3d095-226a1abf-d1ee0557 1135 compared to chest radiographs through . moderate pulmonary edema, large right pleural effusion, bibasilar atelectasis, severity indeterminate, all unchanged since . the heart is top-normal size . Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices 13894716 53254456 b0cbece6-2b0b1434-9aa88346-46174a88-4cabb89d 1136 a tracheostomy tube is present projecting over the thoracic inlet . the tip of a right central venous catheter projects over the cavoatrial junction . no focal consolidation or pneumothorax identified . a trace right pleural effusion is suspected . the size of the cardiac silhouette is enlarged but unchanged . interval exchange of the tracheostomy tube . no pneumothorax identified . suspected trace right pleural effusion . Pleural Effusion&&Support Devices 13894716 53520081 fa919722-4eea7a12-2806e18f-f9050528-40aa3f3b 1137 comparison to . the monitoring and support devices are in stable correct position . mild to moderate bilateral pleural effusions with areas of atelectasis at both the left and the right lung basis . mild cardiomegaly . no overt pulmonary edema . no newly appeared focal parenchymal opacities . Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices 13894716 54308320 6ebbc752-645a64ed-ac355db9-ccca6ae4-31fbb894 1138 og tube tip is not well visualized beyond gastroesophageal junction . consider kub to further evaluate course of ng tube . no significant interval change in bilateral pleural effusions and atelectasis and pulmonary edema compared to chest radiograph performed earlier on the same day . cardiac size is enlarged . there is no pneumothorax . og tube tip is not well visualized beyond the upper svc level . consider kub to further evaluate course of ng tube notification the findings were discussed with , md . by , md . on the telephone on at pm, minutes after discovery of the findings . No Finding&&Support Devices 13894716 54449297 74538a31-cb733388-656f4f32-d5c5a571-959cc764 1139 comparison to . no relevant change is noted . bilateral small to moderate pleural effusions are present . subsequent areas of atelectasis are seen at both lung bases . mild pulmonary edema persists . mild cardiomegaly . the monitoring and support devices are in stable position . Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices 13894716 54846212 9ee1b31b-af06a46c-f0f85a64-b6a302ac-8ab78cee 1140 endotracheal tube terminates approximately . cm above the carina . enteric tube courses below the diaphragm, out of the field of view . right perihilar and upper lobe consolidation is seen, worrisome for pneumonia underlying aspiration, atelectasis, pulmonary contusion not excluded, depending clinical scenario . right perihilar wedge-shaped density may be due to atelectasis . the costophrenic angles are not fully included on the image and pleural effusions are difficult to exclude . the cardiac silhouette is mild to moderately enlarged . Atelectasis&&Cardiomegaly&&Consolidation&&Pneumonia&&Support Devices 13894716 55036314 8eaf1417-a9b5b2b6-bc20c468-6a3f754e-64bd8801 1141 the et tube tip lies above the carina . the ng tube tip is poorly visualized lower mediastinum and beyond due to underpenetration . a right ij central line tip overlies distal svc . no pneumothorax is detected . there is cardiomegaly . there is chf, with interstitial and alveolar edema . there is opacification of both lung bases, which could represent a combination of pleural fluid and underlying collapse andor consolidation . allowing for technical differences, the degree of chf appears increased slightly compared with at chf with interstitial and alveolar edema . this appears slightly worse compared with opacity at both lung bases which likely represents combination of pleural effusions and underlying collapse andor consolidation . ng tube not well visualized in lower esophagus and beyond due to underpenetration . Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Lung Opacity&&Pleural Effusion 13894716 55582331 79bd40db-bf313204-172fcd09-3f35be56-19b3b10a 1142 allowing for differences in positioning, the et tube ng tube and right ij lines are probably similar in position . again seen is mild to moderate cardiomegaly and chf with vascular plethora an interstitial edema . small amount of alveolar edema would be difficult to exclude . retrocardiac opacity consistent with left lower lobe collapse andor consolidation is unchanged . there is increased hazy density over the right over lower half of the right lung and to some degree at the left base . i suspect this reflects layering pleural effusions . presence of progressed collapse andor consolidation at the right base laterally cannot be excluded . lines and tubes essentially unchanged . no pneumothorax detected . mild to moderate cardiomegaly without significant change . chf with interstitial and probably some degree of alveolar edema . persistent left lower lobe collapse andor consolidation . hazy density at right greater left bases is suggestive of layering pleural effusions, more pronounced than on the prior film . possibility of new collapse andor consolidation at the right base laterally cannot be excluded . Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Pleural Effusion&&Support Devices 13894716 55925366 e54e4954-7a3cabf7-4122dcc6-470a5b97-0f7d4bf7 1143 lungs are relatively hyperinflated with the cardiac silhouette appearing slightly smaller as compared the prior study . mediastinal contours unremarkable . no overt pulmonary edema . no focal consolidation, large pleural effusion or pneumothorax . subtle streaky left base retrocardiac opacity is likely atelectasis and overlap of vascular structures . right-sided central venous catheter terminates in the low svc . tracheostomy tube is re- demonstrated . no definite acute cardiopulmonary process . No Finding 13894716 55979282 6eb47aae-b9418849-f08de5c5-25a7216a-1f11ca7e 1144 compared to chest radiographs . collapse of at least segments of the right upper lobe accompanied with fullness in the right paratracheal station of the mediastinum could be explained by central hilar mass and mediastinal adenopathy . ct scanning is recommended . interstitial abnormality in the remainder of the lungs accompanied by a right pleural effusion is better explained by congestive heart failure, even though heart size is only top-normal . Atelectasis&&Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Lung Lesion&&Pleural Effusion&&Support Devices 13894716 56233977 fb4ed69d-b5eb654c-a8d5d6ad-9555058c-7ad04a6a 1145 in comparison with the study of the monitoring and support devices are stable . again there is scatter radiation relating to the size of the patient that is limiting the examination . the cardiac silhouette remains enlarged with pulmonary vascularity and bilateral layering pleural effusions with compressive basilar atelectasis . Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices 13894716 56403155 c7290c26-db21417d-e5ce2c87-a4171ace-026fbeaa 1146 comparison to . monitoring and support devices are in stable position . stable moderate cardiomegaly with mild retrocardiac atelectasis . mild fluid overload but no overt pulmonary edema . small bilateral pleural effusions are unchanged . Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices 13894716 56672330 bb28bb48-5d205700-25fa4499-8d515e45-5cc3286f 1147 in comparison with the study of , the monitoring and support devices are unchanged . the cardiac silhouette remains mildly enlarged with stable pulmonary vascular congestion and bilateral pleural effusions, more prominent on the right . areas of coalescent opacification, especially at the right base, could represent merely volume loss, though in the appropriate clinical setting superimposed pneumonia would have to be considered . Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices 13894716 57233121 d9c17256-9db4d22d-cefc39d7-6a9988c7-acf0f806 1148 right ij tunneled catheter ends in the right atrium . two right ij central venous catheters ending in the high and mid svc are unchanged . a endotracheal tube is appropriately positioned ending approximately . cm above the carina with the patients chin up . there bilateral layering pleural effusions, right greater than left . there is mild pulmonary edema . lung bases are not imaged bilaterally . there is no pneumothorax . appropriate positioning of monitoring and support devices . unchanged pulmonary edema and bilateral layering pleural effusions . Edema&&Pleural Effusion&&Support Devices 13894716 57803270 71ce8c54-2501a856-f9c44787-8585fef6-a6c8ccc6 1149 in comparison with the study of , there is little change . continued enlargement the cardiac silhouette with pulmonary vascular congestion and bilateral layering pleural effusions with underlying basilar atelectatic changes . no evidence of pneumothorax . Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion 13894716 58193028 87fd7d6c-e594fbef-10b4ed5d-1956e77e-6fed9bf0 1150 in comparison with the study of , the monitoring and support devices are essentially unchanged . continued enlargement of the cardiac silhouette . increased haziness of the lungs suggests layering pleural effusions as well as some elevation of pulmonary venous pressure . atelectatic changes seen at both bases . Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices 13894716 58193110 ab58d599-83105f84-08a8af4e-48cf3fcf-53f6e5d0 1151 the tip of the endotracheal tube projects over the mid thoracic trachea . a gastric tube is present, the tip projecting over the stomach . a right internal jugular central venous catheter extends into the midportion of the svc . unchanged opacity in the right peritracheal region and around the right hilum . the right costophrenic angle is not included on these radiographs . no pneumothorax identified . small left pleural effusion . the appearance of the cardiac silhouette is unchanged . no significant interval change since the radiograph from earlier today . No Finding 13894716 58676331 e2cf84dd-8e0f61bb-4068b19d-3dd7f5f6-454cab9e 1152 all enteric tube tip in the mid stomach . endotracheal tube tip in good position . right ij central line, introducer sheath in place, similar . increased heart size, pulmonary vascularity . interstitial prominence, likely edema . bilateral pleural effusions, stable . bilateral lower lung opacities, likely atelectasis . new enteric tube tip in the mid stomach . otherwise stable . No Finding&&Support Devices 13894716 58909423 cc37ee77-09d0c8aa-9c6a813c-7d3bf233-057edd33 1153 comparison to . stable moderate right pleural effusion . no new focal parenchymal opacities . bilateral areas of atelectasis are stable . moderate cardiomegaly . stable monitoring and support devices . Atelectasis&&Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Support Devices 13894716 58956444 f7e47f32-f963529d-65fa70ee-6d4d2e38-71b68d76 1154 large right pleural effusion has increased . presumed left pleural effusion appears unchanged . cardiomediastinal contours stable . lines and tubes are in unchanged standard position, the tip of the ng tube is below the diaphragm out of view . mild vascular congestion is stable . Edema&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices 13894716 58998264 b31f247c-3f8d4aad-babc0ea3-36f3333c-37b65cca 1155 heart size and mediastinum are unchanged as compared to previous study from . bilateral pleural effusions, right more than left as well as supporting devices are unchanged . no pneumothorax . Cardiomegaly&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices 13894716 59179922 62bb6fb0-c42c5225-7a24e047-cfe72663-6f50a6f8 1156 interval placement of an endotracheal tube which projects . cm from the carina . two right internal jugular central venous lines are present, unchanged . the costophrenic angles are not included on this radiograph . unchanged appearance of the visualized lung parenchyma including bilateral layering pleural effusions . the size of the cardiac silhouette is unchanged . interval placement of an endotracheal tube which projects . cm from the carina . findings were communicated to and acknowledged by at h by , md . No Finding&&Support Devices 13894716 59573688 2e0908b4-279ed4d6-7a472d0b-724df717-f35e3948 1157 cardiomediastinal contours are normal . the lungs are clear . there is no pneumothorax or pleural effusion . the osseous structures are unremarkable no acute cardiopulmonary abnormalities . No Finding 13947388 59142924 d0c7e877-8a4b5e21-55d622dd-a6bc538a-9b8b682b 1158 single ap upright portable view of the chest was obtained . there are low lung volumes, which accentuate the bronchovascular markings . given this, there appears to be mild central vascular pulmonary engorgement . soft tissue overlying the lung base likely causes underpenetration . the cardiac and mediastinal silhouettes are stable . no definite focal consolidation or pneumothorax is seen . Enlarged Cardiomediastinum 13970691 50207397 05a331ae-17b42621-787f72cc-ebadd560-6d2586c0 1159 no previous images . cardiac silhouette is within normal limits and there is no vascular congestion, pleural effusion, or acute focal pneumonia . No Finding 14235364 54495813 4a28d5a8-85822fbf-29c6a717-9ca89cfa-9a17ae5b 1160 as compared to the previous examination, there is no relevant change . minimal basal areas of atelectasis . normal size of the cardiac silhouette without pulmonary edema . no interval appearance of new parenchymal opacities suggestive of pneumonia . the contours of the hilar and mediastinal structures are unchanged and normal . Atelectasis&&Lung Opacity 14255450 52612877 fbed2763-32e1610b-cb445bc1-49e2d2d9-404f7105 1161 as compared to the previous radiograph, there is no relevant change . limited image quality . normal size of the cardiac silhouette, in particular normal contour of the right heart . modaerate tortuosity of the thoracic aorta . normal hilar and mediastinal structures . no evidence of pleural effusions or local oligemia . no peripheral wedge-shaped parenchymal opacities . no pneumothorax . no pulmonary edema . no lung nodules or masses . No Finding 14255450 59539063 71c5fd1a-6b349ef4-fa30d201-f780545a-a9a5340d 1162 compared to prior chest radiographs swan-ganz catheter is still coiled in the main pulmonary artery . normal postoperative cardiomediastinal silhouette . lungs clear . no pneumothorax . no appreciable pleural effusion . No Finding&&Support Devices 14290919 54450581 e5b700c3-c3a48c0c-b4bc2257-c1d5699b-795692cf 1163 there is moderate retrocardiac and left basilar atelectasis . a small left pleural effusion is possible . the right lung is clear . heart size is stable . no pulmonary edema or pneumothorax . no focal consolidations are noted . median sternotomy wires are identified . moderate retrocardiac and left basilar atelectasis with a possible small left pleural effusion . no overt pulmonary edema or pneumonia . Atelectasis&&Pleural Effusion 14290919 59462065 a56cf43f-68487112-6618a5b8-67fe4506-0adbd299 1164 ap portable views of the chest were obtained . no focal consolidation, pleural effusion, or evidence of pneumothorax is seen . the cardiac and mediastinal silhouettes are unremarkable . calcification of the aorta is likely present . there is no widening of the mediastinum . degenerative changes are seen at the acromioclavicular joints . no acute cardiopulmonary process . No Finding 14293935 50482534 8a70f2c2-1dc50436-4b6a86ff-ad04bb95-174cc88b 1165 single erect portable view of the chest demonstrates low lung volumes, which accentuate the vasculature . given the low lung volumes, its difficult to discern the heart size, but it is likely normal . no pleural effusion, edema, pneumothorax or evidence of pneumonia . there is no evidence of free air . given low lung volumes, no acute cardiopulmonary process or evidence of free air . No Finding 14319319 52648594 5a8e85f1-3465c903-60688e99-7f50f8b3-a8794171 1166 portable ap chest radiograph again demonstrates low lung volumes, which accentuate the pulmonary vasculature . this may also mask a pneumonia . allowing for this limitation, there is no focal consolidation, pleural effusion, or pneumothorax . the cardiomediastinal silhouette is difficult to delineate . low lung volumes, but no evidence of pneumonia . pa and lateral views would be helpful, if obtainable . No Finding 14319319 55726489 d9d2b934-5af3b11a-2d1bba0d-44da5876-2f409264 1167 the lungs are clear without focal consolidation . no pleural effusion or pneumothorax is seen . the cardiac and mediastinal silhouettes are unremarkable . no evidence of free air is seen beneath the diaphragms . no acute cardiopulmonary process . no evidence of free air beneath the diaphragms . No Finding 14319319 57957540 88827f17-dd2ff5dd-db0d2d89-136a30d8-ca92f929 1168 the lungs are mildly hyperinflated . a dual lead pacemaker is unchanged in position . the cardiomediastinal contour is within normal limits . the heart size is at the upper limits for normal . no consolidation, pneumothorax or pleural effusion seen . mild atherosclerotic calcification in the thoracic aorta . no acute cardiopulmonary process seen . No Finding 14385080 57601753 db537b22-dc6a616a-9ffefaf4-ff2d4311-dd035ac7 1169 ap view of the chest . there is a small nodular opacity in the right lung apex . there is no focal consolidation, pleural effusion or pneumothorax . there is mild cardiomegaly . the mediastinal and hilar contours are normal . left pacemaker leads are in appropriate position . no acute cardiopulmonary process . possible nodule in the right lung apex, may be a pulmonary nodule or possibly bone island . recommend non-urgent apical lordotic view for further assessment . these findings were discussed with dr . by dr . at am on by phone . Lung Lesion 14385080 58083696 0bce12a8-a3f59f85-9b4b37d9-21ea3edf-a6a6ad98 1170 ap and lateral images of the chest . the lungs are well expanded and clear . there is no pleural effusion or pneumothorax . the cardiomediastinal silhouette is unremarkable . no acute cardiopulmonary process . No Finding 14392929 52896510 ab2aaf36-39384bfa-427a821e-2f840195-c542824b 1171 upright frontal view of the chest is limited by patient rotation . within this limitation, there is no acute intrathoracic process . the mediastinal, pleural and pulmonary structures are unremarkable . there is no pleural effusion or pneumothorax identified . calcifications are noted within the aortic arch . degenerative changes of the cervical spine and clips overlying the left neck are seen . limited study, however, no acute intrathoracic process . No Finding 14429763 51748293 aee9dc7d-9e6d2430-2f04c053-254149b6-e4925a31 1172 in comparison with the earlier study of this date, there has been placement of an enteric catheter . although the tip is not well seen, it appears to extend at least to the lower stomach . remainder of the study is essentially unchanged with some retrocardiac opacification consistent with volume loss in the left lower lobe . Lung Opacity&&Support Devices 14429763 56968110 2c27614d-df5d18b9-d93249b6-10178a5f-05a69b81 1173 low lung volumes are present . heart size is accentuated as result, appearing mildly enlarged . mediastinal and hilar contours are grossly unremarkable . crowding of bronchovascular structures is present without overt pulmonary edema . minimal patchy opacities within the lung bases likely reflect areas of atelectasis . no focal consolidation, large pleural effusion or pneumothorax is detected on this supine exam . there are no acute osseous abnormalities . low lung volumes with probable bibasilar atelectasis . Atelectasis 14473057 56003480 e7267408-50278738-19fb9b1a-0e194253-046fa395 1174 no focal consolidation is seen . no pleural effusion or pneumothorax is seen . the cardiac and mediastinal silhouettes are stable . subtle deformity projecting over the anterior right fourth rib rib may be artifactual however, correlate with site of pain for possible nondisplaced subacute rib fracture . no focal consolidation, pneumothorax, or pleural effusion . subtle irregularity projecting over the anterior right fourth rib could be artifactual versus a subacute fracture . correlate with site of point tenderness . Fracture 14482820 51222003 10848775-a37a1df3-15920443-b4c024fb-f364928e 1175 since , mild pulmonary congestion with small bilateral pleural effusions and mild bibasilar atelectasis is appreciated . a focal opacity is seen in the left mid-lung which, given clinical concerns, could represent a pneumonia . lung volumes remain low . heart size is unchanged . no pneumothorax . . a focal opacity is seen in the left mid-lung which, given clinical concerns, could represent a pneumonia . . mild pulmonary vascular congestion with small bilateral pleural effusions and mild bibasilar atelectasis is new since . notification the findings were discussed by dr . with dr . on the telephoneon at pm, minutes after discovery of the findings . Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia 14482820 52063223 86ab6668-1230eeac-ba4ca749-b4cf6c76-9bbae0dd 1176 since , with tip of a new endotracheal tube is a . cm above the carina . mild pulmonary congestion, small left pleural effusion, and left basilar atelectasis is unchanged . heart size is top normal . positioning of the right internal jugular venous line is unchanged . no pneumothorax . . new ett is seen . cm above the carina and should be pulled back . recommendations ett should be pulled back by about - cm for appropriate positioning . notification the findings were discussed by dr . with ccu rn on the telephoneon at am, minutes after discovery of the findings . No Finding 14482820 53870816 bbe7847a-18f0d974-62009a61-82ad2ee0-91ca809e 1177 the et tube is . cm above the carina . right ij line tip is in the right atrium . ng tube tip is in the stomach . heart is mildly enlarged . there is volume loss at both bases . there is no focal infiltrate . there is no pneumothorax . Support Devices 14482820 55715115 d71ef3af-b2cb314a-8a4c01c9-4b18f430-14207ae6 1178 the right lung is clear . there is linear atelectasis in the lingula . no focal consolidation is seen . the cardiomediastinal silhouette and hilar contours are within normal limits . calcifications of the aortic arch is again noted . there is no pleural effusion or pneumothorax . degenerative changes are seen at the bilateral acromioclavicular joints . linear atelectasis in the lingula . no focal consolidation . Atelectasis 14482820 55772608 2602a49c-e35b125f-82408969-f68eb85c-9735bc8b 1179 there is a right ij line with tip at the cavoatrial junction . there is no pneumothorax . lung volumes are slightly low . there is increased patchy opacity in both lower lungs . is unclear if this is due to volume loss or early infiltrate . the et tube and ng tube are unchange . Lung Opacity&&Support Devices 14482820 56645801 ec1d6381-e9419e88-73976f03-de6d851b-3691ae4f 1180 endotracheal tube terminates cm above the level of the carina . enteric tube courses below the level of the diaphragm, terminating in the left abdomen, in the expected location of the stomach . no pneumothorax is seen . there is no focal consolidation or pleural effusion . the cardiac silhouette is top-normal . the aorta is calcified . no pulmonary edema is seen . degenerative changes are seen at the left glenohumeral and acromioclavicular joints . endotracheal tube terminates cm above the level of the carina . enteric tube in appropriate position . no pneumothorax . No Finding&&Support Devices 14482820 56986284 6df752dd-d96e8fa1-d902d33c-4797e505-97594e40 1181 in comparison with the study of , the monitoring and support devices are essentially unchanged . continued low lung volume accentuates the transverse diameter of the heart . mild indistinctness of pulmonary vessels is consistent with mild elevation in pulmonary venous pressure . retrocardiac opacification is consistent with volume loss in the left lower lobe and probable small effusion . Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices 14482820 58199894 36069cc6-7d9f5869-00a6ddd9-a1ff1b73-3df3c8f7 1182 compared to the prior study there is no significant interval change . no change . No Finding 14482820 58257481 35f30547-a26ab9ec-f5962b41-1e1d9b3a-2a9b5f50 1183 in comparison with study of , there are improved lung volumes . monitoring and support devices are unchanged . cardiac silhouette is enlarged, but there is no evidence of vascular congestion . retrocardiac opacification has improved, consistent with atelectatic changes and possible small effusion . Atelectasis&&Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Support Devices 14482820 58693812 2e02cb7f-ec012b6d-6af65d55-6a0a4c93-160776e8 1184 compared to prior chest radiographs through . lungs are low in volume but grossly clear . heart size top-normal . no pneumothorax . pleural effusions small on the left if any . et tube has been withdrawn to standard position . right jugular line ends in the low svc . esophageal drainage tube ends in the upper nondistended stomach . Cardiomegaly&&Pleural Effusion&&Support Devices 14482820 58766220 0d46b39d-93186b93-afd0e40f-7e41e72b-54caf402 1185 compared to prior chest radiographs through . esophageal feeding tube ends in the lower esophagus and would need to be advanced at least cm to end in the stomach . wire stylet is no longer in place . lungs are low in volume and aside from linear atelectasis at the left base, clear . heart is top-normal size . pleural effusions small if any . no pneumothorax . Atelectasis&&Pleural Effusion&&Support Devices 14482820 59257496 b6bf7b6f-86a45cf5-a4fe0214-329758df-c141acdf 1186 in comparison with the study of the monitoring and support devices are unchanged . continued enlargement of the cardiac silhouette without definite vascular congestion . basilar atelectatic changes are seen bilaterally, especially on the left . Atelectasis&&Cardiomegaly&&Support Devices 14482820 59283708 efa280b4-ab9921dd-e10b0695-dea0c2f9-925ee947 1187 dense consolidation in the right upper lobe is probably pneumonia . this needs to be followed to exclude another condition such as bronchogenic carcinoma . tiny right pleural effusion may be present . there is no left pleural effusion or pneumothorax . heart is normal size and pulmonary vasculature is not engorged . thoracic aorta is tortuous but not clearly dilated . there is narrowing of the airway at an below the colitis suggesting local edema . this may be due to recent intubation or laryngitis . clinical correlation is advised . Consolidation&&Edema&&Lung Lesion&&Pleural Effusion&&Pneumonia 14517112 50068096 f4d7124a-97e34422-3896bcd4-fb0af1d2-4cfb07dd 1188 frontal semi-erect view of the chest was obtained . left internal jugular central catheter terminates in stable position, across the midline, in either the upper svc or the left brachiocephalic vein . known right upper lung abscess is not clearly visualized on this radiograph due to semi-erect position . diffuse right hemithorax opacification remains, though aeration of the right lung appears slightly improved . the left costophrenic angle is excluded on this study . slight improvement in aeration of the right hemithorax, although diffuse opacification of the right hemithorax persists . known cavitary lung abscess is not clearly visualized on this semi-upright radiograph . Lung Opacity 14544801 53498120 1e200bbf-a4a3f4ef-5f5971f8-e0280c38-c5d317ef 1189 there has been interval placement of a left internal jugular central line, which is seen crossing the midline . given patient rotation, position of the catheter tip is limited although it appears to terminate in the region of the left brachiocephalic vein or the superior svc . otherwise, there has been no significant interval change with prior study . new left ij central line seen crossing the midline and terminating either within the left brachiocephalic or the upper svc . evaluation limited due to rotated position . No Finding&&Support Devices 14544801 55084779 d1311bd6-e306d59e-a79f3f57-df18a30e-bf78423b 1190 there is complete opacification of the right lower lung with air bronchograms suggestive of pneumonia . the large cavity in the upper lung field is partially opacified by adjacent effusion, which appears intervally increased . increased interstitial thickening in the left lung is unchanged . there is no pleural effusion or pneumothorax in the left . increased opacification in the right lung suggesting pneumonia in the right lower lobe and increased effusion . cavity in the rul slightly obscured to to adjacent increased pleural effusion . Lung Opacity&&Pleural Effusion&&Pneumonia 14544801 55332401 b3d3f351-2f2c324c-963ca19b-fb5f5df2-0d7e9a31 1191 lung volumes are lower today than on , but there is no evidence of pneumonia or pulmonary edema . suprahilar right upper lobe mass appears larger, attributable to differences in radiographic technique although some interval growth is possible . there is no pneumothorax or pleural effusion . heart size is top normal . Lung Lesion 14544801 58556039 d60e5ebe-9d77544b-9235b2f7-13e5bf44-06974f41 1192 ap and lateral views of the chest . again, low lung volumes are noted . there is secondary crowding of the bronchovascular markings but no confluent consolidation the cardiomediastinal silhouette is stable . eventration of the right hemidiaphragm again noted . degenerative changes noted at the left shoulder . low lung volumes without definite superimposed acute process . No Finding 14583397 50892292 d099acf0-536d3ccf-55bae878-94ed75d5-e0df8d76 1193 portable frontal view of the chest a new right internal jugular line ends at the cavoatrial junction . the lung volumes remain low, which causes crowding of the bronchovascular structures . no pulmonary vascular congestion, pleural effusion or pneumothorax is identified . the heart size is top normal . percieved widening of the mediastinum is likely due to technique . No Finding&&Support Devices 14583397 51893215 d3a1d9e4-94eb4b4c-537cbd71-da0ad8c6-d974a241 1194 the lungs are hypoinflated with crowding of vasculature . heterogeneous right lower lobe opacity is most consistent with atelectasis . no pleural effusion or pneumothorax . persistent mild cardiomegaly is noted . mediastinal contour and hila are unremarkable . new right basilar opacities suggestive of atelectasis . followup pa and lateral radiographs may be helpful to ensure resolution and to exclude the possibility of an early infectious pneumonia in the appropriate clinical setting . Atelectasis&&Lung Opacity&&Pneumonia 14583397 52416075 97c9620b-d57b73e6-50f4d0bb-e014ebb1-2d10729b 1195 ap view of the chest . a left internal jugular central venous line ends in the upper-to-mid svc . there are no pleural effusions, focal consolidation or pneumothorax . the cardiomediastinal and hilar contours are normal . left internal jugular central venous line ends in the upper-to-mid svc . otherwise unchanged . No Finding&&Support Devices 14583397 56437925 7fdf802e-9067de1e-6698cf2a-402439f4-e909e8f3 1196 ap view of the chest . there is no focal consolidation, pleural effusion or pneumothorax . the cardiomediastinal and hilar contours are normal . there are low lung volumes . low lung volumes but no evidence of pneumonia . No Finding 14583397 57524173 c0b0c295-64487928-71fd50de-3c50dbdd-08360437 1197 postoperative alterations of the mediastinum appear unchanged in this patient status post esophagectomy procedure . indwelling lines and tubes are unchanged in position, and there is no evidence of a pneumothorax . bibasilar atelectasis has worsened, particularly in the left retrocardiac region . otherwise no relevant short interval change . Atelectasis&&Enlarged Cardiomediastinum&&Support Devices 14798972 51882341 da9bcd9f-310e0f89-ef56f5ed-330d4f9e-c7c83601 1198 indwelling support and monitoring devices are unchanged in position . increased widening of right mediastinal contour is consistent with distention of the patients neoesophagus in this patient status post recent esophagectomy procedure . increasing moderate left pleural effusion is present with adjacent left retrocardiac atelectasis . Atelectasis&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices 14798972 53079362 0159eb74-f5b69f73-6e0faa67-ccf3e55c-474da4bb 1199 as compared to the previous radiograph, the extent of the pre-existing pneumothorax has decreased . the apical part of the pneumothorax has now a diameter of cm . the right pigtail catheter is in unchanged position . slightly increasing amounts of right lateral air collection in the soft tissues . no evidence of tension . no other relevant changes . Pneumothorax&&Support Devices 14798972 53647601 c1baddfe-c5fb89e0-f89fcd8e-46d628ca-81ab567f 1200 nasogastric tube has been repositioned or replaced, with tip now terminating at approximately the t vertebral body level, with the side port at approximately the t level with an intrathoracic neoesophagus in this patient status post esophagectomy . subcutaneous emphysema in right chest wall has slightly improved . lung volumes are slightly increased compared to the prior study with associated improved aeration at lung bases . otherwise, no relevant change . Support Devices 14798972 54849350 feeb7dc4-beddb481-54e49f5e-f8d3d074-dde2412d 1201 previous bibasilar atelectasis and moderate left pleural effusion have cleared . lungs are fully expanded . right apical pleural tube still in place with no appreciable right pleural abnormality . heart size normal . mediastinum has a normal postoperative appearance following esophagectomy and gastric pull-up . heart size normal . nasogastric tube has been partially withdrawn and now ends cm above the level of the diaphragm, projecting over a midline drain . no pneumothorax . No Finding&&Support Devices 14798972 55149101 92939d3d-d0e1a594-0a87af91-b703fa06-a20a1b46 1202 a right chest tube terminates in the stadnard position . an, epidural catheter overlies the patient . a nasoenteric tube terminates below the diaphragm . right perihilar opacity likely represents neoesophagus . there is some subcutaneous emphysema along the right lateral thorax . there is no pneumothorax . low lung volumes, mild pulmonary vascular congestion, and top normal heart size are consistent with recent surgery . Edema&&Lung Opacity&&Support Devices 14798972 56978673 3a839f77-7d3beba4-cd7263f9-55cea333-3d6908b7 1203 there is a single right chest tube with its tip terminating near the right lung apex . no pneumothorax . widening on the right side of the mediastinum is attributed to the neoesophagus . otherwise, cardiomediastinal silhouette is stable in appearance . minimal bibasilar atelectasis is present, unchanged on the right side and minimal increase on the left side . there is no pleural effusion or pneumothorax . Atelectasis&&Enlarged Cardiomediastinum&&Support Devices 14798972 59874624 f10984d9-b7e843e6-ebb071e2-68fe6b30-930a5e31 1204 ap upright and lateral views of the chest providedthere is no focal consolidation, effusion, or pneumothorax . the cardiomediastinal silhouette is stable with top-normal heart size again noted . imaged osseous structures are intact . no definite acute osseous injury . no free air below the right hemidiaphragm is seen . no acute intrathoracic process . No Finding 14962059 57011081 97bfaad2-fb4b2ffe-ad057631-11574fbb-c19ec356 1205 no interval change . the lungs are well inflated and clear . no pleural effusion or pneumothorax . heart size, mediastinal contour, and hila are unremarkable . a left pacer device is seen with lead tips in the right atrium and right ventricle . ekg leads overlie the chest wall . no acute cardiopulmonary process . specifically, no pneumonia . No Finding 14998466 59315725 93caa05e-f8a3f919-ee78818f-04d801af-3c445791 1206 the inspiratory lung volume is improved from the most recent prior study . there is persistent pulmonary vascular congestioninterstitial edema . a moderate-to-large right and small left pleural effusion are unchanged with underlying bibasilar opacification most likely reflecting atelectasis . the cardiomediastinal silhouette remains enlarged but stable . unchanged pulmonary vascular congestion, bilateral pleural effusions and underlying atelectasis . Atelectasis&&Edema&&Pleural Effusion 15004141 54652992 3e286a0f-e9daa593-c7a41a0e-9e3594d6-d8f7394f 1207 heart size remains at least moderately enlarged, though assessment is somewhat limited due to the presence of a moderate-to-large right pleural effusion . a small left pleural effusion is also noted . bibasilar airspace opacities could reflect atelectasis, though infection is difficult to exclude . there appears to be mild pulmonary vascular congestion . no pneumothorax is demonstrated . fusion hardware within the lumbar spine is partially imaged . mild pulmonary edema and bilateral pleural effusions, moderate to large on the right and small on the left . bibasilar airspace opacities could reflect atelectasis, but infection cannot be excluded . Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia 15004141 55606773 dfd9a06c-2994892e-f4a6bc1c-f6ec4803-283e5005 1208 the heart is at the upper limits of normal size . the mediastinal and hilar contours appear within normal limits . there is mild upper zone re-distribution of pulmonary vascularity and indistinctness, suggesting slight vascular congestion or fluid overload, although not striking . there is no pleural effusion or pneumothorax . mild vascular prominence which could be seen with pulmonary venous hypertension or slight congestion . Edema 15072866 53328177 16590c25-c0e530cb-6447694b-ed2dcc9d-04bc1b33 1209 ap single view portable chest x-ray in upright position shows low lung volume without consolidation or nodules . bulging of the right mediastinal border is due to known right paraspinal mass . heart size is normal . there is no pleural effusion or pneumothorax . Lung Lesion 15167936 57549616 6f1d8e56-81ec34dd-4f80edfc-98c577db-9db1f26e 1210 in comparison with the study of , there is little overall change . again there are low lung volumes that accentuate the transverse diameter of the heart . central catheter tip is in the mid to lower svc . some streaks of atelectasis are noted . again, the extensive malignant bone destruction seen on the chest ct of is not appreciated on conventional chest radiographs . Atelectasis&&Cardiomegaly&&Support Devices 15167936 57724934 3b81c9d8-c4ba9c06-8a83c02f-3bb8e8f0-328485e0 1211 there has been interval decrease in the bilateral pleural effusions with small residual pleural effusions left greater than right there is some volume loss at the left base heart is mildly increased in size . improvement in chf . Cardiomegaly&&Edema 15176968 59475713 b4e881ec-b2dbe4eb-824d9649-07862804-17af7264 1212 right and moderate bilateral pleural effusions, mild cardiomegaly, pulmonary vascular redistribution consistent with chf . compared to prior exam there is no significant interval change . chf . Cardiomegaly&&Edema 15176968 59642952 5bf38a0d-d30e0de1-37c34461-92633fb0-d208538e 1213 there has been improvement in the pulmonary edema, now moderate . small bilateral pleural effusions are unchanged . the cardiac silhouette remains mildly enlarged . the mediastinal contours at the hilar structures are unremarkable . there is no pneumothorax or focal airspace consolidation . improving pulmonary edema, now moderate . Edema 15176968 59647298 fa879b10-e59b6500-0f17b51e-22c2d961-29242fa0 1214 lung volumes are normal . note is made of a faint opacity at the left lung base and projecting over the spine on the lateral view, concerning for developing infection . remainder of the lungs are otherwise clear of focal consolidation, pleural effusion or pneumothorax . cardiomediastinal contours are normal . no acute osseous abnormalities identified . left lower lobe opacity, concerning for developing infection . Lung Opacity&&Pneumonia 15198284 59548617 0825ee1f-87c4a68b-20dbe092-f3f397a5-67e49d7e 1215 heart size is top normal . the mediastinal and hilar contours are unremarkable . pulmonary vasculature is normal . patchy opacity in the left lower lobe most likely reflects atelectasis . a small left pleural effusion is likely present . the right lung is clear . no pneumothorax is identified . remote left third anterior rib fracture is identified, but no acutely displaced fractures are otherwise seen . left lower lobe patchy opacity, likely atelectasis with small left pleural effusion . no displaced fractures are visualized . if there is continued concern for a rib fracture, consider a dedicated rib series . Atelectasis&&Fracture&&Lung Opacity&&Pleural Effusion 15361393 50457124 8ac669b7-9257e87a-4a9a70ee-6cbc9515-eacfcabb 1216 cardiomediastinal contours are within normal limits . lungs demonstrate no focal areas of consolidation to suggest the presence of pneumonia . ventriculoperitoneal shunt catheter is noted and has been more fully evaluated on the recent shunt series . Pneumonia&&Support Devices 15452020 53648454 cbdfc009-8a46e75c-5ef74a6c-63e9ee1d-fe7b9093 1217 the lung volumes are normal . borderline size of the cardiac silhouette . no pulmonary edema . no pneumonia, no pleural effusions . no pneumothorax . Cardiomegaly 15452636 52187725 ccd3c424-dd412a6c-654dc449-bc1aa2c0-43dd4d8c 1218 no relevant change as compared to the previous image . low lung volumes . moderate cardiomegaly with mild fluid overload but no overt pulmonary edema . no pneumonia, no pleural effusions . Cardiomegaly 15480043 50719061 ae0d26cc-42f554c9-d591c1f3-0d0de89a-895ffeef 1219 heart size top-normal . lungs clear . no pleural abnormality . Cardiomegaly 15480043 55884194 5e840cc8-fa36ed6d-7367856a-7e0328be-7e9a9ccf 1220 ap upright and lateral views of the chest provided . low lung volumes cause bronchovascular crowding . there is no focal consolidation, effusion, or pneumothorax . the cardiomediastinal silhouette is similar to prior . imaged osseous structures are intact . no free air below the right hemidiaphragm is seen . no acute intrathoracic process . No Finding 15480043 58155175 23268708-bb681a69-9d7f6685-bf0877d4-0ea495b0 1221 there is discontinuation in the shunt at the cervicalthoracic junction measuring approximately mm . the shunt traverses along the right lateral aspect of the upper chest and is no longer visualized . the lungs are unremarkable . the cardiomediastinal contours are within normal limits . there is discontinuation in the shunt at the cervical thoracic junction measuring approximately mm . the shunt traverses along the right lateral aspect of the upper chest and is no longer visualized . No Finding 15568945 59554791 5e754211-f7ae671d-f26bc9e0-5fabd237-73978d1c 1222 nasogastric tube ends in the stomach . normal cardiomediastinal silhouette . right jugular line ends low in mid svc . lungs clear . no pleural abnormality . No Finding&&Support Devices 15620736 51354049 05ae2a75-03fa91ad-ba0cb001-198c6cdb-b5cc4267 1223 as compared to the previous radiograph, no relevant change is seen . the lung volumes have minimally increased, potentially reflecting improved ventilation . the monitoring and support devices are constant . moderate cardiomegaly with mild fluid overload persists . moderate retrocardiac atelectasis is unchanged . no evidence of pneumonia . Atelectasis&&Cardiomegaly&&Support Devices 15634260 53793106 8510d3ca-b0426e32-7dd8e6f5-6e0bc0d6-3f439a43 1224 et tube tip is cm above the carina . dobbhoff tube passes below the diaphragm terminating in the stomach . cardiomediastinal silhouette is unchanged . vascular congestion is re- demonstrated, unchanged . there is no pleural effusion or pneumothorax developed in the interim . Edema&&Enlarged Cardiomediastinum&&Support Devices 15634260 54799576 57f11ad7-668a8ca8-2fd8f02d-44a9a593-0eb9ac6d 1225 no previous images . the tip of the endotracheal tube measures approximately cm above the carina . nasogastric tube extends to the upper stomach where it crosses the lower margin of the image . there is enlargement of the cardiac silhouette in a patient with intact midline sternal wires . poor definition of pulmonary vessels is consistent with some elevation of pulmonary venous pressure . retrocardiac opacification with obscuration of the hemidiaphragm is consistent with volume loss in the left lower lobe and probable small pleural effusion . Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Support Devices 15634260 58248665 e78e7e56-3b76bfbe-c0647f3a-c8b5a476-fc847dad 1226 heart size is within normal limits . there is elevation of the left hemidiaphragm . there is also atelectasis and increased bronchovascular markings at the left base which suggests bronchiectasis an was suggested on the prior study . there has been improved aeration of the right base with apparent resolution of the small pleural effusion . no pneumothoraces are identified . there are no signs for pulmonary edema . Atelectasis&&Edema 15655633 50971251 bb01346b-489ad7a1-de494939-c17e4691-af4f04af 1227 left hemidiaphragm has been considerably higher than the right since at least . new findings on todays study are mild cardiomegaly, moderate mediastinal venous engorgement and bibasilar interstitial abnormality probably edema . appearance of the left lung base suggests bronchiectasis, which could be a primary cause of volume loss in the left lower lobe or the result of chronically retained lower lobe secretionsdue to diminished diaphragmatic function . Cardiomegaly&&Edema 15655633 57179351 b3c095eb-d16fb25c-87e49ad2-ddbe4e2e-2e2e1f55 1228 support lines and tubes are unchanged in position . the left-sided airway stent is unchanged . there is again seen complete collapse of the left lung with shifting of mediastinal structures to the left . known pulmonary nodules in the right side are better characterized on prior ct scan . the right lung appears well aerated . there are no pneumothoraces . overall, the findings appear unchanged . Atelectasis&&Lung Lesion&&Support Devices 15693523 54302400 32b62c2a-3374dbc2-f1fe4be4-9119f9a8-af2df168 1229 complete opacification of the left hemi thorax due to and atelectasis, with subsequent displacement of the mediastinum . postoperative appearance of the right lung with postoperative rib defect . no evidence of acute right lung changes . pacemaker in left pectoral position . Atelectasis&&Enlarged Cardiomediastinum&&Lung Opacity&&Support Devices 15693523 58243808 5ec03a5b-72a566fb-de027ea9-bb847032-a0282268 1230 since the recent ct of , a left airway stent has been placed . there is now complete collapse of the left lung with associated worsened leftward shift of the cardiomediastinal contours and hyper expansion of the right lung . known pulmonary nodules in the right lung have been more fully characterized by a recent ct as well as multifocal pleural abnormalities . Atelectasis&&Enlarged Cardiomediastinum&&Lung Lesion 15693523 59577259 7b66482b-c6de4d3a-04ee2e45-67142f2c-51801f38 1231 one view of the chest 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 . No Finding 15718331 53534550 59c6d360-9e96b2ab-750786c3-b6bfac43-ba99775a 1232 lung volumes are decreased compared to the prior study . the heart size is likely top normal, but is accentuated by low inspiratory volumes . there is crowding of the bronchovascular structures . mild pulmonary vascular engorgement is present . no focal consolidation, pleural effusion or pneumothorax is identified . there are no acute osseous abnormalities . mild pulmonary vascular congestion . Edema 15780880 50930348 0adba4e9-74bf6877-3500bd46-d395ecc6-75dcdc60 1233 as compared to the previous radiograph, the bilateral perihilar opacities have decreased in extent and severity . however, there is unchanged blunting of the left costophrenic sinus, potentially suggesting a small pleural effusion . normal appearance of the cardiac silhouette, but more central pulmonary arteries are still slightly dilated . unchanged monitoring and support devices . Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Support Devices 15780880 51766103 5d8300fe-3a3aaed5-ec3f9f49-769dcb99-a7ffa174 1234 the cardiac, mediastinal and hilar contours are normal . pulmonary vasculature is not engorged . curvilinear opacity in the right apex appears unchanged compared to the prior exams, compatible with an area of scarring as seen on the prior ct . no new focal consolidation, pleural effusion or pneumothorax is present . multilevel degenerative changes are demonstrated in the thoracic spine . no acute cardiopulmonary abnormality . No Finding 15780880 57081361 c46e168d-041b2bfd-39d02b61-186fb589-eb881241 1235 comparison is made with prior study, . et tube is no longer visualized . cardiac size is top normal . aeration of the left lower lobe has improved . there is no pneumothorax or enlarging pleura effusions . right ij catheter tip is in the low svc . right upper lobe and right lower lobe opacities have improved . mild pulmonary edema has improved . Edema&&Lung Opacity&&Support Devices 15780880 59962770 672580ec-ddc9d368-c981b016-a6a8881c-b23e56c3 1236 there have been two changes since . the first is more consolidation in the right upper lobe, as right lower lobe consolidation improves . this suggests either incompletely treated pneumonia, a second pathogen or new aspiration . the second is greater pulmonary vascular engorgement, not to the point of pulmonary edema, but indicating early cardiac dysfunction . heart is mildly enlarged, but not changed since at least . left internal jugular line ends in the upper svc . no pneumothorax, mediastinal widening or pleural effusion . dr . was paged at am . Consolidation&&Pneumonia&&Support Devices 15787214 51063221 6831e70e-667ba211-59160e9a-cb703a95-c16adfc1 1237 in comparison with the study of , there is a little overall change in the degree of bilateral pulmonary opacifications that is more prominent on the right . although some of this may reflect asymmetric pulmonary edema, a multifocal pneumonia is also present . subclavian picc line is difficult to assess, though it appears to extend to the mid-to-lower portion of the svc . Edema&&Lung Opacity&&Pneumonia&&Support Devices 15787214 52734390 e73cd1d5-5e0bf9d7-abf87afe-b9825e7f-6786a135 1238 frontal portable radiographs of the chest demonstrate normal heart size . the cardiomediastinal silhouette and hilar contours are normal . there is diffuse opacity in the right lung more prominently in the right lower and mid lung . compared to the prior study, opacities in the right lower lung appear similar however, there may be slight increased opacity in the right mid lung . there is mild left base atelectasis . there are probable small bilateral pleural effusions . a left internal jugular approach central venous catheter ends in the mid svc . no pneumothorax . no displaced rib fracture identified . diffuse opacities in the right lung concerning for multifocal pneumonia . recommend followup radiograph after treatment to ensure resolution . probable small pleural effusions . Lung Opacity&&Pleural Effusion&&Pneumonia 15787214 55339794 f6088e83-babff51c-fe95c613-7b94b470-3aea3440 1239 as compared to the previous radiograph, the left venous access line has been removed . the right internal jugular vein catheter is in unchanged position . the pre-existing opacities in the right lung are substantially improved but still clearly visible . the appearance of the left lung is unchanged . unchanged moderate cardiomegaly . no pleural effusions . no pneumothorax . Cardiomegaly&&Lung Opacity&&Support Devices 15787214 55726526 ba26edda-e207b86b-665afaa9-47ddab28-78dd3c6e 1240 portable ap chest radiograph . diffuse opacities throughout the right lung and left lower lobe are unchanged . there are probably small bilateral pleural effusions . there is no pneumothorax . multifocal pneumonia with possibly a component of asymmetric pulmonary edema . Edema&&Pneumonia 15787214 56563719 9234b389-6451e413-d153fc6d-87004f87-bbfa50c1 1241 the heart size is top normal with unchanged mediastinal silhouette and hilar contours . there is a large heterogeneous consolidation of the right lower lung with air bronchograms compatible with pneumonia . there also increased reticulonodular opacities in the upper right lung field likely as a component of asymmetric pulmonary edema or multifocal pneumonia . small right pleural effusion may be present . there is also a small left-sided effusion with subtle opacities at the left lung base which could be atelectasis or a further component of pneumonia . there is no pneumothorax . right lung base pneumonia with further reticulonodular densities in the right upper lung field which could be asymmetric pulmonary edema or multifocal pneumonia . additional component of a small left-sided pleural effusion with adjacent opacity which is either atelectasis or additional site of pneumonia . probable small right pleural effusion . Atelectasis&&Edema&&Lung Lesion&&Lung Opacity&&Pleural Effusion&&Pneumonia 15787214 57153575 c710e145-280390c3-5b9ddcf7-faa611b8-b39e60c8 1242 compared to chest radiographs through . et tube in standard placement . left pic line ends in the low svc . esophageal drainage tube can be traced as far as the lower esophagus but the tip is indistinct . emphysema is severe . small region of left perihilar consolidation developed on is unchanged . this could be atelectasis or pneumonia . there is no pleural abnormality . Atelectasis&&Consolidation&&Pneumonia&&Support Devices 15793456 50728268 aeaf352b-20abe2c1-7d09855e-8dcde264-c8dae3b5 1243 compared to chest radiographs since , most recently through . patient has been extubated . new region of left perihilar opacification could be early pneumonia or the first manifestation of pulmonary edema since mild cardiomegaly has recurred and pulmonary vasculature mildly engorged . radiographic follow-up advised . no appreciable pleural effusion or evidence of pneumothorax . Cardiomegaly&&Edema&&Lung Opacity&&Pneumonia&&Pneumothorax 15793456 50776361 8a8be78a-d43d9b42-88872556-82809128-fd11d507 1244 focal left basilar lucency remains similar in appearance to the examination . this likely represents bullae given known history of emphysema, though differentiation from focal pneumothorax remains difficult . the cardiac and mediastinal contours remain unchanged, and there is no mediastinal shift . there is no focal consolidation or pleural effusion . a left picc terminates at the cavoatrial junction . the endotracheal tube terminates . cm above the carina . Enlarged Cardiomediastinum&&Pneumothorax&&Support Devices 15793456 51587887 c7318b14-8802035b-2b793a84-2206a58b-ff64d1a6 1245 compared to chest radiographs since , most recently through at . heart size has returned to new chronic normal caliber . right mediastinal shift persists despite interval clearance of transient right lower lobe consolidation, presumably atelectasis . it might be due to acute hyperinflation of the already dominant bullae in the left lung, particularly in the lower lobe . no pneumothorax or pleural effusion . Atelectasis&&Cardiomegaly&&Support Devices 15793456 51861010 85fdecbd-e6066ee2-2b534974-6cf4108f-ea355efd 1246 portable semi supine chest radiograph is submitted . again seen is extensive emphysema with prominent bullous changes particularly at the bases . however, there is increased lucency at the left base with slight elevation of the left hemidiaphragm as well as increasing infrahilar opacity . findings therefore raise the possibility of a loculated pneumothorax . followup imaging is recommended . endotracheal tube has its tip approximately cm above the carina . a left subclavian picc line has its tip in the distal svc near the cavoatrial junction and a nasogastric tube is seen coursing below the diaphragm with the tip not identified . no pulmonary edema . notification results were communicated to the patients nurse, , on at at the time of discovery . Lung Opacity&&Pneumothorax&&Support Devices 15793456 53169528 ddb6d871-83f1673f-96525527-40edfaa8-32689e38 1247 left picc line tip is at the level of lower svc . heart size and mediastinum are stable . ng tube tip is in the stomach . bibasal lucencies concerning for bullous disease are unchanged . no new consolidations . Cardiomegaly&&Consolidation&&Enlarged Cardiomediastinum&&Support Devices 15793456 53694115 5100714a-7795bb79-6d9a8ab9-2ec22e74-610e28ef 1248 compared to chest radiographs since , most recently at . emphysema is severe distribution suggests alpha one antitrypsin deficiency . . there is no definite focal pulmonary abnormality . heart size normal . no pleural effusion or pneumothorax . 15793456 54257177 d3b11384-e58823ae-545b2484-70475db9-e638bd89 1249 cardiac size is normal . the hilum are enlarged as before . the lungs are hyperinflated and clear . there is no pneumothorax or pleural effusion . lines and tubes are in unchanged standard position severe emphysema . no acute cardiopulmonary abnormality . 15793456 54805725 89c1cb10-0f3f0d50-cdd7903e-91acfc37-51d468d3 1250 compared to chest radiographs through at . no recent radiographic change in severe emphysema and mild left perihilar consolidation . no pulmonary edema, pleural effusion, pneumothorax . heart size normal . ascending thoracic aorta tortuous or dilated but unchanged . Consolidation&&Support Devices 15793456 54908622 7e937bf5-c1220033-6a807ba6-449a1342-c75570f2 1251 no substantial change in the cardiomediastinal contour or and severe emphysema with predominance in the lower lobes demonstrated . as previously mentioned, alpha antitrypsin deficiency at the possibility . no definitive pneumothorax is seen . pulmonary hypertension is suspected based on the substantial enlargement of the pulmonary arteries . Enlarged Cardiomediastinum 15793456 55164257 d10e0fbd-0e8714e0-da3f58e7-a4f2c13e-a6635080 1252 lungs are hyperexpanded . increased lucency in the left base is more prominent than on previous chest radiographs . increased lucency in the right base is stable and likely represents sequela of emphysema . the mediastinal contours, hila, and cardiac borders are normal . endotracheal tube terminates . cm above the carina . left picc is stable terminating in the low svc . no pleural effusion . enteric tube is unchanged with distal tip coursing out of view . . endotracheal tube in appropriate position . . increased lucency in the left base is more prominent than on previous chest radiographs and likely represents emphysematous bulla although if there is any clinical concern for pneumothorax, ct of the chest is recommended to further characterize . notification the findings were discussed with , md . by , md . on the telephone on at pm, minutes after discovery of the findings . Pneumothorax&&Support Devices 15793456 56959421 30ee840e-4c41e9b0-23303f79-e117a2f5-3a93632d 1253 compared to chest radiographs since , most recently and . bullous emphysema is severe . todays study shows possible rightward mediastinal shift and new opacification in the right lower lobe, possibly atelectasis . this is commonly due to aspiration or retention of secretions . follow-up chest radiograph available at the time of this review, performed showed improvement in right lower lobe consolidation and decrease in rightward mediastinal shift suggesting interval clearing of the airway . followup advised . Atelectasis&&Consolidation&&Lung Opacity 15793456 56965263 d8a656ef-21f15997-459800a0-5d6f4b41-9340d5f9 1254 in comparison with the study of , there appears to be a tracheostomy tube in place . otherwise, little change . prominence of central pulmonary arteries is consistent with pulmonary arterial hypertension . severe emphysema with lucency especially involving the left lower lung . as previously noted, this could be consistent with prominent bullous formation in the region or possibly alpha antitrypsin deficiency . Support Devices 15793456 58627159 ae25ab53-728bd61d-0b368ab8-cb45d8ea-8d6cf993 1255 in comparison with the study of , there is again substantial hyperexpansion of the lungs consistent with chronic pulmonary disease . there is increased prominence of the hila, which appears to represent vascular structures and raises the possibility of pulmonary artery hypertension . no evidence of acute pneumonia or vascular congestion . 15793456 58666598 e42b4605-f902c4ae-7379b10b-bb8897a0-0a74f22a 1256 compared to chest radiographs through at . patient has severe emphysema, with most severe vascular deficiency in the lower lungs, especially the left, a distribution which suggests alpha one antitrypsin deficiency . there are no focal pulmonary findings to suggest either pneumonia or edema . however there has been substantial interval increase in the of the left hilus, some of which is due to substantial enlargement of the pulmonary artery proximally, and perhaps the descending pulmonary artery or supra be needing atelectasis . the importance of a cta to exclude a large central pulmonary embolus has been discussed with the clinical care team . no pleural abnormality . Atelectasis&&Support Devices 15793456 59873577 b1c89b98-a8652b78-b91909d9-858c38d3-cf9a6962 1257 the et tube tip is low, approximately . cm above the carina and should be pulled back . there is deviation of the trachea to the left due to a large thyroid mass . heart size and mediastinum are unchanged . the ng tube tip is proximally located with its tip being in the proximal stomach just below the cavoatrial junction and should be further advanced . Cardiomegaly&&Enlarged Cardiomediastinum&&Lung Lesion&&Support Devices 15902493 50324636 2e6da01c-344915d4-bf3a4390-0f00d050-e8e1c919 1258 portable ap chest radiograph a tracheostomy catheter appears in standard unchanged position . a catheter overlying the right mid clavicular line appears similar to prior examination, possibly a vp shunt . elevation of the right hemidiaphragm is unchanged from prior . linear bibasilar opacities are unchanged and likely reflect atelectasis . no confluent consolidation is identified . a significant widening of the right paratracheal stripe corresponds with a known large thyroid goiter, better characterized on prior chest ct . leftward tracheal deviation appears stable . the remainder of the mediastinal and hilar contours are within normal limits for age . the heart size is borderline or slightly enlarged . there is pneumothorax . . grossly stable thyroid goiter causing widening of the right paratracheal stripe . . unchanged elevation of the right hemidiaphragm and bibasilar atelectasis . . no evidence of pneumonia or acute pulmonary edema . Atelectasis 15902493 50591741 41cd0cf2-1993dfdd-7f6bf2e5-a1f49826-59bd4a84 1259 the right hemidiaphragm became elevated between , even more pronounced today . some of this could be due to subpulmonic pleural effusion but i would investigate either phrenic nerve palsy or complete right lower lobe and perhaps middle lobe collapse . moderate cardiomegaly is stable with the mediastinum midline . a large cervicothoracic mass presumably a goiter displaces the trachea to the left . left lung is clear . a left pic line ends roughly at the origin of the svc . Atelectasis&&Cardiomegaly&&Enlarged Cardiomediastinum&&Lung Lesion&&Pleural Effusion&&Support Devices 15902493 50974871 9bc476e8-b785474e-426b2c50-084edab4-725c2fdb 1260 as compared to the previous radiograph, there is no relevant change . the bases of the right lung are minimally better ventilated than before . the monitoring and support devices are constant, constant size of the cardiac silhouette, constant appearance of the left lung . Cardiomegaly&&Support Devices 15902493 51112760 6e7ae597-2cce5608-801fc546-b49044de-8b5fb4c7 1261 the patient is rotated to the left . the endotracheal tube sits just below the clavicular heads the carina is not well seen, and while chest radiography is not ideal to assess for such, the trachea distal to the et tube appears narrowed . the endogastric tube side port is well below the ge junction . the left-sided central line tip in the mid svc . the heart size is within normal limits . mediastinal contours again demonstrate calcified atherosclerotic disease at the aortic knob and a large mass approximately . x cm in the coronal plane dominating the right upper mediastinum better characterized on prior ct . right middle lobe atelectasis is new . there is no large pleural effusion or pneumothorax . . lines and tubes as described above . . stable right upper mediastinal mass . . right middle lobe atelectasis . . question of narrowed trachea beyond the et tube - ct may be considered is clinical concern for poor aeration exists . Atelectasis&&Lung Lesion&&Support Devices 15902493 51395345 f73e6a43-f6ec9972-190a4db6-83b00895-bd737150 1262 the feeding tube has been repositioned and is seen coursing below the diaphragm into the stomach however, the distal end is off radiographic view . tracheostomy tube is in standard position . left-sided picc line ends at mid svc . bilateral lung volumes are low and bibasal atelectasis is similar . there are no new lung opacities of concern . cardiomediastinal silhouette is stable in appearance . heart size is normal . . after repositioning of the feeding tube, it extends into the stomach however, the distal end is off the radiographic view . . bibasal atelectasis is similar . no other relevant changes . Atelectasis&&Support Devices 15902493 52040420 4cceece9-8400f980-a48fb232-e92e5441-6745b601 1263 comparison to prior study of at . single portable supine chest film at am . is submitted . . interval placement of a nasogastric tube with its tip coursing below the diaphragm and projecting over the expected location of the stomach . an endotracheal tube is seen with its tip approximately cm above the carina and coursing to the left of the cervical and upper thoracic spine due to the presence of a right superior mediastinal mass which may represent a thyroid goiter when correlated with a cta of the head and neck dated . . lungs appear well inflated without evidence of focal airspace consolidation or pleural effusions . no evidence of pulmonary edema . overall cardiac and mediastinal contours are within normal limits given portable technique and rotation on the current examination . Lung Lesion&&Support Devices 15902493 52253665 dd5485e4-d3c509f7-b7f8ea8c-70c26a6b-efe68e57 1264 comparison is made with prior study, . ng tube tip is in the stomach still the side port is just distal to the ge junction, can be advanced for more standard position . mild cardiomegaly and widened mediastinum are unchanged due to a large right upper mediastinal mass . right lower lobe atelectasis has worsened . mild pulmonary edema is new . there is no pneumothorax or pleural effusion . there are low lung volumes . et tube is in unchanged position . Atelectasis&&Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Lung Lesion&&Support Devices 15902493 52295399 4805924d-20aa3bfa-d7e7ed46-b01fadbe-743dd101 1265 portable ap radiograph of the chest was reviewed in comparison to . the et tube remains low and should be pulled back for approximately . cm . the ng tube tip should be advanced . there is no substantial change otherwise since the prior study except the potentially interval progression of bibasal areas of atelectasis might reflect suboptimal position of the et tube . findings were discussed with dr . the phone by dr . at am . on . Atelectasis&&Support Devices 15902493 52521607 79b93da8-1a8e3c8d-fb7ee2ba-ad86c2e1-4fa0f78b 1266 as compared to the previous radiograph, the monitoring and support devices are in unchanged position . unchanged coiling of the nasogastric tube in the pharynx . the pre-existing small right pleural effusion is distributing in a slightly different manner than on the previous image, its overall extent, however, is unchanged . the right-sided upper mediastinal mass is unchanged in appearance . no pulmonary edema . no pneumonia . unchanged size of the cardiac silhouette . Cardiomegaly&&Lung Lesion&&Pleural Effusion&&Support Devices 15902493 52681987 2174bfb6-9645eac0-eb4a2c83-0e62dc14-94b436ab 1267 there is no focal consolidation, pleural effusion or pneumothorax . the tracheostomy tube now appears midline . there are in the neck . there is bibasilar atelectasis . the previously elevated right hemidiaphragm is now in normal position . the cardiomediastinal silhouette is unremarkable . . no evidence of pneumothorax . basilar atelectasis . . previously noted elevation of the hemidiaphragm is no longer seen on this radiograph . Atelectasis 15902493 52684400 75590e00-ed59b5d5-547eea97-30378a27-3389c2d4 1268 a vp shunt is seen coursing through the right hemithorax into the right abdomen . tracheostomy tube is noted . though this study is not intended for evaluation of the airway, the trachea does not appear much larger than the tracheostomy tube . a dobbhoff feeding tube is seen coursing into the proximal duodenum . ivc filter projects over the right border of the l and l vertebral bodies . large mass in the right upper lung causes rightward tracheal deviation but is better assessed on the prior chest ct . marked elevation of the right hemidiaphragm is again noted, with resultant right basal atelectasis . there is no pleural effusion or pneumothorax . mild cardiomegaly is noted . right hemidiaphragmatic elevation with resultant atelectasis, perhaps a result of phrenic nerve paralysis secondary to the large right mediastinal mass . Atelectasis&&Lung Lesion 15902493 52849859 386d944b-f1474a69-668285cb-f25d2ef9-56c1ebea 1269 in comparison with the study of , there is increasing opacification at the right base consistent with effusion and atelectasis . mild atelectatic changes are seen at the right base . continued enlargement of the cardiac silhouette with evidence of increased pulmonary venous pressure . the large mass in the right upper zone displacing the trachea to the left is again seen . Atelectasis&&Cardiomegaly&&Lung Lesion&&Lung Opacity&&Pleural Effusion 15902493 53302727 6acb1d9f-c6550f88-03c6298f-563395d2-fbb64a14 1270 in comparison with the study of , the large right superior mediastinal mass is again seen displacing the trachea to the left . monitoring and support devices remain in place . the right hemidiaphragm is not as sharply seen as on prior images . this could merely reflect atelectasis and effusion, though pneumonia would have to be considered in the appropriate clinical setting . Atelectasis&&Lung Lesion&&Pleural Effusion&&Pneumonia&&Support Devices 15902493 53465460 f9036335-d38187db-397f1b39-3e749eed-e4c6307c 1271 since , the volume of consolidation in the right mid and lower lung zone has decreased and mild pulmonary edema has largely cleared . the large cervicothoracic mass to the right of the trachea at the midline might be smaller, although this could be a function of patient rotation . moderate cardiomegaly is stable . pleural effusions are small if any . nasogastric tube passes into the stomach and out of view . left subclavian line ends in the upper svc . et tube tip is at the level of the aortic arch, unchanged . Cardiomegaly&&Consolidation&&Lung Lesion&&Pleural Effusion&&Support Devices 15902493 53501812 6b0e4cdc-b802b8a7-386a0412-cb6b2489-8015a3e9 1272 as compared to the previous radiograph, the monitoring and support devices are unchanged . unchanged appearance of a right apical mass and right basal opacity likely to suggest atelectasis . unchanged elevation of the right hemidiaphragm . borderline size of the cardiac silhouette with tortuosity of the thoracic aorta . no substantial fluid overload . no pleural effusions . Atelectasis&&Cardiomegaly&&Lung Lesion&&Lung Opacity&&Support Devices 15902493 54664886 f67ab78a-c83676b8-efebc7a0-7b79e9df-d200dca1 1273 in comparison with the study of , there is little change in the appearance of the right superior mediastinal mass arising that was shown to arise from the thyroid gland and descend inferiorly into the medial mediastinum on ct . narrowing and displacement of the trachea is again seen . monitoring and support devices remain in place and there is little change in the appearance of the heart and lungs . Cardiomegaly&&Enlarged Cardiomediastinum&&Lung Lesion&&Support Devices 15902493 55687082 2daf4706-acb0e111-7c1f165a-1b733130-32f98a94 1274 ap radiograph of the chest was compared to , as well as ct chest of and chest radiograph obtained in the interim . the et tube is displaced by the large thyroid mass to the left terminates approximately cm above the carina . as previously described this mass can represent large thyroid goiter . on the other hand neoplasm arising from the thyroid gland is another possibility . heart size is enlarged . mediastinal silhouette is otherwise unchanged . lungs are essentially clear . no pleural effusion or pneumothorax seen . Cardiomegaly&&Enlarged Cardiomediastinum&&Lung Lesion&&Support Devices 15902493 56080109 808f11c6-3458709b-ffe153fb-fe069bb3-717cba85 1275 previous moderate right pleural effusion and right basal atelectasis have improved since , mild pulmonary edema has cleared and small left pleural effusion has resolved . et tube in standard position in the trachea which is displaced leftward by large thyroid mass . moderate cardiomegaly stable . left subclavian line ends in the low svc . no pneumothorax . small right pleural effusion . persistent elevation of the right hemidiaphragm may be due to phrenic nerve palsy . Atelectasis&&Cardiomegaly&&Lung Lesion&&Pleural Effusion&&Support Devices 15902493 56835560 84e51680-738978f2-ce0ca7b3-037c1468-d96d0c03 1276 lung volumes are stable, with relative elevation of the right hemidiaphragm, reflecting persistent right lower lobe atelectasis . left lung is grossly clear . moderate cardiomegaly is stable . et tube ends in standard position at the level of the aortic arch and the trachea is severely displaced and narrowed by a large right-sided goiter . nasogastric tube passes into the stomach and out of view . left subclavian line ends in the svc . no pneumothorax or appreciable pleural effusion . Atelectasis&&Cardiomegaly&&Support Devices 15902493 57081697 f6ec06b9-ba98953f-8182f840-4698435b-61296fb9 1277 overall little change in comparison to the prior study with continued elevation of the right hemidiaphragm and silhouetting of the right heart border as well as increased opacity in the right retrocardiac region . there is at least partial right lower and middle lobe atelectasis . cardiomegaly remains stable . left picc is visualized in the left brachiocephalic vein . tracheostomy tube is shifted to the left due to a large superior mediastinal mass shown to be related to the thyroid gland on prior ct scan . ventriculoperitoneal shunt traversing over the right hemithorax appears stable . Atelectasis&&Cardiomegaly&&Lung Lesion&&Lung Opacity&&Support Devices 15902493 57545492 1d8209cf-367611d8-dedd4a43-a8026be1-e639022d 1278 comparison is made to the patients prior study of at . portable upright chest film, at is submitted . . endotracheal tube courses to the left of the spine and has its tip approximately . cm above the carina . subclavian central line has its tip in the mid-to-distal svc . a nasogastric tube is seen coursing below the diaphragm with the tip likely located within the stomach . overall, cardiac and mediastinal contours are stable . there is a persistent right superior mediastinal mass, which is felt to most likely correspond to a thyroid goiter as evident on a cta of the head and neck performed on . lung volumes are slightly decreased with interval appearance of a patchy opacity at both bases, likely reflecting patchy atelectasis . there is no evidence of pulmonary edema or pneumothorax . Atelectasis&&Enlarged Cardiomediastinum&&Lung Lesion&&Lung Opacity&&Support Devices 15902493 58199247 d25c2722-019731e2-c9ae4392-b74b52cb-7459ec6d 1279 the endotracheal tube tip is between the clavicular heads . the endogastric tube courses inferiorly through the expected region of the stomach . the heart size is likely within normal limits, exaggerated by the patients leftward rotation . the mediastinal and hilar contours are also within normal limits . again prominent soft tissue density in the right superior mediastinal space displaces the normal midline structures towards the left this mass likely represents a goiter . the lungs demonstrate mild bibasilar atelectasis . there is no large pleural effusion or pneumothorax . mild bibasilar atelectasis . Atelectasis 15902493 58289892 dd7f98a8-f0bd8f93-d89e5076-48b04556-0792d3c6 1280 previous mild pulmonary edema is improving, but moderate bilateral pleural effusions persist and may have increased, and there is more atelectasis at both lung bases . the et tube is in standard placement, and the trachea which is markedly displaced and, by ct report, severely narrowed by large right-sided goiter . no pneumothorax . left subclavian line ends in the mid svc . the heart size top normal, unchanged . Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices 15902493 58443677 4aeba39a-be4ef35d-83b25701-9af40c72-5130f3eb 1281 unchanged from the prior exam with tracheostomy, ventriculoperitoneal shunt and prominence of the mediastinum due to goiter . no evidence of pneumonia, pleural effusion or pneumothorax . the cardiac silhouette and hila are normal . no evidence of pneumonia . No Finding 15902493 58517313 5514784e-680e830d-5dd03b8a-fff3c159-26e51f27 1282 since prior, there has been interval enlargement of a right-sided pleural effusion which is now moderate to large with associated atelectasis . left chest wall triple lead pacing device is again noted . there is no left-sided effusion . linear opacity in the left lower lung is likely atelectasis versus scarring . there is vascular congestion, lungs are otherwise clear of consolidation . previously seen pneumothorax is no longer visualized . interval enlargement of the right pleural effusion and pulmonary vascular congestion . please note that underlying infection at the right lung base cannot be excluded . Edema&&Pleural Effusion&&Pneumonia 15911529 50329542 5cd9a16f-bb23b3f4-472f8d63-0cb675ed-dce9d747 1283 frontal lateral views of the chest . compared to prior there has been decrease in size of the right pleural effusion which is now small and resolution of previously seen left effusion . the lungs are otherwise clear . triple lead pacing device is again seen with its lead tips in stable position . cardiomediastinal silhouette is unchanged . osseous and soft tissue structures are unremarkable . interval decrease in size of right pleural effusion which is now small . no acute cardiopulmonary process . Pleural Effusion 15911529 50817664 18d4660e-6dd2d7c3-fe755086-42caa066-4c278a62 1284 as seen on the frontal view, there may have been some improvement in the component of right pleural effusion in the lower posterior chest, while the fissural components are slightly larger . pa and lateral views are recommended because they are more informative . the right basal pleural pigtail drainage catheter is unchanged in position . right lung abnormality is relatively mild, probably basal atelectasis . left lung is clear and there is no left pleural abnormality . heart is moderately enlarged, chronically . transvenous right atrial and biventricular pacer leads continuous from the left pectoral generator . no pneumothora . Atelectasis&&Pleural Effusion&&Support Devices 15911529 51122529 0deb7ec1-84b1f3d7-f5ac9938-3054c9dd-3caf0634 1285 the size of the right effusion has decreased . the pulmonary plethora is less marked . the heart remains enlarged . No Finding 15911529 51209889 d06dafbf-e8490fee-797a1c31-810d944e-b0943aea 1286 small right pleural effusion has decreased since . moderate cardiomegaly is chronic . there is no pulmonary edema or pulmonary vascular congestion, or indication of left pleural effusion . transvenous right atrial and ventricular pacer leads are unchanged in position, as far as one can tell from frontal view alone . no pneumothorax . Cardiomegaly&&Pleural Effusion&&Support Devices 15911529 51322181 93a34018-658089f0-17050a39-8b8e1b48-554f4cb7 1287 the small right pleural effusion with adjacent compressive atelectasis is unchanged compared with the prior study of . a right-sided pigtail catheter is in unchanged position . there is no pneumothorax . the left chest wall biventricular pacemaker leads are in unchanged position . there may be a small left pleural effusion . there is stable moderate cardiomegaly . unchanged small right pleural effusion . Pleural Effusion 15911529 51358209 df8d7e2f-54c17397-730c6a12-e6f95950-a64b3f5d 1288 persistent cardiomegaly and upper zone vascular redistribution but no overt pulmonary edema . moderate right pleural effusion has increased in size since the prior study and is accompanied by adjacent atelectasis . small left pleural effusion is similar to the prior study, and a new area of linear atelectasis is present in the left mid lung . Atelectasis&&Cardiomegaly&&Pleural Effusion 15911529 51385148 d3649518-b1379ecd-2740eee0-1ed2da79-392e0086 1289 the patient is rotated to the left . there has been interval removal of a right-sided picc . left-sided pacer device is similar in position, with leads seen . there is a moderate to large right pleural effusion with overlying atelectasis, underlying consolidation is difficult to exclude . no pleural effusion is seen on the left . the cardiac silhouette is enlarged . the aortic knob is calcified . there is mild pulmonary edema . moderate to large right pleural effusion with overlying atelectasis, underlying consolidation not excluded . mild to moderate pulmonary edema . enlarged cardiac silhouette . Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Pleural Effusion 15911529 51562372 afedd930-9d244c0b-0a2edbe6-2ceb376a-23bc266b 1290 substantial interval improvement in the loculated right pleural effusion has been demonstrated after readjustment of the pigtail catheter with no definitive loculation seen . minimal amount of fissure all pleural effusion is still notable . cardiomediastinal silhouette and position of the pacemaker leads is unchanged . mild vascular congestion is present . there is no change in minimal right apical pneumothorax . Edema&&Enlarged Cardiomediastinum&&Pleural Effusion&&Pneumothorax&&Support Devices 15911529 51747240 ef150859-52757bb3-74733e58-ff402137-15580586 1291 right pleural effusion has resolved since following insertion of a right basal pigtail pleural drainage catheter . there is no pneumothorax . lungs are clear . mild cardiomegaly is stable and pulmonary vasculature borderline engorge . Cardiomegaly&&Support Devices 15911529 52561076 ccdac225-47c7b48e-79a78b1c-a6ac307c-ae6bea97 1292 small fissural component of right pleural effusion is new . dependent pleural effusion is probably small and they are still atelectasis at the right base, with the right pigtail pleural drainage catheter unchanged in position . moderate cardiomegaly is stable . left lung is grossly clear . there is no pneumothorax . transvenous right atrial, biventricular pacer leads are in standard positions continuous from the left pectoral generator . Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices 15911529 52646931 6e3a9cd5-91eb5828-ac10bc10-24dfa7c0-0e536576 1293 single portable view of the chest is compared to previous exam from . the lungs are clear of confluent consolidation . cardiac silhouette is enlarged but stable . hypertrophic change is seen in the spine . osseous and soft tissue structures are otherwise unremarkable . cardiomegaly without acute cardiopulmonary process . Cardiomegaly 15911529 53140692 5063d302-87f10189-f63cd435-f9628cbb-ea776d10 1294 as compared to the previous image, a part of the right pleural effusion, notably in the intrafissural space, has re accumulated . as a consequence, the lung volume on the right has decreased and atelectasis have . at the right lung base . moderate cardiomegaly persists . no overt pulmonary edema . no change in appearance of the left lung . Atelectasis&&Cardiomegaly&&Pleural Effusion 15911529 53784524 7ada4149-42025581-bd61e461-9719e7ba-1954ef82 1295 portable ap upright chest film is submitted . right basilar pleural pigtail catheter remains in place . there is a tiny right apical pneumothorax . the heart remains enlarged . mediastinal contours are stable . a left-sided pacer remains in place . there is patchy opacity at the right base which may reflect re-expansion pulmonary edema, although patchy ateclectasis or pneumonia should also be considered . a rounded contour to the right medial lung base may reflect prominent epicardial fat when correlated with abdominal ct studies from and , although a medial lung nodule cannot be entirely excluded . this can be re-assessed on followup imaging . no large effusions . notification the patients house staff, dr . , was notified by phone on at at the time of discovery . he informed us that the pleural catheter has subsequently been removed . Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Lung Lesion&&Lung Opacity&&Pneumonia&&Pneumothorax&&Support Devices 15911529 53878159 a8cb181d-36d8820a-91ffab5c-09e53515-1aaf369c 1296 no relevant change in extent and distribution of the known pleural effusion on the right . the position of the right pigtail catheter is also unchanged . moderate cardiomegaly and low lung volumes persist . no pulmonary edema . no pneumothorax . Cardiomegaly&&Pleural Effusion&&Support Devices 15911529 54190932 09f9cee5-f285e400-c4fe605a-dde10cac-e5d3eb0e 1297 since a recent radiograph of day earlier, a right pigtail pleural catheter has been removed . small right apical pneumothorax is not changed, but a small right pleural effusion has increased in size following tube removal . no additional relevant change since recent study . Pleural Effusion&&Pneumothorax&&Support Devices 15911529 54252168 5817a4b8-c4f832fb-7a33cc26-b05e9ff5-80a03cbc 1298 as compared to the previous radiograph, there is no change in position of the right chest tube . no pneumothorax . a minimal right pleural effusion is constant . mild right basilar atelectasis . unchanged moderate cardiomegaly . unchanged left pectoral pacemaker . Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices 15911529 54368456 51314394-a4c9c16e-9c4046f5-27fb7589-de68759f 1299 in comparison with the study of , there has been placement of a right pigtail catheter with substantial reduction in the amount of fluid within the right pleural space . no evidence of pneumothorax . remainder of the study is unchanged . No Finding&&Support Devices 15911529 55017393 4f1666fe-eb70e076-c045bd55-4a13ebea-89f70922 1300 the right-sided pigtail catheter is unchanged in position . a left-sided biventricular pacer partially obscures the left mid lung . the loculated right pleural effusion has increased, and is now moderate in size . a rounded airspace opacity in the right upper lung zone likely reflects fluid in the major fissure . cardiomegaly is unchanged . lingular linear atelectasis is again noted . new blunting of the left costophrenic angle may be due to a small pleural effusion . interval increase in loculated right pleural effusion, which is now moderate in size . new small left pleural effusion . stable cardiomegaly . Cardiomegaly&&Pleural Effusion 15911529 55211188 3f54680b-15217393-27fff50f-aeb78433-c51498b7 1301 there is a left pectoral pacemaker with leads, unchanged in position . a moderate right pleural effusion has reaccumulated since the most recent prior study, which is similar in appearance to . there is mild pulmonary vascular congestion interstitial edema . no left pleural effusion or pneumothorax is seen . the cardiac silhouette remains enlarged . there is mild calcification of the aortic knob . . moderate left pleural effusion, which is re-accumulated since but appears similar to . . mild pulmonary vascular congestion interstitial edema . Edema&&Pleural Effusion 15911529 55387962 c8a6f765-ffcff546-a4d433d1-fe00ebbf-978fb111 1302 there has been interval increase in the loculated right pleural effusion . this is seen as multiple smoothly marginated opacities projecting over the right lung . there is a small left effusion that is also increased in size . the appearance of the pacemaker is unchanged increase in loculated right effusion . Pleural Effusion 15911529 55431093 5f752c85-93a983b0-ac44e646-e4f71e52-f7d6b934 1303 allowing for changes in positioning and lung volumes, the small right pleural effusion and adjacent compressive atelectasis is probably unchanged compared with . the right-sided pigtail catheter is in unchanged position . the left chest wall atrial and biventricular pacemaker leads are in standard position . there is moderate stable cardiomegaly . unchanged small right pleural effusion . Pleural Effusion 15911529 56521428 6ba26b3a-5314e906-7366a48a-0598d3bd-73c3ca0f 1304 in comparison with the study of , there is little overall change . the right pigtail catheter remains in place, somewhat away from the area of loculated fluid along the right lateral chest wall inferiorly and to the more rounded opacification that probably represents fluid in the major fissure . the remainder the study is unchanged . Lung Opacity&&Support Devices 15911529 56889086 7ea66041-8955dc19-d570afcf-8b34d01a-f3ecff9a 1305 the new right chest wall pigtail catheter is in appropriate position . there is no pneumothorax . the large right pleural effusion has decreased somewhat, but a moderate pleural effusion still remains in spite of drainage catheter placement . there is probably no left pleural effusion . pulmonary vascular congestion has improved, now mild . there is stable cardiomegaly . the left chest wall pacemaker leads are in unchanged stable position . . new right chest wall pigtail catheter in appropriate position with moderate residual right pleural effusion pe . interval improvement of pulmonary vascular congestion, now mild . Edema&&Pleural Effusion&&Support Devices 15911529 57882477 54096c14-0109abb4-f9341bfb-ee3fe012-50d75838 1306 new left pectoral pacemaker has three leads in adequate position . there is no pneumothorax . small bilateral pleural effusions are unchanged . minimal lung haziness and cephalization of pulmonary vessel are consistent with stable mild pulmonary edema . conclusion . new left-sided pectoral pacemaker is in adequate position . there is no pneumothorax . . pulmonary edema is mild and stable . Edema&&Support Devices 15911529 57922122 69bc2b07-10cc7789-3cc5f3af-4c3c6ba3-992abb1d 1307 cardiomegaly is unchanged . right pigtail catheter is in place but there is a gain interval accumulation, substantial of pleural effusion along the chest wall as well as in the major fissure . minimal right apical pneumothorax is noted . Cardiomegaly&&Pleural Effusion&&Pneumothorax&&Support Devices 15911529 58322412 10127a8b-7bfe476a-de96870b-d51d4890-34ca977b 1308 portable frontal ap upright radiograph was obtained of the chest . the lungs appear clear with the exception of small left and possibly trace right pleural effusion and accompanying atelectasis . heart size is mildly enlarged with normal cardiomediastinal contours . Atelectasis&&Cardiomegaly&&Pleural Effusion 15911529 58350152 0042757a-03a7b183-0e56404f-f82c7d1d-cf93667a 1309 right basal pigtail pleural drainage catheter unchanged in position . small right pleural effusion is smaller, revealing atelectasis or persisting consolidation in the right lower lobe . upper lungs are clear . mild cardiomegaly stable . transvenous right atrial and biventricular pacer leads continuous from the left pectoral generator . left lung clear . mild pulmonary vascular engorgement persists . no pneumothorax . Atelectasis&&Cardiomegaly&&Consolidation&&Pleural Effusion&&Support Devices 15911529 59373190 ff1a21e7-453d4f60-95aaa2f2-76bcd93e-8debb861 1310 interval removal of the right pigtail catheter . otherwise, no overall change since the previous exam . the loculated right pleural effusion, which demonstrates some tracking in the minor fissure is grossly stable . mild right lateral pleural thickening . small left pleural effusion . no pneumothorax or pulmonary edema . stable cardiomegaly and cardiomediastinal contours . no changes in the position of the lead cardiac device . no overall change in the size of the right pleural effusion after removal of the right pigtail catheter . no pneumothorax . Pleural Effusion 15911529 59474704 0184704e-f5d6feff-cbe7f37e-d6c77a0f-db1e7472 1311 substantial right pleural effusion collected laterally and in the inter lobar fissures has reaccumulatied since , after previous drainage of the lateral collection after a new or repositioned right pigtail pleural drainage catheter . moderate atelectasis at the base the right lung is stable . pulmonary vascular engorgement has improved since , but severe cardiomegaly has not . transvenous atrioventricular pacer leads are unchanged in their respective positions . tiny residual right apical pneumothorax remains . Atelectasis&&Cardiomegaly&&Pleural Effusion&&Pneumothorax&&Support Devices 15911529 59868000 6f7c8371-2e3b25ff-83624c4e-2be20956-b6845eca 1312 as compared to the previous radiograph, the nasogastric tube was removed . the right picc line is in unchanged position . unchanged appearance of the cardiac silhouette and of the lung parenchyma . the alignment of the sternal wires is constant . Cardiomegaly&&Support Devices 15936884 53163844 9c117d65-7622dfb8-8d925586-8a37e8c7-aaa535de 1313 dobhoff tube tip iscoiled in the stomach . mild cardiomegaly and widened mediastinum are unchanged . right picc tip is in the upper to mid svc . the lungs are clear . there is no pneumothorax or pleural effusion . . sternal wires are aligne . Cardiomegaly&&Enlarged Cardiomediastinum&&Support Devices 15936884 53561431 e3d64e22-fb22f834-a727b3ff-c6c4c66f-5a5d4b5c 1314 the patient is status post cabg and the mediastinum continues to demonstrate the expected postoperative appearance . a right ij catheter terminates within the upper-mid svc . a nasogastric tube courses into the stomach and out of view of the radiograph . as compared to the prior examination, the patients bilateral pulmonary edema has improved and is now mild . bilateral small pleural effusions with adjacent atelectasis are noted . the upper lung fields are grossly clear . status post cabg with interval improvement in now mild bilateral pulmonary edema . small bilateral pleural effusions with adjacent atelectasis . Atelectasis&&Edema&&Pleural Effusion 15936884 55390875 fab89071-f6543b70-eaff3eb7-558c223b-f40a6d6f 1315 the lung volumes are very low . a swan-ganz catheter appears slightly retracted, remaining within a right pulmonary artery . there has been interval extubation and removal of mediastinal drain and left thoracostomy tube . multiple intact sternal wires and mediastinal clips are unchanged in orientation . moderate central pulmonary vascular congestion and pulmonary edema are unchanged since . new small bilateral pleural effusions are present . there is no pneumothorax . . new small bilateral pleural effusions . . unchanged moderate pulmonary edema . . no pneumothorax . Edema&&Pleural Effusion 15936884 55850018 ccb976bd-fe7110eb-f5b9e68c-74886c88-c2d95f6c 1316 dobhoff tube tip iscoiled in the stomach . no other interval change from prior study . No Finding&&Support Devices 15936884 57105691 7e069d55-1e0ebee8-f2c1d7d5-371f7b08-28536c80 1317 the heart is enlarged, and there is moderate pulmonary edema . there are no pneumothoraces . an endotracheal tube terminates in appropriate position, and the nasogastric tube terminates below the view of this radiograph . congestive heart failure with cardiomegaly and moderate pulmonary edema . Cardiomegaly&&Edema 15936884 59347638 5b038a10-d2936918-06b01d36-d6b919fc-be5e03b4 1318 in comparison with study of , there has been extensive increase in opacification at both bases, consistent with pleural effusion and compressive atelectasis at the bases . continued enlargement of the cardiac silhouette with pulmonary vascular congestion . Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion 16029766 57386813 2b6058ea-1a457571-ebed852c-b6879996-ac8b1622 1319 compared to the previous radiograph, the patient has undergone a vats procedure . a left chest tube is in situ . no pneumothorax . no other left-sided findings, except for soft tissue air inclusion in the lateral chest wall . unchanged position and course of the pacemaker . moderate cardiomegaly, plate-like atelectasis at the right lung base . Atelectasis&&Cardiomegaly&&Support Devices 16033763 50369062 0b9a1d90-0d4e09e2-e651a638-81738947-249b3e35 1320 in comparison with the study of , the pleurx catheter remains in place while the chest tube has been removed . no evidence of pneumothorax . multiple pulmonary lesions are again seen . No Finding&&Support Devices 16033763 50853877 3568ad06-c4d7640e-57033b28-70d178fd-c2dd3c78 1321 comparison is made to the patients previous study dated at . portable ap upright chest film, at is submitted . . two left chest tubes and a single-lead left-sided pacer remain in place . there are multiple bilateral pulmonary nodules consistent with known metastases . in addition, there is more focal patchy opacity at the left base in the setting of an effusion, which may reflect compressive atelectasis, although superimposed pneumonia or aspiration should be considered as this appears to be worsening . overall cardiac and mediastinal contours are stable . no pneumothorax appreciated . Atelectasis&&Enlarged Cardiomediastinum&&Lung Lesion&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices 16033763 51278946 883a73c4-7165e6cd-0d076fa5-7e573f4c-ab9a9523 1322 frontal supine portable chest a left pleurx catheter and left chest tube project over the left hemithorax . intracardiac device lead is unchanged ending in the right ventricle . compared to the prior study, the left pleural effusion has significantly decreased, now small . there is a small right pleural effusion . bilateral pulmonary nodules are unchanged . no appreciable pneumothorax is seen on this supine radiograph . cardiac and mediastinal silhouettes are stable . Enlarged Cardiomediastinum&&Lung Lesion&&Pleural Effusion&&Support Devices 16033763 51366910 17c3e7ba-8733dd0f-504a89f9-be30113e-57719df4 1323 portable semi-upright radiograph of the chest demonstrates persistent small bilateral pleural effusions with adjacent atelectasis, not significantly changed from the prior study . again seen are multiple bilateral pulmonary nodules, consistent with metastatic disease . the cardiomediastinal and hilar contours are unchanged . two chest tubes project over the left hemithorax . left-sided oral pacemaker is present with the leads in the appropriate position . there is no pneumothorax . bilateral pleural effusions with adjacent atelectasis are not significantly changed from the prior study . Atelectasis&&Pleural Effusion 16033763 51507991 ed31f48a-f429773b-c9704fad-15c7dc2f-1ad59b8f 1324 ap and lateral radiographs were acquired . there is a left-sided pacemaker with an associated right ventricular lead, appropriately positioned . the lungs are hyperexpanded and there is flattening of the hemidiaphragms with enlargement of the retrosternal airspace, consistent with chronic obstructive pulmonary disease . there is a right lower lung granuloma, as before . the lungs are otherwise clear . the heart size is top normal . the mediastinal contours are normal . there are no pleural effusions . no pneumothorax is seen . . no acute process . . findings consistent with chronic obstructive pulmonary disease . No Finding 16033763 51599066 4969ed80-b6f01bb1-09bc5a19-c44bb4c5-70597525 1325 portable semi-upright radiograph of the chest demonstrates persistent small left-sided pleural effusion, which is not significantly changed . a small right-sided pleural effusion is also seen, and is slightly increased in size over the interval . again seen are multiple bilateral nodules in the lungs consistent with metastatic disease . the cardiomediastinal and hilar contours are unchanged . two chest tubes project over the left hemithorax . persistent small left-sided pleural effusion with adjacent atelectasis, and slight interval increase in size in the small right pleural effusion . Atelectasis&&Pleural Effusion 16033763 53153262 574a4800-1bd863fc-41b229b6-7e737994-5232ce8a 1326 the two chest tubes on the left are in place . the central venous line tip is at the right atrium . there is interval no substantial change in the left pleural effusion and atelectasis . multiple pulmonary lesions are noted . no appreciable pneumothorax is seen . Atelectasis&&Pleural Effusion&&Support Devices 16033763 53415248 a1c0d864-60999f47-337df4cc-6a4a20eb-c78f73b8 1327 in comparison with study of , there is some increasing opacification at the left base consistent with some reaccumulation of pleural fluid . diffuse nodular opacification persist . Lung Lesion&&Lung Opacity&&Pleural Effusion 16033763 53452442 12592f0d-a371e425-2f68a639-fe69e7f1-e085f4c4 1328 moderate cardiomegaly is stable . pacer lead is in standard position with tip in the right ventricle . left chest tubes are in unchanged position . multiple bilateral lung nodules are again noted . bilateral small pleural effusions with adjacent atelectasis are unchanged allowing the difference in positioning of the patient . Atelectasis&&Cardiomegaly&&Lung Lesion&&Pleural Effusion&&Support Devices 16033763 53862445 952e589e-552ab80c-774c8550-52668ef2-3f65359a 1329 comparison is made to the patients previous study of at . a portable ap upright chest film at is submitted . . two left chest tubes and a single-lead left-sided pacer remain in place . there are multiple parenchymal pulmonary nodules consistent with known metastatic disease . small bilateral effusions, left greater than right again are seen . in addition, there is a more focal patchy opacity at the left base which could reflect compressive atelectasis but also raises the possibility of pneumonia or aspiration . overall cardiac and mediastinal contours are stable . no pneumothorax is appreciated . Atelectasis&&Enlarged Cardiomediastinum&&Lung Lesion&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices 16033763 54161955 d330d6ff-0193072b-e04fbffe-53b12b62-596738d1 1330 as compared to the previous radiograph, the two left-sided chest tubes are in unchanged position . unchanged appearance of the small left pleural effusion and the multiple bilateral metastatic lung nodules . unchanged size of the cardiac silhouette . the right costophrenic sinus is also blunted by a small effusion . Cardiomegaly&&Lung Lesion&&Pleural Effusion&&Support Devices 16033763 55725686 377df2cf-286c0596-c5183178-7edd53f5-50475885 1331 comparison is made with prior study . cardiomegaly is stable . pacer lead tip is in a standard position in the right ventricle . two left chest tubes are in place in unchanged position . multiple bilateral lung nodules are again seen . right lower lobe opacity has minimally improved due to improving atelectasis and decrease in small right effusion . small left effusion with adjacent large atelectasis is unchanged . there are no new lung abnormalities or enlarging pneumothoraces . Atelectasis&&Cardiomegaly&&Lung Lesion&&Lung Opacity&&Pleural Effusion&&Pneumothorax&&Support Devices 16033763 56375613 12ee46bd-a7dda698-35218f7a-f344d145-a2f0617f 1332 as compared to the previous radiograph, the patient has undergone thoracocentesis on the left . the pleural effusion has slightly decreased in extent but still occupies approximately two-thirds of the left hemithorax . there is no evidence of pneumothorax . unchanged appearance of the known bilateral extensive pulmonary nodules . Lung Lesion&&Pleural Effusion 16033763 56607012 25142c57-f3723dbf-b7bd3225-66ec6472-ddc1c56c 1333 portable semi-upright radiograph of the chest demonstrates interval decrease in the size of the left pleural effusion, which now occupies approximately half of the left hemithorax . there is improved aeration of the left upper lobe . cardiomediastinal and hilar contours are unchanged . persistent rightward shift of the mediastinum . stable diffuse bilateral pulmonary nodules . no pneumothorax . no pneumothorax . No Finding 16033763 56831830 4aec4b05-d210e192-896bee34-0cbe5e5a-634a75d2 1334 small residual left pleural effusion or pleural thickening is unchanged since at least , now with only a single left drain in place at the base of the left hemithorax . left lower lobe is largely consolidated or collapsed . multiple pulmonary metastases are longstanding . the heart moderately enlarged, whether due to cardiomegaly alone or in combination with pericardial effusion has not changed for several days . the upper lobe pulmonary vasculature is engorged, but there is no pulmonary edema . transvenous right ventricular pacer lead unchanged in longstanding position . Atelectasis&&Cardiomegaly&&Consolidation&&Pleural Effusion&&Pleural Other&&Support Devices 16033763 59614205 907d02e0-45812902-cf944cc5-0b4c93de-bfbab9ea 1335 cardiac silhouette has increased in size and is accompanied by widening of vascular pedicle, pulmonary vascular congestion, and moderate pulmonary edema . additionally, there small pleural effusions are present bilaterally, left greater than right . Cardiomegaly&&Edema&&Pleural Effusion 16034181 50146664 052836b8-b02d3f46-3faf7e36-07ce1ba1-1052a8a6 1336 pulmonary and mediastinal vascular engorgement have improved substantially since and pleural effusions have nearly resolved . residual consolidation in both lower lobes is more pronounced than it was on and therefore might well be pneumonia . extent of central adenopathy is underestimated by these conventional radiographs . calcified pleural plaques are visible to some extent . heart is normal size . emphysema distorts vascular pattern in the upper lobes . moderate size hiatus hernia accounts for fluid collection in the lower midline mediastinum . Consolidation&&Enlarged Cardiomediastinum&&Pneumonia 16034181 56393323 739fbdc0-688ff77c-e70070b7-1e88db74-4482ae5c 1337 mild cardiomegaly has increased in size compared to with increased pulmonary vascular engorgement . small bilateral pleural effusions are unchanged, and the lungs are clear of focal consolidation . increasing cardiomegaly and vascular congestion . unchanged small bilateral pleural effusions . Cardiomegaly&&Edema&&Pleural Effusion 16034181 58175663 84f30297-39be3e30-021f9ceb-c14a866a-ff7053d3 1338 ap view of the chest demonstrates low lung volumes, which accentuate bronchovascular markings . retrocardiac opacity is noted . there is no pleural effusion or pneumothorax . the descending aorta appears tortuous . the hilar and mediastinal silhouettes are unremarkable . the heart size is top normal . there is no pulmonary edema . retrocardiac opacity may represent atelectasis or infection in the appropriate clinical setting . Atelectasis&&Lung Opacity&&Pneumonia 16049879 55504968 e2ae7d0f-49a52396-70e65939-9f855049-f071b61c 1339 pa and lateral views of the chest were provided . the lung volumes are low limiting assessment with bronchovascular crowding atelectasis in the lower lungs . no convincing evidence of pneumonia . no effusion or pneumothorax is seen . the heart and mediastinal contours stable . bony structures are intact . no acute findings . No Finding 16139394 54215495 aeeedb41-57ddfc8b-adfe8c04-c411349c-697bf972 1340 single ap upright portable view of the chest was obtained . the right costophrenic angle is not fully included on the image . given this, no definite focal consolidation is seen . there is left base atelectasis . no large pleural effusion or evidence of pneumothorax is seen . the cardiac silhouette is top normal to mildly enlarged . the aorta is somewhat tortuous . no overt pulmonary edema is seen . left costophrenic angle not fully included on the image . otherwise, aside from top normal to mildly enlarged cardiac silhouette, no acute cardiopulmonary process seen . No Finding 16306599 50173042 b3e3432f-8de35a57-84779127-6d36d4db-a8e9317f 1341 there is mild pulmonary vascular engorgement . moderate compressive atelectasis and pregnancy may be contributing to slight enlarged appearance of the heart on this portable film . no pneumothorax or pulmonary edema . mild pulmonary vascular engorgement without pulmonary edema . no chest x-ray findings suggestive of aortic dissection . No Finding 16307530 57547177 1e7c453c-c31a14f7-14ffd1e5-de7ac337-07746c5f 1342 subtle heterogeneous opacity in the right lower lobe could reflect pneumonia in the appropriate clinical situation . small amount of left lower lobe atelectasis . no pleural effusion or pneumothorax . the heart is normal in size . aortic knob calcifications are unchanged . no acute osseous abnormality . left-sided pacemaker wires are unchanged with tip projecting over the right atrium and the other over the right ventricle . subtle heterogeneous opacity of the right lower lobe could reflect pneumonia or aspiration in the appropriate clinical situation . short term follow-up radiograph may be helpful to ensure resolution . Lung Opacity&&Pneumonia 16319384 53447884 69fad06e-4d630395-0c622820-20e6af98-5a01aaa4 1343 there are no focal opacities . the patient has prominent epicardial fat pads with blunting of the left pleural sulcus and the right cardiophrenic angle, but this is unchanged compared with . mild-to-moderate cardiomegaly is present, but the cardiomediastinal contour is unremarkable otherwise . there is no pleural effusion or pneumothorax . no evidence of acute cardiopulmonary process . No Finding 16319384 55608147 192b6e3d-ec405303-9b315b5d-1dd90a9c-e6310078 1344 single frontal portable view of the chest was obtained . the heart is moderately enlarged, similar to prior . there is calcification of the aortic knob . the pulmonary vasculature is indistinct, compatible with mild pulmonary edema . small bilateral pleural effusions are present . no pneumothorax . osseous structures are unremarkable . no radiopaque foreign body . mild pulmonary edema with small bilateral pleural effusions . Edema&&Pleural Effusion 16319384 58022694 17cf7f7c-b27bc3f4-e902bbcb-b4c608b1-5984f415 1345 frontal and lateral chest radiographs demonstrate cardiomediastinal contours are unchanged . appearance of a left lower lung opacification on the frontal view appears to correspond with a prominent pericardial fat pad, better assessed on the lateral view and stable across multiple prior chest radiographs . overall, lungs appear clear . no pleural effusion or pneumothorax is identified . aortic knob calcifications again identified . no acute intrathoracic process . no overt pulmonary edema . No Finding 16319384 58808936 8f1b6c21-dc13ba3f-d1f686ad-50b5cebd-3c6fb05a 1346 pa and lateral chest radiographs demonstrate a left chest dual pacing device, its leads which appear intact and stable in position . heart size is mildly enlarged . there is central vascular engorgement without overt evidence of pulmonary edema . blunting of the left costophrenic angle is likely atelectatic in etiology . there is no pleural effusion or pneumothorax . there is no evidence to suggest pneumonia . mild central vascular engorgement without overt pulmonary edema or pneumonia . No Finding 16319384 59631748 c06025b9-935d32ff-0efabf34-2f711ce7-e4fc7000 1347 heart size remains moderately enlarged but unchanged . the aortic knob is diffusely calcified . pulmonary vascularity is not engorged . no focal consolidation, pleural effusion or pneumothorax is present . there are mild degenerative changes within the thoracic spine . surgical clip is seen within the upper abdomen on the lateral view . no acute cardiopulmonary abnormality . No Finding 16319384 59964362 8e6a0848-5eb51eaf-ff31f21a-a030a9fb-daef4652 1348 interval placement of a left chest wall biventricular pacemakeraicd is noted . calcification of the aortic arch recommend pa and lateral radiographs to evaluate for lead positioning . cardiac silhouette is enlarged lungs are clear no pneumothorax . this preliminary report was reviewed with dr . , radiologist . as above . recommendations lateral radiograph is recommended . No Finding 16346354 52144904 e0ffdf00-50f31921-d4eb21c6-2f9c26c8-fa5a40e8 1349 on the second image, the et tube tip is . cm from the carina . enteric tube seen with tip in the gastric body . low lung volumes seen with crowding of the bronchovascular markings and bibasilar atelectasis . the cardiomediastinal silhouette is within normal limits . no acute osseous abnormalities . et and enteric tubes appropriately positioned . No Finding&&Support Devices 16389477 55304215 cc802574-9ed7ecb7-b29eaa57-59092e24-9e774cdf 1350 an ng tube terminates in the stomach with side port beyond the expected location the gastroesophageal junction . partially visualized diffusely dilated air-filled loops of small bowel appear likely represent ileus or obstruction . a left port-a-cath terminates in the right atrium, unchanged . platelike opacity in the left base likely represents atelectasis, less likely aspiration . the lung apices are not visualized . there is no large pleural effusion or evidence of pulmonary edema . Atelectasis&&Lung Opacity&&Support Devices 16413061 53036112 e139be8f-a49d5442-2bd59848-b929b102-ab36ea25 1351 ap portable upright view of the chest . left chest wall port-a-cath is seen with catheter tip in the region of the low svc . overlying ekg leads are present . the lungs are clear without focal consolidation, large effusion or pneumothorax . no signs of congestion or edema . cardiomediastinal silhouette is unchanged . bony structures are intact . no free air below the right hemidiaphragm . as above . No Finding 16413061 55655748 15c5f82d-2fbbb3f2-cf605195-ed4839ee-e71fe465 1352 right picc line tip is at the level of lower svc . pigtail catheter is in place . widespread parenchymal consolidations are unchanged . overall the appearance is similar to previous examination except for interval distended of the stomach and progression of bowel distention . Consolidation&&Support Devices 16522757 51439113 2b7c568e-b2ff5adb-34736dd0-23b45126-8693f1ec 1353 severe bibasilar consolidation, probably right lower lobe pneumonia and either left lower lobe pneumonia or left lower lobe collapse, unchanged since earlier on , but both increased substantially since . no pneumothorax following removal of the left pleural drainage catheter . small left pleural effusion is likely . heart size is normal . et tube in standard placement . nasogastric drainage tube ends in the upper portion of a nondistended stomach . Atelectasis&&Consolidation&&Pleural Effusion&&Pneumonia&&Support Devices 16522757 51770964 6a67666e-673793de-b5a60dd5-e0289088-1d99231b 1354 right picc line tip is at the level of mid svc . widespread consolidations are unchanged . the was interval planned placement of the left pigtail with subsequent decrease in the left pleural effusion . there is small left apical pneumothorax present . note is made of substantially distended stomach . right lower lobe consolidation is extensive and might potentially represent a combination of pneumonia with atelectasis . when compared to a demonstrate substantial interval progression of the abnormalities . Atelectasis&&Consolidation&&Pleural Effusion&&Pneumonia&&Pneumothorax&&Support Devices 16522757 51890400 abf84816-90b90529-a631cf93-9569c001-33ec9eaa 1355 new right supraclavicular central venous catheter ends close to the superior cavoatrial junction . lungs clear . heart size normal . no pleural abnormality . No Finding&&Support Devices 16522757 53588718 2bd5ea71-b28fd182-1af6ec2a-b56ec699-3601e432 1356 since the prior radiograph of day earlier, left pleural catheter has been removed, with no definite pneumothorax . no other relevant changes . No Finding 16522757 54238427 a4060ee2-06d52bb2-d1195cc1-7e491888-4882ae4c 1357 small left apical pneumothorax is present with left-sided chest tube in place . tip of endotracheal tube terminates . cm above the carinal and could be advanced for standard positioning . cardiomediastinal contours are normal considering marked patient rotation . lungs are grossly clear . Pneumothorax&&Support Devices 16522757 55401499 29625da6-c727bed4-1a61b739-f2bbdb7f-131be12b 1358 to the patients nurse by telephone at on . i was told the patient was being transferred between services . i instructed her to enlist the nursing supervisor on-call to expedite the patients transfer so he can receive appropriate care . Consolidation&&Enlarged Cardiomediastinum&&Pleural Effusion&&Pneumonia 16522757 56128182 5a29f63b-9703b6a4-015091e1-fd2d093a-b82e7a9e 1359 rotated positioning . et tube present, with tip the top of clavicles proximally . cm above the carina . an ng tube is present, tip beneath diaphragm overlying gastric fundus . portions of the tuber obscured by the patients lumbar spine spinal fixation hardware . there is left-sided chest tube . no pneumothorax is detected . there is minimal hazy opacity at the left lung base, slightly increased . this is non-specific in appearance and could represent atelectasis, parenchymal contusion, or early pneumonic infiltrate . no gross effusion . allowing for overlying tubing and materials, the right lung is grossly clear, without overt chf, focal consolidation, or effusion . the cardiomediastinal silhouette is grossly unchanged . . left chest tube present, similar in position . no pneumothorax detected . . there is minimal hazy opacity at the left lung base, slightly increased . this is non-specific in appearance and could represent atelectasis, parenchymal contusion, or early pneumonic infiltrate . attention to this area on followup films is requested . Atelectasis&&Lung Opacity&&Support Devices 16522757 57104616 df3e801b-e7a2a583-48a4268c-95ae757e-fc8c1172 1360 a left apical pneumothorax is unchanged . left pigtail catheter and right picc line are unchanged in appearance . parenchymal consolidations are bilateral in unchanged . there is slight interval improvement in the right basal atelectasi . Atelectasis&&Consolidation&&Pneumothorax&&Support Devices 16522757 57337921 a9a45704-613f2878-ab492afe-55b839b6-19a841f7 1361 new large areas of consolidation in both lower lobes concerning for pneumonia, particularly on the right, could be atelectasis on the left . small left pleural effusions are probably present as well . no pneumothorax . left apical pleural drainage catheter in place . et tube in standard position . heart size normal . findings on the subsequent chest radiograph were reported to dr . . Atelectasis&&Consolidation&&Pleural Effusion&&Pneumonia&&Support Devices 16522757 58445510 8b10b3e9-60270740-11e12630-f77c8705-1d018ae7 1362 lordotic positioning and low inspiratory volumes . the left hemidiaphragm is elevated . there is upper zone redistribution, likely accentuated by low lung volumes . there is scattered subsegmental atelectasis or scarring in the right upper zone, right base and left base . question sutures at the left base -- there been prior surgery at the left lung base . allowing for technique, the heart is not enlarged . no frank consolidation or gross effusion . no pneumothorax detected . incidental note is made of a partially imaged right shoulder reverse arthroplasty . low inspiratory volumes, with bibasilar and right upper zone atelectasis . no frank consolidation or gross effusion . upper zone redistribution, which is likely accentuated by low inspiratory volumes, but no overt chf . Atelectasis 16545105 50250269 991542cf-d2c81e61-45b8469d-562fc60e-ae64175f 1363 left picc line that projects with its tip over the mid svc . no evidence of complications, notably no pneumothorax . moderate left and small right pleural effusion, left basal atelectasis . Atelectasis&&Pleural Effusion&&Pneumothorax&&Support Devices 16617702 51255886 6361c6cb-2f5fe468-7fd88316-80a44c79-fbe11c02 1364 moderate left and small right pleural effusions have both increased . pulmonary and mediastinal vasculature are mildly engorged . the partially obscured lower lobes are consolidated or partially atelectatic, but less well aerated today than on . left pic line can be traced as far as the low svc, but the tip is obscured . the heart is top normal size, though increased compared to . no pneumothorax . Atelectasis&&Consolidation&&Pleural Effusion&&Support Devices 16617702 51858819 7524da00-43628bf8-818b42cf-2083bd53-a0229b69 1365 left picc line ends approximately at mid svc . small left pleural effusion is new since . there is no pleural abnormality on the right side . lungs are well expanded and without any opacities concerning for pneumonia . heart size, mediastinal and hilar contours are normal . . left picc line ends at mid svc . no pneumothorax . . small left pleural effusion is new since . Pleural Effusion&&Support Devices 16617702 54056728 b75e4086-9352431d-f07e12b0-a8669ac7-28a1f693 1366 cardiac silhouette is upper limits of normal in size and accompanied by pulmonary vascular engorgement and slight perivascular indistinctness . subtle basilar predominant interstitial opacities are visible in the right lung base and may reflect interstitial edema . moderate left and small right pleural effusions are again demonstrated with adjacent basilar opacities which may reflect atelectasis andor consolidation . this has slightly improved at the right base and is unchanged on the left . Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Lung Opacity&&Pleural Effusion 16617702 56813540 1c9ec94e-27e09fa4-bfa23b4a-097d03bb-a6f67389 1367 in comparison with the study of , there has been substantial removal of pleural fluid from the left hemithorax with a small remainder . no evidence of pneumothorax . overall appearance of the heart and lungs is otherwise essentially unchanged . the tip of the left subclavian catheter extends to the mid-to-lower portion of the svc . Cardiomegaly&&Support Devices 16617702 58239562 b15eb932-15df0889-519b3c56-5b813026-c65395a3 1368 ap and lateral views of the chest are compared to previous exam from . lower lung volumes are seen on the current exam . calcified left basilar nodule and left pleural apical pleural-based scarring is again noted . given lower lung volumes, the lungs are clear of focal consolidation or effusion . cardiac silhouette is slightly enlarged but stable in configuration . osseous structures are unchanged noting degenerative change at the shoulders bilaterally and intra-articular body within the left glenohumeral joint . no definite acute cardiopulmonary process . No Finding 16652812 51113785 1adb0f14-f7049b06-787006f9-0cffb6fd-5a8ffe0f 1369 cardiac silhouette size is top normal . mediastinal and hilar contours are normal . lungs are clear . pulmonary vasculature is normal . no pleural effusion or pneumothorax is present . degenerative changes are noted involving both acromioclavicular joints with asymmetric widening of the left ac joint measuring up to the - mm . . no acute cardiopulmonary abnormality . asymmetric widening of the left ac joint suspicious for type ii acromioclavicular dislocation . No Finding 16675957 50956639 9cfdd15d-ffe4a5f7-674b505e-3146e5fb-a115a271 1370 in comparison with the earlier study of this date, the left subclavian catheter extends to the confluence of the brachiocephalic vein and left subclavian, essentially unchanged from the previous study . continued low lung volumes with the degree of pulmonary vascular congestion appearing more prominent on this examination . Edema&&Support Devices 16702545 53227625 2eef5c12-93494114-fde0ba28-47a92aa4-240e4a11 1371 in comparison with the earlier study of this date, the nasogastric tube has been pushed forward so that it extends at least to the mid to lower portion of the body of the stomach . otherwise little change . No Finding&&Support Devices 16702545 53411092 c1e4e895-66af7b86-0fc1918b-2dc76aaf-49aee7c5 1372 previous borderline pulmonary edema and pulmonary and mediastinal vascular congestion have resolved . lung volumes are quite low . heart size top-normal . et tube in standard placement . nasogastric tube ends passes into the upper stomach and out of view . no pneumothorax . Cardiomegaly&&Support Devices 16702545 54372785 fda8d8a6-20e3b495-7f496ea3-e6ecb7c6-864a11c4 1373 endotracheal tube terminates approximately cm above the level of the carina . enteric tube courses into the left upper quadrant, likely terminating in the proximal stomach . left subclavian central venous catheter is stable in position . the cardiac and mediastinal silhouettes are stable . there are low lung volumes . the appears to decrease in mild fluid overload . no appreciable pleural effusion or pneumothorax . Enlarged Cardiomediastinum&&Support Devices 16702545 55127217 3c248c40-b23d88c7-d1751a15-df7e684c-37b6616f 1374 assessment is limited due to positioning . the endotracheal tube ends . cm above the carina . an ng tube is in place with the tip out of view . lung volumes are low . there is bilateral hilar engorgement and pulmonary edema . apparent mediastinal widening may be due to positioning . patchy opacities in the retrocardiac region in both the right and the left aspects of the heart may represent atelectasis although infiltrative process cannot be excluded . there may be a small layering left-sided pleural effusion . no right-sided pleural effusion is seen . there is no pneumothorax . . endotracheal and ng tubes in appropriate position . . pulmonary edema . . patchy opacities in both lung bases may represent atelectasis although infiltrative process cannot be excluded . Atelectasis&&Edema&&Lung Opacity&&Support Devices 16702545 56172736 dfd26dfe-44a8e6b1-7ab24593-1166b595-2313276c 1375 previous mild pulmonary edema has cleared and vascular congestion in the lungs and mediastinal venous engorgement have slightly improved . heart size is top-normal . no pneumothorax or appreciable pleural effusion . left subclavian catheter ends at the origin of the svc . Cardiomegaly&&Edema&&Support Devices 16702545 58046418 baeda180-d5f750be-d32ebc14-e145cab4-a6af000c 1376 ap view of the chest . the lungs are clear . cardiomediastinal silhouette is within normal limits . no acute osseous abnormality detected . no acute cardiopulmonary process . No Finding 16768418 50484024 695acea4-7d4be71d-9243cd6c-c90f68cc-cf5d3a75 1377 the patient is suboptimally positioned . lungs are clear . heart size and mediastinal contours are normal . there is no pleural effusion or pneumothorax . osseous structures are intact . no acute cardiopulmonary process . No Finding 16768418 57445969 60e93ec9-ca47899d-97a8514e-cc353e2b-a0e7bdd7 1378 assessment is limited by motion artifact and low lung volumes . allowing for these limitation, there are no focal parenchymal opacities . cardiomediastinal and hilar contours are unremarkable with the exception of a tortuous aorta . there is no pleural effusion or pneumothorax . low lung volumes otherwise, unremarkable chest radiographic examination . No Finding 16821122 55807597 d8eac14d-acfeb227-de6bf397-eb450434-5c9a3a42 1379 frontal view of the chest was obtained . increased soft tissue thickness along the medial right upper mediastinum may be related to patient rotation . no focal consolidation, pleural effusion, or pneumothorax . the heart size is normal . increased soft tissue thickening along the medial right upper mediastinum may be related to patient rotation . ap and lateral radiographs are recommended, ensuring no patient rotation . findings were communicated via phone call by to at on . Enlarged Cardiomediastinum 16865871 50830615 6520217f-d00d36ae-a55b165c-6d78b2a9-2d6cc885 1380 single ap upright portable view of the chest was obtained . no focal consolidation is seen . there is minimal elevation of the right hemidiaphragm . there is no large pleural effusion . no evidence of pneumothorax . the cardiac and mediastinal silhouettes are unremarkable . no displaced fracture is seen . minimal elevation of the right hemidiaphragm . otherwise, no acute cardiopulmonary process . 16957065 54221130 e4fdc78b-471e3ec0-c31f9192-82a6febe-ed119e32 1381 the lungs are well inflated and grossly clear . the cardiomediastinal silhouette is unremarkable . known left upper lobe nodule has been persistently decreasing in size on sequential exams, and is not perceptible on the current study . no acute cardiopulmonary process . No Finding 17002995 54961891 2467e1fa-601fff83-f7ee16a8-fa135c0c-e9d15320 1382 as compared to the previous radiograph, no relevant change is seen . the lung volumes are low . there is no evidence of pneumonia or pulmonary edema . no pneumothorax or larger pleural effusions . normal size of the cardiac silhouette . the pre described left upper lobe cm pulmonary nodule is no longer clearly identified but might be obscured by the ecg cable . Lung Lesion 17002995 58538849 df414677-421c5571-a5711a01-a5a598b8-a8a439dd 1383 single portable view of the chest . again, low lung volumes are seen . increased interstitial markings on the current exam suggestive of vascular congestion . left costophrenic angle is now more blunted potentially due to atelectasis, although effusion is also possible . linear retrocardiac opacity persists . cardiomediastinal silhouette is stable . there is a new right ij central venous catheter whose tip is in the right atrium and could be withdrawn . cm to be at the lower svc . no visualized pneumothorax . lower cervical fixation hardware is identified . new right ij central venous line with tip likely within the right atrium and could be withdrawn to be in the lower svc . pulmonary vascular congestion . Edema&&Support Devices 17055995 50058197 77dab00f-4b12bcda-d0dfea2c-e540bb9e-fe5b3114 1384 single portable view of the chest . right picc line is no longer seen . the patient is rotated to the left . the lungs however are clear . calcified granuloma seen at the right lung base . cardiomediastinal silhouette is within normal limits . no acute osseous abnormality detected, lower cervical fixation hardware is again seen . no acute cardiopulmonary process . No Finding 17055995 50152901 55a0e030-4bb997bd-b5d19ede-c9996085-f874501a 1385 the lung volumes are low . the cardiac, mediastinal and hilar contours appear stable allowing for differences in technique . there is fairly substantial retrocardiac opacification, although predominantly linear and streaky . elsewhere, the lungs appear clear . there is no pleural effusion or pneumothorax . retrocardiac opacity at the left lung base, somewhat striking although suggestive atelectasis an infectious process is difficult to exclude, however . Atelectasis&&Pneumonia 17055995 51169502 fe3e3ba7-b7222cb7-bce60f53-58872f01-f8d40bcc 1386 frontal and lateral views of the chest were obtained . the lungs are well expanded and clear without focal consolidation, pleural effusion or pneumothorax . heart size is normal . mediastinal silhouette and hilar contours are normal . a -mm nodule in the right lower lung is unchanged since , compatible with a calcified granuloma . cervical spinal hardware is incompletely evaluated on this study . no acute intrathoracic process . No Finding 17055995 51310684 c13310e4-4d76ea1b-5387cec3-e71bbf20-d4e77909 1387 a few scattered calcified granulomas are seen at these right mid to lower lung . subtle patchy opacity at the medial right lung base may represent atelectasis, less likely pneumonia . no pleural effusion is seen . there is no pneumothorax . the cardiac and mediastinal silhouettes are unremarkable . cervical surgical hardware is noted . subtle patchy opacity at the medial right lung base may represent atelectasis, less likely pneumonia, however, pneumonia is not excluded in the appropriate clinical setting . Atelectasis&&Lung Opacity&&Pneumonia 17055995 52484430 7300ed3f-578b9a92-0404bfde-931d53a6-03d1907c 1388 lung volumes are low, making it difficult to distinguish right basal vascular crowding from mild interstitial edema . heart is normal size and there is no mediastinal vascular engorgement or any pleural effusion, so edema is less likely . there is a new left perihilar pulmonary opacity partially obscured by overlying ekg leads, but i suspect there is substantial atelectasis or new pneumonia . left picc line ends in the mid to low svc as before and an upper enteric tube ends in the stomach, which is not particularly distended despite severe gaseous distention of the rest of the intestinal tract in the upper abdomen . no pneumothorax . dr . was paged at am . and i discussed the findings by telephone with the house officer covering the patient at am . Atelectasis&&Edema&&Lung Opacity&&Pneumonia&&Support Devices 17055995 52698656 63a73093-e2949a4b-c2a38b30-87805d05-9375c863 1389 the heart size is normal . lung volumes are low, resulting and pulmonary vascular crowding, otherwise the hilar and mediastinal contours are unremarkable . there is subtle increased opacity within the left perihilar region and upper lung . streaky atelectasis is seen at the left lung base . there is no pneumothorax, or pleural effusion . the visualized osseous structures are unremarkable . subtle increased opacity within the left perihilar region and upper lung, which could be secondary to pneumonia . recommendations pa and lateral chest radiograph to more fully evaluate the lungs when the patients condition permits . Lung Opacity&&Pneumonia 17055995 52770480 e619f4bc-6a72c001-18ee8e31-b4b41aa1-3f57cbc5 1390 new mild peribronchial opacification right lower lobe could be due to recent aspiration or developing pneumonia . lungs otherwise clear . no pleural abnormality . normal cardiomediastinal silhouette . left jugular line ends in the mid svc . Lung Opacity&&Pneumonia&&Support Devices 17055995 53400904 8b0af9e3-cf03e510-2238b168-0fcfeaaa-379dac24 1391 comparison is made to previous study from . the right ij central line has been removed . there is hardware within the lower cervical spine . the heart size is unchanged and stable . there is some atelectasis at the lung bases . there are no signs for overt pulmonary edema or definite consolidation . no pneumothoraces are present . Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Support Devices 17055995 53437515 84c6ebfe-211d33d7-178a645a-3526f767-a15ec657 1392 left ij central line stable . lung volumes are low compared to the prior radiograph . the previously identified right peribronchial consolidation has increased in density, likely secondary to new edema and vascular congestion . heart size and mediastinal contours are stable . no pleural effusion . new mild edema may obscure the previously questioned right aspirationpneumonia . Edema&&Pneumonia 17055995 53609513 906e0eaa-60dfa37d-c7be4868-5d9613b9-f49fd253 1393 as compared to chest radiograph, cardiomediastinal contours are stable . previously present opacities in the periphery of the right mid and lower lung have nearly resolved, more as opacities in the left suprahilar in retrocardiac region have worsened . findings may reflect multifocal aspiration and or developing aspiration pneumonia . no other relevan . Enlarged Cardiomediastinum&&Lung Opacity&&Pneumonia 17055995 53624824 d3640fc5-3d1186eb-94869353-5395e806-1c89a1fe 1394 ap semi-upright and lateral views of the chest were obtained . there are low lung volumes, though allowing for this, the lungs are clear bilaterally with no focal consolidation, effusion, or pneumothorax . a small calcified granuloma in the right lower lung is re-demonstrated with a stable appearance . there is no evidence of chf . cardiomediastinal silhouette is normal . fixation hardware is noted in the lower c-spine . bony structures appear intact . no acute intrathoracic process . No Finding 17055995 54026889 639a09fa-d71c9ec9-825e615e-eabc6326-ddd33f2e 1395 no relevant change as compared to the previous image . low lung volumes . mild cardiomegaly . platelike atelectasis at the left lung bases . new left internal jugular vein catheter in correct position . no pneumothorax . Atelectasis&&Cardiomegaly&&Support Devices 17055995 54149564 c6ba4cd5-16b6db55-ebf864d7-0988ad61-6d88b72a 1396 in comparison to the prior x-ray and ct, the predominantly left upper and mid lung zone opacities have resolved . there is no definite consolidation . there is no pleural effusion, pneumothorax, or pulmonary edema . the cardiomediastinal silhouette is mildly enlarged . a right picc terminates in the low svc . cervical hardware is present in the neck and incompletely evaluated . prominent air-filled loops of bowel are noted below the hemidiaphragms, and not significantly changed from the prior exam . . no acute cardiopulmonary process . . picc terminates in the low svc . . stable mild cardiomegaly . . prominent loops of air-filled bowel are partially imaged, and stable . if further evaluation is necessary, could obtain a dedicated abdominal radiograph . Cardiomegaly&&Support Devices 17055995 54167022 c39a2d49-30932027-84dcf97f-63bfe5de-f9b1bbf5 1397 previously seen multifocal opacities in bilateral lungs have resolved since . no focal consolidation suggestive of pneumonia is identified . linear opacity at lateral left lung base is likely atelectasis . mm ovoid opacity at the right lung base is stable . there is no pneumothorax or large pleural effusion . cardiomediastinal silhouette is normal size . an apparent scar pericardium is an artifact as the patient went on to have a ct urogram which include the heart and does not demonstrate a pneumopericardium . cervical spine hardware is again noted . no radiographic evidence of pneumonia . No Finding 17055995 54934752 d3b0b262-df43c83c-79c07524-fa37aa2e-c76d7762 1398 single portable frontal chest radiograph demonstrates well-expanded lungs . heart is normal in size, and cardiomediastinal contours are unremarkable . there is no pleural effusion or pneumothorax . small calcified granulomas are again noted . the lungs are otherwise clear . lower cervical fusion hardware noted . no evidence of pneumonia . No Finding 17055995 55045318 04ac83c1-740154cd-378f0bed-f4615e94-8e883aaa 1399 as compared to the previous radiograph, no relevant change is seen . low lung volumes . mild cardiomegaly . no pneumonia, no pulmonary edema, minimal platelike atelectasis at the left lung bases . cervical fixation devices are in unchanged position . Atelectasis&&Cardiomegaly&&Support Devices 17055995 55954897 40b1972f-2f6feba2-c5ac00f1-9149a247-96ff94e9 1400 upright ap and lateral views of the chest cardiac, mediastinal and hilar contours are normal . the pulmonary vascularity is normal . a -mm calcified nodule projecting over the right lower lung field is unchanged, compatible with a granuloma . the lungs are otherwise clear without focal consolidation . no pleural effusion or pneumothorax is present . cervical spinal fusion hardware is noted . there is diffuse gaseous distention of the colonic loops of bowel within the upper abdomen . No Finding 17055995 56285032 665d7742-d067640a-b25afbd2-fcb01db1-b6d6e7c9 1401 ap upright and lateral views of the chest is obtained . cervical fusion hardware is partially imaged in the lower c-spine . a calcified granuloma is again noted in the right lower lung . the lungs are clear bilaterally without focal consolidation, effusion, or pneumothorax . the heart and mediastinal contours appear normal . no bony abnormality is seen . no free air below the right hemidiaphragm . no acute intrathoracic process . No Finding 17055995 56479192 4cbadab1-19a3f1d7-924d71a9-80bd338b-860e33bc 1402 as compared to the previous radiograph, the patient has received a nasogastric tube . the tip of the tube projects over the pre-pyloric parts of the stomach . no complications, notably no pneumothorax . the left internal jugular vein catheter is in unchanged position . in the interval, the patient has developed a new parenchymal opacity at the bases of the right upper lobe, likely reflecting pneumonia . the cardiac silhouette and the left lung are normal . Lung Opacity&&Pneumonia&&Pneumothorax&&Support Devices 17055995 56991914 18b5326b-5b4f4980-614310d4-32ef9bce-f33707f6 1403 ap and lateral chest radiographs lungs are clear without confluent consolidation . a peripheral right lower lobe granuloma is unchanged from prior . there is no pulmonary edema or pleural effusions . cardiomediastinal and hilar contours are within normal limits . cervical spinal hardware appears in unchanged position . No Finding 17055995 57644406 514cd541-74dff7cf-998b6616-ddcd3d4b-d3096e80 1404 right pic line passes into the right atrium at least as far as a level cm lower than the carina . as such, it could safely be withdrawn cm and still lie in the low svc . lungs are clear . heart size is normal . there is no pneumothorax or pleural effusion . No Finding&&Support Devices 17055995 57722086 63f3fead-8f7067d8-b703f056-7e6d61c7-4ccfad95 1405 what was relatively limited left perihilar consolidation on , now involves a good deal more of the left lung . there may also be new cavitary lesions in the right lung, suggesting sepsis . pleural effusion is small if any . heart size top normal . no pulmonary edema . dr . was paged at pm . when the findings were recognized . Consolidation&&Lung Lesion&&Pleural Effusion 17055995 57916180 9af43e05-bffaf881-a1c5987f-1e921b28-07fdccc9 1406 as compared to , no relevant change is seen . normal lung volumes . normal size of the cardiac silhouette . no pleural effusions . no pulmonary edema . no pneumonia . No Finding 17055995 57953511 3e243490-c68adc7d-d56b5b8c-9435acf8-7d6b5338 1407 as compared to the most recent prior examination, there has been no significant interval change . redemonstrated is a small degree of linear atelectasis at the left lung base . lung volumes remain low . there is no evidence of focal consolidation, pleural effusion, pneumothorax, or pulmonary edema . the cardiomediastinal silhouette is within normal limits . the patient is status post cervical spine fixation with hardware noted in unchanged position . no evidence of acute cardiopulmonary process . No Finding 17055995 58952124 5b884d40-dbd3f418-77c8b6b7-eecb5a18-035015c0 1408 frontal and lateral chest radiographs the heart size is normal . the hilar and mediastinal contours are within normal limits . there is no pneumothorax, focal consolidation, or pleural effusion . a -mm nodular opacity at the right lung base is unchanged since the examination, most compatible with a calcified granuloma . anterior cervical hardware is unchanged in position and orientation, with no evidence of hardware loosening . of note, there appears to be mild distension of the large bowel . this was not present on the examination . no free air is present . No Finding 17055995 58971922 78c48cee-1c2a502c-9a948c79-770c6b18-1c0335bf 1409 as compared to chest radiograph, cardiomediastinal contours are within normal limits and without change . lungs are clear except for linear left basilar atelectasis . no concerning pleural abnormality . No Finding 17055995 59405581 66b3064a-b52efc14-63d86d5a-2ca784fb-c9d916a7 1410 frontal and lateral views of the chest were obtained . lateral views are suboptimal due to patient positioning and underpenetration . it is difficult to exclude bilateral pleural effusions . low lung volumes persist on the frontal view, with elevated right hemidiaphragm . there is prominence of the interstitium, suggesting interstitial edema . the cardiac and mediastinal silhouettes are stable . surgical clips project over the right aspect of the mediastinum . Edema&&Enlarged Cardiomediastinum 17079101 52544664 1ad714a9-437bbce6-a694ad02-05512130-333e99af 1411 the right picc has been retracted with the tip now terminating in the upper-to-mid svc . the appearance of the chest is otherwise unchanged from chest radiograph performed earlier the same day with evidence of right-sided volume loss, mild pulmonary vascular congestion and mild bibasilar atelectasis . right picc retracted with tip terminating in the upper-to-mid svc . findings were reported by dr . to iv nurse, , via telephone at am . on . No Finding&&Support Devices 17079101 55257270 83cada44-22eeaa71-e5622be6-dd3eb0ad-9b1ccc68 1412 the inspiratory lung volumes remain low . elevation of the right hemidiaphragm is unchanged, compatible with prior right lung resection . there is improved aeration of the left lung base without blunting of the costophrenic angle to suggest pleural effusion . there is increased opacification of the right lung, predominantly affecting the lower lung zone, which silhouettes the right hemidiaphragm and the right heart border . there is mild pulmonary vascular congestion . the cardiomediastinal silhouette remains prominently enlarged but stable compared to the remote prior study of . surgical clips are noted projecting over the right upper mediastinum . hypertrophic degenerative changes of the thoracic spine are also noted . increased opacification of the right lung, likely a combination of pleural fluid and underlying atelectasis . given the mild pulmonary vascular congestion, this may represent fluid overload but given the recent history of trauma, injury is not excluded . if there is clinical concern for trauma, a non-contrast chest ct would be recommended for further evaluation . Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion 17079101 58066330 b6d980d3-b586c166-d29fa9de-6a7335ae-35148194 1413 in comparison to the most recent prior study, there is improved aeration at the right lung base with improved definition of the right hemidiaphragm and right heart border suggesting decreased atelectasis and pleural fluid . the left lung remains clear without pleural effusion or focal consolidation . no pneumothorax is present . the right hemidiaphragm remains elevated compatible with prior right lung resection . there is decreased but persistent mild pulmonary vascular congestion . the cardiomediastinal silhouette remains prominently enlarged but stable . surgical clips project to the right of the trachea, compatible with prior lung resection . . improved aeration of the right lung base compatible with decreased atelectasis and pleural fluid . . improved but persistent mild pulmonary vascular congestion . . stable appearance status post right partial lung resection . Atelectasis&&Edema&&Pleural Effusion 17079101 59546763 c192e7be-3c9c15d0-ae8a7d3d-a117f975-65afe9ad 1414 in comparison with the study of , there again are bilateral pleural effusions with compressive atelectasis at the bases, more prominent on the left . following apparent thoracentesis, there is no evidence of pneumothorax . cardiomediastinal silhouette is unchanged . mild indistinctness of pulmonary vessels suggests some elevated pulmonary venous pressure . Atelectasis&&Edema&&Enlarged Cardiomediastinum&&Pleural Effusion 17093296 52468610 40fa80dc-953c68e3-cbcf1c09-d87a60a4-d82a5ae8 1415 interval removal of endotracheal tube and nasogastric tube as well chest tubes . right ij catheter persists at the cavoatrial junction . no visualized pneumothorax or pleural effusion . lungs are clear . no pneumothorax . No Finding 17093296 55434052 fb12f610-81c4f11d-89fa082e-653ba4ff-ae31e112 1416 comparison to prior study of at . . left-sided subclavian port-a-cath continues to have its tip in the distal svc, near the cavoatrial junction . heart remains enlarged, which may reflect cardiomegaly, although pericardial effusion should also be considered . mediastinal contours are unchanged . there is persistent minimal blunting the left costophrenic angle, which may represent a tiny effusion or chronic pleural thickening . streaky linear opacities at the left base may reflect areas of atelectasis or scarring . no focal airspace consolidation is seen to suggest pneumonia . no pneumothorax . no evidence of pulmonary edema . linear density overlying the left upper quadrant is likely external to the patient, but clinical correlation would be recommended . Atelectasis&&Cardiomegaly&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Pleural Other 17096560 50056854 92846817-78ec0a2e-50265c40-0e7cad3b-6d912f6e 1417 as compared to the previous radiograph, the distribution of the left pleural effusion is slightly changed, but the overall extent is not . the bases of the right lung are better ventilated than on the previous image . the size of the cardiac silhouette continues to be enlarged . no evidence of pneumothorax . unchanged left pectoral port-a-cath . Cardiomegaly&&Pleural Effusion 17096560 54159511 1d8b6f1b-f2623043-0b88aff3-36ffde7e-aba0484f 1418 as compared to the previous radiograph, no relevant change is seen . a pre-existing small left pleural effusion is smaller than on the previous image . mild cardiomegaly without pulmonary edema . no pneumonia . no pneumothorax . the left pectoral port-a-cath is in unchanged position . Cardiomegaly&&Pleural Effusion 17096560 57222183 b3cc74ec-d3bd5172-abf56e57-6a47cce6-7e7a9b99 1419 compared to chest radiographs from , there is been interval removal of an endotracheal tube . lung volumes remain low . moderate cardiomegaly with mild central vascular congestion and possible new mild interstitial pulmonary edema . probable small bilateral pleural effusions with associated atelectasis, left greater than right, are unchanged . no new focal consolidation . no pneumothoraces . mediastinal widening has slightly improved and may reflect mild congestion of mediastinal veins . . persistent probable small bilateral effusions with associated atelectasis . . stable moderate cardiomegaly with central vascular congestion and possible new mild interstitial pulmonary edema . . no new focal consolidation concerning for infection or aspiration . Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Pleural Effusion&&Pneumonia 17123098 53147687 382be4ba-6b111a62-d9907d36-c84223b9-6dedb3a8 1420 compared to chest radiographs from , lung volumes have worsened and retrocardiac opacity has increased, consistent with left lower lobe collapse . small left pleural effusion is new . no large effusion on the right . right basilar opacities have improved . vascular congestion has improved and there is no overt pulmonary edema . heart size, which is difficult to assess in the setting of effusion, is mildly enlarged and unchanged . et tube is in standard placement, unchanged . right pic line terminates at the cavoatrial junction . . retrocardiac opacification reflects new left lower lobe collapse . new small left pleural effusion . . improved right basilar opacities, likely atelectasis . . stable mild cardiomegaly . Atelectasis&&Cardiomegaly&&Lung Opacity&&Pleural Effusion 17123098 54687111 14bbb4e5-1b3f6563-a2dd6104-100f4a33-0719fe11 1421 ng tube has been removed . et tube is in standard position . right picc tip is at the cavoatrial junction . there is no evident pneumothorax . vascular congestion has improved . bibasilar opacities have improved still large in the left lower lobe . no other interval chang . Edema&&Lung Opacity&&Support Devices 17123098 55293550 7a63f567-e729a4cb-1392efd5-a3130267-c02dcb1d 1422 endotracheal tube tip is . cm above carina . right picc low-lying tip is in the mid to low svc, overlie spine and is difficult to see . postoperative changes in the spine . there are bilateral pleural effusions, similar . improved lung aeration since prior . improved pulmonary vascularity . heart is mildly enlarged . left basilar opacity, mildly worsened, in part from atelectasis given volume loss, consider pneumonia or aspiration if clinically appropriate . improved right basilar opacity . no pneumothorax . left basilar opacity has mildly worsened, in part atelectasis, consider aspiration or pneumonia if clinically appropriate . Atelectasis&&Lung Opacity&&Pneumonia 17123098 55374533 46aa0c3b-dfb23768-f0c1ea37-80bf872e-01459617 1423 in comparison with the study of , the endotracheal tube tip lies approximately . cm above the carina . otherwise little change . continued enlargement of the cardiac silhouette with some elevation of pulmonary venous pressure . probable bilateral layering pleural effusions with underlying compressive atelectasis, more prominent on the left . Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices 17123098 55665898 2225b7e3-b00d512a-593b4836-fb3e6b4a-fa2b1ae5 1424 in comparison with the study of , there has been a cervical fusion procedure . endotracheal tube tip is at the clavicular level, approximately cm above the carina . the patient has taken a better inspiration though there again is enlargement of the cardiac silhouette . mild indistinctness of pulmonary vessels could reflect minimal elevation of pulmonary venous pressure . the left hemidiaphragm is obscured, consistent with volume loss left lower lobe and pleural fluid . Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices 17123098 59311887 ce5a7d22-9e290fa1-b2beb2a9-b96c795f-0e1a66a0 1425 the lungs are low in volume and show three right lung nodules measuring mm in the right upper lobe and and mm in the right lower lobe . a left lower lobe lesion is better seen on the concurrently performed abdomen and pelvis ct . the cardiomediastinal silhouette and hilar contours are normal . no pleural effusion or pneumothorax is present . an anterior cervical fusion device is partially imaged . No Finding 17123238 59109176 bb9f6308-e8b75c46-eb75bea5-d3da1b42-7b1ddf12 1426 mild pulmonary edema is improving, moderate cardiomegaly and low lung volumes are also improved . pleural effusions are small if any . no pneumothorax . Cardiomegaly&&Edema&&Pleural Effusion 17223574 50124571 526a62c7-2062d35d-cde3cc73-7934b77c-256c9a3c 1427 lung volumes are low . the heart is normal in size, and there is no overt edema . no focal consolidation, pleural effusion or pneumothorax is seen . no acute cardiopulmonary process . No Finding 17223574 51511763 3e1d14ba-fe736cda-ebd2ef10-3dbcdb89-da6f2980 1428 ett tip ends above the clavicles, mm above the carina . decreased lung volumes . cardiomegaly . marked interval progression of the bilateral mid and lower lung zone airspace opacification with bilateral pleural effusions . et tip mm proximal to the carina, but please note that the patient has a relatively short trachea and no more than - cm advancement is advised . this was telephoned to the referring physician . marked progression of the bilateral mid to lower lung zone airspace opacification which most likely represents pulmonary edema but superimposed infection or aspiration cannot be excluded . Edema&&Lung Opacity&&Pneumonia 17223574 52530059 80394587-5cae6c52-0e47c884-fc81d7a5-aa49039a 1429 as compared to the previous radiograph, 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 can be followed through the upper and mid third of the esophagus but is not visible more peripherally than that . decreased lung volumes and increased diameter of the pulmonary vasculature, combined with blunting of the left costophrenic sinus, potentially reflecting moderate pulmonary edema and a small pleural effusion . in addition atelectases are seen at both lung bases . moderate cardiomegaly . no evidence of pneumonia . Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices 17223574 53272126 8af200b2-6d16d8b6-7cf5ca1c-30dfcdce-74779c42 1430 compared to chest radiographs since , most recently . increased pulmonary vascular and mediastinal venous caliber suggests volume overload andor biventricular cardiac decompensation . no focal pulmonary abnormality or pleural effusion . No Finding 17223574 53660624 3999a847-88ce9e99-f417c320-d26274e2-e47cd770 1431 compared is radiographs dated through . borderline interstitial edema persists along with moderate cardiomegaly and mediastinal vascular engorgement . no focal pulmonary abnormality . no pleural abnormality . tracheostomy tube midline . Cardiomegaly&&Edema&&Support Devices 17223574 56094876 64b12f28-e1b71b36-adbe4920-76807755-1fa29f3b 1432 evaluation is limited by body habitus . there is a tracheostomy in similar position . lung volumes are low causing accentuation of the central bronchovascular structures . the heart is enlarged, and there is no pulmonary edema . the lungs are clear without focal consolidation, pleural effusion or pneumothorax . . cardiomegaly . . if clinical concern for positioning of the tracheostomy, a lateral chest radiograph would be helpful . Cardiomegaly 17223574 56459009 6231218a-08114abf-f7126f7b-47637bda-23592f97 1433 comparison to , . further increase in extent of the right pleural effusion . otherwise no relevant change . severe cardiomegaly with mild to moderate pulmonary edema . extensive areas of atelectasis at the left lung basis . no pneumothorax . stable position of the tracheostomy tube . Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices 17223574 57523955 7875b25f-a66526e3-18d0bf41-b6c02def-fecc262f 1434 comparison to . the patient has received a tracheostomy tube . the tube appears to be in correct position . no evidence of pneumothorax or other complication . low lung volumes . massive cardiomegaly with bilateral moderate pleural effusions and subsequent areas of atelectasis . mild pulmonary edema . Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices 17223574 57575964 ce3497c0-922d4dd2-08069cc3-2a7c30c2-b8169070 1435 as compared to the previous radiograph, the monitoring and support devices are in unchanged position . there is unchanged moderate cardiomegaly at low lung volumes, but evidence suggesting mild-to-moderate pulmonary edema is more tangible than on the previous image . small bilateral pleural effusions could be present . there is relatively extensive bilateral basal atelectasis . no evidence of pneumothorax . Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices 17223574 57690878 6eb8281f-7dcfeab5-b9e25878-92be8a26-531519ea 1436 heart size is normal with mild tortuosity of thoracic aorta . hilar contours are unremarkable . lungs are clear . pleural surfaces are clear without large effusion or pneumothorax . no acute cardiopulmonary abnormality . No Finding 17257394 50572758 d6f297e0-277785b9-0dade959-c098d1a4-1d5c202a 1437 frontal chest radiographs the heart size is normal . the hilar and mediastinal contours are within normal limits . there is no pneumothorax, focal consolidation, or pleural effusion . No Finding 17302021 54886667 a7b2360a-51a1d662-06afece8-5d11b64b-088479bb 1438 in comparison to portable chest radiograph, there is mild improvement of the pulmonary vascular congestion and bilateral interstitial edema . blunted left costophrenic angle is likely due to an obscuring bowel lobe rather than a true left pleural effusion . heart size is moderately enlarged but stable . no consolidation, masses nor nodules are seen . . mild improvement of pulmonary vascular congestion and bilateral interstitial edema since without complete resolution . . no radiographic evidence of pneumonia . Edema 17387103 52711234 44cacbf6-9d96a84b-4fe9670d-106a3b5d-ac3ae803 1439 lung volume is low . mild bibasilar opacities are consistent with atelectasis . pulmonary vascular congestion is mild . there is no pneumothorax or large pleural effusion . cardiac silhouette is mildly enlarged . mild pulmonary vascular congestion . Edema 17387103 53005482 3f158a92-aa819c5e-ed04bbfe-c4cd87bd-11325ff1 1440 portable frontal chest radiograph demonstrates the et tube terminating . cm above the carina . ng tube courses through below the diaphragm and terminates outside the field of view . prominence of the cardiomediastinal silhouette, mild vascular plethora, and retrocardiac atelectasis likely reflect supine position and low lung volumes . no frank consolidaiton or gross effusion . no supine film evidence of pneumothorax . Atelectasis&&Enlarged Cardiomediastinum&&Support Devices 17407585 52233812 2c2db1f5-bd6c1fed-5bf8b486-1595b5aa-131e48e8 1441 lung volumes are appreciably lower and large bands of atelectasis have appeared in both lower lungs . upper lungs are clear . there is no pulmonary edema or pleural effusion . no pneumothorax or mediastinal abnormality . Atelectasis 17408386 58616139 5414ab29-3dace40f-aa5394d0-7ae927a5-8feb219e 1442 no comparison . a minimal left-sided pneumothorax, previously visualized on the ct examination from , is not visible on the chest radiograph . minimal atelectasis at the left lung basis . normal size of the heart . no pneumonia, no pulmonary edema . Atelectasis&&Pneumothorax 17437534 50987704 560a1b2f-765df9cb-b8def580-05ad8ebd-d6edc6b3 1443 there are confluent bilateral parenchymal opacities with a lower lobe predominance . the cardiomediastinal silhouette is within normal limits for technique . no displaced fractures identified . diffuse bilateral parenchymal opacities with a lower lobe distribution . findings may represent bilateral infection, edema or ards . Edema&&Lung Opacity&&Pneumonia 17483408 52493039 f1ea5a2c-ce5a610d-aff80fde-8392148f-39f4982a 1444 there is a new endotracheal tube seen with tip approximately . cm from the carina . otherwise, there has been no significant interval change of diffuse bilateral parenchymal opacities . endotracheal tube seen with tip between the clavicular heads, . cm from the carina . No Finding&&Support Devices 17483408 52798138 aaff472f-e41c0470-87efd349-ba763de2-55568bd8 1445 the patient was extubated in the meantime interval . the right internal jugular line tip is at the level of lower svc . heart size and mediastinum are unchanged in appearance . bilateral pleural effusions and bibasilar areas of consolidation are unchanged . there is no evidence of pulmonary edema . Cardiomegaly&&Consolidation&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices 17483408 53694670 7ab4bbe7-3b408b7e-6b04c772-f84f0465-402304a0 1446 endotracheal tube is seen with tip between the clavicular heads, . cm from the carina . enteric tube seen with tip in the gastric body however the side port is likely proximal to the ge junction . confluent bilateral parenchymal opacities are grossly unchanged . et tube . cm from the carina and could be advanced cm for optimal positioning . enteric tube tip in the gastric body however side-port proximal to the ge junction and should be advanced . No Finding&&Support Devices 17483408 57650946 fe0ef5cf-90e3c227-e3b3602a-280add66-27988ed3 1447 note is made of an asymmetry of the positions of both scapulae, with linear lucency through the scapula on the right suggestive of fracture . the possibility of some occult right-sided rib fractures is difficult to exclude . there are low inspiratory volumes . heart size is borderline enlarged . there is prominence of the right mediastinum, not clearly accounted for by low inspiratory volumes . probable vascular plethora . possible small amount of pleural fluid on the right . there is band-like atelectasis at the left lung base . no pneumothorax is detected . surgical clips overlie the superior mediastinum . . likely right scapular fracture . occult rib fractures may also be present . . low inspiratory volumes . possible prominence of the right superior mediastinum - in this setting, the possibility of mediastinal hematoma would be difficult to exclude . . probable increased interstitial markings, albeit likely accentuated by low lung volumes . small right effusion may be present . Enlarged Cardiomediastinum&&Fracture&&Lung Opacity&&Pleural Effusion 17546877 51020784 5d078eef-0971db82-2db85307-67669d0a-8f1a2250 1448 frontal and lateral views of the chest are obtained . mild bibasilar atelectasis is seen . no focal consolidation, pleural effusion, or evidence of pneumothorax is seen . the cardiac silhouette is top normal . the aorta remains calcified and tortuous . there is diffuse osteopenia . degenerative changes are seen at bilateral shoulder and acromioclavicular joints . there are also degenerative changes along the spine along with severe compression again seen in the lower thoracic vertebral body . no acute cardiopulmonary process . No Finding 17551032 58987039 73e0e7b4-4ffbe566-feb48f1c-6201bc17-363b1bbf 1449 tiny right apical pneumothorax is slightly smaller today, with the apical visceral pleural line rising from the level of the third posterior rib to the second posterior interspace . the obliquely inclined right pleural tube is unchanged in position . there is no appreciable pleural effusion . severe residual infiltrative pulmonary abnormality looks slightly improved compared to , probably residual of pcp infection and diffuse alveolar damage . heart size is normal . left pic line ends in the mid svc . findings discussed by telephone with dr . at the time of dictation . Pneumonia&&Pneumothorax&&Support Devices 17559288 50750948 55d65e1e-1812835f-30e06612-c15a1621-fddc8581 1450 moderately severe widespread infiltrative pulmonary abnormality has improved . heterogeneity in the right lower lobe may represent cavitation or a region of pneumonia . pleural effusion is presumed, but not substantial . no pneumothorax . heart size normal . et tube and right jugular line in standard placements . nasogastric tube would need to be advanced cm to move all the side ports into the stomach . dr . was paged . Pleural Effusion&&Pneumonia&&Support Devices 17559288 51039446 03f20727-d42b6bb8-d53cb13f-c3eb462e-fb257484 1451 right internal jugular line ends at upper svc . ogt is seen to course below the diaphragm into the stomach, however the distal end is beyond the view of radiograph . bilateral, diffuse, ground-glass opacities concerning for infection per clinical history are unchanged since . heart size is normal . mediastinal and hilar contours are normal . no pleural effusion . Lung Opacity&&Pneumonia&&Support Devices 17559288 51757784 f3f33b0e-fe7c9ba5-dad10964-bc8ce4a1-b74ebb51 1452 as compared to the previous radiograph, the extent of the known right apical pneumothorax is unchanged . no signs of tension . correct position of the right chest tube . unchanged monitoring and support devices . unchanged extensive bilateral parenchymal opacity, caused by the known pneumocystis carinii pneumonia . Lung Opacity&&Pneumonia&&Pneumothorax&&Support Devices 17559288 51790690 f30ac310-feddb6e1-a0bf1a2c-4311961b-74a32eed 1453 comparison to at . single portable ap upright chest film, at is submitted . right internal jugular central line continues to have its tip in the mid svc . a feeding tube is seen coursing below the diaphragm with the tip not identified . there continues to be bilateral airspace disease with more focal patchy areas in the left mid and the right mid and lower lung consistent with a diffuse pneumonia in this immunocompromised patient . no pleural effusions . no evidence of pneumothorax . Lung Opacity&&Pneumonia&&Support Devices 17559288 51910000 888f3658-e541329c-5c12b9b9-10185f6d-11f0cd6c 1454 since the prior examination, there are low lung volumes . even accounting for decreased lung volumes, there is increased diffuse opacification, more prominent within the lower lobes, compatible with worsening disease . an enteric feeding tube is demonstrated coursing below the diaphragm . there is no evidence of pleural effusions or pneumothorax . the cardiomediastinal and hilar contours are stable . pulmonary vascularity is not increased . increasing diffuse opacification compatible with continued progression of disease . no evidence of pneumothorax . Lung Opacity 17559288 52177147 2365d0ef-d1cafbfe-24afa38d-5390baed-46e9e9ef 1455 single portable view of the chest is compared to previous exam from . left-sided picc is no longer seen . the lungs have shown interval resolution of the perihilar parenchymal opacities, they are now clear . cardiomediastinal silhouette is within normal limits . no acute cardiopulmonary process, resolution of previously seen bilateral parenchymal opacities . stable mild prominence of the left hila . 17559288 52265333 d68e61e0-f41d1489-ba3b0c4c-ae35171f-1abd4615 1456 in comparison with the study of , the monitoring and support devices remain in place . diffuse bilateral pulmonary opacifications are seen bilaterally, though with some mild improvement in aeration . although this could represent pulmonary edema, the absence of cardiac enlargement raises the possibility of a noncardiogenic cause . in the appropriate clinical setting, widespread pneumonia would have to be considered, as well as ards . Cardiomegaly&&Edema&&Lung Opacity&&Pneumonia&&Support Devices 17559288 52289887 78b0f724-759138a6-255f6ef3-48d0690c-4d9405cf 1457 comparison is made to prior study from . endotracheal tube, feeding tube, right-sided central venous catheters are unchanged in position . there are again seen diffuse airspace opacities bilaterally likely due to worsening of the pulmonary edema . heart size is within normal limits . there is prominence of the vascular pedicle, consistent with the edema . no pneumothoraces are present . Edema&&Lung Opacity&&Support Devices 17559288 52687222 56381c64-278c220e-719702c4-6e5d4bf7-193da1ab 1458 a right ij approach central line again terminates in the mid-to-distal svc . there is a new dobbhoff feeding tube, which is coiled within the stomach . bilateral multifocal parenchymal opacities are little changed from prior study . no new effusion or pneumothorax . stable cardiomediastinal silhouette . No Finding&&Support Devices 17559288 54071279 0cae2952-def96aa7-1e84fd97-cf21d3d3-341189c9 1459 as compared to the previous radiograph, the nasogastric tube has been removed . internal jugular vein catheter remains in unchanged position . the pre-existing bilateral diffuse parenchymal alveolar opacities with air bronchograms show a further slight increase in severity . there is no evidence of interval pleural effusions . minimal bilateral, left more than right areas of atelectasis . no pneumothorax, no pneumomediastinum . Atelectasis&&Lung Opacity&&Support Devices 17559288 54614197 7e6df081-ae0880f5-c5c3aba7-77eaa2c1-d46f09a8 1460 portable ap radiograph of the chest was reviewed in comparison to . the et tube tip is . cm above the carina . the right internal jugular line tip is at the level of mid svc . the ng tube passes below the diaphragm, most likely terminating in the stomach . cardiomediastinal silhouette is stable, but there is also no change in widespread parenchymal opacities involving the entire lungs bilaterally . Enlarged Cardiomediastinum&&Lung Opacity&&Support Devices 17559288 54970629 d295710b-13067198-5224086c-19034f1a-cec8b94f 1461 portable ap radiograph of the chest was compared to . heart size and mediastinum are stable . lungs are clear . no pleural effusion or pneumothorax is demonstrated . hyperinflation is re-demonstrated, substantial . a percutaneous feeding tube is projecting over the left upper quadrant . Cardiomegaly&&Enlarged Cardiomediastinum&&Support Devices 17559288 55226234 1b456b8e-4bd0f874-af8673f3-bc3c4d68-1820cf35 1462 ng tube tip is in the stomach . cardiomediastinal contours are normal . et tube is in a standard position . right ij catheter tip is in the mid-svc . there is no pneumothorax . bilateral pleural effusions with adjacent atelectasisconsolidations are better seen in concurrent ct . mild-to-moderate pulmonary edema has markedly improved . Atelectasis&&Consolidation&&Edema&&Pleural Effusion&&Support Devices 17559288 55553088 5180cc08-8134a7bf-2748567b-1fcd9fcf-836c902c 1463 since the prior examination there is little relevant change . a small to moderate right apical pneumothorax is unchanged . there is no evidence of tension . a right chest tube is in standard unchanged position . a right subclavian approach central venous catheter tip projects in the cavoatrial junction . an enteric feeding tube courses below the diaphragm out of field of view . there is unchanged diffuse asymmetrically distributed parenchymal opacification, compatible with known pneumocystis carinii pneumonia . no significant change . unchanged extent of a small-to-moderate right apical pneumothorax . Pneumothorax 17559288 56246644 cb254c2a-704a6902-121ca734-a8fdc3e1-b5111cb3 1464 upright ap view of the chest previously noted right apical pneumothorax is not visualized on the current study . the left picc tip remains in unchanged position within the upper svc . heart size is normal . aortic knob calcifications are again noted . worsening parenchymal opacities are demonstrated in both lungs, with more focal consolidative opacity in the right lung base . no pleural effusion is identified . there are no acute osseous abnormalities . . worsening diffuse parenchymal opacities in the lungs concerning for worsening pcp . more focal consolidation in the right lung base may represent a secondary pneumonic process . . previously noted small right apical pneumothorax is not visualized on the current exam . Consolidation&&Lung Opacity&&Pneumothorax 17559288 56336499 7438cd11-ca6cba83-c3d0b14e-b4f04d84-cdd824b4 1465 a left-sided picc line has been removed . the cardiac, mediastinal, and hilar contours appear unchanged . aside from streaky left basilar opacity suggesting minor atelectasis, the lungs appear clear . there is no pleural effusion or pneumothorax . no free air is demonstrated . a partly imaged catheter projects over the left upper quadrant of the abdomen, compatible with a gastrostomy tube . no evidence for free air or acute cardiopulmonary disease . No Finding 17559288 56488515 a3b20c27-ba0b465e-3eab2b86-991f3d46-80a07aee 1466 as compared to the previous radiograph, the monitoring and support devices are in unchanged position . unchanged bilateral diffuse parenchymal opacities, that are unchanged in extent . no newly appeared parenchymal opacities . no pleural effusions . borderline size of the cardiac silhouette without substantial areas of basal atelectasis . Cardiomegaly&&Lung Opacity&&Support Devices 17559288 56995004 a8d102b8-6cc0e5e7-21fc3831-79e95011-003fc4f9 1467 bilateral, diffuse, confluent pulmonary opacities is concerning for severe pulmonary edemaardshemorrhage although a concurrent infection cannot be excluded . heart size is normal . because of the diffuse pulmonary opacities obscuration the margins of the mediastinal and hilar contours, assessment was . bilateral, diffuse, confluent pulmonary opacities . differential diagnosis include severe pulmonary edema or ards or hemorrhage . concurrent lung infection cannot be ruled out . Edema&&Lung Opacity&&Pneumonia 17559288 57177744 494f62af-2213616c-20174f23-c3d781fd-fed10e18 1468 status post removal of a right chest tube, the known small right apical pneumothorax is decreasing in extent . no evidence of tension . the parenchymal opacities have substantially improved, particularly in the right middle and lower lung . no pleural effusions . normal size of the cardiac silhouette . Lung Opacity 17559288 57820639 464448a4-f1229c37-3a509617-2edb4a04-cef4335c 1469 in the interval, the patient has received a dobbhoff catheter . the catheter is coiled in the stomach, and the tip points upwards towards the proximal parts of the stomach . there is no evidence of complications, notably no pneumothorax . the pre-existing diffuse parenchymal opacities have minimally decreased in severity . Lung Opacity&&Support Devices 17559288 58408693 8cca0878-51f27942-9aec337b-398ae7fd-2014bdcb 1470 greater consolidation in the right mid lung of the diffuse infiltrative pulmonary abnormality could be due to progression of pneumonia, mild edema or local pulmonary hemorrhage . no pneumothorax or appreciable pleural effusion . normal cardiomediastinal and hilar silhouettes . feeding tube ends in the stomach . right jugular line ends in the low svc . Consolidation&&Edema&&Pneumonia&&Support Devices 17559288 58500412 7178c919-44dfb11d-9c099d27-1eb09d58-3cc6cb14 1471 since prior radiograph acquired hours apart, bilateral, diffuse and confluent opacities show asymmetric changes with mild improvement in the right and worsening in left lung, overall unchanged in severity . heart size and mediastinal contours are normal . since prior radiograph acquired hours apart, bilateral, extensive, pulmonary opacities concerning for pulmonary edemaardshemorrhage is overall unchanged in severity . a concurrent infection cannot be ruled out . Edema&&Lung Opacity&&Pneumonia 17559288 59217802 bf8bed6d-ee8d4d92-df4bc99c-0733597b-e4a90442 1472 in comparison with the study of earlier in this date, there has been placement of a right chest tube with some decrease in the still moderate apical pneumothorax . remainder of the study is unchanged . Pneumothorax&&Support Devices 17559288 59397370 293051c7-fe34be87-e9c6cd58-0e979833-3f579639 1473 endotracheal tube ends approximately cm above the carina and is appropriate . right internal jugular line terminates at mid svc . an orogastric tube is seen to course below the level of the diaphragm into the stomach however, distal end is beyond the view of radiograph . bilateral, diffuse, lung opacities reflecting moderate-to-severe pulmonary edema, improved between and , but since then has minimally worsened . top normal sized heart, mediastinal and hilar contours are stable in appearance . bilateral moderate-to-severe pulmonary edema has worsened over last hours . Edema 17559288 59460245 8bae8ab0-e159b156-5842575c-b4b8c1ae-e9c64339 1474 the patient has been extubated and the orogastric tube has been removed . right ij central line again extends to the mid svc . widespread pulmonary opacities appear slightly more confluent at the right lung base, though there is slightly improved aeration in the retrocardiac region . the appearance at the right base may reflect atelectasis in the setting of extubation . presumed effusions are again not readily apparent . there is no pneumothorax . hilar and cardiomediastinal contours are unchanged . there is no free air in the upper abdomen . Lung Opacity 17559288 59602068 7cd4e7d0-69d6bb9f-93a8c61e-941e3664-68a658d2 1475 in comparison with the earlier study of this date, there has been placement of an endotracheal tube with its tip approximately . cm above the carina . diffuse bilateral pulmonary opacifications are again seen, possibly even more intense than previously on the right . Lung Opacity&&Support Devices 17559288 59762894 94cf13e6-4ce08671-ed55ba8e-42a83718-37c56071 1476 in comparison with the study of , there is little change in the diffuse primarily reticular changes involving both lungs, consistent with the diagnosis of pcp . the endotracheal tube has been removed . the other monitoring and support devices are essentially unchanged . Support Devices 17559288 59847097 5c817d58-918d46f3-7e31bce6-2a7e7cd8-f30eaae6 1477 the lungs are well inflated and clear . the cardiomediastinal silhouette, hila contours, and pleural surfaces are normal . there is no pleural effusion or pneumothorax . there is no pneumoperitoneum . no evidence of pneumoperitoneum . clear lungs . No Finding 17561996 53913349 24849e83-f5ccffbb-364e8c3a-9c1bcd91-dd0d628f 1478 an endotracheal tube terminates at the orifice of right mainstem bronchus . an enteric tube passes far into the stomach . evaluation of the chest is limited due to multiple overlying lines and tubes . within this limitation, there are widespread interstitial opacities throughout the right lung with a basilar predominance as well as the left lung base . there is mild pulmonary vascular congestion and subtle kerley b lines suggesting interstitial edema . a small right pleural effusion cannot be excluded . no pneumothorax is detected on this semi-erect view . the cardiac silhouette is incompletely visualized in the setting of bibasilar opacities . the mediastinal contours are prominent due to tortuosity of the thoracic aorta with partial calcification of the aortic knob . densities projecting over the right humerus and soft tissues of the upper arm are likely external to the patient . . right mainstem intubation . recommend re-positioning . . asymmetric pulmonary interstitial edema and vascular congestion on the right greater than the left . superimposed infection cannot be excluded in the appropriate clinical context . Edema&&Pneumonia 17617589 53371757 d3e8fc04-74fae9fb-787da683-4705e3a6-8e7dd7a6 1479 as compared to the previous radiograph, the previously malpositioned endotracheal tube has been pulled back . the tip of the tube now projects approximately - cm above the carina . the course of the nasogastric tube is unchanged . unchanged appearance of the moderately enlarged cardiac silhouette and of the preexisting parenchymal opacities . these have not changed in extent and severity . Cardiomegaly&&Lung Opacity&&Support Devices 17617589 57385565 51356fab-8f076a2e-2d204a97-8c47b3ca-0b015c10 1480 ap single view of the chest has been obtained with patient in sitting upright position . analysis is performed in direct comparison with the next preceding similar study of . high-positioned diaphragms conceal major portion of cardiac silhouette, but significant cardiac enlargement is unlikely . the thoracic aorta is mildly widened and elongated but does not demonstrate any local contour abnormalities . the pulmonary vasculature is not congested . there exists bilateral plate thin atelectasis . there is no evidence of any new discrete pulmonary parenchymal infiltrate of pneumonic nature . also, the lateral pleural sinuses are free, which excludes major pleural effusion . no pneumothorax identified in right apical area . a right internal jugular approach central venous line remains similar as on the preceding study . bilateral basal plate atelectasis, high-positioned diaphragms, no evidence of new acute parenchymal infiltrates or pleural effusion . no pneumothorax . Atelectasis&&Lung Opacity&&Pleural Effusion&&Support Devices 17622916 50758668 cf1b8e9d-4f84cf87-e2281943-859fbd1a-ec648bdf 1481 as compared to prior chest radiograph from , patient has been extubated, and there are lower lung volumes . bibasilar opacities have increased, likely reflecting a combination of pleural effusion and atelectasis . however, an underlying early infectious process cannot be excluded . right ij central venous catheter tip lies at the level of the cavoatrial junction . nasogastric tube extends into the gastric fundus . worsening bibasilar opacities which likely reflect a combination of pleural fluid and volume loss . however, in the appropriate clinical setting, an underlying early infectious process cannot be excluded . Lung Opacity&&Pleural Effusion&&Pneumonia 17622916 54905271 9ab97962-156e4dae-c1188f7d-7dae9ea4-c5a69d40 1482 in comparison with study of , there is now an endotracheal tube in place with its tip approximately cm above the carina . right ij swan-ganz catheter tip lies at the level of the cavoatrial junction . nasogastric tube extends well into the stomach . continued low lung volumes with bibasilar atelectatic changes . blunting of the costophrenic angles is consistent with pleural fluid . Atelectasis&&Pleural Effusion&&Support Devices 17622916 55309653 2e1cd5e0-fd2c7f50-176e7b18-1f7ac651-bcf8152a 1483 in comparison with the study of , there again are bilateral pleural effusions with evidence of pulmonary vascular congestion and compressive atelectasis at the bases . in the appropriate clinical setting, superimposed pneumonia would have to be considered . the right ij catheter extends at least to the cavoatrial junction and quite probably into the upper portion of the right atrium . Atelectasis&&Edema&&Pleural Effusion&&Pneumonia&&Support Devices 17622916 57419136 468df880-10005e8e-d4fa6433-d08fa89c-7b141448 1484 the lungs are clear . heart size and mediastinal contours are normal . there is no pleural effusion or pneumothorax . degenerative changes are noted at the shoulders . no acute cardiopulmonary process . No Finding 17657668 56393977 313ea739-0a9a0ae2-1c998dba-cdecfea2-567819cd 1485 the tip of dual-lumen hemodialysis catheter through the right internal jugular approach is partially curled and unchanged since prior study . monitoring and supporting devices are in standard position . bilateral diffuse, lung opacities representing mild to moderate pulmonary edema has improved . opacity in right lower has progressed and it is likely due to aspiration . small right pleural effusion is unchanged . Edema&&Lung Opacity&&Pleural Effusion&&Support Devices 17660889 50363438 bb6dd3b1-bf62aa24-b39fba26-f00d7c46-fe9658a3 1486 a newly placed endotracheal tube ends at the thoracic inlet . dual-channel right supraclavicular central venous dialysis catheter ends low in the svc . nasogastric tube passes into the stomach and out of view . no pneumothorax or pleural effusion . moderate-to-severe enlargement of the cardiac silhouette is longstanding . pulmonary edema which worsened from to has subsequently improved, but is mild and slightly worse compared to earlier in the day . Cardiomegaly&&Edema&&Support Devices 17660889 51233577 dfef7b7e-62b05c07-d04db5b0-e12181ec-ab79f1d0 1487 the left internal jugular line is currently crossing the midline through the left brachiocephalic vein, most likely continuing towards the right internal jugular vein and should be repositioned . the hemodialysis catheter tip continues to be looped in the superior mid svc . the patient is in slightly worsened pulmonary edema . there is no change in the cardiomediastinal silhouette, position of the ng tube and the et tube . Edema&&Enlarged Cardiomediastinum&&Support Devices 17660889 51258980 5602b830-58232330-2bb725b9-3a407c98-3ace2a37 1488 the endotracheal tube tip is . cm above the carina . a left internal jugular approach catheter tip terminates within the lower svc . a large-bore venous catheter via right internal jugular approach is in stable position curving into the azygous . a dobbhoff feeding is demonstrated within the stomach . diffuse severe pulmonary edema is worsened since the prior examination . there is bibasilar atelectasis . there are no pleural effusions or pneumothorax . mild interval worsening of now severe interstitial pulmonary edema . otherwise, stable standard positions of hardware . Edema&&Support Devices 17660889 52206316 c5e117fa-2d2eb000-fb83fe99-ba779346-4bafd663 1489 comparison is made with prior study performed a day earlier . lines and tubes remain in unchanged position including kinking of the distal large right supraclavicular catheter . severe cardiomegaly is stable . there is no pneumothorax . moderate-to-severe pulmonary edema is unchanged . right lower lobe opacities have increased consistent with increased atelectasis . left lower lobe atelectasis has improved . Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Support Devices 17660889 52835139 082b7c54-b543f7eb-6131a843-2ad68a17-26f98ca2 1490 moderately severe pulmonary edema has improved minimally since . a large region of opacification in the right lower chest could be loculated pleural fluid or consolidation in the right lower lobe, a concern for pneumonia . uniform opacification in the left lower lobe, obscuring the entire diaphragmatic interface has worsened appreciably and could be due to pneumonia or dramatic worsening of atelectasis . et tube and left internal jugular line are in standard placements . a large bore right-sided central venous catheter may hook into the azygos vein . no pneumothorax . Atelectasis&&Consolidation&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices 17660889 54956015 569f137a-5df7c2fe-e17acef1-d50a45fc-affedf84 1491 single supine portable radiograph of the chest was reviewed in comparison to prior chest radiographs through through . the distal end of the right-sided hemodialysis catheter is partially looped, unchanged from prior radiographs from and . tip of endotracheal tube ends . cm above the carina and is appropriate . patient is status post medial sternotomy with intact sternal sutures . orogastric tube is seen to course below the diaphragm into the stomach, however, the distal end is beyond the radiograph view . mild-to-moderate pulmonary edema, moderately enlarged heart, mediastinal and hilar contours are stable . increased retrocardiac density reflecting left lower lung atelectasis is new . mild right infrahilar atelectasis has minimally worsened . Atelectasis&&Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Support Devices 17660889 54985815 2bba3f51-24971b01-0e8a666e-dedf8909-61742c95 1492 there is moderate-to-severe cardiomegaly with moderate pulmonary edema, slightly improved compared to yesterday . there is minimal blunting of the costophrenic angles, consistent with small pleural effusions . a right subclavian hemodialysis catheter is at the distal svc . no pneumothorax . there are no concerning lung consolidations . moderate-to-severe cardiomegaly and mild pulmonary edema, slightly improved since yesterday . Cardiomegaly&&Edema 17660889 55083011 84f56140-5f674b67-4431f058-4752511b-24be0d89 1493 upright ap view of the chest right-sided central venous catheter tip terminates in the svc . patient is status post median sternotomy and mitral annular repair with several anterior mediastinal clips redemonstrated . moderate cardiomegaly persists . there is continued mild congestive heart failure with perihilar haziness and vascular indistinctness, which appears slightly worse in the interval . no large pleural effusion or pneumothorax is visualized . there are no acute osseous abnormalities . the aorta remains calcified . Cardiomegaly&&Edema 17660889 55570682 f2cdfb35-5e55a845-072cade1-37104e77-15844094 1494 in comparison with the study of , there is continued substantial cardiomegaly with mild-to-moderate pulmonary edema . hemodialysis catheter again extends to the mid-to-lower portion of the svc . mild basilar atelectasis without frank pneumonia . Atelectasis&&Cardiomegaly&&Edema&&Support Devices 17660889 56605758 a680d992-08c800c8-27ab9581-4d70707a-cb5d31db 1495 question infection . pulmonary edema worsened from through , and has remained relatively stable since although there is more opacification in the right lower hemithorax which could be posterior pleural effusion layering in the supine patient . supine positioning probably accounts for some increase in pulmonary vascular congestion in the upper lungs though moderate cardiomegaly is stable and there is no mediastinal vascular engorgement to speak of . a large bore catheter still cannulates the azygous vein . et tube is in standard placement and a nasogastric feeding tube passes into the stomach and out of view . no pneumothorax . Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices 17660889 57078296 ec28f7bb-28ea31db-2380e13d-96518c46-1c3b59d4 1496 previous mild pulmonary edema has improved, but moderate pulmonary vascular engorgement persists . moderate cardiomegaly is chronic . there is no appreciable pleural effusion . a dual-channel right supraclavicular central venous dialysis catheter ends in the low svc, as before . Cardiomegaly&&Edema&&Support Devices 17660889 58199826 13875055-a92c44c3-772d6e38-332cff16-3ed6380f 1497 in comparison with the study of , the monitoring and support devices remain in place . continued enlargement of the cardiac silhouettes with some improvement in pulmonary edema . the area of increased opacification at the right base is not definitely appreciated . poor definition of the left hemidiaphragm is consistent with some volume loss in the left lower lobe or possible supervening pneumonia . Cardiomegaly&&Edema&&Lung Opacity&&Pneumonia&&Support Devices 17660889 58789604 904cd93c-1da40b8a-14194a57-7ba145c9-66af87e3 1498 as compared to the previous radiograph, the bilateral parenchymal opacities have minimally increased . no other changes . moderate cardiomegaly without pleural effusions . unchanged monitoring and support devices . the double-lumen right-sided central venous access line might have its tip positioned in the azygos vein . Cardiomegaly&&Lung Opacity&&Support Devices 17660889 58965143 425c4fa7-0d48e151-0758d818-9e8b1ea9-e9074977 1499 in comparison with the study of , the tip of the endotracheal tube is approximately . cm above the carina . there is continued enlargement of the cardiac silhouette with continued pulmonary edema . no acute focal pneumonia or pleural effusion . dual-channel right supraclavicular central venous dialysis catheter again extends to the mid-to-lower portion of the svc . Cardiomegaly&&Edema&&Support Devices 17660889 59218047 2a88d2ea-b4df4439-14b9c286-c0e29650-2acedd69 1500 moderately severe pulmonary edema has changed in distribution but not in overall severity . previous right lower lobe collapse has substantially improved . small right pleural effusion is presumed . severe cardiomegaly has decreased . et tube, left internal jugular line, and nasogastric feeding tube are in standard placements . the dual-channel right-sided central venous line still cannulates the azygous vein . no pneumothorax . Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices 17660889 59585133 015ea7fc-c85de02a-66fb71f2-6ba30068-7bc3cd06 1501 right port-a-cath ends at upper svc, left internal jugular line terminates at lower svc, and an endotracheal tube terminates approximately . cm above the carina all are in appropriate position . feeding tube is seen to course below the diaphragm into the stomach however, its distal end is off radiographic view . mild to moderate bilateral pulmonary edema is unchanged since , however pulmonary vascular congestion appear little more than before . mild to moderately enlarged heart, mediastinal and hilar contours are stable . mild to moderate pulmonary edema, unchanged since . Edema 17660889 59588714 442f2cb0-2fcd458a-939733cf-ba72f0cc-0fed5672 1502 comparison is made to the patients prior study of and . a portable semi-erect chest film at am . is submitted . . right internal jugular hemodialysis catheter is unchanged in position . left internal jugular central line with its tip in the superior vena cava . endotracheal tube has its tip approximately . cm above the carina . a nasogastric tube is seen coursing below the diaphragm with the tip not identified . . there has been interval worsening of the diffuse bilateral airspace process, likely representing worsening pulmonary edema, less likely superimposed infectious process . no pleural effusions . no evidence of pneumothorax . heart remains borderline enlarged . aorta is calcified . Edema&&Pneumonia&&Support Devices 17660889 59755997 7c25c976-41dc34c9-ccd3aa02-da854aa5-27de7109 1503 pa and lateral views of the chest provided . left-sided chest tube, endotracheal tube, swan-ganz catheter, and nasogastric tubes have been removed . there is a small pneumothorax in the left apex . there is increased hazy opacity in the right lower lung, likely reflecting layering effusion combined with loss of lung volume . compared to prior study, there is slightly more pulmonary vascular congestion . heart size has increased in size . small pneumothorax in the right apex . Pneumothorax 17680905 57350348 aec99028-85963e75-247669dd-f5c64825-6802b7c4 1504 the heart is mildly enlarged . the aorta is mildly tortuous and calcified . there is a intra-aortic balloon pump with the tip obscured . an exact measurement below the aortic knob cannot be obtained . it is at least in the upper descending aorta . there is patchy areas of alveolar edema . there is mild pulmonary vascular redistribution . there is no pleural effusion . there is no focal infiltrate . intra aortic balloon pump in the upper to mid descending thoracic aorta . no pleural effusion . no convincing findings for pneumonia . Pneumonia 17680905 59156144 231fd0bd-bf21c178-9c9bbc5a-d859a30c-7086f6a6 1505 no relevant change as compared to the previous radiograph . improved ventilation of the lung bases . no evidence for the presence of a pneumothorax . a minimal right pleural effusion might be present . no pulmonary edema . unchanged alignment of the sternal wires . unchanged postoperative appearance of the cardiac silhouette . Cardiomegaly&&Pleural Effusion&&Pneumothorax 17680905 59435140 52d0b1e8-13061056-a5c5ab19-2b06aa45-a87d4502 1506 the intra-aortic balloon pump tip is mm below the aortic knob the remainder the appearance of the chest is unchanged . No Finding 17680905 59578157 5706865f-64746402-2e5c6bfb-943aa9c1-3e276a08 1507 comparison is made with prior study, . mild-to-moderate cardiomegaly and very tortuous aorta are unchanged . bibasilar opacities are new this could be due to atelectasis andor aspiration . minimal opacities in the left perihilar region also could be due to atelectasis or aspiration . there is no pneumothorax or large effusions . scoliosis is again noted . Atelectasis&&Cardiomegaly&&Lung Opacity 17691303 57672159 cfa78cb8-df874080-6760f3a6-8aac74fb-ca97b6d9 1508 ap portable upright view of the chest . cardiomegaly is again seen . the mediastinal contour is unchanged from prior . the hila appear congested though there is no frank edema . no large effusion or pneumothorax . no convincing evidence for pneumonia . bony structures are intact . cardiomegaly and hilar congestion . no frank edema or pneumonia . Cardiomegaly 17933711 53605255 262aec66-02c3d815-9e02b897-1f697799-42735ce8 1509 in comparison with study of , there is again prominence of the cardiac silhouette with left ventricular configuration . no vascular congestion, pleural effusion, or acute focal pneumonia . Cardiomegaly 17933711 58596812 6c9b8bc4-94ef9ac4-cd7187f1-d90c32b0-75b2e5a5 1510 single frontal view of the chest demonstrates marked levoconvex thoracic scoliosis, distorting cardiomediastinal contours . allowing for such the heart is normal in size . an air-fluid level projecting over the heart is consistent with a large hiatal hernia . the lungs are clear, without evidence of pneumothorax, consolidation, or pleural effusion . . no definite evidence of acute cardiopulmonary process, including pneumonia or pulmonary edema as queried . . marked thoracic scoliosis and moderate to large hiatal hernia . Edema&&Pneumonia 17934731 52852563 b08aaf75-27433984-2f2fe0d6-12a22932-c87cc8d7 1511 the left-sided pacemaker and wires are unchanged in position . there is a persistent right middle lobe opacity, stable . there is also prominence of the pulmonary interstitial markings which have worsened . there are no pleural effusions or pneumothoraces . there is extensive thoracic aortic calcification . heart size is enlarged . Cardiomegaly&&Lung Opacity&&Support Devices 17945610 50752160 abc19309-ae3abcce-b79cc9e9-7b84b6a2-e61602d6 1512 ett tip is in standard position . an enteric tube traverses the diaphragm with its tip not seen . the stomach is non-distended . left jugular line is appropriately positioned . dual lead cardiac device is overall unchanged in position with tip ending in the right atrium and the other in the right ventricle . right-sided pigtail catheter projects over the right hemithorax and right mediastinum and appears intact . right upper lobe opacity persists, but lower lung opacities are significantly improved . the right pleural effusion appears resolved . hazy opacification of the left costophrenic angle and the left lung base suggests persistent layering small pleural effusion . no change in retrocardiac opacity which may represent atelectasis, although focal consolidation cannot be excluded in appropriate clinical setting . no pneumothorax . stable appearance of the cardial mediastinal silhouette without cardiomegaly . . improved edema with persistent right upper lobe opacity concerning for concurrent pneumonia . . resolved right pleural effusion . Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia 17945610 51154172 53aeee8a-c2f7a428-34ede058-f7d0aa79-183fc763 1513 previous moderate right pleural effusion is smaller . heterogeneous opacification right lung looks unchanged since , but more abnormal than earlier in the day which may be due to recent hemoptysis . left lung is grossly clear . moderate cardiomegaly is chronic . atrioventricular pacer leads in standard placements . Cardiomegaly&&Lung Opacity&&Pleural Effusion&&Support Devices 17945610 51234546 4f0b2afa-30cb00e2-18711010-d4bc3f13-84cc4f7a 1514 as compared to radiograph, cardiac silhouette remains markedly enlarged . right heart border and majority of right hemidiaphragm now obscured, likely due to worsening consolidation and or atelectasis in this region, accompanied by a small to moderate pleural effusion . pulmonary vascular congestion is accompanied by resolving edema . no other relevant changes . Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Pleural Effusion 17945610 51621842 3845e98f-500b7d8f-b2376aa8-3355c4fa-074d73d0 1515 an et tube is present, tip approximately . cm above the carina . left ij central line is present -- tip partially obscured, but likely overlying the mid svc . no pneumothorax is detected . there is extensive somewhat patchy opacification of the right lung, with air bronchograms . there is a vascular plethora in the left lungthere is increased retrocardiac density, consistent with left lower lobe collapse andor consolidation . probable small right-greater-than-left effusions . biapical pleural scarring is present . a left-sided dual lead pacemaker is present, with lead tips over the right atrium and right ventricle . there is cardiomegaly . aortic calcification is present . osteopenia and scoliosis of the spine are noted, not fully evaluated . . et tube approximately . cm above the carina . left ij central line tip over mid svc . no pneumothorax detected . . extensive opacification of the right lung, with air bronchograms . the differential diagnosis includes pulmonary edema, as chf is also seen the left lung, and infection or, in the appropriate clinical setting , ards . . left lower lobe collapse andor consolidation . . bilateral right-greater-than-left effusions . Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices 17945610 51939978 a9415ba1-3d12f1ec-964b6738-a9e76fa5-30aca88b 1516 the ett is in standard position . the right pigtail catheter also appears intact and unchanged in position projecting over the right aspect of the mediastinum in the lower hemithorax . the enteric tube crosses the midline and the is tip is not seen . the stomach is nondistended . bilateral pulmonary edema has markedly improved since and minimally improved since , now mild in severity . persistent focal right upper lobe opacity could represent concurrent pneumonia . hazy opacification blunting of the left costophrenic angle is overall similar and suggest persistent small left pleural effusion . no definite right pleural effusion . mild to moderate cardiomegaly persists and is unchanged . the mediastinum is not widened . no pneumothorax . aortic knob calcifications are re- demonstrated . dextroconvex scoliosis of the thoracic spine is unchanged . improving, now mild, pulmonary edema with persistent right upper lobe opacity which could represent concurrent pneumonia . Edema&&Lung Opacity&&Pneumonia 17945610 52122560 889de77f-1402d0bf-fd2d2420-a6980f4b-09ae6ed7 1517 with the chin down, tip of the new endotracheal tube less than a cm from the carina is . cm below appropriate positioning . esophageal drainage tube passes into the stomach and out of view . new left internal jugular line ends in the low svc . transvenous right atrial right ventricular pacer leads continuous from the left pectoral generator . previous mild pulmonary edema has improved or cleared, but there is still very severe bilateral pulmonary consolidation, worst throughout the right lung but in the left lower lobe as well . this is pneumonia andor pulmonary hemorrhage . moderate bilateral pleural effusion, right greater than left, has increased since , probablya reflection of previous transient heart failure . Cardiomegaly&&Consolidation&&Edema&&Pleural Effusion&&Pneumonia&&Support Devices 17945610 53456512 ba6dbc8f-1a49e9ff-024c2020-64ad895a-bca8cb55 1518 obscuration of the right heart border with wedge opacity projecting over the right middle lobe is noted . lungs are otherwise notable for increased interstitial markings, overall improved since priors . there is no effusion . mild cardiomegaly is again seen . left chest wall dual lead pacing device is again noted . ivc filter visualized within the abdomen . right middle lobe opacity compatible with atelectasis and posssible infection . Atelectasis&&Lung Opacity&&Pneumonia 17945610 54490035 ab618eee-2a493884-a478b561-100f5f42-562e5657 1519 compared with at , the et tube, ng tube and left ij central line have been removed . the right pigtail has also been removed . minimal blunting of the right costophrenic angle is very slightly greater . no pneumothorax or other evidence of right-sided effusion is identified . allowing for technical differences, there is otherwise minimal interval change . again seen is focal sclerosis in the right proximal humerus . is there history of old healed fracture . no lucent fracture line is identified . as above . No Finding 17945610 54832536 35b9c6fa-00c88823-d2b016e7-860235a2-35e10b1b 1520 as compared to the previous radiograph, there is a slight increase of the moderate right pleural effusion . moderate cardiomegaly persists . the pacemaker wires are in unchanged position . normal appearance of the left lung . Cardiomegaly&&Pleural Effusion&&Support Devices 17945610 55278676 03c75931-b2196163-ee0a3e6e-0decfe16-830818ae 1521 left-sided pacemaker with leads are unchanged in position . there is unchanged cardiomegaly . there is mild improved aeration . there remains prominence of the pulmonary interstitial markings . there is an opacity at the right medial heart border . this may represent pneumonia or aspiration . no pneumothoraces are seen . Cardiomegaly&&Lung Opacity&&Pneumonia&&Support Devices 17945610 56803911 7faad21d-d5e10065-97ed8c34-1de6fab7-d7a77f09 1522 et tube has been repositioned, in standard placement . slight increase in the extent of opacification in the right lung is probably due to a decrease in moderate bilateral pleural effusion, right still greater than left, rather than much change in severe bilateral pulmonary consolidation due to pneumonia andor pulmonary hemorrhage . mild cardiomegaly is stable . other lines and tubes in stable, standard positions . no pneumothorax . Cardiomegaly&&Consolidation&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices 17945610 58920910 ccdf59cc-7eee47c2-02d0bc2e-3a7bcf33-0a35c23e 1523 as compared to the previous image, the patient has received a pigtail catheter inserted into the right pleural space . the catheter has drained parts of the pre-existing right pleural effusion . no evidence of pneumothorax . on the left, after an attempt of tube placement, there is no evidence for the presence of a pneumothorax . the nasogastric tube and the endotracheal tube are unchanged . unchanged appearance of the cardiac silhouette . Cardiomegaly&&Pleural Effusion&&Pneumothorax&&Support Devices 17945610 59139883 d1049806-4b17d015-4e13b1d0-05247bd2-7b72efcb 1524 no previous images . there is a left chest tube following a vats wedge resection with probably a tiny apical pneumothorax . the cardiac silhouette is within normal limits and there is no vascular congestion, pleural effusion, or acute focal pneumonia . Pneumothorax&&Support Devices 17971994 51622821 6660e8d2-6381a94a-843d96da-11713488-59a660eb 1525 comparison is made with prior study, . there is mild cardiomegaly . the aorta is tortuous . the mediastinum and hilum are within normal limits . there is mild vascular congestion . there is no pneumothorax . bibasilar opacities larger on the left side are new . this could be due to atelectasis but superimposed infection could not be excluded . Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pneumonia 17978047 56446041 86dbc6ef-f634f370-e999d971-ce11f386-667e8955 1526 the patient is intubated, the tip of the endotracheal tube projects cm above the carina . to right and left-sided chest tube are in place . nasogastric tube shows a normal course . left retrocardiac atelectasis . minimal right pleural effusion . no visible pneumothorax . non displaced rib fractures described on the ct examination from , , are not visualized on the radiograph . Atelectasis&&Fracture&&Pleural Effusion&&Support Devices 18007398 50340409 3eeeb2ac-9bca9174-549fbb9e-0dad8292-81377269 1527 no focal consolidation, pleural effusion, or pneumothorax is seen . heart and mediastinal contours are within normal limits . two nodular opacities project over the right anterior second rib . . no radiographic evidence for acute cardiopulmonary process . . possible right upper lobe nodules . shallow oblique views are recommended for further evaluation . these findings and recommendations were discussed with dr . by dr . by telephone at am . on . Lung Lesion 18014772 54285117 a6d4bff1-d42c2ba8-4e17dc8b-1cd7a3a8-46d67185 1528 hardware is seen within the lower cervical spine . cardiomediastinal silhouette is within normal limits . there has been improved aeration since the prior study . there remains atelectasis at the lung bases and likely a small left-sided pleural effusion . there are no pneumothoraces . severe scoliosis of the thoracolumbar spine is again seen . Atelectasis&&Pleural Effusion&&Support Devices 18043502 54358320 c3429ad6-8e5e462a-4c90cdef-f2d92103-a0820652 1529 the study is somewhat limited due to the patients thoracolumbar scoliosis as well as the chin projecting over the lung apices . cardiomediastinal silhouette is within normal limits . there is a left-sided pleural effusion and a left retrocardiac opacity . there are no signs for overt pulmonary edema or pneumothoraces . Edema&&Lung Opacity&&Pleural Effusion&&Pneumothorax 18043502 57430048 f720a50a-3a52b680-e44f6730-6f239683-55ab1ac3 1530 frontal and lateral views of the chest compared to the most recent prior chest radiograph of , there has been an interval decrease in lung volumes and interval development of bibasilar patchy airspace opacities . the cardiac and mediastinal contours are stable . mild pulmonary vascular congestion is present and probable trace bilateral pleural effusions . there is no pneumothorax . surgical clips project over the left upper abdomen . interval development of left greater than right bibasilar opacities, possibly atelectasis, but aspiration or pneumonia cannot be excluded . mild pulmonary vascular congestion and probable trace bilateral pleural effusions . Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia 18057037 50285888 e4a62f0a-718060e7-49ef0069-e95d38ff-96fac7fd 1531 volume loss in both lower lungs has increased compared to the prior day . the heart size is mildly enlarged and there is mild pulmonary vascular redistribution . an underlying infectious infiltrate cannot be excluded . Cardiomegaly&&Lung Opacity&&Pneumonia 18057037 50572963 ab80b235-0f6e4319-62504f7b-e293fad3-0ad33347 1532 ap and lateral chest radiographs . lung volumes remain low with right basilar atelectasis, similar to recent radiographs . the main pulmonary artery remains markedly enlarged . small bilateral pleural effusions are similar to cta chest of . there is no pneumothorax . moderate cardiomegaly is stable . surgical clips are noted in the upper abdomen . Atelectasis&&Cardiomegaly&&Pleural Effusion 18057037 51935226 57ae3cb1-97ee6261-ad57fd24-2fdfb967-9f57b03e 1533 compared to the prior film, there is new chf, with upper zone redistribution, diffuse vascular blurring and areas of interstitial and alveolar edema . this is asymmetrically more prominent on the right, present but less pronounced on the left side . there are low inspiratory volumes, but the possibility of bibasilar collapse andor consolidation cannot be excluded . the basilar findings are relatively similar to the prior film . small left effusion again noted . multiple clips again incidentally noted in the abdomen . . new chf with interstitial and probable early alveolar edema . . bibasilar collapse andor consolidation and small left effusion similar to the radiograph . Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Pleural Effusion 18057037 51940572 7aba81f6-645a2f48-7aa04bfb-489d2880-2f72270c 1534 frontal and lateral views of the chest . the cardiac and mediastinal silhouettes are stable . prominence of the interstitial markings as well as bilateral patchy airspace opacities consistent with pulmonary edema which is new since . moderate, left greater than right, pleural effusions are unchanged . no pneumothorax is identified . there are surgical clips in the left upper abdomen . there is eventration of the right hemidiaphragm . new mild pulmonary edema and unchanged small bilateral pleural effusions, since . Edema&&Pleural Effusion 18057037 52244987 57949fd6-88aba5c8-27f26572-80587301-346f13c9 1535 comparison is made to the prior radiographs from . heart size is enlarged but stable . there is atelectasis at the lung bases . there are again seen bilateral pleural effusions, left worse than right and there is prominence of the pulmonary interstitial markings which is slightly improved . there are no pneumothoraces . Atelectasis&&Cardiomegaly&&Lung Opacity&&Pleural Effusion 18057037 53273352 d37198a2-d588ccee-08feb12c-5d4942b3-98453d12 1536 the cardiac, mediastinal, and hilar contours appear stable including enlargement of the heart and main pulmonary artery contour . the lung volumes are low . there are somewhat increased patchy densities at both lung bases which are not specific but which can probably be explained by atelectasis particularly on the left, also perhaps coinciding small pleural effusion . there is similar mild interstitial abnormality, although vasculature appears more distinct, suggesting improvement . Atelectasis&&Cardiomegaly&&Enlarged Cardiomediastinum&&Pleural Effusion 18057037 53912941 e7159328-08569709-798aa964-ee7f2027-c51daa27 1537 there is new pulmonary vascular cephalization and mild interstitial pulmonary edema, compared to the prior radiograph from . atelectasis in the right middle lobe is substantial no pneumothorax or large pleural effusion is seen . mild cardiomegaly is chronic . the mediastinal contours are otherwise normal . multiple surgical clips project over the left mid-to-upper abdomen . there is levoscoliosis of the thoracolumbar spine . . new mild interstitial pulmonary edema . chronic mild cardiomegaly . . new right middle lobe atelectasis . Atelectasis&&Cardiomegaly&&Edema 18057037 54064052 af3f9a0c-07676bf2-1d617e8f-3296d7ff-7c04924a 1538 atelectasis or consolidation in the right middle lobe is increased since , and lateral view showed small bilateral pleural effusions, probably unchanged . mild cardiomegaly and mediastinal vascular engorgement stable . upper lungs grossly clear . no pneumothorax . Atelectasis&&Cardiomegaly&&Consolidation&&Pleural Effusion 18057037 54565799 d41856c5-443e32f5-5cb1c4d7-e56e908c-563ca827 1539 in comparison with study of , there are continued relatively low lung volumes with bilateral pleural effusions, more prominent on the right, with compressive atelectasis at the bases . some elevation of pulmonary vascularity is seen . the left lung is essentially clear . given the low lung volumes and effusion on the right, it would be difficult to exclude supervening pneumonia in the appropriate clinical scenario . of incidental note is an apparent curvilinear opacification just above the right humeral head, worrisome for calcific tendinosis in the rotator cuff or calcific deposits in the deltoid bursa . Atelectasis&&Lung Opacity&&Pleural Effusion 18057037 55093079 dee24a5d-8e44ec45-f88ab6f6-4846c054-3da6b73d 1540 comparison is made with prior study performed the same day earlier in the morning . mild edema has improved . there are persistent low lung volumes . bibasilar atelectasis larger on the right, have increased on the left . there is no pneumothorax . cardiomegaly cannot be assessed . bilateral effusions are small . surgical clips project in the left upper quadrant . Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion 18057037 55180678 e90a2054-7960de3e-ea00d408-b6a8048d-5361011d 1541 lung volumes are low . assessment of the apices is somewhat obscured by the patients chin and soft tissues of the neck projecting over and obscuring this region . the heart size appears unchanged, which is within normal limits . there does appear to be a left ventricular predominance . the mediastinal and hilar contours are unchanged . there is crowding of the bronchovascular structures as a result of low lung volumes . streaky opacities in the lung bases likely reflect atelectasis, and appear improved compared to the previous radiograph . no pleural effusion or focal consolidation is seen . there is no pneumothorax . numerous clips are demonstrated in the left upper quadrant of the abdomen . diffuse demineralization of the osseous structures is redemonstrated . low lung volumes with improving bibasilar atelectasis . Atelectasis 18057037 56972774 3ada78bb-a6dcb49e-ac2a09e8-3671d4fe-e3b5aa68 1542 portable ap chest radiograph lung volumes are low, however, no consolidation is identified on this single frontal view . there is no overt pulmonary edema or large pleural effusions . moderate cardiomegaly is unchanged . mediastinal and hilar contours are otherwise normal . no pneumothorax or pneumomediastinum is evident . surgical clips overlie the left upper quadrant of the abdomen . No Finding 18057037 57649308 3455b174-7955b50f-69214401-26f4d34d-3672b50a 1543 frontal and lateral views of the chest . the lung volumes are very low, which is only slightly worsened since . this accentuates the cardiac silhouette which appears stably enlarged . there is mild vascular congestion, but no overt pulmonary edema . the mediastinal contour is stable the pulmonary artery is enlarged . patchy bilateral lower lobe opacities likely represent atelectasis . there is a small left pleural effusion . no pneumothorax is seen . there are clips in the left upper quadrant of the abdomen . very low lung volumes have slightly decreased since . patchy bilateral lower lobe opacities most likely represent atelectasis . a small left pleural effusion is unchanged since . mild pulmonary vascular congestion is unchanged since . Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion 18057037 57717537 87d13784-35495ec2-cffeda97-23cf108b-c05e835b 1544 lung volumes are low . interstitial markings are increased bilaterally . the lung apices are partially obscured by the patients chin and incompletely evaluated . the heart size is moderately enlarged . basilar atelectasis is mild . bilateral pleural effusions are small . surgical clips project over the left upper quadrant . the thoracic aorta is unfolded with atherosclerotic calcifications . moderately cardiomegaly is worse with small bilateral pleural effusions, and moderate interstitial pulmonary edema in the setting of chf exacerbation . Cardiomegaly&&Edema&&Pleural Effusion 18057037 57929210 ab01ebc0-71496a3e-2e7445dd-732ceb26-0b6aff7c 1545 in comparison with the study of , there is substantial improvement in the pulmonary edema . indeed, the vascularity is now essentially within normal limits . some atelectatic changes are seen at the right base, silhouetting the hemidiaphragm . in the appropriate clinical setting, supervening pneumonia would have to be considered . low lung volumes accentuate the transverse diameter of the heart . Atelectasis&&Cardiomegaly&&Edema&&Pneumonia 18057037 58078706 031e1a10-9b03a629-29234928-e2dbc65d-7ac75537 1546 portable ap radiograph of the chest was reviewed in comparison to prior study obtained the same day earlier . heart size and mediastinum are stable . prominence of the pulmonary artery is redemonstrated, consistent with pulmonary hypertension . no interval change in the small amount of pleural effusion is noted . there is no pneumothorax . there is mild vascular engorgement, but no overt edema seen and overall, no change since prior examination noted . Cardiomegaly&&Enlarged Cardiomediastinum&&Pleural Effusion 18057037 58184634 ce3cc6c1-e86d6dfd-5844331c-1767c5e5-329f8741 1547 lung volumes are reduced . this accentuates the size of the cardiac silhouette which is mildly enlarged . crowding of the bronchovascular structures is also demonstrated, without overt pulmonary edema noted . the mediastinal contour is unremarkable . bibasilar patchy opacities may reflect atelectasis though infection is not excluded . there appears to be a trace left pleural effusion, and a small right pleural effusion cannot be excluded . no pneumothorax is seen . there are multiple clips demonstrated within the left upper quadrant of the abdomen . low lung volumes . bibasilar patchy opacities may reflect atelectasis but infection is not excluded . small left pleural effusion and possible trace right pleural effusion . no overt pulmonary edema . Atelectasis&&Lung Opacity&&Pleural Effusion&&Pneumonia 18057037 58548470 a185bea9-f95f19a1-32f0ea92-8d192ae9-1f3a5a07 1548 single ap upright portable chest radiograph was provided . there is increase of interstitial markings bilaterally although worse in the right lung, which may be due to asymmetric pulmonary edema . there is bibasilar atelectasis . obscuration of the right hemidiaphragm may be due to atelectasis however, infection cannot be excluded . cardiomediastinal silhouette is unchanged . the bones are intact . pulmonary edema, worse in the right lung with bibasilar atelectasis . pneumonia in the right lower lobe may be possible in the correct clinical setting . Atelectasis&&Edema&&Pneumonia 18057037 58608862 11362097-a0bac3fa-316e02be-b753a0b5-16e69386 1549 diffuse interstitial prominence with moderate cardiomegaly is consistent with moderate pulmonary edema . more linear area of focal consolidation within the right lower lobe is unchanged and is thought to reflect scarringatelectasis . there is chronic elevation of the right hemidiaphragm . there is no pleural effusion or pneumothorax . while the patient has known mediastinal lymphadenopathy, this and mediastinal lipomatosis, are better appreciated on the prior ct . clips within the left upper abdomen are unchanged . moderate pulmonary edema . Edema 18057037 59332345 a250f743-48863d40-60cab50b-3c50f654-52796233 1550 there is persistent elevation of the right hemidiaphragm, unchanged . otherwise, the lungs are well expanded and clear . no pulmonary edema . stable appearance of the cardiomediastinal silhouette . no pleural effusion . no pneumothorax . no evidence of pneumonia . stable elevation of the right hemidiaphragm . 18088902 53067857 db21cdac-6b505ece-719ff0fc-4c4291ad-e52017ab 1551 single portable view of the chest . left greater than right basilar opacities suggestive of atelectasis . the lungs are otherwise clear . the cardiomediastinal silhouette is within normal limits . no acute osseous abnormality is identified . no free intraperitoneal air identified . no definite acute cardiopulmonary process . No Finding 18113771 54922575 c7e010a6-159db893-31dac930-c5bc900b-9feb9c89 1552 in comparison with the study of , there are lower lung volumes . no vascular congestion or pleural effusion . there is a faint suggestion of some increased opacification at the right base medially . this most likely represents merely atelectasis or crowding of pulmonary vessels . in the appropriate clinical setting, this could conceivably represent the early stages of aspiration . Atelectasis&&Lung Opacity 18137951 53975230 17f90d58-ab2032f6-2a154aae-fe200888-93cc7dcb 1553 ap single view of the chest has been obtained with patient in upright position . available for comparison is the next preceding chest examination of . relatively high positioned diaphragms obscure major portion of the heart shadow . the heart size may be at the upper limit of normal variation, but no typical configurational abnormalities identified . unremarkable and unchanged appearance of thoracic aorta . the pulmonary vasculature is not congested . no signs of acute or chronic parenchymal infiltrates are present and the lateral pleural sinuses are free . no evidence of pneumothorax in the apical area . skeletal structures of the thorax grossly unremarkable . on previous examination of , small left-sided pleural effusion was diagnosed . this cannot be confirmed as a lateral view was not obtained at this time . mostly unremarkable chest findings on single view examination . No Finding 18137951 58460896 1a102f04-c4935ccf-9ee44ac4-ab62d6f6-49575979 1554 portable upright radiograph of the chest demonstrates well expanded and clear lungs . the cardiomediastinal and hilar contours are unremarkable . there is no pneumothorax, pleural effusion, or opacity . pneumomediastinum is not apparent on this radiograph . normal chest x-ray examination . no evidence of pneumomediastinum . No Finding 18162895 57889329 32f085e4-a986fed6-56bf1ebe-f3cd4874-fd51818f 1555 heart size is normal . mediastinum is normal . lungs are well inflated . there is left basal opacity, new as compared to , concerning for all interval aspiration or infection . there is also slight interval progression of interstitial opacities that might be consistent with mild degree of interstitial edema . Edema&&Lung Opacity&&Pneumonia 18166102 57599964 54a0a07c-a256fe2b-d0e96074-68ce7def-af588be7 1556 there is no focal consolidation, effusion, or pneumothorax . there is mild pulmonary vascular congestion . there is mild peribronchial thickening . the cardiomediastinal silhouette is normal . imaged osseous structures are intact . no free air below the right hemidiaphragm is seen . endotracheal tube tip is approximately cm above the carina . side port of the ng tube is near the ge junction . . endotracheal tube tip is approximately cm above the carina . . side port of the ng tube is near the ge junction . advancement by approximately cm may be considered . . mild interstitial edema . Edema&&Support Devices 18166102 58826153 396e5b3c-00057105-b7061e7b-156f2268-0e379e3b 1557 comparison to . the picc line on the right has been pulled back . the tip of the line now projects over the mid svc . no evidence of complications, notably no pneumothorax . no pleural effusions . normal size of the heart . Pneumothorax&&Support Devices 18260067 57032495 254eb3cc-aa57e502-283895be-388e5661-ad37acfe 1558 lung volumes are low . heart size is normal accounting for the low lung volumes . mediastinal and hilar contours are unremarkable . there is no pulmonary edema . streaky opacities in the lung bases likely reflect atelectasis . no focal consolidation, pleural effusion or pneumothorax is seen . there are no acute osseous abnormalities . low lung volumes with mild bibasilar atelectasis . Atelectasis 18267367 58083874 0207a7bb-11610206-8ac040e0-8e2749f5-afc70954 1559 in comparison with the study of , there is little overall change . some widening of the mediastinum, which in the appropriate clinical setting could reflect some bleeding with in the mediastinum . cardiac silhouette is mildly enlarged and indistinctness of pulmonary vessels suggests some elevated pulmonary venous pressure . multiple rib fractures are again seen, though there is no evidence of pneumothorax . Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Fracture 18351086 58927022 45e83449-8e77917b-9b15cf9a-2ae245a7-7114989c 1560 as compared to , there has been further worsening of a bilateral interstitial pattern, now with a mid and lower lung predominance . it is uncertain whether this represents interstitial edema or a progressive atypical pneumonia . Edema&&Lung Opacity&&Pneumonia 18373333 52364831 26d91d75-cf5c6002-96b0a11b-d3f93367-d109b784 1561 heart size is within normal limits . there is prominence of the pulmonary interstitial markings without overt pulmonary edema or focal areas of consolidation . there is subsegmental atelectasis at the left base . there are no pneumothoraces . Atelectasis&&Lung Opacity 18373333 52931972 f476d858-db17c76e-3282dfa8-d9202f8a-764adcbd 1562 as compared to the previous radiograph, the signs of interstitial lung edema have decreased in extent and severity but continue to be clearly visible . mild cardiomegaly persists . no pleural effusions . no new focal parenchymal opacities . Cardiomegaly&&Edema&&Lung Opacity 18373333 56279753 2c4551ac-f33843fc-07abff12-2c11868b-b5674eea 1563 as compared to chest radiograph, subtle interstitial opacities have apparently increased compared to the prior exam . it is uncertain whether this represents acute interstitial edema or an atypical pneumonia . exam is otherwise unchanged . Edema&&Lung Opacity&&Pneumonia 18373333 56591492 809d5574-2c6ccb2e-96dceef8-4833e730-8599ec91 1564 no focal consolidation is seen . no pleural effusion or pneumothorax is seen . the cardiac and mediastinal silhouettes are unremarkable . no acute cardiopulmonary process . No Finding 18383430 51327502 11ba7b99-79869f9b-4e54a718-f74bd86f-50205054 1565 in comparison with the study of , there are interstitial markings in the region of the previous opacification overlying the fifth lateral posterior rib on the left . this could reflect interval consolidation with fibrous healing . the cardiac silhouette is within normal limits and there is no vascular congestion, pleural effusion, or acute focal consolidation . right ij port-a-cath extends to the mid to lower portion of the svc . Consolidation&&Lung Opacity 18429449 50698281 7142481e-5cdb79dd-d3fb4159-d280d895-b663f1ab 1566 the lung volumes are low . moderate cardiomegaly . small bilateral pleural effusions with areas of subsequent atelectasis . mild to moderate pulmonary edema . no pneumothorax . no pneumonia . Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion 18437840 56589490 255028bc-0d427abe-7648f577-5c5161c9-7bd1a3e9 1567 lung volumes are low compared to the prior study . the heart is moderately enlarged . there is pulmonary vascular redistribution . there increased lung markings right greater than left . there small bilateral effusions . the overall impression is that of mild ch . Cardiomegaly&&Edema&&Pleural Effusion 18457691 57704953 f6c5958a-7b37c4fa-304dac93-268f2d4f-0dacd28a 1568 bibasilar opacities are again seen silhouetting the hemidiaphragm, suggestive of pleural effusions . indistinct pulmonary vascular markings seen superiorly . there is more focal opacity in the right infrahilar region . there is likely cardiomegaly although given silhouetting, assessment is limited . no acute osseous abnormalities . moderate bilateral pleural effusions with adjacent atelectasis and mild pulmonary edema . superimposed infection cannot be excluded . more focal opacity in the infrahilar region on the right which should be followed for resolution on subsequent exams . Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia 18536624 54882674 f3de0579-711a8c1f-7d79200b-cadc13ed-61edf359 1569 cardiomegaly is substantial with interval increase in size of the cardiac silhouette, highly concerning for pericardial effusion, correlation with echocardiography is recommended . replaced mitral valve is in expected position . mild vascular enlargement is present . small left apical pneumothorax is noted . Cardiomegaly&&Pneumothorax&&Support Devices 18536624 55739485 74cb0482-4e08c24c-84bc00b1-327a2c16-342697fb 1570 since the chest radiograph obtained day prior, there has been interval removal of the right-sided pleural drainage catheter . small left apical pneumothorax is unchanged . approximately . cm right apical pneumothorax is new . cardiomegaly is unchanged since day prior, but new since days prior . increased left lower lobe atelectasis and probably a new, small left pleural effusion . a small rounded opacity in the lateral right lung is likely a focus of atelectasis or hematoma in the prior location of the pleural drainage catheter . lungs are otherwise fully expanded and clear . new right apical pneumothorax as described above . unchanged, small, left apical pneumothorax . cardiomegaly unchanged since day prior, but new since days prior . correlation with echocardiogram recommended . notification the findings were discussed by dr . with , pa on the telephone on at pm, approximately minutes after discovery of the findings . Cardiomegaly&&Pneumothorax 18536624 58825648 48069ad7-2198507a-3a1a76f6-2f451959-3323f7de 1571 patient is status post median sternotomy and cardiac valve replacement . lungs remain hyperinflated suggesting chronic obstructive pulmonary disease . no focal consolidation is seen . there is no pleural effusion or pneumothorax . the cardiac and mediastinal silhouettes are stable . no displaced fracture is identified . no acute cardiopulmonary process . No Finding 18536624 58872394 d54665db-507b626e-61a70dc4-41fd219f-cb59c1f4 1572 cardiomediastinal contours are normal . lungs are well expanded and grossly clear . No Finding 18548611 54082213 5e4621d6-249803ba-afaa008b-2751e009-8daaa308 1573 bullet fragments project over the left humeral head . heart size is normal . an opacity in the left lung may represent atelectasis and mild pulmonary vascular congestion . there is no osseous abnormality . there is no pneumothorax or pleural effusion . mild pulmonary vascular congestion . bullet fragments are re- demonstrated . Edema 18552428 53452152 3b09934f-106f393a-5f3d7fda-81d7cd07-48d3b226 1574 on patient had large right and moderate left pleural effusion . today the moderate left pleural effusion is smaller, but the right hemi thorax is now fully opacified . since the mediastinum is not shifted to the left, there is an equivalent loss of volume a due to atelectasis compared to the residual right pleural effusion, often an indication that the pleural effusion accumulated slowly . in addition there is an abrupt termination to the air column in the right main bronchus the strongly suggesting retained impacted secretions . feeding tube ends in the upper stomach . no endotracheal tube is seen . heterogeneous opacification at the apex of the left lung is new from . although interpreted prospectively it might have been diagnosed as pneumonia, the subsequent chest radiograph performed at available the time of this review showed clearing . therefore this is either edema or aspiration . Atelectasis&&Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices 18573829 50660145 41d2924f-85f8e580-6d8773b6-5ede09de-b23811f6 1575 as compared to the previous radiograph, the right pleural effusion has decreased . the effusion is now limited to the right costophrenic sinus . there is no evidence of pneumothorax . no pneumonia, no pulmonary edema . unchanged alignment of the sternal wires . no cardiomegaly . mild tortuosity of the thoracic aorta . Pleural Effusion 18573829 52255209 51cd61fb-702bc603-25a5fc14-7ed07e7e-4628c152 1576 portable ap radiograph of the chest was reviewed in comparison to chest ct from . heart size is normal . mediastinum is normal . the patient is after cabg and stable appearance of sternotomy wires are demonstrated . mild interstitial pulmonary edema is seen, but no overt pulmonary edema is present . minimal bibasal opacities might be reflecting atypical pneumonia as well . no pleural effusion or pneumothorax is seen . Edema&&Lung Opacity&&Pneumonia 18573829 54154294 a6a98f2d-89802254-926441f1-5a5948d5-7c207a91 1577 large bilateral pleural effusions right greater than left associated with atelectasis are unchanged . of note the images were taken with the patient very rotated, these limits the evaluation of the study . there is no evident pneumothorax . cardiomediastinal silhouette is grossly unchanged . left picc tip is in the upper svc there are no new lung abnormalitie . Atelectasis&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices 18573829 56404519 f1148b37-70b8bdb2-2bf622b4-d2c92d4d-23d892a6 1578 left subclavian central venous catheter is stable . lung volumes are reduced, and the cardiomediastinal contours are unchanged . basilar lung haziness is likely fluid or atelectasis . no evidence of pneumonia or pulmonary edema . no evidence of pneumonia or pulmonary edema . No Finding 18573829 57045282 dc77150b-061bf4d5-09e23a26-52d9ada0-45856897 1579 slightly rotated positioning . the left ij central line tip overlies the upper right atrium . no pneumothorax is detected . sternotomy wires are present and there is probable cardiomegaly . there is upper zone re-distribution and diffuse vascular blurring, consistent with chf . hazy opacity at the lung bases suggests layering effusions, likely with underlying collapse andor consolidation . the chf and pleural parenchymal findings are new compared with the cxr . note is made of slight change in caliber in the trachea at the level of the lower neck, which is similar to the film . Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices 18573829 58940888 7bb64264-3a27db3b-774da98c-671a380d-9805e329 1580 the left-sided picc line is confirmed to end at the level of the mid svc in the lateral view . otherwise there is no significant change compared with radiograph performed hr earlier, with bilateral pleural effusions, right worse than left with probable associated atelectasis . no focal parenchymal opacities are seen in the aerated portions of the lungs . there is no pneumothorax . a left-sided ij line ends in the upper atrium . sternotomy wires are intact . left-sided picc line is confirmed to end at the level of the mid svc in the lateral view . otherwise unchanged appearance of the thorax compared with radiograph performed hr earlier . No Finding&&Support Devices 18573829 59567651 c1f674d5-7e36152f-fbd6eadc-a4030a72-2000a929 1581 portable upright frontal view of the chest a new left central venous line ends in the mid superior vena cava . there are surgical clips and median sternotomy wires . the cardiac and mediastinal contours are stable . right lower lobe opacity is slightly increased since , and it corresponds to a known right pleural effusion . there is no left pleural effusion . there is no focal consolidation . No Finding&&Support Devices 18573829 59688115 135f0d17-a5c68038-e9f9097a-b89be36b-245e82fe 1582 cardiomediastinal silhouette and hilar contours are normal . again appreciated are innumerable bilateral nodular densities, better appreciated and evaluated on recent chest cta . there is no evidence of vascular congestion and interstitial edema . there is no large pleural effusion or pneumothorax . innumerable bilateral nodular opacities, better evaluated on recent ct, without evidence of edema or large area of consolidation worrisome for pneumonia . Consolidation&&Lung Lesion&&Lung Opacity&&Pneumonia 18580594 51202750 d9dbe791-88e5c7a0-dc34613c-5913966a-50de825a 1583 as compared to the previous radiograph, there is no relevant change . the extent and severity of the known bilateral diffuse metastatic lung disease is unchanged . no new areas of focal consolidations or opacities . unchanged size of the cardiac silhouette . no pleural effusions . no pneumothorax . unchanged course and position of the right picc line . Cardiomegaly&&Consolidation&&Lung Opacity&&Support Devices 18580594 52783924 79d26270-6ac0b789-8f537c71-f31636b6-652a10b8 1584 and as compared to the prior examination, lung volumes are decreased . there is crowding of previously seen bilateral nodular opacities due to decreased lung volumes, however there is likely superimposed fluid overload . there may be minimal increase in cardiac size however the majority of the apparent increase is due to differences in technique . Cardiomegaly&&Lung Lesion&&Lung Opacity 18580594 54419841 c5c3a5a3-5e5063e6-7ebc4940-55888e2a-27a9bf62 1585 as compared to the previous radiograph, there is no relevant change . known diffuse metastatic lung disease, but no evidence of new parenchymal opacities . a slightly denser area next to the left chest wall is unchanged in extent and severity . unchanged appearance of the cardiac silhouette . unchanged left picc line . Cardiomegaly&&Lung Opacity&&Support Devices 18580594 55411644 e9fd9d5d-4686d244-07a3bcbf-1f4fe6d7-c8a17d5d 1586 in comparison with study of , there is little overall change in the diffuse bilateral pulmonary nodules, consistent with widespread metastases from renal cell carcinoma . the patient has taken a slightly better inspiration . there may be some mild elevation of pulmonary venous pressure . Lung Lesion 18580594 56772300 184bb758-6458694f-18e228fd-256ef804-8bfa0dba 1587 cardiac silhouette is upper limits of normal in size . mediastinal and hilar contours are stable . widespread pulmonary metastases are again demonstrated, with a dominant -cm diameter peripheral mass in the lingula . on the lateral view, increasing confluent opacity is seen overlying the lower thoracic spine as compared to the lateral chest radiograph of , with associated partial obscuration of the right hemidiaphragm . small right pleural effusion is present, similar to radiograph . . widespread pulmonary metastases . . dependent consolidation overlying the lower thoracic spine on lateral chest x-ray, which could be due to an infectious pneumonia in the appropriate clinical setting . . small pleural effusions . Consolidation&&Pleural Effusion&&Pneumonia 18580594 58794154 c2bd3ed1-3fb9aa51-ff427719-79f840dd-3d5cefd4 1588 the cardiomediastinal silhouette and pulmonary vasculature are normal . no focal consolidation is seen . there is no pleural effusion or pneumothorax . no acute intrathoracic abnormality . No Finding 18627107 56692775 9a063e8a-bd122987-f2d98d01-b6af36e3-6ddb5311 1589 in comparison with the study of , there is little change and no evidence of acute focal pneumonia . right apical pleural and parenchymal abnormalities again seen, most likely related to previous infection and scarring . continued hyperinflation of the lungs consistent with chronic pulmonary disease . no vascular congestion or acute focal pneumonia . Lung Opacity&&Pneumonia 18648021 57833703 93318c78-1b671842-1af554f7-52f54a25-91a64acf 1590 as compared to the previous radiograph, the patient has undergone left thoracocentesis . there is no visualization of an apical or basal pneumothorax . the effusion has moderately decreased in extent . borderline size of the cardiac silhouette . double-lumen dialysis catheter . the left heart border is delineated in a sharper manner than on the previous radiograph, likely caused by slight patient rotation to the left . Cardiomegaly&&Pleural Effusion&&Support Devices 18711952 56213448 45efdb5c-2180d248-108c9392-5955178b-868c7a3c 1591 as compared to the previous radiograph, the lung volumes have slightly increased, however, not returned to normal . there is decrease of the pre-existing pulmonary edema bilaterally, however there is still mild-to-moderate pulmonary edema bilaterally . the cardiomediastinal silhouette is slightly smaller than the prior radiograph . Edema&&Enlarged Cardiomediastinum 18713335 56629662 2c7ae42e-e41f0d63-f348381f-7888cf5b-491ac2cc 1592 as compared to the previous radiograph, the size of the cardiac silhouette is moderately increased . given lower lung volumes, there is more crowding of the vascular and bronchial structures, notably at the lung bases, but no pulmonary edema is present . no pneumonia . no pleural effusions . no lung nodules or masses . Cardiomegaly 18713335 58318194 29e8cd30-6d1c3bf6-20b37ebf-0129c596-941196da 1593 as compared to the previous radiograph, the lung volumes have decreased . there is now moderate cardiomegaly with signs of predominantly centralized moderate pulmonary edema . increased areas of atelectasis are seen at both lung bases . the asymmetry of the changes does not clearly support the suspicion for pneumonia . at the time of dictation and observation, am, on the , the referring physician, . was paged for notification . Atelectasis&&Cardiomegaly&&Edema&&Pneumonia 18713335 58417790 b29d0852-2f33563f-2443c212-e00db2ff-74a4c5d7 1594 in addition to new interstitial abnormality, there is uniform opacification in the right lower hemithorax due in part to moderate pleural effusion but potentially concealing pneumonia . careful followup with conventional chest radiographs if possible should be obtained . there is no pneumothorax . right central venous infusion line ends low in the svc . findings were discussed by telephone with the staff physician covering this patient at am . Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices 18783450 54421674 08f2e527-aed6e0fd-7613e553-eebf480b-65419307 1595 the right port-a-cath catheter tip is at the level of low svc . heart size and mediastinum appear to be unchanged . bibasal, right more than left areas of consolidation most likely represent a combination of pleural effusion and parenchymal opacity . as compared to , overall the appearance is stable or minimally improved . there is no pneumothorax . Cardiomegaly&&Consolidation&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Support Devices 18783450 57910629 712bc05c-fcb07be3-8b5fbf1a-43379379-df689356 1596 comparison is made to the previous study from . there is improved aeration at the right base . there remains some atelectasis at the bases bilaterally . there is an unchanged right-sided port-a-cath with distal lead tip at the distal svc . heart size is normal . there are no pneumothoraces . Atelectasis 18783450 58473980 1f400fee-753579b0-b459be3b-04c5dbab-120f6074 1597 nasogastric tube now terminates in the stomach, sideport at the esophagus . lung volumes are low . there is persistent elevation of the right hemidiaphragm . the left hemidiaphragm is obscured by retrocardiac opacity . the left costophrenic angle is not fully imaged . there is no right pleural effusion . no pneumothorax . hilar and mediastinal silhouettes are unchanged . heart size is top normal . no pulmonary edema . . nasogastric tube terminates in the stomach, side port likely at the esophagus . . retrocardiac opacities may represent atelectasis, aspiration or infection in the correct clinical setting . Atelectasis&&Lung Opacity&&Pneumonia&&Support Devices 18795271 51515861 f1f1e890-138d12a5-79b715a3-cba88b1a-39949fcf 1598 portable ap radiograph of the chest was reviewed with no prior studies available for comparison . heart size and mediastinum are unremarkable . calcifications of the thoracic arch are noted . lungs are clear and there is no pleural effusion or pneumothorax . 18795271 51769537 01884108-3101cca3-0fe40d44-deb3e031-fe8bc647 1599 three sequential frontal views of the chest show final position of the nasogastric tube loops low in the esophagus, with the tip at the level of the aortic arch . marked elevation of the right hemidiaphragm may be due in part or may be responsible for moderate-to-severe atelectasis at the right lung base, in the setting of severe distention of the intestinal tract . the heart is top normal size . lungs are otherwise clear . no pleural abnormality . findings were discussed by telephone with dr . at am . on . Atelectasis&&Support Devices 18795271 52414889 ff254bc5-0c37dfa0-c2191df8-a419d5f7-e45ad7e4 1600 single ap upright portable view of the chest was obtained . there is persistent elevation of the right hemidiaphragm with overlying right base atelectasis . an enteric tube is seen, distal aspect terminating in the region of the gastroesophageal junction . recommend advancement by several centimeters so that it is well within the stomach . there is no large pleural effusion or pneumothorax . the aortic knob is calcified . the cardiac silhouette is unremarkable . . elevation of the right hemidiaphragm which is increased as compared to the prior study with overlying basilar atelectasis . . enteric tube terminates in the region of the gastroesophageal junction, recommend advancement so that it is well within the stomach . Atelectasis&&Support Devices 18795271 55361629 416015bf-a5b87cdb-e0e532be-9c61feb1-ef52aed5 1601 two frontal views of the chest, one centered above the diaphragm, the other below both show nasogastric tube looped in lower esophagus, with the tip above the level of the aortic knob . severe distention of the intestines may be responsible in part for diaphragm elevation, with the right hemidiaphragm is appreciably higher than the left accounting for marked atelectasis at the base of the right lung . heart size normal . Atelectasis&&Support Devices 18795271 56199418 73bdc9a7-084b4bc2-929e8902-1ce75d51-b919696e 1602 a portable frontal chest radiograph initially demonstrate a dobbhoff tube looped back upon itself projecting over the mid chest . subsequent images demonstrate interval removal of the dobbhoff tube . a nasoenteric tube is looped within a hiatal hernia . the tip of the endotracheal tube is approximately cm above the carina . the cardiomediastinal silhouette is unchanged and the lungs are without focal consolidation . there is no pleural effusion or pneumothorax . . unchanged chest radiograph . . the tip of the endotracheal tube is cm above the carina . these findings were communicated to the covering team at approximately on , at which time the patient had already been extubated . No Finding&&Support Devices 18827738 54191170 ca4ee096-74120228-b98bdda3-8a6b881a-616b1793 1603 portable semi-upright view of the chest was provided . the endotracheal tube is seen with its tip located . cm above the carina . the lungs are clear bilaterally . no effusion or pneumothorax is seen, though the right cp angle is partially excluded . cardiomediastinal silhouette appears grossly unremarkable . no acute bony abnormalities are seen . however, a defect within the right humeral head is compatible with a reverse hill- deformity likely reflecting chronic posterior shoulder dislocations . appropriately positioned endotracheal tube without acute intrathoracic process . No Finding&&Support Devices 18827738 55331592 f487266f-6dea1fff-43365092-396868ad-c98b60cb 1604 the dobbhoff tube tip is coiled in the hiatal hernia with the tip pointed upward the appearance of the lungs are unchanged . Support Devices 18827738 57151471 d3192abb-0a9a4cea-e86ebeea-5600dcd0-f6447318 1605 the feeding tube has a tortuous course with the tip coiled in a hiatal hernia, pointed upward in the chest . the cardiac and mediastinal silhouettes are unchanged . Enlarged Cardiomediastinum&&Support Devices 18827738 58586249 f158d781-2937f072-b4cabcce-b2330204-b4b8eda0 1606 new upper enteric drainage tube loops below the diaphragm and returns to end either in the distal esophagus or more likely hiatus hernia . et tube is in standard placement . lungs are clear and the heart is normal size . Support Devices 18827738 59572474 a2f79d75-984aa22b-2dc274bc-9c638708-85192992 1607 there are low lung volumes which accentuate the bronchovascular markings . given this, there is central pulmonary vascular engorgement and mild vascular congestion without overt pulmonary edemano definite focal consolidation is seen . no pleural effusion or pneumothorax is seen . the cardiac and mediastinal silhouettes are stable given differences in technique and inspiration . low lung volumes which accentuate the bronchovascular markings . given this, there may be central vascular engorgement, mild vascular congestion without overt pulmonary edema . no lobar consolidation . Edema 18969267 52558395 2b07a6ee-51d37168-a67a3218-d5454eee-2a3dbae5 1608 pa and lateral views of the chest provided . extensive consolidation in the left lower lobe is compatible with pneumonia . there is mild opacity at the right lung base which in the correct clinical setting may represent additional site of pneumonia . cardiomediastinal silhouette appears grossly unchanged . no large pneumothorax or effusion . bony structures are intact . left lower lobe pneumonia, possible additional focus of pneumonia at the right lung base . Pneumonia 18969267 52583675 76397f30-d006d063-4a74816b-c9a7771f-091df4d9 1609 the lungs remain hyperinflated . the cardiac and mediastinal silhouettes are stable with the aorta calcified and tortuous the cardiac silhouette mildly enlarged . there is aortic valve calcification . no focal consolidation, pleural effusion, or evidence of pneumothorax is seen . no acute cardiopulmonary process . no significant interval change . No Finding 18971051 51076696 dcda9207-1934e86d-ee932544-116c6360-2c689e4d 1610 ap upright and lateral views of the chest provided . the lungs appear clear . no focal consolidation, large effusion or pneumothorax is seen . the heart appears mildly enlarged with aortic atherosclerosis noted . no bony abnormalities . no free air below the right hemidiaphragm . no acute findings . No Finding 18971051 52465162 0c088f46-a898f4d0-f2c3ebaf-d0ebdf2f-26b6a95e 1611 lungs are hyperinflated and diaphragms are flattened, consistent with copd . the heart is moderately enlarged . coronary artery calcification noted . aortic calcification and mediastinal contours are similar to prior . bibasilar streaky opacities are consistent with atelectasis . no focal consolidation, pleural effusion, or pneumothorax . copd . moderate cardiomegaly bibasilar atelectasis . no chf or focal consolidation identified . Atelectasis&&Cardiomegaly 18971051 57901910 0469019a-6cd3631d-c792015d-a2891105-1e527c1a 1612 as compared to the previous radiograph, no relevant change is seen . low lung volumes . substantial calcifications of the elongated descending aorta . moderate cardiomegaly . contrast is seen in the esophagus . Cardiomegaly 18971051 58408306 1d61f7d6-031720b7-8d226ade-2f1b8262-31b028fa 1613 the patient is status post median sternotomy and cabg . left-sided dual-chamber pacemaker device is seen with leads terminating in the right atrium and right ventricle . the heart is normal in size . mediastinal and hilar contours are unremarkable . the pulmonary vascularity is normal . lungs are clear without focal consolidation . no pleural effusion or pneumothorax is seen . there are no acute osseous abnormalities . multiple spiral radiopaque densities within the upper anterior abdominal wall are compatible with prior ventral hernia repair . no free air is seen under the diaphragms . no acute cardiopulmonary abnormality . no free air under the diaphragms . No Finding 19001598 54038226 2c8f15e6-d3fed417-e5c8efc5-20074fce-ef925ffa 1614 compared with the prior study, the cardiomediastinal silhouette is probably unchanged . there is upper zone redistribution, without overt chf . fractured inferior sternotomy wire again noted . the left hemidiaphragm and left costophrenic sulcus are now better defined, suggesting interval improvement in the the left effusion and left lower lobe collapseconsolidation . some residual left lower lobe atelectasis persists . on the right, there has been slight improvement in the right cardiophrenic opacity . the small right effusion is again seen, similar to prior . left-greater-than-right apical pleural thickening again noted . fractures of the midlower posterior right ribs again noted, presumably old . no pneumothorax detected . ng tube, pacemaker, and presumed epidural catheter again noted . partial interval improvement in collapseconsolidation at the left base and in the right cardiophrenic opacity . marked improvement in left pleural effusion . ng tube extends beneath the diaphragm off the film . the sideport is not well delineated, but appears to lie immediately beyond the ge junction . Atelectasis&&Consolidation&&Lung Opacity&&Pleural Effusion&&Support Devices 19001598 58253643 01ac23e4-2e8ff6db-5c62d77f-fd15e7d9-9850b8c5 1615 low lung volumes accentuate the cardiomediastinal contours and result in crowding of bronchovascular structures . there are no focal areas of consolidation to suggest the presence of pneumonia . . cardiomediastinal silhouette is stable . no pleural effusion or pneumothorax is seen . no acute cardiopulmonary process . No Finding 19045192 54353558 51ccd2f2-81bd59a9-10d57832-76910dd4-9757fbf3 1616 portable supine chest film of at is submitted . patient is status post median sternotomy with postoperative cardiac and mediastinal contours . the aorta is somewhat unfolded and tortuous . lung volumes are low with faint opacities at both bases most likely representing patchy atelectasis in this setting of low lung volumes . no evidence of pulmonary edema, pleural effusions or pneumothorax . Atelectasis&&Enlarged Cardiomediastinum&&Lung Opacity 19079797 52498426 ca35468b-f8c1177c-cb354cc1-79281df8-b354b74d 1617 the lungs are clear . there is no consolidation, effusion or edema . cardiac silhouette is within normal limits . there is somewhat increased density of the aortic arch which may be technical however repeat with pa technique is suggested to further evaluate . no acute osseous abnormalities . no acute cardiopulmonary process . apparent increased density projecting over the aortic arch, potentially technical however further clarification with pa film is suggested to confirm . Lung Opacity 19109135 57563883 d991387d-c47df4dc-71e59cb0-adf1a788-5c14659b 1618 portable semi-erect chest radiograph at is submitted . the right internal jugular swan-ganz catheter and nasogastric tube are unchanged in position . endotracheal tube has its tip approximately cm above the carina . the heart remains stably enlarged . overall, there is improving aeration in both lungs suggestive of resolving moderate pulmonary edema . retrocardiac consolidation persists likely reflecting lobar collapse in the setting of a pleural effusion . pneumonia in the retrocardiac area cannot be excluded . the and right pleural effusion . patient is status post median sternotomy for cabg . no pneumothorax . Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Pleural Effusion&&Pneumonia&&Support Devices 19112585 50417837 e3bf86d4-2c188caf-80a8b447-d21fd5c8-83251226 1619 there is a swan-ganz catheter with the distal lead tip in the main pulmonary artery . endotracheal tube tip is . cm above the carina, appropriately sited . mediastinal drains and chest tubes are seen . there is an intra-aortic balloon pump whose tip is low and could be advanced cm for more optimal placement . there is a left retrocardiac opacity . there are no pneumothoraces . there is atelectasis at the lung bases . there is mild prominence of the pulmonary vascular markings . Atelectasis&&Lung Opacity&&Support Devices 19112585 50907555 98e92146-cf132a6d-d90a4651-242ac169-fea4e9f8 1620 in comparison with the study of , there is little change in the monitoring and support devices, which appear to be in good position . continued enlargement of the cardiac silhouette with layering bilateral effusions, more prominent on the right, and bibasilar compressive atelectasis . Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices 19112585 51263600 2eb2c117-a495b0ea-466306d2-d1850d33-09918dc6 1621 portable semi-erect chest radiograph at is submitted . interval intubation with the endotracheal tube having its tip approximately . cm above the carina . the feeding tube courses below the diaphragm with the tip not identified . the right internal jugular swan- catheter continues to have its tip in the right pulmonary outflow tract . there are layering effusions, right greater than left, with associated bibasilar opacities suggestive of atelectasis . increasing retrocardiac consolidation likely reflects left lower lobe collapse . there is stable bilateral diffuse airspace process suggestive of moderate pulmonary edema . no pneumothorax . status post median sternotomy with stable cardiac enlargement . Atelectasis&&Cardiomegaly&&Consolidation&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices 19112585 51825039 ed33263a-e35f6636-9c2018a1-259dfa81-3022c5b4 1622 comparison to . the aortic balloon pump was removed . newly placed . feeding tube shows a normal course . the tip is not visualized on the image . no relevant change in appearance of the cardiac silhouette and the lung parenchyma . Cardiomegaly&&Support Devices 19112585 51995292 5cc68f09-82923919-b78e0dc5-7b2ffc0a-64b53314 1623 portable semi-erect chest radiograph at is submitted . right internal jugular swan-ganz catheter, endotracheal tube and nasogastric tube are unchanged in position . status post median sternotomy with stable postoperative cardiac and mediastinal enlargement . layering bilateral effusions with bibasilar patchy opacities likely representing lower lobe atelectasis . prominent perihilar vasculature likely reflects combination of low lung volumes and residual perihilar edema . no pneumothorax . Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices 19112585 52350751 bcdccbea-2977c6e2-95eeb72a-3a7b6a89-ce41591a 1624 there are bibasilar opacities which are most likely due to atelectasis in the setting of relatively low lung volumes . the lungs are otherwise clear . there is no pneumothorax . the cardiomediastinal silhouette is within normal limits . no visualized acute osseous abnormality . no acute cardiopulmonary process . No Finding 19112585 54898602 d6b8c37f-5e300c14-2ef5df39-9a6aaed8-96b5e681 1625 portable semi-erect chest film at feeding tube courses below the diaphragm with tip not identified . right internal jugular swan-ganz catheter has its tip in the right pulmonary outflow tract . status post median sternotomy with expected stable postoperative cardiac and mediastinal contours . interval worsening of moderate pulmonary edema an infectious process would be less likely . probable layering effusions, left greater than right . no pneumothorax . Edema&&Enlarged Cardiomediastinum&&Pleural Effusion&&Pneumonia&&Support Devices 19112585 55060173 a5ccbb4c-fe240b55-19cfa1a7-48bc782d-22e7841a 1626 previous postoperative widening of the cardiomediastinal silhouette has improved, pulmonary edema has resolved . combination of moderate right pleural effusion and atelectasis and severe left lower lobe atelectasis are unchanged . intra-aortic balloon pump is in standard position, as are endotracheal tube, esophageal drain, swan-ganz catheter in the right pulmonary artery, midline and left pleural drains . no pneumothorax . Atelectasis&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices 19112585 55332191 6e0c3a9d-b6a3aad7-a1167a4c-7aa2cbf2-f2410dc0 1627 mild pulmonary edema and moderate postoperative widening of the upper mediastinum are unchanged since at . the intra-aortic balloon pump has been partially withdrawn, now in standard placement midway between the upper margin of the left main bronchus and the aortic apex . moderately severe left lower lobe atelectasis and small right pleural effusion have increased . left pleural drain and mediastinal drains are still in place . et tube, esophageal drainage tube, right internal jugular line, swan-ganz catheter are all in standard placements unchanged . no pneumothorax . Atelectasis&&Edema&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices 19112585 55747398 3e8150f5-16ec8826-edb42d0e-18f9504b-dc42097f 1628 as compared to the previous radiograph, the chest tubes and mediastinal drains have been removed . there is no evidence for the presence of a pneumothorax . the other monitoring and support devices, including the intra-aortic balloon pump are in unchanged correct position . mild right-sided pleural effusion . mild fluid overload but no overt pulmonary edema . unchanged bilateral areas of atelectasis . no pneumothorax . Atelectasis&&Pleural Effusion&&Pneumothorax&&Support Devices 19112585 55937978 2d9ed611-bc3073f4-d4e08942-1248dbfd-bacafcb5 1629 in comparison with the study of , the monitoring and support devices are unchanged, with the nasogastric and dobhoff tubes extending at least to the distal stomach . the dobhoff tube appears to take a downward course, suggesting that extends into the duodenum . continued enlargement of the cardiac silhouette with pulmonary vascular congestion and bilateral pleural effusions with compressive basilar atelectasis, more prominent on the right . Atelectasis&&Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices 19112585 56896133 d3dee386-e9b6900f-6ef74044-1b87f5dc-768f423a 1630 portable semi-erect chest radiograph at is submitted . there has been interval removal of the right internal jugular swan-ganz catheter with the introducer sheath remaining in place . interval placement of a left internal jugular swan-ganz catheter which has its tip in the right pulmonary artery . a nasogastric tube is seen coursing below the diaphragm with the tip not identified . no pneumothorax is seen . there continues to be perihilar fullness and pulmonary vascular indistinctness consistent with mild pulmonary edema . overall, aeration has improved at the right base but the left basilar opacity is unchanged and likely reflects lower lobe atelectasis in the setting of a layering effusion . status post median sternotomy with stable postoperative cardiac and mediastinal contours . Atelectasis&&Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pleural Effusion&&Support Devices 19112585 58052191 9f997d60-cf0331fe-18c6ed7f-d56768f9-1fac8323 1631 mild to moderate pulmonary edema has improved . cardiomegaly is stable . swan-ganz catheter tip is in the proximal right pulmonary artery . sternal wires are aligned . enteric tube tip is out of view below the diaphragm . there is no evident pneumothorax . if any there is a small right effusion . Cardiomegaly&&Edema&&Pleural Effusion&&Support Devices 19112585 58996566 f1f2b384-1ed8cf77-dbdb7e4c-c5c50a77-ffb579d3 1632 moderate cardiomegaly is stable . widening mediastinum is grossly unchanged . moderate to severe pulmonary edema has worsened . small to moderate bilateral effusions have increased with increasing adjacent atelectasis . et tube is in standard position . swan-ganz catheter tip is in the main pulmonary artery . enteric tube tip is out of view below the diaphragm . sternal wires are aligne . Atelectasis&&Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices 19112585 59975773 bccf39d1-b1198fdc-c79b3778-9ae6e91c-8804d3ac 1633 the cardiomediastinal and hilar contours are normal . there is no focal consolidation, pleural effusion or pneumothorax . no acute cardiopulmonary process . No Finding 19245983 54164846 9113059a-7f7d2278-1cf93415-c8add273-78e36ba7 1634 postoperative subcutaneous emphysema in the left anterior and lateral chest wall extends up the axilla to the neck . i do not believe there is appreciable pneumothorax, left apical pleural tube crosses the left chest obliquely . a uniform opacity also marginated obliquely in the left upper hemithorax is probably loculated pleural fluid or blood . left lower lobe is mildly atelectatic . right lung is low in volume but well aerated . heart size is normal . dr . was paged at , minute after the findings were recognized, and again at pm and pm . Atelectasis&&Lung Opacity&&Pleural Effusion&&Pneumothorax&&Support Devices 19254322 54219769 89f3149c-f6f200a1-5dbedfd8-3206d746-7401ee75 1635 no pneumothorax, pleural effusion, or mediastinal widening . aside from left basal lung nodule, lungs are clear . heart size normal . ascending thoracic aorta is tortuous but not appreciably dilated, as seen on chest ct , which also showed extensive pleural calcification, not evident on the conventional radiographs . 19254322 54752436 6552c73b-641178aa-c4ebf4fa-a12d5896-b0902876 1636 the cardiomediastinal silhouette is difficult to assess given posttreatment changes in left lung . mediastinal surgical clips are noted . there is opacity in the left lower lung with elevation of the left hemidiaphragm and blunting of left lateral cp angle with left lateral pleural thickening . this correlates to findings on a ct chest from , likely relating to post treatment changes in the left lung . the left upper lung is grossly clear . the right lung is mildly hypoinflated but clear . there is no pneumothorax . there is no right pleural effusion . there is no pulmonary edema . post-treatment changes in the left lung correlate to findings from prior ct chest from , not appreciably changed . no evidence of superimposed acute cardiopulmonary process . No Finding 19254322 57036456 06b75236-ced07b2e-79c9e581-f467c788-1f9b791f 1637 small-to-moderate left pleural effusion has redistributed, slightly larger . there is no appreciable left pleural effusion and atelectasis is restricted to the base of the postoperative left lung . right lung is clear . bulge in the mediastinum in the region of the ascending aorta is unexplained . i had repeated chest radiograph later this afternoon to make sure that there is no mediastinal fluid accumulation . moderate-to-severe gaseous distention of the stomach, with air and fluid, present with no visible nasogastric tube . subcutaneous emphysema in the left chest wall is relatively stable . dr . was paged at am . as soon as the findings were recognized . Atelectasis&&Enlarged Cardiomediastinum&&Pleural Effusion 19254322 57699153 07433a77-6618a230-fa1a2487-25bdc989-873a79da 1638 there has been interval increase in right lower lobe consolidations pneumonia . right apical subpleural consolidation is more conspicuous than before, part of it is chronic scarring . there appears to be also vascular congestion . right pleural effusion has increased . multifocal opacities in the left lung are grossly unchanged . there is evidence of loss of volume in the left lung, distortion of the lung architecture and shifting of the cardiomediastinal structures to the left . et tube is in standard position . right picc tip is in the lower svc . ng tube tip is in the stomac . Consolidation&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices 19358609 50338064 f97a3cfc-72288627-14f2608a-5806db3f-293a557c 1639 as compared to the previous radiograph, the post-surgical left lung is unchanged . in the right lung, there is an increase in interstitial markings, notably at the lung bases and in the right lower lung . in addition, there is blunting of the right costophrenic sinus, suggesting the presence of a small right pleural effusion . the size of the cardiac silhouette is unchanged . the findings in the right lung might represent a combination of pulmonary edema and pneumonia . at the time of observation and dictation, pm, on , the referring physician, . , was paged for notification and the findings were subsequently discussed over the telephone . Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia 19358609 50510466 83e5f26d-15cf2429-72ba60ba-801c754d-2a8d1fbc 1640 in comparison with the earlier study of this date, there has been placement of a nasogastric tube that extends to the mid body of the stomach with the side port distal to the esophagogastric junction . otherwise little change . No Finding&&Support Devices 19358609 50546404 19acab4d-9db0ca67-2cd73a86-53c399fe-f5fabe3e 1641 in comparison with the study , the monitoring and support devices are unchanged . the opacification in the left mid and upper zone has decreased . basilar opacification on this side is consistent with postsurgical changes . Lung Opacity&&Support Devices 19358609 50588678 6c51a20d-ad614c00-74639c29-a955b0c2-daf48f6e 1642 frontal and lateral radiographs demonstrate stable extensive post-surgical changes of the left hemithorax with associated loss of volume . stable scarring noted in the right lung apex . on a background of chronic lung disease and chronic bibasilar opacifications there is new prominence of the interstitium as well as kerley b lines consistent with pulmonary edeam . heart size is top normal and stable . no pleural effusion or pneumothorax identified . stable background chronic lung changes . stable top normal heart size with evidence of volume overload consistent with provided diagnosis of right ventricular regurgitation . No Finding 19358609 50685017 96f87f7a-986127ad-254bbe00-6092f98c-b455bf5e 1643 portable frontal radiograph of the chest demonstrates a consolidation in the left lower lobe which is slightly increased compared to the recent ct . parenchymal opacification in the right lower lobe likely reflects aspiration . diffusely abnormal background parenchymal changes are again seen . the bilateral pleural effusions have decreased in size . there is an unchanged rounded structure in the right costophrenic sinus which was masked by the pleural effusion on the prior ct exam . there is stable deformity of the left thoracic cage . no pneumothorax . Consolidation&&Lung Opacity&&Pleural Effusion 19358609 51015335 d6578a26-c6384eff-9c8f4ab6-bfb13557-27002f4f 1644 superimposed on chronic volume loss, parenchymal scarring, and pleural thickening in the left hemithorax, there is a persistent superimposed opacification in the left lung, which has worsened somewhat between over two days including increased volume loss . findings in the right lung appear more chronic . worsening volume loss and opacification of the left lung suggesting pneumonia superimposed on chronic findings . Lung Opacity&&Pneumonia 19358609 51677032 d13ad04b-c27e53cc-ff9b10b6-436d461b-1193ec8b 1645 as compared to the previous radiograph, there is no relevant change . extensive post-surgical left lung changes with reduction in volume of the left hemithorax, extensive probably post-tuberculous changes in the right apex, known moderate parenchymal changes at the left lung bases . no new focal parenchymal opacity . normal size of the cardiac silhouette . Lung Opacity&&Support Devices 19358609 52687447 64a79d58-bf2c5aca-fb7bf4f7-833548bf-24fa5543 1646 the heart size is at upper limits of normal, but stable compared to prior study as are the mediastinal contours . the lungs continue to demonstrate bibasilar opacities, becoming slightly more confluent on the left - a developing pneumonia cannot be excluded . pulmonary vascular congestion is also present in the setting of severe emphysema . biapical scarring is unchanged . there is no large pleural effusion or pneumothorax . Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Lung Opacity&&Pneumonia 19358609 53338001 e3b156eb-4c598a51-50f9b5e6-4c4dc426-84eee081 1647 in comparison with the study , there is little change in the appearance of the heart and lungs and monitoring and support devices . Cardiomegaly&&Support Devices 19358609 53579425 960a353d-a835332d-fb31336b-b05f1fbf-749acc88 1648 in comparison with the earlier study of this date, the nasogastric tube extends to the mid to upper stomach . other monitoring and support devices are unchanged . the degree of pulmonary vascular congestion appears to have improved . extensive opacification is again seen involving much of the left hemithorax . Edema&&Lung Opacity&&Support Devices 19358609 53839366 2b50b42f-50c05b8c-99e75eff-0b02afd4-9ceb9ef7 1649 portable ap upright view of the chest was provided . there is again noted to be post-surgical change of the left lung apex with volume loss and leftward retraction of the mediastinal structures . there is also evidence of prior left upper rib cage resection with chest wall deformity evident . the right lung is hyperinflated with upper lobe lucency, likely reflecting underlying emphysema . coarsened interstitial markings with micronodular opacity in the right lower lung likely reflect scarring and appears stable from prior exam . the left cp angle is excluded thus limiting evaluation . no definite new consolidation in the left lung to suggest the presence of pneumonia . the heart size appears stable . post-surgical changes in the left upper chest, with no definite signs of pneumonia . No Finding 19358609 53857831 5a9c035a-33267a29-76c4b71b-04e91d63-e786f0ab 1650 substantial distortion of the chest in particular left hemi thorax with chronic changes in the right apex and in the left upper lung are noted . on the other hand there is new right basal and to lesser extent left basal opacity, findings concerning for pneumonia . no definitive evidence of pulmonary edema is present . no pleural effusion demonstrated . nodular opacity as part of the scarring is demonstrated in the right apex, slightly more conspicuous on current examination and should be reassessed with chest ct to exclude the possibility of growing malignanc . Lung Lesion&&Lung Opacity&&Pneumonia 19358609 53962747 a3c6daf4-a1f8a440-b76bea37-642515bf-da5c72bd 1651 comparison to . the patient is of the change of the endotracheal tube . the tip of the tube is within cm of the carina . if possible, the tube should be pulled back by approximately cm . no complications . stable position of the feeding tube and of the right picc line . extensive parenchymal and pleural abnormalities are stable . No Finding&&Support Devices 19358609 54721865 90dc8a36-b65c30b0-f61c7c30-0cb97d36-9c2108dc 1652 in comparison with the study of , the endotracheal tube and nasogastric tubes have been removed . little overall change in the appearance of the heart and lungs . Cardiomegaly 19358609 54944374 7d8e75db-5a64240f-63dbb72d-72d03f5c-1bd59e3b 1653 one portable ap view of the chest . patient is post left left upper lobe resection with thoracoplasty . top normal heart size is stable . mediastinal and hilar contours are stable . bibasilar opacities are unchanged . mild pulmonary vascular congestion is also unchanged . severe emphysematous changes are again seen . biapical scarring is unchanged . no pleural effusion or pneumothorax . no significant change in bibasilar opacities and pulmonary vascular congestion compared to study done yesterday . Edema&&Lung Opacity 19358609 55623177 3b855f21-6bd34ead-a839a055-cfb4b29a-2a914e01 1654 scarring of the lung parenchyma and a left chest wall deformity are stable . hyperinflated lungs with lucency reflect known emphysema . the previously seen left retrocardiac opacity has cle resolved ared . no focal opacity . prominent interstitial markings may indicate mild edema . there is no pleural effusion or pneumothorax . the heart size is top normal . the aortic knob is calcified in the aorta is ectatic . there is no free air beneath the right hemidiaphragm . mild interstitial edema superimposed on a background of severe emphysema . no signs of pneumonia or pneumothorax . Edema 19358609 55682079 e4532f81-d73cf78d-6747f5f7-f662d37a-93adfab2 1655 et tube tip points toward the left main bronchus and should be pulled back at least cm . heart size and mediastinum are stable . bilateral pleural effusions and bibasal consolidations are extensive but unchanged as compared to the previous study . Cardiomegaly&&Consolidation&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices 19358609 56325235 2fed9c2c-64914c97-cb9d127e-7724fdc3-079b6dc1 1656 compared to chest radiographs through . greater opacification in the right lower hemi thorax is due to increasing moderate right pleural effusion and probable substantial consolidation or atelectasis in the right lower lobe, both persistent, recurrent problems . left pleural effusion is small . no pneumothorax . scarring following left upper thoracoplasty unchanged . heart size indeterminate . et tube in standard placement . nasogastric drainage tube ends in the upper stomach . right central venous line ends in the low svc . Atelectasis&&Cardiomegaly&&Consolidation&&Lung Opacity&&Pleural Effusion&&Support Devices 19358609 56345686 2eded953-12e403aa-4515137d-deea45f7-2743ebe9 1657 ap upright and lateral views of the chest were provided . the lungs are hyperinflated with chronic deformity of the left upper hemithorax and rib cage . there are opacities in the lower lungs which raise concern for pneumonia . underlying scarring is better assessed on the prior ct . the heart size is difficult to assess, though appears grossly stable . the mediastinal contour also is grossly unchanged . small right pleural effusion is present . findings concerning for pneumonia within the lower lungs . Pneumonia 19358609 56360897 731ab0b4-e2d74d1d-aa17c85c-e9b48928-13109378 1658 patient has had left upper thoracoplasty, usually for tuberculosis or lung cancer . heterogeneous opacification in the right lung has worsened since , probably pulmonary edema, accompanied by increasing small right pleural effusion . predominant abnormality in the axillary region of the right upper lobe could be concurrent pneumonia, but i am not surprised by asymmetric distribution of edema in this patient with moderate-to-severe emphysema and scarring at the right lung apex . heart size is normal, in the leftward shifted mediastinum . no pneumothorax . Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices 19358609 57135581 190c77fc-21f447bf-1bcfcedc-289f119d-bf901d30 1659 in comparison with the earlier study of this date, there is increased opacification at the left base with poor definition of the hemidiaphragm . this is consistent with developing pneumonia, possibly associated with some volume loss in the left lower lobe and pleural effusion . increased opacification at the right base could reflect either atelectatic changes or a multifocal infiltrate . Atelectasis&&Lung Opacity&&Pleural Effusion&&Pneumonia 19358609 57935686 19b27bf0-71c9fedb-001e6ba5-2e5dda70-8c6ed8b4 1660 increased opacity at the left upper and lower lung concerning for multi focal pneumonia . left basilar atelectasis and pleural effusion is present . small right pleural effusion is also noted . right apical scarring is unchanged . there is no pneumothorax . the cardiac and mediastinal silhouettes are unchanged . an endotracheal tube is in standard position . enteric tube terminates in the stomach . a linear tube extending to the level of the endotracheal tube it may represent esophageal probe . the right picc terminates in the distal svc . . the endotracheal tube is in standard position . . multi focal pneumonia affecting the left upper lower lungs . . moderate left pleural effusion and small right pleural effusion . Pleural Effusion&&Pneumonia&&Support Devices 19358609 57984800 feaef4bc-9543453e-5299332e-ba1069aa-f1907e03 1661 bibasal opacities and the entire chronic deformity of the chest appears to be similar to the previous study concerning for bibasal multifocal pneumoni . Lung Opacity&&Pneumonia 19358609 58119690 23b893a4-1cc40a42-3da788ed-83286c42-25495fd6 1662 the patients neck is flexed to the right . the et tube tip appears to be . cm above the carina . right picc tip is in the lower svc . side port of the ng tube is likely below the ge junction, with the tip out of view . there is moderate pulmonary edema . moderate right and small to moderate left effusions appear similar to prior, allowing for differences in patient positioning . retrocardiac opacity and silhouetting of the left hemidiaphragm are similar to prior . left upper lung distortion is similar to prior . there is no pneumothorax . the cardiomediastinal silhouette is normal . aortic calcification projecting over the heart is similar to prior . no free air below the right hemidiaphragm is seen . . evaluation of et tube location is suboptimal due to patient positioning, but appears low . . right picc and ng tube are similar to prior . . moderate right and small to moderate left effusions appear similar to prior, allowing for differences in patient positioning . . other findings are similar to . Pleural Effusion&&Support Devices 19358609 58676813 a910b094-06011b04-d15075aa-21b8d267-25f63219 1663 there has been some interval partial clearing of the right-sided infiltrate . however given the extensive distortion of the thoracic anatomy it is difficult to assess for resolution of the acute on chronic changes . the et tube is unchange . No Finding&&Support Devices 19358609 58804781 916c8cda-4a5b71e7-48853bfe-64498756-5f944dfe 1664 compared to the prior study there is no significant interval change . no change . No Finding 19358609 59338434 3ae34505-09ffb124-9c5fe036-82b07f1e-8705cb06 1665 in comparison with the study , there is little change in the appearance of the heart and lungs and the monitoring and support device . Cardiomegaly&&Support Devices 19358609 59343870 ae4f09dd-f871aed3-8165305a-661a70af-14375e0d 1666 compared to chest radiographs through . combination of moderate right pleural effusion and right lower lobe atelectasis has decreased slightly . severe volume loss in the left lower lobe and somewhat smaller left pleural effusion are stable . multifocal left upper lobe consolidation is unchanged . heart size is indeterminate . right pic line, et tube, nasogastric drainage tube are all in standard placements . Atelectasis&&Cardiomegaly&&Consolidation&&Pleural Effusion&&Support Devices 19358609 59658365 2d432182-9bf3ffc9-5168db43-277efaa2-9a16f74a 1667 in comparison with the study of , there is little overall change in the post-surgical appearance of the left upper chest . chronic changes are seen bilaterally, but no evidence of acute focal pneumonia . No Finding 19358609 59926281 6f58b90c-095967a1-12f62c81-70614815-9208a903 1668 compared to the prior study there is no significant interval change . no change . No Finding 19358609 59969313 37230aa4-c435f397-efca09f0-e71f6a7f-ccd59a4a 1669 there are low lung volumes . cardiac size is top-normal accentuated by the projection of the low lung volumes . lines and tubes are in unchanged standard position . there is mild vascular congestion . increasing bibasilar opacities are likely atelectasis . atelectasis in the perihilar regions bilaterally are unchange . Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Support Devices 19366448 50411452 da94e05c-941be1ba-f5996c0b-75dd288f-278d8503 1670 there is interval worsening of pulmonary vascular congestion . there is mild pulmonary edema . the heart and mediastinal structures are unchanged . an endotracheal tube nasogastric tube and left internal jugular catheter remain in place . there are no concerning bone findings . interval worsening of vascular congestion . there is mild pulmonary edema . Edema 19366448 51571135 da330caa-eaa7ebe9-4d1535ac-17f87653-e729c518 1671 in comparison with the earlier study of this date, the monitoring and support devices are essentially unchanged . relatively low lung volumes with the cardiac silhouette at the upper limits of normal or mildly enlarged . continued mild to moderate pulmonary vascular congestion with bibasilar atelectatic changes . in the appropriate clinical setting, it would be difficult to unequivocally exclude superimposed pneumonia, especially in the absence of a lateral view . Atelectasis&&Edema&&Support Devices 19366448 51687346 7edb8547-95df07ca-f8f9e9d2-6c7ffe4e-34a97b30 1672 lung volumes remain persistently low . left internal jugular central venous catheter tip terminates at the confluence of the brachiocephalic veins . no pneumothorax . endotracheal tube is in standard position terminating approximately cm from the carina . enteric tube courses below the left hemidiaphragm, into the stomach and off the inferior borders of the film . heart size is normal . mediastinal and hilar contours are unchanged . mild pulmonary vascular congestion is slightly improved in the interval . patchy atelectasis is noted in the lung bases . no large pleural effusion is noted however the extreme left costophrenic angle is excluded from the field of view . no acute osseous abnormalities are detected . . left internal jugular central venous catheter tip at the confluence of the brachiocephalic veins . no pneumothorax . . standard positioning of the endotracheal and enteric tubes . . improving mild pulmonary vascular congestion . Edema&&Support Devices 19366448 55970267 861e6fd8-db9763b1-684e5bf9-a814a02e-e28cca70 1673 lung volumes remain low . there is continued evidence of mild pulmonary edema mediastinal structures are unchanged . an endotracheal tube, nasogastric tube and left internal jugular catheter remain in place . there is no significant change . no significant change . No Finding 19366448 56614916 4c21d27a-14b093bd-9c833943-ccdfb838-1b72eec0 1674 in comparison with the study of , the monitoring and support devices are essentially unchanged . scatter radiation related to the size of the patient somewhat obscures detail . cardiac silhouette remains at the upper limits of normal in size with mild elevation of pulmonary venous pressure in bilateral pleural effusions with compressive basilar atelectasis, with the volume loss most prominent in the left lower lobe . Atelectasis&&Cardiomegaly&&Pleural Effusion&&Support Devices 19366448 57258316 c5c9ba27-4ce72de1-06e2852c-338a1906-49904456 1675 comparison to . no relevant change is noted . low lung volumes . mild fluid overload but no overt pulmonary edema . borderline size of the cardiac silhouette . mild bilateral pleural effusions . stable left lower lobe atelectasis . Atelectasis&&Cardiomegaly&&Pleural Effusion 19366448 57729179 865486e4-6d43765f-e1cebccc-d80670c5-b9aeea25 1676 the patient is rotated, limiting assessment . the mediastinum is normal in size and contour . the cardiac silhouette is normal in size . the hila are unremarkable . there is no pneumothorax lungs are expanded and clear without focal consolidation . gaseous distention of multiple bowel loops is noted in the upper abdomen . no acute cardiopulmonary process . No Finding 19468400 59457175 013d509d-3aabeff2-5f8a03ca-0fa9071b-9475198d 1677 new heterogeneous opacification in the right mid lung, particularly projecting over the anterior right second and third ribs could be edema or early pneumonia . careful followup advised . left lower lobe atelectasis is new, along the descending thoracic aorta . small left pleural effusion is present . no appreciable pneumothorax, left apical pleural tube in place . heart size normal . dr . was paged to report these findings . Atelectasis&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia 19486351 57905310 8a4e1705-f30d7e1d-dd1ef999-a8521d7e-e64ad0c9 1678 patient is status post left upper lobectomy . left chest tube is seen terminating at the left upper lung . lung volumes are low . mild haziness of the left lung, volume loss and mild mediastinal shift to the left attributed to left upper lobectomy . there is no pneumothorax or pleural effusion . Support Devices 19486351 58557335 278ef848-f481280c-dc9c5c10-bbaaf9d2-37100e82 1679 the cardiomediastinal and hilar contours are within normal limits . there is mild tortuosity of the thoracic aorta . lung volumes are slightly decreased when compared to prior examination . there is no focal consolidation, pleural effusion or pneumothorax . no acute cardiopulmonary process . No Finding 19580789 55456794 a4fb4d63-a48fc7f0-fce5fdee-044f6290-6963a261 1680 heart size is normal . the mediastinal and hilar contours are normal . the pulmonary vasculature is normal . the lungs are clear . no pleural effusion or pneumothorax is seen . no acute cardiopulmonary abnormality . No Finding 19587538 52370369 f615e0cd-8708c9de-4c3c409c-61733455-21d87814 1681 ap upright portable view of the chest provided . the lungs appear largely clear bilaterally aside from mild dependent basilar atelectasis . slightly underpenetrated technique limits the evaluation for subtle mild congestion, though there is no overt evidence for pulmonary edema . the heart size appears normal . the mediastinal contour is stable and within normal limits . the bony structures appear intact . there is no free air below the right hemidiaphragm . bibasilar atelectasis . no overt evidence for pneumonia or edema . Atelectasis 19587538 52705257 af3bd66e-b12a61bb-31b04389-8bfe9264-e50eef1b 1682 exam is limited by significant rotation . heart size is enlarged . 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 . cardiomegaly, but no evidence of pulmonary edema or pneumonia . Cardiomegaly 19598137 50422579 c5157006-1a73eeaf-efe1fd1c-7c18314b-7183f206 1683 comparison to . no relevant change . moderate cardiomegaly . no pleural effusions . no pneumonia, no pulmonary edema . the course of the feeding tube is stable . Cardiomegaly&&Support Devices 19598137 51118033 ea096f49-af1e650c-7f97b6e7-1a3d6813-f7276d49 1684 there is a small amount of pneumoperitoneum below the left hemidiaphragm, which may be expected considering the recent percutaneous g-tube placement . there is persistent mild pulmonary edema . the small bilateral pleural effusions are unchanged in size . there are no new focal consolidations . the cardiomediastinal silhouette is stable . there is no pneumothorax . . small amount of pneumoperitoneum, which may be expected with the recent percutaneous g-tube placement . . persistent mild pulmonary edema . . small bilateral pleural effusions . notification the findings were discussed with , md . by , md . on the telephone on at am, minutes after discovery of the findings . Edema&&Pleural Effusion&&Support Devices 19598137 52070310 6f9b4419-458e6f28-c82d6907-73e32753-6c0c1e05 1685 compared with the prior radiograph, moderate cardiomegaly is unchanged, without pleural effusions or pneumothorax . edema has improved . course of the feeding tube is unchanged . a faint right lower lobe opacity is new . a very faint right lower lobe opacity is new, and pa and lateral radiographs may be helpful to evaluate, when the patient is able to tolerate . edema has improved . Edema&&Lung Opacity 19598137 54003094 2eccb67e-a8677000-bc5af537-c58f2e49-f4234ef1 1686 re- demonstration of a small amount of presumed free subdiaphragmatic air below left hemidiaphragm, described previously as the likely a consequence of recent percutaneous g-tube placement . on this semi-erect view, it is difficult to evaluate for interval change . persistent mild pulmonary edema, without new focal consolidation or pneumothorax . small bilateral effusions are unchanged . the cardiomediastinal silhouette is also unchanged . . persistent presumed free left subdiaphragmatic air due to recent g-tube placement, as discussed with the clinician yesterday . on this semi-erect view, it is difficult to evaluate for interval change . . persistent mild pulmonary edema . Edema&&Support Devices 19598137 57114319 837f34fb-f3caa2c0-91f85420-2a52db56-db213e08 1687 in comparison to the previous study of day earlier, a new area of right upper lobe opacification is accompanied by a elevation of the minor fissure, favoring atelectasis . coexisting infection or aspiration are also possible in the appropriate clinical setting . exam is otherwise remarkable for improved aeration at both lung bases and decreased amount of free intraperitoneal air below the diaphragm . no other relevant changes . Atelectasis&&Lung Opacity&&Pneumonia 19598137 57529558 8057c454-92e4f89a-2c84ed68-c2a9a717-ce21fb60 1688 there is a dobhoff coursing below the diaphragm, however the tip is not visualized . there is increasing interstitial pulmonary edema . there are small bilateral pleural effusions and bibasilar atelectasis, however an underlying pneumonia cannot be excluded . the cardiomediastinal silhouette is stable . there is no pneumothorax . . appropriately positioned dobhoff . . increasing interstitial pulmonary edema with small bilateral pleural effusions, however an underlying pneumonia cannot be excluded . Edema&&Pleural Effusion&&Pneumonia 19598137 57551344 ea288c46-b57777bf-b5b617cc-c21e01ab-f7a752af 1689 the lungs are hyperinflated but clear without consolidation, effusion, or pneumothorax . cardiomediastinum silhouette is stable . no displaced fractures identified . hypertrophic changes are noted in the spine . no acute cardiopulmonary process . No Finding 19636128 50421655 8c1f9b73-cfb72331-df480911-a6810f9a-a3fcbcb9 1690 the lungs are clear . cardiomediastinal silhouette is top-normal in size . there is no pneumothorax or pleural effusion . visualized osseous structures are unremarkable . no free air is identified diaphragm . no acute cardiopulmonary process . no free air under the diaphragm . No Finding 19636128 53867841 3d798d0a-869fac09-5939ab06-011a871f-2f43260b 1691 there are relatively low lung volumes . mild pulmonary vascular congestion is seen . there is no focal consolidation . no large pleural effusion or pneumothorax is seen . the cardiac silhouette is mildly enlarged . the aorta is calcified and tortuous . mild pulmonary vascular congestion . Edema 19680874 57007394 dc232a2f-f3e99d0f-a4433b11-fcccd1c7-334c161d 1692 compared with prior radiographs on , the right hemidiaphragm is not sharply seen . there is a small right pleural effusion and atelectasis at the right lung base . there is no new focal consolidation to suggest pneumonia . there is no edema or pneumothorax . cardiomediastinal silhouette is unchanged . small right pleural effusion and a basilar atelectasis . Atelectasis&&Pleural Effusion 19769430 58783883 2a46f86f-aa12bf29-81681d7d-afb9c9d8-23629fe0 1693 since , there has been interval placement of a left pectoral pacemaker with transvenous leads seen in the right atrium, right ventricle, and a left coronary vein . the lungs are clear . mild to moderate bibasilar atelectasis is noted . no pneumothorax . the median sternotomy wires are intact and aligned . patient is status post aortic valve and mitral valve repair . left pectoral pacemaker with transvenous leads in the ra, rv, and a left coronary vein . no pneumothorax . No Finding&&Support Devices 19837705 52132258 e8b2aa8e-420f069d-51dc7f6f-2c778b27-c505a888 1694 severe cardiomegaly is stable . the lungs are clear . there is no pneumothorax or enlarging pleural effusions . the patient is status post aortic and mitral valve repair . sternal wires are aligned . Cardiomegaly&&Support Devices 19837705 53199615 409ab484-fda170e7-cda34211-b9ba9941-eb94231c 1695 in comparison with the study of , the swan-ganz catheter has been removed . continued enlargement of the cardiac silhouette with worsening pulmonary edema . little change in the degree of bilateral pleural effusions, more prominent on the left . Cardiomegaly&&Edema&&Pleural Effusion 19890030 51104313 59b03271-bcecfa84-7b2e92ae-e5846d6d-e977136a 1696 in comparison with the study of , the monitoring and support devices have been removed with a right ij sheath remaining in place . no evidence of pneumothorax . the cardiac silhouette is enlarged and there is evidence of retrocardiac opacification consistent with volume loss in the left lower lobe . mild atelectatic changes are seen on the right and there is blunting of both costophrenic angles . Atelectasis&&Cardiomegaly&&Lung Opacity&&Support Devices 19890030 51116903 f82ff9bb-9bbb3f96-d55b669c-6b737ab9-ec52275a 1697 in comparison with the earlier study of this date, there has been placement of a right picc line that terminates in the left axilla . otherwise little change . No Finding&&Support Devices 19890030 52519588 9da44dd4-f08ae82f-ac9dd82e-966b3d51-9fec0a87 1698 in comparison with the study of , the monitoring and support devices are essentially unchanged . again, there are diffuse areas of increased opacification bilaterally, consistent with pulmonary edema with cardiomegaly and bilateral pleural effusions with compressive atelectasis at the bases . in the appropriate clinical setting, supervening pneumonia would have to be considered . Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Pneumonia&&Support Devices 19890030 52916619 ed3ea821-d5846c32-5f18d81a-657f73d8-472d55eb 1699 portable ap radiograph of the chest was reviewed in comparison to . there is interval development of moderate-to-severe interstitial pulmonary edema with some element of alveolar edema and bilateral pleural effusions, substantial progression as compared to the prior study . the patient was subsequently intubated as demonstrated on the subsequent chest radiograph . Edema&&Pleural Effusion 19890030 53194989 6df0cd0f-91dd20ee-536b79af-b3e50b34-32f3f9b1 1700 in comparison with the earlier film of this date, the swan-ganz catheter tip has been pulled back to the proximal portion of the right pulmonary artery . nasogastric tube extends into the stomach . endotracheal tube is unchanged . bilateral chest tubes are in place without evidence of pneumothorax . improved aeration in the retrocardiac region with sharp demonstration of the hemidiaphragm . improvement in pulmonary vascular congestion . Edema&&Support Devices 19890030 54123605 4ba74541-1812cc99-3b99acbf-6b40a2bd-03715cdd 1701 support and monitoring devices are in standard position, and cardiomediastinal contours are stable . persistent pulmonary vascular congestion accompanied by improving pulmonary edema and slight decrease in size of bilateral pleural effusions . Edema&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices 19890030 55960980 7836bdb5-cf4a3248-ef755485-efddc4f8-838caea7 1702 as compared to the previous radiograph, the interstitial component of the pre-existing pulmonary edema has minimally decreased and the pleural effusions have minimally increased in extent . signs of pulmonary edema, however, are still clearly present . the monitoring and support devices, including the swan-ganz catheter, are in unchanged correct position . no new focal parenchymal opacities . no pneumothorax . Edema&&Lung Opacity&&Pleural Effusion&&Support Devices 19890030 56131156 6d0fb843-3f18a296-cc24e0d5-d5196b76-d27ae8c5 1703 as compared to the previous radiograph, the patient has been extubated and the nasogastric tube was removed . the lung volumes have slightly decreased . a pleural effusion on the left is minimally increased and signs of mild to moderate pulmonary edema are present in almost unchanged manner . no pneumothorax . no new parenchymal opacities . Edema&&Lung Opacity&&Pleural Effusion 19890030 57351800 a467ed3c-e5c2d31f-310831c5-6bfd3ab4-fc6a815b 1704 an et tube terminates cm above the carina . and ng tube passes inferiorly off the image in the expected region of the stomach . the lungs are well expanded . diffusely increased interstitial markings are again seen, along with engorged pulmonary vasculature and cardiomegaly and bilateral pleural effusions, consistent with moderate pulmonary edema . increased opacity at the left lung base compared to prior likely reflects atelectasis . no focal consolidation is seen . there is no pneumothorax . . et tube terminates cm above the carina . . moderate pulmonary edema with bilateral pleural effusions . Edema&&Pleural Effusion&&Support Devices 19890030 57378297 eac34627-0d789691-739a8249-d2bf5f3c-c4240547 1705 in comparison with study of , the left ij swan-ganz catheter again extends well into the left pulmonary artery . this could be withdrawn a few centimeters for standard positioning . otherwise, little change in the diffuse bilateral pulmonary opacifications . Lung Opacity&&Support Devices 19890030 57508468 8027d184-a9e2e118-bcdce505-fcbd9f09-34dd5c61 1706 in comparison with the study of hour previously, there is some worsening of the pulmonary edema . continued bilateral pleural effusions with compressive atelectasis at the bases . Atelectasis&&Edema&&Pleural Effusion 19890030 57519317 10e73dc9-0b884e25-eafa8a2f-300f0487-def8b4d6 1707 as compared to the previous radiograph, the signs indicative of interstitial lung edema have substantially improved . there is a new retrocardiac atelectasis . no pleural effusions . borderline size of the cardiac silhouette persists . unchanged position of the monitoring and support devices . Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Support Devices 19890030 57919531 d1ea5ea1-2de5c378-91bf68a9-68b52f49-c9f7e486 1708 the right ij central venous catheter has been removed . there is no pneumothorax . mild to moderate pulmonary edema has increased since the prior exam . small bilateral pleural effusions are unchanged . the patient is status post median sternotomy with stable cardiomegaly . there is generalized osteopenia . interval worsening of pulmonary edema with stable small bilateral pleural effusions . stable cardiomegaly . Cardiomegaly&&Edema&&Pleural Effusion 19890030 57980997 e174e22d-517ea52f-b085dd2a-be0e9ea0-7d59e8de 1709 a new right ij central line terminates in the mid to low svc . the et tube and ng tube are unchanged from prior exam . the lungs are well expanded . diffusely increased interstitial markings are again noted in the lungs bilaterally, along with engorged pulmonary vasculature, cardiomegaly, and bilateral pleural effusions, consistent with moderate pulmonary edema, similar to prior exams . opacity at the left lung base is again noted, consistent with atelectasis . no focal consolidation is seen and there is no pneumothorax . . right ij central line terminates in the mid to low svc . . moderate pulmonary edema with bilateral pleural effusions . Edema&&Pleural Effusion&&Support Devices 19890030 58510002 3435ed46-ac4d2fc9-701d2553-97322bab-a7090480 1710 portable ap radiograph of the chest was reviewed in comparison to prior study obtained the same day earlier . the ng tube tip is currently . cm above the carina . the ng tube tip is in the stomach . the left internal jugular line tip is at the level of mid svc . heart size and mediastinum are unchanged including cardiomegaly but there is interval progression of pulmonary edema and interval increase in pleural effusion . Cardiomegaly&&Edema&&Enlarged Cardiomediastinum&&Pleural Effusion&&Support Devices 19890030 58522311 70902757-a017a659-da4b19d2-03d0af76-59db344f 1711 the lungs are well expanded . diffusely increased interstitial markings, pulmonary vasculature engorgement, cardiomegaly, and small bilateral pleural effusions are seen, consistent with moderate pulmonary edema . no focal consolidation is seen . there is no pneumothorax . moderate pulmonary edema with small bilateral pleural effusions . Edema&&Pleural Effusion 19890030 59340980 7302c211-bcfb3845-18039b6f-551fc6f1-549ee247 1712 in comparison with the study of , the monitoring and support devices are essentially unchanged . diffuse bilateral pulmonary opacification is consistent with pulmonary edema in a patient with cardiomegaly and bilateral pleural effusions with compressive atelectasis at the bases . Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Pleural Effusion&&Support Devices 19890030 59921918 fd85d68f-eb20917f-47c20d2b-ecd0f4e7-2bdee415 1713 as compared to , a swan-ganz catheter has been removed, and a right internal jugular catheter terminates deep in the right atrium . lung volumes are lower compared to prior study . diffuse alveolar pulmonary edema has probably slightly worse in the interval, although lower lung volumes limit comparison . Edema&&Support Devices 19932024 50370886 fc82e711-14ed01dc-ce2a326a-162251e4-aee54953 1714 as compared to the previous radiograph, the patient has been extubated and the nasogastric tube was removed . the right internal jugular vein catheter and the swan-ganz catheter are in unchanged position . newly appeared massive bilateral parenchymal opacities, the time course of the changes suggests pulmonary edema rather than pneumonia, notably given the presence b lines and of a retrocardiac atelectasis . moderate cardiomegaly persists . short-term followup is required . Atelectasis&&Cardiomegaly&&Edema&&Lung Opacity&&Support Devices 19932024 50963033 fc325dc2-bf224206-062f3c9e-47aae515-4ef25cc0 1715 as compared to the previous image, the swan-ganz catheter has been pulled back . the tip now projects over the proximal parts of the right pulmonary artery . the other monitoring and support devices are constant . low lung volumes and moderate cardiomegaly persists . mild pulmonary edema is present on todays image . no pneumonia . Cardiomegaly&&Edema&&Support Devices 19932024 54345212 68ccd799-61e98428-3c7d8e41-6cbc342c-3426519b 1716 despite the low lung volumes . the increase in the perihilar interstitial opacities and increase in the azygos vein is consistent with interstitial pulmonary edema . small bilateral pleural effusions are most likely present . Edema&&Lung Opacity&&Pleural Effusion 19932024 54635186 63632dd8-b728b108-982f3619-2ca6f6b2-61729c7f 1717 as compared to the previous radiograph, the extensive bilateral parenchymal opacities, diffusely distributed in both lungs, are not substantially changed . the lung volumes remain low . moderate cardiomegaly . no pleural effusions . Cardiomegaly&&Lung Opacity 19932024 56211786 e83af64a-ef08e235-e0e92758-c6fe1b4d-09380b28 1718 lung volumes are lower, but increased pulmonary vascularity is real, consistent with increase pulmonary circulation or left ventricular dysfunction . there is no definite focal pulmonary abnormality . heart size top-normal . no appreciable pleura . Cardiomegaly 19932024 57682201 d067947d-61c60fe1-b73bc826-356d3d2c-fd22bb48 1719 the lung volumes are low . there are bibasilar linear opacities, atelectasis and or consolidation . diffuse vascular prominence and cardiomegaly noted . no pleural effusion or pneumothorax present . ekg leads overlie the anterior chest . bony thorax is stable . low lung volumes with bibasilar atelectasis andor consolidation . underlying mild pulmonary edema also noted . Atelectasis&&Consolidation&&Edema 19932024 58536194 937ff0e8-71a2ffe2-83753442-7400aa5e-eceef12c 1720 normal lung volumes . normal size of the cardiac silhouette . normal hilar and mediastinal contours . no pneumothorax, no pleural effusions, no pulmonary edema . no pneumonia . No Finding 19932024 58958645 f77e46ef-2fa9d49a-1defe019-ac2c199d-7695e244 1721 moderately well inflated lungs with no change in prominence of pulmonary vasculature . stable cardiomegaly . enlarged left atrial shadow is again identified . no pleural effusions or pneumothorax . no change in bony thorax . no change in mild to moderate pulmonary edema and cardiomegaly . no lobar consolidation . Cardiomegaly&&Edema 19932024 59300264 943f96be-7c33efa1-3665b82f-60d8f305-a6ed2d9d 1722 parenchymal abnormality including emphysema with mild interstitial disease appears stable . there is mild pulmonary vascular congestion and interstitial edema . scarring at the left lung base also unchanged . no pleural effusion or pneumothorax . mild cardiomegaly is noted . the aortic knob is calcified . emphysema with mild congestion and edema . bibasal atelectasis, mild cardiomegaly . Atelectasis&&Cardiomegaly&&Edema 19950864 53502057 1fc7bf88-79d4deaf-2efe8540-6361e421-37a2c6fa