JB/mimic-cxr-rrg · Datasets at Hugging Face

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1		AP chest compared to ___: Tip of the endotracheal tube at the upper margin of the clavicles is no less than 45 mm from the carina. Care should be taken that the tube does not withdraw any further. Lungs are clear. Cardiomediastinal and hilar silhouettes and pleural surfaces are normal.
2		ET tube in standard placement. The nasogastric tube ends in the stomach. The lungs are fully expanded and clear. The heart size is normal. Adenopathy at least in the left hilus is evident.
3		No evidence of acute cardiopulmonary process.
4		No acute intrathoracic process.
5		No acute cardiopulmonary process.
6		No radiographic findings to suggest pneumonia.
7		1. Status post median sternotomy for CABG with stable cardiac enlargement and calcification of the aorta consistent with atherosclerosis. Relatively lower lung volumes with no focal airspace consolidation appreciated. Crowding of the pulmonary vasculature with possible minimal perihilar edema, but no overt pulmonary edema. No pleural effusions or pneumothoraces.
8		1. Left PICC tip appears to terminate in the distal left brachiocephalic vein. 2. Mild pulmonary vascular congestion. 3. Interval improvement in aeration of the lung bases with residual streaky opacity likely reflective of atelectasis. Interval resolution of the left pleural effusion.
9		No definite acute cardiopulmonary process. Enlarged cardiac silhouette could be accentuated by patient's positioning.
10		Increased mild pulmonary edema and left basal atelectasis.
11		1. Decreased left basilar consolidation with mild pulmonary edema. 2. Possible pulmonary arterial hypertension.
12		AP chest compared to ___: ET tube in standard placement. Nasogastric tube passes into the stomach and out of view. No pneumothorax. Leftward mediastinal shift suggests a new opacification at the base of the left lung is atelectasis. The right lung is clear. Left jugular line ends at the origin of the SVC.
13		1. Hazy opacity in the right lung which may represent aspiration versus pleural effusion or hemorrhage. 2. Mild pulmonary edema. 3. No displaced rib fractures.
14		The patient is markedly rotated to his left limiting evaluation of the cardiac and mediastinal contours. The heart remains enlarged. There has been interval removal of the endotracheal tube with placement of a tracheostomy tube, which has its tip at the thoracic inlet. The right subclavian PICC line still has its tip in the distal SVC. A nasogastric tube is seen coursing below the diaphragm with the tip projecting over the expected location in the stomach. Patchy opacity in the retrocardiac region may reflect an area of atelectasis, although pneumonia cannot be entirely excluded. No evidence of pulmonary edema. No pneumothorax. Probable small layering left effusion.
15		1. Mild chronic congestive heart failure with stable trace pulmonary edema at the right lung base. 2. Stable bibasilar atelectasis.
16		No significant interval change since prior. Pulmonary vascular congestion. Bibasilar opacities potentially due to atelectasis; however, infection is not excluded.
17		1. Unchanged bibasilar opacities are consistent with atelectasis or consolidation and pneumonia should be considered in the appropriate clinical context. 2. Improved pulmonary edema.
18		Mild residual retrocardiac opacification remains, pneumonia vs. atelectasis.
19		Limited study with hazy opacity in the right upper and mid lungs which may be infectious in etiology, atelectasis or artifact.
20		No evidence of pneumonia. Stable cardiomegaly.
21		Faint increased opacification in left mid lung may indicate developing infectious process. Could further evaluate with right anterior oblique view to further evaluate lung.
22		Consolidation in the right base is most consistent with pneumonia. Results were communicated with Dr. ___ at 11:10 a.m. on ___ via telephone by Dr. ___.
23		No acute intrathoracic process.
24		1. Mild improvement of pulmonary vascular congestion. 2. Less opacification at the right lower; no evidence of pneumonia on today's radiograph. Results were communicated with the surgery team by Dr. ___.
25		No acute cardiopulmonary process.
26		No acute cardiopulmonary process. No significant interval change. Please note that peribronchovascular ground-glass opacities at the left greater than right lung bases seen on the prior chest CT of ___ were not appreciated on prior chest radiography on the same date and may still be present. Additionally, several pulmonary nodules measuring up to 3 mm are not not well appreciated on the current study-CT is more sensitive.
27		AP chest compared to ___: Bronchial wall thickening or peribronchial infiltration in the lower lungs where most pronounced bronchiectasis is have worsened since ___ consistent either with a flare of bronchiectasis or development of peribronchial pneumonia. Heart size is normal. There is no pleural effusion, no pneumothorax. Feeding tube ends in the upper stomach.
28		1. Dobbhoff feeding tube is seen coursing below the diaphragm with the tip not completely identified but positioned within the stomach proximally. It does not appear to be significantly changed. Bilateral lower lobe bronchiectasis is stable. No focal airspace consolidation is seen to suggest an acute pneumonia. No pleural effusions or pneumothoraces. Overall, cardiac and mediastinal contours are unchanged. Lungs remain hyperinflated.
29		1) Small left effusion with underlying collapse and/or consolidation. In the appropriate clinical setting, the differential would include a pneumonic infiltrate. Findings discussed with the covering house officer on the afternoon of the exam.
30		PA and lateral chest compared to ___ through ___, extent of peribronchial thickening and impaction of extensive bibasilar bronchiectasis may have increased slightly since the most recent prior lateral chest radiograph, ___. There is really no change in the appearance of the frontal views as recently as ___. Generalized hyperinflation is due to emphysema. Heart size is normal. There is no pulmonary edema, consolidation. A tiny right pleural effusion may be new, but probably not clinically significant. Findings would therefore be attributed to decompensation of emphysema and bronchiectasis.
31		Bilateral lower lobe bronchiectasis with improved right lower medial lung peribronchial consolidation.
32		AP chest compared to ___: Feeding tube, now without the wire stylet ends in the same place, upper stomach. The apex and lateral right lower hemithorax are excluded from this examination. Remaining pleural surfaces are normal and the imaged lungs show no pneumonia or edema, but there are several small nodules and bronchiectasis in the right lower lobe.
33		PA and lateral chest compared to ___: Slight hyperinflation, chest CTA prior to surgery did not show emphysema. It did show mild to moderately severe bronchiectasis, particularly in the left lower lobe. Postoperatively, left lower lobe consolidation is probably due to atelectasis, stable since ___. There is new peribronchial opacification on the right, conceivably aspiration. Exacerbation of bronchiectasis is another possibility. There is no pulmonary edema, and the upper lungs are clear. Tiny left pleural effusion is of no clinical significance. Heart size is normal.
34		Stable chest radiographs without acute change.
35		Little change in the severe bronchiectasis and emphysema.
36		1. Moderate right apical pneumothorax has very minimally decreased since yesterday. 2. Right lower lung opacity concerning for aspiration/atelectasis is more denser than before, though not increased in size. Small right pleural effusion is unchanged. No new left pleural effusion.
37		1. New left pleural effusion and slight mediastinal shift. Recommend obtaining PA expiratory films to exclude a left pneumothorax. 2. Stable right pneumothorax. Findings were discussed by Dr. ___ with Dr. ___.
38		New large right-sided pleural effusion with underlying atelectasis and possible consolidation in the middle and lower lobes. CT scan may offer additional detail of underlying parenchymal abnormalities. Small left-sided pleural effusion.
39		Interval decrease in size of right effusion, though a moderate to moderately-large right effusion remains. No pneumothorax detected.
40		Stable large right pleural effusion and increasing left pleural effusion. Feasibility of of thoracentesis would best be evaluated with decubitus films. Ultrasound guidance can also be considered.
41		Significant interval increase in the bilateral pleural effusions since prior exam with possible underlying airspace disease not excluded.
42		Reoccurrence of right-sided pleural effusion in patient with history of pancreatic carcinoma. No radiographic evidence of CHF, cardiac enlargement or fluid overload.
43		Folowing right pigtail catheter placement, moderate right pleural effusion has near completely resolved, whereas large left pleural effusion associated with passive collapse of adjacent lung and mediastinal shift to the right side is persisting. No pneumothorax.
44		1. New mild-to-moderate left pneumothorax with mild rightward shift of the mediastinum. 2. Stable right pneumothorax. 3. Moderate left pleural effusion. The case was discussed by Dr. ___ with Dr. ___.
45		AP chest compared to ___ through ___: Feeding tube with a wire stylet in place passes into the stomach and out of view. Comparing today's examination with many chest radiographs since ___, it looks like there is a mild degree of pulmonary edema superimposed on chronic interstitial lung disease. Specifically, on ___ the interstitial abnormality is comparable to that on ___, whereas at other times there has been at least a component of acute pulmonary edema. Today, the findings are very similar to ___. Severe cardiomegaly and pulmonary vascular plethora are chronic. Left subclavian infusion port ends in the mid-to-low SVC. Pleural effusion, if any, is minimal and there is no pneumothorax.
46		New pulmonary parenchymal abnormalities on top of chronic pulmonary fibrosis most likely represents pulmonary edema. Infection is less likely.
47		Superimposed pulmonary edema on a background of pulmonary fibrosis. Low lung volumes limit assessment for basilar consolidation.
48		Left-sided Port-A-Cath placement, terminates within the right atrium. Can be withdrawn 3 cm and still remain within the low SVC.
49		Moderate to severe pulmonary edema is increased from the prior examination. No focal consolidation to suggest pneumonia is seen. No significant pleural effusion or pneumothorax is present. There is moderate cardiomegaly. A left-sided port is unchanged. There are multiple vertebroplasties.
50		PA and lateral chest compared to ___: Heterogeneous pulmonary opacification has worsened in both lungs. This is largely pulmonary edema, but more focal abnormalities in the axillary portion of the left lung and at the right lung base could be concurrent pneumonia. In addition, chest radiographs from ___ suggest concurrent substantial interstitial lung disease. Mild-to-moderate cardiomegaly is stable. Endotracheal tube is no less than 2 cm from the carina, with the chin in neutral position. Care must be taken that it not advance inadvertently. A left subclavian infusion port ends in the right atrium. Dr. ___ was paged at the time of dictation.
51		Some improvement in still prominent pulmonary vascular congestion.
52		Pulmonary edema superimposed on known lung fibrosis.
53		Improved but not resolved mild-to-moderate pulmonary edema.
54		Mild pulmonary edema superimposed on known lung fibrosis. Severe chronic cardiomegaly and pulmonary hypertension. No displaced rib fracture. Multiple vertebroplasties, similar to prior.
55		No evidence of acute disease. Severe pulmonary fibrosis, not significantly changed.
56		No acute intrathoracic process.
57		Pulmonary edema.
58		Stable frontal chest radiograph. Limited evaluation in the setting of single frontal view; lateral view would be helpful for more thorough evaluation. This was discussed with Dr. ___ by Dr. ___ by phone at 12:45 p.m. on ___.
59		No significant change since the prior study and no evidence of overt pulmonary edema.
60		Thickening of the pleural margins in the abnormal contour of the left heart border oral due to fat deposition. Lungs are reasonably well expanded and clear. Heart is probably top normal size but there is no pulmonary vascular engorgement, mediastinal venous engorgement, edema or any pleural effusion. The thoracic aorta is generally tortuous, but not focally aneurysmal.
61		In comparison to study of ___, the patient has taken a better inspiration. Again there is evidence of previous CABG with median sternotomy wires in place. Scarring at the right base and costophrenic angle again noted. No evidence of acute focal pneumonia, vascular congestion, or pleural effusion.
62		No acute cardiopulmonary process.
63		No acute cardiopulmonary process.
64		The nasogastric tube is in adequate position and there is resolution of the gastric distention.
65		Mild pulmonary edema with increased size of small to moderate right pleural effusion and right basilar opacity, possibly reflecting atelectasis but infection is not excluded.
66		1. Interval placement of a feeding tube, which courses below the diaphragm with the tip likely within the stomach. The patient is markedly rotated to the right, limiting evaluation of the cardiac and mediastinal contours. Overall, however, there is a more focal airspace opacity in the left mid and lower lung, which may reflect asymmetric pulmonary edema or an infectious process, less likely atelectasis. Clinical correlation is advised. Possible layering left effusion.
67		Mild pulmonary edema and presumed small left pleural effusion, new since ___.
68		Since ___, moderately enlarged heart, mild bilateral pleural effusions and lung aeration have improved
69		Stable cardiomegaly without signs of pneumonia or CHF.
70		AP chest compared to ___: Large cardiomediastinal silhouette has not changed appreciably since at least ___, early postoperatively. Moderate-to-severe cardiomegaly is comparable to the preoperative appearance. Small bilateral pleural effusions persist. There is no longer any pulmonary edema. ET tube and left internal jugular line are in standard placements and a nasogastric tube passes into the stomach and out of view. No pneumothorax.
71		Mild acute congestive heart failure.
72		Right basal nodules as a whole minimally decreased since the prior study. Differential for these lesions includes amiodarone toxicity and cryptogenic organizing pneumonia. While chest radiographs are likely suitable for monitoring for change over time, a baseline CT examination can be obtained to allow for better characterization.
73		Marked improvement in right basilar opacities compared to ___.
74		New multifocal parenchymal opacities in the lower and middle lobes bilaterally, which given concurrent increased hepatic density from ___ to ___, could represent amiodarone-induced pulmonary toxicity. Differential would includes infectious processes in the proper clinical setting or organizing pneumonia. CT could be considered for further evaluation. This was discussed with Dr ___ at noon by Dr ___ on ___ via phone.
75		Cardiomegaly without acute cardiopulmonary process.
76		1. Small right pleural effusion is new; however, there is no evidence of pneumonia and no other significant appreciable change. 2. Mild cardiomegaly is unchanged. The above results were communicated via telephone by Dr. ___ to Dr. ___ ___ at 2:45 p.m. as requested.
77		Relatively similar appearance of diffuse chronic chronic lung disease. No new gross focal consolidation identified.
78		Findings compatible with pulmonary fibrosis with likely superimposed edema. Please note that infection cannot be excluded and clinical correlation is necessary.
79		Minimally increased opacification of the right lower lung may reflect mild edema superimposed on chronic severe interstitial lung disease.
80		Relatively unchanged appearance of the chest compared to prior exam. Persistent opacities within the right upper lobe, left lung base and left perihilar region are redemonstrated on a background of chronic interstitial lung disease which on the prior chest CT was thought to reflect UIP or fibrosing NSIP. As before, these more focal opacities may reflect progression of chronic interstitial lung disease, acute exacerbation of interstitial lung disease, or possibly infection.
81		There are low lung volumes. Cardiomegaly and widened mediastinum are stable. Extensive interstitial reticular abnormalities larger in the left perihilar and left lower lobe region are grossly unchanged allowing the difference in inspiratory effort of the patient without evidence of new abnormalities pneumothorax or effusion. .
82		1. New right PICC is difficult to visualize but likely ends within the lower SVC. 2. Marked interval improvement in what was likely multifocal pneumonia as well as near complete clearance of the bilateral pleural effusions compared to ___. 3. Stable interstitial lung markings consistent with chronic pulmonary fibrosis.
83		In comparison with the study of ___, there are somewhat better lung volumes. Continued enlargement of the cardiac silhouette with extensive parenchymal opacities bilaterally consistent with known fibrotic lung disease.
84		Findings compatible chronic interstitial lung disease, previously characterized on chest CT as UIP or fibrosing NSIP. No new areas of focal consolidation or pulmonary edema.
85		Multifocal opacities worrisome for pneumonia superimposed on severe underlying interstitial lung disease; although recent prior radiographs are not available for comparison and progression of chronic lung disease could be considered as an alternative, acute superimposed pneumonia seems most likely.
86		AP chest compared to ___ through ___: Interval improvement in the severity of severe interstitial lung abnormality, at least in the left lung, is due to recent decrease in the component of reversible pulmonary edema, aside from severe pulmonary fibrosis. Right lung has not appreciably improved. Pleural effusions small if any. Moderate-to-severe cardiomegaly stable. No pneumothorax.
87		Findings again compatible with patient's known pulmonary fibrosis without definite superimposed acute process, noting that subtle change would be difficult to detect based on a portable film.
88		AP chest compared to ___ through ___: Moderate right pleural effusion is new, obscuring some of the right lower lung, but changing the contour of the lung base substantially since ___. Postoperative left hemithorax is unchanged following left upper lobectomy. Heart is partially obscured by postoperative contour changes. Right middle lobe collapse seen on lateral chest films, ___ and ___ and on chest CT, ___, presumably unchanged.
89		1. Postoperative appearance to left hemithorax is stable. There is a patchy opacity at the right base which could reflect a combination of a layering effusion with atelectasis, although an acute infectious process cannot be excluded. Overall, however, there is not significant interval change since ___. No pneumothorax. Cardiac and mediastinal contours is difficult to assess due to the postoperative state of the patient as well as patient positioning on the current examination. No evidence of pulmonary edema.
90		Right lower lobe opacity with volume loss, likely atelectasis, unchanged since the earlier study of ___.
91		AP chest compared to ___: Pulmonary vascular engorgement has improved. There is no mediastinal widening. The heart is unchanged in size, probably mildly enlarged, but obscured by mediastinal fat deposition. The postoperative appearance of the left hemithorax including bulbous left hilus is also longstanding. Large scale atelectasis in the right lower lobe has also been a feature since mid ___, probably progressed to complete collapse. Tracheostomy tube in standard placement.
92		Right lower lobe pneumonia, which has not cleared, and small right pleural effusion.
93		Post left upper lobectomy changes, with no superimposed acute intrathoracic process detected.
94		Right basilar opacity silhouetting the hemidiaphragm, possibly due to any combination of effusion, atelectasis or consolidation. Clinical correlation recommended. Two-view chest x-ray may also offer additional detail.
95		Cardiomegaly and venous congestion.
96		AP chest compared to ___ at 9:59 a.m.: Mild pulmonary edema worsened slightly since earlier in the day. No pneumothorax. Small left pleural effusion and moderate left basal atelectasis are unchanged. Pulmonary artery catheter ends in the right pulmonary artery. Transvenous right atrial and right ventricular pacer leads are unchanged in longstanding locations including the more medial than usual positioning of the tip of the right atrial lead. Mild-to-moderate cardiomegaly comparable to the preoperative appearance.
97		No significant interval changes during the last 24 hours interval. The described changes with postoperative status, CHF, pleural effusion and intra-aortic balloon pump device in place is of course compatible with the patient's hypoxia.
98		AP chest compared to ___ at 9:19 a.m.: No appreciable pneumothorax or right pleural effusion following removal of the right basal pleural drain. Mild pulmonary edema collected in the right lower lung. Left lower lobe atelectasis is moderate-to-severe and small left pleural effusion is stable. Normal post-operative cardiomediastinal silhouette including mild-to-moderate cardiomegaly, improved since pre-operative chest radiograph. Nasogastric tube passes below the diaphragm and out of view. Transvenous right atrial and right ventricular pacer leads are unchanged in their longstanding positions, including a more medial location than generally seen for the tip of the right atrial lead. Swan-Ganz or other pulmonary arterial line ends in the right pulmonary artery. No pneumothorax.
99		AP chest compared to ___ at 2:29 p.m.: Lateral aspect left lower chest is excluded from the examination. Remaining pleural surfaces show no pneumothorax and minimal if any pleural effusion. Nasogastric tube passes into the stomach and out of the field of view. Swan-Ganz catheter tip is partially obscured by cardiac motion, but is probably in the right pulmonary artery in standard placement. Right pleural, left pleural, midline drains in place. Pulmonary vascular congestion and moderate postoperative widening of the cardiomediastinal silhouette are unchanged. There is more atelectasis in the right lower lobe, left lower lobe atelectasis is mild-to-moderate. There is probably no pulmonary edema.
100		Chronic fibrotic changes within both lung apices. Low lung volumes with probable bibasilar atelectasis, though infection or aspiration cannot be excluded. Small left pleural effusion. Known left 11th rib fracture is not clearly seen on the current exam.

1

AP chest compared to ___: Tip of the endotracheal tube at the upper margin of the clavicles is no less than 45 mm from the carina. Care should be taken that the tube does not withdraw any further. Lungs are clear. Cardiomediastinal and hilar silhouettes and pleural surfaces are normal.

2

ET tube in standard placement. The nasogastric tube ends in the stomach. The lungs are fully expanded and clear. The heart size is normal. Adenopathy at least in the left hilus is evident.

3

No evidence of acute cardiopulmonary process.

4

No acute intrathoracic process.

5

No acute cardiopulmonary process.

6

No radiographic findings to suggest pneumonia.

7

1. Status post median sternotomy for CABG with stable cardiac enlargement and calcification of the aorta consistent with atherosclerosis. Relatively lower lung volumes with no focal airspace consolidation appreciated. Crowding of the pulmonary vasculature with possible minimal perihilar edema, but no overt pulmonary edema. No pleural effusions or pneumothoraces.

8

1. Left PICC tip appears to terminate in the distal left brachiocephalic vein. 2. Mild pulmonary vascular congestion. 3. Interval improvement in aeration of the lung bases with residual streaky opacity likely reflective of atelectasis. Interval resolution of the left pleural effusion.

9

No definite acute cardiopulmonary process. Enlarged cardiac silhouette could be accentuated by patient's positioning.

10

Increased mild pulmonary edema and left basal atelectasis.

11

1. Decreased left basilar consolidation with mild pulmonary edema. 2. Possible pulmonary arterial hypertension.

12

AP chest compared to ___: ET tube in standard placement. Nasogastric tube passes into the stomach and out of view. No pneumothorax. Leftward mediastinal shift suggests a new opacification at the base of the left lung is atelectasis. The right lung is clear. Left jugular line ends at the origin of the SVC.

13

1. Hazy opacity in the right lung which may represent aspiration versus pleural effusion or hemorrhage. 2. Mild pulmonary edema. 3. No displaced rib fractures.

14

The patient is markedly rotated to his left limiting evaluation of the cardiac and mediastinal contours. The heart remains enlarged. There has been interval removal of the endotracheal tube with placement of a tracheostomy tube, which has its tip at the thoracic inlet. The right subclavian PICC line still has its tip in the distal SVC. A nasogastric tube is seen coursing below the diaphragm with the tip projecting over the expected location in the stomach. Patchy opacity in the retrocardiac region may reflect an area of atelectasis, although pneumonia cannot be entirely excluded. No evidence of pulmonary edema. No pneumothorax. Probable small layering left effusion.

15

1. Mild chronic congestive heart failure with stable trace pulmonary edema at the right lung base. 2. Stable bibasilar atelectasis.

16

No significant interval change since prior. Pulmonary vascular congestion. Bibasilar opacities potentially due to atelectasis; however, infection is not excluded.

17

1. Unchanged bibasilar opacities are consistent with atelectasis or consolidation and pneumonia should be considered in the appropriate clinical context. 2. Improved pulmonary edema.

18

Mild residual retrocardiac opacification remains, pneumonia vs. atelectasis.

19

Limited study with hazy opacity in the right upper and mid lungs which may be infectious in etiology, atelectasis or artifact.

20

No evidence of pneumonia. Stable cardiomegaly.

21

Faint increased opacification in left mid lung may indicate developing infectious process. Could further evaluate with right anterior oblique view to further evaluate lung.

22

Consolidation in the right base is most consistent with pneumonia. Results were communicated with Dr. ___ at 11:10 a.m. on ___ via telephone by Dr. ___.

23

No acute intrathoracic process.

24

1. Mild improvement of pulmonary vascular congestion. 2. Less opacification at the right lower; no evidence of pneumonia on today's radiograph. Results were communicated with the surgery team by Dr. ___.

25

No acute cardiopulmonary process.

26

No acute cardiopulmonary process. No significant interval change. Please note that peribronchovascular ground-glass opacities at the left greater than right lung bases seen on the prior chest CT of ___ were not appreciated on prior chest radiography on the same date and may still be present. Additionally, several pulmonary nodules measuring up to 3 mm are not not well appreciated on the current study-CT is more sensitive.

27

AP chest compared to ___: Bronchial wall thickening or peribronchial infiltration in the lower lungs where most pronounced bronchiectasis is have worsened since ___ consistent either with a flare of bronchiectasis or development of peribronchial pneumonia. Heart size is normal. There is no pleural effusion, no pneumothorax. Feeding tube ends in the upper stomach.

28

1. Dobbhoff feeding tube is seen coursing below the diaphragm with the tip not completely identified but positioned within the stomach proximally. It does not appear to be significantly changed. Bilateral lower lobe bronchiectasis is stable. No focal airspace consolidation is seen to suggest an acute pneumonia. No pleural effusions or pneumothoraces. Overall, cardiac and mediastinal contours are unchanged. Lungs remain hyperinflated.

29

1) Small left effusion with underlying collapse and/or consolidation. In the appropriate clinical setting, the differential would include a pneumonic infiltrate. Findings discussed with the covering house officer on the afternoon of the exam.

30

PA and lateral chest compared to ___ through ___, extent of peribronchial thickening and impaction of extensive bibasilar bronchiectasis may have increased slightly since the most recent prior lateral chest radiograph, ___. There is really no change in the appearance of the frontal views as recently as ___. Generalized hyperinflation is due to emphysema. Heart size is normal. There is no pulmonary edema, consolidation. A tiny right pleural effusion may be new, but probably not clinically significant. Findings would therefore be attributed to decompensation of emphysema and bronchiectasis.

31

Bilateral lower lobe bronchiectasis with improved right lower medial lung peribronchial consolidation.

32

AP chest compared to ___: Feeding tube, now without the wire stylet ends in the same place, upper stomach. The apex and lateral right lower hemithorax are excluded from this examination. Remaining pleural surfaces are normal and the imaged lungs show no pneumonia or edema, but there are several small nodules and bronchiectasis in the right lower lobe.

33

PA and lateral chest compared to ___: Slight hyperinflation, chest CTA prior to surgery did not show emphysema. It did show mild to moderately severe bronchiectasis, particularly in the left lower lobe. Postoperatively, left lower lobe consolidation is probably due to atelectasis, stable since ___. There is new peribronchial opacification on the right, conceivably aspiration. Exacerbation of bronchiectasis is another possibility. There is no pulmonary edema, and the upper lungs are clear. Tiny left pleural effusion is of no clinical significance. Heart size is normal.

34

Stable chest radiographs without acute change.

35

Little change in the severe bronchiectasis and emphysema.

36

1. Moderate right apical pneumothorax has very minimally decreased since yesterday. 2. Right lower lung opacity concerning for aspiration/atelectasis is more denser than before, though not increased in size. Small right pleural effusion is unchanged. No new left pleural effusion.

37

1. New left pleural effusion and slight mediastinal shift. Recommend obtaining PA expiratory films to exclude a left pneumothorax. 2. Stable right pneumothorax. Findings were discussed by Dr. ___ with Dr. ___.

38

New large right-sided pleural effusion with underlying atelectasis and possible consolidation in the middle and lower lobes. CT scan may offer additional detail of underlying parenchymal abnormalities. Small left-sided pleural effusion.

39

Interval decrease in size of right effusion, though a moderate to moderately-large right effusion remains. No pneumothorax detected.

40

Stable large right pleural effusion and increasing left pleural effusion. Feasibility of of thoracentesis would best be evaluated with decubitus films. Ultrasound guidance can also be considered.

41

Significant interval increase in the bilateral pleural effusions since prior exam with possible underlying airspace disease not excluded.

42

Reoccurrence of right-sided pleural effusion in patient with history of pancreatic carcinoma. No radiographic evidence of CHF, cardiac enlargement or fluid overload.

43

Folowing right pigtail catheter placement, moderate right pleural effusion has near completely resolved, whereas large left pleural effusion associated with passive collapse of adjacent lung and mediastinal shift to the right side is persisting. No pneumothorax.

44

1. New mild-to-moderate left pneumothorax with mild rightward shift of the mediastinum. 2. Stable right pneumothorax. 3. Moderate left pleural effusion. The case was discussed by Dr. ___ with Dr. ___.

45

AP chest compared to ___ through ___: Feeding tube with a wire stylet in place passes into the stomach and out of view. Comparing today's examination with many chest radiographs since ___, it looks like there is a mild degree of pulmonary edema superimposed on chronic interstitial lung disease. Specifically, on ___ the interstitial abnormality is comparable to that on ___, whereas at other times there has been at least a component of acute pulmonary edema. Today, the findings are very similar to ___. Severe cardiomegaly and pulmonary vascular plethora are chronic. Left subclavian infusion port ends in the mid-to-low SVC. Pleural effusion, if any, is minimal and there is no pneumothorax.

46

New pulmonary parenchymal abnormalities on top of chronic pulmonary fibrosis most likely represents pulmonary edema. Infection is less likely.

47

Superimposed pulmonary edema on a background of pulmonary fibrosis. Low lung volumes limit assessment for basilar consolidation.

48

Left-sided Port-A-Cath placement, terminates within the right atrium. Can be withdrawn 3 cm and still remain within the low SVC.

49

Moderate to severe pulmonary edema is increased from the prior examination. No focal consolidation to suggest pneumonia is seen. No significant pleural effusion or pneumothorax is present. There is moderate cardiomegaly. A left-sided port is unchanged. There are multiple vertebroplasties.

50

PA and lateral chest compared to ___: Heterogeneous pulmonary opacification has worsened in both lungs. This is largely pulmonary edema, but more focal abnormalities in the axillary portion of the left lung and at the right lung base could be concurrent pneumonia. In addition, chest radiographs from ___ suggest concurrent substantial interstitial lung disease. Mild-to-moderate cardiomegaly is stable. Endotracheal tube is no less than 2 cm from the carina, with the chin in neutral position. Care must be taken that it not advance inadvertently. A left subclavian infusion port ends in the right atrium. Dr. ___ was paged at the time of dictation.

51

Some improvement in still prominent pulmonary vascular congestion.

52

Pulmonary edema superimposed on known lung fibrosis.

53

Improved but not resolved mild-to-moderate pulmonary edema.

54

Mild pulmonary edema superimposed on known lung fibrosis. Severe chronic cardiomegaly and pulmonary hypertension. No displaced rib fracture. Multiple vertebroplasties, similar to prior.

55

No evidence of acute disease. Severe pulmonary fibrosis, not significantly changed.

56

No acute intrathoracic process.

57

Pulmonary edema.

58

Stable frontal chest radiograph. Limited evaluation in the setting of single frontal view; lateral view would be helpful for more thorough evaluation. This was discussed with Dr. ___ by Dr. ___ by phone at 12:45 p.m. on ___.

59

No significant change since the prior study and no evidence of overt pulmonary edema.

60

Thickening of the pleural margins in the abnormal contour of the left heart border oral due to fat deposition. Lungs are reasonably well expanded and clear. Heart is probably top normal size but there is no pulmonary vascular engorgement, mediastinal venous engorgement, edema or any pleural effusion. The thoracic aorta is generally tortuous, but not focally aneurysmal.

61

In comparison to study of ___, the patient has taken a better inspiration. Again there is evidence of previous CABG with median sternotomy wires in place. Scarring at the right base and costophrenic angle again noted. No evidence of acute focal pneumonia, vascular congestion, or pleural effusion.

62

No acute cardiopulmonary process.

63

No acute cardiopulmonary process.

64

The nasogastric tube is in adequate position and there is resolution of the gastric distention.

65

Mild pulmonary edema with increased size of small to moderate right pleural effusion and right basilar opacity, possibly reflecting atelectasis but infection is not excluded.

66

1. Interval placement of a feeding tube, which courses below the diaphragm with the tip likely within the stomach. The patient is markedly rotated to the right, limiting evaluation of the cardiac and mediastinal contours. Overall, however, there is a more focal airspace opacity in the left mid and lower lung, which may reflect asymmetric pulmonary edema or an infectious process, less likely atelectasis. Clinical correlation is advised. Possible layering left effusion.

67

Mild pulmonary edema and presumed small left pleural effusion, new since ___.

68

Since ___, moderately enlarged heart, mild bilateral pleural effusions and lung aeration have improved

69

Stable cardiomegaly without signs of pneumonia or CHF.

70

AP chest compared to ___: Large cardiomediastinal silhouette has not changed appreciably since at least ___, early postoperatively. Moderate-to-severe cardiomegaly is comparable to the preoperative appearance. Small bilateral pleural effusions persist. There is no longer any pulmonary edema. ET tube and left internal jugular line are in standard placements and a nasogastric tube passes into the stomach and out of view. No pneumothorax.

71

Mild acute congestive heart failure.

72

Right basal nodules as a whole minimally decreased since the prior study. Differential for these lesions includes amiodarone toxicity and cryptogenic organizing pneumonia. While chest radiographs are likely suitable for monitoring for change over time, a baseline CT examination can be obtained to allow for better characterization.

73

Marked improvement in right basilar opacities compared to ___.

74

New multifocal parenchymal opacities in the lower and middle lobes bilaterally, which given concurrent increased hepatic density from ___ to ___, could represent amiodarone-induced pulmonary toxicity. Differential would includes infectious processes in the proper clinical setting or organizing pneumonia. CT could be considered for further evaluation. This was discussed with Dr ___ at noon by Dr ___ on ___ via phone.

75

Cardiomegaly without acute cardiopulmonary process.

76

1. Small right pleural effusion is new; however, there is no evidence of pneumonia and no other significant appreciable change. 2. Mild cardiomegaly is unchanged. The above results were communicated via telephone by Dr. ___ to Dr. ___ ___ at 2:45 p.m. as requested.

77

Relatively similar appearance of diffuse chronic chronic lung disease. No new gross focal consolidation identified.

78

Findings compatible with pulmonary fibrosis with likely superimposed edema. Please note that infection cannot be excluded and clinical correlation is necessary.

79

Minimally increased opacification of the right lower lung may reflect mild edema superimposed on chronic severe interstitial lung disease.

80

Relatively unchanged appearance of the chest compared to prior exam. Persistent opacities within the right upper lobe, left lung base and left perihilar region are redemonstrated on a background of chronic interstitial lung disease which on the prior chest CT was thought to reflect UIP or fibrosing NSIP. As before, these more focal opacities may reflect progression of chronic interstitial lung disease, acute exacerbation of interstitial lung disease, or possibly infection.

81

There are low lung volumes. Cardiomegaly and widened mediastinum are stable. Extensive interstitial reticular abnormalities larger in the left perihilar and left lower lobe region are grossly unchanged allowing the difference in inspiratory effort of the patient without evidence of new abnormalities pneumothorax or effusion. .

82

1. New right PICC is difficult to visualize but likely ends within the lower SVC. 2. Marked interval improvement in what was likely multifocal pneumonia as well as near complete clearance of the bilateral pleural effusions compared to ___. 3. Stable interstitial lung markings consistent with chronic pulmonary fibrosis.

83

In comparison with the study of ___, there are somewhat better lung volumes. Continued enlargement of the cardiac silhouette with extensive parenchymal opacities bilaterally consistent with known fibrotic lung disease.

84

Findings compatible chronic interstitial lung disease, previously characterized on chest CT as UIP or fibrosing NSIP. No new areas of focal consolidation or pulmonary edema.

85

Multifocal opacities worrisome for pneumonia superimposed on severe underlying interstitial lung disease; although recent prior radiographs are not available for comparison and progression of chronic lung disease could be considered as an alternative, acute superimposed pneumonia seems most likely.

86

AP chest compared to ___ through ___: Interval improvement in the severity of severe interstitial lung abnormality, at least in the left lung, is due to recent decrease in the component of reversible pulmonary edema, aside from severe pulmonary fibrosis. Right lung has not appreciably improved. Pleural effusions small if any. Moderate-to-severe cardiomegaly stable. No pneumothorax.

87

Findings again compatible with patient's known pulmonary fibrosis without definite superimposed acute process, noting that subtle change would be difficult to detect based on a portable film.

88

AP chest compared to ___ through ___: Moderate right pleural effusion is new, obscuring some of the right lower lung, but changing the contour of the lung base substantially since ___. Postoperative left hemithorax is unchanged following left upper lobectomy. Heart is partially obscured by postoperative contour changes. Right middle lobe collapse seen on lateral chest films, ___ and ___ and on chest CT, ___, presumably unchanged.

89

1. Postoperative appearance to left hemithorax is stable. There is a patchy opacity at the right base which could reflect a combination of a layering effusion with atelectasis, although an acute infectious process cannot be excluded. Overall, however, there is not significant interval change since ___. No pneumothorax. Cardiac and mediastinal contours is difficult to assess due to the postoperative state of the patient as well as patient positioning on the current examination. No evidence of pulmonary edema.

90

Right lower lobe opacity with volume loss, likely atelectasis, unchanged since the earlier study of ___.

91

AP chest compared to ___: Pulmonary vascular engorgement has improved. There is no mediastinal widening. The heart is unchanged in size, probably mildly enlarged, but obscured by mediastinal fat deposition. The postoperative appearance of the left hemithorax including bulbous left hilus is also longstanding. Large scale atelectasis in the right lower lobe has also been a feature since mid ___, probably progressed to complete collapse. Tracheostomy tube in standard placement.

92

Right lower lobe pneumonia, which has not cleared, and small right pleural effusion.

93

Post left upper lobectomy changes, with no superimposed acute intrathoracic process detected.

94

Right basilar opacity silhouetting the hemidiaphragm, possibly due to any combination of effusion, atelectasis or consolidation. Clinical correlation recommended. Two-view chest x-ray may also offer additional detail.

95

Cardiomegaly and venous congestion.

96

AP chest compared to ___ at 9:59 a.m.: Mild pulmonary edema worsened slightly since earlier in the day. No pneumothorax. Small left pleural effusion and moderate left basal atelectasis are unchanged. Pulmonary artery catheter ends in the right pulmonary artery. Transvenous right atrial and right ventricular pacer leads are unchanged in longstanding locations including the more medial than usual positioning of the tip of the right atrial lead. Mild-to-moderate cardiomegaly comparable to the preoperative appearance.

97

No significant interval changes during the last 24 hours interval. The described changes with postoperative status, CHF, pleural effusion and intra-aortic balloon pump device in place is of course compatible with the patient's hypoxia.

98

AP chest compared to ___ at 9:19 a.m.: No appreciable pneumothorax or right pleural effusion following removal of the right basal pleural drain. Mild pulmonary edema collected in the right lower lung. Left lower lobe atelectasis is moderate-to-severe and small left pleural effusion is stable. Normal post-operative cardiomediastinal silhouette including mild-to-moderate cardiomegaly, improved since pre-operative chest radiograph. Nasogastric tube passes below the diaphragm and out of view. Transvenous right atrial and right ventricular pacer leads are unchanged in their longstanding positions, including a more medial location than generally seen for the tip of the right atrial lead. Swan-Ganz or other pulmonary arterial line ends in the right pulmonary artery. No pneumothorax.

99

AP chest compared to ___ at 2:29 p.m.: Lateral aspect left lower chest is excluded from the examination. Remaining pleural surfaces show no pneumothorax and minimal if any pleural effusion. Nasogastric tube passes into the stomach and out of the field of view. Swan-Ganz catheter tip is partially obscured by cardiac motion, but is probably in the right pulmonary artery in standard placement. Right pleural, left pleural, midline drains in place. Pulmonary vascular congestion and moderate postoperative widening of the cardiomediastinal silhouette are unchanged. There is more atelectasis in the right lower lobe, left lower lobe atelectasis is mild-to-moderate. There is probably no pulmonary edema.

100

Chronic fibrotic changes within both lung apices. Low lung volumes with probable bibasilar atelectasis, though infection or aspiration cannot be excluded. Small left pleural effusion. Known left 11th rib fracture is not clearly seen on the current exam.

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mimic-cxr-rrg

Dataset Card for "mimic-cxr-rrg"