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mimic_chest_xray_v_1

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chest x-ray; 'Pleural Effusion'; 'Support Devices'

Portable AP radiograph of the chest was reviewed in comparison to ___. The CoreValve is in right position. Heart size and mediastinum are stable. Bilateral pleural effusions, right more than left are demonstrated, at least moderate on the right and small-to-moderate on the left. Minimal vascular engorgement is present. No pneumothorax is seen. No new consolidations demonstrated.

chest x-ray;

The lung volumes are slightly low, with elevation of the right hemidiaphragm. There is mild peribronchial cuffing and engorgement of the pulmonary vasculature. Blunting of the costophrenic angles may represent small bilateral pleural effusions. There is no pneumothorax or consolidation concerning for pneumonia. The heart size is top-normal.

chest x-ray; 'Lung Lesion'; 'Support Devices'

In comparison with the study of ___, the monitoring and support devices remain in place. The feeding tube passes below the diaphragm, though the tip and side port are not clearly visualized. The tube adjacent and to the right of the feeding tube is likely external to the patient. In the right lung, there has been decrease in the area of consolidation or possible loculated effusion. Little change in the multiple nodules.

chest x-ray; 'Enlarged Cardiomediastinum'

In comparison with the study of ___, the patient has taken a much better inspiration. The lungs are clear and there is no vascular congestion or pleural effusion. There is continued elevation of the right hemidiaphragmatic contour.

chest x-ray; 'Edema'; 'Lung Opacity'; 'Support Devices'

Supine AP portable view of the chest was obtained. There has been interval placement of right internal jugular central venous catheter terminating at the cavoatrial junction without evidence of pneumothorax. In the interval since the prior study, there has been mild increase in pulmonary edema. Indistinctness of the hila has increased. Bibasilar opacities likely relate to pulmonary edema though again underlying infection or aspiration cannot be excluded in the appropriate clinical setting. No large pleural effusion.

chest x-ray; 'Lung Opacity'; 'Support Devices'

A right-sided internal jugular catheter is in-situ, the tip terminates in knee right atrium, this could be withdrawn 3 cm to be positioned in the SVC. A linear metallic density projects over the left hemi thorax, unchanged compared to the prior study. A presumed to be external to the patient. There is in the left basilar airspace opacity with partial silhouetting of the left hemidiaphragm. This may reflect atelectasis or consolidation. No other areas of concern for consolidation are seen. No definite pleural effusion. No pneumothorax. The visualized bony structures are unremarkable in appearance.

chest x-ray; 'Atelectasis'; 'Support Devices'

Right-sided jugular pacemaker wire is unchanged. Cardiomediastinal silhouette is within normal limits. There is subsegmental atelectasis at the lung bases, left worse than right, stable. There are no pneumothoraces.

chest x-ray; 'Atelectasis'; 'Enlarged Cardiomediastinum'; 'Pleural Effusion'; 'Support Devices'

Normal postoperative appearance, including caliber of the widened cardiomediastinal silhouette and mild bibasilar atelectasis. Pleural effusion is minimal if any. No pneumothorax or pulmonary edema. A Swan-Ganz catheter ends in the region of the pulmonic valve. Transvenous right atrial and left ventricular pacer leads and right ventricular pacer defibrillator leads are continuous from the left pectoral pacemaker.

chest x-ray; 'Enlarged Cardiomediastinum'; 'Support Devices'

NG tube tip isout of view, below the diaphragm. Widening of the mediastinum has minimally improved. Distention of the stomach has improved. No other interval change from prior study.

chest x-ray; 'No Finding'

The cardiac, mediastinal and hilar contours are normal. Pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is present, although the extreme left costophrenic angle is excluded from the field of view. No acute osseous abnormality is seen.

chest x-ray; 'Edema'; 'Lung Opacity'; 'Support Devices'

ET tube tip is 5.5 cm above the carinal. Right internal jugular line tip is at the level of superior SVC. Multifocal opacities have substantially progressed in the interim, concerning for pulmonary edema multifocal infection

chest x-ray; 'Fracture'; 'Support Devices'

AP chest compared to ___: Tip of the endotracheal tube, with the chin flexed, 25 mm above the carina, is appropriate. Lungs are low in volume but clear. Normal cardiomediastinal and hilar silhouettes and pleural surfaces. Callus surrounding two right posterior rib fractures indicates chronicity, one healed, one probably not.

chest x-ray; 'Atelectasis'; 'Lung Opacity'; 'Pleural Effusion'; 'Support Devices'

This film was submitted for interpretation on ___ at 4:45 p.m. (unclear if prior dictation was lost). Many subsequent chest x-rays and a chest CT have been performed in the interval. The ET tube is 9 cm above the carina. There is a right-sided chest tube. There is near-complete opacity of the right hemithorax likely due to layering effusion and right sided collapse. There is right subcutaneous emphysema. Heart is mildly enlarged. NG tube tip is in the stomach. There is mild pulmonary vascular redistribution with the left lateral lower lung being relatively spared. Compared to the prior study, the opacity in the right hemithorax has dramatically increased. Subsequent film from two hours later again documented the right lung collapse and associated right pleural effusion.

chest x-ray; 'Atelectasis'; 'Support Devices'

Endotracheal tube tip terminates at the level of the thoracic inlet, approximately 8 cm from the carina. Cardiac, mediastinal and hilar contours are normal. Pulmonary vasculature is normal. Atelectasis is noted in the left lung base. Lungs are otherwise clear without focal consolidation. Tiny right upper lobe calcified granuloma is again noted. No pleural effusion or pneumothorax is identified. No acute osseous abnormalities detected.

chest x-ray; 'Atelectasis'; 'Lung Opacity'; 'Pleural Effusion'; 'Support Devices'

In comparison with the study of ___, there has been placement of an endotracheal tube with its tip approximately 6 cm above the carina. Nasogastric tube extends to at least the mid body of the stomach, were crosses the margin of the image. The side-port is clearly beyond the esophagogastric junction. Bibasilar opacifications are consistent with pleural effusions and compressive atelectasis, more prominent on the right. In the appropriate clinical setting, it would be impossible to exclude superimposed pneumonia, especially in the absence of a lateral view.

chest x-ray; 'Edema'; 'Support Devices'

As reported to the clinical house staff by Dr. ___ at 7:53 p.m. on ___, the new OG tube, previously in the stomach, is looped either in the upper esophagus or less likely in the trachea returning to the neck and passing out of view. By 8:29 p.m., there is radiographic evidence of appropriate repositioning. ET tube is in standard placement. Mild pulmonary edema is stable. Cardiomediastinal silhouette unremarkable. Pulmonary arteries large, suggesting pulmonary arterial hypertension. No pneumothorax or appreciable pleural effusion.

chest x-ray; 'Atelectasis'; 'Lung Opacity'; 'Support Devices'

NG tube is seen with tip in the fundus of the stomach and side port at the level of the GE junction. ET tube is in appropriate position with tip 3 cm above the level of the carina. The lungs are well expanded. Linear opacity in the left lower lobe likely represents atelectasis, however, may represent aspiration pneumonia in the appropriate clinical setting. The right pleural surface is clear. The left costophrenic angle is not fully imaged; however, no large pleural effusion seen. No pneumothorax. Mildly enlarged heart is likely attributed to AP technique and supine positioning. Mediastinal contour and hila are normal. Medialization of aortic arch calcifications without irregularity of the aortic knob contour or apical cap is of unclear significance.

chest x-ray; 'Cardiomegaly'

In comparison with study of ___, there are lower lung volumes that accentuate the transverse diameter of the heart. There is no evidence of acute pneumonia, vascular congestion, or pleural effusion.

chest x-ray; 'Atelectasis'; 'Cardiomegaly'; 'Edema'; 'Support Devices'

As compared to the previous radiograph, the patient has received an orogastric tube and an endotracheal tube. Comments about the orogastric tube are included in a separate report. The tip of the endotracheal tube projects 3 cm above the carina. There is no evidence of complications, notably no pneumothorax. Evidence of mild-to-moderate pulmonary edema. Borderline size of the cardiac silhouette with tortuous of the aorta and areas of left paramediastinal atelectasis. Small retrocardiac atelectasis. No evidence of pneumonia.

chest x-ray; 'Atelectasis'; 'Cardiomegaly'; 'Pleural Effusion'

Compared to chest radiographs ___. Lung volumes are extremely low, particular the right. Abnormality at the base of the right lung looks nearly identical to its appearance in ___. Either it is persistent or recurrent. Diagnostic possibilities are atelectasis or pneumonia. Atelectasis at the left lung base medially is more severe today. Pleural effusion is small if any. Heart size top-normal.

chest x-ray; 'Atelectasis'; 'Edema'

As compared to the previous radiograph, no relevant changes seen. Low lung volumes. Mild-to-moderate pulmonary edema. Questionable left pleural effusion with areas of atelectasis at the left lung bases. No new parenchymal opacities.

chest x-ray; 'Atelectasis'; 'Consolidation'; 'Edema'; 'Lung Lesion'; 'Lung Opacity'; 'Pleural Effusion'; 'Pneumonia'; 'Support Devices'

AP chest compared to ___: Small left pleural effusion has re-accumulated despite the presence of both pigtail and large-bore drainage catheters. There is no pneumothorax. Leftward mediastinal shift coupled with opacification in the lower lobe are indicative of severe persistent left lower lobe atelectasis. It is possible that this severe persistent left lower lobe consolidation marked by pronounced volume loss could be organized pneumonia rather than atelectasis alone. The multiple cavitary nodules demonstrated by recent chest CT are barely visible on conventional chest radiograph. Upper lobe shows vascular engorgement and mild edema, perhaps a function of recent collapse, or diminished ventilation retarding with clearance of lymphatics. Poor definition of the left lower bronchial airway suggests retained secretions or endobronchial obstruction.

chest x-ray; 'Atelectasis'; 'Cardiomegaly'; 'Lung Opacity'; 'Pleural Effusion'; 'Support Devices'

As compared to the previous radiograph, no relevant change is seen in the extensive bilateral parenchymal opacities, the associated moderate pleural effusions, the areas of basal atelectasis and moderate cardiomegaly. The tracheostomy tube and the left PICC line are also unchanged. No new parenchymal opacities. No pneumothorax.

chest x-ray; 'Cardiomegaly'; 'Consolidation'

AP chest radiograph. The patient is intubated with unilateral, left bronchus intubation. There is new substantial right upper lobe consolidation concerning for massive aspiration. Heart size is enlarged, in particular left ventricle. There is no evidence of pneumothorax or pleural effusion.

chest x-ray; 'Pneumothorax'; 'Support Devices'

Support and monitoring devices are in standard position, and cardiomediastinal contours are stable, allowing differences in lung volumes. Pulmonary vascular congestion has improved, and edema has nearly resolved with minimal residual interstitial edema remaining. Prominent lucency in left upper quadrant of abdomen may be due to effects of rotation, but attention to this region on short-term followup radiograph is suggested to exclude the possibility of basilar pneumothorax or atypical manifestation of free intraperitoneal air.

chest x-ray; 'No Finding'; 'Support Devices'

New right-sided PICC line is in adequate position, ending at cavoatrial junction. Bilateral pulmonary edema, pleural effusion, and atelectasis have completely resolved. There is significant calcification of the mitral valve annulus. There is no pneumothorax.

chest x-ray; 'Lung Opacity'; 'Pneumothorax'; 'Support Devices'

As compared to the previous image, the malpositioned right-sided PICC line has been pulled back. The tip of the line is now visible in the axillary region. The catheter needs to be re-positioned. Unchanged right basal opacity. No complications, notably no pneumothorax.

chest x-ray; 'Cardiomegaly'; 'Edema'; 'Lung Lesion'; 'Lung Opacity'

1. Mild cardiomegaly with mild interstitial pulmonary edema. 2. ___-mm nodular opacity superior to the right costophrenic angle, possibly a calcified pulmonary nodule. Further assessment with conventional radiographs should be performed once the patient's fluid status has normalized. 3. Bulbous appearance of the right hilus should be reassessed on the same conventional radiographs as recommended in impression point #2. Findings and recommendations were discussed with Dr. ___ by Dr. ___ at 7:41 a.m. via telehpone on ___.

chest x-ray; 'No Finding'

Single AP upright portable chest radiograph obtained. Low lung volumes significantly limit the evaluation. Allowing for this, bronchovascular crowding likely accounts for the relative increase in bronchovascular opacities in the lower lungs. No definite sign of pneumonia, pleural effusion, or pneumothorax. Cardiomediastinal silhouette is stable with top normal heart size. Bony structures are intact. No free air below the right hemidiaphragm.

chest x-ray; 'Atelectasis'; 'Cardiomegaly'; 'Support Devices'

Compared to chest radiographs ___. Right upper lobe collapse is acute ; the most common cause in intensive care unit patients is mucous plugging. . Previous pulmonary vascular congestion has improved. Mild cardiomegaly is unchanged. No pleural effusion. ET tube in standard placement. Nasogastric drainage tube would need to be advanced at least 8 cm to move all side ports into the stomach.

chest x-ray; 'Lung Opacity'; 'Support Devices'

Support lines and tubes are unchanged in position. Heart size is within normal limits. The lower lobe opacities particularly at the right base have continued to worsen. This may represent aspiration or pneumonia. No pneumothoraces are seen.

chest x-ray; 'Atelectasis'

The patient is intubated. The endotracheal tube lies below the thoracic inlet, approximately 5 cm above the carina; previously it closely approached the carina. An orogastric tube courses into the stomach, its distal course not imaged. The heart is at the upper limits of normal size. The mediastinal and hilar contours are unremarkable. There is a focal hazy opacification projecting over the left upper lung while the left lung base appears clear. Although a confounding factor is moderate rightward convex scoliosis, there is a suggestion of mild volume loss with leftward shift of mediastinal structures. There is no definite pleural effusion or pneumothorax.

chest x-ray; 'No Finding'

Cardiac, mediastinal and hilar contours are normal. Pulmonary vasculature is normal. Lungs are clear. A tiny punctate granuloma is noted in the left upper lobe. No pleural effusion or pneumothorax is present. No subdiaphragmatic free air is present. There are no acute osseous abnormalities.

chest x-ray; 'Support Devices'

AP chest compared to preoperative chest radiograph, ___: Mild cardiomediastinal widening is common early postoperatively. Left apical pleural drain in place. Lung volumes are only mildly diminished. There is no mediastinal shift, pneumothorax or appreciable left pleural effusion, although there is subcutaneous emphysema in the left chest wall, traversed by the left pleural drain which terminates at the apex of the hemithorax. Heart size is normal. What appears to be a loop of catheter projects just inferior to the left hilus. It could be external. Clinicians need to identify what this might be. It could be an epidural catheter.

chest x-ray; 'Atelectasis'; 'Support Devices'

The course of the nasogastric tube is unremarkable, with the exception of a slight deviation of the tube at the level of the lower esophageal third, suggesting the potential presence of a hiatal hernia. The site of the tube is located at the gastroesophageal junction, the tip of the tube projects over the proximal parts of the stomach. The tube should be advanced by approximately 5 cm. There is no evidence of complication, notably no pneumothorax. Mild retrocardiac areas of atelectasis.

chest x-ray; 'Lung Opacity'; 'Support Devices'

There has been interval placement of an endotracheal tube with the tip terminating 4.5 cm above the carina. There is interval decreased dilatation of the trachea from the most recent prior radiograph. The lung volumes remain low with increased opacification at the left lung base greater than the right which may represent substantial atelectasis but potentially pneumonia in the appropriate setting. The lung volumes are increased with somewhat better aeratation especially at the left lung base. Tortuosity and calcification of the thoracic aorta is re-demonstrated. The cardiac silhouette is incompletely evaluated. Surgical clips in the right upper quadrant of the abdomen are compatible with prior cholecystectomy. Surgical clips are also noted at the left hemidiaphragm and in the left upper quadrant of the abdomen.

chest x-ray; 'Atelectasis'; 'Pleural Effusion'; 'Support Devices'

In comparison with the study of ___, there has been placement of a Dobhoff tube that extends at least to the upper stomach were crosses the lower margin of the image. Cardiac silhouette is unchanged. However, there has been engorgement of increasingly indistinct pulmonary vessels, consistent with worsening pulmonary vascular congestion. The right hemidiaphragm has been obscured, consistent with development of pleural effusion and substantial volume loss in the right lower lobe. The right heart border is still sharply seen, so that the middle lobe is probably non involved. Mild atelectatic changes seen at the left base. In the appropriate clinical setting, it would be difficult to exclude aspiration, especially in the absence of a lateral view.

chest x-ray; 'Cardiomegaly'; 'Lung Opacity'; 'Pleural Effusion'

Tortuous and dilated thoracic aorta appears similar to prior study, and cardiac silhouette is also similar in size and configuration. Worsening patchy and linear right basilar opacities favor atelectasis, but developing infectious process is difficult to exclude and short-term followup radiographs may be helpful in this regard. Small left pleural effusion is also noted.

chest x-ray; 'Lung Lesion'; 'Lung Opacity'; 'Pneumonia'; 'Support Devices'

Comparison is made with prior study ___. There are low lung volumes. Right mid and lower lobe opacities have minimally increased consistent with worsening pneumonia. Lines and tubes are in unchanged standard position. Cardiomediastinal contours are stable. Multiple bilateral lung nodules are again noted, better seen in prior CT from ___.

chest x-ray; 'Edema'; 'Support Devices'

There is an endotracheal tube whose distal tip is 4.6 cm above the carina. Nasogastric tube has been removed. Heart size is within normal limits. There is no focal consolidation, pleural effusions, or signs for pulmonary edema. No pneumothoraces are seen.

chest x-ray; 'Atelectasis'; 'Cardiomegaly'; 'Support Devices'

As compared to the previous radiograph, the position of the left-sided PICC line is unchanged. The tip continues to project over the cavoatrial junction. There is no pneumothorax. The lung volumes remain low. Moderate atelectasis at the left and the right lung bases. Borderline size of the cardiac silhouette without pulmonary edema.

chest x-ray; 'Lung Opacity'

There is a chronic diffuse interstitial abnormality that is not significantly changed compared to the prior radiograph from ___ from ___. Focal heterogeneous opacity in the left retrocardiac region has been seen on prior radiographs, possibly scarring/atelectasis, although infection is certainly possible. Mild enlargement of the cardiac silhouette is not significantly changed. The mediastinal contours are normal. There are no definite pleural effusions. No pneumothorax is seen.

chest x-ray; 'Atelectasis'; 'Support Devices'

Endotracheal tube terminates approximately 3.6 cm above the level of the carina. Enteric tube is seen coursing below the level of the diaphragm, tip is unchanged in position, with distal tip at the region of the stomach. However, side hole is again approximately at the level of the esophagogastric junction. Overall, lung volumes are relatively low. There is mild left base atelectasis. Mild elevation of the right hemidiaphragm persists. Overall, there has been no significant interval change.

chest x-ray; 'Atelectasis'; 'Cardiomegaly'; 'Edema'; 'Pleural Effusion'; 'Support Devices'

All worsened since ___ are: Severe cardiomegaly, pulmonary vascular engorgement, and mediastinal widening due to venous distention. Although there is no pulmonary edema as yet, these findings all reflect cardiac decompensation, particularly right heart failure, and perhaps volume overload. Left lower lobe atelectasis is severe, small bilateral pleural effusions are stable. ET Tube is in standard placement. Esophageal drainage tube would need to be advanced 10 cm to move all the side ports into the stomach. There is no longer a right jugular central venous catheter in place. No pneumothorax is present.

chest x-ray; 'Lung Lesion'; 'Lung Opacity'

The previously described masslike opacity since ___ has significantly improved, with residual heterogeneous opacity, suggesting focal infection or atelectasis over malignancy. There is new mild opacity in the right middle lobe. The lungs are otherwise clear. Heart size is stable with mild cardiomegaly. The mediastinal and hilar contours are stable. The pulmonary vasculature is normal. No pleural effusion or pneumothorax is seen.

chest x-ray; 'Atelectasis'; 'Consolidation'; 'Edema'; 'Pleural Effusion'; 'Support Devices'

Comparison is made with prior study performed seven hours earlier. There has been interval worsening of bilateral perihilar consolidations. They are consistent with worsening pulmonary edema superimposed to likely an area of aspiration in the left. There are persistent low lung volumes. If any, there are small bilateral pleural effusions. Lines and tubes are in unchanged position. There are increasing bibasilar atelectasis. Cardiomediastinal contours are obscured by the lung abnormalities.

chest x-ray; 'No Finding'; 'Support Devices'

AP upright portable chest radiograph provided. The patient's chin projects over the lung apices and superior mediastinum limiting assessment. The previously noted left IJ central venous catheter is not visualized nor is the previously visualize right upper extremity access PICC line. Chronic right rib cage deformity again noted. Cardiomediastinal silhouette is unchanged with a markedly unfolded thoracic aorta. The lungs appear clear.

chest x-ray; 'Atelectasis'

Comparison to ___. Of the left-sided bronchoscopy, the pre-existing retrocardiac atelectasis has Re expanded. No pneumothorax or other complications. Otherwise stable radiograph.

chest x-ray; 'Cardiomegaly'

As compared to the previous radiograph, the size of the cardiac silhouette has slightly increased. No pulmonary edema. No pleural effusions. No pneumonia. Normal hilar and mediastinal structures.

chest x-ray; 'Fracture'; 'Support Devices'

AP single view of the chest has been obtained with patient in upright position. Comparison is made with the next preceding similar study of ___. On the present examination, a left-sided PICC line is identified, seen to terminate overlying the right-sided mediastinal structures at a level 4 cm below the carina. This is compatible with the lower third of the SVC. The termination point appears to be just above the expected entrance into the right atrium. No pneumothorax is identified. Chest findings of the single view demonstrate a heart size within normal limits and no evidence of acute pulmonary infiltrates. A local deformity of the seventh right-sided rib in posterior lateral location indicates an old healed rib fracture. On the previous chest examination of ___, a left-sided PICC line had deviated into the left jugular vein and re-positioning was recommended. Referring physician, ___, was paged to transmit findings at 3:15 p.m.

chest x-ray; 'No Finding'

Compared to the prior study there is no significant interval change. Continued extensive bilateral, right greater the left, pulmonary opacities concerning for multifocal pneumonia.

chest x-ray; 'Atelectasis'; 'Lung Lesion'

In comparison with the study of ___, there is little overall change. Multiple bilateral lung nodules again are consistent with metastases in this patient with Port-A-Cath and previous CABG procedure with intact sternal wires. Probable mild atelectatic changes are seen at the bases, without definite focal consolidation.

chest x-ray; 'Cardiomegaly'; 'Pneumonia'; 'Support Devices'

Portable AP semi-upright view of the chest provided. Dialysis catheter is in unchanged position. AICD is in unchanged position. Midline sternotomy wires are again seen. The heart remains mildly enlarged. There are no definite signs of infection or pulmonary edema. Mediastinal contour appears stable. Bony structures are intact.

chest x-ray; 'Atelectasis'

The lungs are mildly hypoinflated with crowding of vasculature and mild vascular congestion. Left lower lobe atelectasis is present with elevation of left hemidiaphragm. Chronic blunting of the right costophrenic angle is noted. No left pleural effusion. No pneumothorax. Heart size, mediastinal contour, and hila are unremarkable.

chest x-ray; 'Lung Opacity'

Since the prior study there has been no substantial change in widespread parenchymal opacities with slightly more uniform distribution of similar severity, does pulmonary edema versus ARDS would be the most likely diagnosis. Parenchymal hemorrhage or pneumonia are substantially less likely. Since no substantial response after diuresis is demonstrated, continuous surveillance with chest radiographs is indicated. No cardiomediastinal change demonstrated

chest x-ray; 'Pleural Effusion'

The lungs are moderately well inflated. Retrocardiac density is more prominent than on the previous study representing either atelectasis or early consolidation. Small left effusion is present and there may be a tiny right effusion. Aortic arch calcification is present. The heart is not enlarged. The osseous structures are normal for age. Monitor leads overlie the chest.

chest x-ray; 'Pneumothorax'

Tiny left apical pneumothorax is stable. Improved subcutaneous emphysema left chest wall. Small right pleural effusion has resolved. Left pleural effusion has decreased. Right lung is clear.

chest x-ray; 'Atelectasis'; 'Support Devices'

ET tube ends 6.1 cm above the carina. Feeding tube is curled in the stomach and ends in the first portion of the duodenum. Left double-lumen jugular line ends in lower SVC. Right lower atelectasis and LLL collapse are unchanged as shown on recent CT. Left pleural effusion is minimal. There is no pneumothorax.

chest x-ray; 'No Finding'

The lungs are well inflated and clear. No pleural effusion or pneumothorax. Heart size, mediastinal contour, and hila are unremarkable.

chest x-ray; 'Atelectasis'; 'Fracture'; 'Pneumonia'

When compared to most recent radiograph dated ___, there is improved aeration of the left lung. However, persistent opacification and leftward mediastinal shift in addition to right lung hyperexpansion is consistent with left lung collapse. There is increased opacity of the right lower lobe with obscuration of the right hemidiaphragm. While this may reflect atelectasis, infection cannot be excluded. There is likely a small left pleural effusion. There is no pneumothorax. Redemonstration of anteriorly dislocated right shoulder as well as third and second right rib fractures, present previously.

chest x-ray; 'Atelectasis'; 'Cardiomegaly'; 'Support Devices'

As compared to the previous radiograph, there is no relevant change. Borderline size of the cardiac silhouette. Atelectasis in the retrocardiac lung regions. Mild fluid overload. The monitoring and support devices are constant. No changes in the right lung.

chest x-ray; 'Edema'; 'Enlarged Cardiomediastinum'; 'Support Devices'

Radiographs centered at the thoracoabdominal junction was obtained to localize a nasogastric tube, which initially courses into the stomach before coiling back into the esophagus, with distal tip directed cephalad in the lower thoracic esophagus approximately 3.5 cm above the left hemidiaphragm level. Interval widening of cardiomediastinal contours accompanied by pulmonary vascular congestion and mild interstitial edema. No focal areas of consolidation within the lungs. Dr. ___ was successfully paged to discuss this finding at 3:51 p.m. on ___ at the time of discovery.

chest x-ray; 'Atelectasis'; 'Consolidation'; 'Pleural Effusion'; 'Pneumothorax'; 'Support Devices'

Comparison is made with prior study ___. Right lower lobe atelectasis has almost completely resolved. Mediastinal lymphadenopathy is better seen in prior CT. Small to moderate bilateral effusions are grossly unchanged. There is no pneumothorax. ET tube is in a standard position. Left lower lobe atelectasis has improved. A small hydropneumothorax in the left lung apex is not seen in this radiograph, better seen in prior CT. Irregular consolidation in the left apex is unchanged.

chest x-ray; 'No Finding'

The cardiomediastinal contour is unchanged compared to the prior study. No lobe were consolidation, pneumothorax or pleural effusion seen. Lung volumes are within normal limits. The trachea is central. No free air under the diaphragm.

chest x-ray; 'Cardiomegaly'; 'Consolidation'; 'Edema'; 'Pleural Effusion'; 'Support Devices'

Compared to chest radiographs ___ through ___. Moderately severe pulmonary edema which worsened between ___ and ___ at 05:02 is unchanged. Severe left lower lobe consolidation, presumably atelectasis is stable over at least the past 5 days. Mild to moderate cardiomegaly also unchanged. Pleural effusions are presumed, but not large. No pneumothorax. Tracheostomy tube is midline. No mediastinal widening or pneumothorax.

chest x-ray; 'Edema'

The ET tube terminates approximately 3.3 cm above the carina. Left-sided IJ terminates at the upper-to-mid SVC. Small bilateral pleural effusions, left greater than right, are overall stable compared to the prior exam. Moderate cardiomegaly is unchanged compared to exams dated back to ___. There has been interval improvement in the mild-to-moderate pulmonary edema. There is no evidence for pneumothorax. The visualized osseous structures are unremarkable.

chest x-ray; 'Atelectasis'; 'Support Devices'

Portable AP radiograph of the chest was reviewed in comparison to prior study obtained on ___. Left PICC line tip is at the cavoatrial junction. Heart size and mediastinum are stable. Bibasal, left more than right linear atelectasis are unchanged. No appreciable pneumothorax or pleural effusion is demonstrated.

chest x-ray; 'Lung Opacity'

The lungs are well expanded. There are patchy opacities in the left lower lung region as well as in the right lower lung, more prominently in the right cardiophrenic angle which appear new or more conspicuous than on the previous examination. No other focal opacities are identified. Bilateral apical pleural parenchymal scarring is present. Cardiomediastinal and hilar contours are unremarkable. Significant atherosclerotic calcifications of the aortic knob are present. There is no pleural effusion or pneumothorax.

chest x-ray; 'Cardiomegaly'; 'Lung Opacity'; 'Pleural Effusion'; 'Support Devices'

Prior study available for comparison is ___. Mild-to-moderate cardiomegaly is stable. ET tube tip is low, 1.5 cm above the carina, can be withdraw couple of centimeters for more standard position. NG tube tip is in the stomach, but the side hole is at the EG junction and should be advanced for more standard position. Right IJ catheter tip is at the cavoatrial junction. Left perihilar and lower lobe opacities are worrisome for aspiration given the clinical concern. There is mild vascular congestion. There is no pneumothorax. If any, there is a small left pleural effusion. Findings were discussed by Dr. ___ with Dr. ___ at 8:10 p.m. on ___.

chest x-ray; 'Edema'; 'Lung Opacity'; 'Pleural Effusion'; 'Support Devices'

In comparison with the study of ___, the monitoring and support devices are essentially unchanged. No evidence of pneumothorax. Continued retrocardiac opacification consistent with volume loss in the left lower lobe. Bilateral layering pleural effusions more prominent on the right with engorgement of pulmonary vessels consistent with mild to moderate pulmonary edema.

chest x-ray; 'Atelectasis'

Single frontal view of the chest. Lung volumes are low, exaggerating heart size, which is top normal. Cardiomediastinal contours are unremarkable. Undulating contours of aortic calcifications could represent an ectatic aorta. Retrocardiac and right lung base linear opacities are compatible with atelectasis. Indistinct appearance of the left costophrenic angle suggests a small pleural effusion. No pneumothorax. No radiopaque foreign body.

chest x-ray; 'No Finding'; 'Support Devices'

Right internal jugular approach central venous catheter terminates in the mid superior vena cava. No associated pneumothorax. Heart size is normal. Cardiomediastinal silhouette and hilar contours are unremarkable. Several surgical clips project over the mediastinum. Lungs are clear. Pleural surfaces are clear without effusion or pneumothorax.

chest x-ray; 'No Finding'

Compared to the prior study there is no significant interval change.

chest x-ray; 'No Finding'

The cardiac, mediastinal and hilar contours appear stable. Lung volumes remain low. Minimal opacification at each lung base suggests minor atelectasis. Otherwise, the lungs appear clear. There are no pleural effusions or pneumothorax.

chest x-ray; 'Consolidation'; 'Pleural Effusion'; 'Pneumonia'

In comparison to ___ chest radiograph, worsening, poorly defined areas of consolidation in the right mid and both lower lungs are concerning for developing multifocal pneumonia. Small bilateral pleural effusions are also demonstrated.

chest x-ray; 'Cardiomegaly'

In comparison with the earlier study of this date, the right chest tube has been removed and there is no evidence of pneumothorax. Overall, there is little change in the appearance of the heart and lungs.

chest x-ray; 'Pleural Effusion'; 'Support Devices'

The endotracheal tube terminates 5 cm above the carina. The NG tube terminating in the stomach and the right PICC line terminating at the cavoatrial junction are unchanged. No change in the bilateral pleural effusions or known bilateral rib fractures.

chest x-ray; 'Lung Opacity'

No relevant change as compared to the previous radiograph. Low lung volumes. No parenchymal opacity (the opacities seen on the recent CT is not visualized on the chest radiograph). No pneumonia, no pleural effusions, no pulmonary edema.

chest x-ray; 'Atelectasis'; 'Lung Opacity'; 'Pleural Effusion'

In comparison with the study of ___ there is increased opacification in the retrocardiac region consistent with collapse of the left lower lobe and associated pleural effusion. Change in the degree of obliquity of the patient makes it very difficult to determine whether there has been an the mediastinal shift. The right lung is clear.

chest x-ray; 'Atelectasis'; 'Cardiomegaly'; 'Consolidation'; 'Lung Opacity'; 'Pleural Effusion'; 'Pneumonia'; 'Support Devices'

Comparison is made with prior study, ___. Cardiomegaly is stable. Bibasilar consolidations larger on the left side have minimally increased on the right. Left PICC tip is in the upper SVC. If any, there is a small left pleural effusion. Opacities in the lungs could correspond to atelectasis and complete collapse of the left lower lobe with superimposed infection given the clinical history of pseudomona pneumonia.

chest x-ray; 'Lung Opacity'; 'Pleural Effusion'

There is a left chest tube, which appears unchanged in comparison to the prior chest radiograph. There is a small residual left apical pneumothorax, which is also unchanged. There is rounded opacity in the left mid lung likely atelectasis, and there is veil like opacity over the left lung which is likely layering left pleural effusion. The small right pleural effusion has increased and increasing opacity in the right lower lobe, likely worsening atelectasis. Heart size is stable. The mediastinal and hilar contours are stable. The pulmonary vasculature is not significantly enlarged.

chest x-ray; 'Lung Opacity'; 'Pleural Effusion'; 'Support Devices'

Comparison is made with prior study performed a day earlier. Cardiac size is normal. Extensive multifocal diffuse bilateral lung opacities have improved in the right upper lobe. There is no pneumothorax. Small left effusion is probably unchanged allowing the difference in positioning of the patient. ET tube is in standard position. Left IJ catheter tip is in the mid-to-lower SVC. The small right effusion is unchanged.

chest x-ray; 'Atelectasis'

There is this a stable or slightly decreased amount of free air visualized in the subdiaphragmatic region. There has atelectasis in both lung bases. There is no pneumothorax or CHF.

chest x-ray; 'Edema'; 'Pleural Effusion'; 'Support Devices'

AP chest compared to ___ at 5:07 a.m.: Moderate bilateral pleural effusions and mild pulmonary edema have both improved since earlier in the day. Tip of the endotracheal tube at the upper margin of the clavicles, is no less than 5 cm from the carina. Heart size normal. No pneumothorax. Upper enteric drainage tube is curled in the gastric fundus. Right subclavian line ends in the mid-to-low SVC. No pneumothorax.

chest x-ray; 'Atelectasis'; 'Support Devices'

Portable AP radiograph of the chest was compared to ___. The central venous line tip terminates at the level of cavoatrial junction. Heart size and mediastinum are stable. Right middle lobe atelectasis is unchanged. Lungs are essentially clear with no new abnormalities demonstrated.

chest x-ray; 'Support Devices'

In comparison with the study of ___, the patient has taken a somewhat better inspiration. Left chest tube remains in place and there is no evidence of pneumothorax. However, there is a large amount of fluid within the pleural space on the left with underlying volume loss. The right lung remains essentially clear.

chest x-ray; 'Lung Opacity'; 'Support Devices'

The NG tube tip is in the stomach. The lung volumes are low and there compressive changes at the bases. An early infiltrate in these regions can't be excluded

chest x-ray; 'No Finding'

The tip of the Dobbhoff is in the stomach while the proximal weighted portion is at the GE junction. Right hemodialysis catheter is in stable position in the right atrium. There is chronic elevation of the right hemidiaphragm with low lung volumes.

chest x-ray; 'Atelectasis'; 'Cardiomegaly'; 'Edema'; 'Fracture'; 'Support Devices'

Mild cardiomegaly is stable. Patient has known emphysema. Interstitial pulmonary edema has markedly improved. Bibasilar atelectasis have improved. The there is no pneumothorax or large effusions. Again noted are left rib fractures. Left PICC tip is in the mid SVC

chest x-ray; 'Pleural Effusion'; 'Support Devices'

AP portable upright view of the chest. A new left thoracostomy tube is present, resulting and improved aeration of the left lung and decreased left effusion. The right lung remains clear. There is no pneumothorax. Multiple intact sternal wires, prosthetic valve, and a left pacemaker generator pack projecting leads into the right ventricle and atrium remain unchanged. A right IJ catheter terminates at the cavoatrial junction.

chest x-ray; 'No Finding'

Heart appears to be normal in size and configuration. Trachea is midline. Cardiomediastinal contours are unremarkable. Lung fields are clear with no evidence of focal infiltrates. No pleural effusions or pneumothorax. Bony structures show some degenerative changes, but are otherwise unremarkable.

chest x-ray; 'Atelectasis'

Lungs are mildly hypoinflated with crowding of vasculature and right lower lobe plate like atelectasis. No pleural effusion or pneumothorax. Stable cardiomediastinal silhouette with top-normal heart. Air-filled loops of bowel are noted.

chest x-ray; 'Atelectasis'; 'Cardiomegaly'; 'Lung Opacity'; 'Pleural Effusion'; 'Support Devices'

In comparison with the study of ___, the right PICC line again extends to the mid to lower portion of the SVC. Continued enlargement of the cardiac silhouette with mild elevation of pulmonary venous pressure. Opacification at the right base with silhouetting of the hemidiaphragm is consistent with pleural fluid and volume loss in the right lower lung. Less prominent atelectatic changes are seen at the left base. In the appropriate clinical setting, it would be difficult to unequivocally exclude superimposed pneumonia, especially in the absence of a lateral view.

chest x-ray; 'Lung Opacity'

Right-sided Port-A-Cath terminates in the low SVC without evidence of pneumothorax. Low lung volumes persist. No focal consolidation is seen. Re- demonstrated minimal bibasilar patchy opacities most likely represent atelectasis or overlap of vascular structures. No large pleural effusion is seen. The cardiac and mediastinal silhouettes are stable.

chest x-ray; 'Pneumothorax'

AP chest reviewed in the absence of prior chest radiographs: Lungs are low in volume, heart is normal size, and pulmonary vasculature is normal as well. Suggestion of mild interstitial abnormality in the right lower lung could be resolving edema, based on subsequent improvement in chest radiograph performed three hours later available at the time of this review. No appreciable pleural effusion or evidence of pneumothorax.

chest x-ray; 'Atelectasis'; 'Edema'; 'Pleural Effusion'

Bold since ___, the patient has been extubated. Stable postoperative appearance of cardiomediastinal contours. Pulmonary vascular congestion is accompanied by mild edema and bilateral pleural effusions, right greater than left. Bibasilar retrocardiac atelectasis is unchanged.

chest x-ray; 'Pneumonia'

As compared to ___ chest radiograph, pulmonary vascular congestion has improved. No new foci of consolidation are evident to suggest the presence of pneumonia, but standard PA and lateral chest radiographs would be more sensitive for assessing the lung bases and may be helpful if clinical suspicion for infection persists. Diffuse skeletal metastases are again demonstrated.

chest x-ray; 'Cardiomegaly'; 'Pleural Effusion'; 'Support Devices'

AP chest compared to ___: Large bilateral pleural effusions may have increased slightly, particularly on the left. Following extubation, there has been no loss of lung volume. Left lower lobe still airless. The heart is moderately enlarged. No pneumothorax. Left PIC line ends low in the SVC. No pneumothorax.

chest x-ray; 'No Finding'; 'Support Devices'

Supine portable view of the chest demonstrates left internal jugular central venous catheter tip projecting over cavoatrial junction. No pneumothorax. The endotracheal tube terminates 4 cm above the carina. Nasogastric tube terminates within the esophagus. Low lung volumes accentuate bronchovascular markings. Hilar and mediastinal silhouettes are unchanged. Heart is moderately enlarged.

chest x-ray; 'Atelectasis'; 'Lung Opacity'; 'Support Devices'

Comparison to ___. No relevant change is noted. The position of the left chest tube is stable. The right upper lobe opacity is stable in extent and severity. The opacity needs to be monitoring until complete resolution. Retrocardiac atelectasis is slightly improved. No pleural effusions.