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mimic_chest_xray_v_1

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

The tip of the newly placed OG tube is not seen below the diaphragm. A repeat chest x-ray using the carina as the superior border, with abdominal technique, is recommended to definitively identify the OG tube tip.

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

There has been interval placement of a right-sided pigtail catheter, there may be a small right pleural effusion. There may also be a small right apical pneumothorax. No focal consolidations concerning for pneumonia are identified. Heart size is normal. Visualized osseous structures are unremarkable.

chest x-ray; 'Cardiomegaly'; 'Edema'; 'Pneumonia'

Massive enlargement of cardiac silhouette, which may be due to cardiomegaly with or without pericardial effusion, is similar in appearance to the prior radiograph, and accompanied by pulmonary vascular congestion and improving pulmonary edema with mild residual interstitial edema remaining. No localized areas of consolidation are present to suggest the presence of pneumonia.

chest x-ray; 'No Finding'

Endotracheal and enteric tubes are unchanged in position. Small left pleural effusion and bilateral lower lobe collapse are similar. Bronchial opacification may signify retained endobronchial secretions. No new consolidation.

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

Compared to prior chest radiographs ___ through ___. Large region of consolidation in the right lower lobe is improving. Upper lungs clear. Moderate cardiomegaly chronic. Pleural effusions are presumed, but not large. No pneumothorax. Right PIC line ends in the mid SVC.

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

Portable AP radiograph of the chest was reviewed in comparison to ___. Heart size is top normal. Mediastinum is stable. Right pleural effusion appears to be unchanged. There is interval progression of interstitial pulmonary edema. Minimal left pleural effusion cannot be excluded. Alternatively to pulmonary edema, diffuse infection is a possibility, although less likely, clinical correlation is advised.

chest x-ray; 'Pleural Effusion'

Compared to prior chest radiographs since ___, most recently ___ and ___. Lung volumes have not improved. There are no findings to suggest either cardiac decompensation or pneumonia. There is most likely a small right pleural effusion. Heart size is normal. No pneumothorax.

chest x-ray;

The patient remains intubated. The endotracheal tube terminates about 2 cm above the carina. There is a left subclavian stent projecting over the left upper chest that appears unchanged. The venous stent appears compressed centrally which may be due to mass effect from adjacent bony structures. The cardiac, mediastinal and hilar contours appear stable reflecting a combination of lymphadenopathy and proliferation of mediastinal fat. There is similar perihilar atelectasis on the left and bilateral heterogeneous opacification. Left lower lobe consolidation is not very well assessed on portable AP radiography but left retrocardiac opacification appears similar to perhaps slightly increased.

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

Comparison is made with prior study ___. Cardiomediastinal contours are normal. Small-to-moderate right and small left pleural effusions are probably unchanged allowing the difference in positioning of the patient. Adjacent opacities are likely atelectases. The upper lungs are clear. NG tube tip is in the stomach.

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

As compared to the previous radiograph, the extent and severity of both the pre-existing left pleural effusion and the pre-existing left lower lobe opacity have substantially increased. No pulmonary edema. Unchanged normal size of the cardiac silhouette. No pneumothorax.

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

Mild to moderate pulmonary edema has improved. Opacities in the right lower lobe and left upper lobe have also improved consistent with improving atelectasis. Left lower lobe retrocardiac opacities are grossly unchanged a combination of pleural effusion and atelectasis. Patient's chin obscures the apices of the lungs. Right IJ catheter tip is in the lower SVC. Pacer leads are in standard position. Cardiomediastinal contours are unchanged.

chest x-ray; 'No Finding'

No pneumothorax.

chest x-ray; 'Cardiomegaly'

No airspace opacity concerning for pneumonia is identified. Single semi-upright portable radiograph of the chest demonstrates the lungs are well expanded, with no evidence of pneumothorax or large pleural effusion. Cephalization of the pulmonary vasculature is unchanged compared to multiple prior studies. The heart size is mild to moderately enlarged. Calcifications are noted in the aortic arch. A prominent right pulmonary artery is also unchanged. A right approach PICC terminates in the mid SVC, and a jejunostomy tube, right upper quadrant embolization coils, and a plastic common bile duct stent are noted in the abdomen.

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

In comparison with the study of ___, the monitoring and support devices are unchanged. Diffuse opacification is again seen in the right hemithorax, consistent with the clinical diagnosis of pneumonia. Obscuration of the hemidiaphragm is consistent with layering effusion and compressive atelectasis at the base. Less prominent changes are seen at the left base. Some of the increased opacification on the right could be a manifestation of asymmetric edema.

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

As compared to the previous radiograph, the patient has been extubated. The currently are no monitoring and support devices. The lung volumes are normal. Normal size of the cardiac silhouette. Normal hilar and mediastinal structures. No pneumonia, no pleural effusion, no pulmonary edema.

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

ET tube tip is 6.3 cm above the carinal. The cough tube tip is in the stomach. Right PICC line tip is at the level of lower SVC. There is interval progression of pulmonary edema. Alternatively right upper lobe infectious process is another possibility although less likely. There is no pneumothorax.

chest x-ray; 'No Finding'

Tracheostomy tube is midline, grossly unchanged in position compared to prior. Median sternotomy wires are intact. Left PICC ends in the mid SVC. There is no focal lung consolidation. Cardiomediastinal silhouette is stable. There is no pleural effusion or pneumothorax.

chest x-ray; 'No Finding'

There has been interval advancement of the feeding tube with its tip now positioned in the proximal stomach. Small right pleural effusion unchanged.

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

Right chest tube terminates in medial right base. ET tube terminates 4.3 cm above carina. Enteric tube terminates within the stomach. Right IJ CVC terminates at the SVC RA junction. Previous moderate right pleural effusion has been largely evacuated. There is no pneumothorax. Small left pleural effusion is also smaller. Right infrahilar consolidation is probably atelectasis, but the consolidation at the base of the left lung could be pneumonia.

chest x-ray; 'No Finding'

The patient is status post median sternotomy and CABG. The patient is slightly rotated. There is stable elevation of the right hemidiaphragm. There is no pneumothorax or pleural effusion. The lungs remain clear. The heart and mediastinum are magnified by the projection.

chest x-ray; 'No Finding'

CHEST, SINGLE AP PORTABLE VIEW. Compared with earlier the same day (7:27 a.m.), the right IJ sheath has been converted to a right IJ central line, with tip over distal most SVC. No pneumothorax is detected. Otherwise, I doubt significant interval change.

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

In comparison with the study of ___, the orogastric tube has been pushed forward so that the side hole is clearly below the level of the esophagogastric junction. Endotracheal tube remains in place, and there is little change in the appearance of the heart and lungs.

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

Severe cardiomegaly is unchanged. No change to the positioning of the left-sided pacer leads projecting over the right atrium and right ventricle. Elevation of the right hemidiaphragm is again noted. Hilar congestion again noted without overt pulmonary edema. Small pleural effusions are likely present. Bony structures appear intact.

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

As compared to previous radiograph of 1 day earlier, a moderate sized, partially loculated right pleural effusion has increased in size. Cardiomegaly persists, accompanied by massive enlargement of the pulmonary arteries in keeping with pulmonary arterial hypertension. Exam is otherwise remarkable for increasing confluent opacity in the periphery of the left mid lung, a finding that was not evident on prior chest CTA ___. Developing infectious pneumonia should be considered in the appropriate clinical setting. Given the peripheral distribution, infarct is an additional consideration.

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

As compared to the previous radiograph, the patient has received a right central venous access line, with the tip projecting over the cavoatrial junction. The patient has also received a right pectoral pacemaker, the leads project over the right atrium and the right ventricle respectively. Finally, a left chest tube has been inserted. There is no evidence of pneumothorax. Apparently displaced left-sided rib fractures. No larger left pleural effusion. Moderate cardiomegaly with small retrocardiac atelectasis.

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

As compared to the previous radiograph, there is a partial reexpansion of the right lung. A right pleural effusion and an area of atelectasis and parenchymal consolidation at the level of the right hilus, both centrally and peripherally, however, persist. Moderate tortuosity of the thoracic aorta. Borderline size of the cardiac silhouette. Old humeral fracture on the right, not visible on the prior chest x-ray, and left-sided humeral head replacement.

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

As compared to ___, right-sided PICC at the cavoatrial junction. Weighted feeding tube with the tip in the body of the stomach. Increasing left basal opacity and moderate left effusion. Minimal subsegmental atelectasis in the right lung base. Possible new nodular opacity with central cavitation in the right lower lobe. No pneumothorax. The cardiac mediastinal contours are stable.

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

In comparison to previous radiograph from earlier the same date, a nasogastric tube has been placed, with tip terminating in the stomach. Exam is otherwise remarkable for decrease in extent of pulmonary edema and slight decrease in size of pleural effusions.

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

As compared to ___, pulmonary edema has improved which is now mild. Bibasilar opacities, right greater than left have marginally worsened. Moderate bilateral pleural effusion are again demonstrated. Moderate cardiomegaly.

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

As compared to the previous radiograph, there is no relevant change. Unchanged opacities at the right lung base and in the retrocardiac lung areas. Unchanged mild cardiomegaly. No overt pulmonary edema. Tracheostomy tube and right PICC line are constant.

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

As compared to the previous radiograph, the patient is intubated. The tip of the endotracheal tube projects 4.7 cm above the carinal. The patient also carries a nasogastric tube which is coiled in the stomach, the tip is not included on the image. The lung volumes are normal. Normal size of the cardiac silhouette. Normal hilar and mediastinal structures. No pulmonary edema. No pneumonia, no pleural effusions.

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

Bilateral chest tubes and the left mediastinal drain remain unchanged in position. Left subclavian line terminates at the low SVC. Tip of the enteric tube is seen in the stomach. Endotracheal tube terminates 2.8 cm above the carina. Bilateral pleural effusions continue to improve. Specifically, the loculated right pleural effusion is significantly better compared to yesterday's radiograph at 13:30, and mildly improved since the radiograph at 16:54. There is no pneumothorax. Cardiomediastinal silhouette is stable.

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

As compared to ___ and earlier time, a feeding tube has apparently been removed, and no feeding tube is currently visualized. If this has indeed been replaced, it may be coiled within the oro or hypopharynx. Exam is otherwise remarkable for improving interstitial edema and a new patchy right upper lobe opacity which could reflect a new site of aspiration in this patient with history of aspiration pneumonia.

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

ET tube tip is 2.3 above the carina. NG tube tip is in the stomach. Left PICC line tip is at the level of cavoatrial junction. Bibasal consolidations, left more than right are noted but minimally improved since the prior study. There is no pneumothorax.

chest x-ray; 'No Finding'

Interval extubation. Cardiomediastinal contours are within normal limits. Lungs are clear except for patchy and linear atelectasis at the bases.

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

The endotracheal tube is again high-lying, lying about 9 cm above the carina. An orogastric tube courses into the stomach. The cardiac, mediastinal and hilar contours appear unchanged. Superimposed on bibasilar opacities, left greater than right, as seen previously, is an increasing hazy perihilar abnormality with peribronchial cuffing, suggestive of fluid overload, but etiologies such as rapidly developing infection or acute respiratory distress syndrome could also be considered.

chest x-ray; 'Cardiomegaly'

Compared to the prior study the heart is mildly enlarged and is slightly larger than on the prior exam there is no focal infiltrate or effusion

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

A right-sided PICC terminates at the mid SVC. The cardiac and mediastinal contours are unchanged. Since ___18 a.m. there has been placement of a right Pleurx catheter, resulting and near resolution of the right pleural effusion. A tiny right basilar pneumothorax is seen. Small left pleural effusion is unchanged. A dense left retrocardiac opacity with air bronchograms is unchanged, and remains concerning for a small consolidation or worsening atelectasis.

chest x-ray; 'Lung Opacity'

One portable supine view of the chest. Endotracheal tube ends 2 cm from the carina. Heart size is top normal. The aorta is tortuous. There are patchy opacities in the mid and upper lung zones bilaterally. This may represent aspiration given that the patient was found lying down. No pleural effusions or pneumothorax. No fractures identified however evaluation is limited given technique.

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

The tip of the endotracheal tube lies 5.5 cm from the carinal angle in satisfactory position. There is no evidence of an orogastric tube. Position of the dialysis catheter is unchanged. The heart remains enlarged with a right effusion.

chest x-ray; 'Cardiomegaly'

Mild cardiomegaly has improved and pulmonary vascular engorgement has nearly cleared and previous substantial pleural effusions have resolved since ___. The lower esophagus is moderately distended with air. There is no pneumo mediastinum, pneumothorax, or appreciable pleural effusion. Lungs are grossly clear.

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

In comparison with the study of ___, the PICC line is unchanged with the tip in the mid portion of the SVC. There is increased opacification at the left base, consistent with volume loss in the left lower lobe. Some indistinctness of pulmonary markings, especially at the right base, raises the possibility of some asymmetric pulmonary edema.

chest x-ray; 'No Finding'

Compared to ___. Allowing for differences in technique and positioning, there has not been a substantial change in the appearance of the chest since the recent radiograph.

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

The endotracheal tube has been pulled back a few centimeters and now is appropriately sited with the distal lead tip 4 cm above the carina at the level of the aortic knob. The right IJ central line has distal lead tip at the distal SVC. There is improved aeration. There are no signs of overt pulmonary edema. There remains atelectasis at the lung bases. No pneumothoraces are seen. There is a left humeral hemiarthroplasty.

chest x-ray; 'Lung Opacity'

Semi-erect portable AP radiograph of the chest. The lungs are hyperinflated and clear. The right costophrenic sulcus is not imaged. Mild cardiomegaly is unchanged. Tortuosity of the aorta is noted. There are diffusely increased interstitial markings which appear to be chronic and also seen on scout image from ___ CT. Prominent mediastinal contour may represent aortic aneurysm. Correlate with clinical history. Median sternotomy cerclage wires and mediastinal clips are unchanged. There is no pneumothorax or pleural effusion.

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

Portable AP radiograph of the chest was reviewed in comparison to ___. Tracheostomy is in place with the tracheostomy tip being approprietly positioned. The right central venous line tip is at the level of low SVC. Cardiomediastinal silhouette is unchanged as well as widespread parenchymal opacities, especially involving the right lung.

chest x-ray; 'No Finding'

A portable frontal chest radiograph again demonstrates slightly low lung volumes and mild cardiomegaly. Diffuse interstitial opacities are unchanged. Perihilar congestion is decreased compared to ___. No new focal consolidation, pleural effusion, or pneumothorax is seen.

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

Interval placement of nasogastric tube, terminating in the stomach. Heart size remains normal, and lungs are clear except for minimal left basilar atelectasis.

chest x-ray; 'No Finding'

The patient is status post median sternotomy and CABG. Cardiac silhouette size remains top normal. Mediastinal and hilar contours are similar. Pulmonary vasculature is normal. No focal consolidation, pleural effusion or pneumothorax is present. Partially imaged is spinal fusion hardware within the thoracolumbar spine.

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

Portable AP radiograph of the chest was reviewed in comparison to ___ obtained at 04:41 a.m. The ET tube tip is approximately 4.4 cm above the carina. NG tube tip is in the stomach. The right PICC line tip is at the level of mid SVC. The widespread parenchymal perihilar opacities are demonstrated, unchanged consistent with severe pulmonary edema. No interval development of pleural effusion or pneumothorax demonstrated.

chest x-ray; 'Atelectasis'; 'Cardiomegaly'; 'Lung Opacity'

Heart size is enlarged, unchanged and mediastinum is stable. Right lower lung atelectasis and bibasal opacities are unchanged, most likely representing atelectasis. The findings are similar to ___ and most likely chronic

chest x-ray; 'No Finding'

Cardiomediastinal silhouette is within normal limits. There are no focal consolidations, pleural effusion, or pulmonary edema. There are no pneumothoraces.

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

Portable frontal upright radiograph of the chest. Compared to the prior study there is stable heart size and tortuosity of the aorta. The right upper lung mass is again seen measuring approximately 4.5 cm. There is a small right pleural effusion and trace left pleural effusion with associated atelectasis. No pulmonary edema.

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

There is an opacity at the left upper lung increasing from prior. Tracheostomy tube terminates 2 cm above the carina. Right PICC line is in the lower SVC. A chest drain is seen terminating at the right lung base. Bilateral pleural effusions are unchanged. A stent is seen in the right common carotid. There is minimally improved mild to moderate pulmonary edema. Cardiomediastinal silhouette is unchanged.

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

A left subclavian PICC line is in place. The tip overlies the mid right atrium, slightly distal to its position on the ___ radiograph. If clinically indicated, the PICC line could be retracted by approximately 5 to 5.5 cm. Low inspiratory volumes with minimal bibasilar atelectasis. No CHF, frank consolidation or effusion. No pneumothorax.

chest x-ray; 'No Finding'

Compare to ___, there is no significant change. Mildly increased opacity in the right lower lobe is likely due to atelectasis. Tortuous thoracic aorta is again seen. The heart size is unchanged. The mediastinal and hilar contours are unchanged.

chest x-ray; 'Lung Opacity'

Multiple calcified pleural plaques are unchanged from yesterday. New increased opacity at the right lung base could represent aspiration. Indistinctness of the pulmonary vasculature is consistent with pulmonary vascular congestion. Stable appearance of the cardiomediastinal silhouette and elevated right hemidiaphragm. No pleural effusion or pneumothorax.

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

As compared to the previous radiograph, the right pigtail catheter was removed from the pleural space. There is a small apical lateral right-sided pneumothorax, limited to the apical lateral parts of the hemi thorax. Close radiographic monitoring should be performed. No other relevant changes are noted. The other monitoring and support devices are in constant position. Moderate cardiomegaly and bilateral parenchymal opacities at the lung bases persist.

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

The lung volumes are normal. The monitoring and support devices are constant. Minimal increase in radiodensity at the right lung bases, likely caused by a a minimal right pleural effusion. On the left, the lung is better ventilated than on the previous image. Unchanged size of the cardiac silhouette.

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

ETT is 6 cm above the carina. Heart size is mildly enlarged, unchanged. Bilateral linear areas of atelectasis are unchanged. Upper lungs are clear. No appreciable pleural effusion or pneumothorax. No pulmonary edema.

chest x-ray; 'Atelectasis'

Slightly lower lung volumes seen on the current exam. Streaky bibasilar opacities may be secondary to atelectasis. There is possible small right pleural effusion as previously-seen. There is mild pulmonary vascular congestion. Cardiac enlargement is stable. No acute osseous abnormalities.

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

Cardiac, mediastinal and hilar contours appear stable. There is no pleural effusion or pneumothorax. Streaky opacities at the lung bases indicate minor, unchanged sites of scarring. Otherwise, the lungs appear clear. A nasogastric tube courses into the stomach and terminates to the right of midline. There is no free air.

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

Comparison is made to previous study from ___. There has been no interval change in the airspace opacities at the lung bases, right worse than left. This likely represents developing pneumonia within the background of known bronchioalveolar carcinoma. Heart size is within normal limits. There are no pneumothoraces.

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

Comparison is made with prior study performed a day earlier. Cardiomediastinal contours are normal. The pulmonary edema has markedly improved, now mild to moderate. Residual persistent right upper, mid, and lower lobe opacities and left upper lobe opacities could be due to residual asymmetric pulmonary edema or a combination of this and either contusions or aspiration pneumonia. Right subclavian catheter tip is at the confluence of the brachiocephalic veins. There is no evident large pneumothorax. Two right chest tubes and one left chest tube are in place. ET tube is in standard position. NG tube tip is out of view below the diaphragm. Findings were discussed with Dr. ___ by phone on ___ at 10:35 a.m., 5 minutes after the discovery of the findings.

chest x-ray; 'Cardiomegaly'

AP chest compared to ___: Generalized pulmonary vascular engorgement is new and the heart size larger, though still within normal limits. Mediastinal veins are also dilated, findings pointing to volume overload and/or biventricular decompensation.

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

As compared to the previous radiograph, a left pleural effusion has minimally increased. The pre-existing previously minimal right pleural effusion has massively increased. Mild to moderate pulmonary edema is now present. Bilateral areas of atelectasis. Right PICC line and tracheostomy tube in unchanged position.

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

In comparison with the study of ___, there again are low lung volumes that accentuate the prominence of the transverse diameter of the heart. The degree of pulmonary edema is stable, as are the bilateral pleural effusions with compressive basilar atelectasis on both sides. Opacification in the retrocardiac region is consistent with volume loss in the left lower lobe. An area of apparent opacification just above the minor fissure laterally is not appreciated at the current time.

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

In comparison with the study of ___, the endotracheal tube is been removed and replaced with a tracheostomy tube. Continued low lung volumes may be responsible for much of the prominence of the mediastinum and cardiac silhouette. Indistinctness of pulmonary vessels is consistent with elevated pulmonary venous pressure. Poor definition of the hemidiaphragms with blunting of the costophrenic angles suggests small effusions and basilar atelectasis.

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

In comparison with study of ___, the endotracheal tube appears to have been removed. Nasogastric tube extends to the lower stomach, where it coils on itself so that the tip lies pointing upward at the level of the esophagogastric junction. This information has been conveyed to Dr. ___. Increased opacification at the bases with silhouetting of the hemidiaphragm is consistent with pleural effusions and volume loss in the lower lobes. Cardiac silhouette remains within normal limits.

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

Interval intubation with the tip of the endotracheal tube at the proximal orifice of the right mainstem bronchus. Pullback of approximately 3 cm would be advised. The right internal jugular central is unchanged with its tip in the proximal SVC. The right hemidiaphragm remains elevated of uncertain significance. Lungs appear well inflated without evidence of focal airspace consolidation, pulmonary edema, pleural effusions or pneumothorax. Interval placement of a nasogastric tube which courses below the diaphragm with the tip not identified on this study. ___, the coordinator in the SICU, was notified of the need to pull back the endotracheal tube on ___ at 3:30 p.m. She will be informing the patient's nurse who was unavailable at the time of the phone call.

chest x-ray; 'No Finding'

AP single view of the chest has been obtained with patient in sitting semi-upright position. Comparison is made with the next preceding portable chest examination of ___. The heart size is normal. No configurational abnormality is seen. Thoracic aorta and mediastinal structures are unremarkable. The pulmonary vasculature is normal. No signs of acute infiltrates and the lateral pleural sinuses are free. No pneumothorax in apical area. In comparison with the next previous chest examination, no significant interval change.

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

Since ___ only a small portion of the left lower lobe is re-expanded, the base of the lower lobe and the entire left upper lobe and now final the some do not on doubt he air new heterogeneous opacification has developed the base of the right lung. I suspect this is dependent edema. Marked leftward mediastinal shift prevents assessment of heart size is. There is no pneumothorax.

chest x-ray; 'Cardiomegaly'

Comparison to ___. No evidence of free intra-abdominal air. Mild cardiomegaly without pulmonary edema. Elongation of the descending aorta. No pleural effusions. No pneumonia.

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

AP chest compared to ___: Leftward shift of the persistently enlarged cardiac silhouette suggests volume loss in the left lower lobe has progressed. Moderate right pleural effusion and mild-to-moderate pulmonary edema are unchanged. No pneumothorax. ET tube ends above the thoracic inlet, no less than 7 cm above the carina and it should be advanced at least 3 cm. This could improve aeration of the left lung. NG tube ends in a non-distended stomach. ___ was paged at 11:30 a.m. as soon as the findings were recognized.

chest x-ray; 'Atelectasis'

Lung volumes are low. This accentuates the size of the cardiac silhouette which is likely top normal. The mediastinal contour appears widened, likely due to low lung volumes, with crowding of the bronchovascular structures. There is hazy opacification within both lung bases likely reflective of atelectasis. No pneumothorax is detected. No acute osseous abnormalities are seen.

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

Comparison to ___. The known left basal parenchymal opacity is unchanged in extent and severity. The pre-existing right basal opacity is also stable. The lung volumes have decreased in the interval, there is radiologic evidence of mild pulmonary edema. Moderate cardiomegaly is unchanged. The monitoring and support devices are constant.

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

Left pic line ends at the origin of the SVC. Moderate left pleural effusion is moderately larger and large right pleural effusion is essentially new relative to ___. Left lower lobe still collapsed. Heart size normal.

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

The patient has now been extubated. The NG tube is been removed. The right internal jugular vein Swan-Ganz catheter tip lies within the mediastinal contours and appropriately positioned in the main pulmonary artery, slightly more proximal than previously. Aeration of the lungs has improved. Interval improvement in right pleural effusion, now minimal in size. Left pleural effusion has resolved. The heart remains moderately to severely enlarged, overall unchanged. Pulmonary vascular congestion is mild and improved. No pneumothorax.

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

As compared to the previous radiograph, no relevant change is seen. Minimally improved ventilation of the left lung bases. The appearance of the heart and of the right hemi thorax, including the right PICC line, is constant.

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

Improvement in generalized level of radiodensity in the lungs over 24 hr is presumably due to improvement in the component that is due to recover verbal pulmonary edema, but the severe infiltrative pulmonary abnormality, probably largely pulmonary fibrosis, is of course unchanged. Pleural effusions small if any. No pneumothorax. Tracheostomy tube midline. Right PIC line ends in the mid to low SVC.

chest x-ray; 'Atelectasis'; 'Lung Opacity'; 'Pneumothorax'

In comparison with the earlier study of this date, there is again probably a small left apical pneumothorax. Basilar opacification on the left is consistent with atelectatic changes. Otherwise, little interval change.

chest x-ray; 'Cardiomegaly'

A right internal jugular Port-A-Cath is present with its tip in the upper-to-mid SVC, unchanged from prior exams. There is no evidence of kinking of the line. There is an unchanged calcified nodule in the right mid lung zone. Streaky linear opacities are most consistent with atelectasis, not significantly changed. There is no new consolidation. There is no pneumothorax. There is no right pleural effusion. The left costophrenic angle is obscured by the overlying cardiac shadow. The heart remains severely enlarged. The mediastinal contours are normal. The patient is status post a median sternotomy. The wires are intact.

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

NG tube terminates in the stomach. Surgical clips overlie the right upper quadrant. The heart is severely enlarged, similar to prior, with stable cardiomediastinal contours. Bilateral pleural effusions, right greater than left, are similar to prior with stable alveolar opacity at the right base. Opacity of the left base has minimally improved, with persistent retrocardiac opacity. No pneumothorax.

chest x-ray;

Compared to chest radiographs from ___, there is no significant change. Lung volumes remain low. There is moderate central vascular congestion without overt pulmonary edema. Mild bibasilar atelectasis persists. No focal consolidation. No pleural effusions. No pneumothorax. Right PICC line tip terminates in the mid SVC. Orogastric tube extends below the diaphragm and beyond the field-of-view.

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

An NG tube is present, the tip and side port lie beneath the diaphragm, overlying the mid stomach. There are some patchy opacities at both lung bases with blunting of both costophrenic angles. Allowing for significant differences in technique, the appearance is slightly worse than on the prior film.

chest x-ray; 'No Finding'

No change.

chest x-ray; 'Atelectasis'

The heart size is within normal limits. The mediastinal and hilar contours appear unchanged. The previously described left pleural effusion is now markedly decreased. There is no pneumothorax. Minimal left basal atelectasis persists but is improved from before.

chest x-ray; 'Atelectasis'

As compared to ___, there is a newly appeared left upper lobe and lingular are atelectasis. The stent in the left main bronchus appears unremarkable. Minimally decreased lung volumes on the right, with resulting increase in lung density at the right lung basis.

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

Compared to chest radiographs ___ through ___. Severe infiltrative pulmonary abnormality has not improved. Diaphragmatic and mediastinal contours are now entirely obscured. Moderate right pleural effusion is likely. Left pleural fluid volume and heart size are indeterminate. No pneumothorax. Right supraclavicular central venous catheter and a left PIC line both end in the upper right atrium.

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

Compared to prior chest radiographs ___ through ___. New consolidation in the left lower lobe is accompanied by ipsilateral mediastinal shift. Although that indicates a component of atelectasis, there could be concurrent pneumonia in the left lower lobe particularly if patient has aspirated. Right lung is clear. Heart size top-normal. Left pleural effusion is presumed, but not large. Left PIC line ends in the mid SVC. ET tube tip is one cm below optimal placement with the chin down. Esophageal drainage tube ends in a nondistended stomach. .

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

As compared to the previous radiograph from ___, the patient has received a right external pacemaker. Mild cardiomegaly. No pulmonary edema. No pneumothorax. No pleural effusions.

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

In comparison with the earlier study of this date, there has been placement of a right IJ catheter that extends to the mid portion of the SVC. Otherwise, little change.

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

A right hemodialysis catheter ends in the atrium. Mild cardiomegaly is unchanged. A pigtail catheter is stable. The moderate right and small left pleural effusion are unchanged. Bibasilar atelectasis has slightly improved. There is no new consolidation or pneumothorax.

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

Heart size remains mildly enlarged. Mediastinal contour is similar with diffuse atherosclerotic calcifications noted. Low lung volumes are demonstrated with crowding of the bronchovascular structures and possible mild pulmonary vascular congestion. Focal opacity in the retrocardiac region is concerning for pneumonia with blunting of the left costophrenic angle suggestive of a trace left pleural effusion. No pneumothorax is identified. There are no acute osseous abnormalities.

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

Left subclavian PICC line now courses across the midline and heads cephalad in the proximal right brachiocephalic vein near its junction with the SVC. Repositioning would be recommended. However, it is noted that the patient was subsequently imaged on ___ at 10 am and on that study, the PICC line is now in satisfactory position. The left basilar opacity and associated small effusion are unchanged likely reflecting compressive atelectasis, although pneumonia cannot be entirely excluded. There is stable pulmonary vascular congestion. No pneumothorax is seen. The heart remains enlarged. Overall mediastinal contours are stable.