Sushmit/diffMe · Datasets at Hugging Face

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	As compared to the previous image, the patient was extubated and the nasogastric tube was removed. The left subclavian line remains in situ. Improvement of the ventilation of the lung bases, with, however, persisting cardiomegaly, signs of mild pulmonary edema and a retrocardiac atelectasis. The presence of a small pleural effusion on the left cannot be excluded.
	As compared to ___ radiograph, cardiomediastinal contours are stable. Left lower lung opacification has partially cleared with associated resolution of small left pleural effusion. No new focal areas of consolidation are identified to suggest a new source of infection.
	In comparison with the earlier study of this date, the right PICC line now terminates in the mid-to-lower portion of the SVC. Otherwise, little change.
	Cardiomegaly is unchanged. Mediastinal silhouette is stable. Left basal opacity and to lesser extent right basal opacity have progressed, concerning for progression of infection or potentially aspiration. No pulmonary edema is demonstrated although a interval increase in vascular congestion is noted.
	There is interval placement of Dobhoff tube with a guidewire still in place. This tube terminating well in the stomach. The cardiomediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. Lung volumes are low, but there is no focal consolidation concerning for pneumonia. Bibasilar atelectasis is mild. The upper abdomen is unremarkable in appearance.
	Portable supine frontal view of the chest. There are median sternotomy wires and mediastinal clips from prior CABG. A small left pleural effusion appears decreased since ___. There is no pneumothorax. There is bibasilar opacities most likely representing atelectasis; however, no areas of consolidation or pulmonary edema are seen. The heart size is enlarged but stable. The previously seen left apical pneumothorax has resolved.
	As compared to the previous radiograph, there is no relevant change. Low lung volumes. Patient rotation. Atelectasis in the retrocardiac lung areas. Normal size of the cardiac silhouette. No pneumonia, no pulmonary edema.
	A gastrostomy tube is noted over the left upper quadrant. The left PICC terminates in the left brachiocephalic vein. There is no pneumothorax. There is no focal consolidation, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is within normal limits.
	In comparison with the study of ___, there is little interval change. Continued enlargement of the cardiac silhouette with tortuosity of a diffusely calcified aorta. However, no evidence of acute focal pneumonia or pulmonary edema. Chronic interstitial changes are seen at the bases.
	In comparison with the chest radiograph obtained 1 day prior, there is been interval intubation. An ET tube terminates 2.8 cm above the carina. An enteric tube side port projects over the mid stomach. No other significant changes are appreciated. Right upper lung and perihilar opacification is similar, probably a combination of known lung cancer with postobstructive pneumonia. Substantial emphysematous changes are stable bilaterally.
	Diffuse interstitial abnormality improved on ___, and worsened again on ___, likely edema. Today it has improved slightly, or looks that way because lung volumes are slightly bigger. Moderate cardiomegaly persists but there is no longer mediastinal venous engorgement. ET tube and left internal jugular line are in standard placements and an upper enteric drainage tube passes to the distal portion of the nondistended stomach, with the tip is indistinct.
	1. Dual-lead left-sided pacemaker with its leads terminating over the expected location of the right atrium and right ventricle respectively. Left internal jugular central line has its tip in the proximal superior vena cava. Endotracheal tube continues to have its tip approximately 3 cm above the carina. Nasogastric tube seen coursing below the diaphragm with the tip not identified. 2. The heart remains mildly enlarged but unchanged. Mediastinal contours are within normal limits. Interval improvement in aeration with improving mild pulmonary and interstitial edema. Probable small layering right effusion. More patchy opacity at the left base may reflect a combination of compressive atelectasis and effusion, although pneumonia cannot be entirely excluded. Clinical correlation is advised. No evidence of pneumothorax.
	Comparison is made to previous study from ___. There are low lung volumes with crowding of the pulmonary vascular markings due to poor inspiratory effort. There is plate-like atelectasis at both lung bases, which has worsened since the prior study. No pulmonary edema or pleural effusions are seen.
	Since a prior study of 1 day earlier, the patient has been extubated. None previously present left mid and lower lung opacities have markedly improved, but right basilar opacities not appreciably changed. Small pleural effusions are again demonstrated.
	As compared to ___ radiograph, left pleural effusion has decreased in size adjacent left retrocardiac opacity has nearly resolved. Large, partially loculated right pleural effusion with adjacent right mid and lower lung atelectasis and or consolidation is again demonstrated. Right pigtail pleural catheter continues to terminate medially in the lower right hemi thorax, and there has likely been a decrease in the extent of medially loculated pleural effusion within this region.
	A right upper extremity PICC terminates in the distal superior vena cava. Lung volumes are minimally improved. There is an unchanged infiltrative pulmonary abnormality, right greater than left, consistent with the history of ARDS. A more focal area of airspace consolidation seen in the right upper lobe is new. Cardiac and mediastinal contours are unchanged. There is no pneumothorax or definite pleural effusion.
	Single frontal view of the chest was obtained. There are low lung volumes that accentuate the bronchovascular markings. There is bibasilar atelectasis. Slight blunting of the costophrenic angles likely relates to low lung volumes, although trace pleural effusion would be difficult to exclude. Right perihilar opacity is seen, which could be due to underlying consolidation, prominent vasculature, underlying mass is not excluded. Dedicated PA and lateral views would be helpful for further evaluation. Old right-sided rib fracture is again seen. Cardiac silhouette remains mildly enlarged. The aorta is calcified and tortuous.
	1. Interval increase in airspace opacity in both lungs, right slightly more than the left, consistent with worsening pulmonary edema. Overall, cardiac and mediastinal contours are likely stable. No evidence of pneumothorax. Probable small layering right effusion.
	As compared to the previous radiograph bilateral pigtail catheters in the pleural space are in unchanged position. However, on the left, a relatively large apical and basal pneumothorax has developed and signs of tension starts to be can visible. At the time of dictation and observation, 09:24, on the ___, the referring physician ___. ___ was paged for notification. Minimally increasing opacities at the right lung base. Unchanged moderate cardiomegaly.
	In comparison with the study of ___, the cardio mediastinal silhouette is essentially unchanged. Opacification of the left base is consistent with a small effusion and mild atelectatic changes. No definite pulmonary vascular congestion. There is again some prominence of the right hilar region especially when compared to the study of ___. This could merely represent relatively lower lung volumes. If clinically possible, a repeat study should be obtained with full inspiration and a lateral view would be helpful.
	ET tube tip is 4 cm above the carina. NG tube passes below the diaphragm, not included in the field of view. Patient continues to be in severe pulmonary edema associated with bibasal atelectasis and bilateral pleural effusion. No appreciable pneumothorax is seen.
	Lung volumes are low. There is severe right convex scoliosis of the visualized spine, centered in the lower cervical spine. Ill-defined bibasilar opacities may represent atelectasis or aspiration. There is no pleural effusion. No pneumothorax. Mediastinal and hilar contours are stable with unchanged severe tortuosity of the thoracic aorta. Mild cardiomegaly is unchanged.
	On the frontal projection, the right lower lobe appears to be better aerated and the previous identified opacity is lower less conspicuous, although there is no lateral projection for comparison. Bibasilar atelectasis is noted. The remainder of the lungs are essentially clear without pleural effusion, pneumothorax, or pulmonary edema. Stable, mild cardiomegaly is noted. The mediastinal and hilar contours are otherwise unchanged.
	Single AP portable view of the chest was obtained. There are slightly low lung volumes. Bibasilar atelectasis is seen. Relative opacity projecting over the costophrenic angles most likely relates to overlying soft tissue. No radiopaque foreign body is seen. Cardiac and mediastinal silhouettes are unremarkable.
	Comparison is made to prior study from ___. There is a feeding tube whose distal tip is in the body of the stomach. There is a dual-lead left-sided pacemaker. There is a right-sided PICC line with distal lead tip in the proximal SVC. This appears to have migrated more proximally by 3 cm. There is mild cardiomegaly. There is improved aeration at the right base. There are no pneumothoraces or signs for overt pulmonary edema.
	AP radiograph of the chest was reviewed in comparison to ___. The pacemaker leads terminate in the expected location of right atrium, right ventricle, and left ventricle epicardial vein. The dilated left ventricle and the left ventricular calcified aneurysm are re-demonstrated. There is no pulmonary edema. Right PICC line tip terminates at the level of mid SVC. No interval development of pleural effusion or pneumothorax is demonstrated.
	Mild right lower lobe atelectasis improved since ___. Left lung fully expanded and clear. No appreciable pleural effusion. Tiny left apical pneumothorax is new or newly apparent, with apical pleural drainage pigtail catheter still place.
	Portable AP chest radiograph was reviewed in comparison to ___. Substantial left scapular, rib and clavicular fracture is re-demonstrated. Subcutaneous air is large and unchanged since the prior study. Left chest tube is in place. Left basal consolidation is unchanged and there is slight interval development of right basal opacity that might reflect atelectasis, but infectious process is a possibility. Also, there is a new right apical pneumothorax, not seen on the prior study, reason unclear.
	Support and monitoring devices are in standard position. Widespread subcutaneous emphysema is again demonstrated, as well as pneumomediastinum, pneumopericardium, and a small right apicolateral pneumothorax. These findings are similar to the prior radiograph, with no acute short interval changes since the recent study.
	As compared to the previous radiograph, no relevant change is seen. Moderate cardiomegaly with extensive retrocardiac atelectasis. Additional lingular opacity that could reflect pneumonia. Signs of interstitial fluid overload persist. No pneumothorax.
	Right chest wall port is again seen. There is a moderate to large right pleural effusion and a smaller left pleural effusion, both appear larger when compared to ___. Superiorly, lungs are clear. Surgical clips stent and catheter wall identified in the upper abdomen.
	In comparison with the study of ___, there has been decrease in opacification in the right upper and mid zone. The appearance of the residual opacification suggests aspiration pneumonia in this patient with known prominent paramediastinal lymphadenopathy. Cardiac silhouette remains enlarged and there is evidence of elevated pulmonary venous pressure. Suggestion of some areas of increased opacification in the left upper and lower zones. This could reflect new areas of aspiration.
	Persisting cardiomegaly and the bilateral pulmonary edema with no significant interval change. No chest tube position of the various tubes with the ET tube above the carina. The right PICC line in the SVC and the NG tube probably in the stomach.
	Interval insertion of a left PleurX catheter has resulted in a small left pneumothorax with apical and medial components. No evidence of mediastinal shift. A small left and trace right pleural effusions are decreased from earlier today. A right chest central venous catheter terminates in the right atrium, unchanged.
	Multifocal consolidation predominantly involving the right upper and both lower lobes is slightly improved from scout image of CT of ___ in the right lung, but appears worse in the left lower lobe. These findings likely represent multifocal aspiration pneumonia. Small to moderate bilateral pleural effusions are noted, left greater than right.
	Since prior, there has been interval placement of an endotracheal tube with tip approximately 3.5 cm from the carina. Enteric tube passes below the inferior field of view. There has been interval progression of the bilateral perihilar parenchymal opacities. There is no large pleural effusion or pneumothorax on this supine film.
	As compared to the previous radiograph, the right pleural effusion has increased in extent and severity. There also is an increase in extent of the accompanying atelectasis. Moderate cardiomegaly. No change in appearance of the left lung.
	As compared to the previous image, patient has received a nasogastric tube. As intended, the tip of the tube is located in the middle third of the esophagus. The other monitoring and support devices are constant. Constant appearance of the cardiac silhouette and of the lung parenchyma. The known bilateral pleural effusions are unchanged in extent and severity.
	As compared to the previous image, the ___ of the known right pneumothorax are unchanged. No evidence of tension. Normal appearance of the left lung, except for a retrocardiac atelectasis. Unchanged opacities at the right lung bases. Borderline size of the cardiac silhouette.
	Single portable upright AP image of the chest. The lungs are well expanded. Mild interstitial markings and cardiomegaly are consistent with mild pulmonary edema, improved from prior exam. The left upper lobe known mass is not well visualized on this exam due to overlying wires. No other focal pulmonary lesion is seen. There is no left pleural effusion. There may be a small right pleural effusion. There is no pneumothorax.
	Lung volumes are very low and there are compressive changes at the bases. There is pulmonary vascular congestion. The heart is minimally enlarged
	Lumbar luminal lobe, accounting for some bronchovascular crowding. No focal opacities concerning for pneumonia. Cardiac size is unchanged compared with the previous exam. The aorta is tortuous as before. There is no pleural effusion or pneumothorax.
	In comparison with the study ___ ___, there is diffuse increase in opacification bilaterally, with a pattern most likely reflecting worsening pulmonary edema. In the appropriate clinical setting, superimposed pneumonia would have to be considered. The endotracheal tube is been removed. Right IJ Swan-Ganz catheter tip again is in the right pulmonary artery.
	No previous images. The heart is normal in size and there is no vascular congestion, pleural effusion, or acute focal pneumonia.
	Compared to prior chest radiographs since ___, most recently ___. Heart size normal. Lungs clear. No pleural abnormality.
	In comparison with study of ___, there is little change. No evidence of pneumothorax or other acute abnormality. The most superior sternal wire is fragmented in this patient with previous CABG procedure.
	The position of the various lines and tubes is unchanged. A left chest tube is present. There is no evidence of a pneumothorax. Bilateral pleural effusions are again noted. Increased opacities are seen in the left lower lobe in the retrocardiac region, which could represent an area of aspiration pneumonia. This was not present on the prior chest x-ray.
	Heart size remains mildly enlarged. The mediastinal contour is unchanged. Perihilar haziness and vascular indistinctness is compatible with mild pulmonary edema, not substantially changed in the interval. No large pleural effusion or pneumothorax is seen. Previously noted peripheral opacity in the right lung base continues to improve. Atelectatic changes are re- demonstrated in the lung bases. No acute osseous abnormality is visualized.
	As compared to the previous radiograph, the lateral and basal components of the known right pneumothorax have substantially decreased in extent and severity. The apical component is not substantially changed. Signs of tension are no longer present. Unchanged appearance of the heart and the left lung.
	An endotracheal tube tip is 2.2 cm above the carina. An enteric feeding tube courses below the diaphragm out of field of view. There is persistent bibasilar atelectasis with no new focal opacities concerning for pneumonia. There are no pleural effusions or pneumothorax. The cardiomediastinal and hilar contours are normal. Pulmonary vascularity is normal.
	As compared to the previous radiograph, the patient has received a nasogastric tube. The course of the tube is unremarkable, the tip of the tube projects over the middle parts of the stomach. On the current radiograph, there is substantial patient rotation, which makes subtle changes difficult to evaluate. However, no larger pleural effusions and no pneumothorax is seen. The size of the cardiac silhouette appears to be unchanged.
	There are moderate size bilateral pleural effusions that have increased compared to the prior exam. There is Associated volume loss in the lower lobes. An underlying infectious infiltrate can't be excluded. There is mild pulmonary vascular redistribution. Feeding tube tip is off the film, at least in the stomach.
	An endotracheal tube is again seen, with the tip approximately 3 cm above the carina. NG tube is present, curled within the stomach. Left-sided central venous catheter is present, with the tip at the junction of the brachiocephalic vein. Right-sided subclavian dialysis catheter is also noted, the tip of this is unchanged, somewhat higher than usual at the level of the cavoatrial junction. A left-sided chest tube is present, unchanged. Again, multifocal pulmonary opacities are seen predominantly in the left upper-to-mid lung zones, and appearing relatively unchanged. There may be slight improvement of the overall appearance of edema within the right hemithorax. A small left-sided pleural effusion is present, unchanged. A trace right-sided pleural effusion is also likely present. No new pneumothorax. Degenerative changes are seen at the shoulders. A notable scoliosis of the lumbar spine is seen, convex to the right. Vascular calcifications are noted at the aortic arch.
	The moderate right loculated pleural effusion has increased, particularly in the apical and lateral portions with resultant increasing consolidation in the right lung. While much of this is likely compressive atelectasis, concomitant pulmonary edema or infectious process would be difficult to exclude. Given the short time course, malignant progression is less likely. Left dependent pleural effusion is also likely increased with accompanying mild interstitial edema given the presence of thickened septal lines. The cardiac silhouette is unchanged. Left Port-A-Cath is in unchanged position with interval removal of right PICC. Bibasilar chest tubes are in similar position.
	Moderate pulmonary edema, small left pleural effusion, and right fissural fluid have worsened since the ___ examination. There is no pneumothorax. The heart size is normal. The hilar mediastinal contours are unchanged.
	There has been no interval change in position of the tips of the central lines. The left axillary PICC line tip is again perpendicular to the SVC wall. There are no pneumothoraces. There is a small right-sided pleural effusion.
	AP portable upright view of the chest. Multiple overlying EKG leads are present. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact.
	Compared to prior chest radiographs since ___, most recently ___. Feeding tube, with the wire stylet in place now ends below the diaphragm in the mid stomach. Lungs lung volume but clear. No pulmonary edema. Moderate cardiomegaly increased. No appreciable pleural effusion or indication of pneumothorax.
	There are persistent low lung volumes. Retrocardiac opacities have improved. Right lower lobe atelectasis are stable. There is no pneumothorax. Cardiomegaly is a stable. Tracheostomy tube is in standard position.
	In comparison to ___ radiograph, bibasilar atelectasis has slightly worsened. Orogastric tube has been slightly advanced in the stomach. No other relevant change.
	Rotated positioning. Probable hyperinflation/COPD. The patient is status post sternotomy, with mild cardiomegaly. The aorta is calcified and slightly unfolded. There is upper zone re-distribution, without overt CHF. Minimal atelectasis at both lung bases. No effusion and no frank consolidation identified. Dense calcification is noted diffusely in the more peripheral soft tissues.
	AP chest compared to ___ and ___ at 7 p.m.: Dobbhoff tube is little changed in position compared to ___, looped in the upper stomach. Mild pulmonary edema has changed in distribution but not in overall severity since ___. Left lower lobe is still consolidated either due to atelectasis or pneumonia, and bilateral pleural effusions, moderate on the right, small on the left, have increased only slightly. Severe cardiomegaly and mediastinal vascular engorgement are longstanding. No pneumothorax.
	The cardiomediastinal and hilar contours are within normal limits. There is likely a small left pleural effusion with minimal adjacent atelectasis. No focal consolidation or pneumothorax is identified. Surgical clips and the stent are identified in the upper abdomen.
	In comparison to previous study from earlier today, a Swan-Ganz catheter is unchanged in position terminating in the lateral aspect of the right hilum. Cardiomegaly is accompanied by pulmonary vascular congestion and improving asymmetrical pattern of pulmonary edema. Bilateral pleural effusions have also decreased in size.
	In comparison with the study of ___, the patient has taken a better inspiration. There is no evidence of pneumonia, vascular congestion, or pleural effusion. Clips in the lower neck suggest previous thyroid surgery.
	Endotracheal tube terminates 3.5 cm from the carina. Enteric tube and side port are within the stomach. Lung volumes are low. This accentuates the size of the cardiac silhouette which appears mildly enlarged. Apparent widening of the superior mediastinal contour also is likely due to low lung volumes. There is crowding of the bronchovascular structures without overt pulmonary edema. Patchy and linear opacities in the lung bases likely reflect areas of atelectasis. No large pleural effusion or pneumothorax is present. No acute osseous abnormalities are visualized.
	The lung volumes are low. There is moderate pulmonary edema and moderate cardiomegaly. No pleural effusions. No focal parenchymal opacity suggesting pneumonia. No current evidence of rib fractures. No pneumothorax.
	Compared to chest radiographs since ___ most recently ___. Moderate right pneumothorax has recurred despite apical pleural drainage tube. There is no appreciable right pleural effusion. Current mild interstitial edema in the base of the severely emphysematous right lung is a recurrent feature. Severe postoperative volume loss left hemi thorax is chronic. Marked leftward mediastinal shift obscures the cardiac silhouette. ET tube in standard placement. Nasogastric drainage tube probably ends in the mid stomach.
	In comparison with the study of ___, there has been placement of a PEG with resultant substantial free intraperitoneal gas. Tracheostomy tube remains in unchanged position with the tip approximately 6.5 cm above the carina. Little change in the appearance of the heart and lungs.
	Heterogeneous opacification in the right mid and lower lungs has increased. Whether this is pneumonia or combination of atelectasis and increasing small right pleural effusion is radiographically indeterminate. Small left pleural effusion and moderate cardiomegaly unchanged. No pneumothorax. Pulmonary vasculature is engorged, but there is no good evidence for edema. ET tube and transvenous right atrial and right ventricular pacer leads, right jugular line and esophageal drainage tube ending in the stomach are in standard placements respectively.
	Midline tracheostomy tube is again seen. The tube terminates approximately 3 cm above the carina. Again seen is patient's right lower lobe calcified mass, similar compared to prior study. The left lung is grossly clear. There has been interval removal of a left-sided PICC.
	In comparison with study of ___, the pigtail catheter at the right base has been slightly re-positioned. The diffuse bilateral pulmonary opacification appears to have increased bilaterally. There is still extensive gas in soft tissues, especially in the lower neck. No definite pneumothorax.
	Compared to chest radiographs since ___, most recently ___ through ___. Mild pulmonary edema has improved since ___, while small bilateral pleural effusions have increased. Heart size normal. No focal pulmonary abnormality. No pneumothorax. Infusion catheter ends close to the superior cavoatrial junction. ___, MD ___=___
	Mild cardiomegaly is stable. Left lower lobe opacities are combination of stable small effusion and minimal atelectasis. There is no evidence of pneumothorax, pneumonia, or pulmonary edema.
	Right IJ catheter tip is in thelower SVC. Cardiac size is normal. The lungs are clear. There is no pneumothorax or pleural effusion.
	In comparison with the study of ___, there is little overall change. Monitoring and support devices remain in place. The tip of the endotracheal tube lies approximately 5 cm above the carina. Cardiac silhouette is within normal limits. Hazy opacification at the bases with obscuration of the hemidiaphragms is consistent with layering effusions and volume loss in the lower lungs. No definite vascular congestion.
	Dual lead left-sided pacer device is stable in position, with leads extending to the expected positions of the right atrium and right ventricle, stable. The cardiac and mediastinal silhouettes are stable. Mild left base atelectasis is seen without focal consolidation. There is no pleural effusion or pneumothorax.
	ET tube tip is 3.3 cm above the carinal. NG tube tip passes below diaphragm. Left subclavian line tip is at the level of mid SVC. Bibasal consolidations in large bilateral pleural effusions as well as mild interstitial edema are similar to previous examination.
	A left internal jugular central line terminates at the cavoatrial junction. A right subclavian line terminates in the right atrium. Severe cardiomegaly is stable. There is no focal consolidation or pneumothorax. There has been improvement in the right pleural effusion and a small left pleural effusion is stable.
	Comparison is made to the previous study from ___. There is an endotracheal tube whose tip is low and only 3 cm from the carina. This could be pulled back 1-2 cm for more optimal placement. There are low lung volumes. There is some atelectasis at the lung bases. There are no signs for overt pulmonary edema or focal consolidation. No pneumothoraces are seen.
	Patient is status post partial right pneumonectomy and radiation therapy. A pigtail catheter within the right costophrenic angle is unchanged in position. A moderate right effusion with presumed underlying atelectasis is unchanged in severity. The left lung remains clear. There is no pneumothorax. Cardiomediastinal and hilar contours are within normal limits.
	Compared to the prior study. There is no significant interval change.
	A single upright portable chest radiograph is obtained. A small right apical pneumothorax is present. There is a right chest tube seen in appropriate position. Previous right apical nodule has been resected. Mild bibasilar atelectasis is present. Cardiomegaly is mild.
	As compared to the previous examination, the parenchymal opacities have increased in extent and severity. These opacities, located in the right lung, now occupy most of the right hemi thorax. The show more extensive air bronchograms than on the previous image. The right internal jugular vein catheter has been removed in the interval. Unchanged mild cardiomegaly. Mild fluid overload but no overt pulmonary edema. No larger pleural effusions.
	As compared to the previous radiograph, lung volumes have increased. The pre-existing parenchymal opacities, notably at the lung bases, have substantially decreased in extent. New opacities are seen, ventriculoperitoneal shunt and tracheostomy tube as well as venous line are in unchanged position.
	Stent in the right main bronchus is noted. There is a questionable tiny right apical pneumothorax. Elevation of the left hemidiaphragm is unchanged. Left perihilar opacities have increase could be atelectasis or aspiration. Right mid hemi thorax large opacity is unchanged due to known large rib metastasis. Cardiac size cannot be evaluated. Left pleural effusion has decreased.
	Marked interval improvement in bilateral diffuse alveolar opacities, consistent with resolving pulmonary edema in the setting of recent dialysis. Residual edema affects the left lung to a slightly greater degree than the right. Cardiac size has slightly decreased in size in the interval, and azygos vein distention has slightly decreased as well. Small bilateral pleural effusions persist.
	In comparison with the study of ___, there is little overall change. Hyperexpansion of the lungs is consistent with the clinical diagnosis of COPD. However, no evidence of acute pneumonia, vascular congestion, or pleural effusion. The endotracheal tube
	Left retrocardiac opacity is seen which raises concern for pleural effusion with possible atelectasis underlying consolidation not excluded. However, there appears to be some lucencies within the region of opacity which could be due to necrosis/infection however, hernia with bowel content is not entirely excluded. The right lung is clear. No pneumothorax seen. The aortic knob is calcified.
	In comparison with the study ___ ___, the right IJ catheter has been pulled back so that the tip is in the lower SVC. Cardiac silhouette remains mildly enlarged without appreciable vascular congestion. However, there is increased opacification at the bases silhouetting the hemidiaphragms, consistent with layering pleural effusions and compressive atelectasis on both sides. It is possible that a more supine position of the patient could be contributing to this difference in appearance.
	A left-sided pacemaker projects leads into the right atrium and ventricle. The heart is mildly enlarged. The hilar and mediastinal contours are unchanged. Central pulmonary vascular prominence appears minimally changed, though, in combination with lower lung volumes, likely represents overall improvement. There is no longer any appreciable edema. There is no pneumothorax. A small left pleural effusion is unchanged. A previously seen a very large hiatal hernia is not easily seen on the current study, due to lack of intraluminal gas.
	In comparison with the study of ___, the patient has taken a better inspiration. There again is substantial enlargement of the cardiac silhouette with prominent pulmonary edema. Widening of the vascular pedicle is again seen. No evidence of acute focal pneumonia, though this would be extremely difficult to exclude in the appropriate clinical setting, given the widespread lung changes and absence of a lateral view.
	AP chest compared to ___: ET tube in standard placement. Right PIC line ends in the mid-to-low SVC. No upper enteric drainage tube is detected. Heart mildly enlarged. Lungs have nearly cleared of previously asymmetric pulmonary edema, in the left lower lobe, which has resolved everywhere else. No appreciable pleural effusion.
	AP single view of the chest has been obtained with patient in upright position. Comparison can be made with the next preceding PA and lateral chest examination of ___. The heart size is normal. No configurational abnormality is present. Thoracic aorta and mediastinal structures are unremarkable. The pulmonary vasculature is not congested. No signs of acute or chronic parenchymal infiltrates are present and the lateral pleural sinuses are free. No pneumothorax in the apical area. On the preceding examination in ___ increased translucency at the bases raise suspicion for emphysema. Similar changes are not present on today's portable examination. Referring physician ___ was paged for stat report.
	Portable frontal radiograph of the chest demonstrates stable top-normal heart size with normal mediastinal and hilar contours. No focal consolidation, pleural effusion, pneumothorax.
	Transesophageal drainage tube is still looped in the upper esophagus. Lung volumes are low and there is probably some atelectasis at the base the left lung, and perhaps small left pleural effusion, but this has not changed since earlier in the day. Heart is moderately enlarged. A left PIC line ends in the low SVC. No pneumothorax.
	In comparison with the chest radiograph obtained 1 day prior, the patient has been intervally extubated. There has been resolution of pulmonary vascular congestion and pulmonary edema. Heart size and cardiomediastinal silhouettes are unchanged. Bibasilar atelectasis has minimally improved. Pleural effusions are small, if any. No focal consolidations.
	Moderate to large right pleural effusion, unchanged since ___, including large fissural component in the right major fissure. Small left pleural effusion has increased, collected medially on the frontal view. Heart size top- normal. Upper lungs clear. Right base moderately atelectatic.
	In comparison with the study of ___, the monitoring and support devices are unchanged. Cardiac silhouette remains within normal limits and there is minimal elevation of pulmonary venous pressure. The medial portion of the right hemidiaphragm is now silhouetted with retrocardiac opacification consistent with increasing volume loss in the left lower lobe.
	Mild Right lung base opacity and small right pleural effusion are unchanged. There is no new consolidation. There is no pulmonary edema. Cardiomediastinal silhouette is normal size. Small right pleural effusion is slightly more.

As compared to the previous image, the patient was extubated and the nasogastric tube was removed. The left subclavian line remains in situ. Improvement of the ventilation of the lung bases, with, however, persisting cardiomegaly, signs of mild pulmonary edema and a retrocardiac atelectasis. The presence of a small pleural effusion on the left cannot be excluded.

As compared to ___ radiograph, cardiomediastinal contours are stable. Left lower lung opacification has partially cleared with associated resolution of small left pleural effusion. No new focal areas of consolidation are identified to suggest a new source of infection.

In comparison with the earlier study of this date, the right PICC line now terminates in the mid-to-lower portion of the SVC. Otherwise, little change.

Cardiomegaly is unchanged. Mediastinal silhouette is stable. Left basal opacity and to lesser extent right basal opacity have progressed, concerning for progression of infection or potentially aspiration. No pulmonary edema is demonstrated although a interval increase in vascular congestion is noted.

There is interval placement of Dobhoff tube with a guidewire still in place. This tube terminating well in the stomach. The cardiomediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. Lung volumes are low, but there is no focal consolidation concerning for pneumonia. Bibasilar atelectasis is mild. The upper abdomen is unremarkable in appearance.

Portable supine frontal view of the chest. There are median sternotomy wires and mediastinal clips from prior CABG. A small left pleural effusion appears decreased since ___. There is no pneumothorax. There is bibasilar opacities most likely representing atelectasis; however, no areas of consolidation or pulmonary edema are seen. The heart size is enlarged but stable. The previously seen left apical pneumothorax has resolved.

As compared to the previous radiograph, there is no relevant change. Low lung volumes. Patient rotation. Atelectasis in the retrocardiac lung areas. Normal size of the cardiac silhouette. No pneumonia, no pulmonary edema.

A gastrostomy tube is noted over the left upper quadrant. The left PICC terminates in the left brachiocephalic vein. There is no pneumothorax. There is no focal consolidation, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is within normal limits.

In comparison with the study of ___, there is little interval change. Continued enlargement of the cardiac silhouette with tortuosity of a diffusely calcified aorta. However, no evidence of acute focal pneumonia or pulmonary edema. Chronic interstitial changes are seen at the bases.

In comparison with the chest radiograph obtained 1 day prior, there is been interval intubation. An ET tube terminates 2.8 cm above the carina. An enteric tube side port projects over the mid stomach. No other significant changes are appreciated. Right upper lung and perihilar opacification is similar, probably a combination of known lung cancer with postobstructive pneumonia. Substantial emphysematous changes are stable bilaterally.

Diffuse interstitial abnormality improved on ___, and worsened again on ___, likely edema. Today it has improved slightly, or looks that way because lung volumes are slightly bigger. Moderate cardiomegaly persists but there is no longer mediastinal venous engorgement. ET tube and left internal jugular line are in standard placements and an upper enteric drainage tube passes to the distal portion of the nondistended stomach, with the tip is indistinct.

1. Dual-lead left-sided pacemaker with its leads terminating over the expected location of the right atrium and right ventricle respectively. Left internal jugular central line has its tip in the proximal superior vena cava. Endotracheal tube continues to have its tip approximately 3 cm above the carina. Nasogastric tube seen coursing below the diaphragm with the tip not identified. 2. The heart remains mildly enlarged but unchanged. Mediastinal contours are within normal limits. Interval improvement in aeration with improving mild pulmonary and interstitial edema. Probable small layering right effusion. More patchy opacity at the left base may reflect a combination of compressive atelectasis and effusion, although pneumonia cannot be entirely excluded. Clinical correlation is advised. No evidence of pneumothorax.

Comparison is made to previous study from ___. There are low lung volumes with crowding of the pulmonary vascular markings due to poor inspiratory effort. There is plate-like atelectasis at both lung bases, which has worsened since the prior study. No pulmonary edema or pleural effusions are seen.

Since a prior study of 1 day earlier, the patient has been extubated. None previously present left mid and lower lung opacities have markedly improved, but right basilar opacities not appreciably changed. Small pleural effusions are again demonstrated.

As compared to ___ radiograph, left pleural effusion has decreased in size adjacent left retrocardiac opacity has nearly resolved. Large, partially loculated right pleural effusion with adjacent right mid and lower lung atelectasis and or consolidation is again demonstrated. Right pigtail pleural catheter continues to terminate medially in the lower right hemi thorax, and there has likely been a decrease in the extent of medially loculated pleural effusion within this region.

A right upper extremity PICC terminates in the distal superior vena cava. Lung volumes are minimally improved. There is an unchanged infiltrative pulmonary abnormality, right greater than left, consistent with the history of ARDS. A more focal area of airspace consolidation seen in the right upper lobe is new. Cardiac and mediastinal contours are unchanged. There is no pneumothorax or definite pleural effusion.

Single frontal view of the chest was obtained. There are low lung volumes that accentuate the bronchovascular markings. There is bibasilar atelectasis. Slight blunting of the costophrenic angles likely relates to low lung volumes, although trace pleural effusion would be difficult to exclude. Right perihilar opacity is seen, which could be due to underlying consolidation, prominent vasculature, underlying mass is not excluded. Dedicated PA and lateral views would be helpful for further evaluation. Old right-sided rib fracture is again seen. Cardiac silhouette remains mildly enlarged. The aorta is calcified and tortuous.

1. Interval increase in airspace opacity in both lungs, right slightly more than the left, consistent with worsening pulmonary edema. Overall, cardiac and mediastinal contours are likely stable. No evidence of pneumothorax. Probable small layering right effusion.

As compared to the previous radiograph bilateral pigtail catheters in the pleural space are in unchanged position. However, on the left, a relatively large apical and basal pneumothorax has developed and signs of tension starts to be can visible. At the time of dictation and observation, 09:24, on the ___, the referring physician ___. ___ was paged for notification. Minimally increasing opacities at the right lung base. Unchanged moderate cardiomegaly.

In comparison with the study of ___, the cardio mediastinal silhouette is essentially unchanged. Opacification of the left base is consistent with a small effusion and mild atelectatic changes. No definite pulmonary vascular congestion. There is again some prominence of the right hilar region especially when compared to the study of ___. This could merely represent relatively lower lung volumes. If clinically possible, a repeat study should be obtained with full inspiration and a lateral view would be helpful.

ET tube tip is 4 cm above the carina. NG tube passes below the diaphragm, not included in the field of view. Patient continues to be in severe pulmonary edema associated with bibasal atelectasis and bilateral pleural effusion. No appreciable pneumothorax is seen.

Lung volumes are low. There is severe right convex scoliosis of the visualized spine, centered in the lower cervical spine. Ill-defined bibasilar opacities may represent atelectasis or aspiration. There is no pleural effusion. No pneumothorax. Mediastinal and hilar contours are stable with unchanged severe tortuosity of the thoracic aorta. Mild cardiomegaly is unchanged.

On the frontal projection, the right lower lobe appears to be better aerated and the previous identified opacity is lower less conspicuous, although there is no lateral projection for comparison. Bibasilar atelectasis is noted. The remainder of the lungs are essentially clear without pleural effusion, pneumothorax, or pulmonary edema. Stable, mild cardiomegaly is noted. The mediastinal and hilar contours are otherwise unchanged.

Single AP portable view of the chest was obtained. There are slightly low lung volumes. Bibasilar atelectasis is seen. Relative opacity projecting over the costophrenic angles most likely relates to overlying soft tissue. No radiopaque foreign body is seen. Cardiac and mediastinal silhouettes are unremarkable.

Comparison is made to prior study from ___. There is a feeding tube whose distal tip is in the body of the stomach. There is a dual-lead left-sided pacemaker. There is a right-sided PICC line with distal lead tip in the proximal SVC. This appears to have migrated more proximally by 3 cm. There is mild cardiomegaly. There is improved aeration at the right base. There are no pneumothoraces or signs for overt pulmonary edema.

AP radiograph of the chest was reviewed in comparison to ___. The pacemaker leads terminate in the expected location of right atrium, right ventricle, and left ventricle epicardial vein. The dilated left ventricle and the left ventricular calcified aneurysm are re-demonstrated. There is no pulmonary edema. Right PICC line tip terminates at the level of mid SVC. No interval development of pleural effusion or pneumothorax is demonstrated.

Mild right lower lobe atelectasis improved since ___. Left lung fully expanded and clear. No appreciable pleural effusion. Tiny left apical pneumothorax is new or newly apparent, with apical pleural drainage pigtail catheter still place.

Portable AP chest radiograph was reviewed in comparison to ___. Substantial left scapular, rib and clavicular fracture is re-demonstrated. Subcutaneous air is large and unchanged since the prior study. Left chest tube is in place. Left basal consolidation is unchanged and there is slight interval development of right basal opacity that might reflect atelectasis, but infectious process is a possibility. Also, there is a new right apical pneumothorax, not seen on the prior study, reason unclear.

Support and monitoring devices are in standard position. Widespread subcutaneous emphysema is again demonstrated, as well as pneumomediastinum, pneumopericardium, and a small right apicolateral pneumothorax. These findings are similar to the prior radiograph, with no acute short interval changes since the recent study.

As compared to the previous radiograph, no relevant change is seen. Moderate cardiomegaly with extensive retrocardiac atelectasis. Additional lingular opacity that could reflect pneumonia. Signs of interstitial fluid overload persist. No pneumothorax.

Right chest wall port is again seen. There is a moderate to large right pleural effusion and a smaller left pleural effusion, both appear larger when compared to ___. Superiorly, lungs are clear. Surgical clips stent and catheter wall identified in the upper abdomen.

In comparison with the study of ___, there has been decrease in opacification in the right upper and mid zone. The appearance of the residual opacification suggests aspiration pneumonia in this patient with known prominent paramediastinal lymphadenopathy. Cardiac silhouette remains enlarged and there is evidence of elevated pulmonary venous pressure. Suggestion of some areas of increased opacification in the left upper and lower zones. This could reflect new areas of aspiration.

Persisting cardiomegaly and the bilateral pulmonary edema with no significant interval change. No chest tube position of the various tubes with the ET tube above the carina. The right PICC line in the SVC and the NG tube probably in the stomach.

Interval insertion of a left PleurX catheter has resulted in a small left pneumothorax with apical and medial components. No evidence of mediastinal shift. A small left and trace right pleural effusions are decreased from earlier today. A right chest central venous catheter terminates in the right atrium, unchanged.

Multifocal consolidation predominantly involving the right upper and both lower lobes is slightly improved from scout image of CT of ___ in the right lung, but appears worse in the left lower lobe. These findings likely represent multifocal aspiration pneumonia. Small to moderate bilateral pleural effusions are noted, left greater than right.

Since prior, there has been interval placement of an endotracheal tube with tip approximately 3.5 cm from the carina. Enteric tube passes below the inferior field of view. There has been interval progression of the bilateral perihilar parenchymal opacities. There is no large pleural effusion or pneumothorax on this supine film.

As compared to the previous radiograph, the right pleural effusion has increased in extent and severity. There also is an increase in extent of the accompanying atelectasis. Moderate cardiomegaly. No change in appearance of the left lung.

As compared to the previous image, patient has received a nasogastric tube. As intended, the tip of the tube is located in the middle third of the esophagus. The other monitoring and support devices are constant. Constant appearance of the cardiac silhouette and of the lung parenchyma. The known bilateral pleural effusions are unchanged in extent and severity.

As compared to the previous image, the ___ of the known right pneumothorax are unchanged. No evidence of tension. Normal appearance of the left lung, except for a retrocardiac atelectasis. Unchanged opacities at the right lung bases. Borderline size of the cardiac silhouette.

Single portable upright AP image of the chest. The lungs are well expanded. Mild interstitial markings and cardiomegaly are consistent with mild pulmonary edema, improved from prior exam. The left upper lobe known mass is not well visualized on this exam due to overlying wires. No other focal pulmonary lesion is seen. There is no left pleural effusion. There may be a small right pleural effusion. There is no pneumothorax.

Lung volumes are very low and there are compressive changes at the bases. There is pulmonary vascular congestion. The heart is minimally enlarged

Lumbar luminal lobe, accounting for some bronchovascular crowding. No focal opacities concerning for pneumonia. Cardiac size is unchanged compared with the previous exam. The aorta is tortuous as before. There is no pleural effusion or pneumothorax.

In comparison with the study ___ ___, there is diffuse increase in opacification bilaterally, with a pattern most likely reflecting worsening pulmonary edema. In the appropriate clinical setting, superimposed pneumonia would have to be considered. The endotracheal tube is been removed. Right IJ Swan-Ganz catheter tip again is in the right pulmonary artery.

No previous images. The heart is normal in size and there is no vascular congestion, pleural effusion, or acute focal pneumonia.

Compared to prior chest radiographs since ___, most recently ___. Heart size normal. Lungs clear. No pleural abnormality.

In comparison with study of ___, there is little change. No evidence of pneumothorax or other acute abnormality. The most superior sternal wire is fragmented in this patient with previous CABG procedure.

The position of the various lines and tubes is unchanged. A left chest tube is present. There is no evidence of a pneumothorax. Bilateral pleural effusions are again noted. Increased opacities are seen in the left lower lobe in the retrocardiac region, which could represent an area of aspiration pneumonia. This was not present on the prior chest x-ray.

Heart size remains mildly enlarged. The mediastinal contour is unchanged. Perihilar haziness and vascular indistinctness is compatible with mild pulmonary edema, not substantially changed in the interval. No large pleural effusion or pneumothorax is seen. Previously noted peripheral opacity in the right lung base continues to improve. Atelectatic changes are re- demonstrated in the lung bases. No acute osseous abnormality is visualized.

As compared to the previous radiograph, the lateral and basal components of the known right pneumothorax have substantially decreased in extent and severity. The apical component is not substantially changed. Signs of tension are no longer present. Unchanged appearance of the heart and the left lung.

An endotracheal tube tip is 2.2 cm above the carina. An enteric feeding tube courses below the diaphragm out of field of view. There is persistent bibasilar atelectasis with no new focal opacities concerning for pneumonia. There are no pleural effusions or pneumothorax. The cardiomediastinal and hilar contours are normal. Pulmonary vascularity is normal.

As compared to the previous radiograph, the patient has received a nasogastric tube. The course of the tube is unremarkable, the tip of the tube projects over the middle parts of the stomach. On the current radiograph, there is substantial patient rotation, which makes subtle changes difficult to evaluate. However, no larger pleural effusions and no pneumothorax is seen. The size of the cardiac silhouette appears to be unchanged.

There are moderate size bilateral pleural effusions that have increased compared to the prior exam. There is Associated volume loss in the lower lobes. An underlying infectious infiltrate can't be excluded. There is mild pulmonary vascular redistribution. Feeding tube tip is off the film, at least in the stomach.

An endotracheal tube is again seen, with the tip approximately 3 cm above the carina. NG tube is present, curled within the stomach. Left-sided central venous catheter is present, with the tip at the junction of the brachiocephalic vein. Right-sided subclavian dialysis catheter is also noted, the tip of this is unchanged, somewhat higher than usual at the level of the cavoatrial junction. A left-sided chest tube is present, unchanged. Again, multifocal pulmonary opacities are seen predominantly in the left upper-to-mid lung zones, and appearing relatively unchanged. There may be slight improvement of the overall appearance of edema within the right hemithorax. A small left-sided pleural effusion is present, unchanged. A trace right-sided pleural effusion is also likely present. No new pneumothorax. Degenerative changes are seen at the shoulders. A notable scoliosis of the lumbar spine is seen, convex to the right. Vascular calcifications are noted at the aortic arch.

The moderate right loculated pleural effusion has increased, particularly in the apical and lateral portions with resultant increasing consolidation in the right lung. While much of this is likely compressive atelectasis, concomitant pulmonary edema or infectious process would be difficult to exclude. Given the short time course, malignant progression is less likely. Left dependent pleural effusion is also likely increased with accompanying mild interstitial edema given the presence of thickened septal lines. The cardiac silhouette is unchanged. Left Port-A-Cath is in unchanged position with interval removal of right PICC. Bibasilar chest tubes are in similar position.

Moderate pulmonary edema, small left pleural effusion, and right fissural fluid have worsened since the ___ examination. There is no pneumothorax. The heart size is normal. The hilar mediastinal contours are unchanged.

There has been no interval change in position of the tips of the central lines. The left axillary PICC line tip is again perpendicular to the SVC wall. There are no pneumothoraces. There is a small right-sided pleural effusion.

AP portable upright view of the chest. Multiple overlying EKG leads are present. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact.

Compared to prior chest radiographs since ___, most recently ___. Feeding tube, with the wire stylet in place now ends below the diaphragm in the mid stomach. Lungs lung volume but clear. No pulmonary edema. Moderate cardiomegaly increased. No appreciable pleural effusion or indication of pneumothorax.

There are persistent low lung volumes. Retrocardiac opacities have improved. Right lower lobe atelectasis are stable. There is no pneumothorax. Cardiomegaly is a stable. Tracheostomy tube is in standard position.

In comparison to ___ radiograph, bibasilar atelectasis has slightly worsened. Orogastric tube has been slightly advanced in the stomach. No other relevant change.

Rotated positioning. Probable hyperinflation/COPD. The patient is status post sternotomy, with mild cardiomegaly. The aorta is calcified and slightly unfolded. There is upper zone re-distribution, without overt CHF. Minimal atelectasis at both lung bases. No effusion and no frank consolidation identified. Dense calcification is noted diffusely in the more peripheral soft tissues.

AP chest compared to ___ and ___ at 7 p.m.: Dobbhoff tube is little changed in position compared to ___, looped in the upper stomach. Mild pulmonary edema has changed in distribution but not in overall severity since ___. Left lower lobe is still consolidated either due to atelectasis or pneumonia, and bilateral pleural effusions, moderate on the right, small on the left, have increased only slightly. Severe cardiomegaly and mediastinal vascular engorgement are longstanding. No pneumothorax.

The cardiomediastinal and hilar contours are within normal limits. There is likely a small left pleural effusion with minimal adjacent atelectasis. No focal consolidation or pneumothorax is identified. Surgical clips and the stent are identified in the upper abdomen.

In comparison to previous study from earlier today, a Swan-Ganz catheter is unchanged in position terminating in the lateral aspect of the right hilum. Cardiomegaly is accompanied by pulmonary vascular congestion and improving asymmetrical pattern of pulmonary edema. Bilateral pleural effusions have also decreased in size.

In comparison with the study of ___, the patient has taken a better inspiration. There is no evidence of pneumonia, vascular congestion, or pleural effusion. Clips in the lower neck suggest previous thyroid surgery.

Endotracheal tube terminates 3.5 cm from the carina. Enteric tube and side port are within the stomach. Lung volumes are low. This accentuates the size of the cardiac silhouette which appears mildly enlarged. Apparent widening of the superior mediastinal contour also is likely due to low lung volumes. There is crowding of the bronchovascular structures without overt pulmonary edema. Patchy and linear opacities in the lung bases likely reflect areas of atelectasis. No large pleural effusion or pneumothorax is present. No acute osseous abnormalities are visualized.

The lung volumes are low. There is moderate pulmonary edema and moderate cardiomegaly. No pleural effusions. No focal parenchymal opacity suggesting pneumonia. No current evidence of rib fractures. No pneumothorax.

Compared to chest radiographs since ___ most recently ___. Moderate right pneumothorax has recurred despite apical pleural drainage tube. There is no appreciable right pleural effusion. Current mild interstitial edema in the base of the severely emphysematous right lung is a recurrent feature. Severe postoperative volume loss left hemi thorax is chronic. Marked leftward mediastinal shift obscures the cardiac silhouette. ET tube in standard placement. Nasogastric drainage tube probably ends in the mid stomach.

In comparison with the study of ___, there has been placement of a PEG with resultant substantial free intraperitoneal gas. Tracheostomy tube remains in unchanged position with the tip approximately 6.5 cm above the carina. Little change in the appearance of the heart and lungs.

Heterogeneous opacification in the right mid and lower lungs has increased. Whether this is pneumonia or combination of atelectasis and increasing small right pleural effusion is radiographically indeterminate. Small left pleural effusion and moderate cardiomegaly unchanged. No pneumothorax. Pulmonary vasculature is engorged, but there is no good evidence for edema. ET tube and transvenous right atrial and right ventricular pacer leads, right jugular line and esophageal drainage tube ending in the stomach are in standard placements respectively.

Midline tracheostomy tube is again seen. The tube terminates approximately 3 cm above the carina. Again seen is patient's right lower lobe calcified mass, similar compared to prior study. The left lung is grossly clear. There has been interval removal of a left-sided PICC.

In comparison with study of ___, the pigtail catheter at the right base has been slightly re-positioned. The diffuse bilateral pulmonary opacification appears to have increased bilaterally. There is still extensive gas in soft tissues, especially in the lower neck. No definite pneumothorax.

Compared to chest radiographs since ___, most recently ___ through ___. Mild pulmonary edema has improved since ___, while small bilateral pleural effusions have increased. Heart size normal. No focal pulmonary abnormality. No pneumothorax. Infusion catheter ends close to the superior cavoatrial junction. ___, MD ___=___

Mild cardiomegaly is stable. Left lower lobe opacities are combination of stable small effusion and minimal atelectasis. There is no evidence of pneumothorax, pneumonia, or pulmonary edema.

Right IJ catheter tip is in thelower SVC. Cardiac size is normal. The lungs are clear. There is no pneumothorax or pleural effusion.

In comparison with the study of ___, there is little overall change. Monitoring and support devices remain in place. The tip of the endotracheal tube lies approximately 5 cm above the carina. Cardiac silhouette is within normal limits. Hazy opacification at the bases with obscuration of the hemidiaphragms is consistent with layering effusions and volume loss in the lower lungs. No definite vascular congestion.

Dual lead left-sided pacer device is stable in position, with leads extending to the expected positions of the right atrium and right ventricle, stable. The cardiac and mediastinal silhouettes are stable. Mild left base atelectasis is seen without focal consolidation. There is no pleural effusion or pneumothorax.

ET tube tip is 3.3 cm above the carinal. NG tube tip passes below diaphragm. Left subclavian line tip is at the level of mid SVC. Bibasal consolidations in large bilateral pleural effusions as well as mild interstitial edema are similar to previous examination.

A left internal jugular central line terminates at the cavoatrial junction. A right subclavian line terminates in the right atrium. Severe cardiomegaly is stable. There is no focal consolidation or pneumothorax. There has been improvement in the right pleural effusion and a small left pleural effusion is stable.

Comparison is made to the previous study from ___. There is an endotracheal tube whose tip is low and only 3 cm from the carina. This could be pulled back 1-2 cm for more optimal placement. There are low lung volumes. There is some atelectasis at the lung bases. There are no signs for overt pulmonary edema or focal consolidation. No pneumothoraces are seen.

Patient is status post partial right pneumonectomy and radiation therapy. A pigtail catheter within the right costophrenic angle is unchanged in position. A moderate right effusion with presumed underlying atelectasis is unchanged in severity. The left lung remains clear. There is no pneumothorax. Cardiomediastinal and hilar contours are within normal limits.

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

A single upright portable chest radiograph is obtained. A small right apical pneumothorax is present. There is a right chest tube seen in appropriate position. Previous right apical nodule has been resected. Mild bibasilar atelectasis is present. Cardiomegaly is mild.

As compared to the previous examination, the parenchymal opacities have increased in extent and severity. These opacities, located in the right lung, now occupy most of the right hemi thorax. The show more extensive air bronchograms than on the previous image. The right internal jugular vein catheter has been removed in the interval. Unchanged mild cardiomegaly. Mild fluid overload but no overt pulmonary edema. No larger pleural effusions.

As compared to the previous radiograph, lung volumes have increased. The pre-existing parenchymal opacities, notably at the lung bases, have substantially decreased in extent. New opacities are seen, ventriculoperitoneal shunt and tracheostomy tube as well as venous line are in unchanged position.

Stent in the right main bronchus is noted. There is a questionable tiny right apical pneumothorax. Elevation of the left hemidiaphragm is unchanged. Left perihilar opacities have increase could be atelectasis or aspiration. Right mid hemi thorax large opacity is unchanged due to known large rib metastasis. Cardiac size cannot be evaluated. Left pleural effusion has decreased.

Marked interval improvement in bilateral diffuse alveolar opacities, consistent with resolving pulmonary edema in the setting of recent dialysis. Residual edema affects the left lung to a slightly greater degree than the right. Cardiac size has slightly decreased in size in the interval, and azygos vein distention has slightly decreased as well. Small bilateral pleural effusions persist.

In comparison with the study of ___, there is little overall change. Hyperexpansion of the lungs is consistent with the clinical diagnosis of COPD. However, no evidence of acute pneumonia, vascular congestion, or pleural effusion. The endotracheal tube

Left retrocardiac opacity is seen which raises concern for pleural effusion with possible atelectasis underlying consolidation not excluded. However, there appears to be some lucencies within the region of opacity which could be due to necrosis/infection however, hernia with bowel content is not entirely excluded. The right lung is clear. No pneumothorax seen. The aortic knob is calcified.

In comparison with the study ___ ___, the right IJ catheter has been pulled back so that the tip is in the lower SVC. Cardiac silhouette remains mildly enlarged without appreciable vascular congestion. However, there is increased opacification at the bases silhouetting the hemidiaphragms, consistent with layering pleural effusions and compressive atelectasis on both sides. It is possible that a more supine position of the patient could be contributing to this difference in appearance.

A left-sided pacemaker projects leads into the right atrium and ventricle. The heart is mildly enlarged. The hilar and mediastinal contours are unchanged. Central pulmonary vascular prominence appears minimally changed, though, in combination with lower lung volumes, likely represents overall improvement. There is no longer any appreciable edema. There is no pneumothorax. A small left pleural effusion is unchanged. A previously seen a very large hiatal hernia is not easily seen on the current study, due to lack of intraluminal gas.

In comparison with the study of ___, the patient has taken a better inspiration. There again is substantial enlargement of the cardiac silhouette with prominent pulmonary edema. Widening of the vascular pedicle is again seen. No evidence of acute focal pneumonia, though this would be extremely difficult to exclude in the appropriate clinical setting, given the widespread lung changes and absence of a lateral view.

AP chest compared to ___: ET tube in standard placement. Right PIC line ends in the mid-to-low SVC. No upper enteric drainage tube is detected. Heart mildly enlarged. Lungs have nearly cleared of previously asymmetric pulmonary edema, in the left lower lobe, which has resolved everywhere else. No appreciable pleural effusion.

AP single view of the chest has been obtained with patient in upright position. Comparison can be made with the next preceding PA and lateral chest examination of ___. The heart size is normal. No configurational abnormality is present. Thoracic aorta and mediastinal structures are unremarkable. The pulmonary vasculature is not congested. No signs of acute or chronic parenchymal infiltrates are present and the lateral pleural sinuses are free. No pneumothorax in the apical area. On the preceding examination in ___ increased translucency at the bases raise suspicion for emphysema. Similar changes are not present on today's portable examination. Referring physician ___ was paged for stat report.

Portable frontal radiograph of the chest demonstrates stable top-normal heart size with normal mediastinal and hilar contours. No focal consolidation, pleural effusion, pneumothorax.

Transesophageal drainage tube is still looped in the upper esophagus. Lung volumes are low and there is probably some atelectasis at the base the left lung, and perhaps small left pleural effusion, but this has not changed since earlier in the day. Heart is moderately enlarged. A left PIC line ends in the low SVC. No pneumothorax.

In comparison with the chest radiograph obtained 1 day prior, the patient has been intervally extubated. There has been resolution of pulmonary vascular congestion and pulmonary edema. Heart size and cardiomediastinal silhouettes are unchanged. Bibasilar atelectasis has minimally improved. Pleural effusions are small, if any. No focal consolidations.

Moderate to large right pleural effusion, unchanged since ___, including large fissural component in the right major fissure. Small left pleural effusion has increased, collected medially on the frontal view. Heart size top- normal. Upper lungs clear. Right base moderately atelectatic.

In comparison with the study of ___, the monitoring and support devices are unchanged. Cardiac silhouette remains within normal limits and there is minimal elevation of pulmonary venous pressure. The medial portion of the right hemidiaphragm is now silhouetted with retrocardiac opacification consistent with increasing volume loss in the left lower lobe.

Mild Right lung base opacity and small right pleural effusion are unchanged. There is no new consolidation. There is no pulmonary edema. Cardiomediastinal silhouette is normal size. Small right pleural effusion is slightly more.