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The right IJ central venous catheter terminates in mid to lower SVC. The enteric tube terminates in the gastric antrum. Bilateral lower lobe consolidation is unchanged. The underlying bilateral lower lobe atelectasis and bilateral pleural effusion are unchanged. Component of pulmonary edema has improved. . The cardiomediastinal silhouette is unchanged. | Component of pulmonary edema has improved, unchanged bilateral lower lobe consolidations and pleural effusions. |
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A single frontal portable radiograph of the chest was acquired. The heart is mildly enlarged. There are diffuse interstitial opacities radiating from the hila as well as Kerley B lines and vascular cephalization, consistent with mild interstitial pulmonary edema. A -mm nodular opacity projects just superior to the right costophrenic angle. The mediastinal contours are normal. The right hilus is bulbous in appearance. There are no pleural effusions. No pneumothorax is seen. | Mild cardiomegaly with mild interstitial pulmonary edema. -mm nodular opacity superior to the right costophrenic angle, possibly a calcified pulmonary nodule. Further assessment with conventional radiographs should be performed once the patient's fluid status has normalized. Findings and recommendations were discussed with Dr. by Dr. m. via telehpone on . |
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Single supine view of the chest. Feeding tube passes off the inferior field of view. Vague linear right basilar opacity is most suggestive of atelectasis. Elsewhere the lungs are grossly clear and the cardiomediastinal silhouette is within normal limits. Likely chronic deformity of the lateral right clavicle. Potentially acute deformity of the proximal left humerus is incompletely visualized. | Expected position of endotracheal tube. Probable right basilar atelectasis. Potentially acute deformity of the proximal left humerus is incompletely visualized. |
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Heart size is at the upper limits of normal or slightly enlarged. Aorta is calcified. No CHF, focal infiltrate, or effusion is identified. No pneumothorax is detected. | No acute pulmonary process identified. |
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A single portable semi-erect chest radiograph was obtained the lungs are well expanded. Blunting of the right costophrenic angle may be due to a small pleural effusion. A right lower lobe calcified pleural plaque is unchanged. There is no focal consolidation or pneumothorax. Cardiac and mediastinal contours are normal. | Blunting of the right costophrenic angle may be due to small pleural effusion. |
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Compared to prior exam, there appears to be increased bilateral pleural effusion with left lower lobe atelectasis, mildly increased from but it is an abrupt change since . The cardiomediastinal silhouette is enlarged, but not significantly changed. No pneumothorax is seen. Median sternotomy wires are intact and aligned, surgical clips and other support lines appear to be unchanged in position. | Mildly increased bilateral pleural effusion and right lower lobe atelectasis since . ETT in standard place. |
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The patient is status post median sternotomy and CABG. Left-sided dual-chamber pacemaker device is noted with leads terminating in the right atrium and right ventricle. Moderate to severe cardiomegaly is not substantially changed in the interval. Mild pulmonary edema appears slightly worse from the previous exam. No large pleural effusion or pneumothorax is seen. Atelectasis is demonstrated in the lung bases. | Slight interval worsening of mild pulmonary edema. Similar moderate to severe cardiomegaly. |
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Left chest wall pacer has leads in the right atrium and right ventricle. Left internal jugular central venous catheter terminates in the mid SVC. Enteric tube courses into the stomach and beyond the field of view. There is continued improvement in right upper lobe opacity. Small bilateral pleural effusions are likely unchanged. There is no large pleural effusion or pneumothorax. Severe cardiomegaly is unchanged. | Continued improvement of right upper lobe opacity. Unchanged small bilateral pleural effusions. Persistent severe cardiomegaly. |
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ETT in standard position. Left cardiac pacemaker device is unchanged. Median sternotomy wires and multiple mediastinal clips are unchanged. Heart remains moderate to severely enlarged. Lung volumes remain low. Moderate edema persists, with interval increased opacity in the right upper lobe; this asymmetric edema can be seen in the setting of mitral regurgitation. No large pleural effusion. No pneumothorax. | Moderate edema with new asymmetric increased edema in the right upper lobe which can be seen in the setting of mitral regurgitation. Correlate with clinical history. |
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Enteric tube seen coursing below the level of the diaphragm, inferior aspect not included on the image, but side port appears to be in the left upper quadrant in expected location of the stomach. There is left base opacity which may represent combination of pleural effusion and atelectasis or underlying consolidation due to aspiration or contusion. Additional left perihilar opacity is seen which may also relate to aspiration, asymmetric pulmonary edema, or infection. There is slight blunting of the right costophrenic angle and a trace pleural effusion may be present. The cardiac and mediastinal silhouettes are grossly stable. The superior mediastinum remains widened although slightly less prominent as compared to this prior study and findings are likely accentuated by supine position in the AP technique. However, if there is clinical concern for acute mediastinal injury, CT is more sensitive. | Endotracheal and nasogastric tubes in appropriate position. Left base opacity may be combination of pleural effusion and atelectasis with also aspiration. Additional opacity in the left lung may be due to additional areas of aspiration, although infection or contusion/pulmonary hemorrhage is not excluded within the appropriate clinical setting. Possible trace right pleural effusion. Prominence of the superior mediastinum likely accentuated by supine position and AP technique and appears slightly less prominent as compared to the prior study; however, if there is concern for acute mediastinal process, chest CT is more sensitive. |
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Unchanged mediastinal and hilar borders. Heart size demonstrates stable cardiomegaly. Multifocal opacifications throughout both lungs and may represent atypical infectious process with a less likely consideration given to pulmonary edema; there is relative absence of central pulmonary vessel prominence. No pleural effusion or pneumothorax is evident. Redemonstration of pacemaker including abandoned leads in the right atrium, right ventricle and left ventricle epicardial location, unchanged. | Multifocal opacification throughout both lungs, possibly representing atypical infectious process, with a less likely consideration given to pulmonary edema. |
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An enteric tube courses below the level the diaphragm, inferior aspect not included on this study, but likely courses at least into the stomach. The lungs are clear without focal consolidation. No large pleural effusion is seen. There is no evidence of pneumothorax. The cardiac and mediastinal silhouettes are unremarkable. | An enteric tube courses below the level the diaphragm, inferior aspect not included on this study, but likely courses at least into the stomach. Clear lungs. |
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The new right IJ central venous catheter ends at the cavoatrial junction. There is no pneumothorax. There is mildly increased density at both lung bases, which is likely due to atelectasis, but in the right clinical setting could be due to pneumonia. There is no pleural effusion, or pulmonary edema. The cardiomediastinal silhouette is within normal limits. | New right IJ central venous catheter ends at the cavoatrial junction. Minimal bibasilar densities, likely atelectasis. |
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The cardiomediastinal and hilar contours are within normal limits. The lungs are clear without consolidation, effusion or pneumothorax. | No acute cardiopulmonary process. |
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Left-sided Port-A-Cath is present, tip over mid SVC. No pneumothorax is detected. The heart is not enlarged. Aorta is tortuous. No CHF, focal infiltrate or effusion is detected. Minimal bibasilar atelectasis noted. Calcifications over the lung apices may represent vascular calcifications. Possibility of a tiny right apical calcified granuloma cannot be excluded. Incidental note made of severe osteoarthritis in the right glenohumeral joint. | Port-A-Cath tip over mid SVC. No acute pulmonary process identified. |
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There is no evidence of pneumothorax or pleural effusions. Moderate pulmonary edema is present. The heart is enlarged and this is stable when compared to the prior exam. The thoracic aorta is slightly ectatic. There is no evidence of pneumoperitoneum and osseous structures are grossly unchanged. | Moderate pulmonary edema without focal consolidation to suggest pneumonia or aspiration. |
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Heart appears to be normal in size and configuration. Trachea is midline. Cardiomediastinal contours are unremarkable. Lung fields are clear with no evidence of focal infiltrates. No pleural effusions or pneumothorax. Bony structures show some degenerative changes, but are otherwise unremarkable. | Normal radiographic study of the chest. |
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Median sternotomy wires are noted and are intact. Clips overlying the mediastinum are consistent with patient's prior CABG. There is cardiomegaly. There is mild pulmonary vascular congestion. There is no focal consolidation, pleural effusion or pneumothorax. | Mild pulmonary vascular congestion and cardiomegaly. |
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An enteric tube is seen coursing below the diaphragm but the tip is not identified. No focal consolidation is identified. There is dilatation of the main and left pulmonary artery. The cardiac silhouette is within normal limits. Mild perihilar vascular prominence with no overt pulmonary edema. No large pleural effusion or pneumothorax is seen. | Dilatation of the main and left pulmonary artery possibly related to known pulmonary embolism or underlying pulmonary arterial hypertension. Clinical correlation is recommended. |
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The tip of a new left internal jugular central venous line is seen in the mid to low SVC. The tip of a right internal jugular venous central line is seen in the mid to low SVC. The endotracheal tube is appropriately placed. Otherwise, no interval change. No pneumothorax. | The tip of a new left internal jugular central venous line is in the mid to low SVC. No pneumothorax. Otherwise, no interval change. |
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Lung volumes have decreased with crowding of the bronchovascular markings. Central vascular congestion likely reflects volume overload. Bibasilar opacities, slightly asymmetric in left lower lobe can be asymmetric atelectasis or left lower lobe early consolidation. No substantial effusions. No pneumothorax. | Mild pulmonary congestion. Bibasilar opacities, slightly worse in left lower lobe can be asymmetric atelectasis with low lung volumes or early consolidation. |
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Lung volumes are slightly low. There is persistent atelectasis in the left mid lung. Left lower lobe opacities are not significantly changed. There is mild increase in pulmonary edema. Moderate cardiomegaly is unchanged. There may be a small left pleural effusion. There is no pneumothorax. | Mild pulmonary edema has slightly worsened. Left lower lobe opacities which may reflect pneumonia and/or atelectasis are not significantly changed. Atelectasis in the left midlung is unchanged. |
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Assessment is slightly limited by patient rotation. Left-sided Port-A-Cath tip terminates in the right atrium. Heart size is moderately enlarged. The aorta is diffusely calcified and tortuous. Mediastinal and hilar contours are otherwise grossly unremarkable. No pulmonary edema is seen. Patchy retrocardiac opacity likely reflects atelectasis. Lungs appear hyperinflated. Small left pleural effusion may be present. No pneumothorax is identified. Multilevel degenerative changes are noted in the thoracic spine. | Patchy retrocardiac opacity, likely atelectasis. Please note that infection is not excluded in the correct clinical setting. Possible trace left pleural effusion. |
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Heart size is borderline enlarged. Mediastinal and hilar contours are unremarkable. The pulmonary vasculature is normal. Except for linear subsegmental atelectasis or scarring in the right lung base, the lungs are clear. No pleural effusion or pneumothorax is present. Cholecystectomy clips are demonstrated in the right upper quadrant of the abdomen. . | No acute cardiopulmonary abnormality. |
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A single supine portable chest radiograph was obtained. COMPARISON: to . FINDINGS: Lung volumes are slightly decreased, accentuating the prominence of the central pulmonary vasculature. Otherwise, the lungs are clear. There is no focal consolidation, effusion, or pneumothorax. Moderate cardiomegaly is unchanged. Dual-chamber pacing lead project in stable position. | Stable cardiomegaly. No acute cardiopulmonary process. |
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The lungs are hyperexpanded, an a left retrocardiac airspace opacity is identified. There are probable small bilateral pleural effusions. No pneumothorax or pulmonary edema. Mild cardiac enlargement is unchanged. Extensive calcifications are seen in the aortic arch. | Mild cardiomegaly and small bilateral pleural effusions. Left retrocardiac airspace opacity likely reflects atelectasis, although superimposed infection is difficult to exclude. |
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A nasogastric tube courses inferior to the diaphragm and extends beyond the imaged field. The heart remains mildly enlarged and there is mild central pulmonary vascular congestion. Bibasilar atelectasis and trace bilateral pleural effusions are noted. There is no pneumothorax identified. The upper lungs are grossly clear. No acute fractures identified. Note that the lateral aspect of the right hemithorax is excluded on this radiograph. | Mild cardiomegaly and central pulmonary vascular congestion, bibasilar atelectasis, and trace bilateral pleural effusions. Status post intubation with endotracheal tube in standard position. |
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Single AP portable upright view the chest provided. There has been placement of a right subclavian central venous catheter with its tip in the mid SVC region. The NG tube courses below the left hemidiaphragm, tip excluded from view. Right-sided interstitial opacity again noted which could reflect asymmetric pulmonary edema. | The heart is mildly enlarged. No pneumothorax. |
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AP portable upright view of the chest. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. | No acute intrathoracic process |
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AP single view of the chest has been obtained with patient in sitting semi-upright position. Analysis is performed in direct comparison with the next preceding similar study of . On the single AP view chest examination, the heart size remains unchanged and is within normal limits. The pulmonary vasculature is not congested. No signs of acute new infiltrates in comparison with the previous study obtained four days earlier. No evidence of pleural effusion as the lateral pleural sinuses are free. A previously existing right internal jugular approach central venous line has been removed. There is no evidence of pneumothorax in the apical area. | No evidence of pneumonia. |
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No focal consolidation is seen. There is no large pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are stable. | No significant change from the prior study. |
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AP portable upright view of the chest. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. Prominent costochondral calcification projects over the right lung base. | No acute intrathoracic process |
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Portable frontal view of the chest. The lung volumes are low. No pleural effusion or pneumothorax. There is bibasilar atelectasis, left greater than right. Heart size is normal. Mediastinal and hilar structures are unremarkable. The configuration of the trachea is unchanged from prior cross-sectional imaging. | Low lung volumes without an acute cardiopulmonary process. |
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Lung volumes are low. There is hazy increased density at the lung bases likely representing pleural fluid. The retrocardiac area is not well penetrated and there is a suggestion of air bronchograms in the lower right lung. The cardiac silhouette appears large although cardiac size may be exaggerated by technical factors. Mediastinal structures are otherwise unremarkable. A nasogastric tube is in place and terminates well below the diaphragm, off of the bottom of the image. A no other radiopaque catheter is projected over the lower left chest, with its tip projected over the left hilus. | Evidence for bilateral pleural effusions and consolidation or atelectasis in the left lower lobe. Prominent cardiac silhouette. Repeat examination with a better inspiratory effort and lateral view would be helpful. |
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A right PICC terminates at the lower SVC. An orogastric tube terminates within the stomach. The lung volumes are very low. There is central pulmonary vascular congestion with new mild edema since the examination. Small pleural effusions, greater on the left, are unchanged. Right and left retrocardiac opacities are unchanged, likely atelectasis. | Central pulmonary vascular congestion with new mild edema since the examination. The lung volumes remain low. Unchanged pleural effusions and bibasilar atelectasis. |
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Appliances in good position. Drainage catheter in place. Left basilar consolidation, similar. Increase cardiac silhouette, stable. Mild worsening right basilar opacity. Small right pleural effusion, similar. | Mild worsening right basilar opacity. Stable left basilar consolidation |
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Right-sided PICC line in situ with the tip in the mid to distal SVC. No pneumothorax. NG tube in situ coursing out of sight inferiorly. Bilateral pulmonary venous congestion. Left lower lobe atelectasis with a small associated effusion. Mild right basal atelectasis with a suspected small effusion. | No significant interval change. |
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Median sternal wires are intact and in standard position. No acute focal consolidation. No pulmonary edema, pleural effusions or pneumothorax. Mild cardiomegaly persists. | No acute pneumonia or pulmonary edema. |
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Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Chain sutures are noted in the left upper quadrant of the abdomen. | No acute cardiopulmonary abnormality. |
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Left large bore catheter terminates an right atrium, unchanged from prior. Right PICC terminates in the mid to low SVC, unchanged from prior. The lungs are well expanded and clear. No pleural abnormality is seen. The heart is normal in size. The mediastinal and hilar contours are normal. | Capsule endoscopy projecting over mid abdomen. Repeat abdominal radiographs are recommended for documenting passage. with Dr. |
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ETT in standard position with the neck in extension. Right IJ catheter tip projects over the expected region of the mid-low SVC. Right PICC line projects over the region on expected SVC-RA junction. Enteric tube and sideport traverses the diaphragm into the left upper quadrant beyond the scope of this image. Bilateral perihilar opacities persist with mild peribronchiolar cuffing. No edema. No pleural effusions. Heart size is normal. No pneumothorax. | Persistent bilateral airspace opacities. |
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Bilateral pulmonary edema is worsening. Heart size is unchanged. Right PICC ends in the right atrium. | Worsening bilateral pulmonary edema. |
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Lung volumes are unchanged compared to the prior study. There are persistent perihilar airspace opacities, similar in extent when compared to the prior study. Given the rapid development, this likely reflects pulmonary edema. There is left lower lobe atelectasis. . No pneumothorax seen. A right internal jugular catheter terminates in the distal SVC. | Persistent bilateral predominate perihilar airspace opacities likely reflecting pulmonary edema. Superimposed infection cannot be excluded. |
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Low lung volumes. The lungs are clear, the cardiomediastinal silhouette and hila are normal. There is no pleural effusion and no pneumothorax. | No acute cardiothoracic process. |
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Portable chest radiograph demonstrates unchanged mediastinal, hilar, and cardiac contours. There has been interval development of bibasilar opacities likely reflecting atelectasis, though cannot exclude developing infectious process. Additionally, there has been interval increase in small right-sided pleural effusion. | Bibasilar opacities, likely atelectasis. Increased small right pleural effusion. |
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Compared with , I doubt significant interval change. Again seen is asymmetric pleural thickening at the right lung apex, with apparent retraction of the minor fissure. The cardiomediastinal silhouette is unchanged. There is probably very slight upper zone redistribution, but I doubt overt CHF. Possible minimal blunting of the right costophrenic angle, which is not clearly changed. No focal consolidation or gross effusion is identified. The cardiomediastinal silhouette is borderline enlarged with a calcified slightly unfolded aorta, but is unchanged. Incidental note is made of a probable large subchondral cyst in the left glenoid. | No significant change detected compared with . Right apical pleural thickening, with apparent retraction of the mild fissure, again noted. Upper zone redistribution and minimal blunting of the right costophrenic angle are probably unchanged, allowing for technical differences. |
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The heart size is top normal. Mild cardiomegaly is unchanged compared to the prior exam. The aorta is tortuous. Otherwise, the hilar and mediastinal contours are normal. The lungs are clear without evidence of focal consolidations concerning for pneumonia. There is a new small left-sided pleural effusion. There is no evidence of pneumothorax. The visualized osseous structures are unremarkable. | No focal consolidations concerning for pneumonia identified. New small left pleural effusion. were d/w Dr. by Dr. by phone at : pm on the day of the exam. by phone. |
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The lung volumes are noted to be slightly low. No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is seen. The heart size is top normal. The ascending aorta is mildly prominent, unchanged from the prior exam, and may be secondary to aortic tortuosity versus mild dilation. | No radiographic evidence for acute cardiopulmonary process. |
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Since , the previously small left apical pneumothorax is increased, small right apical pneumothorax is mildly improved, and previously mild left basilar atelectasis is increased. The heart size is unchanged. Right chest tube remains in place. | The previously small left apical pneumothorax is increased, small right apical pneumothorax is mildly improved, and previously mild left basal atelectasis increased since . with Dr. |
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Since , small bilateral pneumothoraces are minimally changed. A right chest tube is noted. Diffuse opacification in the right middle and lower lobes likely represents atelectasis. Small bilateral pleural effusions are presumed. Multiple rib fractures are again seen. Previously noted subcutaneous emphysema is largely unchanged. The heart size is normal. | Stable appearance of small bilateral pneumothoraces status post right chest tube placement. Diffuse opacification in the right middle and lower lobes likely represents atelectasis. Multiple fractures and subcutaneous emphysema are unchanged. |
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The cardiomediastinal silhouettes are normal. The bilateral hila are normal. A linear opacity in the right lower lung is compatible with platelike atelectasis. Otherwise, the lungs are clear. There is no pneumothorax or effusion. | No acute cardiopulmonary process. |
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The right subclavian central line tip overlies the proximal SVC, unchanged. Minimal interval change in the appearance of the lungs with low inspiratory volumes, and findings suggestive of pulmonary edema. There is however slightly increased aeration of the right infrahilar region. There is a persisting retrocardiac opacity likely secondary to atelectasis and/or a small effusion. No pneumothorax. The cardiac silhouette is enlarged but unchanged. | Slightly increased aeration of the right infrahilar region. Otherwise no significant interval change. |
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Right subclavian PICC line tip overlies proximal SVC, unchanged. Again seen are low inspiratory volumes. As before, there is moderately severe cardiomegaly prominence of both hila upper zone two-view shin and diffuse vascular blurring, consistent with CHF and interstitial edema. Increased retrocardiac density is similar to the previous film. Opacity in the right infrahilar region is also overall similar. The right hemidiaphragm may be slightly better defined. Though there is likely some degree of pleural fluid, no gross effusion is seen on either side. | Continued cardiomegaly. Continued CHF with interstitial edema. Retrocardiac density and confluent opacity in the right infrahilar region are overall similar to the prior film. The differential diagnosis includes opacity due to alveolar edema, but underlying pneumonic infiltrates cannot be entirely excluded. |
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A nasogastric tube terminates within the stomach. The heart appears mildly enlarged, unchanged since the examination. Prominence of the central pulmonary vessels appears improved in comparison to the examination. A persistent left retrocardiac opacity likely represents atelectasis. There is no new edema, focal consolidation, effusion, or pneumothorax. | No acute intrathoracic process. Nasogastric tube terminating within the stomach. Mild cardiomegaly. |
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Interval placement of NG tube as well with distal portion traversing B on the diaphragm and extending beyond the lower margins of the film. Right subclavian PICC with tip in the SVC, position unchanged. Low lung volumes bilaterally. There is a new left mid lung opacity consistent with pneumonia. There is increased opacity in the left lung base obscuring the left hemidiaphragm consistent with left lower lobe collapse and pleural effusion. There is inferior displacement of the minor fissures consistent with volume loss and increased collapse of the right middle lobe. Cardiac size appears enlarged in this portable view but unchanged from previous. There is no pneumothorax. | , D. by , D. on the telephone on at : AM, minutes after discovery of the findings. |
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There appears to be interval improvement of the moderate right-sided pleural effusion. There is also evidence of a right-sided fissural loculation of pleural fluid. There is also improvement of the left-sided atelectasis. No new focal consolidations are noted. Again seen is the large pleural calcification which obscures the upper right lung. There is no pneumothorax. The Dobbhoff tube terminates below the diaphragm in the upper stomach. Mild cardiomegaly is stable. The hilar and mediastinal contours are unchanged. | Interval improvement of the moderate right-sided pleural effusion and left-sided atelectasis. |
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There has been interval partial withdrawal of the post-pyloric feeding tube and the distal portion of the tube appears to be folded upon itself with the tip pointing proximally contained within the third portion of the duodenum. | Post-pyloric tube folded upon itself in the third portion of the duodenum. Results were discussed over the telephone with Dr. m. at the time of initial review. |
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An enteric tube traverses below the diaphragm coiled within the stomach, coursing inferiorly out of view, with tip seen in the similar region of ligament of Treitz as compared to prior abdominal radiograph dated . The heart is normal in size. The mediastinal and hilar contours are unremarkable. A calcific density projecting over the right upper lung is compatible with a calcified pleural plaque. The lungs are clear. There is no pneumothorax, pulmonary vascular congestion, or pleural effusion. | Feeding tube likely in stable position as compared to . |
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The lungs are clear without focal consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities. | No acute cardiopulmonary process. |
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There has been continued interval improvement of the opacity at the right upper lung when compared to last month's exam. Faint left upper lung opacity is similar compared to recent exam which had developed since older exam. There is no new focal opacity. Cardiomediastinal silhouette is unchanged given projection. Tubing projects over the left upper quadrant. No acute osseous abnormalities. | Continued interval resolution of the parenchymal opacity on the right with stable parenchymal opacity on the left worrisome for infection. |
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This study is presented on for dictation. A right internal central jugular venous catheter again terminates in the superior vena cava. There is overall slightly better aeration of the chest but similar heterogeneous multifocal opacities with suspected pleural effusions. Some improvement may be due to decrease in edema. | Mild improvement in aeration, possibly due to decreased edema superimposed on severe bilateral heterogeneous opacification which is otherwise unchanged. |
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Compared to the study from the prior day, there has been interval increase in the alveolar infiltrates. This increase is in the extent of the infiltrates and their density. Heart is moderately enlarged. | Worsened appearance of the infiltrates. |
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There has been interval worsening of the bilateral upper lobe infiltrates. continued infiltrates iare seen in bilateral lower lobes that appear similar or slightly improved compared to prior . right midlung infiltrate is slightly improved. Heart size continues to be moderately enlarged. | Changing appearance of infiltrates that are worse particularly in the upper lobes. |
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Single upright view of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen. | No acute intrathoracic process. |
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AP portable upright view of the chest. Overlying EKG leads are present. Mildly elevated right hemidiaphragm again noted. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. | No acute intrathoracic process |
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Heart size is normal. Mediastinal and hilar contours are unremarkable. The pulmonary vasculature is normal. Atelectatic changes are noted in the lung bases. Elevation of the right hemidiaphragm is similar. No pleural effusion, focal consolidation, or pneumothorax is present. No acute osseous abnormalities are seen. | No acute cardiopulmonary process. |
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Compared to the prior study there is no significant interval change. | No change. |
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A portable semi-erect AP chest radiograph was obtained. There is cardiomegaly and pulmonary edema, as well as a right pleural effusion. No clear focal consolidation is seen, although pulmonary edema makes it difficult to exclude. No pneumothorax or intra-abdominal air is identified. There is no bony abnormality. | Pulmonary edema, right pleural effusion, and unchanged cardiomegaly. |
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Single frontal radiograph of the chest demonstrates enlarged cardiac silhouette, increased compared to the prior. There is pulmonary vascular congestion and mild pulmonary edema. Opacities in the bilateral mid lungs could represent atelectasis or edema although a superimposed infectious process is also possible. No large pleural effusions. No pneumothorax. | Increased cardiomegaly with signs of volume overload. Opacities in the bilateral mid lungs could represent atelectasis or edema; however, superimposed infection is possible. Telephone notification to Dr |
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There is moderate cardiomegaly as on prior. Engorged hila and indistinct pulmonary vascular markings suggest pulmonary edema. Given differences in technique and positioning this is not significantly changed. No acute osseous abnormalities. Surgical clips project over the left upper extremity. | Mild pulmonary edema. No focal consolidation. |
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AP portable upright view of the chest. Overlying EKG leads are present. There is persistent mild cardiomegaly. Hilar congestion and moderate pulmonary edema is noted. Linear densities in the mid to lower lungs likely represent platelike atelectasis. Tiny effusions are likely present. No pneumothorax. Bony structures are intact. | Moderate pulmonary edema. |
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There is at least moderate enlargement of the cardiac silhouette. The mediastinal contours are within normal limits. The hila are unremarkable. Bilateral airspace opacities with a central predominance likely reflects pulmonary vascular congestion and mild pulmonary edema, although superimposed infection is difficult to exclude in the appropriate clinical setting. There is no pneumothorax or pleural effusion. | Bilateral airspace opacities with a central predominance likely reflect pulmonary vascular congestion and mild pulmonary edema. Difficult to exclude superimposed infection in the appropriate clinical setting. |
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All the monitoring devices are unchanged and in standard position. Lung volumes persist, low, now with new opacification of the right lung for increased pleural fluid. There is no pleural effusion on the left lung. Heart size is mildly enlarged. | New pleural effusion at the right lung. Unchanged all the monitoring devices. |
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The inspiratory lung volumes remain low. As a result, the cardiomediastinal and bronchovascular structures are accentuated. The heart demonstrates a left ventricular configuration as before and the thoracic aorta remains tortuous. No focal consolidation concerning for pneumonia is identified. There is no pleural effusion or pneumothorax. Chronic rib deformities are unchanged related to prior fracture. | No focal consolidation concerning for pneumonia. Unchanged healed rib fractures. |
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The NG tube is unchanged and end in proximal gastric cavity. The Swan-Ganz catheter has been pulled back, ending in proximal main pulmonary artery. Lung volume are slightly increased, with reduced opacification of the right lung mainly for reduced pleural effusion. Persistent atelectasis and small pleural effusion left lung. Heart size is still markedly enlarged. | Improvement of the ventilation at the right base with reduced pleural effusion. Unchanged atelectasis and small pleural effusion on the left base. Heart size is still markedly enlarged. |
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AP portable supine view of the chest. Evaluation is limited by low lung volumes and large body habitus. The lungs are grossly clear. Hila appear slightly congested. The heart and mediastinal contours appear mildly prominent likely due to supine portable technique. No supine evidence for large effusion or pneumothorax. Bony structures are intact. | As above. |
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AP portable upright view of the chest. Lung volumes are low limiting assessment. There is mild elevation of the right hemidiaphragm. Hilar congestion is noted without frank edema. No large effusion or pneumothorax. No convincing signs of pneumonia. Heart appears top-normal in size. | Top normal heart size with mild hilar congestion without frank edema. |
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Tracheostomy tube again noted. NG tube again noted, extending beneath the diaphragm to overlie the stomach. Right subclavian PICC line tip lies near the SVC/ RA junction, similar to prior. Cardiomediastinal silhouette is unchanged. Equivocal minimal upper zone redistribution, without other evidence of CHF. Patchy opacity at the left lung base again noted. However, there has been interval improvement, with the left hemidiaphragm now visible. Small left pleural effusion difficult to exclude, but this appears improved. Equivocal minimal right pleural effusion. The right lung remains grossly clear. | Interval improvement in retrocardiac opacity with some residual patchy opacity and probable small left and right pleural effusions. No overt CHF. |
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Increased solid aeration in the right lower lobe again seen. Retrocardiac density also present. ET tube is above the carina. Right PICC line in lower SVC. Left PICC line removed | Right lower lobe opacity increased since the previous film. |
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The tip of the right PICC line extends to the upper right atrium. The left central venous catheter tip is unchanged projecting within the azygos vein. A feeding tube extends into the stomach. Improved aeration of both lungs. There is mild pulmonary edema. Bibasilar opacity likely reflect atelectasis although superimposed consolidation cannot be excluded in the proper clinical context. Small bilateral pleural effusions are suspected. No pneumothorax identified. The size of the cardiomediastinal silhouette is within normal limits. | Improved expansion of both lungs. Mild pulmonary edema. A new bibasilar opacities likely reflect atelectasis however superimposed infection cannot be excluded in the proper clinical context. |
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Left-sided central venous catheter with configuration near the tip likely due to its course within the azygos vein. Enteric tube passes below the field of view. Appearance of the lungs again notable for bibasilar opacities. | No significant interval change. Left central venous catheter tip likely within the azygos. Persistent bibasilar opacities. |
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The lungs are clear. The cardiomediastinal silhouette and hila are normal. There is no pleural effusion and no pneumothorax. | No acute cardiothoracic process. |
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Single frontal view of the chest was obtained. Nasogastric tube terminates underneath the diaphragm, but appears looped within the oropharynx. Lung volumes are low, but the lungs are clear. No focal consolidation, substantial pleural effusion, or pneumothorax. Heart size and cardiomediastinal contours are normal. | New NG tube is coiled within the oropharynx. Findings were communicated via phone call by Dr. to Dr |
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There is a small left pleural effusion. The heart is upper limits normal in size. NG tube tip is off the film, at least in the stomach. | Compared to prior study,no significant change. |
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Portable semi upright frontal view of the chest. The lungs are clear without focal opacity, pleural effusion or pneumothorax. The cardiac and mediastinal contours are normal. No acute soft tissue or osseous abnormality is seen. An old third left anterior rib fracture is noted. Known nondisplaced left 5th rib fracture is not seen. | No visualized pneumothorax on this semi erect film. |
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The lung volumes are low. The cardiac, mediastinal and hilar contours appear unchanged allowing for differences in technique. There is pleural effusion or pneumothorax. The lungs appear clear. | No evidence of acute cardiopulmonary disease. |
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The lungs are clear of focal consolidation or pneumothorax. There is a small left pleural effusion or pleural thickening. The heart continues to be enlarged, and there is a left cardiac pacer device is with leads terminating in appropriate position. The mediastinal contours are normal. Outpouching of the left hemidiaphragm may reflect a hiatal hernia or eventration which can be better assessed with a conventional PA radiograph. | No pneumonia or pulmonary edema. Small left pleural effusion or pleural thickening. |
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Severe cardiomegaly with slight increase in size compared to . Hilar contours are unremarkable. A left anterior chest wall single-lead pacer is unchanged in position. No focal consolidation worrisome for pneumonia; however, left lung base is difficult to assess. There is no large pleural effusion or pneumothorax. | No acute intrathoracic process. No frank interstitial edema. Severe global cardiomegaly slightly increased in size from prior examination. This could be due to pericardial effusion; however, no definite fat pad sign is seen. Conventional lateral view may be helpful to assess the left lung base. |
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New veil like opacity of the left hemithorax with a crescent of air surrounding the aortic arch and keeping with left upper lobe collapse. The left hilum and mediastinum are enlarged. A small left-sided pleural effusion is seen. The right lung is clear. No pneumothorax. Marked scoliosis convex to the right. | Left upper lobe collapse, with large hilar mass and small pleural effusion. No pneumothorax. |
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There is persistent elevation of the left hemidiaphragm with opacity of the left hemithorax and elevation of the left mainstem bronchus and a stable Luftsichel sign, consistent with continued left upper lobe collapse although the volume of the collapsed lobe and the large central mass have mass have both decreased since . Right basilar atelectasis is noted and there could be a small metastatic nodule. There is no radiographic evidence of pneumonia, though evaluation on recent CT is more specific. The cardiac silhouette and pulmonary vasculature are unremarkable and unchanged since the prior examinations. No definite pleural effusion or pneumothorax identified. | Persistent left upper lobe collapse without evidence of pneumonia. Decreasing mass, left hilus and left upper lobe. Possible pulmonary metastasis, right lower lobe. This examination neither suggests nor excludes the diagnosis of pulmonary embolism. |
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AP portable upright view of the chest. The heart size is normal. The hilar mediastinal contours remain within normal limits. This is small left and moderate right pleural effusion, both unchanged since . Linear bibasilar opacities reflect adjacent compressive atelectasis. There is no pneumothorax. The central pulmonary vessels are not engorged. Mild pulmonary edema seen on the study appears improved | Improved mild pulmonary edema. Unchanged moderate right and small left pleural effusions. |
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As compared to , interval increase in right lower lobe and right upper lobe nodular airspace opacities. There is probable small bilateral effusions. Moderate cardiomegaly persists. No pneumothorax. Left-sided PICC terminates in the low SVC. | Interval worsening of the airspace consolidation involving the right lung, may reflect secondary atypical infection including viral or fungal to the known Nocardia infection. |
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No significant changes compared to prior exam. The patient is status post right lung biopsy. Postsurgical changes are seen at the right lung base. Stable calcified granuloma in the left lung base. Small bilateral pleural effusions can't be excluded. Enlarged heart size is unchanged. There is no pneumothorax. | No evidence of pneumothorax. |
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Since the prior chest x-ray on , there has been interval development of a new small to moderate right-sided pleural effusion. Bibasilar parenchymal opacities, right greater than left, which has slightly increased compared to the prior CXR. No pneumothorax. Left lower lobe calcified granuloma is unchanged since . The heart is enlarged. Right PICC line has been adjusted since the prior radiograph, but is now coiled along its course and terminates in the mid-SVC. | New small/moderate right pleural effusion. Bibasilar parenchymal opacities with cardiomegaly suggests underlying pulmonary edema, but cannot exclude right lung base pneumonia. Right PICC is coiled, but terminates in mid-SVC. by Dr. |
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A single portable frontal view of the chest was performed. An overlying trauma board limits complete evaluation. There is no pleural effusion or pneumothorax. The cardiac and mediastinal contours are normal. There is no displaced rib fracture appreciated. A minimal dextroscoliosis of the thoracic spine is likely positional and unrelated to trauma. There is no paraspinal hematoma appreciated. The imaged upper abdomen is unremarkable. | No acute cardiopulmonary process. |
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Portable AP upright chest radiograph was provided. There are unchanged findings as compared with prior radiograph from three days ago with stable right pleural effusion with probable associated compressive lower lobe atelectasis. There is a small left pleural effusion with subtle increase in left lower lobe consolidation, likely atelectasis. Please note pneumonia cannot be excluded. No pneumothorax. Heart size is difficult to assess but appears grossly stable, but mediastinal contour is unremarkable. Bony structures appear intact. | Bilateral pleural effusions with lower lobe consolidation is likely atelectasis, though cannot exclude pneumonia. Recommend followup to resolution. |
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Scattered linear opacities are compatible with bibasilar atelectasis. There is no large pleural effusion. No pneumothorax is identified. Cardiac size within normal limits. Aortic calcifications are moderate. A questionable deformity is also noted of the fifth lateral rib on the right. | Minimally displaced fracture of the right sixth posterior rib without underlying pneumothorax on this chest radiograph. Possible fracture of the fifth lateral rib as well. |
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Enteric tube is within the stomach though the tip is not imaged on this exam. Cardiac, mediastinal and hilar contours are normal. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is present. No acute osseous abnormalities present. | No acute cardiopulmonary abnormality. Standard positioning of the endotracheal and enteric tubes. |
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Supine portable radiograph of the chest demonstrates interval increase in size of left apical pneumothorax since the prior study. The left pigtail pleural catheter is unchanged in position. Gastric distention has decreased since the prior study. Otherwise, the right lung is unchanged. | Interval increase in size of left apical pneumothorax. A left pleural pigtail catheter is unchanged in position. Decreased gastric distention. |
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Portable supine radiograph of the chest demonstrates interval development of large left pneumothorax with no significant mediastinal shift or signs of tension. An esophageal tube courses below the diaphragm and out of view. Widespread right lung parenchymal opacities persist, consistent with ARDS. Cystic and linear lucencies in the right lung are likely due to pulmonary interstitial emphysema (PIE). There is gaseous distension of the stomach. | New large left pneumothorax with no evidence of tension. The above findings were communicated to Dr. by Dr. m. , at the time of review. |
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