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MIMIC-CXR-JPG/2.0.0/files/p17355856/s58219500/8b5acbd2-e681359c-fe09489f-4d896252-3004df6e.jpg
no evidence of acute cardiopulmonary process.
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consolidation at the left lung base may represent compressive atelectasis from an adjacent small pleural effusion, however underlying pneumonia cannot be excluded. an opacity in the right midlung is incompletely characterized and nonemergent chest ct is recommended for further evaluation. copd, cardiomegaly with sternotomy wires, upper zone redistribution, without overt chf. recommendation(s): an opacity in the right midlung is incompletely characterized and nonemergent chest ct is recommended for further evaluation.
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elevated right hemidiaphragm. no acute cardiopulmonary process. no evidence of fracture.
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mild bilateral atelectasis in the mid lung but no evidence of pneumonia. mild cardiomegaly unchanged since.
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no radiographic evidence of pneumonia.
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no acute cardiopulmonary abnormality.
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no acute cardiopulmonary process.
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no pneumothorax. normal chest radiograph. the findings were discussed with , m. d. by , m. d. on the telephone on at am, <num> minutes after discovery of the findings.
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left lower lobe opacity, concerning for pneumonia.
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no acute cardiopulmonary process.
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bilateral lower lung opacities concerning for acute infectious process. right lower lobe atelectasis with elevation of the right hemidiaphragm. hydroxyapatite deposition disease about the right shoulder.
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endotracheal tube, left ij central line, bronchial stents, right-sided chest tube, and left basilar chest tube are unchanged in position. large areas of parenchymal consolidation within both lungs are relatively stable. no pneumothoraces are seen.
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mild bibasilar atelectasis. no focal consolidations concerning for pneumonia identified.
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no acute chest abnormality.
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slightly increasing bilateral pleural effusions since without any clear cause. possible old right humeral fracture, recommend clinical correlation or dedicated films of the right shoulder.
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no acute cardiopulmonary process.
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no acute cardiopulmonary process. no significant interval change.
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compared to prior chest radiographs through. diffuse infiltrative pulmonary abnormality which was much more heterogeneous, with qualities of consolidation and nodulation on , is still present, though without the consolidation. i am not sure whether this is pneumonia in a patient with emphysema or whether there is widespread infection. cardiac silhouette was substantially larger on. pleural effusions are presumed, but not large. no pneumothorax. et tube, right internal jugular line are in standard placements and a nasogastric drainage tube passes into the stomach and out of view.
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lung volumes are low. atelectasis at the bases, particular the right, could obscure early pneumonia, but there is no good evidence for infection currently. heart size is normal. there is no pulmonary edema and no pleural effusion.
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no acute cardiopulmonary process.
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mild interstitial pulmonary edema.
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no significant interval change when compared to the prior study.
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dobhoff tube tip isout of view, below the diaphragm. et tube is in standard position. large right pleural effusion is minimally larger than before. left lower lobe atelectasis have increased. no other interval change from prior study.
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no acute cardiopulmonary process.
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in comparison with the study , the patient has taken a lower inspiration. continued moderate cardiomegaly with evidence of pulmonary vascular congestion. probable bilateral pleural effusions with some compressive atelectasis at the bases. there is some asymmetry of opacification at the right base. this could well represent some asymmetric pulmonary edema. however, in the appropriate clinical setting, superimposed pneumonia could be considered.
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bibasilar opacities, greater on the left than right, could represent atelectasis, pneumonia or aspiration.
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no evidence of pneumothorax. unchanged appearance of multiple opacities in right lung, representing multifocal pneumonia.
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no acute cardiopulmonary process, no focal consolidation.
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heart size and mediastinum are stable. left basal opacity has improved since the prior study. rest of the lungs are clear. there is no pleural effusion. there is no pneumothorax.
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no acute findings.
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there is no pneumothorax or appreciable pleural effusion. borderline cardiomegaly and pulmonary vascular congestion and borderline pulmonary edema are increased. a new band of atelectasis at base of the right lung could be collapsed right middle lobe. small nodular opacity projecting over the right upper lung at the level of the second anterior rib is new since could be focus of infection. careful followup advised. a vascular line ends in the right axilla. feeding tube ends in the stomach
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in comparison with the study of , the dobbhoff tube is in within the upper stomach on the final image. little change in the appearance of the heart and lungs.
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ap chest reviewed in the absence of prior chest radiographs: cardiac silhouette is very large due to cardiomegaly, with or without pericardial effusion. in the absence of mediastinal vascular engorgement any pericardial effusion is not hemodynamically significant. thoracic aorta is calcified in the ascending portion, but not dilated. pulmonary vasculature is unremarkable and lungs are clear. there is no appreciable pleural abnormality.
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small right pleural effusion has decreased since the prior study. right middle and lower lobes atelectasis has also significantly decreased in the interval. relative ovoid lucency projecting over the lateral right lower hemi thorax is felt to most likely be artifactual versus less likely loculated pneumothorax.
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in comparison with the study , there are lower lung volumes. specifically, there is no evidence of pneumothorax. continued enlargement of the cardiac silhouette with central pulmonary vascular congestion. opacification at the left base is consistent with volume loss in the left lower lobe and small pleural effusion.
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compared to chest radiographs through. patient has been extubated. new esophageal drainage tube ends in the stomach. no swan-ganz or other central venous catheter is seen on this examination. mild to moderate symmetric dependent pulmonary abnormality has not changed appreciably since. there is no evidence of cardiac decompensation in the upper lungs, normal heart size or mediastinal caliber, so the even though the process looks like edema, it could be bilateral pneumonia instead. pleural effusions are small if any. no pneumothorax.
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in comparison with the study of , there is again striking elevation of the left hemidiaphragmatic contour with minimal atelectatic changes above it. otherwise, no evidence of pneumonia, vascular congestion, or pleural effusion. gastrostomy tube is seen in place.
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no acute cardiopulmonary abnormality.
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no pneumonia. radiographic findings concerning for an mediastinal abnormality. recommendation(s): ct chest advised
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et tube tip is <num> cm above the carinal. ng tube tip is in the stomach. right internal jugular line tip is at the level of mid to low svc. port-a-cath catheter tip is at the level lower svc. heart size and mediastinum are stable. interval improvement of left basal consolidation is noted. bilateral pleural effusions are present, small to moderate. right upper lobe opacity is unchanged. no new consolidations to suggest interval development of alveolar hemorrhage present
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no acute cardiopulmonary process.
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compared to prior chest radiographs since , most recently. there is no pulmonary edema or appreciable right pleural effusion. left lower hemi thorax is obscured by the chronically severely enlarged cardiac silhouette, although substantially smaller today than in , with a pericardial drainage catheter in place. there some left lower lobe consolidation and some left pleural effusion, and no pneumothorax. right jugular line ends in the region of the superior cavoatrial junction. atrioventricular pacer leads are unchanged in their expected courses. the unusual course of the left ventricular lead is also unchanged showing marked elevation of the coronary sinus with regard to cardiac silhouette, presumably a function of severe right atrial enlargement and perhaps residual pericardial effusion. this would require echocardiography or chest ct for confirmation, although that may not be clinically pertinent.
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satisfactory position of the left port-a-cath. no evidence of complication. results were discussed with at on via telephone by dr at the time the findings were discovered.
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as compared to the previous radiograph, the pre described rounded opacity, previously projected ste over the sixth right rib, now projects over the <num> ste right rib. the opacity is less well seen than on the previous image but nevertheless still present. the opacity should be further worked up by ct. low lung volumes. moderate cardiomegaly with minimal fluid overload. no larger pleural effusions. the finding was added to the radiology dashboard.
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no focal consolidation concerning for pneumonia. low lung volumes with bibasilar atelectasis.
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left lower lobe pneumonia. mildly enlarged heart, possibly within normal limits, but a pericardial effusion cannot be excluded; correlate with ultrasound findings.
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compared to chest radiographs through. moderately severe pulmonary edema has worsened slightly. moderate bilateral pleural effusions, right greater than left, are also larger. heart size top-normal. no pneumothorax. et tube in standard placement. feeding tube passes into the stomach and out of view. right jugular line ends in the low svc.
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no acute cardiopulmonary process.
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no pneumonia.
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emphysema/ild without superimposed pneumonia. known right humeral head fracture.
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no acute cardiopulmonary process.
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widespread pulmonary opacities superimposed on the background of known pulmonary interstitial fibrosis, concerning for atypical infection, edema, or hemorrhage. increased right paramediastinal opacity, representing more focal consolidation or lymphadenopathy.
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increase in right pleural effusion with associated atelectasis since. improved aeration of left lower lung with decreased left pleural effusion.
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no definite focal consolidation is seen on the frontal view, however, there may be subtle retrocardiac opacity on the lateral view. correlation with priors would be helpful.
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no acute cardiopulmonary abnormality.
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as compared to the previous radiograph, the right central venous access line was removed. overall, the lung volumes have increased, likely reflecting improved ventilation. this has caused the decrease in extent of the bilateral areas of atelectasis. however, moderate cardiomegaly persists. no pulmonary edema. normal alignment of the sternal wires.
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no acute intrathoracic process.
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no acute intrathoracic abnormality.
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no acute cardiopulmonary process.
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no acute cardiopulmonary process.
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no acute cardiopulmonary process.
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subtle left lower lobe opacity may reflect overlapping shadows vs early pneumonia in the correct clinical context.
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endotracheal tube tip <num> cm from the carina and should be advanced. new right sided upper mediastinal soft tissue. in light of clinically suspected hematoma in the neck on the left, this could be tracking hematoma. followup after planned surgery is suggested.
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no acute cardiopulmonary process
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no acute cardiopulmonary abnormality or evidence of amiodarone-related toxicity.
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in comparison with the study of , there again are low lung volumes that accentuate the prominence of the transverse diameter of the heart. no evidence of appreciable pulmonary edema or definite pleural effusion.
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in comparison with the study , there is continued substantial enlargement of cardiac silhouette with pulmonary edema and bilateral basilar opacifications consistent with layering effusions and compressive atelectasis. right ij catheter again extends to the mid portion of the svc.
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cardiomegaly. hyperinflation of the lungs. no evidence of pneumonia or pulmonary edema.
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resolution of the left pleural effusion. unchanged patchy opacities and loculated pleural effusion on the right.
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no definite pneumothorax detected, though small pneumothorax might be obscured by overlying tubing and subcutaneous emphysema. more pronounced triangular opacity at the right base -- subsegmental atelectasis. otherwise, doubt significant interval change.
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mild pulmonary vascular engorgement without confluent consolidation or frank pulmonary edema.
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moderate right pleural effusion is different in distribution, now l more argely depending, and slightly smaller. small to moderate left pleural effusion is smaller as well. severe enlargement of the cardiac silhouette is chronic. the upper lungs are clear. no pneumothorax. bibasilar atelectasis is minimal on the left and mild to moderate on the right, but both have improved since. right jugular line ends in the mid svc. transvenous right atrial right ventricular pacer leads follow their expected courses from the left pectoral pacemaker. no pneumothorax.
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cardiac silhouette appears to be enlarged compared to the prior study. small bilateral pleural effusions. a <num>-mm pulmonary nodule noted projecting over the second anterior rib on the right.
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no acute cardiopulmonary process.
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since the recent study of earlier the same date, bilateral perihilar and basilar alveolar opacities have slightly worsened, and are likely due to pulmonary edema. differential diagnosis includes pulmonary hemorrhage, massive aspiration, and pulmonary infection. no other relevant changes.
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no evidence of pneumonia, pulmonary edema, or pneumothorax. cardiac size top normal. extensive calcifications of the aorta.
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no acute cardiopulmonary abnormality.
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multiple healing right-sided rib fractures. no acute cardiopulmonary process.
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no acute cardiopulmonary abnormality.
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low lung volumes with bibasilar atelectasis.
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nasogastric tube has been advanced or replaced, now terminating in the stomach. heart size is normal, and lungs remain clear.
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ap chest compared to : tip of the endotracheal tube is approximately <num> cm above the carina in a patient with a long trachea. since the tube extends inferior to the lower margin of the clavicles, it would need to be advanced only <num> cm for optimal positioning. emphysema is severe. lower lungs are clear. heart size is normal and there is no pleural effusion.
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no radiographic evidence of an acute cardiopulmonary process.
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no acute cardiopulmonary process.
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interval appearance of bibasilar lung opacities and pleural effusions, correlating with the findings of ground-glass consolidations/aspiration pneumonia on the ct chest from the prior day.
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no evidence of injury. status post anterior lower cervical fusion.
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comparison to. improved ventilation and improved transparent see of the lung parenchyma. a minimal right and a mild left pleural effusion with subsequent areas of basilar atelectasis persists but a previous right basal opacity has completely resolved. sternal wires are in constant correct alignment. the zone of right apical thickening is unchanged.
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normal chest radiograph.
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no acute intrathoracic abnormality.
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subtle increased density in the right lower lobe is of uncertain significance and could reflect an early or developing pneumonia. correlation with clinical circumstances is recommended.
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no acute cardiopulmonary process.
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no acute intrathoracic process.
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in comparison with the earlier study of this date, the endotracheal tube is been pushed forward so that the tip lies approximately <num> cm above the carina. other monitoring support devices are unchanged. diffuse bilateral pulmonary opacifications are again seen.
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no acute cardiopulmonary process seen.
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layering effusion of the left lung with adjacent rib fractures raises the concern for growing hemothorax. dedicated upright chest radiograph can be obtained to evaluate for true size of left pleural effusion rather than apparent increase in size due to supine positioning.
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no acute findings in the chest.
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no evidence of rib fracture. no focal consolidation.
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interval improvement.
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interval removal of the right chest tube with no obvious pneumothorax, although the sensitivity to detect pneumothorax is diminished given semi supine technique. an upright or decubitus study would be more sensitive. there continue be patchy bilateral opacities throughout both lungs concerning for diffuse infection or ards. the right internal jugular central line, nasogastric tube, left internal jugular central line and endotracheal tube are unchanged position. hardware overlying the thoracic spine and left brachiocephalic stent are again seen.
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comparison to. slight increase in extent of a right pre-existing pleural effusion. moderate cardiomegaly and mild to moderate pulmonary edema persist. no new focal parenchymal opacities.