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MIMIC-CXR-JPG/2.0.0/files/p19864484/s50242188/d999ac80-55311a44-e8ed2225-3e4fa541-cc8b0c8a.jpg
no acute cardiopulmonary process.
MIMIC-CXR-JPG/2.0.0/files/p18001529/s58906888/1fd1c866-892f3ae6-fa43aea9-bebc4a22-b3fd9170.jpg
normal chest.
MIMIC-CXR-JPG/2.0.0/files/p16154666/s58644194/6620f7e1-f815ac27-a214c2bc-0713a80d-4cde9189.jpg
mild pulmonary vascular congestion without overt pulmonary edema.
MIMIC-CXR-JPG/2.0.0/files/p19421690/s54539899/716edee6-1431c959-d22791fa-064f37ce-bee57330.jpg
no relevant change as compared to the previous examination. bilateral chest tubes in situ. unchanged extent of the bilateral parenchymal opacities. the appearance of the lung parenchyma and the cardiac silhouette is stable.
MIMIC-CXR-JPG/2.0.0/files/p11121168/s59446481/af408577-89987f1d-0d21c94c-321e4d30-7abf1748.jpg
no evidence of new pulmonary or cardiovascular abnormality as seen on portable single ap chest view examination.
MIMIC-CXR-JPG/2.0.0/files/p13395321/s52833015/11b30ff7-e1774097-f8cb0937-df195c5d-5a5699c1.jpg
no acute intrathoracic process.
MIMIC-CXR-JPG/2.0.0/files/p10657705/s51597482/36bad5a3-ac25e8bf-62b06c68-2a1ff691-d84f41e1.jpg
right lung base opacity is new since exam and may represent atelectasis, aspiration or infection in the appropriate clinical setting.
MIMIC-CXR-JPG/2.0.0/files/p13768004/s54460418/a2e4173b-368412a9-bb80897b-283e7657-7496f759.jpg
no acute cardiopulmonary abnormality.
MIMIC-CXR-JPG/2.0.0/files/p19043685/s53032775/0cb98227-7d592cc0-3031d43a-c0cad6c8-70f2c156.jpg
somewhat improved aeration of the right lower lobe with persistent right middle lobe collapse and right lower lobe atelectasis.
MIMIC-CXR-JPG/2.0.0/files/p11737016/s53553186/cb08d16d-7058951c-b6cfcbbe-4d865f6b-90336543.jpg
normal chest radiograph.
MIMIC-CXR-JPG/2.0.0/files/p17915699/s59833437/c22c31e7-fac10280-4be4763f-3eecbb64-a780b12d.jpg
no acute cardiopulmonary process.
MIMIC-CXR-JPG/2.0.0/files/p10827966/s53227432/19a1c78f-2faac811-0d9b993b-0ad22681-500388c6.jpg
no evidence of acute cardiopulmonary process.
MIMIC-CXR-JPG/2.0.0/files/p16102737/s56005018/1a1e7f7a-27a79bd4-8c7e2cc5-cdbbd5af-5dd92e6b.jpg
possible small left pleural effusion and b/l lower lung(left greater than right) opacities that most likely represent atelectasis.
MIMIC-CXR-JPG/2.0.0/files/p18040018/s55458522/8052008b-8893777c-a20fdc7a-6d43d20c-a036de36.jpg
no acute cardiopulmonary process.
MIMIC-CXR-JPG/2.0.0/files/p14645934/s55881048/45a31644-80c089c9-610c2857-93a65873-4f21b215.jpg
there are mild atelectatic changes at the bilateral bases, left greater than right.
MIMIC-CXR-JPG/2.0.0/files/p17169508/s57118981/051a23a6-8ea95a3e-7afd12df-d399456b-8acfc0a0.jpg
support lines and tubes are unchanged in position. there is volume loss on the left with increased opacity in the left upper lung field. this may represent new left upper lobe collapse. there is a persistent left retrocardiac opacity. the right lung is relatively clear. no pneumothoraces are seen.
MIMIC-CXR-JPG/2.0.0/files/p11971081/s57168104/65718cb6-61815fa5-61c4d8be-1d9347e1-14eed215.jpg
stable appearance of the chest with small to moderate right pleural effusion and trace left pleural effusion compared to.
MIMIC-CXR-JPG/2.0.0/files/p15235731/s53208975/dbbcbba7-8cf7bca9-ecb21bf4-22b66bc8-78446252.jpg
no acute cardiopulmonary process.
MIMIC-CXR-JPG/2.0.0/files/p11696418/s51598549/087fb0f8-b9b0cf42-36b35c2d-b782a4c6-1d7c0fae.jpg
no acute cardiopulmonary process.
MIMIC-CXR-JPG/2.0.0/files/p19553666/s54370876/f1e9895d-fbb4ac51-58e88ad2-46f8d457-46adef51.jpg
ett terminates at the thoracic inlet <num> cm above the carina. enteric tube with side port at the ge junction. consider advancing if the tube is used for feeding. clear lungs.
MIMIC-CXR-JPG/2.0.0/files/p11259210/s59365265/1fe33689-6bac9e47-4dcfbb44-fc60d0f5-9fd5f76d.jpg
top-normal to mildly enlarged cardiac silhouette. no focal consolidation.
MIMIC-CXR-JPG/2.0.0/files/p14979764/s54149378/c6c05bb3-44f6df1c-c745ca4a-8634e177-5348c3a4.jpg
persistent right basilar region of consolidation compatible with patient's known non-small-cell lung carcinoma. no evidence of superimposed acute cardiopulmonary process.
MIMIC-CXR-JPG/2.0.0/files/p11175776/s55037496/6b7821fc-73b4b303-ed7fa8ec-fb439bc4-b1723acf.jpg
right basilar opacity reflecting aspiration or pneumonia.
MIMIC-CXR-JPG/2.0.0/files/p15446534/s55995541/b8eea5a7-c7f66657-1332128a-801c305a-340e3858.jpg
no evidence of acute cardiopulmonary disease.
MIMIC-CXR-JPG/2.0.0/files/p18889303/s53434776/b6f7585e-89556469-95a3b4b4-ddac40a3-e670de4a.jpg
pa and lateral chest read in conjunction with ct scanning of the chest on a torso ct, : moderate right pleural effusion is comparable to the appearance in. multiple pulmonary nodules are roughly comparable. small left pleural effusion persists. progressive rightward mediastinal shift suggests worsening atelectasis in t...
MIMIC-CXR-JPG/2.0.0/files/p17896016/s56897179/d44a8e66-998d9710-f8874da6-6c71a8b1-f25007a9.jpg
no acute intrathoracic process.
MIMIC-CXR-JPG/2.0.0/files/p11390883/s51471966/0074aeae-a1107f30-c41a2850-4d8c7711-1d037e2f.jpg
severe infiltrative pulmonary abnormality improved substantially from to , little if any since. heart is mildly enlarged, increased since. leftward mediastinal shift to new opacification left lower lobe suggest atelectasis, but this could be due to aspiration and should be followed to detect any subsequent pneumonia. ...
MIMIC-CXR-JPG/2.0.0/files/p13474473/s54404666/3f4d9104-7e1b3563-17a465c7-5201bff6-3a1340f3.jpg
no acute cardiopulmonary process.
MIMIC-CXR-JPG/2.0.0/files/p13269859/s51674491/cb4e3dad-2c9aa619-4b965bfa-30ee0b6a-e4257a69.jpg
stable mild cardiomegaly. no pneumonia.
MIMIC-CXR-JPG/2.0.0/files/p10364180/s55136438/5c9512c4-97883a48-3375b19c-878e1bb7-160bb77e.jpg
no acute cardiopulmonary findings.
MIMIC-CXR-JPG/2.0.0/files/p17463311/s52515537/c0e5d176-83e0bf99-9702fa93-e05b224f-f4d41898.jpg
no acute cardiopulmonary process.
MIMIC-CXR-JPG/2.0.0/files/p15244957/s58855620/94a2064f-582815e5-87029cdb-358896f0-9fa9cc4c.jpg
as compared to , asymmetrically distributed pulmonary opacities involving the right lung to a greater degree than the left have slightly improved. otherwise no relevant changes.
MIMIC-CXR-JPG/2.0.0/files/p11052273/s54389393/d7395617-98bb6ef8-6f0187e5-2c3df909-6f3a57c4.jpg
pulmonary vascular congestion, small effusions with probable fluid in the right fissure.
MIMIC-CXR-JPG/2.0.0/files/p19624478/s57520541/be6a0686-72f03976-30b28943-e2ab42fc-b1204a1a.jpg
as compared to , previously present asymmetrically distributed combined alveolar and interstitial opacities have markedly improved with residual opacities predominantly in the right perihilar region. this most likely represents asymmetrical edema. worsening opacity in left retrocardiac region is demonstrated, likely a ...
MIMIC-CXR-JPG/2.0.0/files/p19442637/s59509185/0e0c1433-2f4f1039-e9fa105f-12ef196a-f1c09fdf.jpg
mild prominence of the upper zone vessels, without overt chf. minimal atelectasis at the left base. no definite focal infiltrate and no frank consolidation identified.
MIMIC-CXR-JPG/2.0.0/files/p16751763/s56782843/fdd70403-5b8bd3c5-f9320457-6b50c850-2ec3d745.jpg
no acute cardiopulmonary process
MIMIC-CXR-JPG/2.0.0/files/p13299333/s51664947/9a4c4e69-7bd70fef-0d42a51d-392aab65-90e79e22.jpg
no acute cardiopulmonary process.
MIMIC-CXR-JPG/2.0.0/files/p16161095/s52790583/39f5048d-50e87b9b-4068c9da-a92507ba-06ea6346.jpg
bibasilar opacities which may represent atelectasis/aspiration given known pe. right lower lobe infarct better characterized on concurrent ct chest.
MIMIC-CXR-JPG/2.0.0/files/p11100802/s55996246/a506865b-7e0f77e0-fb9f1308-198cbb0a-60bc2b32.jpg
no acute cardiopulmonary process.
MIMIC-CXR-JPG/2.0.0/files/p17391262/s59350817/8fdb9489-52962549-8e2ede27-baa7c3d7-27fcced8.jpg
increasing atelectasis, right lower lobe.
MIMIC-CXR-JPG/2.0.0/files/p16870674/s52921632/7bf4b423-115941ed-a6323703-5cb71934-7a3f6d19.jpg
-mm opacity again seen in the right middle lung just superior to the minor fissure, likely representing a nodule versus consolidation versus aspiration. comparison with previous imaging from outside facilities would facilitate identification of the mass.
MIMIC-CXR-JPG/2.0.0/files/p14572656/s56325371/82ab703c-fcac053b-e830eb5f-a8b4bfd5-fc82dd66.jpg
<num>) no acute cardiopulmonary process. <num>) stable central adenopathy
MIMIC-CXR-JPG/2.0.0/files/p11880930/s53415971/15f94c67-ebe5035a-6176b62e-4f1510e3-a9328a60.jpg
streaky right basilar opacities, most suggestive of atelectasis. no suspicious findings.
MIMIC-CXR-JPG/2.0.0/files/p14102384/s53917743/c198d822-fc3240d8-f32e0b64-8eb74617-5e49bf90.jpg
interval insertion right-sided pigtail catheter with tiny right apical pneumothorax. moderate interstitial and alveolar pulmonary edema with bilateral pleural effusions.
MIMIC-CXR-JPG/2.0.0/files/p17125760/s50358804/bb056d77-c3c3eac5-d9d1ce16-0eb2183a-feed53f0.jpg
no evidence of acute cardiopulmonary disease.
MIMIC-CXR-JPG/2.0.0/files/p18001923/s53583856/16223b07-56093629-926eb65b-f76b50f5-8986763a.jpg
lung volumes are normal. mild cardiomegaly. no pulmonary edema. mild elongation of the descending aorta. on the current image, no central venous access line is visualized. tips in situ.
MIMIC-CXR-JPG/2.0.0/files/p13652979/s50406046/1f45fb8b-170a268a-d2134fb0-2cb9993d-f26a19bd.jpg
in comparison with the study of , there is little change and no evidence of acute cardiopulmonary disease. no pneumonia, vascular congestion, or pleural effusion. no evidence of pneumothorax or rib fracture, though if there is serious clinical concern, coned rib views could be obtained.
MIMIC-CXR-JPG/2.0.0/files/p11803001/s53007437/15d93df8-f44a2559-011a0528-0264b679-c95a15b7.jpg
no pulmonary edema or confluent consolidation. tortuosity of the ascending and descending thoracic aorta.
MIMIC-CXR-JPG/2.0.0/files/p11819377/s53886973/01c91a38-34bab24d-33854dd0-2323e52c-b33e7550.jpg
pneumoperitoneum, new. near complete resolution of the bilateral pleural effusions. left thyroid lesion; see ct report for recommendation.
MIMIC-CXR-JPG/2.0.0/files/p12756653/s58667735/170a36ba-d85e298f-8164deab-573eea6b-846244f4.jpg
no acute cardiopulmonary abnormality.
MIMIC-CXR-JPG/2.0.0/files/p10013569/s57151026/63af38ce-8915b633-19f3a00b-3d6fde60-675b3525.jpg
enlarging right pleural effusion without pulmonary edema. recommend obtaining pa and lateral chest radiograph.
MIMIC-CXR-JPG/2.0.0/files/p15020971/s54651539/378e771d-beb3849e-e10d8369-ebbbdc98-48ae076e.jpg
no acute cardiopulmonary process.
MIMIC-CXR-JPG/2.0.0/files/p15814642/s52659807/a018280a-eef0c0b8-a55c66f0-59b88c31-8c72811f.jpg
worsening non-small-cell lung cancer in the right upper lung since. no evidence of drainable pleural effusion. somewhat ill-defined <num> mm nodular density projecting over the left mid lung may represent either nipple shadow or new metastasis. recommendation(s): if there is clinical concern, a new ct chest exam can be...
MIMIC-CXR-JPG/2.0.0/files/p10858207/s52517961/0195f9ee-6e3e324b-5586a465-7d40821c-d6231d78.jpg
no acute intrathoracic process.
MIMIC-CXR-JPG/2.0.0/files/p10548962/s56020682/9673d26d-05874080-02f957de-8e61f8d4-a58421bb.jpg
slight interval improvement in right pleural effusion with continued small right pleural effusion.
MIMIC-CXR-JPG/2.0.0/files/p11055521/s56808827/8be8fdc1-1595880f-e8ac3dc2-49015e73-63ddec5f.jpg
small left apical pneumothorax is slightly larger now than it was at. the left pleural drainage catheter which crosses the midline impinging on the mediastinum is unchanged in position. the volume of subcutaneous emphysema in the left chest wall is unchanged. left pleural effusion small if any. small right pleural effu...
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bronchial wall thickening and diffuse interstitial opacities probably represent an atypical pneumonia in the setting of fever. an atypical distribution of pulmonary edema in the setting of upper lobe predominant emphysema is an additional consideration.
MIMIC-CXR-JPG/2.0.0/files/p18798845/s57552781/6e84de9b-7eea2922-1b778d32-54eb14b7-870ff7ea.jpg
no acute cardiopulmonary abnormality. no displaced rib fracture.
MIMIC-CXR-JPG/2.0.0/files/p13106312/s59377929/318b8f4c-3eee896d-a2128377-64cf378a-5e38a730.jpg
no acute cardiopulmonary abnormality.
MIMIC-CXR-JPG/2.0.0/files/p13875890/s52861116/2366ae1d-cf6f8a0f-9b4d8fb9-d873acc2-2b5c0cc2.jpg
compared to chest radiographs through. new region of consolidation in the right upper lobe marginates the minor fissure and a another in the left apex are consistent with progressive pneumonia. residual pneumonia elsewhere in both lungs is relatively unchanged. no pneumothorax. heart size normal. pleural effusion smal...
MIMIC-CXR-JPG/2.0.0/files/p10260867/s59085055/3f4d4445-090b46e5-a196ecee-65903629-eb50d2f6.jpg
no acute cardiopulmonary process.
MIMIC-CXR-JPG/2.0.0/files/p17755058/s57556002/bf9f3296-40a877fe-4fe3d58d-e6b4cd24-01317610.jpg
comparison to. stable moderate right and small left pleural effusion. stable moderate cardiomegaly. the aortic valve replacement and the external pacemaker are also in stable position. no new focal parenchymal opacities.
MIMIC-CXR-JPG/2.0.0/files/p13088713/s55248637/c60f95e4-1d8cb121-df4f3799-baadad75-17a516fe.jpg
mild interstitial pulmonary edema.
MIMIC-CXR-JPG/2.0.0/files/p10717732/s59269790/26f9068a-5811547a-e8a15790-5a47c60f-54193baf.jpg
decreased left lower lung atelectasis and left pleural effusion since. decrease in cardiomegaly.
MIMIC-CXR-JPG/2.0.0/files/p15201268/s51480590/1a2df313-8353ae13-5c3f2655-be353e01-0a81a96a.jpg
no acute cardiopulmonary process.
MIMIC-CXR-JPG/2.0.0/files/p11941849/s59097883/a2ef2db9-1aeaad68-699ea6a6-48a9d23e-958d509f.jpg
no relevant change as compared to the previous examination. borderline size of the cardiac silhouette. minimal bilateral pleural effusions, left more than right, with subsequent areas of atelectasis at the lung bases. borderline size of the cardiac silhouette without pulmonary edema. no evidence of pneumonia.
MIMIC-CXR-JPG/2.0.0/files/p19418926/s53927498/cde2b988-d276fc27-ee36733d-ca4ba954-920688aa.jpg
ill-defined opacity in the left lower lung, may reflect aspiration or asymmetric edema. et tube tip approximately <num> cm from the carina. enteric tube in the distal stomach. central line in mid svc.
MIMIC-CXR-JPG/2.0.0/files/p16010838/s56125936/b5b61273-9489d779-cec61cd8-ed0181f6-4a026d47.jpg
minimal patchy opacity within the right perihilar region could reflect an area of infection or inflammation.
MIMIC-CXR-JPG/2.0.0/files/p11458022/s59747196/6ee72174-df3aebe5-e07dc3e1-f4d56f88-5dd3de71.jpg
no acute cardiopulmonary process.
MIMIC-CXR-JPG/2.0.0/files/p18756147/s55091856/477fa49e-7ea34617-a67121ce-a963c00e-50a9fe54.jpg
the patient was extubated with removal of the ng tube as well as swan-ganz catheter and mediastinal drains. left picc line tip is at the level of mid svc. right internal jugular line introducer is at the level of superior svc. pulmonary edema is substantial, unchanged
MIMIC-CXR-JPG/2.0.0/files/p11895151/s56444521/98bd593e-9ce2f383-963c9f2b-623d284d-e3327022.jpg
moderate left-sided pleural effusion with adjacent atelectasis. cardiomegaly with crowding of the bronchovascular structures which may be related to low lung volumes versus asymmetric pulmonary edema. rounded retrocardiac density likely relates hiatal hernia. correlate on pending ct.
MIMIC-CXR-JPG/2.0.0/files/p14588689/s53438422/eb1e97ea-86123131-4b4fe4c0-47e3b4db-4cf76de6.jpg
no relevant change as compared to the previous image. borderline size of the cardiac silhouette. no pulmonary edema. no pneumonia. minimal elongation of the descending aorta. no focal parenchymal opacities. no pleural effusions.
MIMIC-CXR-JPG/2.0.0/files/p13269859/s53093679/78c571d7-c76d5e4a-cb55aaf8-a772c574-12e98438.jpg
as compared to the previous radiograph, no relevant change is seen. the patient remains intubated. the course of the nasogastric tube is constant. mild cardiomegaly but no pulmonary edema. no pleural effusions. no pneumonia.
MIMIC-CXR-JPG/2.0.0/files/p13561687/s54889600/a0c8c663-8687ee45-c89266eb-3b5d7691-a724681e.jpg
no definite acute cardiopulmonary process.
MIMIC-CXR-JPG/2.0.0/files/p19298916/s58204679/6211682b-b3de73fb-cb98102b-5993f625-c0cb742f.jpg
no acute cardiopulmonary process.
MIMIC-CXR-JPG/2.0.0/files/p10053357/s59379546/381d8274-bed40d1e-99a1d3df-3e07a36a-c8ac4032.jpg
no previous images. the heart is normal in size and there is no vascular congestion, pleural effusion, or acute focal pneumonia. of incidental note is a partial eventration of the right hemidiaphragm, of no clinical significance.
MIMIC-CXR-JPG/2.0.0/files/p12537194/s57203771/fec6477d-139531e1-4ba0fa75-182c4eed-1dccd86d.jpg
large right hydropneumothorax, unchanged compared to prior radiograph from.
MIMIC-CXR-JPG/2.0.0/files/p17703631/s54072538/5f190b1c-300e5195-db1d3907-a6dc426f-48b87ce7.jpg
no evidence of chf or acute pulmonary infiltrates. no significant new abnormalities in comparison with similar study in.
MIMIC-CXR-JPG/2.0.0/files/p12729607/s56462350/e0a1bb68-10258a88-ca0ccd24-4228ec61-ec823b49.jpg
no pneumonia.
MIMIC-CXR-JPG/2.0.0/files/p15998296/s53831447/91446aea-9bad0ee9-0ec8b4f3-268e277c-0c8b760a.jpg
extensive bilateral parenchymal opacities, right greater than left, with apparent worsening of left perihilar and basilar opacities since , though similar to. findings are compatible with known history of multifocal pneumonia although superimposed edema may be present.
MIMIC-CXR-JPG/2.0.0/files/p15498867/s52730135/6355a0e5-abab4c11-45e17829-2ebbcc13-9de08406.jpg
no acute cardiopulmonary process.
MIMIC-CXR-JPG/2.0.0/files/p18860416/s53496082/ad593b1a-a93c6fae-9676fa09-9c89e384-27c8374e.jpg
no acute intrathoracic process.
MIMIC-CXR-JPG/2.0.0/files/p10613328/s57891168/5aa92207-d1ef995d-65e96f08-ac31ffcb-1ad3964f.jpg
increased right effusion.
MIMIC-CXR-JPG/2.0.0/files/p13566123/s57786555/3add0cbb-20f8d036-cb34fb31-fce39738-8f14815a.jpg
no acute cardiopulmonary process.
MIMIC-CXR-JPG/2.0.0/files/p17559288/s52177147/2365d0ef-d1cafbfe-24afa38d-5390baed-46e9e9ef.jpg
increasing diffuse opacification compatible with continued progression of disease. no evidence of pneumothorax.
MIMIC-CXR-JPG/2.0.0/files/p17568699/s57341744/4dad376a-42a52b47-4ba8f7d6-cbfbcb4e-a8283c42.jpg
slightly improved parenchymal opacity in the right lower lung field, with continued bilateral airspace opacities concerning for multifocal infection. nodular opacities in the right mid lung are possibly related to the infectious process.
MIMIC-CXR-JPG/2.0.0/files/p19464468/s59194958/e5a5f1d7-810b14b1-0ec90d12-b7c5b25e-788c7f4c.jpg
in comparison with the study of , the patient has taken a much better inspiration. cardiac silhouette is within normal limits and there is no evidence of vascular congestion or pleural effusion. specifically, no acute focal pneumonia.
MIMIC-CXR-JPG/2.0.0/files/p19404719/s51387841/8def2c8e-be93410b-b64cbed9-5a85e189-cbddcc1d.jpg
no acute cardiopulmonary abnormality.
MIMIC-CXR-JPG/2.0.0/files/p17033197/s53890361/bf7423b0-f57dc7e6-66035e85-0853a815-d116c1d7.jpg
mild left lower lobe atelectasis otherwise no acute cardiopulmonary findings.
MIMIC-CXR-JPG/2.0.0/files/p12949905/s50403139/6b39e1f1-60192aa2-3a0704b9-bf98cbbb-b6338514.jpg
improved ventilation of right lung compared to prior.
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right lower lung linear opacity seen on the pa radiograph, could represent atelectasis, however pneumonia or aspiration are also possible.
MIMIC-CXR-JPG/2.0.0/files/p13243522/s53771660/13caee7e-bbd47c69-a5b25118-f432a718-460a647d.jpg
slight interval improvement in the right perihilar airspace opacity, otherwise no significant interval change when compared to the prior study.
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low lung volumes with likely left basilar atelectasis.
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small left pleural effusion. no pulmonary edema.
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increased upper zone redistribution and vascular plethora compared with , consistent with mild fluid overload/early chf. probable right lower lobe atelectasis, unchanged. no new infiltrate identified.
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as compared to the previous radiograph, the sternal fixations and wires of the cabg have been removed. there is no evidence for the presence of a pneumothorax or pneumopericardium. no pneumomediastinum. no pleural effusions. no pulmonary edema.
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no evidence of pneumonia.
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minimal bibasilar atelectasis without focal consolidation.
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allowing for differences in technique, there has not been a relevant change the appearance of the chest since the previous study of <num> day earlier.
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persistent small left apical pneumothorax, certainly not smaller perhaps marginally larger.