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Ap chest radiograph. As compared to prior study obtained the same day earlier at 1:39 p.m., there is interval substantial increase in pneumothorax, currently moderate to large on the left. There is right mediastinal shift worrisome for tension. Left subclavian line tip is at the mid SVC. The right lung is clear. No def... | |
Small right pneumothorax has continued to decrease. Opacities in the left base have worsened, likely atelectasis. There are persistent low lung volumes. Persistent dilatation of the stomach. Bilateral chest tubes remain in place. Cardiomediastinal contours are unchanged. Subcutaneous emphysema has continued to decrease | |
Comparison is made with prior study, ___. NG tube tip is out of view below the diaphragm likely in the stomach. ET tube tip is in standard position. Right IJ catheter tip is in the right atrium, can be withdrawal couple of centimeters for more standard position. There are low lung volumes. Cardiomediastinal contours ar... | |
Portable AP radiograph of the chest was reviewed in comparison to ___ (pre-surgical radiograph). Heart size is enlarged, stable. Mediastinum is stable. Lungs are essentially clear with no new consolidation demonstrated. Surgical stent is projecting over partially imaged abdominal aorta. | |
In comparison with the study of ___, the opacification at the left base has decreased, suggesting that this represents only atelectasis. No evidence of vascular congestion or cardiomegaly at this time. | |
As compared to the previous radiograph, no relevant change is seen. Moderate enlargement of the cardiac silhouette, in particular of the left ventricle. Signs of mild pulmonary edema with evidence of basilar apical blood flow redistribution. Areas of small atelectasis at the bases of the right lung. No larger pleural e... | |
AP portable view of the chest. There has been placement of a left pigtail catheter which overlies the left upper hemithorax. There has been significant decrease in left pneumothorax, now small. There is a small left pleural effusion and adjacent atelectasis. Again seen are malposition pacemaker leads. | |
Right upper lobe subsegmental atelectasis has resolved. The lungs are clear. There is no pneumothorax. The heart appears enlarged suspected projection. The pulmonary arteries appear prominent, as in the past. Prominent supraclavicular soft tissues corresponds to known multinodular goiter. | |
A nasogastric tube enters the stomach where it makes a single coil. The heart is mildly enlarged. The lungs appear clear. There are no pleural effusions or pneumothorax. No free air is demonstrated. The mediastinal and hilar contours appear unchanged. | |
AP portable upright view of the chest. Right IJ access dialysis catheter again seen with tip extending into the right cavoatrial junction. There is mild pulmonary vascular congestion and probable mild interstitial pulmonary edema. There is no focal consolidation concerning for pneumonia. No large effusion or pneumothor... | |
As compared to the previous radiograph, no relevant change is seen. The monitoring and support devices are constant. Mild cardiomegaly. Mild retrocardiac atelectasis. Mild fluid overload but no overt pulmonary edema. | |
An endotracheal tube terminates 5.0 cm above the carina. An orogastric tube terminates within the stomach. A left IJ central venous catheter terminates at the mid SVC. Small bilateral pleural effusions are minimally changed since ___. Bilateral ill-defined pulmonary opacities appear slightly improved since ___. | |
Lung volumes are lower today than on ___, but atelectasis has not progressed and pulmonary vascular congestion has not worsened. Mediastinal widening is due to borderline enlargement of aorta and pulmonary arteries, not bleeding. Heart is mildly enlarged. Pleural effusion if any is not significant. No pneumothorax. Rig... | |
Right internal jugular line tip is at the level of mid SVC. Cardiomediastinal silhouette is unchanged including substantial cardiomegaly and distended azygos vein that there is interval substantial improvement in pulmonary edema currently mild as compared to moderate to severe is seen on the prior study. | |
Lung volumes are somewhat low. There is streaky density bilaterally most consistent with subsegmental atelectasis or scarring as before. There is evidence of a small right pleural effusion as well. The patient is status post median sternotomy and valvular plasty. A PICC remains in place. It can be followed to the upper... | |
Comparison is made with prior study from ___. Mild cardiomegaly is stable. Pneumothorax has resolved. Left chest tube has been removed. If any, there is a small left effusion. There are low lung volumes. Multiple bilateral lung masses are again noted, largest in the right upper lobe. | |
Since the prior study there is no substantial change in the cardiomediastinal silhouette as well as bilateral pleural effusions with overall minimal decrease in the left pleural fluid after placement of the left pigtail catheter. No pneumothorax is demonstrated. | |
The patient is intubated. The tip of the endotracheal tube projects approximately 6 cm above the carina. The course of the nasogastric tube is unremarkable. There is massive intraperitoneal air. At the time of dictation and observation, 8:56 a.m., on ___, the referring physician, ___. ___, was paged for notification. I... | |
No change in the following: No pneumothorax, large left pleural effusion, large left hilar mass with atelectasis. The right lung is clear. | |
The endotracheal tube ends 1.5 cm above the carina. A transesophageal tube ends with its side port approximately 6 cm above the gastroesophageal junction. There is a ventriculoperitoneal shunt catheter. Incidental note is made of a right-sided aortic arch. The heart size is normal. The lungs are clear without focal opa... | |
Low lung volumes are present. Right-sided Port-A-Cath tip terminates in the low SVC. Heart size is top-normal. The aorta is mildly tortuous. The mediastinal and hilar contours are within normal limits. Pulmonary vasculature is not engorged. Patchy atelectasis is noted in the lung bases without focal consolidation. No l... | |
An accessed right pectoral MediPort terminates at the superior cavoatrial junction. There is no pneumothorax. Mild prominence with increased density of the right hilus as compared to ___ may be due to mild pulmonary artery dilatation or lymphadenopathy. A faint nodular opacity projecting at the superior aspect of the l... | |
No right pneumothorax. Small right pleural effusion if any. Right lung grossly clear. Previous transient cardiac enlargement and mediastinal vascular engorgement have both improved. There is no pulmonary edema. Left lung is clear. | |
As compared to the previous radiograph, the patient has received a Dobbhoff catheter. The previously placed nasogastric tube was removed. The tip of the Dobbhoff catheter is projecting over the gastroesophageal junction. The device needs to be advanced by approximately 5 cm. . The previously placed right hemodialysis c... | |
The tip of the intra-aortic balloon pump projects 1.7 cm below the aortic knob apex, unchanged but higher than usual. Heart size is normal and the lungs are clear without pleural effusion, focal consolidation or pneumothorax. | |
As compared to the previous radiograph, the patient was intubated. The tip of the endotracheal tube projects 6.5 cm above the carinal. The course of the nasogastric tube is unremarkable but the tip is not visualized on the image. Unchanged normal position of the right internal jugular vein catheter, projecting over the... | |
In comparison with the study of ___, the monitoring and support devices remain in place. Again there is enlargement of the cardiac silhouette with elevation of pulmonary venous pressure and extensive opacification in the retrocardiac area consistent with volume loss in the lower lobe. In the appropriate clinical settin... | |
AP single view of the chest has been obtained with patient in semi-upright position. Comparison is made with the next preceding portable chest examination obtained five hours earlier during the same day. An NG tube has now been placed, seen to pass well below the diaphragm and pointing within the stomach towards the py... | |
There are no lung opacities concerning for pneumonia. Both pleural spaces are normal. Heart size is normal, mediastinal and hilar contours are unremarkable. | |
There is ill definition of both hemidiaphragms, left greater than right that could represent areas of atelectasis or small infiltrate. There is mild pulmonary vascular redistribution and mild cardiomegaly. Right-sided PICC line is again visualized. Kerley B lines are present. The overall impression is that of mild CHF ... | |
As compared to ___, all monitoring and support devices, including the left pectoral Port-A-Cath and the tracheostomy tube are in unchanged position. There is a stable atelectasis in the retrocardiac lung regions and at the right lung basis. No larger pleural effusions. No pneumonia, no pulmonary edema. Normal size of t... | |
As compared to prior chest radiograph from ___, there is overall increased pulmonary vascular markings and the pulmonary vasculature. This is more prominent at the right lung base, where there is an area of new ill-defined opacity which also obscures the right cardiac border. There is no pleural effusion or pneumothora... | |
In comparison with the earlier study of this date, there has been placement of a nasogastric tube that extends to the mid stomach. The side-port appears to be just distal to the esophagogastric junction. The tube could be pushed forward several cm for more optimal positioning. Little change in the other monitoring and ... | |
The inspiratory lung volumes remain low with an unchanged large hernia containing bowel in the left hemi thorax. Right middle lobe atelectasis is slightly improved from the most recent prior study. No other focal consolidations are noted. There is no increase in size of a small right pleural effusion. There is no overt... | |
In comparison with the study of ___, there is little change. Monitoring and support devices remain in good position. Continued low lung volumes with atelectatic changes less prominent at the left base. | |
As compared to the previous radiograph, the patient has been extubated and the monitoring and support devices were removed, including the left chest tube. The only monitoring and support device that persists is the right internal jugular vein catheter. Mild cardiomegaly. Mild right basilar atelectasis. No pulmonary ede... | |
In comparison to prior radiograph of 1 day earlier, left hemidiaphragm is less distinct, probably due to a combination of a small left pleural effusion and adjacent minor atelectasis. Left PICC remains malpositioned, coiling in the left axilla and terminating in the left subclavian vein. | |
As compared to the previous radiograph, left-sided chest tube has been removed. There is no evidence of recurrent left pneumothorax. The image is otherwise unchanged, with tracheostomy tube and nasogastric tube in situ. New is a left-sided central venous access line. The subclavian line shows a normal course, the tip p... | |
In comparison with the earlier study of this date, there has been placement of a nasogastric tube that extends well into the stomach. Other monitoring and support devices are unchanged, as are the heart and lungs. | |
In comparison with the study of ___, there has been some clearing of the opacification at the right base. Nevertheless, there are dense streaks of atelectasis as well as slightly less prominent atelectatic changes at the right base. No vascular congestion or enlargement of the cardiac silhouette. No new focal areas of ... | |
A enteric tube has been placed terminating in the stomach with side port beyond expected location of the gastroesophageal junction. The endotracheal tube is in appropriate position, appearing closer to the carina than on previous same-day radiograph because the patient's chin is down. Moderate right and small left left... | |
New Dobbhoff passes into the stomach and curls back into the esophagus. Bibasilar opacification continues to be seen and is unchanged. The cardiac silhouette is normal. | |
Cardiac silhouette is enlarged but stable. There is tortuosity of the thoracic aorta. There is mild prominence of the pulmonary vascular markings without overt pulmonary edema. There is mild blunting of the costophrenic angles which may represent small pleural effusions. There are no pneumothoraces | |
Compared to prior radiograph of 1 day earlier, exam is overall similar to the prior study except for slight worsening right basilar atelectasis with associated elevation of right hemidiaphragm. | |
Previously extensive left lower lobe atelectasis or consolidation is improving. Less severe consolidation in the right lung base has been relatively stable since ___. Upper lungs are clear. Small to moderate left pleural effusion unchanged. Moderate cardiomegaly stable. ET tube and left pic line are in standard placeme... | |
In comparison to prior radiograph of 1 day earlier, a right pleural catheter has been removed. Moderate, partially loculated right pleural effusion appear similar with no definite pneumothorax. With the exception of improving aeration at both lung bases, there is otherwise no substantial change in the appearance of the... | |
As compared to the previous radiograph, there is no relevant change. The pigtail catheter in the left pleural space remains. On today's examination, a millimetric left apical pneumothorax is noted. Bilaterally at the lung bases, the known parenchymal opacities, dominated by a nodular pattern, are unchanged. No new pare... | |
Lung volumes are low. Heart size is top normal. Aorta is unfolded. Pulmonary vascularity is normal. Lungs are clear. No pleural effusion, focal consolidation or pneumothorax is present. No acute osseous abnormalities are seen. | |
Endotracheal tube tip is 3.2 cm from the carina. Enteric tube passes below the field of view. Hazy left basilar and retrocardiac opacity is noted which is likely due to atelectasis. Cardiomediastinal silhouette is within normal limits. No displaced fractures identified. | |
The right IJ venous catheter terminates in the lower SVC. The lung volumes are stable. The cardiomediastinal and hilar contours are enlarged but stable. Mediastinal veins are mildly dilated but unchanged. No pulmonary edema. The pleural surfaces are normal. The right IJ venous catheter terminates in the lower SVC. The ... | |
Compared to earlier postoperative chest radiograph, 12:23. New fluid collection at the apex of the left lung is either loculated hemo thorax or mediastinal bleeding dissecting over the apex of the lung extrapleural E. Left lower lobe consolidation has worsened, presumably atelectasis since there is ipsilateral mediasti... | |
Cardiac size remains unchanged. There has been complete reaeration of the right upper lobe. A dense streak is again seen along the normal position of the minor fissure. There are lower lung volumes. Increased opacification at the left lung base is consistent with volume loss in the lower lobe. There is no pneumothorax.... | |
No displaced rib fracture is seen. The lungs are clear. The hilar and cardiomediastinal contours are normal. There is no pneumothorax. There is no pleural effusion. Pulmonary vascularity is normal. | |
In comparison with study of earlier in this date, there are improved lung volumes. Right IJ sheath has been removed. Nasogastric tube again extends well into the stomach. Endotracheal tube tip lies approximately 4 cm above the carina. Continued enlargement of the cardiac silhouette with substantial pulmonary vascular c... | |
As compared to the previous radiograph, there is no relevant change. Status post aortic repair, the monitoring and support devices are constant. Unchanged probably postoperative left interstitial parenchymal changes, but no evidence of larger pleural effusions. Unremarkable right lung. | |
The lungs are clear of focal consolidation, pleural effusion or pneumothorax. Lower lobe bronchiectasis is noted. The heart is normal in size. There are surgical clips projecting over the right breast. No displaced rib fractures are noted. Although no acute fracture or other chest wall lesion is seen, conventional ches... | |
As compared to the previous radiograph, the pre-existing left pleural effusion has been drained with a pigtail catheter. The pigtail catheter is in place. The effusion has almost completely resolved. There is no safe evidence of left pneumothorax. Otherwise, the radiograph is unchanged. Moderate cardiomegaly. | |
Evidence of failure. | |
As compared to the previous radiograph, no relevant change is seen. 1 cm right postoperative pneumothorax. The soft tissue and lung parenchymal changes at the level of the right lung apex are constant. Resolving retrocardiac atelectasis. Otherwise unremarkable appearance of the left hemi thorax. | |
Aeration of the left upper lobe continues to clear, but could still be substantial pneumonia. Consolidation at the base of the left lung is more likely atelectasis than pneumonia since it developed suddenly on ___. Mild to moderate pulmonary edema has improved slightly and has changed in distribution, now more dependen... | |
Borderline interstitial edema has been present for several days, exaggerated by persistently low lung volumes. Pleural effusions if any are not substantial. Heart size is normal. Mediastinal veins are more dilated today than on ___ suggesting increased intravascular volume or pressure. There is no pneumothorax. A right... | |
In comparison with the study ___ ___, the right chest tube remains in place and there has been essentially complete re-expansion of the right lung. The left lung remains clear. The soft tissues adjacent to the right hemithorax have been excluded from the image, so that it is impossible to assess the degree of subcutane... | |
AP chest compared to ___ at 5:21 a.m.: Left pleural effusion is much smaller following insertion of a pigtail pleural drain at the base of the left hemithorax. Mild cardiomegaly and mediastinal vascular engorgement have progressed, pulmonary edema is mild. Small right pleural effusion is minimally smaller following ins... | |
SMALL RIGHT APICAL PNEUMOTHORAX IS UNCHANGED IN VOLUME SINCE ___, BUT NOW CONTAINS A SMALL VOLUME OF FLUID. APICAL PLEURAL PIGTAIL DRAINAGE CATHETER UNCHANGED IN POSITION. NO ADETECTABLE LAYERING PLEURAL EFFUSION. NO MEDIASTINAL SHIFT. RIGHT UPPER LOBE BRONCHIAL WALL THICKENING AND POSTOPERATIVE ATELECTASIS OR SCARRING... | |
AP radiograph of the chest was reviewed in comparison to ___. The ET tube tip is 6.5 cm above the carina. The esophageal temperature probe, the left subclavian line are in unchanged unremarkable positions. NG tube tip is in the stomach. Heart size and mediastinum are stable. There is substantial interval progression in... | |
In comparison with the study of ___, there is continued enlargement of the cardiac silhouette with ill-defined pulmonary vessels consistent with some elevation of pulmonary venous pressure. The area of opacification at the left base appears somewhat less prominent, consistent with slow clearing of an infectious process... | |
Heart size and mediastinum are stable. There is interval development of more conspicuous upper zone re- distribution of the vasculature as well as perihilar opacities concerning for interval progression of interstitial pulmonary edema. No pleural effusion or pneumothorax is seen. | |
AP chest compared to ___: Progressive left perihilar consolidation could be edema but is more concerning for pneumonia. A small left pleural effusion unchanged. Extensive consolidation in the right lung and abscess or fissural fluid collection in right mid lung unchanged for several days. The heart size normal. No pneu... | |
Lungs are well expanded and clear. Cardiomediastinal and hilar silhouettes and pleural surfaces are normal. Yesterday's dilatation of pulmonary and mediastinal vessels has resolved. ET tube is in standard placement and an esophageal drainage tube passes into the stomach and out of view. | |
As compared to the previous radiograph, there is no relevant change. No visible pleural effusions. Unchanged moderate cardiomegaly with signs of minimal fluid overload and bilateral areas of atelectasis. Unchanged venous introduction sheath in the right internal jugular vein. | |
NG tube tip isin the stomach. No other interval change from prior study. | |
Compared to the prior study there is no significant interval change. | |
As compared to the prior examination performed several hours earlier, there has been interval advancement of the nasogastric tube. The NGT side port is now noted to be just below the gastroesophageal junction, and the tip is seen within the stomach. The remainder of the examination is largely unchanged. | |
Right upper chest catheter unchanged in position but its location remains unclear. Tracheostomy tube remains in satisfactory position. Persistent retrocardiac consolidation with elevation of the left hemidiaphragm suggestive of lower lobe collapse and probable layering left effusion. Increasing faint opacity in the lef... | |
Compared to prior chest radiographs since ___, most recently ___. Lungs grossly clear. Heart size normal. No pleural abnormality. Thoracic aorta is heavily calcified, but CT scanning would be required to detect aneurysm. | |
New large opacity in the left mid lung is consistent with partial collapse of the left lung. New opacities in the right upper lobe are worrisome aspiration. Right lower lobe atelectasis have improved. Right PICC tip is in the lower SVC Dobhoff tube tip isin the stomach. Cardiomediastinal contours are obscured by the pa... | |
In comparison with the study of ___, there is little change. Continued enlargement of the cardiac silhouette with tortuosity of the aorta, but no evidence of acute pneumonia or vascular congestion. Of incidental note are bilateral shoulder arthroplasties and to kyphosis procedures, as well as scoliosis. | |
AP chest compared to ___ through ___. Large left pleural effusion is bigger, moderate right pleural effusion and mild pulmonary edema, unchanged. Cardiac silhouette is obscured. No pneumothorax. Dr. ___ was paged at 11:45 a.m., when the findings were recognized. | |
Following removal of right chest tubes, there is no visible pneumothorax. Cardiomediastinal contours are stable. Bibasilar atelectasis is again demonstrated, slightly improved on the left and slightly worse on the right. Small pleural effusions are present. | |
VP shunt is in place. NG tube has been removed. Cardiomediastinal silhouette is unchanged including substantial cardiomegaly. Small bilateral pleural effusions are present. Mild interstitial edema has minimally changed in the interim. | |
In comparison with the study of ___, there is little overall change. There is again enlargement of the cardiac silhouette without vascular congestion or pleural effusion. Mild retrocardiac opacification persists. Specifically, no evidence of acute focal pneumonia. | |
Portable AP radiograph of the chest was reviewed in comparison to ___. Bilateral pleural effusions and bilateral pigtail catheters appear unchanged. No substantial change in moderate to large amount of fluid is noted. There is no pneumothorax. Cardiomediastinal silhouette is unchanged within the limitations of the asse... | |
In comparison with the earlier study of this date, there is again a large left loculated pleural effusion with associated compressive atelectasis. There may be slightly improved aeration of the left lung. The right lung remains clear and there is again substantial enlargement of the cardiac silhouette. | |
Single AP view of the chest provided. A right central venous catheter terminates at the cavoatrial junction, possibly right atrium. A Dobbhoff extends below the diaphragm and ends beyond the pylorus. Prominence of the pulmonary vasculature and mild interstitial edema are unchanged. Mild atelectasis at the lung bases is... | |
Comparison to ___. Newly appeared minimal right pleural effusion. The extent of a left pleural effusion is stable. Stable correct position of the monitoring and support devices. Stable normal size of the cardiac silhouette. No evidence of pneumonia. | |
In comparison with the study of ___, the ___ support devices as essentially unchanged. Hazy opacification at the bases with poor definition of the hemidiaphragms is again consistent with layering pleural effusions and basilar atelectasis. Again there is mild elevation of pulmonary venous pressure. | |
As compared to ___, no relevant change is seen. The monitoring and support devices, including the left-sided chest tube, are constant. The extent of the left pneumothorax is stable. Unchanged evidence of air in the left chest wall. Unchanged moderate cardiomegaly. | |
Left internal jugular central venous catheter tip terminates at the confluence of the brachiocephalic veins. No pneumothorax is present. Heart size is normal. Mediastinal and hilar contours are unremarkable. Pulmonary vascularity is normal. Lungs are clear. No large pleural effusion is identified although the left cost... | |
Nasogastric tube courses below the diaphragm beyond the field of view of the radiograph. Within the image portion of the chest, there has been no relevant change in appearance since the recent study performed a few hr earlier. | |
Decrease in extent of the free intra-abdominal air. No pneumothorax. Unchanged right chest tube and feeding tube. Minimal atelectasis at the right lung bases. Otherwise normal postoperative appearance of the right hemi thorax. Minimal retrocardiac atelectasis. Signs of mild fluid overload have completely cleared. Norma... | |
In comparison with the study of ___. The patient has taken a better inspiration. Again there is enlargement of the cardiac silhouette with pulmonary vascular congestion. Bibasilar opacification, with silhouetting of the hemidiaphragm on the left, is consistent with atelectasis and left pleural effusion. However, in the... | |
Compared to the study from earlier the same day, there is no significant interval change. | |
There is a right chest tube in place. There is no apical pneumothorax however, difficult to evaluate the bases due to known bullous disease. Subcutaneous emphysema is seen in the right lateral chest wall. Linear opacities at the left base are most likely atelectasis. There is no focal consolidation or pleural effusion.... | |
As compared to the previous radiograph, no relevant change is noted. The lung volumes remain low. The monitoring and support devices are in constant position. The appearance of the aortic stent graft is constant. Constant size of the cardiac silhouette. The diffuse parenchymal opacities, peribronchial in distribution a... | |
In comparison to previous radiograph of 2 days earlier, pulmonary vascular congestion persists, but mild edemahas resolved in the interval. There are no areas of consolidation to suggest the presence of pneumonia, and no pleural effusion or pneumothorax is detected. | |
Overall cardiac and mediastinal contours are stable. There has been some interval improvement in the bilateral airspace process suggesting improving moderate pulmonary edema. No large effusions are seen. No pneumothorax is appreciated. Several rounded opacities overlying the stomach and in the right upper quadrant may ... | |
Single portable upright view of the chest. The lungs are clear of large confluent consolidation. There is no pulmonary vascular congestion. The cardiac silhouette is slightlty enlarged, likely accentuated by technique with component of cardiomegaly. Blunting of the left lateral costophrenic angle could be due to atelec... | |
A right-sided central venous catheter terminates just below the cavoatrial junction. The cardiomediastinal and hilar contours are within normal limits and stable. The heart is normal in size. Scattered opacities in both lungs are improved from the prior study. No pleural effusion or pneumothorax is identified. | |
AP portable view of the chest and upper abdomen. This exam is limited due to positioning of the patient. Low lung volumes. A new retrocardiac opacity may represent atelectasis or pneumonia. The cardiomediastinal and hilar contours are grossly stable. No large pleural effusion. No pneumothorax. | |
In comparison with study of ___, with the right chest tube on water seal there is no evidence of pneumothorax. The right Swan-Ganz catheter has been exchanged for a sheath that extends to the mid portion of the SVC. Substantial enlargement of the cardiac silhouette with some elevation in pulmonary venous pressure. Opac... |
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