itsanmolgupta/mimic-cxr-dataset · Datasets at Fast360

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	Frontal radiograph of the chest shows stable bilateral alveolar opacities with unchanged ECMO catheter, endotracheal tube, and enteric tube. No pneumothorax is appreciated.	Unchanged appearance of lung parenchyma with no evidence of pneumothorax.
	Frontal radiograph of the chest demonstrates unchanged monitoring and support devices. m. Otherwise, there is no change in the severe bilateral alveolar opacities. No contralateral pneumothorax is seen.	No change in left pneumothorax or bilateral opacities.
	Single portable upright chest radiograph demonstrate cardiomegaly. Heart size appears slightly increased compared to prior study, though this may be exaggerated by low lung volumes. Faint bibasilar opacifications may represent combination of atelectasis and portable technique. No opacification concerning for pneumonia. No pleural effusions or pneumothorax evident.	No acute cardiopulmoanry process.
	AP upright portable chest radiograph obtained. An AICD device is unchanged with lead tips extending to the right atrium and right ventricular regions. The heart remains mildly enlarged. While the lung volumes are low, the lungs appear grossly clear without large consolidation, effusion, or pneumothorax. Bony structures are intact.	Limited, negative.
	Left-sided pacemaker/AICD device is noted with leads terminating in the right atrium and right ventricle. Low lung volumes are present. There is mild enlargement of the cardiac silhouette which is unchanged. Mediastinal and hilar contours are stable. Bibasilar interstitial opacities are re- demonstrated, compatible with chronic interstitial lung disease. No large pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.	Low lung volumes with bibasilar interstitial opacities compatible with chronic interstitial lung disease.
	There are no new focal opacities. The extent of peribronchial ground glass infiltration seen on the CT from is not expected to be seen on the radiograph. There is a small stable left pleural effusion. There is no pneumothorax. The right-sided IJL ends in the mid SVC. The left sided pacemaker and AICD leads end in the right atrium and right ventricle respectively. Mildly cardiomegaly is stable. The hilar and mediastinal contours are otherwise normal.	No acute interval changes to suggest pneumonia.
	The heart is normal in size. The mediastinal and hilar contours appear unchanged. The lungs appear clear. There are no pleural effusions or pneumothorax.	No evidence of acute disease.
	Otherwise, there is no relevant change. Enteric tube courses below the diaphragm and out of view.	No other relevant change.
	Single upright view of the chest provided. There is no focal consolidation, effusion, or pneumothorax. There is mild pulmonary vascular congestion and mild asymmetric pulmonary edema in the left lung. Prominence of the left hilum is similar to prior. The patient is status post right upper lobectomy. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.	No pneumonia. There is mild asymmetric pulmonary edema in the left lung.
	Supine portable chest radiograph obtained. Lung volumes are low, though there is no definite consolidation, or supine evidence of effusion or pneumothorax. The heart and mediastinal contours are grossly unremarkable. The bony structures appear intact. Moderate gaseous distention of the stomach is noted.	No acute abnormality.
	There is a focal opacity obscuring the right heart border. The heart is markedly enlarged without overt pulmonary edema. Atherosclerotic calcifications of the aortic arch are noted. There is no large pleural effusion or pneumothorax.	Right middle lobe opacity obscuring the right heart border which may reflect consolidation in the appropriate clinical setting. Marked cardiomegaly without overt edema.
	An NG tube is noted to be terminating in the mid esophagus. There is a large right-sided dense consolidation occupying the upper of the lung. In the lower third of the lungs, there is more patchy consolidation. There are also patchy left lower lobe opacities. No definitive pleural effusion on the left; a small one may be present on the right.	Endotracheal tube in appropriate position. NG tube terminating in the mid esophagus. Recommend repositioning/advancement so that it is well within in the stomach. Multifocal consolidations, worst in the right upper lobe.
	Semi-upright portable view of the chest demonstrates low lung volumes, which accentuate bronchovascular markings. There is a small left pleural effusion. Left basilar opacities are noted. Mild perihilar vascular congestion is noted. Otherwise, hilar and mediastinal silhouettes are unremarkable. Heart size is normal. Right internal jugular central venous catheter tip projects over mid SVC.	Small left pleural effusion. Perihilar vascular congestion. Bibasilar opacities, likely atelectasis, however, superimposed infection cannot be excluded.
	A single frontal portable view of the chest was performed. There is no pleural effusion or pneumothorax. Opacification at the left lung base is new from the prior study. The cardiac and mediastinal contours are normal. The hilar structures and pleural surfaces are unremarkable. The imaged upper abdomen is grossly unremarkable.	New opacification of the left low lung raises concern for possible aspiration.
	Trauma board and other overlying material limits evaluation of fine bony detail. The lungs are low in volume but otherwise clear without focal consolidation, pleural effusion or pneumothorax. The heart is normal in size, normal cardiomediastinal silhouette. No definite fractures are seen.	No acute intrathoracic process.
	As compared to chest x-ray from earlier same day, there is improved aeration of the left upper lobe. There is persistent left lower lobe collapse with associated effusion. Endotracheal tube and nasogastric tube in similar position. Minimal subsegmental atelectasis in the right lower lobe.	Slight improved aeration of the left upper lobe when compared to the prior.
	Unchanged appearance of severe infiltrative pulmonary abnormality, right greater than left, since . The previously noted bilateral pleural effusions, right greater than left, are mildly improved since . Heart size is unchanged. Mild leftward tracheal deviation may be due to thyroid enlargement. A left central venous line is in unchanged position. No pneumothorax.	Unchanged appearance of severe infiltrative pulmonary abnormality, right greater than left, since . Mild improvement of previously noted bilateral pleural effusions, right larger than left, since .
	Diffuse, right greater than left opacities are increased. No large pleural effusion. Heart size is normal. Cardiomediastinal silhouette is not well evaluated. Dense aortic arch calcifications are noted. A left PICC terminates in the right atrium.	D.
	AP portable semi supine view of the chest. A left upper extremity access PICC line is seen with its tip in the region of the lower SVC. Extensive bilateral pulmonary opacities concerning for pneumonia. Difficult to exclude a component of edema. No large effusion or pneumothorax is seen. Overall heart size appears relatively normal. Mediastinal contour is prominent likely due to supine position. Bony structures are intact.	Extensive bilateral pulmonary opacities concerning for multifocal pneumonia, likely with a component of edema. PICC line positioned with its tip in the low SVC.
	The lung volumes are normal. There are several bilateral ill-defined opacities which likely correspond to postprocedural hemorrhage. Mild-to-moderate bibasilar atelectasis. When compared to PA chest radiograph from the cardiomediastinal contours appear larger, however this could be exaggerated by AP technique. No pleural effusions. No pneumothoraces. The left pacemaker is intact with leads terminating in the appropriate positions. Median sternotomy wires are intact.	No pneumothorax. Bilateral ill-defined opacities likely secondary to post procedural hemorrhages.
	There is substantial cardiomegaly. A left lower lobe opacity is overall unchanged from the prior exam. There is likely a small right pleural effusion, which is unchanged. There is no evidence of pneumothorax. No other significant change from the prior study.	Left lower lobe opacity not significantly changed. No significant change from the prior exam.
	Comparison is made to prior study from . There is a right-sided central venous catheter with distal lead tip in the mid right atrium. The cardiac silhouette is upper limits of normal. There are airspace opacities bilaterally, most confluent in the left mid lung field. This may represent underlying infiltrate. There is also an infiltrate at the right base laterally, which appears stable. There are no signs for overt pulmonary edema. There are no pneumothoraces. The distal tip of the endotracheal tube is not included on the field of view of the study that cuts off the lung bases.	Bilateral opacities more confluent in the left lung.
	There has been significant interval improvement in the right basal opacity with minimal residual airspace opacity. Given the rapid change, this likely reflects area pulmonary edema. Prominence of the bilateral hila has slightly improved. Unchanged left lower lobe atelectasis. Probable mild cardiomegaly.	Interval improvement in the right basal parenchymal opacity, nearly resolved. Given the rapid interval improvement this likely represented pulmonary edema.
	Low lung volumes. Cardiac size is top-normal . The lungs are grossly clear there are minimal right lower atelectasis. The main pulmonary artery is slightly enlarged. There is no pneumothorax or effusion	No pulmonary edema
	Supine portable AP view of the chest was provided. The NG tube courses into the left upper abdomen, tip excluded from view. There is consolidation at the left lung base which likely represents a combination of effusion and possibly aspiration/atelectasis. The right lung appears grossly clear. Heart size cannot be readily assessed. Mediastinal contour appears normal. A right humeral head replacement is noted. Degenerative changes are severe at the left glenohumeral joint.	ET and NG tubes positioned appropriately. Opacity at the left lung base likely reflects atelectasis, aspiration, and effusion.
	Portable AP upright chest radiograph obtained. The lungs are clear bilaterally. No pneumothorax or signs of pneumomediastinum. Heart and cardiomediastinal contour is normal. Bony structures are intact. No free air below the right hemidiaphragm.	No acute intrathoracic process.
	Supine portable AP view of the chest was provided. An NG tube is seen extending along the midline with its tip coiled in the distal esophagus and the distal tip extending cephalexin in the mid esophagus region. This positioning is unchanged from prior exam. Please advance for more optimal positioning. Since the prior exam, there is again noted to be extensive pulmonary airspace consolidation, slightly more confluent in the right lung, concerning for pneumonia. Air bronchograms are noted in the left lower lobe. Bony structures are intact. The possibility of pulmonary edema is also raised. No large effusions are seen. Old right clavicular deformity noted.	Endotracheal tube positioned appropriately. Malpositioned nasogastric tube with tip coiled in the distal esophagus. Please advance for more optimal positioning. Diffuse pulmonary airspace consolidation concerning for pneumonia and/or pulmonary edema. Findings posted and flagged to ED dashboard at the time of this dictation.
	The right internal jugular central venous catheter still ends in mid SVC. 5cm above the carina is in standard position. An upper enteric tube passes into the stomach and out of view. Perihilar opacification, right greater than left is unchanged as is mild edema. There is no large pleural effusion or pneumothorax.	Bilateral perihilar opacification and mild edema are unchanged. Endotracheal tube and other lines in appropriate position.
	Low left lung volume with new elevation of the left hemidiaphragm. Linear bands at the left base likely reflect basilar atelectasis. Normal cardiomediastinal contours. Mild right convex thoracic scoliosis. Normal hilar contours. There is new engorgement and indistinctness of the pulmonary vasculature, consistent with moderate pulmonary edema. There is no pneumothorax or pleural effusion.	New, moderate pulmonary edema.
	Single portable chest radiograph is provided. The patient is status post esophageal pull-through procedure, which results in the opacity adjacent to the right mediastinal border. No evidence of pneumomediastinum. The lungs are clear without focal consolidation, pleural effusion or pneumothorax. The heart size is normal.	No evidence of pneumomediastinum status post esophageal dilation.
	No significant interval change from radiograph. Persistent large fluid-filled neoesophagus. Likely small bilateral pleural effusions and left lower lobe atelectasis are unchanged. No new focal opacity or pulmonary edema. No pneumothorax. Heart size, left mediastinal contour and left hilus are normal. No bony abnormality.	No interval change from . Persistent large fluid-filled neoesophagus. Results were conveyed via telephone to by Dr. m. within five minutes of observation of findings.
	The heart is normal in size. The patient is status post gastric pull-up with parenchymal opacification demonstrated over the lower mediastinal contour on the right, as before. There are diffuse reticular, interstitial opacities, particularly at the left base which likely reflect edema. There is some increased perihilar fullness, particularly on the left which is consistent with volume overload.	Diffuse, interstitial opacities, predominantly at the left base likely refect pulmonary edema, however superimposed infection/ aspiration should be considered given the clinical history.
	Single AP view of the chest demonstrates mild-to-moderate cardiomegaly, accentuated by AP projection. The lungs are relatively well expanded. There is pulmonary vascular congestion and mild interstitial edema. No pneumothorax. Small effusions cannot be excluded. Moderate right greater than left glenohumeral osteoarthritis is present.	Moderate cardiomegaly and mild pulmonary edema.
	Portable upright chest radiograph demonstrates an endotracheal tube with its tip at the level of the clavicular heads. An NG tube passes through the stomach, and a right subclavian central venous catheter tip is at the cavoatrial junction. There is an interval decrease in lung volumes; small bilateral pleural effusions and bibasilar atelectasis is mild and increased. The cardiac silhouette is enlarged and unchanged. The mediastinal contours are little changed. Pulmonary vasculature is normal and improved.	Interval decrease in lung volumes with increase in bibasilar atelectasis and small bilateral pleural effusions, although edema has improved.
	An NG tube is in place, its tip is not seen below the inferior margin of the film. An esophageal temperature probe is in place. A right subclavian central venous catheter tip is located at the cavoatrial junction. The lungs are clear, with somewhat low lung volumes. There is no pleural effusion or pneumothorax. The cardiac silhouette and mediastinal contours are unchanged.	No acute chest abnormality.
	Given differences in positioning and technique, there has been no significant interval change. Bibasilar opacities are most likely due to superimposed soft tissue structures and overlying material. Superiorly the lungs are clear. The cardiomediastinal silhouette is stable. Leftward deviation of the trachea at the thoracic inlet is suggestive of underlying right-sided thyroid enlargement. Calcification suggesting intra-articular bodies project over the glenohumeral joints.	No acute cardiopulmonary process. Leftward deviation of the trachea at the thoracic inlet as on prior suggestive right thyroid enlargement which can be further assessed by dedicated thyroid ultrasound.
	There is mild right basilar atelectasis. Right internal jugular central venous catheter ends at or just below the cavoatrial junction. There is no focal consolidation. There is no pleural effusion or pneumothorax. There is a slight increase in density in the right paratracheal area which may represent mild bleeding from line placement. The heart size is normal.	Right IJ ends either at or just below the superior cavoatrial junction. Slight increase in density in the right paratracheal mediastinum may represent mild bleeding from line placement. Attention on follow up. Right basilar atelectasis. No focal consolidation.
	Linear opacity at the right base likely represents atelectasis. No consolidation, pleural effusion, pneumothorax, or pulmonary edema is detected on this single view. Heart and mediastinal contours are stable. Patulous esophagus is again noted.	No radiographic evidence for acute cardiopulmonary process on this single frontal view.
	Compared to the prior study there is no significant interval change.	No change.
	Lung volumes are low but improved since the next most recent radiograph. Bibasilar atelectasis is worse on the left but unchanged on the right. There is likely a new small left pleural effusion. The cardiomediastinal silhouette and hilar contours are normal. There is no pneumothorax. An NG tube terminates in the stomach.	Bibasilar atelectasis is worse on the left and unchanged on the right. A new small left pleural effusion is likely present. There are no focal airspace opacities to suggest pneumonia. The above results were communicated via telephone by Dr. to Dr. m. on .
	The NG tube terminates in the fundus of the stomach. Surgical project over the midline abdomen. Lung volumes are low and the bibasilar atelectasis is mild. The heart may be mildly enlarged however this is exaggerated by the low lung volumes. The mediastinum is normal. There is no pneumothorax or large pleural effusion.	The NG tube terminates in the fundus of the stomach. Lung volumes are low and bibasilar atelectasis is mild.
	Again seen is a right pneumothorax, slightly increased in size compared to , which may be due to expiratory phase at which current study was taken. There is a small right pleural effusion, consistent with history of interval talc pleurodesis. Right-sided pigtail catheter is again seen, slightly superior in position compared to the prior exam.	Persistent small right pneumothorax, may appear larger due to expiratory phase. New pleural effusion, likely due to interval top pleurodesis. Apparent change and pigtail catheter. Please correlate clinically. with Dr.
	Compared with most recent prior radiograph, the lung volumes are lower. A moderate right pleural effusion is unchanged. Moderate left pleural effusion layers posteriorly in somewhat different distribution, likely related to positioning. Retrocardiac consolidation is likely compressive atelectasis. Heart size is unchanged.	Moderate bilateral pleural effusions with retrocardiac consolidation, likely compressive atelectasis. Telephone notification to Dr. by Dr. m. on .
	This exam is severely limited by suboptimal positioning. A right PICC terminates at the lower SVC. Small bilateral pleural effusions are suggested, appearing new since . No definite consolidation is detected. No large pneumothorax is seen.	Limited evaluation due to suboptimal positioning. Repeat radiographs should be performed with improved posture. Equivocal small bilateral pleural effusions.
	Interval removal of the ETT and right IJ. Stable bilateral lower lung volumes, with expected slightly increased bibasilar atelectasis status-post ETT removal. New small bilateral pleural effusions, slightly greater on the left compared to the right, since . Otherwise, no focal consolidation, overt pulmonary edema, or pneumothorax. The cardiomediastinal silhouette is overall unchanged. The moderate hiatal hernia is also unchanged.	New small bilateral pleural effusions since . Expected post-extubation bibasilar atelectasis.
	AP portable supine view of the chest. A right IJ central venous catheter tip is positioned in the region of the low SVC. Lung volumes are low limiting assessment. No large consolidation or supine evidence for effusion or pneumothorax. Mediastinal contour is difficult to assess due to rotation. Bony structures are grossly intact. Degenerative changes are partially noted in the lumbar spine.	Right IJ central venous catheter and endotracheal tube positioned appropriately.
	A right sided IJ line ends in the upper to mid SVC. A right-sided PICC ends in the lower SVC. There is no evidence of pneumothorax. No focal opacities concerning for pneumonia identified. There is no pleural effusion or pneumothorax. A vague opacity in the right costophrenic angle is likely artifactual due to positioning. Cardiomediastinal and hilar contours are unremarkable.	Supportive devices are in appropriate position. No focal parenchymal opacity. No evidence of pneumothorax.
	New esophageal ube loops and ends within the thorax, likely within a large hiatal hernia. Otherwise there is no significant change compared with the previous exam. A right sided IJ line ends in the upper to mid SVC. A right-sided PICC ends in the lower SVC. There is no evidence of pneumothorax. No focal opacities concerning for pneumonia identified. No pleural effusion is identified. Previous right costophrenic angle vague opacity has cleared and it was most likely due to positioning. There is no pneumothorax. Cardiomediastinal and hilar contours are unremarkable.	New esophageal tube ends above the diaphragm, likely within a large hiatal hernia. Otherwise unchanged from recent exam. No evidence of pleural effusion or pneumothorax.
	Nasogastric tube is seen below the diaphragmwith tip in at least distal stomach. . A left-sided internal jugular central venous catheter with tip tip in the upper upper superior vena cava. Right-sided internal jugular venous catheter with tip likely at the confluence of the brachiocephalic veins. Endotracheal tube is in standard position. There has been interval minimal decreased in size of the right pleural effusion, now moderate in size with overall improved aeration of the right lung base. Large left effusion is probably stable in size, though assessment difficult given increased retrocardiac opacification, likely due to worsened collapse.	Well-positioned nasogastric tube. Minimally improved right pleural effusion now small in size. Stable large left pleural effusion. Increased left lower lobe collapse.
	Right subclavian catheter tip terminates in the lower SVC. Cardiac size is normal. The lungs are clear. There is no pneumothorax or pleural effusion.	No evidence of pneumonia.
	There is mild cardiomegaly and a large hernia containing stomach causing streak-like atelectatic change at the right lower lobe. Incidental note is made of an azygos lobe at the right side. No pleural effusion and no pneumothorax.	No acute cardiothoracic process. Large hiatal hernia containing at least stomach.
	Two frontal images of the chest demonstrate well-expanded lungs, which are generally clear with some slight atelectatic changes at the lung bases. There is no pneumothorax or pleural effusion. Cardiomediastinal silhouette is unchanged. Again seen is a large hiatal hernia containing stomach elevating the lower lobe of the right lung.	No acute pulmonary process seen. Unchanged chest radiograph.
	The lungs are hyperinflated. No focal consolidation is identified. The cardiomediastinal silhouette and hilar contours are normal. Calcifications of the costochondral cartilage is present. There is no pleural effusion or pneumothorax.	No acute cardiopulmonary process.
	The patient is status post median sternotomy and CABG. The cardiac silhouette size is normal. Mediastinal and hilar contours are unchanged. There is mild interstitial pulmonary edema. Small to moderate pleural effusions appear similar compared to the prior exams. Bibasilar airspace opacities likely reflect compressive atelectasis. Scarring within the lung apices is re- demonstrated. No pneumothorax is present. No acute osseous abnormalities are demonstrated.	Mild pulmonary edema and small to moderate size bilateral pleural effusions. Bibasilar airspace opacities likely reflecting atelectasis.
	Portable single frontal chest x-ray was performed with the patient in upright position. Compared to earlier study, there has been no significant interval change in the moderate bilateral pleural effusions and associated bibasilar atelectasis. Lung volumes are low. The heart remains moderately enlarged. There is no pneumothorax or pulmonary edema. A left subclavian central line has been removed. Median sternotomy wires are intact.	No interval change in the appearance of the heart and lungs.
	Single portable AP chest radiograph was provided. There is prominence of the upper zone vessels, compatible with pulmonary congestion, increased since the recent prior exam. Again seen are layering moderate-sized bilateral pleural effusions with associated compressive atelectasis. Nodular opacities in the right apex are unchanged. Median sternotomy wires are intact.	Pulmonary vascular congestion. Moderate layering pleural effusions, similar to prior study.
	There is no consolidation, pleural effusion, or pneumothorax. Cardiomediastinal and hilar silhouettes are normal size.	No acute cardiopulmonary process.
	A metallic stent is seen within the expected region of the bronchus intermedius, new compared to the prior study. There has been interval collapse of the right upper lobe. Minimal bibasilar atelectasis is not significantly changed. The heart size is normal. No definite pleural effusions are seen. There is no pneumothorax.	No pneumothorax. New collapse of the right upper lobe status post stenting of the bronchus intermedius. Upon discussion with the patient's physician, . , was explained that the stent needed to be positioned in such a way that it excluded the right upper lobe bronchus.
	As compared to prior radiograph, there has been an overall decrease of inspiratory lung volumes with apparent increase of radiodensity throughout lungs bilaterally. There has been interval improvement of multilobar opacities along both lungs. No new consolidations are identified. There is no pneumothorax. There has been interval removal of right main stem bronchus stent. Tracheostomy tube has a vertical course, no tube component that clearly reaches down the trachea is identified.	Interval improvement of multilobar opacities bilaterally with no evidence of pneumothorax. Tracheostomy tube demonstrates a vertical course with no evidence of tube component reaching down the trachea.
	A tracheostomy tube is appropriately positioned. An enteric catheter is visualized only to the level of the thoracic inlet, likely obscured more distally due to underpenetration of this radiograph. A metallic stent within the right main stem bronchus appears appropriately positioned. A left internal jugular central venous catheter ends at the confluence of the brachiocephalic veins, not significantly changed. A right superior mediastinal mass extends to the right hilus, not significantly changed. Fluid within the minor fissure is increased. There is mild-to-moderate bibasilar atelectasis. Small layering pleural effusions may be present, not significantly changed. There is no pneumothorax. Mild cardiomegaly is not significantly changed.	Unchanged moderate bibasilar atelectasis. Possible small bilateral pleural effusions, not significantly changed. Mild cardiomegaly, not significantly changed. Incompletely assessed enteric catheter, only visualized to the level of the thoracic inlet. Recommend conventional PA and lateral radiographs on future studies to improve visualization.
	There are new bilateral lower lung heterogeneous opacities, left greater than right, highly concerning for multifocal pneumonia. There is a small right pleural effusion and probable small left pleural effusion. Mild enlargement of the cardiac silhouette is not significantly changed. The mediastinal contours are unchanged. There is no pneumothorax. Dextroscoliosis of the thoracolumbar spine is redemonstrated.	New bilateral lower lung opacities, concerning for multifocal pneumonia. Small right and likely small left pleural effusions.
	An enteric feeding tube is seen coursing below the diaphragm and out of view on this image. There is opacification of the left lung base obscuring the left costophrenic angle. The right lung base is clear. No significant pneumothorax is seen on this supine view. The cardiomediastinal and hilar contours are within normal limits.	Left basilar opacity potentially atelectasis, infection or aspiration. A small left pleural effusion is not excluded.
	The cardiomediastinal and hilar contours are within normal limits. Lungs are clear. There are no focal consolidations or pleural effusions. Mild elevation of the right hemidiaphragm is redemonstrated. A sclerotic focus on the left sixth anterior rib is again seen and is unchanged, previously described as a bone island on CT torso of .	No radiographic evidence of an acute cardiopulmonary process.
	AP portal view of the chest. There is no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal and hilar contours are normal.	No acute cardiopulmonary process.
	The lungs are hyperinflated, with flattening of the diaphragms, suggestive of emphysematous disease. Cardiomediastinal and hilar contours are unremarkable with the exception of extensive atherosclerotic calcifications of the thoracic aorta. Biapical pleural parenchymal scarring is present. There is no pleural effusion or pneumothorax. Calcifications in the right neck and right subclavicular region are likely vascular.	Lung hyperinflation compatible with emphysema. No focal parenchymal opacities to suggest pneumonia. Extensive atherosclerotic calcifications of the thoracic aorta as well as vessels within the right neck and right infraclavicular region is observed. NG tube has its tip at the gastroesophageal junction and the side port within the terminal esophagus. Advancement is recommended.
	No evidence of pneumothorax. Lung volumes are low causing expected vascular congestion status post surgery. No focal opacities are concerning for an infectious process. Bones are intact.	No evidence of pneumothorax.
	No focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac silhouette is top-normal to mildly enlarged. Mediastinal contours unremarkable. No pulmonary edema is seen.	Top-normal to mildly enlarged cardiac silhouette without pulmonary edema. No definite focal consolidation.
	The cardiac, mediastinal and hilar contours appear unchanged including mild cardiomegaly and calcification along the aortic arch. The central pulmonary vascularity shows upper zone redistribution with distinct but prominent vessels, similar to prior findings, suggesting pulmonary venous hypertension without congestive heart failure. A small hyperdense nodule projecting over the right mid lung is unchanged and suggests a granuloma. There is similar mild relative elevation of the right hemidiaphragm. There is no pleural effusion or pneumothorax. The patient is status post right shoulder hemiarthroplasty. Flattening and sclerosis have progressed along the left humeral head with corresponding effacement of the glenoid appears worse; findings could be seen with a history of avascular necrosis in the appropriate setting.	No evidence of acute cardiopulmonary disease. Increased flattening of the left humeral head, although likely a chronic process, possibly avascular necrosis.
	The lungs are well expanded. Bibasilar streaky opacities likely represent subsegmental atelectases. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax. An NG tube ends in the distal stomach.	No evidence of acute cardiopulmonary process. NG tube in appropriate position.
	AP portable upright view of the chest. Clips in the left neck base noted. Cardiomegaly is unchanged. No focal consolidation, effusion or pneumothorax. No convincing signs of edema. Mediastinal contour is stable with atherosclerotic calcifications along the aortic knob. No acute bony abnormality.	Stable cardiomegaly, otherwise unremarkable.
	A central venous catheter terminates at the cavoatrial junction. The cardiac, mediastinal and hilar contours appear stable. There is no pleural effusion or pneumothorax. The lungs appear clear.	No evidence of acute disease.
	Anterior cervical fixation hardware is redemonstrated. A right Port-A-Cath ends in the right atrium, as before. Pre-existing parenchymal opacities are increased from , particularly in the right lung base and possibly in the left lung base. There is unchanged background pulmonary interstitial edema. No large pleural effusion or pneumothorax is appreciated. The cardiomediastinal contours are within normal limits and unchanged.	Unchanged pulmonary edema. Concurrent right basilar pneumonia and possible multifocal infection involving the left lung base.
	Portable AP image of the chest. There has been interval placement of a right-sided chest tube which crosses the right lung base and impinges on the mediastinum. Haziness is seen in the right upper lung, which has an convex margin inferiorly and may represent loculated pleural effusion. No pneumothorax is seen. No dependent pleural fluid is seen. Opacities in the left lung base consistent with atelectasis. The cardiomediastinal silhouette is unremarkable.	Interval placement of right-sided chest tubes which cross the right lung base impinges and mediastinum. Haziness in the right upper lung, which may represent loculated pleural effusion. A lateral radiograph could be obtained to further evaluate this opacity.
	AP portable upright view of the chest. Clips in the soft tissues of the lower neck noted. Lung volumes are low limiting assessment. Allowing for this, the lungs appear clear. Cardiomediastinal silhouette appears grossly normal. Bony structures are intact. No free air below the right hemidiaphragm.	No acute findings. Limited exam.
	AP view of the chest provided. Left-sided subclavian line terminates in the mid SVC. Since prior study from earlier today, the degree of pulmonary edema has improved. Cardiomediastinal and hilar contours are normal. There are no pleural effusions. Focal stenosis of the upper trachea has been previously evaluated on chest CT from , and does not appear different compared to the scout images then. There is no pneumothorax.	Subclavian line in the mid SVC. No pneumothorax or mediastinal widening.
	Apparent slight enlargement of the cardiac silhouette in comparison to prior chest x-ray from likely relates to lower lung volumes and AP technique. The cardiomediastinal contours are otherwise stable and within normal limits, with unchanged aortic arch calcifications. The bilateral hila are unremarkable. The lungs are clear without focal consolidation. There is no evidence of pulmonary vascular congestion. There is no pneumothorax or pleural effusion.	No acute cardiopulmonary process.
	Moderate cardiomegaly is stable. Mild to moderate pulmonary edema is new. Right lower lobe opacities are likely atelectasis. There is pleural small right effusion. There is no evident pneumothorax. Catheter projects in the right upper quadrant of the abdomen	Mild to moderate pulmonary edema
	Both lungs are remarkable for diffuse, multifocal opacities predominantly in the lower lungs. Given clinical history, findings are concerning for multifocal pneumonia. There is probably a small left pleural effusion. Heart size, mediastinal and hilar contours are normal.	Multifocal pneumonia.
	The cardiac silhouette remains markedly enlarged. Mediastinal contours are stable there is likely a tortuous aorta. The right costophrenic angle is not completely included in the image. Given this, no pleural effusion is seen. There is no focal consolidation or evidence of pneumothorax.	Right costophrenic angle not completely included on the image; given this, no pleural effusion seen. Persistent enlargement of the cardiac silhouette without overt pulmonary edema.
	Lungs are well expanded and clear. There are no lung opacities of concern. Heart size, mediastinal and hilar contours are normal. There is no pneumothorax or pleural effusion. Left Port-A-Cath through the left internal jugular approach ends at lower SVC. No evidence of pneumothorax.	Left Port-A-Cath terminates at the level of lower SVC. No pneumothorax. Both lungs are clear.
	There has been interval placement of a right-sided catheter with pigtail projecting over the liver. A persistent moderate size right pneumothorax remains with continued leftward shift of mediastinal structures as seen on the chest CT scout. Increased subcutaneous emphysema in the right lateral chest wall is noted. Streaky opacities are noted in the right lung likely reflective of atelectasis. Low lung volumes are present which results in crowding of bronchovascular structures and left basilar atelectasis. Cardiac and mediastinal contours otherwise remain unchanged. Right lateral rib fractures are better assessed on the previous CT.	Interval placement of right-sided catheter with pigtail projecting over the liver. Persistent moderate size right pneumothorax with continued mild leftward shift of mediastinal structures. Patchy atelectasis in both lungs. Increased subcutaneous emphysema in the right lateral chest wall.
	Compared to the prior study there is no significant interval change.	No change.
	Portable AP chest radiograph. Left-sided IJ catheter tip is in the mid SVC. Median sternotomy wires are intact. Prosthetic aortic valve is in similar position. Lung volumes are still low with bibasilar atelectasis and a small pleural effusion on the right. However, there is no interstitial edema. The cardiomediastinal silhouette is stable.	Left-sided IJ catheter tip is in the mid SVC. Bibasilar atelectasis and small right pleural effusion.
	Lung volumes continue to be low, and mild bilateral effusions and interstitial edema have increased since . Heart size is normal and the lungs are clear of focal consolidation. Left IJ central venous line ends in the mid SVC, and the median sternotomy wires are intact. Right upper quadrant drainage catheter is seen in the abdomen.	Increasing bilateral pleural effusions and interstitial edema. No consolidation to suggest pneumonia.
	The heart is mild to moderately enlarged. The aortic arch is partly calcified. The mediastinal and hilar contours are otherwise unremarkable. There is no cephalization of pulmonary vascularity. Upper lung fields appear clear. There is a fine reticular abnormality which is fairly widespread in both visualized lower lobes and suggestive of a more chronic abnormality such as underlying interstitial lung disease or extensive scarring. An acute abnormality is felt more likely. Correlation to prior films could be helpful, if clinically indicated, to investigate further.	Reticulation in the lower lungs, probably chronic and suggestive of scarring or interstitial lung disease. If available, correlation with prior radiographs may be helpful if clinically indicated.
	Lung volumes are very low, resulting an bronchovascular crowding, and accentuation of the cardiac silhouette. Left basilar opacity may represent atelectasis, however aspiration or pneumonia could be considered in the appropriate clinical setting. No pneumothorax or pleural effusion. No acute displaced rib fracture.	Left basilar opacity may represent atelectasis, however aspiration or pneumonia could be considered in the appropriate clinical setting.
	There continues to be a pigtail catheter entering the right lower chest wall, with the pigtail in the right apical pleural space. A tiny pneumothorax persists along the right apex and along the right lateral chest wall. There is no evidence of diaphragmatic flattening or mediastinal shift. Otherwise, the cardiomediastinal contours and lungs are within normal limits. There is a small amount of right sided pleural fluid.	Continued tiny right apical lateral pneumothorax without evidence of tension.
	There appears to be interval improvement of the left large pleural effusion; however, this may be secondary to differences in positioning. Again seen is bibasilar atelectasis. There has been an interval increase in vascular congestion bilaterally. There is no pneumothorax. A right-sided PICC line appears to terminate in the mid SVC. The heart and mediastinal contours are otherwise unremarkable.	Interval increase in vascular congestion bilaterally. Slight improvement in the left pleural effusion/hemothorax, although this may be secondary to positioning and technique.
	The right-sided PIC line ends in the right atrium however the tip is not well seen on this exam. The left-sided chest tube abuts the mediastinum. There has been interval improvement of the large left-sided pleural effusion compared to the study from . The moderate right-sided pleural effusion appears stable compared to multiple prior studies dating back to at-least . Mild bibasilar atelectasis is also unchanged since . There are no focal consolidations. There is no pneumothorax. The heart and mediastinal contours are otherwise normal. There is an S-shaped scoliosis of the spine.	Interval improvement of the left-sided pleural effusion compared to the study from . . The tip of the PIC is not well seen on this exam.
	The right-sided PIC line terminates in the right atrium, however the tip is better delineated on this exam compared to the exam this morning. The left-sided chest tube abuts the mediastinum. There has been no change in the large left-sided pleural effusion compared to the study from earlier this morning. The moderate right-sided pleural effusion also appears stable compared to the exam from the same morning. Mild bibasilar atelectasis is also unchanged. There are no focal consolidations. There is no pneumothorax. The heart and mediastinal contours are otherwise normal.	These findings were discussed with Dr. m. by Dr. on the day of the exam by telephone.
	There is a new right PICC with the tip in the the superior cavoatrial junction. There is no pneumothorax. Lung volumes remain low. Increased pulmonary vascular congestion persists. Focal parenchymal opacities again noted at the right base and appears stable, representing either pneumonia or asymmetric edema. Small bilateral pleural effusions are present. Heart appears stably enlarged. Heavy aortic arch calcifications are again noted. Dextroscoliosis of the thoracic spine is stable.	Right PICC with tip in the superior cavoatrial junction. Again noted is moderate pulmonary edema with a right basilar opacity which may represent pneumonia or asymmetric edema. Cardiomegaly. These findings were discussed by Dr. with Dr.
	Cardiomegaly is noted with pulmonary edema and trace pleural effusions, right greater than left. No pneumothorax. Bony structures intact. Degenerative AC joint arthropathy.	Findings compatible with congestive heart failure.
	There has been interval decrease in the amount of vascular plethora. The heart continues to be mildly enlarged. There small bilateral effusions. There is volume loss at the bases.	Slight improvement in fluid status.
	The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silouhettes are unremarkable. There is a chronic deformity of the right clavicle presumably from prior healed fracture.	No acute cardiopulmonary process.
	PA and lateral views of the chest were provided. Lungs are clear bilaterally without focal consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette appears normal. Imaged osseous structures are intact. No free air is seen below the right hemidiaphragm.	No acute intrathoracic process.
	AP portable single view chest x-ray in upright position shows stable right subclavian PICC with tip in lower SVC. Lung volume is normal without consolidation or nodules suspicious for pneumonia. Cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax.	No pneumonia.
	Right internal jugular central venous catheter terminates in the low SVC. The lungs are normally expanded and clear. The heart is not enlarged. The mediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax.	No evidence of acute cardiopulmonary abnormality.
	The cardiac silhouette is indistinct. Hazy perihilar opacities and ill-defined pulmonary vascular markings are consistent with pulmonary edema. Blunting of the costophrenic angles and basilar opacities are compatible with moderate-sized pleural effusions and bibasilar atelectasis. Narrowing of the right acromiohumeral interval is consistent with rotator cuff injury. Deformity of the distal right clavicle is compatible with a prior injury at this location. Leads of a right chest wall pacer terminate over the right atrium and ventricle.	Pulmonary edema with moderate-sized bilateral pleural effusions and atelectasis.
	Pulmonary vasculature is less dilated and there is less pulmonary edema than on prior exam. There is a right pleural effusion. There is plate atelectasis in the left mid zone. The right ventricle pacer wire passes in a supero-oblique direction within the heart instead the usual infero-oblique direction. There is no pneumothorax. Heart size cannot be assessed due to bilateral bibasilar opacities. There is a possibility that there an underlying pneumonia hidden by the pleural effusion and pulmonary edema. Recommend followup imaging as the edema clears.	Right pleural effusion. Left basilar plate atelectasis. Improving pulmonary edema. Recommend followup chest imaging to rule out pneumonia after pulmonary edema has cleared.
	Lung volumes are slightly lower than on the prior exam. There compressive changes at the bases versus early infiltrates. Otherwise the appearance of the lungs are unchanged	Volume loss versus early infiltrates in the lower lobes

Frontal radiograph of the chest shows stable bilateral alveolar opacities with unchanged ECMO catheter, endotracheal tube, and enteric tube. No pneumothorax is appreciated.

Unchanged appearance of lung parenchyma with no evidence of pneumothorax.

Frontal radiograph of the chest demonstrates unchanged monitoring and support devices. m. Otherwise, there is no change in the severe bilateral alveolar opacities. No contralateral pneumothorax is seen.

No change in left pneumothorax or bilateral opacities.

Single portable upright chest radiograph demonstrate cardiomegaly. Heart size appears slightly increased compared to prior study, though this may be exaggerated by low lung volumes. Faint bibasilar opacifications may represent combination of atelectasis and portable technique. No opacification concerning for pneumonia. No pleural effusions or pneumothorax evident.

No acute cardiopulmoanry process.

AP upright portable chest radiograph obtained. An AICD device is unchanged with lead tips extending to the right atrium and right ventricular regions. The heart remains mildly enlarged. While the lung volumes are low, the lungs appear grossly clear without large consolidation, effusion, or pneumothorax. Bony structures are intact.

Limited, negative.

Left-sided pacemaker/AICD device is noted with leads terminating in the right atrium and right ventricle. Low lung volumes are present. There is mild enlargement of the cardiac silhouette which is unchanged. Mediastinal and hilar contours are stable. Bibasilar interstitial opacities are re- demonstrated, compatible with chronic interstitial lung disease. No large pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.

Low lung volumes with bibasilar interstitial opacities compatible with chronic interstitial lung disease.

There are no new focal opacities. The extent of peribronchial ground glass infiltration seen on the CT from is not expected to be seen on the radiograph. There is a small stable left pleural effusion. There is no pneumothorax. The right-sided IJL ends in the mid SVC. The left sided pacemaker and AICD leads end in the right atrium and right ventricle respectively. Mildly cardiomegaly is stable. The hilar and mediastinal contours are otherwise normal.

No acute interval changes to suggest pneumonia.

The heart is normal in size. The mediastinal and hilar contours appear unchanged. The lungs appear clear. There are no pleural effusions or pneumothorax.

No evidence of acute disease.

Otherwise, there is no relevant change. Enteric tube courses below the diaphragm and out of view.

No other relevant change.

Single upright view of the chest provided. There is no focal consolidation, effusion, or pneumothorax. There is mild pulmonary vascular congestion and mild asymmetric pulmonary edema in the left lung. Prominence of the left hilum is similar to prior. The patient is status post right upper lobectomy. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.

No pneumonia. There is mild asymmetric pulmonary edema in the left lung.

Supine portable chest radiograph obtained. Lung volumes are low, though there is no definite consolidation, or supine evidence of effusion or pneumothorax. The heart and mediastinal contours are grossly unremarkable. The bony structures appear intact. Moderate gaseous distention of the stomach is noted.

No acute abnormality.

There is a focal opacity obscuring the right heart border. The heart is markedly enlarged without overt pulmonary edema. Atherosclerotic calcifications of the aortic arch are noted. There is no large pleural effusion or pneumothorax.

Right middle lobe opacity obscuring the right heart border which may reflect consolidation in the appropriate clinical setting. Marked cardiomegaly without overt edema.

An NG tube is noted to be terminating in the mid esophagus. There is a large right-sided dense consolidation occupying the upper of the lung. In the lower third of the lungs, there is more patchy consolidation. There are also patchy left lower lobe opacities. No definitive pleural effusion on the left; a small one may be present on the right.

Endotracheal tube in appropriate position. NG tube terminating in the mid esophagus. Recommend repositioning/advancement so that it is well within in the stomach. Multifocal consolidations, worst in the right upper lobe.

Semi-upright portable view of the chest demonstrates low lung volumes, which accentuate bronchovascular markings. There is a small left pleural effusion. Left basilar opacities are noted. Mild perihilar vascular congestion is noted. Otherwise, hilar and mediastinal silhouettes are unremarkable. Heart size is normal. Right internal jugular central venous catheter tip projects over mid SVC.

Small left pleural effusion. Perihilar vascular congestion. Bibasilar opacities, likely atelectasis, however, superimposed infection cannot be excluded.

A single frontal portable view of the chest was performed. There is no pleural effusion or pneumothorax. Opacification at the left lung base is new from the prior study. The cardiac and mediastinal contours are normal. The hilar structures and pleural surfaces are unremarkable. The imaged upper abdomen is grossly unremarkable.

New opacification of the left low lung raises concern for possible aspiration.

Trauma board and other overlying material limits evaluation of fine bony detail. The lungs are low in volume but otherwise clear without focal consolidation, pleural effusion or pneumothorax. The heart is normal in size, normal cardiomediastinal silhouette. No definite fractures are seen.

No acute intrathoracic process.

As compared to chest x-ray from earlier same day, there is improved aeration of the left upper lobe. There is persistent left lower lobe collapse with associated effusion. Endotracheal tube and nasogastric tube in similar position. Minimal subsegmental atelectasis in the right lower lobe.

Slight improved aeration of the left upper lobe when compared to the prior.

Unchanged appearance of severe infiltrative pulmonary abnormality, right greater than left, since . The previously noted bilateral pleural effusions, right greater than left, are mildly improved since . Heart size is unchanged. Mild leftward tracheal deviation may be due to thyroid enlargement. A left central venous line is in unchanged position. No pneumothorax.

Unchanged appearance of severe infiltrative pulmonary abnormality, right greater than left, since . Mild improvement of previously noted bilateral pleural effusions, right larger than left, since .

Diffuse, right greater than left opacities are increased. No large pleural effusion. Heart size is normal. Cardiomediastinal silhouette is not well evaluated. Dense aortic arch calcifications are noted. A left PICC terminates in the right atrium.

D.

AP portable semi supine view of the chest. A left upper extremity access PICC line is seen with its tip in the region of the lower SVC. Extensive bilateral pulmonary opacities concerning for pneumonia. Difficult to exclude a component of edema. No large effusion or pneumothorax is seen. Overall heart size appears relatively normal. Mediastinal contour is prominent likely due to supine position. Bony structures are intact.

Extensive bilateral pulmonary opacities concerning for multifocal pneumonia, likely with a component of edema. PICC line positioned with its tip in the low SVC.

The lung volumes are normal. There are several bilateral ill-defined opacities which likely correspond to postprocedural hemorrhage. Mild-to-moderate bibasilar atelectasis. When compared to PA chest radiograph from the cardiomediastinal contours appear larger, however this could be exaggerated by AP technique. No pleural effusions. No pneumothoraces. The left pacemaker is intact with leads terminating in the appropriate positions. Median sternotomy wires are intact.

No pneumothorax. Bilateral ill-defined opacities likely secondary to post procedural hemorrhages.

There is substantial cardiomegaly. A left lower lobe opacity is overall unchanged from the prior exam. There is likely a small right pleural effusion, which is unchanged. There is no evidence of pneumothorax. No other significant change from the prior study.

Left lower lobe opacity not significantly changed. No significant change from the prior exam.

Comparison is made to prior study from . There is a right-sided central venous catheter with distal lead tip in the mid right atrium. The cardiac silhouette is upper limits of normal. There are airspace opacities bilaterally, most confluent in the left mid lung field. This may represent underlying infiltrate. There is also an infiltrate at the right base laterally, which appears stable. There are no signs for overt pulmonary edema. There are no pneumothoraces. The distal tip of the endotracheal tube is not included on the field of view of the study that cuts off the lung bases.

Bilateral opacities more confluent in the left lung.

There has been significant interval improvement in the right basal opacity with minimal residual airspace opacity. Given the rapid change, this likely reflects area pulmonary edema. Prominence of the bilateral hila has slightly improved. Unchanged left lower lobe atelectasis. Probable mild cardiomegaly.

Interval improvement in the right basal parenchymal opacity, nearly resolved. Given the rapid interval improvement this likely represented pulmonary edema.

Low lung volumes. Cardiac size is top-normal . The lungs are grossly clear there are minimal right lower atelectasis. The main pulmonary artery is slightly enlarged. There is no pneumothorax or effusion

No pulmonary edema

Supine portable AP view of the chest was provided. The NG tube courses into the left upper abdomen, tip excluded from view. There is consolidation at the left lung base which likely represents a combination of effusion and possibly aspiration/atelectasis. The right lung appears grossly clear. Heart size cannot be readily assessed. Mediastinal contour appears normal. A right humeral head replacement is noted. Degenerative changes are severe at the left glenohumeral joint.

ET and NG tubes positioned appropriately. Opacity at the left lung base likely reflects atelectasis, aspiration, and effusion.

Portable AP upright chest radiograph obtained. The lungs are clear bilaterally. No pneumothorax or signs of pneumomediastinum. Heart and cardiomediastinal contour is normal. Bony structures are intact. No free air below the right hemidiaphragm.

No acute intrathoracic process.

Supine portable AP view of the chest was provided. An NG tube is seen extending along the midline with its tip coiled in the distal esophagus and the distal tip extending cephalexin in the mid esophagus region. This positioning is unchanged from prior exam. Please advance for more optimal positioning. Since the prior exam, there is again noted to be extensive pulmonary airspace consolidation, slightly more confluent in the right lung, concerning for pneumonia. Air bronchograms are noted in the left lower lobe. Bony structures are intact. The possibility of pulmonary edema is also raised. No large effusions are seen. Old right clavicular deformity noted.

Endotracheal tube positioned appropriately. Malpositioned nasogastric tube with tip coiled in the distal esophagus. Please advance for more optimal positioning. Diffuse pulmonary airspace consolidation concerning for pneumonia and/or pulmonary edema. Findings posted and flagged to ED dashboard at the time of this dictation.

The right internal jugular central venous catheter still ends in mid SVC. 5cm above the carina is in standard position. An upper enteric tube passes into the stomach and out of view. Perihilar opacification, right greater than left is unchanged as is mild edema. There is no large pleural effusion or pneumothorax.

Bilateral perihilar opacification and mild edema are unchanged. Endotracheal tube and other lines in appropriate position.

Low left lung volume with new elevation of the left hemidiaphragm. Linear bands at the left base likely reflect basilar atelectasis. Normal cardiomediastinal contours. Mild right convex thoracic scoliosis. Normal hilar contours. There is new engorgement and indistinctness of the pulmonary vasculature, consistent with moderate pulmonary edema. There is no pneumothorax or pleural effusion.

New, moderate pulmonary edema.

Single portable chest radiograph is provided. The patient is status post esophageal pull-through procedure, which results in the opacity adjacent to the right mediastinal border. No evidence of pneumomediastinum. The lungs are clear without focal consolidation, pleural effusion or pneumothorax. The heart size is normal.

No evidence of pneumomediastinum status post esophageal dilation.

No significant interval change from radiograph. Persistent large fluid-filled neoesophagus. Likely small bilateral pleural effusions and left lower lobe atelectasis are unchanged. No new focal opacity or pulmonary edema. No pneumothorax. Heart size, left mediastinal contour and left hilus are normal. No bony abnormality.

No interval change from . Persistent large fluid-filled neoesophagus. Results were conveyed via telephone to by Dr. m. within five minutes of observation of findings.

The heart is normal in size. The patient is status post gastric pull-up with parenchymal opacification demonstrated over the lower mediastinal contour on the right, as before. There are diffuse reticular, interstitial opacities, particularly at the left base which likely reflect edema. There is some increased perihilar fullness, particularly on the left which is consistent with volume overload.

Diffuse, interstitial opacities, predominantly at the left base likely refect pulmonary edema, however superimposed infection/ aspiration should be considered given the clinical history.

Single AP view of the chest demonstrates mild-to-moderate cardiomegaly, accentuated by AP projection. The lungs are relatively well expanded. There is pulmonary vascular congestion and mild interstitial edema. No pneumothorax. Small effusions cannot be excluded. Moderate right greater than left glenohumeral osteoarthritis is present.

Moderate cardiomegaly and mild pulmonary edema.

Portable upright chest radiograph demonstrates an endotracheal tube with its tip at the level of the clavicular heads. An NG tube passes through the stomach, and a right subclavian central venous catheter tip is at the cavoatrial junction. There is an interval decrease in lung volumes; small bilateral pleural effusions and bibasilar atelectasis is mild and increased. The cardiac silhouette is enlarged and unchanged. The mediastinal contours are little changed. Pulmonary vasculature is normal and improved.

Interval decrease in lung volumes with increase in bibasilar atelectasis and small bilateral pleural effusions, although edema has improved.

An NG tube is in place, its tip is not seen below the inferior margin of the film. An esophageal temperature probe is in place. A right subclavian central venous catheter tip is located at the cavoatrial junction. The lungs are clear, with somewhat low lung volumes. There is no pleural effusion or pneumothorax. The cardiac silhouette and mediastinal contours are unchanged.

No acute chest abnormality.

Given differences in positioning and technique, there has been no significant interval change. Bibasilar opacities are most likely due to superimposed soft tissue structures and overlying material. Superiorly the lungs are clear. The cardiomediastinal silhouette is stable. Leftward deviation of the trachea at the thoracic inlet is suggestive of underlying right-sided thyroid enlargement. Calcification suggesting intra-articular bodies project over the glenohumeral joints.

No acute cardiopulmonary process. Leftward deviation of the trachea at the thoracic inlet as on prior suggestive right thyroid enlargement which can be further assessed by dedicated thyroid ultrasound.

There is mild right basilar atelectasis. Right internal jugular central venous catheter ends at or just below the cavoatrial junction. There is no focal consolidation. There is no pleural effusion or pneumothorax. There is a slight increase in density in the right paratracheal area which may represent mild bleeding from line placement. The heart size is normal.

Right IJ ends either at or just below the superior cavoatrial junction. Slight increase in density in the right paratracheal mediastinum may represent mild bleeding from line placement. Attention on follow up. Right basilar atelectasis. No focal consolidation.

Linear opacity at the right base likely represents atelectasis. No consolidation, pleural effusion, pneumothorax, or pulmonary edema is detected on this single view. Heart and mediastinal contours are stable. Patulous esophagus is again noted.

No radiographic evidence for acute cardiopulmonary process on this single frontal view.

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

No change.

Lung volumes are low but improved since the next most recent radiograph. Bibasilar atelectasis is worse on the left but unchanged on the right. There is likely a new small left pleural effusion. The cardiomediastinal silhouette and hilar contours are normal. There is no pneumothorax. An NG tube terminates in the stomach.

Bibasilar atelectasis is worse on the left and unchanged on the right. A new small left pleural effusion is likely present. There are no focal airspace opacities to suggest pneumonia. The above results were communicated via telephone by Dr. to Dr. m. on .

The NG tube terminates in the fundus of the stomach. Surgical project over the midline abdomen. Lung volumes are low and the bibasilar atelectasis is mild. The heart may be mildly enlarged however this is exaggerated by the low lung volumes. The mediastinum is normal. There is no pneumothorax or large pleural effusion.

The NG tube terminates in the fundus of the stomach. Lung volumes are low and bibasilar atelectasis is mild.

Again seen is a right pneumothorax, slightly increased in size compared to , which may be due to expiratory phase at which current study was taken. There is a small right pleural effusion, consistent with history of interval talc pleurodesis. Right-sided pigtail catheter is again seen, slightly superior in position compared to the prior exam.

Persistent small right pneumothorax, may appear larger due to expiratory phase. New pleural effusion, likely due to interval top pleurodesis. Apparent change and pigtail catheter. Please correlate clinically. with Dr.

Compared with most recent prior radiograph, the lung volumes are lower. A moderate right pleural effusion is unchanged. Moderate left pleural effusion layers posteriorly in somewhat different distribution, likely related to positioning. Retrocardiac consolidation is likely compressive atelectasis. Heart size is unchanged.

Moderate bilateral pleural effusions with retrocardiac consolidation, likely compressive atelectasis. Telephone notification to Dr. by Dr. m. on .

This exam is severely limited by suboptimal positioning. A right PICC terminates at the lower SVC. Small bilateral pleural effusions are suggested, appearing new since . No definite consolidation is detected. No large pneumothorax is seen.

Limited evaluation due to suboptimal positioning. Repeat radiographs should be performed with improved posture. Equivocal small bilateral pleural effusions.

Interval removal of the ETT and right IJ. Stable bilateral lower lung volumes, with expected slightly increased bibasilar atelectasis status-post ETT removal. New small bilateral pleural effusions, slightly greater on the left compared to the right, since . Otherwise, no focal consolidation, overt pulmonary edema, or pneumothorax. The cardiomediastinal silhouette is overall unchanged. The moderate hiatal hernia is also unchanged.

New small bilateral pleural effusions since . Expected post-extubation bibasilar atelectasis.

AP portable supine view of the chest. A right IJ central venous catheter tip is positioned in the region of the low SVC. Lung volumes are low limiting assessment. No large consolidation or supine evidence for effusion or pneumothorax. Mediastinal contour is difficult to assess due to rotation. Bony structures are grossly intact. Degenerative changes are partially noted in the lumbar spine.

Right IJ central venous catheter and endotracheal tube positioned appropriately.

A right sided IJ line ends in the upper to mid SVC. A right-sided PICC ends in the lower SVC. There is no evidence of pneumothorax. No focal opacities concerning for pneumonia identified. There is no pleural effusion or pneumothorax. A vague opacity in the right costophrenic angle is likely artifactual due to positioning. Cardiomediastinal and hilar contours are unremarkable.

Supportive devices are in appropriate position. No focal parenchymal opacity. No evidence of pneumothorax.

New esophageal ube loops and ends within the thorax, likely within a large hiatal hernia. Otherwise there is no significant change compared with the previous exam. A right sided IJ line ends in the upper to mid SVC. A right-sided PICC ends in the lower SVC. There is no evidence of pneumothorax. No focal opacities concerning for pneumonia identified. No pleural effusion is identified. Previous right costophrenic angle vague opacity has cleared and it was most likely due to positioning. There is no pneumothorax. Cardiomediastinal and hilar contours are unremarkable.

New esophageal tube ends above the diaphragm, likely within a large hiatal hernia. Otherwise unchanged from recent exam. No evidence of pleural effusion or pneumothorax.

Nasogastric tube is seen below the diaphragmwith tip in at least distal stomach. . A left-sided internal jugular central venous catheter with tip tip in the upper upper superior vena cava. Right-sided internal jugular venous catheter with tip likely at the confluence of the brachiocephalic veins. Endotracheal tube is in standard position. There has been interval minimal decreased in size of the right pleural effusion, now moderate in size with overall improved aeration of the right lung base. Large left effusion is probably stable in size, though assessment difficult given increased retrocardiac opacification, likely due to worsened collapse.

Well-positioned nasogastric tube. Minimally improved right pleural effusion now small in size. Stable large left pleural effusion. Increased left lower lobe collapse.

Right subclavian catheter tip terminates in the lower SVC. Cardiac size is normal. The lungs are clear. There is no pneumothorax or pleural effusion.

No evidence of pneumonia.

There is mild cardiomegaly and a large hernia containing stomach causing streak-like atelectatic change at the right lower lobe. Incidental note is made of an azygos lobe at the right side. No pleural effusion and no pneumothorax.

No acute cardiothoracic process. Large hiatal hernia containing at least stomach.

Two frontal images of the chest demonstrate well-expanded lungs, which are generally clear with some slight atelectatic changes at the lung bases. There is no pneumothorax or pleural effusion. Cardiomediastinal silhouette is unchanged. Again seen is a large hiatal hernia containing stomach elevating the lower lobe of the right lung.

No acute pulmonary process seen. Unchanged chest radiograph.

The lungs are hyperinflated. No focal consolidation is identified. The cardiomediastinal silhouette and hilar contours are normal. Calcifications of the costochondral cartilage is present. There is no pleural effusion or pneumothorax.

No acute cardiopulmonary process.

The patient is status post median sternotomy and CABG. The cardiac silhouette size is normal. Mediastinal and hilar contours are unchanged. There is mild interstitial pulmonary edema. Small to moderate pleural effusions appear similar compared to the prior exams. Bibasilar airspace opacities likely reflect compressive atelectasis. Scarring within the lung apices is re- demonstrated. No pneumothorax is present. No acute osseous abnormalities are demonstrated.

Mild pulmonary edema and small to moderate size bilateral pleural effusions. Bibasilar airspace opacities likely reflecting atelectasis.

Portable single frontal chest x-ray was performed with the patient in upright position. Compared to earlier study, there has been no significant interval change in the moderate bilateral pleural effusions and associated bibasilar atelectasis. Lung volumes are low. The heart remains moderately enlarged. There is no pneumothorax or pulmonary edema. A left subclavian central line has been removed. Median sternotomy wires are intact.

No interval change in the appearance of the heart and lungs.

Single portable AP chest radiograph was provided. There is prominence of the upper zone vessels, compatible with pulmonary congestion, increased since the recent prior exam. Again seen are layering moderate-sized bilateral pleural effusions with associated compressive atelectasis. Nodular opacities in the right apex are unchanged. Median sternotomy wires are intact.

Pulmonary vascular congestion. Moderate layering pleural effusions, similar to prior study.

There is no consolidation, pleural effusion, or pneumothorax. Cardiomediastinal and hilar silhouettes are normal size.

No acute cardiopulmonary process.

A metallic stent is seen within the expected region of the bronchus intermedius, new compared to the prior study. There has been interval collapse of the right upper lobe. Minimal bibasilar atelectasis is not significantly changed. The heart size is normal. No definite pleural effusions are seen. There is no pneumothorax.

No pneumothorax. New collapse of the right upper lobe status post stenting of the bronchus intermedius. Upon discussion with the patient's physician, . , was explained that the stent needed to be positioned in such a way that it excluded the right upper lobe bronchus.

As compared to prior radiograph, there has been an overall decrease of inspiratory lung volumes with apparent increase of radiodensity throughout lungs bilaterally. There has been interval improvement of multilobar opacities along both lungs. No new consolidations are identified. There is no pneumothorax. There has been interval removal of right main stem bronchus stent. Tracheostomy tube has a vertical course, no tube component that clearly reaches down the trachea is identified.

Interval improvement of multilobar opacities bilaterally with no evidence of pneumothorax. Tracheostomy tube demonstrates a vertical course with no evidence of tube component reaching down the trachea.

A tracheostomy tube is appropriately positioned. An enteric catheter is visualized only to the level of the thoracic inlet, likely obscured more distally due to underpenetration of this radiograph. A metallic stent within the right main stem bronchus appears appropriately positioned. A left internal jugular central venous catheter ends at the confluence of the brachiocephalic veins, not significantly changed. A right superior mediastinal mass extends to the right hilus, not significantly changed. Fluid within the minor fissure is increased. There is mild-to-moderate bibasilar atelectasis. Small layering pleural effusions may be present, not significantly changed. There is no pneumothorax. Mild cardiomegaly is not significantly changed.

Unchanged moderate bibasilar atelectasis. Possible small bilateral pleural effusions, not significantly changed. Mild cardiomegaly, not significantly changed. Incompletely assessed enteric catheter, only visualized to the level of the thoracic inlet. Recommend conventional PA and lateral radiographs on future studies to improve visualization.

There are new bilateral lower lung heterogeneous opacities, left greater than right, highly concerning for multifocal pneumonia. There is a small right pleural effusion and probable small left pleural effusion. Mild enlargement of the cardiac silhouette is not significantly changed. The mediastinal contours are unchanged. There is no pneumothorax. Dextroscoliosis of the thoracolumbar spine is redemonstrated.

New bilateral lower lung opacities, concerning for multifocal pneumonia. Small right and likely small left pleural effusions.

An enteric feeding tube is seen coursing below the diaphragm and out of view on this image. There is opacification of the left lung base obscuring the left costophrenic angle. The right lung base is clear. No significant pneumothorax is seen on this supine view. The cardiomediastinal and hilar contours are within normal limits.

Left basilar opacity potentially atelectasis, infection or aspiration. A small left pleural effusion is not excluded.

The cardiomediastinal and hilar contours are within normal limits. Lungs are clear. There are no focal consolidations or pleural effusions. Mild elevation of the right hemidiaphragm is redemonstrated. A sclerotic focus on the left sixth anterior rib is again seen and is unchanged, previously described as a bone island on CT torso of .

No radiographic evidence of an acute cardiopulmonary process.

AP portal view of the chest. There is no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal and hilar contours are normal.

No acute cardiopulmonary process.

The lungs are hyperinflated, with flattening of the diaphragms, suggestive of emphysematous disease. Cardiomediastinal and hilar contours are unremarkable with the exception of extensive atherosclerotic calcifications of the thoracic aorta. Biapical pleural parenchymal scarring is present. There is no pleural effusion or pneumothorax. Calcifications in the right neck and right subclavicular region are likely vascular.

Lung hyperinflation compatible with emphysema. No focal parenchymal opacities to suggest pneumonia. Extensive atherosclerotic calcifications of the thoracic aorta as well as vessels within the right neck and right infraclavicular region is observed. NG tube has its tip at the gastroesophageal junction and the side port within the terminal esophagus. Advancement is recommended.

No evidence of pneumothorax. Lung volumes are low causing expected vascular congestion status post surgery. No focal opacities are concerning for an infectious process. Bones are intact.

No evidence of pneumothorax.

No focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac silhouette is top-normal to mildly enlarged. Mediastinal contours unremarkable. No pulmonary edema is seen.

Top-normal to mildly enlarged cardiac silhouette without pulmonary edema. No definite focal consolidation.

The cardiac, mediastinal and hilar contours appear unchanged including mild cardiomegaly and calcification along the aortic arch. The central pulmonary vascularity shows upper zone redistribution with distinct but prominent vessels, similar to prior findings, suggesting pulmonary venous hypertension without congestive heart failure. A small hyperdense nodule projecting over the right mid lung is unchanged and suggests a granuloma. There is similar mild relative elevation of the right hemidiaphragm. There is no pleural effusion or pneumothorax. The patient is status post right shoulder hemiarthroplasty. Flattening and sclerosis have progressed along the left humeral head with corresponding effacement of the glenoid appears worse; findings could be seen with a history of avascular necrosis in the appropriate setting.

No evidence of acute cardiopulmonary disease. Increased flattening of the left humeral head, although likely a chronic process, possibly avascular necrosis.

The lungs are well expanded. Bibasilar streaky opacities likely represent subsegmental atelectases. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax. An NG tube ends in the distal stomach.

No evidence of acute cardiopulmonary process. NG tube in appropriate position.

AP portable upright view of the chest. Clips in the left neck base noted. Cardiomegaly is unchanged. No focal consolidation, effusion or pneumothorax. No convincing signs of edema. Mediastinal contour is stable with atherosclerotic calcifications along the aortic knob. No acute bony abnormality.

Stable cardiomegaly, otherwise unremarkable.

A central venous catheter terminates at the cavoatrial junction. The cardiac, mediastinal and hilar contours appear stable. There is no pleural effusion or pneumothorax. The lungs appear clear.

No evidence of acute disease.

Anterior cervical fixation hardware is redemonstrated. A right Port-A-Cath ends in the right atrium, as before. Pre-existing parenchymal opacities are increased from , particularly in the right lung base and possibly in the left lung base. There is unchanged background pulmonary interstitial edema. No large pleural effusion or pneumothorax is appreciated. The cardiomediastinal contours are within normal limits and unchanged.

Unchanged pulmonary edema. Concurrent right basilar pneumonia and possible multifocal infection involving the left lung base.

Portable AP image of the chest. There has been interval placement of a right-sided chest tube which crosses the right lung base and impinges on the mediastinum. Haziness is seen in the right upper lung, which has an convex margin inferiorly and may represent loculated pleural effusion. No pneumothorax is seen. No dependent pleural fluid is seen. Opacities in the left lung base consistent with atelectasis. The cardiomediastinal silhouette is unremarkable.

Interval placement of right-sided chest tubes which cross the right lung base impinges and mediastinum. Haziness in the right upper lung, which may represent loculated pleural effusion. A lateral radiograph could be obtained to further evaluate this opacity.

AP portable upright view of the chest. Clips in the soft tissues of the lower neck noted. Lung volumes are low limiting assessment. Allowing for this, the lungs appear clear. Cardiomediastinal silhouette appears grossly normal. Bony structures are intact. No free air below the right hemidiaphragm.

No acute findings. Limited exam.

AP view of the chest provided. Left-sided subclavian line terminates in the mid SVC. Since prior study from earlier today, the degree of pulmonary edema has improved. Cardiomediastinal and hilar contours are normal. There are no pleural effusions. Focal stenosis of the upper trachea has been previously evaluated on chest CT from , and does not appear different compared to the scout images then. There is no pneumothorax.

Subclavian line in the mid SVC. No pneumothorax or mediastinal widening.

Apparent slight enlargement of the cardiac silhouette in comparison to prior chest x-ray from likely relates to lower lung volumes and AP technique. The cardiomediastinal contours are otherwise stable and within normal limits, with unchanged aortic arch calcifications. The bilateral hila are unremarkable. The lungs are clear without focal consolidation. There is no evidence of pulmonary vascular congestion. There is no pneumothorax or pleural effusion.

No acute cardiopulmonary process.

Moderate cardiomegaly is stable. Mild to moderate pulmonary edema is new. Right lower lobe opacities are likely atelectasis. There is pleural small right effusion. There is no evident pneumothorax. Catheter projects in the right upper quadrant of the abdomen

Mild to moderate pulmonary edema

Both lungs are remarkable for diffuse, multifocal opacities predominantly in the lower lungs. Given clinical history, findings are concerning for multifocal pneumonia. There is probably a small left pleural effusion. Heart size, mediastinal and hilar contours are normal.

Multifocal pneumonia.

The cardiac silhouette remains markedly enlarged. Mediastinal contours are stable there is likely a tortuous aorta. The right costophrenic angle is not completely included in the image. Given this, no pleural effusion is seen. There is no focal consolidation or evidence of pneumothorax.

Right costophrenic angle not completely included on the image; given this, no pleural effusion seen. Persistent enlargement of the cardiac silhouette without overt pulmonary edema.

Lungs are well expanded and clear. There are no lung opacities of concern. Heart size, mediastinal and hilar contours are normal. There is no pneumothorax or pleural effusion. Left Port-A-Cath through the left internal jugular approach ends at lower SVC. No evidence of pneumothorax.

Left Port-A-Cath terminates at the level of lower SVC. No pneumothorax. Both lungs are clear.

There has been interval placement of a right-sided catheter with pigtail projecting over the liver. A persistent moderate size right pneumothorax remains with continued leftward shift of mediastinal structures as seen on the chest CT scout. Increased subcutaneous emphysema in the right lateral chest wall is noted. Streaky opacities are noted in the right lung likely reflective of atelectasis. Low lung volumes are present which results in crowding of bronchovascular structures and left basilar atelectasis. Cardiac and mediastinal contours otherwise remain unchanged. Right lateral rib fractures are better assessed on the previous CT.

Interval placement of right-sided catheter with pigtail projecting over the liver. Persistent moderate size right pneumothorax with continued mild leftward shift of mediastinal structures. Patchy atelectasis in both lungs. Increased subcutaneous emphysema in the right lateral chest wall.

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

No change.

Portable AP chest radiograph. Left-sided IJ catheter tip is in the mid SVC. Median sternotomy wires are intact. Prosthetic aortic valve is in similar position. Lung volumes are still low with bibasilar atelectasis and a small pleural effusion on the right. However, there is no interstitial edema. The cardiomediastinal silhouette is stable.

Left-sided IJ catheter tip is in the mid SVC. Bibasilar atelectasis and small right pleural effusion.

Lung volumes continue to be low, and mild bilateral effusions and interstitial edema have increased since . Heart size is normal and the lungs are clear of focal consolidation. Left IJ central venous line ends in the mid SVC, and the median sternotomy wires are intact. Right upper quadrant drainage catheter is seen in the abdomen.

Increasing bilateral pleural effusions and interstitial edema. No consolidation to suggest pneumonia.

The heart is mild to moderately enlarged. The aortic arch is partly calcified. The mediastinal and hilar contours are otherwise unremarkable. There is no cephalization of pulmonary vascularity. Upper lung fields appear clear. There is a fine reticular abnormality which is fairly widespread in both visualized lower lobes and suggestive of a more chronic abnormality such as underlying interstitial lung disease or extensive scarring. An acute abnormality is felt more likely. Correlation to prior films could be helpful, if clinically indicated, to investigate further.

Reticulation in the lower lungs, probably chronic and suggestive of scarring or interstitial lung disease. If available, correlation with prior radiographs may be helpful if clinically indicated.

Lung volumes are very low, resulting an bronchovascular crowding, and accentuation of the cardiac silhouette. Left basilar opacity may represent atelectasis, however aspiration or pneumonia could be considered in the appropriate clinical setting. No pneumothorax or pleural effusion. No acute displaced rib fracture.

Left basilar opacity may represent atelectasis, however aspiration or pneumonia could be considered in the appropriate clinical setting.

There continues to be a pigtail catheter entering the right lower chest wall, with the pigtail in the right apical pleural space. A tiny pneumothorax persists along the right apex and along the right lateral chest wall. There is no evidence of diaphragmatic flattening or mediastinal shift. Otherwise, the cardiomediastinal contours and lungs are within normal limits. There is a small amount of right sided pleural fluid.

Continued tiny right apical lateral pneumothorax without evidence of tension.

There appears to be interval improvement of the left large pleural effusion; however, this may be secondary to differences in positioning. Again seen is bibasilar atelectasis. There has been an interval increase in vascular congestion bilaterally. There is no pneumothorax. A right-sided PICC line appears to terminate in the mid SVC. The heart and mediastinal contours are otherwise unremarkable.

Interval increase in vascular congestion bilaterally. Slight improvement in the left pleural effusion/hemothorax, although this may be secondary to positioning and technique.

The right-sided PIC line ends in the right atrium however the tip is not well seen on this exam. The left-sided chest tube abuts the mediastinum. There has been interval improvement of the large left-sided pleural effusion compared to the study from . The moderate right-sided pleural effusion appears stable compared to multiple prior studies dating back to at-least . Mild bibasilar atelectasis is also unchanged since . There are no focal consolidations. There is no pneumothorax. The heart and mediastinal contours are otherwise normal. There is an S-shaped scoliosis of the spine.

Interval improvement of the left-sided pleural effusion compared to the study from . . The tip of the PIC is not well seen on this exam.

The right-sided PIC line terminates in the right atrium, however the tip is better delineated on this exam compared to the exam this morning. The left-sided chest tube abuts the mediastinum. There has been no change in the large left-sided pleural effusion compared to the study from earlier this morning. The moderate right-sided pleural effusion also appears stable compared to the exam from the same morning. Mild bibasilar atelectasis is also unchanged. There are no focal consolidations. There is no pneumothorax. The heart and mediastinal contours are otherwise normal.

These findings were discussed with Dr. m. by Dr. on the day of the exam by telephone.

There is a new right PICC with the tip in the the superior cavoatrial junction. There is no pneumothorax. Lung volumes remain low. Increased pulmonary vascular congestion persists. Focal parenchymal opacities again noted at the right base and appears stable, representing either pneumonia or asymmetric edema. Small bilateral pleural effusions are present. Heart appears stably enlarged. Heavy aortic arch calcifications are again noted. Dextroscoliosis of the thoracic spine is stable.

Right PICC with tip in the superior cavoatrial junction. Again noted is moderate pulmonary edema with a right basilar opacity which may represent pneumonia or asymmetric edema. Cardiomegaly. These findings were discussed by Dr. with Dr.

Cardiomegaly is noted with pulmonary edema and trace pleural effusions, right greater than left. No pneumothorax. Bony structures intact. Degenerative AC joint arthropathy.

Findings compatible with congestive heart failure.

There has been interval decrease in the amount of vascular plethora. The heart continues to be mildly enlarged. There small bilateral effusions. There is volume loss at the bases.

Slight improvement in fluid status.

The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silouhettes are unremarkable. There is a chronic deformity of the right clavicle presumably from prior healed fracture.

No acute cardiopulmonary process.

PA and lateral views of the chest were provided. Lungs are clear bilaterally without focal consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette appears normal. Imaged osseous structures are intact. No free air is seen below the right hemidiaphragm.

No acute intrathoracic process.

AP portable single view chest x-ray in upright position shows stable right subclavian PICC with tip in lower SVC. Lung volume is normal without consolidation or nodules suspicious for pneumonia. Cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax.

No pneumonia.

Right internal jugular central venous catheter terminates in the low SVC. The lungs are normally expanded and clear. The heart is not enlarged. The mediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax.

No evidence of acute cardiopulmonary abnormality.

The cardiac silhouette is indistinct. Hazy perihilar opacities and ill-defined pulmonary vascular markings are consistent with pulmonary edema. Blunting of the costophrenic angles and basilar opacities are compatible with moderate-sized pleural effusions and bibasilar atelectasis. Narrowing of the right acromiohumeral interval is consistent with rotator cuff injury. Deformity of the distal right clavicle is compatible with a prior injury at this location. Leads of a right chest wall pacer terminate over the right atrium and ventricle.

Pulmonary edema with moderate-sized bilateral pleural effusions and atelectasis.

Pulmonary vasculature is less dilated and there is less pulmonary edema than on prior exam. There is a right pleural effusion. There is plate atelectasis in the left mid zone. The right ventricle pacer wire passes in a supero-oblique direction within the heart instead the usual infero-oblique direction. There is no pneumothorax. Heart size cannot be assessed due to bilateral bibasilar opacities. There is a possibility that there an underlying pneumonia hidden by the pleural effusion and pulmonary edema. Recommend followup imaging as the edema clears.

Right pleural effusion. Left basilar plate atelectasis. Improving pulmonary edema. Recommend followup chest imaging to rule out pneumonia after pulmonary edema has cleared.

Lung volumes are slightly lower than on the prior exam. There compressive changes at the bases versus early infiltrates. Otherwise the appearance of the lungs are unchanged

Volume loss versus early infiltrates in the lower lobes