itsanmolgupta/mimic-cxr-dataset · Datasets at Hugging Face

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	Cardiac size is normal. The lungs are grossly clear. There is no pneumothorax or pleural effusion. Postoperative changes are noted in the right upper lobe. Right chest tube is in place	No pneumothorax
	The nasogastric tube courses through the esophagus, below the diaphragm and terminates in the fundus of the stomach, in appropriate position. The previously seen NG tube coil in the hypopharynx is not imaged on this study. Otherwise, the lungs, mediastinum, and heart are unchanged in appearance.	NG tube is in appropriate position, terminating in the stomach.
	Patchy retrocardiac opacity is also present behind the right an left cardiac silhouettes. Minimal blunting of left costophrenic angle is again noted. Mild vascular plethora is likely present. The right costophrenic angle is clear. No pneumothorax detected.	Worsening opacities in both lungs with prominent confluent opacity in the right upper and mid zones and left perihilar region as well as in the retrocardiac region. The differential remains similar and includes asymmetric CHF related to or independent of mitral valve or papillary muscle abnormalities or edema with concurrent right upper lobe pneumonia.
	An NG tube is present, tip extending beneath diaphragm, off film. Left IJ central line tip overlies the distal SVC near the SVC/RA junction. No pneumothorax is detected. Again seen is extensive parenchymal opacity in both lungs, worse on the right. Patchy opacity at the right base is probably slightly worse. Opacity at the left base may also be slightly worse, as left hemidiaphragm is now less distinct.	As above.
	Shallow inspiration accentuates heart size, pulmonary vascularity. Stable bilateral perihilar opacities, likely edema. Mildly worsened right apical opacity, edema likely, consider pneumonitis. Stable left pleural effusion, with left basilar consolidation.	Mildly worsened right apical opacity, likely edema, consider pneumonitis
	The left IJ line projects slightly more distal, near the cavoatrial junction. Lines and tubes are otherwise grossly unchanged. No pneumothorax detected. Again seen are extensive patchy opacities in both lungs, most pronounced in the right upper and mid zones but also seen at the right and left bases and left perihilar region. The overall distribution is similar. Changes in the right upper and suprahilar zones may be slightly less dense. No gross effusion. Cardiomediastinal silhouette unchanged. Prominence of the main pulmonary artery is again noted.	Extensive multiple bilateral opacities, non-specific, but compatible with multifocal pneumonia. There has been possible minimal improvement in the right upper/ suprahilar zones.
	Mild to moderate interstitial pulmonary edema with associated asymmetric right upper lobe opacity. A small left pleural effusion with adjacent basal atelectasis. No pneumothorax. The heart size is top-normal.	Moderate interstitial edema with asymmetric right upper lobe airspace disease can be asymmetric edema in the setting of mitral valve disease, acute papillary muscle injury in the setting of myocardial infarction or edema with concurrent right upper lobe pneumonia.
	Mild left pleural effusion has worsened. Left basilar consolidation, likely represents atelectasis, consider pneumonitis in the appropriate clinical setting. Right basilar opacity has improved. Mildly increased pulmonary vascularity has worsened. Stable heart size. No pneumothorax.	Left pleural effusion has worsened. Left basilar consolidation, likely atelectasis, consider pneumonitis in the appropriate clinical setting. Increased pulmonary vascularity.
	AP portable semi upright view of the chest. Low lung volumes limits evaluation. Bibasilar atelectasis is present. There is no convincing evidence for pneumonia or edema. No large effusion or pneumothorax. Heart size is difficult to assess. Mediastinal contour is normal. Bony structures are intact.	Bibasilar atelectasis. Otherwise unremarkable.
	As compared to prior chest x-ray, there are no interval changes. The stent project in the same position without changes in caliber or confirmation. The right upper parahilar mass is redemonstrated. There is no pneumothorax or new consolidations. Cardiomediastinal silhouette is unchanged. There is moderate air gastric distension	Status quo.
	Enteric catheter terminates in the fundus of the stomach with sideport at the expected level of GE junction and could be advanced several centimeters for better function. Right central venous catheter terminates at the cavoatrial junction. Remainder of exam is unchanged with unremarkable cardiomediastinal borders, clear lungs and no pleural fluid.	Enteric catheter terminates in the fundus and could be advanced several centimeters. Otherwise, unchanged exam.
	There is no focal consolidation, pleural effusion or pneumothorax. Accounting for portable technique, the cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities are identified.	No acute cardiopulmonary radiographic abnormality.
	No focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are unremarkable. No pulmonary edema is seen. No displaced fracture is identified.	No acute cardiopulmonary process.
	AP portable single view chest x-ray in upright position shows reduced lung volume with new bilateral widespread opacification and interval increase of the vascular pedicle, compatible with new moderate pulmonary edema. Heart size is still moderately enlarged in a patient who has had median sternotomy for cardiac surgery. Bibasilar opacities, denser in the left lung base are probably due to the bibasilar pleural effusion, larger to the left. There is no pneumothorax.	New moderate pulmonary edema with central vein distention, moderate cardiomegaly and bibasilar pleural effusion, larger to the left.
	Compared to the study from the prior day, the pulmonary edema appears worse. There are small bilateral pleural effusions. There is volume loss at both bases. There is hazy alveolar infiltrate bilaterally. There is pulmonary vascular re-distribution. The ET tube, left-sided PICC line, feeding tube with tip coiled in the stomach, sternal wires, and mediastinal clips are unchanged.	Worsened pulmonary edema.
	A portable frontal chest radiograph again demonstrates multiple sternotomy, a nasogastric tube, endotracheal tube, and left PICC, all of which are unchanged in position. The exam is not significantly changed from prior chest radiograph, and redemonstrates mild cardiomegaly and pulmonary edema, as well as bibasilar atelectasis and a small to moderate left pleural effusion. Right base atelectasis may be slightly improved.	Possible minimal improvement in right lower lobe atelectasis. Otherwise unchanged chest radiograph.
	AP portable upright view of the chest. Mild basal atelectasis. No large consolidation, effusion or pneumothorax is seen. The cardiomediastinal silhouette appears within normal limits. Right-sided rib fractures are better assessed on the same day CT torso.	No pneumothorax. Rib fractures better assessed on same-day CT exam.
	The heart size is mildly enlarged, stable compared to the prior exam. There is no pulmonary edema. The hilar and mediastinal contours are stable. There is stable pleural scarring over the right lateral hemithorax, likely secondary to post-radiation changes. No new focal consolidations are seen. There is no evidence of a pneumothorax. Trace left pleural effusion appears stable.	No new focal consolidation suggestive of an infection identified.
	Coalescent, bilateral, perihilar opacities reflect alveolar edema. Linear densities in the right mid and lower lung may reflect atelectasis. Blunting of the costophrenic angles suggests small, bilateral pleural effusions.	Central alveolar edema and small, bilateral pleural effusions suggest volume overload.
	A right internal jugular central venous line terminates in the mid SVC. An enteric tube terminates in the stomach. Lung volumes are low causing crowding of the central bronchovascular structures. The heart is top-normal in size given the low lung volumes. There is no focal consolidation, pleural effusion or pneumothorax. There is no pulmonary edema.	Appropriate position of support lines and devices. Low lung volumes.
	Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.	No acute cardiopulmonary abnormality.
	Portable frontal chest radiograph demonstrates clear well-expanded lungs. There is no pleural effusion or pneumothorax. The cardiac silhouette is moderately enlarged, the mediastinal contours are normal. The pulmonary vasculature is normal.	Moderate cardiomegaly, without acute chest abnormality.
	The right PICC line terminates in the mid to lower SVC, unchanged since the most recent radiograph on . No other relevant changes. Platelike atelectasis at the left base is unchanged. Lungs are otherwise clear without new focal consolidation, large pleural effusions, or pneumothorax. Heart size, mediastinal, and hilar contours are stable.	The right PICC line terminates in the mid to lower SVC, unchanged since the most recent radiograph.
	Since the prior chest radiograph, the Dobhoff tube has been removed. Lung volumes are slightly lower, with exaggeration of bronchovascular markings. Diffuse reticular opacities including left lung base consolidation is unchanged, and reflective of underlying interstitial lung disease. No new consolidation. No sizeable pleural effusion or pneumothorax.	Lower lung volumes compared to . Otherwise no new consolidation.
	There is a minimal volume loss at both bases but no definite infiltrate. The heart size is mildly enlarged but is similar compared to prior. Bony thorax is unremarkable.	Volume loss at both bases.
	The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The lungs are clear. There are no pleural effusions or pneumothorax.	No evidence of acute disease.
	Compared with prior exam, there has been mild interval improvement of aeration of both lungs, but there are still bilateral diffuse alveolar opacities compatible with pulmonary edema. The left apical opacity is also stable. There is no evidence of pneumothorax. An esophageal tube has been placed, with the side port seen below the gastroesophageal junction and the tip out of view.	Endotracheal tube and esophageal tube in appropriate positions. Mild interval improvement of bilateral lung aeration, but with severe pulmonary edema and possible pleural effusions. Left apical opacity, also unchanged from prior.
	Again demonstrated are calcified pleural plaques more pronounced within the right hemithorax, compatible with a prior history of asbestos exposure. Lung volumes are reduced. The heart size is mildly enlarged. The mediastinal and hilar contours are unchanged. There is moderate pulmonary edema which appears similar when compared to the prior exam. Patchy opacities in the lung bases appear slightly progressed in the right lung base, and may reflect areas of worsening atelectasis though infection is not excluded. Consolidation within the left upper lobe is chronic. Small bilateral pleural effusions are also noted. No pneumothorax is identified. Mildly displaced acute fracture of the left proximal humerus is re- demonstrated. Multilevel degenerative changes in the thoracic spine are noted.	Moderate pulmonary edema, similar compared to the prior exam with small bilateral pleural effusions. Bibasilar airspace opacities, slightly worse on the right, and may reflect areas of worsening atelectasis but infection is not excluded. Bilateral calcified pleural plaques, more extensive on the right, and compatible with prior history of asbestos exposure. Re- demonstration of mildly displaced acute left proximal humeral fracture.
	In comparison with study of , the left IJ catheter has been removed. There is continued prominence of the cardiac silhouette with evidence of elevated pulmonary venous pressure. Extensive pleural calcifications again seen, along with bibasilar atelectasis or pneumonia and left effusion.	Severe pulmonary edema as seen on the recent CT scan.
	There are diffuse bilateral alveolar opacities, with relative sparing of the upper lung fields, with obscuration of the right and left heart borders as well as the bilateral hemidiaphragm margins. A dense opacification is also seen in the left apex, without tracheal deviation or obscuration of the left spine border. There is also significant irregular pleural thickening in the right apex, possibly secondary to layering pleural effusion. Right basilar plueral calcifications are noted. Cardiac size cannot be assessed due to obscuration of the cardiac silhouette. There is no evidence of pneumothorax. Layering pleural effusions are possible. No fractures are identified.	Findings compatible with acute pulmonary edema with possible layering pleural effusions. Superimposed infectious/inflammatory process cannot be excluded. Significant left apical density may represent a loculated pleural effusion versus a mass. Followup of this will be necessary after treatment.
	Frontal radiograph of the chest demonstrate upper limits of normal heart size. Enteric tube passes below the diaphragm and out of the field of view. Clear lungs, no pleural effusion or pneumothorax.	No acute cardiopulmonary radiographic abnormality.
	The ET tube is in stable position. A left central line terminates in the upper to mid SVC. An NG tube terminates in the stomach. There is a new opacity in the right lower lung suggesting aspiration or pneumonia. The opacity at the left base is resolved. The cardiomediastinal silhouette and hilar contours are unchanged. There is no large pleural effusion or pneumothorax. The aorta is calcified and tortuous.	New opacity at the right lower lung may represent aspiration or pneumonia. Resolved left lower lung opacity. Results telephoned to Dr. by Dr.
	Endotracheal tube terminates at the level of the clavicles. The enteric catheter is coiled in the fundus of the stomach with the tip likely at the level of the gastroesophageal junction, heading cephalad. Recommend repositioning particularly given aspiration event. Left-sided central venous catheter likely at the confluence of the brachiocephalic veins. On a background of mild pulmonary edema, multifocal bilateral airspace opacifications may represent alveolar edema versus multifocal pneumonia. There is interval development of a left mid lung large opacification concerning for pneumonia/aspiration. No pleural effusion or pneumothorax identified. Cardiomediastinal and hilar contours are unchanged.	Enteric catheter is coiled in the fundus of the stomach, terminating in the gastroesophageal junction with cephalad orientation. Concern for increased risk of aspiration. Recommend repositioning. On a background of mild pulmonary edema and otherwise stable multifocal opacifications, there is a new large left mid lung opacification concerning for pneumonia/aspiration.
	A frontal supine view of the chest was obtained portably. The left subclavian line ends in the upper SVC. An upper enteric tube ends in the stomach. Lung volumes are slightly lower than on the prior study. The right basilar opacity is unchanged. New left basilar opacity is likely atelectasis given the lower lung volumes. Hyperlucency at the left lung base is likely due to confluence of shadows, unchanged since and unlikely to be a pneumothorax. There is no substantial pleural effusion. Cardiac and mediastinal silhouettes are stable.	ETT ends 7cm above the carina and could be advanced for better seating. Otherwise, little change from .
	The heart is at the upper limits of normal size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. Streaky basilar densities, greater on the left than right, are most consistent with minor atelectasis. There is no evidence for free air.	No evidence for acute disease or free air.
	Since the prior radiograph, the left sided chest tube has been removed and the left pleural effusion has increased in size. The superior portion of the left hemithorax is also diffusely opacified, which is due to layering pleural effusion. Oval shaped lucency abutting left heart border is likely a basilar pneumothorax and has remained stable since . The right lung essentially clear. Cardiomediastinal silhouette is stable. No acute osseous abnormalities. Median sternotomy wires and left subclavian catheter are unchanged in position. Left midline catheter terminates in the axillary or left brachiocephalic vein, unchanged.	Interval removal of the left pigtail catheter, with worsening layering left pleural effusion. Stable small left basilar pneumothorax.
	AP portable upright view of the chest. A left approach tunneled central line terminates at the right atrium. Multiple intact sternal wires are again seen. A large left pleural effusion has enlarged since . The right lung appears clear. There is no pneumothorax. A left PICC remains within the left axillary vein.	Left PICC terminating within the left axillary vein. Large left pleural effusion has enlarged since . with Dr.
	Again seen is a left chest tunneled hemodialysis/pheresis catheter. Multiple median sternotomy wires are re- demonstrated. The cardiomediastinal silhouettes are stable and within normal limits. The bilateral hila are unremarkable. There are low lung volumes. Linear opacities at the lung bases are consistent with atelectasis. There is a chronic interstitial pulmonary abnormality most conspicuous at the lung bases. There is no focal lung consolidation, however subtle superimposed infectious process is difficult to exclude given underlying lung abnormalities. There is no pneumothorax or pleural effusion.	Low lung volumes and bibasilar atelectasis. No focal consolidation, however it is difficult to exclude underlying pneumonia given background interstitial abnormality and bibasilar atelectasis.
	Status post prior median sternotomy. The left hemodialysis catheter is unchanged, projecting over the right atrium. No focal consolidation, pleural effusion or pneumothorax identified. Unchanged linear atelectasis/ scarring in the left lower lung zone. The size of the cardiomediastinal silhouette is within normal limits.	No significant interval change since the prior exam. Unchanged position of the hemodialysis catheter.
	Since the previous examination a pigtail catheter is seen in the left lower pole region. The large left pleural effusion has substantially resolved. There is a small left pneumothorax presumably due to trapped or hypoinflated lung. The right lung is clear. Monitor leads overlie the chest. double lumen large bore catheter terminates in the right atrium. The patient has median sternotomy closures and mediastinal clips consistent with coronary artery bypass graft.	Evidence for interval placement of a pigtail catheter in the left pleural space with and substantial reduced affection of the large pleural effusion. Small pneumothorax is present The right lung is clear.
	The lungs are clear. The previous left pleural effusion has mostly resolved. Dialysis subclavian line remains in place. Median sternotomy wires are noted. No pneumothorax. Normal cardiac size.	No evidence of acute cardiopulmonary process. Nearly completely resolved left pleural effusion.
	Since prior exam, the patient is status post a left thoracentesis. The left pleural effusion has significantly decreased in size. A small pleural effusion persists. There is no evidence of a pneumothorax. Bibasilar atelectasis appears improved, though still present. There is no new consolidation or pulmonary edema. Fibrotic changes at the bases are stable. There is no right pleural effusion. The cardiomediastinal silhouette is normal.	Interval decrease in size of the left pleural effusion. No evidence of pneumothorax.
	The heart is mildly enlarged. The mediastinal and hilar contours appear within normal limits. Blunting of the left costophrenic sulcus and flattening of the hemidiaphragmatic contour suggest a small pleural effusion. Retrocardiac opacity is nonspecific. On the prior study, there was a known mass that may partly account for this appearance, but associated atelectasis or superimposed pneumonia are not excluded.	Stable appearance of the chest. Standard PA and lateral radiographs may be helpful in short-term follow-up if pulmonary symptoms are present and were to persist.
	A portable frontal chest radiograph redemonstrates irregular aeration of the left lung, particularly the lingula and lower lobe, which is no worse than on prior radiograph. The right lung and cardiomediastinal silhouette are unchanged. There is a residual small left pleural effusion. There is no pneumothorax.	No pneumothorax. Irregular aeration of the left lung (particularly the lingula and left lower lobe) is no worse than before. Residual small left pleural effusion.
	Since the prior exam performed after the earlier thoracentesis, there appears to have been a slight increase in the residual left pleural effusion. It remains small in size. Again, some left basilar atelectasis persists. There are persistent fibrotic changes at the bases. No pneumothorax is identified. The cardiomediastinal silhouette is normal.	Very slight interval increase in the size of the small residual left pleural effusion. No evidence of pneumothorax.
	Status post minimally invasive esophagectomy. Mediastinal and pleural drains in good position. The first side port of the NG tube is in the lower neo esophagus and tip in the upper abdomen. No pneumothorax. Peripheral opacity in the left lower lobe is likely small left-sided pleural effusion and bibasal atelectasis. Subcutaneous emphysema in the upper neck related to recent surgery.	First side port of the nasogastric tube in the lower neo esophagus. No pneumothorax.
	Compared to the prior study there is no significant interval change.	No change.
	Chest PA and lateral radiograph demonstrates bilateral low lung volumes. Mediastinal and main pulmonary artery engorgement with dense air space opacification noted throughout both lungs as well as hazy pulmonary vasculature likely representing edema. Hear size is minimally enlarged. Retrocardiac opacity is likely atelectasis.	Diffuse bilateral opacities with hazy pulmonary vasculature likely represents pulmonary edema; however, concurrent pneumonia cannot be excluded. Recommend repeat conventional radiographs when feasible.
	Portable semi-upright AP view of the chest was provided. There is a new left IJ central venous catheter with its tip extending into the left subclavian vein with the tip near the left axilla. Endotracheal tube and nasogastric tubes are in unchanged position. A Port-A-Cath is also unchanged.	Malpositioned left IJ central venous catheter tip in the left subclavian vein.
	Atelectasis is noted at the left lung base. In addition, indistinctness of the right heart border may be due to infection versus atelectasis. A better evaluation would be provided on a chest CT, which has already been ordered. A right-sided Port-A-Cath terminates in the mid-to-low SVC. There is no evidence of pneumothorax. No large pleural effusion. Cardiac size is normal limits.	Left lower lobe atelectasis. Possible right middle lobe pneumonia. This will be better evaluated on patient's upcoming chest CT.
	Lung volumes are slightly decreased. The cardiac silhouette is unremarkable. The pulmonary vasculature is stable since prior examination. There is likely mild left basilar atelectasis ; consolidation is not excluded. No definite pleural effusion or pneumothorax is present. The left-sided Port-A-Cath with the tip terminating in the upper SVC is stable.	In the absence of a lateral view, left basilar consolidation is difficult to exclude. Correlation with symptoms is recommended.
	A left sided Port-A-Cath tip projects just to the right of midline a over the expected region of the mid to upper SVC. Left lower lobe dense consolidation is perhaps slightly more conspicuous particularly in the perihilar region compared to the prior exam - this likely reflects a combination of infection in the setting of sepsis, atelectasis, as well as a small pleural effusion. New heterogeneous right lower lobe consolidation is likely pneumonia. Mild interstitial edema is improved since . Probable mild cardiomegaly is overall similar. No pneumothorax.	Catheter tip projects over the expected region of the mid to upper SVC. Bibasilar pneumonia increased since . Persistent small left pleural effusion and atelectasis. Mild interstitial edema, improved.
	Left-sided Port-A-Cath tip terminates in the upper SVC. Heart size is top normal. Mediastinal and hilar contours are within normal limits. Pulmonary vasculature is not engorged. Streaky opacities in the lung bases likely reflect atelectasis. No focal consolidation, pleural effusion or pneumothorax is present. Partially imaged within the left upper abdomen is a nephro ureteral stent.	Streaky opacities in the lung bases, likely atelectasis.
	Lung volumes are unchanged compared to the prior study with bibasal, layering pleural effusions. In addition, bile airspace opacities are noted, similar when compared to the prior study and likely reflecting pulmonary edema. A left-sided PICC terminates in the proximal SVC. A Dobhoff tube terminates in the distal stomach. No pneumothorax seen.	The Dobhoff tube terminates in the distal stomach.
	Mild right basilar atelectasis. Cardiomediastinal and hilar contours are unchanged. There is no pneumothorax, pleural effusion, or consolidation. The aorta is tortuous.	No pneumonia.
	Since the prior exam, there is increase in the right apical pneumothorax, now moderate in size and without evidence of tension. There is increased right pleural effusion and right basal atelectasis. The previously noted right chest wall subcutaneous emphysema has resolved. Numerous right rib fractures are redemonstrated.	Increasing right effusion, increasing right pneumothorax. No evidence of tension. Numerous right rib fractures. by Dr.
	There is subcutaneous gas overlying the right chest wall. There is a small right apical pneumothorax identified. Multiple right-sided rib fractures are seen, specifically involving the posterior right seventh, eighth and potentially ninth ribs. Increased hazy opacity projecting over the right lung base could represent an effusion or hemothorax. The left lung is clear. The cardiomediastinal silhouette is within normal limits.	Right rib fractures with subcutaneous gas and a small right apical pneumothorax. Right basilar opacity could represent an effusion or hemothorax.
	Low lung volumes. No acute focal consolidation. The cardiac silhouette is within normal limits. No significant effusions or pneumothorax.	No acute focal consolidation.
	Right central venous line is in stable position at the mid SVC, and the left PICC line ends near the cavoatrial junction. Gastric tube passes below the diaphragm and ends in the body of the stomach. Low lung volumes continue to be seen. Previous vascular congestion has improved, and the heart size and mediastinal contours are normal.	No focal consolidation to suggest pneumonia.
	AP single view of the chest has been obtained with patient in sitting semi-upright position. Comparison is made to the next preceding similar study of . High positioned diaphragms indicate poor inspirational effort and result in crowded appearance of basal pulmonary vasculature bilaterally. There is no evidence of new acute pulmonary parenchymal infiltrates and the lateral pleural sinuses remain free. Heart size cannot be assessed as major portions of the heart are obliterated by high positioned diaphragms. There is no evidence of pneumothorax in the apical area and the previously described right-sided PICC line terminates in unchanged position.	Stable chest findings without evidence of new acute infiltrates as identified by portable chest examination.
	Left basal opacification may represent effusion or atelectasis. Low lung volumes continue to be seen. ET tube is in appropriate position and unchanged. Right upper central venous line is unchanged in appropriate position, and a gastric tube traverses past the diaphragm and ends outside the view of the chest radiograph. The cardiac silhouette is unchanged, and no focal consolidation or pulmonary edema is seen.	Stable position of lines and support devices. Left basal opacifaction may represent atelectasis or effusion.
	A portable frontal upright chest radiograph demonstrates interval repositioning or replacement of the nasogastric tube, which now terminates within the stomach. Lung volumes are slightly lower. Allowing for this, moderate cardiomegaly and mild pulmonary edema are unchanged. Previously noted bilateral pleural effusions are likely unchanged, although the left costophrenic angle is incompletely imaged and cannot be fully evaluated. Residual contrast is again seen within the colon.	Nasogastric tube terminating within the stomach. Slightly lower lung volumes with unchanged moderate cardiomegaly and mild pulmonary edema.
	The lungs are clear without consolidation or edema. There is no pneumothorax of pleural effusion. The previously seen lingular pneumonia has resolved. The cardiomediastinal silhouette is normal. The osseous structures are unremarkable.	No acute cardiopulmonary process.
	Portable semi-upright radiograph is obtained. Endotracheal tube and nasogastric tube have been removed. New pulmonary opacities are seen in the bases bilaterally with accompanying small right pleural effusion. In the setting of a seizure history, these findings could reflect aspiration, though pneumonia in the appropriate setting is an alternative explanation. Heart is normal. No pneumothorax is seen.	New bibasilar opacities could reflect aspiration given the seizure history, though in the appropriate clinical setting could also reflect developing multifocal pneumonia Findings discussed with Dr. by Dr. by phone at on .
	A single portable frontal radiograph of the chest was acquired. There is a new left PICC, with its tip in the mid right atrium. There is subsegmental right infrahilar atelectasis. The lungs are otherwise clear. The heart size is normal. The mediastinal contours are normal. There are no pleural effusions. No pneumothorax is seen.	New left PICC tip in the mid right atrium. Recommend repositioning. No acute cardiopulmonary process. Pertinent findings were discussed with Dr. by Dr. m. via telephone on the day of the study.
	There is redemonstration of a left PICC, with its tip now near the superior cavoatrial junction, previously seen to terminate within the right atrium. The lungs are clear. There are no pleural effusions. No pneumothorax is seen. The cardiac and mediastinal contours are unchanged.	Appropriately positioned left PICC, terminating near the superior cavoatrial junction. Otherwise, no significant interval change.
	AP portable upright view of the chest. Lungs are hyperinflated and clear. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. A hair clip is seen overlapping with the superior mediastinum.	No acute intrathoracic process.
	Frontal and lateral views of the chest. The appearance of the mediastinum is unchanged, accounting for differences in technique. There is no pleural effusion, pneumothorax or focal airspace consolidation. Bibasilar atelectasis is present. The heart size is normal. The hilar structures are unremarkable.	Unchanged, normal-appearing mediastinum.
	The lungs appear hyperexpanded. Unchanged left basilar opacities may reflect atelectasis/scarring. No pleural effusion or pneumothorax identified. The size the cardiac silhouette is enlarged but unchanged. Calcification of the aortic arch is again present. Tubing material extends over the left neck, left hemithorax and loops in the right upper quadrant.	No radiographic evidence of acute cardiopulmonary disease.
	Marked interval cardiac enlargement with pulmonary congestion. Confluent areas of airspace opacification most likely representing alveolar pulmonary edema. Left lower lobe atelectasis with an associated pleural effusion. Left-sided PICC line with the tip in the mid SVC. Calcification of the aortic arch. Widening of the vascular pedicle due to central venous engorgement. Prosthetic aortic valve in situ. No pneumothorax.	Biventricular cardiac decompensation with associated pulmonary edema. Left lower lobe atelectasis. IABP position standard.
	Patient is status post median sternotomy and cardiac valve replacement. There is moderate cardiomegaly. Aortic calcification is seen There is moderate pulmonary edema. More confluent opacity involving the left mid to lower lung may relate to fluid overload however, superimposed consolidation due to infection or aspiration not excluded. There is a small right pleural effusion.	Moderate pulmonary edema. More confluent opacity projecting over the left mid to lower lung may relate to fluid overload, however, consolidation due to infection or aspiration not excluded in the appropriate clinical setting. Cardiomegaly. Small right pleural effusion.
	Interval placement of a right IJ central venous catheter terminates in the mid to lower SVC without evidence of pneumothorax. Enteric tube is not well seen beyond the midchest. There is moderate pulmonary edema. The cardiac silhouette is mild to moderately enlarged. Left base opacity may be due to atelectasis although underlying consolidation is not excluded. No large pleural effusion is seen.	Interval placement of right IJ central venous catheter terminates the mid to lower SVC without evidence of pneumothorax. Again, enteric tube not well seen be on the mid chest. Suggest repeat centered more inferior to attempted better assess the distal aspect of the enteric tube. Left base opacity may be due to atelectasis although underlying consolidation not excluded.
	Enteric tube courses into the lower chest, but is not well seen distally. Suggest repeat with the image centered along the lower chest tp better assess position of enteric tube. Patient is status post median sternotomy and CABG. Cardiac silhouette is mildly enlarged. Mediastinum is slightly prominent which may relate to pulmonary hypertension. There is moderate pulmonary edema. No large pleural effusion is seen. There is no evidence of pneumothorax.	Enteric tube courses into the lower chest is not well seen distally; suggest repeat with image centered along the lower chest to better assess position of the distal enteric tube. Moderate pulmonary edema. Slightly prominent mediastinum may relate to pulmonary hypertension.
	Widespread airspace and interstitial opacities are minimally improved since . There do not appear to be new pleural effusions. There is no pneumothorax. The heart and mediastinum are within normal limits. A rounded calcification in the right upper quadrant likely corresponds to a gallstone. Right shoulder degenerative changes are advanced.	Slightly improved widespread airspace and interstitial opacities, which may be due to alveolitis in the setting of drug reaction, noncardiogenic pulmonary edema or infection such as PCP.
	The ET tube ends at the level of the clavicles. The left IJ central venous catheter ends in lower SVC. Nasogastric tube coils in stomach. Extensive bilateral airspace opacities are unchanged. The followup radiograph of shows minimal decrease in the right pneumothorax with no other significant interval change.	Latest radiograph shows slight interval decrease in moderate right pneumothorax with right apical pigtail catheter in place. Unchanged diffuse bilateral airspace opacities are likely due to severe pulmonary edema.
	The ET tube ends at the level of the clavicles. The left IJ central venous catheter ends in lower SVC. Nasogastric tube coils in stomach. Extensive bilateral airspace opacities are unchanged. The followup radiograph of shows minimal decrease in the right pneumothorax with no other significant interval change.	Latest radiograph shows slight interval decrease in moderate right pneumothorax with right apical pigtail catheter in place. Unchanged diffuse bilateral airspace opacities are likely due to severe pulmonary edema.
	Cardiac silhouette size is mildly enlarged, accentuated by the presence of low lung volumes. The aorta is diffusely calcified. Mediastinal contour is widened superiorly, and this is likely attributable to supine positioning. There are diffuse alveolar opacities, with vascular indistinctness suggestive of moderate pulmonary edema. No pleural effusion or pneumothorax is seen. Extensive degenerative changes of the left glenohumeral joint are noted, with moderate degenerative changes of the right glenohumeral joint also demonstrated. No acute osseous abnormalities demonstrated.	Diffuse alveolar opacities bilaterally, which could reflect moderate pulmonary edema, though atypical infection should be considered.
	There is minor streaky opacification of the lung bases suggesting minor atelectasis. No definite consolidation is present. There is no pulmonary edema, pleural effusion or pneumothorax. The cardiomediastinal silhouette is otherwise normal.	Calcified mediastinal lymph node suggesting a prior granulomatous process. Streaky right basilar opacity suggesting minor atelectasis.
	The lungs appear clear without evidence of focal consolidation. There is no evidence of pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette and hilar contours are normal. There is diffuse dilatation of multiple loops of small bowel, which is incompletely evaluated on this non dedicated exam. There is equivocal appearance for free intraperitoneal air in the left upper quadrant. Evaluation for intraperitoneal free air will be resolved with CT Abdomen, which will be obtained shortly later today.	No acute cardiopulmonary process. Diffuse dilatation of multiple loops of small bowel, which is incompletely evaluated on this nondedicated exam. Equivocal appearance for free intraperitoneal air in the left upper quadrant. Evaluation for intraperitoneal free air will be resolved with CT Abdomen, which will be obtained shortly later today.
	Low lung volumes bilaterally. The enteric tube tip is coiled within fundus of stomach. There are dilated loops of bowel, most likely small bowel given history of hemicolectomy. Cardiac silhouette is unchanged. No focal consolidation or opacities noted. There is no pneumothorax or pleural effusion.	NG tube with tip coiled within the fundus of the stomach. Large dilated loops of bowel, likely small bowel given history of hemicolectomy. D. by , M. D.
	The tip of the right PICC line projects over the distal SVC. The gastric tube has been removed Persisting bibasilar atelectasis, greater on the left. No pleural effusion or pneumothorax identified. There are dilated loops of bowel projecting over the left upper quadrant.	Interval removal of the gastric tube. Bibasilar atelectasis, greater on the left. Dilated loops of bowel project over the left upper quadrant.
	Enteric tube tip is in the proximal stomach. There are multiple dilated small bowel loops, mildly improved since prior. Very shallow inspiration. Bibasilar opacities are new, likely atelectasis. Pneumonitis cannot be excluded in the appropriate clinical setting. Shallow inspiration accentuates heart size, pulmonary vascularity. There may be tiny left pleural effusion. No pneumothorax.	Enteric tube tip is in the proximal stomach. Multiple dilated small bowel loops, mildly improved. Very shallow inspiration. Bibasilar opacities, likely atelectasis ; pneumonitis cannot be excluded, clinically correlate.
	The lung volume is small. Bilateral lower lobe atelectasis, right more than left, is mild. The lungs otherwise clear. No pleural effusions or pneumothorax. The visualized cardiomediastinal silhouette is stable. Distended colon is consistent with postoperative adynamic ileus.	Bilateral lower lobe atelectasis, right more than left. Distended colon is consistent with postoperative adynamic ileus.
	The cardiomediastinal silhouette is stable. Known left upper lobe mass is grossly stable. Left basilar opacity is seen with obscuration of the left hemidiaphragm which may be due to atelectasis; however, underlying consolidation or disease spread is not excluded. The previously more focal right basilar opacity is less dense; however, there continues to be patchy opacities in the right mid-to-lower lung which may be due to multifocal infection and/or mass suprahilar. Left costophrenic angle is blunted and a small left pleural effusion is not excluded. No evidence of pneumothorax is seen.	Grossly stable cardiomediastinal silhouette with grossly stable known left suprahilar mass. Obscuration of left hemidiaphragm may due to underlying consolidation; however, there may also be a possible pleural effusion and atelectasis. Right mid-to-lower lung opacities are less confluent as compared to the prior study; however, remain concerning for infection.
	An AP upright portable view of the chest was obtained. Cardiac silhouette remains top normal to mildly enlarged. There is minimal central pulmonary vascular engorgement. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. Mild left base atelectasis is seen. The aorta is calcified and tortuous.	Minimal central pulmonary vascular engorgement without overt pulmonary edema.
	There is significant opacification of the right hemi thorax, mostly secondary to a large pleural effusion. Underlying parenchymal consolidation cannot be excluded. The left lung is well inflated with no focal consolidation. Cardiomediastinal silhouette is midline and within normal limits.	Large right pleural effusion with resultant significant collapse of the of the right lung, however underlying pneumonia cannot be excluded.
	A right upper extremity PICC terminates in the distal superior vena cava. Lung volumes are minimally improved. There is an unchanged infiltrative pulmonary abnormality, right greater than left, consistent with the history of ARDS. A more focal area of airspace consolidation seen in the right upper lobe is new. Cardiac and mediastinal contours are unchanged. There is no pneumothorax or definite pleural effusion.	New right upper lobe airspace opacification which may reflect asymmetric pulmonary edema or a developing pneumonia.
	The right internal jugular line ends in satisfactory position with tip in the mid-to-distal SVC. Enteric tube is in standard position coursing towards the stomach with tip off the film. The ET tube is in satisfactory position, although the diameter of the ET tube is only one-third of the diameter of the trachea. Cardiomediastinal and hilar contours are stable. There is no pneumothorax. Bilateral pleural effusions are worsening. Extensive air space opacification of the right lung is unchanged; however, there is increasing left lung opacification, now involving most of the left lung. Heterogeneity of the consolidation suggests a nodular component. There is also mild pulmonary edema.	Widespread multifocal pneumonia, worsening on the left. Possiblle pulmonary nodules. ET tube appears small given the size of the trachea. Clinical correlation is recommended.
	There is no significant change compared to prior examination with redemonstration of scattered asymmetric right greater than left opacities compatible with multifocal pneumonia. There is a probable small left pleural effusion. There is no pneumothorax. An NG tube remains in appropriate position. A right-sided PICC line terminates in the mid SVC.	Multifocal pneumonia, relatively unchanged in appearance from prior examination.
	In comparison with the study of , the monitoring and support devices are essentially unchanged. Diffuse bilateral pulmonary opacifications again seen, possibly slightly worse, consistent with the clinical diagnosis of ARDS. The possibility of supervening pneumonia would be very difficult to exclude in the appropriate clinical setting.	Little overall change.
	Compared to the prior study there is no significant interval change.	No change.
	There are diffuse, bilateral ground glass and reticular opacities, consistent with ARDS. Compared to yesterday there is minimal improvement in aeration of both lungs. There is no pleural effusion or pneumothorax. There is no focal airspace consolidation. An enteric tube courses along the esophagus and terminates out of the field of view, likely within the stomach.	Minimal improvement in severe, bilateral ground glass and reticular opacities consistent with ARDS.
	A new NG tube is present; however, the left side port is not clearly seen and may be above the GE junction. Advancement of this NG tube is recommended. Asymmetric pulmonary opacities, right greater than left is again present consistent with pulmonary edema. Bibasilar atelectasis is present and unchanged. There is no pneumothorax.	Asymmetric pulmonary edema. NG tube courses to the stomach but the last side port is not clearly seen. Advancement is recommended to assure proper placement.
	Endotracheal tube is in satisfactory position. The enteric tube courses along the esophagus and terminates either field-of-view, likely within the stomach. Diffuse, bilateral interstitial opacities are worse than yesterday. There is likely a small left pleural effusion. Cardiac and mediastinal contours are unchanged and normal. There is no pneumothorax.	Worsened bilateral interstitial opacities consistent with multifocal pneumonia.
	There is extensive airspace opacification involving the entire right lung, new compared to the prior exam. There is also patchy left basilar opacification. There is evidence of mild volume loss in the right lung as well. Thickening of the right paratracheal stripe is suggestive of underlying mediastinal lymphadenopathy. There are probable small bilateral pleural effusions. There is no pneumothorax. The heart size is normal.	Extensive right lung opacification and patchy left basilar opacity concerning for multifocal pneumonia.
	There is a right IJ which terminates in the mid SVC. No pneumothorax. Again seen is extensive airspace opacification of the right lung. There is also patchy left basilar opacification. There has been slight interval increase in the prominence of the vasculature. No definite pleural effusions are identified. The heart size is normal. Again seen is prominent thickening of the right paratracheal stripe.	Right-sided IJ terminates in the mid SVC. Interval increase in pulmonary vascular congestion.
	Sternotomy wires are intact. Right Swan-Ganz catheter is close to pulmonic valve. Mitral valve replacement is in correct position. Mild interval increase in retrocardiac opacity from moderate atelectasis and left pleural effusion. No pneumothorax and right lung is clear. Heart is mildly enlarged and there is a post op appearance to mediastinam. Hila are normal. No bony abnormality.	Mild interval increase in left lower lobe atelectasis and pleural effusion. Right Swan-Ganz catheter is close to pulmonic valve.
	Lower lung volumes cause bronchovascular crowding. Bibasilar atelectasis is identified. However no focal consolidation concerning for pneumonia. No pneumothorax. The heart size, mediastinal, and hilar contours are normal.	No acute cardiopulmonary process.
	Cardiomegaly. The mediastinal and hilar contours are normal. There is calcification of the aorta, indicating atherosclerosis. There is prominence of the main pulmonary artery. The pulmonary vasculature is otherwise normal. There is bibasilar atelectasis. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. There is mild elevation of the right hemidiaphragm.	Cardiomegaly with prominence of the main pulmonary artery contour, correlate for pulmonary arterial hypertension. Otherwise unremarkable. Please refer to subsequent CTA of the chest for further details.
	The lungs are well expanded and clear. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax. An NG tube is seen with the tip and side port beyond the gastroesophageal junction. No subdiaphragmatic free air is identified.	Appropriate position the NG tube. No evidence of subdiaphragmatic free air.

Cardiac size is normal. The lungs are grossly clear. There is no pneumothorax or pleural effusion. Postoperative changes are noted in the right upper lobe. Right chest tube is in place

No pneumothorax

The nasogastric tube courses through the esophagus, below the diaphragm and terminates in the fundus of the stomach, in appropriate position. The previously seen NG tube coil in the hypopharynx is not imaged on this study. Otherwise, the lungs, mediastinum, and heart are unchanged in appearance.

NG tube is in appropriate position, terminating in the stomach.

Patchy retrocardiac opacity is also present behind the right an left cardiac silhouettes. Minimal blunting of left costophrenic angle is again noted. Mild vascular plethora is likely present. The right costophrenic angle is clear. No pneumothorax detected.

Worsening opacities in both lungs with prominent confluent opacity in the right upper and mid zones and left perihilar region as well as in the retrocardiac region. The differential remains similar and includes asymmetric CHF related to or independent of mitral valve or papillary muscle abnormalities or edema with concurrent right upper lobe pneumonia.

An NG tube is present, tip extending beneath diaphragm, off film. Left IJ central line tip overlies the distal SVC near the SVC/RA junction. No pneumothorax is detected. Again seen is extensive parenchymal opacity in both lungs, worse on the right. Patchy opacity at the right base is probably slightly worse. Opacity at the left base may also be slightly worse, as left hemidiaphragm is now less distinct.

As above.

Shallow inspiration accentuates heart size, pulmonary vascularity. Stable bilateral perihilar opacities, likely edema. Mildly worsened right apical opacity, edema likely, consider pneumonitis. Stable left pleural effusion, with left basilar consolidation.

Mildly worsened right apical opacity, likely edema, consider pneumonitis

The left IJ line projects slightly more distal, near the cavoatrial junction. Lines and tubes are otherwise grossly unchanged. No pneumothorax detected. Again seen are extensive patchy opacities in both lungs, most pronounced in the right upper and mid zones but also seen at the right and left bases and left perihilar region. The overall distribution is similar. Changes in the right upper and suprahilar zones may be slightly less dense. No gross effusion. Cardiomediastinal silhouette unchanged. Prominence of the main pulmonary artery is again noted.

Extensive multiple bilateral opacities, non-specific, but compatible with multifocal pneumonia. There has been possible minimal improvement in the right upper/ suprahilar zones.

Mild to moderate interstitial pulmonary edema with associated asymmetric right upper lobe opacity. A small left pleural effusion with adjacent basal atelectasis. No pneumothorax. The heart size is top-normal.

Moderate interstitial edema with asymmetric right upper lobe airspace disease can be asymmetric edema in the setting of mitral valve disease, acute papillary muscle injury in the setting of myocardial infarction or edema with concurrent right upper lobe pneumonia.

Mild left pleural effusion has worsened. Left basilar consolidation, likely represents atelectasis, consider pneumonitis in the appropriate clinical setting. Right basilar opacity has improved. Mildly increased pulmonary vascularity has worsened. Stable heart size. No pneumothorax.

Left pleural effusion has worsened. Left basilar consolidation, likely atelectasis, consider pneumonitis in the appropriate clinical setting. Increased pulmonary vascularity.

AP portable semi upright view of the chest. Low lung volumes limits evaluation. Bibasilar atelectasis is present. There is no convincing evidence for pneumonia or edema. No large effusion or pneumothorax. Heart size is difficult to assess. Mediastinal contour is normal. Bony structures are intact.

Bibasilar atelectasis. Otherwise unremarkable.

As compared to prior chest x-ray, there are no interval changes. The stent project in the same position without changes in caliber or confirmation. The right upper parahilar mass is redemonstrated. There is no pneumothorax or new consolidations. Cardiomediastinal silhouette is unchanged. There is moderate air gastric distension

Status quo.

Enteric catheter terminates in the fundus of the stomach with sideport at the expected level of GE junction and could be advanced several centimeters for better function. Right central venous catheter terminates at the cavoatrial junction. Remainder of exam is unchanged with unremarkable cardiomediastinal borders, clear lungs and no pleural fluid.

Enteric catheter terminates in the fundus and could be advanced several centimeters. Otherwise, unchanged exam.

There is no focal consolidation, pleural effusion or pneumothorax. Accounting for portable technique, the cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities are identified.

No acute cardiopulmonary radiographic abnormality.

No focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are unremarkable. No pulmonary edema is seen. No displaced fracture is identified.

No acute cardiopulmonary process.

AP portable single view chest x-ray in upright position shows reduced lung volume with new bilateral widespread opacification and interval increase of the vascular pedicle, compatible with new moderate pulmonary edema. Heart size is still moderately enlarged in a patient who has had median sternotomy for cardiac surgery. Bibasilar opacities, denser in the left lung base are probably due to the bibasilar pleural effusion, larger to the left. There is no pneumothorax.

New moderate pulmonary edema with central vein distention, moderate cardiomegaly and bibasilar pleural effusion, larger to the left.

Compared to the study from the prior day, the pulmonary edema appears worse. There are small bilateral pleural effusions. There is volume loss at both bases. There is hazy alveolar infiltrate bilaterally. There is pulmonary vascular re-distribution. The ET tube, left-sided PICC line, feeding tube with tip coiled in the stomach, sternal wires, and mediastinal clips are unchanged.

Worsened pulmonary edema.

A portable frontal chest radiograph again demonstrates multiple sternotomy, a nasogastric tube, endotracheal tube, and left PICC, all of which are unchanged in position. The exam is not significantly changed from prior chest radiograph, and redemonstrates mild cardiomegaly and pulmonary edema, as well as bibasilar atelectasis and a small to moderate left pleural effusion. Right base atelectasis may be slightly improved.

Possible minimal improvement in right lower lobe atelectasis. Otherwise unchanged chest radiograph.

AP portable upright view of the chest. Mild basal atelectasis. No large consolidation, effusion or pneumothorax is seen. The cardiomediastinal silhouette appears within normal limits. Right-sided rib fractures are better assessed on the same day CT torso.

No pneumothorax. Rib fractures better assessed on same-day CT exam.

The heart size is mildly enlarged, stable compared to the prior exam. There is no pulmonary edema. The hilar and mediastinal contours are stable. There is stable pleural scarring over the right lateral hemithorax, likely secondary to post-radiation changes. No new focal consolidations are seen. There is no evidence of a pneumothorax. Trace left pleural effusion appears stable.

No new focal consolidation suggestive of an infection identified.

Coalescent, bilateral, perihilar opacities reflect alveolar edema. Linear densities in the right mid and lower lung may reflect atelectasis. Blunting of the costophrenic angles suggests small, bilateral pleural effusions.

Central alveolar edema and small, bilateral pleural effusions suggest volume overload.

A right internal jugular central venous line terminates in the mid SVC. An enteric tube terminates in the stomach. Lung volumes are low causing crowding of the central bronchovascular structures. The heart is top-normal in size given the low lung volumes. There is no focal consolidation, pleural effusion or pneumothorax. There is no pulmonary edema.

Appropriate position of support lines and devices. Low lung volumes.

Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.

No acute cardiopulmonary abnormality.

Portable frontal chest radiograph demonstrates clear well-expanded lungs. There is no pleural effusion or pneumothorax. The cardiac silhouette is moderately enlarged, the mediastinal contours are normal. The pulmonary vasculature is normal.

Moderate cardiomegaly, without acute chest abnormality.

The right PICC line terminates in the mid to lower SVC, unchanged since the most recent radiograph on . No other relevant changes. Platelike atelectasis at the left base is unchanged. Lungs are otherwise clear without new focal consolidation, large pleural effusions, or pneumothorax. Heart size, mediastinal, and hilar contours are stable.

The right PICC line terminates in the mid to lower SVC, unchanged since the most recent radiograph.

Since the prior chest radiograph, the Dobhoff tube has been removed. Lung volumes are slightly lower, with exaggeration of bronchovascular markings. Diffuse reticular opacities including left lung base consolidation is unchanged, and reflective of underlying interstitial lung disease. No new consolidation. No sizeable pleural effusion or pneumothorax.

Lower lung volumes compared to . Otherwise no new consolidation.

There is a minimal volume loss at both bases but no definite infiltrate. The heart size is mildly enlarged but is similar compared to prior. Bony thorax is unremarkable.

Volume loss at both bases.

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

No evidence of acute disease.

Compared with prior exam, there has been mild interval improvement of aeration of both lungs, but there are still bilateral diffuse alveolar opacities compatible with pulmonary edema. The left apical opacity is also stable. There is no evidence of pneumothorax. An esophageal tube has been placed, with the side port seen below the gastroesophageal junction and the tip out of view.

Endotracheal tube and esophageal tube in appropriate positions. Mild interval improvement of bilateral lung aeration, but with severe pulmonary edema and possible pleural effusions. Left apical opacity, also unchanged from prior.

Again demonstrated are calcified pleural plaques more pronounced within the right hemithorax, compatible with a prior history of asbestos exposure. Lung volumes are reduced. The heart size is mildly enlarged. The mediastinal and hilar contours are unchanged. There is moderate pulmonary edema which appears similar when compared to the prior exam. Patchy opacities in the lung bases appear slightly progressed in the right lung base, and may reflect areas of worsening atelectasis though infection is not excluded. Consolidation within the left upper lobe is chronic. Small bilateral pleural effusions are also noted. No pneumothorax is identified. Mildly displaced acute fracture of the left proximal humerus is re- demonstrated. Multilevel degenerative changes in the thoracic spine are noted.

Moderate pulmonary edema, similar compared to the prior exam with small bilateral pleural effusions. Bibasilar airspace opacities, slightly worse on the right, and may reflect areas of worsening atelectasis but infection is not excluded. Bilateral calcified pleural plaques, more extensive on the right, and compatible with prior history of asbestos exposure. Re- demonstration of mildly displaced acute left proximal humeral fracture.

In comparison with study of , the left IJ catheter has been removed. There is continued prominence of the cardiac silhouette with evidence of elevated pulmonary venous pressure. Extensive pleural calcifications again seen, along with bibasilar atelectasis or pneumonia and left effusion.

Severe pulmonary edema as seen on the recent CT scan.

There are diffuse bilateral alveolar opacities, with relative sparing of the upper lung fields, with obscuration of the right and left heart borders as well as the bilateral hemidiaphragm margins. A dense opacification is also seen in the left apex, without tracheal deviation or obscuration of the left spine border. There is also significant irregular pleural thickening in the right apex, possibly secondary to layering pleural effusion. Right basilar plueral calcifications are noted. Cardiac size cannot be assessed due to obscuration of the cardiac silhouette. There is no evidence of pneumothorax. Layering pleural effusions are possible. No fractures are identified.

Findings compatible with acute pulmonary edema with possible layering pleural effusions. Superimposed infectious/inflammatory process cannot be excluded. Significant left apical density may represent a loculated pleural effusion versus a mass. Followup of this will be necessary after treatment.

Frontal radiograph of the chest demonstrate upper limits of normal heart size. Enteric tube passes below the diaphragm and out of the field of view. Clear lungs, no pleural effusion or pneumothorax.

No acute cardiopulmonary radiographic abnormality.

The ET tube is in stable position. A left central line terminates in the upper to mid SVC. An NG tube terminates in the stomach. There is a new opacity in the right lower lung suggesting aspiration or pneumonia. The opacity at the left base is resolved. The cardiomediastinal silhouette and hilar contours are unchanged. There is no large pleural effusion or pneumothorax. The aorta is calcified and tortuous.

New opacity at the right lower lung may represent aspiration or pneumonia. Resolved left lower lung opacity. Results telephoned to Dr. by Dr.

Endotracheal tube terminates at the level of the clavicles. The enteric catheter is coiled in the fundus of the stomach with the tip likely at the level of the gastroesophageal junction, heading cephalad. Recommend repositioning particularly given aspiration event. Left-sided central venous catheter likely at the confluence of the brachiocephalic veins. On a background of mild pulmonary edema, multifocal bilateral airspace opacifications may represent alveolar edema versus multifocal pneumonia. There is interval development of a left mid lung large opacification concerning for pneumonia/aspiration. No pleural effusion or pneumothorax identified. Cardiomediastinal and hilar contours are unchanged.

Enteric catheter is coiled in the fundus of the stomach, terminating in the gastroesophageal junction with cephalad orientation. Concern for increased risk of aspiration. Recommend repositioning. On a background of mild pulmonary edema and otherwise stable multifocal opacifications, there is a new large left mid lung opacification concerning for pneumonia/aspiration.

A frontal supine view of the chest was obtained portably. The left subclavian line ends in the upper SVC. An upper enteric tube ends in the stomach. Lung volumes are slightly lower than on the prior study. The right basilar opacity is unchanged. New left basilar opacity is likely atelectasis given the lower lung volumes. Hyperlucency at the left lung base is likely due to confluence of shadows, unchanged since and unlikely to be a pneumothorax. There is no substantial pleural effusion. Cardiac and mediastinal silhouettes are stable.

ETT ends 7cm above the carina and could be advanced for better seating. Otherwise, little change from .

The heart is at the upper limits of normal size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. Streaky basilar densities, greater on the left than right, are most consistent with minor atelectasis. There is no evidence for free air.

No evidence for acute disease or free air.

Since the prior radiograph, the left sided chest tube has been removed and the left pleural effusion has increased in size. The superior portion of the left hemithorax is also diffusely opacified, which is due to layering pleural effusion. Oval shaped lucency abutting left heart border is likely a basilar pneumothorax and has remained stable since . The right lung essentially clear. Cardiomediastinal silhouette is stable. No acute osseous abnormalities. Median sternotomy wires and left subclavian catheter are unchanged in position. Left midline catheter terminates in the axillary or left brachiocephalic vein, unchanged.

Interval removal of the left pigtail catheter, with worsening layering left pleural effusion. Stable small left basilar pneumothorax.

AP portable upright view of the chest. A left approach tunneled central line terminates at the right atrium. Multiple intact sternal wires are again seen. A large left pleural effusion has enlarged since . The right lung appears clear. There is no pneumothorax. A left PICC remains within the left axillary vein.

Left PICC terminating within the left axillary vein. Large left pleural effusion has enlarged since . with Dr.

Again seen is a left chest tunneled hemodialysis/pheresis catheter. Multiple median sternotomy wires are re- demonstrated. The cardiomediastinal silhouettes are stable and within normal limits. The bilateral hila are unremarkable. There are low lung volumes. Linear opacities at the lung bases are consistent with atelectasis. There is a chronic interstitial pulmonary abnormality most conspicuous at the lung bases. There is no focal lung consolidation, however subtle superimposed infectious process is difficult to exclude given underlying lung abnormalities. There is no pneumothorax or pleural effusion.

Low lung volumes and bibasilar atelectasis. No focal consolidation, however it is difficult to exclude underlying pneumonia given background interstitial abnormality and bibasilar atelectasis.

Status post prior median sternotomy. The left hemodialysis catheter is unchanged, projecting over the right atrium. No focal consolidation, pleural effusion or pneumothorax identified. Unchanged linear atelectasis/ scarring in the left lower lung zone. The size of the cardiomediastinal silhouette is within normal limits.

No significant interval change since the prior exam. Unchanged position of the hemodialysis catheter.

Since the previous examination a pigtail catheter is seen in the left lower pole region. The large left pleural effusion has substantially resolved. There is a small left pneumothorax presumably due to trapped or hypoinflated lung. The right lung is clear. Monitor leads overlie the chest. double lumen large bore catheter terminates in the right atrium. The patient has median sternotomy closures and mediastinal clips consistent with coronary artery bypass graft.

Evidence for interval placement of a pigtail catheter in the left pleural space with and substantial reduced affection of the large pleural effusion. Small pneumothorax is present The right lung is clear.

The lungs are clear. The previous left pleural effusion has mostly resolved. Dialysis subclavian line remains in place. Median sternotomy wires are noted. No pneumothorax. Normal cardiac size.

No evidence of acute cardiopulmonary process. Nearly completely resolved left pleural effusion.

Since prior exam, the patient is status post a left thoracentesis. The left pleural effusion has significantly decreased in size. A small pleural effusion persists. There is no evidence of a pneumothorax. Bibasilar atelectasis appears improved, though still present. There is no new consolidation or pulmonary edema. Fibrotic changes at the bases are stable. There is no right pleural effusion. The cardiomediastinal silhouette is normal.

Interval decrease in size of the left pleural effusion. No evidence of pneumothorax.

The heart is mildly enlarged. The mediastinal and hilar contours appear within normal limits. Blunting of the left costophrenic sulcus and flattening of the hemidiaphragmatic contour suggest a small pleural effusion. Retrocardiac opacity is nonspecific. On the prior study, there was a known mass that may partly account for this appearance, but associated atelectasis or superimposed pneumonia are not excluded.

Stable appearance of the chest. Standard PA and lateral radiographs may be helpful in short-term follow-up if pulmonary symptoms are present and were to persist.

A portable frontal chest radiograph redemonstrates irregular aeration of the left lung, particularly the lingula and lower lobe, which is no worse than on prior radiograph. The right lung and cardiomediastinal silhouette are unchanged. There is a residual small left pleural effusion. There is no pneumothorax.

No pneumothorax. Irregular aeration of the left lung (particularly the lingula and left lower lobe) is no worse than before. Residual small left pleural effusion.

Since the prior exam performed after the earlier thoracentesis, there appears to have been a slight increase in the residual left pleural effusion. It remains small in size. Again, some left basilar atelectasis persists. There are persistent fibrotic changes at the bases. No pneumothorax is identified. The cardiomediastinal silhouette is normal.

Very slight interval increase in the size of the small residual left pleural effusion. No evidence of pneumothorax.

Status post minimally invasive esophagectomy. Mediastinal and pleural drains in good position. The first side port of the NG tube is in the lower neo esophagus and tip in the upper abdomen. No pneumothorax. Peripheral opacity in the left lower lobe is likely small left-sided pleural effusion and bibasal atelectasis. Subcutaneous emphysema in the upper neck related to recent surgery.

First side port of the nasogastric tube in the lower neo esophagus. No pneumothorax.

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

No change.

Chest PA and lateral radiograph demonstrates bilateral low lung volumes. Mediastinal and main pulmonary artery engorgement with dense air space opacification noted throughout both lungs as well as hazy pulmonary vasculature likely representing edema. Hear size is minimally enlarged. Retrocardiac opacity is likely atelectasis.

Diffuse bilateral opacities with hazy pulmonary vasculature likely represents pulmonary edema; however, concurrent pneumonia cannot be excluded. Recommend repeat conventional radiographs when feasible.

Portable semi-upright AP view of the chest was provided. There is a new left IJ central venous catheter with its tip extending into the left subclavian vein with the tip near the left axilla. Endotracheal tube and nasogastric tubes are in unchanged position. A Port-A-Cath is also unchanged.

Malpositioned left IJ central venous catheter tip in the left subclavian vein.

Atelectasis is noted at the left lung base. In addition, indistinctness of the right heart border may be due to infection versus atelectasis. A better evaluation would be provided on a chest CT, which has already been ordered. A right-sided Port-A-Cath terminates in the mid-to-low SVC. There is no evidence of pneumothorax. No large pleural effusion. Cardiac size is normal limits.

Left lower lobe atelectasis. Possible right middle lobe pneumonia. This will be better evaluated on patient's upcoming chest CT.

Lung volumes are slightly decreased. The cardiac silhouette is unremarkable. The pulmonary vasculature is stable since prior examination. There is likely mild left basilar atelectasis ; consolidation is not excluded. No definite pleural effusion or pneumothorax is present. The left-sided Port-A-Cath with the tip terminating in the upper SVC is stable.

In the absence of a lateral view, left basilar consolidation is difficult to exclude. Correlation with symptoms is recommended.

A left sided Port-A-Cath tip projects just to the right of midline a over the expected region of the mid to upper SVC. Left lower lobe dense consolidation is perhaps slightly more conspicuous particularly in the perihilar region compared to the prior exam - this likely reflects a combination of infection in the setting of sepsis, atelectasis, as well as a small pleural effusion. New heterogeneous right lower lobe consolidation is likely pneumonia. Mild interstitial edema is improved since . Probable mild cardiomegaly is overall similar. No pneumothorax.

Catheter tip projects over the expected region of the mid to upper SVC. Bibasilar pneumonia increased since . Persistent small left pleural effusion and atelectasis. Mild interstitial edema, improved.

Left-sided Port-A-Cath tip terminates in the upper SVC. Heart size is top normal. Mediastinal and hilar contours are within normal limits. Pulmonary vasculature is not engorged. Streaky opacities in the lung bases likely reflect atelectasis. No focal consolidation, pleural effusion or pneumothorax is present. Partially imaged within the left upper abdomen is a nephro ureteral stent.

Streaky opacities in the lung bases, likely atelectasis.

Lung volumes are unchanged compared to the prior study with bibasal, layering pleural effusions. In addition, bile airspace opacities are noted, similar when compared to the prior study and likely reflecting pulmonary edema. A left-sided PICC terminates in the proximal SVC. A Dobhoff tube terminates in the distal stomach. No pneumothorax seen.

The Dobhoff tube terminates in the distal stomach.

Mild right basilar atelectasis. Cardiomediastinal and hilar contours are unchanged. There is no pneumothorax, pleural effusion, or consolidation. The aorta is tortuous.

No pneumonia.

Since the prior exam, there is increase in the right apical pneumothorax, now moderate in size and without evidence of tension. There is increased right pleural effusion and right basal atelectasis. The previously noted right chest wall subcutaneous emphysema has resolved. Numerous right rib fractures are redemonstrated.

Increasing right effusion, increasing right pneumothorax. No evidence of tension. Numerous right rib fractures. by Dr.

There is subcutaneous gas overlying the right chest wall. There is a small right apical pneumothorax identified. Multiple right-sided rib fractures are seen, specifically involving the posterior right seventh, eighth and potentially ninth ribs. Increased hazy opacity projecting over the right lung base could represent an effusion or hemothorax. The left lung is clear. The cardiomediastinal silhouette is within normal limits.

Right rib fractures with subcutaneous gas and a small right apical pneumothorax. Right basilar opacity could represent an effusion or hemothorax.

Low lung volumes. No acute focal consolidation. The cardiac silhouette is within normal limits. No significant effusions or pneumothorax.

No acute focal consolidation.

Right central venous line is in stable position at the mid SVC, and the left PICC line ends near the cavoatrial junction. Gastric tube passes below the diaphragm and ends in the body of the stomach. Low lung volumes continue to be seen. Previous vascular congestion has improved, and the heart size and mediastinal contours are normal.

No focal consolidation to suggest pneumonia.

AP single view of the chest has been obtained with patient in sitting semi-upright position. Comparison is made to the next preceding similar study of . High positioned diaphragms indicate poor inspirational effort and result in crowded appearance of basal pulmonary vasculature bilaterally. There is no evidence of new acute pulmonary parenchymal infiltrates and the lateral pleural sinuses remain free. Heart size cannot be assessed as major portions of the heart are obliterated by high positioned diaphragms. There is no evidence of pneumothorax in the apical area and the previously described right-sided PICC line terminates in unchanged position.

Stable chest findings without evidence of new acute infiltrates as identified by portable chest examination.

Left basal opacification may represent effusion or atelectasis. Low lung volumes continue to be seen. ET tube is in appropriate position and unchanged. Right upper central venous line is unchanged in appropriate position, and a gastric tube traverses past the diaphragm and ends outside the view of the chest radiograph. The cardiac silhouette is unchanged, and no focal consolidation or pulmonary edema is seen.

Stable position of lines and support devices. Left basal opacifaction may represent atelectasis or effusion.

A portable frontal upright chest radiograph demonstrates interval repositioning or replacement of the nasogastric tube, which now terminates within the stomach. Lung volumes are slightly lower. Allowing for this, moderate cardiomegaly and mild pulmonary edema are unchanged. Previously noted bilateral pleural effusions are likely unchanged, although the left costophrenic angle is incompletely imaged and cannot be fully evaluated. Residual contrast is again seen within the colon.

Nasogastric tube terminating within the stomach. Slightly lower lung volumes with unchanged moderate cardiomegaly and mild pulmonary edema.

The lungs are clear without consolidation or edema. There is no pneumothorax of pleural effusion. The previously seen lingular pneumonia has resolved. The cardiomediastinal silhouette is normal. The osseous structures are unremarkable.

No acute cardiopulmonary process.

Portable semi-upright radiograph is obtained. Endotracheal tube and nasogastric tube have been removed. New pulmonary opacities are seen in the bases bilaterally with accompanying small right pleural effusion. In the setting of a seizure history, these findings could reflect aspiration, though pneumonia in the appropriate setting is an alternative explanation. Heart is normal. No pneumothorax is seen.

New bibasilar opacities could reflect aspiration given the seizure history, though in the appropriate clinical setting could also reflect developing multifocal pneumonia Findings discussed with Dr. by Dr. by phone at on .

A single portable frontal radiograph of the chest was acquired. There is a new left PICC, with its tip in the mid right atrium. There is subsegmental right infrahilar atelectasis. The lungs are otherwise clear. The heart size is normal. The mediastinal contours are normal. There are no pleural effusions. No pneumothorax is seen.

New left PICC tip in the mid right atrium. Recommend repositioning. No acute cardiopulmonary process. Pertinent findings were discussed with Dr. by Dr. m. via telephone on the day of the study.

There is redemonstration of a left PICC, with its tip now near the superior cavoatrial junction, previously seen to terminate within the right atrium. The lungs are clear. There are no pleural effusions. No pneumothorax is seen. The cardiac and mediastinal contours are unchanged.

Appropriately positioned left PICC, terminating near the superior cavoatrial junction. Otherwise, no significant interval change.

AP portable upright view of the chest. Lungs are hyperinflated and clear. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. A hair clip is seen overlapping with the superior mediastinum.

No acute intrathoracic process.

Frontal and lateral views of the chest. The appearance of the mediastinum is unchanged, accounting for differences in technique. There is no pleural effusion, pneumothorax or focal airspace consolidation. Bibasilar atelectasis is present. The heart size is normal. The hilar structures are unremarkable.

Unchanged, normal-appearing mediastinum.

The lungs appear hyperexpanded. Unchanged left basilar opacities may reflect atelectasis/scarring. No pleural effusion or pneumothorax identified. The size the cardiac silhouette is enlarged but unchanged. Calcification of the aortic arch is again present. Tubing material extends over the left neck, left hemithorax and loops in the right upper quadrant.

No radiographic evidence of acute cardiopulmonary disease.

Marked interval cardiac enlargement with pulmonary congestion. Confluent areas of airspace opacification most likely representing alveolar pulmonary edema. Left lower lobe atelectasis with an associated pleural effusion. Left-sided PICC line with the tip in the mid SVC. Calcification of the aortic arch. Widening of the vascular pedicle due to central venous engorgement. Prosthetic aortic valve in situ. No pneumothorax.

Biventricular cardiac decompensation with associated pulmonary edema. Left lower lobe atelectasis. IABP position standard.

Patient is status post median sternotomy and cardiac valve replacement. There is moderate cardiomegaly. Aortic calcification is seen There is moderate pulmonary edema. More confluent opacity involving the left mid to lower lung may relate to fluid overload however, superimposed consolidation due to infection or aspiration not excluded. There is a small right pleural effusion.

Moderate pulmonary edema. More confluent opacity projecting over the left mid to lower lung may relate to fluid overload, however, consolidation due to infection or aspiration not excluded in the appropriate clinical setting. Cardiomegaly. Small right pleural effusion.

Interval placement of a right IJ central venous catheter terminates in the mid to lower SVC without evidence of pneumothorax. Enteric tube is not well seen beyond the midchest. There is moderate pulmonary edema. The cardiac silhouette is mild to moderately enlarged. Left base opacity may be due to atelectasis although underlying consolidation is not excluded. No large pleural effusion is seen.

Interval placement of right IJ central venous catheter terminates the mid to lower SVC without evidence of pneumothorax. Again, enteric tube not well seen be on the mid chest. Suggest repeat centered more inferior to attempted better assess the distal aspect of the enteric tube. Left base opacity may be due to atelectasis although underlying consolidation not excluded.

Enteric tube courses into the lower chest, but is not well seen distally. Suggest repeat with the image centered along the lower chest tp better assess position of enteric tube. Patient is status post median sternotomy and CABG. Cardiac silhouette is mildly enlarged. Mediastinum is slightly prominent which may relate to pulmonary hypertension. There is moderate pulmonary edema. No large pleural effusion is seen. There is no evidence of pneumothorax.

Enteric tube courses into the lower chest is not well seen distally; suggest repeat with image centered along the lower chest to better assess position of the distal enteric tube. Moderate pulmonary edema. Slightly prominent mediastinum may relate to pulmonary hypertension.

Widespread airspace and interstitial opacities are minimally improved since . There do not appear to be new pleural effusions. There is no pneumothorax. The heart and mediastinum are within normal limits. A rounded calcification in the right upper quadrant likely corresponds to a gallstone. Right shoulder degenerative changes are advanced.

Slightly improved widespread airspace and interstitial opacities, which may be due to alveolitis in the setting of drug reaction, noncardiogenic pulmonary edema or infection such as PCP.

The ET tube ends at the level of the clavicles. The left IJ central venous catheter ends in lower SVC. Nasogastric tube coils in stomach. Extensive bilateral airspace opacities are unchanged. The followup radiograph of shows minimal decrease in the right pneumothorax with no other significant interval change.

Latest radiograph shows slight interval decrease in moderate right pneumothorax with right apical pigtail catheter in place. Unchanged diffuse bilateral airspace opacities are likely due to severe pulmonary edema.

The ET tube ends at the level of the clavicles. The left IJ central venous catheter ends in lower SVC. Nasogastric tube coils in stomach. Extensive bilateral airspace opacities are unchanged. The followup radiograph of shows minimal decrease in the right pneumothorax with no other significant interval change.

Latest radiograph shows slight interval decrease in moderate right pneumothorax with right apical pigtail catheter in place. Unchanged diffuse bilateral airspace opacities are likely due to severe pulmonary edema.

Cardiac silhouette size is mildly enlarged, accentuated by the presence of low lung volumes. The aorta is diffusely calcified. Mediastinal contour is widened superiorly, and this is likely attributable to supine positioning. There are diffuse alveolar opacities, with vascular indistinctness suggestive of moderate pulmonary edema. No pleural effusion or pneumothorax is seen. Extensive degenerative changes of the left glenohumeral joint are noted, with moderate degenerative changes of the right glenohumeral joint also demonstrated. No acute osseous abnormalities demonstrated.

Diffuse alveolar opacities bilaterally, which could reflect moderate pulmonary edema, though atypical infection should be considered.

There is minor streaky opacification of the lung bases suggesting minor atelectasis. No definite consolidation is present. There is no pulmonary edema, pleural effusion or pneumothorax. The cardiomediastinal silhouette is otherwise normal.

Calcified mediastinal lymph node suggesting a prior granulomatous process. Streaky right basilar opacity suggesting minor atelectasis.

The lungs appear clear without evidence of focal consolidation. There is no evidence of pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette and hilar contours are normal. There is diffuse dilatation of multiple loops of small bowel, which is incompletely evaluated on this non dedicated exam. There is equivocal appearance for free intraperitoneal air in the left upper quadrant. Evaluation for intraperitoneal free air will be resolved with CT Abdomen, which will be obtained shortly later today.

No acute cardiopulmonary process. Diffuse dilatation of multiple loops of small bowel, which is incompletely evaluated on this nondedicated exam. Equivocal appearance for free intraperitoneal air in the left upper quadrant. Evaluation for intraperitoneal free air will be resolved with CT Abdomen, which will be obtained shortly later today.

Low lung volumes bilaterally. The enteric tube tip is coiled within fundus of stomach. There are dilated loops of bowel, most likely small bowel given history of hemicolectomy. Cardiac silhouette is unchanged. No focal consolidation or opacities noted. There is no pneumothorax or pleural effusion.

NG tube with tip coiled within the fundus of the stomach. Large dilated loops of bowel, likely small bowel given history of hemicolectomy. D. by , M. D.

The tip of the right PICC line projects over the distal SVC. The gastric tube has been removed Persisting bibasilar atelectasis, greater on the left. No pleural effusion or pneumothorax identified. There are dilated loops of bowel projecting over the left upper quadrant.

Interval removal of the gastric tube. Bibasilar atelectasis, greater on the left. Dilated loops of bowel project over the left upper quadrant.

Enteric tube tip is in the proximal stomach. There are multiple dilated small bowel loops, mildly improved since prior. Very shallow inspiration. Bibasilar opacities are new, likely atelectasis. Pneumonitis cannot be excluded in the appropriate clinical setting. Shallow inspiration accentuates heart size, pulmonary vascularity. There may be tiny left pleural effusion. No pneumothorax.

Enteric tube tip is in the proximal stomach. Multiple dilated small bowel loops, mildly improved. Very shallow inspiration. Bibasilar opacities, likely atelectasis ; pneumonitis cannot be excluded, clinically correlate.

The lung volume is small. Bilateral lower lobe atelectasis, right more than left, is mild. The lungs otherwise clear. No pleural effusions or pneumothorax. The visualized cardiomediastinal silhouette is stable. Distended colon is consistent with postoperative adynamic ileus.

Bilateral lower lobe atelectasis, right more than left. Distended colon is consistent with postoperative adynamic ileus.

The cardiomediastinal silhouette is stable. Known left upper lobe mass is grossly stable. Left basilar opacity is seen with obscuration of the left hemidiaphragm which may be due to atelectasis; however, underlying consolidation or disease spread is not excluded. The previously more focal right basilar opacity is less dense; however, there continues to be patchy opacities in the right mid-to-lower lung which may be due to multifocal infection and/or mass suprahilar. Left costophrenic angle is blunted and a small left pleural effusion is not excluded. No evidence of pneumothorax is seen.

Grossly stable cardiomediastinal silhouette with grossly stable known left suprahilar mass. Obscuration of left hemidiaphragm may due to underlying consolidation; however, there may also be a possible pleural effusion and atelectasis. Right mid-to-lower lung opacities are less confluent as compared to the prior study; however, remain concerning for infection.

An AP upright portable view of the chest was obtained. Cardiac silhouette remains top normal to mildly enlarged. There is minimal central pulmonary vascular engorgement. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. Mild left base atelectasis is seen. The aorta is calcified and tortuous.

Minimal central pulmonary vascular engorgement without overt pulmonary edema.

There is significant opacification of the right hemi thorax, mostly secondary to a large pleural effusion. Underlying parenchymal consolidation cannot be excluded. The left lung is well inflated with no focal consolidation. Cardiomediastinal silhouette is midline and within normal limits.

Large right pleural effusion with resultant significant collapse of the of the right lung, however underlying pneumonia cannot be excluded.

A right upper extremity PICC terminates in the distal superior vena cava. Lung volumes are minimally improved. There is an unchanged infiltrative pulmonary abnormality, right greater than left, consistent with the history of ARDS. A more focal area of airspace consolidation seen in the right upper lobe is new. Cardiac and mediastinal contours are unchanged. There is no pneumothorax or definite pleural effusion.

New right upper lobe airspace opacification which may reflect asymmetric pulmonary edema or a developing pneumonia.

The right internal jugular line ends in satisfactory position with tip in the mid-to-distal SVC. Enteric tube is in standard position coursing towards the stomach with tip off the film. The ET tube is in satisfactory position, although the diameter of the ET tube is only one-third of the diameter of the trachea. Cardiomediastinal and hilar contours are stable. There is no pneumothorax. Bilateral pleural effusions are worsening. Extensive air space opacification of the right lung is unchanged; however, there is increasing left lung opacification, now involving most of the left lung. Heterogeneity of the consolidation suggests a nodular component. There is also mild pulmonary edema.

Widespread multifocal pneumonia, worsening on the left. Possiblle pulmonary nodules. ET tube appears small given the size of the trachea. Clinical correlation is recommended.

There is no significant change compared to prior examination with redemonstration of scattered asymmetric right greater than left opacities compatible with multifocal pneumonia. There is a probable small left pleural effusion. There is no pneumothorax. An NG tube remains in appropriate position. A right-sided PICC line terminates in the mid SVC.

Multifocal pneumonia, relatively unchanged in appearance from prior examination.

In comparison with the study of , the monitoring and support devices are essentially unchanged. Diffuse bilateral pulmonary opacifications again seen, possibly slightly worse, consistent with the clinical diagnosis of ARDS. The possibility of supervening pneumonia would be very difficult to exclude in the appropriate clinical setting.

Little overall change.

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

No change.

There are diffuse, bilateral ground glass and reticular opacities, consistent with ARDS. Compared to yesterday there is minimal improvement in aeration of both lungs. There is no pleural effusion or pneumothorax. There is no focal airspace consolidation. An enteric tube courses along the esophagus and terminates out of the field of view, likely within the stomach.

Minimal improvement in severe, bilateral ground glass and reticular opacities consistent with ARDS.

A new NG tube is present; however, the left side port is not clearly seen and may be above the GE junction. Advancement of this NG tube is recommended. Asymmetric pulmonary opacities, right greater than left is again present consistent with pulmonary edema. Bibasilar atelectasis is present and unchanged. There is no pneumothorax.

Asymmetric pulmonary edema. NG tube courses to the stomach but the last side port is not clearly seen. Advancement is recommended to assure proper placement.

Endotracheal tube is in satisfactory position. The enteric tube courses along the esophagus and terminates either field-of-view, likely within the stomach. Diffuse, bilateral interstitial opacities are worse than yesterday. There is likely a small left pleural effusion. Cardiac and mediastinal contours are unchanged and normal. There is no pneumothorax.

Worsened bilateral interstitial opacities consistent with multifocal pneumonia.

There is extensive airspace opacification involving the entire right lung, new compared to the prior exam. There is also patchy left basilar opacification. There is evidence of mild volume loss in the right lung as well. Thickening of the right paratracheal stripe is suggestive of underlying mediastinal lymphadenopathy. There are probable small bilateral pleural effusions. There is no pneumothorax. The heart size is normal.

Extensive right lung opacification and patchy left basilar opacity concerning for multifocal pneumonia.

There is a right IJ which terminates in the mid SVC. No pneumothorax. Again seen is extensive airspace opacification of the right lung. There is also patchy left basilar opacification. There has been slight interval increase in the prominence of the vasculature. No definite pleural effusions are identified. The heart size is normal. Again seen is prominent thickening of the right paratracheal stripe.

Right-sided IJ terminates in the mid SVC. Interval increase in pulmonary vascular congestion.

Sternotomy wires are intact. Right Swan-Ganz catheter is close to pulmonic valve. Mitral valve replacement is in correct position. Mild interval increase in retrocardiac opacity from moderate atelectasis and left pleural effusion. No pneumothorax and right lung is clear. Heart is mildly enlarged and there is a post op appearance to mediastinam. Hila are normal. No bony abnormality.

Mild interval increase in left lower lobe atelectasis and pleural effusion. Right Swan-Ganz catheter is close to pulmonic valve.

Lower lung volumes cause bronchovascular crowding. Bibasilar atelectasis is identified. However no focal consolidation concerning for pneumonia. No pneumothorax. The heart size, mediastinal, and hilar contours are normal.

No acute cardiopulmonary process.

Cardiomegaly. The mediastinal and hilar contours are normal. There is calcification of the aorta, indicating atherosclerosis. There is prominence of the main pulmonary artery. The pulmonary vasculature is otherwise normal. There is bibasilar atelectasis. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. There is mild elevation of the right hemidiaphragm.

Cardiomegaly with prominence of the main pulmonary artery contour, correlate for pulmonary arterial hypertension. Otherwise unremarkable. Please refer to subsequent CTA of the chest for further details.

The lungs are well expanded and clear. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax. An NG tube is seen with the tip and side port beyond the gastroesophageal junction. No subdiaphragmatic free air is identified.

Appropriate position the NG tube. No evidence of subdiaphragmatic free air.