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chest x-ray; 'Cardiomegaly'; 'Lung Opacity'

Lung volumes are low. Retrocardiac opacity with silhouetting of the left hemidiaphragm and lateral border of the descending aorta is nonspecific and could reflect any of a combination of atelectasis, focal pneumonia or even a small effusion. Right infrahilar opacity with slight indistinctness of the right heart border could reflect infection in the appropriate clinical scenario. Apparent elevation of the right hemidiaphragm may be related to positioning and technique versus volume loss. There is cardiomegaly, but no CHF. Aortic calcifications are present. No pneumothorax.

chest x-ray; 'Cardiomegaly'; 'Edema'; 'Lung Opacity'; 'Support Devices'

Support lines and tubes are unchanged in position. Heart size is upper limits of normal but stable. There is persistent pulmonary edema with a more focal area of increased density in the left long which has increased since prior. There is a developing left retrocardiac opacity. No pneumothoraces are seen.

chest x-ray; 'Cardiomegaly'; 'Lung Opacity'; 'Support Devices'

There has been interval resolution of the moderate to severe pulmonary edema with only minimal residual patchy opacity in the left mid lung. A left-sided pacemaker remains in place. There has been a median sternotomy and the heart remains stably enlarged. No large effusions. No pneumothorax.

chest x-ray; 'No Finding'

Compared to the prior study the ET tube has been removed, otherwise there is no significant interval change

chest x-ray; 'No Finding'

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.

chest x-ray; 'Lung Opacity'

Portable AP radiograph of the chest was reviewed in comparison to ___ and ___. As compared to the prior study, there is slight interval progression of left basal opacity. Otherwise, no substantial change demonstrated.

chest x-ray; 'No Finding'; 'Support Devices'

1. Endotracheal tube terminates 3.5 cm from the carina. 2. Low lung volumes without evidence of acute cardiopulmonary process.

chest x-ray; 'Cardiomegaly'; 'Support Devices'

In comparison with the earlier study of this date, there is no convincing evidence of pneumothorax. Monitoring and support devices are essentially unchanged, as is the appearance of the heart and lungs.

chest x-ray; 'Cardiomegaly'; 'Pleural Effusion'; 'Support Devices'

Comparison to ___. Minimal increase in extent of the pre-existing right pleural effusion. The left pleural effusion is stable. Mild cardiomegaly. Unchanged monitoring and support devices.

chest x-ray; 'Cardiomegaly'; 'Pneumothorax'

The patient is status post a right upper lobectomy with a new right apical pneumothorax. Cardiac enlargement and mediastinal widening are likely postoperative. There is no pulmonary edema and little if any pleural fluid. Chest tube ends in the right lung apex. Right ventricular transvenous pacing wire is in expected location.

chest x-ray; 'No Finding'

Portable semi-upright radiograph of the chest demonstrates well expanded clear lungs. The cardiomediastinal and hilar contours are unchanged. There is no pneumothorax, pleural effusion, or consolidation.

chest x-ray; 'No Finding'

Evidence of failure.

chest x-ray; 'Pleural Other'; 'Support Devices'

In comparison with the study of ___, the endotracheal tube remains in good position while the side port of the nasogastric tube remains above the esophagogastric junction and should be pushed forward several centimeters. Again there is upper lobe predominant emphysema with pulmonary fibrosis that predominantly affects the lower lungs. No evidence of acute focal pneumonia.

chest x-ray; 'Lung Opacity'

As compared to prior chest radiograph from ___, there has been interval increase in density and extension of an opacity in the right mid lung zone. There has also been interval progression of opacities in the right lower lung. Left lung is clear. Costophrenic sulci are blunted bilaterally, likely related to pleural thickening. There is no pneumothorax. The cardiomediastinal and hilar contours are within normal limits.

chest x-ray; 'Atelectasis'; 'Lung Opacity'; 'Support Devices'

In comparison with the study of ___, the Dobbhoff tube extends to the lower body or antrum of the stomach. The endotracheal tube again remains at the upper clavicular level. Atelectatic changes are seen in the retrocardiac region. It is difficult to assess the right apical region because of overlapping bony structures. This area should be assessed on subsequent studies to see whether there is continued opacification in this region.

chest x-ray; 'Cardiomegaly'; 'Lung Opacity'

As compared to ___ chest radiograph, cardiac silhouette has decreased in size and pulmonary vascular congestion has improved. Previously described bibasilar opacities have improved with residual patchy opacities remaining as well as possible small bilateral pleural effusions.

chest x-ray; 'Lung Opacity'; 'Pleural Effusion'; 'Pneumothorax'; 'Support Devices'

Widespread subcutaneous emphysema and pneumomediastinum are new compared to the prior radiograph. The presence of this extent of subcutaneous emphysema reduces the sensitivity for detecting pneumothorax. At the time of this dictation, the patient has undergone a chest CT, which more clearly delineates the abnormal gas collections. Please see separately dictated CT under clip ___. Right pigtail pleural catheter has changed in position compared to prior radiograph, and is more fully evaluated on the subsequent CT as well. Moderate-to-large right pleural effusion has increased in size since the prior radiograph. Worsening opacity in the right mid and lower lung may reflect atelectasis or aspiration.

chest x-ray; 'Atelectasis'; 'Cardiomegaly'; 'Consolidation'; 'Pleural Effusion'; 'Support Devices'

Tracheostomy tube is in satisfactory position with the tip 4.5 cm above the carina. The right internal jugular central line and nasogastric tube are unchanged in position. The heart remains stably enlarged. Lung volumes are markedly reduced and there is a small layering left effusion with persistent retrocardiac consolidation likely reflecting partial lower lobe atelectasis. No pulmonary edema. No obvious pneumothorax.

chest x-ray; 'Support Devices'

New tracheostomy is midline. The approximate diameter of the tube, 11 mm, compares to the diameter of the trachea, 27 mm. This sizing should be evaluated clinically. Pneumomediastinum outlines the tracheal wall and extends into deep subcutaneous emphysema in the neck, presumably a function of tracheostomy. Followup advised. There is no pneumothorax or pleural effusion. Lungs are clear. Heart size is normal.

chest x-ray; 'Atelectasis'; 'Enlarged Cardiomediastinum'; 'Lung Opacity'; 'Support Devices'

Comparison is made with prior study performed same day earlier in the morning. There are low lung volumes. Cardiomediastinum is shifted towards the left as before. New right lower lobe opacities are likely atelectasis. There is no pneumothorax. Widened mediastinum is unchanged. Large left lower lobe retrocardiac opacity is unchanged. Lines and tubes are in unchanged standard position.

chest x-ray; 'Atelectasis'; 'Consolidation'; 'Lung Opacity'; 'Support Devices'

1. The endotracheal tube continues to have its tip in the right main stem bronchus. A wet reading was again provided to ___ by Dr. ___ ___ on ___ at 20:59. Repositioning was advised. Right internal jugular central line has its tip in the distal SVC near the cavoatrial junction. Nasogastric tube has now been retracted and the side port is in the distal esophagus. Advancement is also advised of this tube. 2. Low lung volumes with persistent linear opacity in the right mid lung consistent with subsegmental atelectasis and retrocardiac consolidation with air bronchograms likely representing lower lobe atelectasis given the position of the endotracheal tube being in the right main stem bronchus. No evidence of pulmonary edema. No pneumothorax.

chest x-ray; 'Edema'

Comparison is made with prior study ___. Mild pulmonary edema is new. Cardiac size is normal, mediastinal contours are stable. Port-A-Cath is in the standard position. There is no pneumothorax or large effusion.

chest x-ray; 'Cardiomegaly'; 'Lung Opacity'; 'Support Devices'

Comparison to ___. New opacity in the right mid lung is stable in extent and severity. No new parenchymal opacity. Stable mild cardiomegaly and mild fluid overload. The monitoring and support devices are in correct position.

chest x-ray; 'Cardiomegaly'; 'Fracture'; 'Lung Opacity'; 'Pneumonia'

Compared to prior chest radiograph and chest CT on ___ which showed generally clear lungs and severe central adenopathy and a large goiter. Some pulmonary vascular congestion are new peribronchial opacification has developed in the right lower lobe and should be followed for potential early pneumonia Severe cardiomegaly is stable. Mediastinum is widened by adenopathy. There is no appreciable pleural effusion or pneumothorax. Left rib fractures noted.

chest x-ray; 'Pneumothorax'; 'Support Devices'

In comparison with the study of ___, there is slight further increase in the left pneumothorax, with the right pneumothorax slightly less prominent. Monitoring and support devices are essentially unchanged, as is the diffuse abnormality involving both lungs. The subcutaneous gas on the left appears less prominent than on the previous study.

chest x-ray; 'Atelectasis'; 'Consolidation'; 'Pleural Effusion'; 'Support Devices'

Monitoring and supporting devices are in standard positions. Over the last 24 hours biapical consolidation in the left side more than right is unchanged. However, has improved as compared to the radiograph from ___. Increased retrocardiac density reflecting left lower lung atelectasis and presumed small left pleural effusion is unchanged. There are no other interval changes in the lung.

chest x-ray; 'Cardiomegaly'; 'Lung Opacity'; 'Pneumothorax'; 'Support Devices'

Comparison to ___. The small right apical pneumothorax is stable and unchanged. The right chest tube is in stable position. Unchanged parenchymal opacity at the left lung base. Unchanged size of the cardiac silhouette and stable position of the right internal jugular vein catheter.

chest x-ray; 'Atelectasis'; 'Lung Opacity'; 'Support Devices'

Comparison to ___. Monitoring and support devices are in stable position. Stable left retrocardiac atelectasis and right basal parenchymal opacity. No pulmonary edema. No larger pleural effusions. No pneumothorax.

chest x-ray; 'Lung Opacity'

Homogeneous opacification in the right lower lobe most pronounced superior segment is most likely retained lavage and/or pulmonary hemorrhage. There is no right pleural effusion but there may be a tiny right apical pneumothorax. Left lung is grossly clear. Heart size normal. One of the largest cystic lung lesions is barely visible projecting over the right heart.

chest x-ray; 'Atelectasis'

Lung volumes are low. Bibasilar opacities may represent dependent atelectasis. However, there are also air bronchograms at the medial right lung base which should be followed closely to exclude aspiration. No pleural effusion or pneumothorax. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified. No subdiaphragmatic free air is detected.

chest x-ray; 'No Finding'

The endotracheal tube has been withdrawn, and now terminates at the level of the clavicles. The left-sided PICC line terminates in the low SVC. A nasogastric tube coils in the stomach. Bilateral interstitial and airspace opacities most likely due to pulmonary edema are not appreciably changed. Moderate cardiomegaly despite the projection is also unchanged. A right upper quadrant stent and coils are again noted.

chest x-ray; 'Pleural Effusion'; 'Pneumothorax'; 'Support Devices'

Support lines and tubes are unchanged in position. The left-sided pleural effusion continues to decrease in size. There is improved aeration at the left base. Partially layering right-sided pleural effusion is again seen. There is a new small left-sided apical pneumothorax.

chest x-ray; 'Atelectasis'; 'Pleural Effusion'; 'Support Devices'

Indwelling support and monitoring devices remain in standard position. Cardiomediastinal contours are stable in appearance. Improving aeration in the left retrocardiac region with improved visualization of the left hemidiaphragm, likely due to a combination of improving atelectasis and effusion in this region. Otherwise, no relevant short interval change since recent study.

chest x-ray; 'No Finding'

The lungs are clear. No pneumothorax or pleural effusion is present. The cardiac silhouette, hilar, and mediastinal contours appear normal.

chest x-ray; 'Edema'; 'Lung Opacity'; 'Pleural Effusion'; 'Support Devices'

As compared to ___ radiograph, right pigtail pleural catheter remains in place with slight decrease in size of small right pleural effusion and no visible pneumothorax. Diffuse pulmonary opacities attributed to edema have slightly improved, and a moderate sized a partially loculated left pleural effusion is unchanged with adjacent left retrocardiac opacification.

chest x-ray; 'No Finding'

Dextroscoliosis of the thoracic spine is unchanged. Mild left apical thickening and an area of sclerosis within left anterior third rib are unchanged from multiple prior studies. Homogeneously increased retrocardiac density likely corresponds to hiatal hernia based on chest CT from ___. There is no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. Mild cardiomegaly is unchanged.

chest x-ray; 'Pleural Effusion'

There is small to moderate left greater than right pleural effusions with adjacent atelectasis. Superiorly the lungs are clear of consolidation. Prosthetic mitral valve is noted. Heart is enlarged but not well evaluated due to silhouetting at the bases. Bilateral shoulder arthroplasties are noted.

chest x-ray; 'Enlarged Cardiomediastinum'; 'Lung Opacity'

1. Overall cardiac and mediastinal contours are stable. There has been interval appearance of patchy opacity predominantly at the right base which may represent layering of fluid as there is also a linear opacity in the right mid lung which may represent fluid tracking within the horizontal fissure. Pneumonia or atelectasis are also in the differential. Followup imaging would be advised. There is no evidence of pulmonary edema or pulmonary venous hypertension. No pneumothorax. Overall cardiac and mediastinal contours are stable.

chest x-ray; 'Cardiomegaly'; 'Enlarged Cardiomediastinum'; 'Lung Opacity'; 'Support Devices'

As compared to the previous radiograph, the patient has received a nasogastric tube. The tube is malpositioned in the right bronchial system and needs to be withdrawn immediately. Later films will show a correction and finally a complete retrieval of the device. At telephone message was delivered at the time of image acquisition. There is no evidence for the presence of a pneumothorax or other complications. Bilateral parenchymal opacity at both lung bases pre existed. Unchanged appearance of the mediastinum and of the cardiac silhouette.

chest x-ray; 'Cardiomegaly'; 'Support Devices'

Comparison to ___, 00:46. The tip of the endotracheal tube continues to be relatively high, in positioned 5 cm above the carinal. The other monitoring and support devices are stable, with the exception of a new right external pacemaker, the lead projects over the right ventricle. No pneumothorax. Borderline size of the cardiac silhouette. No pulmonary edema. No pneumonia.

chest x-ray; 'Cardiomegaly'; 'Edema'; 'Support Devices'

Compared to chest radiographs ___ through ___. Mild pulmonary edema has worsened slightly since ___. No appreciable pleural effusion. No pneumothorax. Moderate cardiomegaly stable. Transvenous atrial biventricular pacer leads are unchanged in their positions, but cannot be localized with any precision in the absence of a lateral view.

chest x-ray; 'Cardiomegaly'; 'Edema'; 'Pleural Effusion'

Portable AP radiograph of the chest was compared to ___. The patient's Dobhoff tube has been removed. The heart size and mediastinum are unchanged, and there is overall no substantial change in widespread interstitial edema associated with large bilateral pleural effusions. Otherwise, no substantial change since the prior study has been demonstrated.

chest x-ray; 'Atelectasis'; 'Support Devices'

Monitoring and supporting devices are in standard position. Lateral lung volumes are low. Increased retrocardiac density, reflecting left lower lung atelectasis and minimal right lower lung atelectasis are unchanged. There are no new lung opacities of concern. Mediastinal silhouette is stable.

chest x-ray; 'Atelectasis'; 'Enlarged Cardiomediastinum'; 'Lung Opacity'; 'Pleural Effusion'; 'Support Devices'

1. A dual-lead left-sided pacer remains in place. A nasogastric tube is seen coursing below the diaphragm with the tip not identified. An endotracheal tube remains in place with its tip approximately 3 cm above the carina. Overall cardiac and mediastinal contours are stable. There are persistent streaky opacities at the left base most likely reflecting atelectasis. There is possibly a small associated layering left effusion. No evidence of pulmonary edema. No pneumothorax. When compared to the previous study, the opacity at the left base is not significantly changed favoring atelectasis, although an early infectious process cannot be entirely excluded. Clinical correlation is advised.

chest x-ray; 'Cardiomegaly'; 'Edema'; 'Pleural Effusion'; 'Support Devices'

Slight worsening of cardiomegaly and mild-to-moderate pulmonary edema, accompanied by increasing moderate left pleural effusion and persistent small right pleural effusion. Indwelling support and monitoring devices are unchanged in position, including a proximally located left PICC, terminating at the junction of the left axillary and subclavian veins.

chest x-ray; 'No Finding'

AP chest compared to ___ Normal heart, lungs, hila, mediastinum and pleural surfaces. There are no findings of cardiac decompensation.

chest x-ray; 'Atelectasis'; 'Pleural Effusion'; 'Support Devices'

Portable AP radiograph of the chest was compared to ___, ___. The left chest tube appearance is unchanged. There is no interval development of pneumothorax or substantial increase in pleural effusion. Bibasilar areas of atelectasis are unchanged.

chest x-ray; 'Edema'

Two frontal images of the chest demonstrate low lung volumes, likely secondary to poor inspiration. There is asymmetric, right greater than left, diffuse opacification of the lungs which is consistent in appearance with vascular congestion and pulmonary edema, though in the appropriate clinical context pneumonia cannot be completely excluded. There is no pneumothorax or pleural effusion. Cardiomegaly is again seen.

chest x-ray; 'Cardiomegaly'; 'Pleural Effusion'

There are small bilateral pleural effusions, which may be new since ___. No evidence of pneumonia or pulmonary edema. No pneumothorax. The mediastinum and hila are normal. There are atherosclerotic calcifications of the aortic arch. Moderate to severe cardiomegaly, better demonstrated on CT chest dated ___. Transvenous pacer-defibrillator is unchanged in position with leads terminating in the right atrium and right ventricle.

chest x-ray; 'Cardiomegaly'

As compared to the previous radiograph, there is a minimal increase in size of the cardiac silhouette. Mild tortuosity of the thoracic aorta. Normal appearance of the lung parenchyma. No evidence of pneumonia, no pleural effusions. No pneumothorax.

chest x-ray; 'Edema'; 'Enlarged Cardiomediastinum'; 'Support Devices'

A Swan-Ganz catheter terminates in the main pulmonary artery and has been repositioned. Bilateral chest tubes and nasogastric tube has been removed. Mediastinal drains are present. Median sternotomy wires are intact and surgical clips are seen in the right mediastinum. The cardiomediastinal silhouette demonstrates normal postoperative appearance. Moderate pulmonary edema is stable.

chest x-ray; 'Atelectasis'; 'Pneumothorax'; 'Support Devices'

Comparison is made with prior study performed a day earlier. There is a new right apical chest tube. A chest tube on the right base has been pulled out, and the side hole appears to be outside the pleura. There is new subcutaneous emphysema on the right side. Moderate subcutaneous emphysema on the left chest wall has improved. Small right pneumothorax has improved. Small left pneumothorax is unchanged. Bibasilar atelectasis, larger on the left side, has increased on the left base. Other lines and tubes are in unchanged position. Position of lower right chest tube was discussed by phone on ___ with ___

chest x-ray; 'Atelectasis'; 'Pleural Effusion'; 'Pneumothorax'

1. Interval increase in size of the right upper lung pneumothorax with interval worsening of partial right lung collapse. 2. New small bilateral effusions and new minimal atelectasis at the left base. The ptx findings were called to Dr. ___ at the time of discovery at 9:49 a.m. on ___ and discussed with her by Dr. ___ by phone.

chest x-ray; 'Consolidation'; 'Edema'

Interval improvement in the right upper lobe consolidation is demonstrated most likely as part of overall improvement of interstitial pulmonary edema. Cardiomediastinal silhouette is unchanged

chest x-ray; 'Atelectasis'; 'Cardiomegaly'; 'Lung Opacity'; 'Support Devices'

As compared to the previous radiograph, there is a further increase in extent of the opacities in the right lung. The left lung is constant. Changed nasogastric tube. Moderate cardiomegaly with extensive retrocardiac atelectasis.

chest x-ray; 'Cardiomegaly'; 'Edema'; 'Support Devices'

As compared to the previous radiograph, the patient is still intubated and a nasogastric tube is in place. There is unchanged obvious cardiomegaly with signs of mild pulmonary edema. However, pre-existing opacity in the right perihilar areas and at the right lung base have almost completely cleared. No interval appearance of new opacities. No larger pleural effusions. No pneumothorax.

chest x-ray; 'Lung Opacity'; 'Pleural Effusion'; 'Pneumonia'

In comparison with the study of ___, there is increased opacification in the lower ___ of the right hemithorax in this patient with severe chronic pulmonary disease and biapical scarring. These findings could reflect volume loss in the right middle and lower lobes with pleural effusion. However, much of this appearance could be a manifestation of developing pneumonia. Little change in the opacification is at the left base.

chest x-ray; 'Atelectasis'; 'Cardiomegaly'; 'Pleural Effusion'; 'Support Devices'

In comparison with the study of ___, the endotracheal tube and right IJ catheter are unchanged. The nasogastric tube is not well seen, though it appears to extend at least to the upper stomach, where it crosses the lower margin of the image. There is enlargement of the cardiac silhouette with pulmonary vascular congestion and bilateral pleural effusions with compressive atelectasis at the bases, quite similar to the previous study.

chest x-ray; 'Atelectasis'; 'Pneumothorax'; 'Support Devices'

As compared to ___ radiograph, a small to moderate left pneumothorax is similar when considerations are made for differences in positioning and lung volumes. Left chest tube remains in place. Slight worsening of left basilar atelectasis with otherwise similar appearance of the chest.

chest x-ray; 'Cardiomegaly'

Lungs fully expanded and clear. Heart size top-normal. Normal mediastinal and hilar contours and pleural surfaces. No displaced rib fracture is seen. Although no fracture is seen, conventional chest radiographs are not sensitive for detection of chest cage trauma. Regions where there are focal findings of possible trauma should be clearly marked and imaged with bone detail views.

chest x-ray;

IJ catheter tip is unchanged. Worsening pulmonary vascular congestion likely reflecting volume overload. Cardiomediastinal silhouette is notable for interval bulging of the left pulmonary outflow tract reflecting pulmonary arterial dilatation. This can be due to extensive vascular congestion and volume overload or perhaps embolic phenomena leading to acute increase in pulmonary pressures which needs to be correlated clinically. Heart size is top normal. No significant pleural effusions and no pneumothorax.

chest x-ray; 'Atelectasis'; 'Pleural Effusion'; 'Pneumonia'

Unchanged mild overinflation. Blunting of the left costophrenic sinus, likely caused by a small left pleural effusion. Retrocardiac opacity that likely reflects atelectasis, but pneumonia cannot be excluded. No other parenchymal changes. Moderate tortuosity of the thoracic aorta. Normal-appearing hilar and mediastinal structures.

chest x-ray; 'Cardiomegaly'; 'Support Devices'

In comparison with the earlier study of this date, there is an placement of a Dobhoff tube with its tip in the upper stomach. The tube should be pushed forward about 8-10 cm for more optimal positioning. Little change in the appearance of the heart and lungs and the various monitoring and support devices.

chest x-ray; 'Atelectasis'; 'Lung Opacity'; 'Pleural Effusion'; 'Pneumothorax'

Heart size and mediastinum are grossly unchanged in appearance. Lung volumes are low. Left basal opacities consistent with area of atelectasis. There is small right apical pneumothorax. There is minimal left apical pneumothorax seen, although it is not clearly seen. No appreciable pulmonary edema is demonstrated. Small amount of pleural effusion is most likely present, but no overt fluid in the fissure is seen.

chest x-ray; 'Atelectasis'; 'Cardiomegaly'

As compared to the previous radiograph, the lung volumes continue to be low. The diameter of the pulmonary vessels are slightly increasing, potentially reflecting mild fluid overload. Atelectases are seen at both lung bases, but no pneumonia is present. No pleural effusion. Unchanged borderline size of the cardiac silhouette.

chest x-ray; 'Atelectasis'; 'Cardiomegaly'; 'Lung Opacity'; 'Pneumonia'

No previous images. There is enlargement of the cardiac silhouette probably with some elevation of pulmonary venous pressure. Increased opacification is seen at the right base with poor definition of the hemidiaphragm but visualization of vessels coursing through the area. This could represent pleural fluid with compressive atelectasis, though the possibility of supervening pneumonia would be difficult to exclude. If clinically possible, a lateral view would be most helpful.

chest x-ray; 'Atelectasis'; 'Lung Opacity'; 'Support Devices'

As compared to the previous radiograph, there is a right upper lobe atelectasis in addition to the pre-existing widespread parenchymal opacities. No other changes. The monitoring and support devices are constant. At the time of observation and dictation, 8:48 a.m., the referring physician, ___. ___ was paged for notification and the findings were subsequently discussed over the telephone.

chest x-ray; 'Lung Opacity'; 'Support Devices'

Increasing patchy opacity at the right medial lung base with lower lung volumes which could reflect worsening atelectasis, although pneumonia or aspiration should also be considered. The right basilar pleural pigtail catheter remains in place. No pneumothorax is appreciated. Overall cardiac and mediastinal contours are likely unchanged given differences in inspiration.

chest x-ray; 'No Finding'

Portable AP upright chest radiograph was provided. Evaluation is markedly limited due to low lung volumes and under penetrated technique. There is limited evaluation, possible at the lower lungs. There is increased pulmonary opacity which could in part reflect technique, though the possibility of edema or infection is impossible to exclude. The heart and mediastinal contours appear grossly stable. No definite bony abnormalities are seen.

chest x-ray; 'Atelectasis'; 'Support Devices'

Previous large left pneumothorax has substantially resolved following insertion of a pigtail pleural drainage catheter ending in the left upper chest. Atelectasis at the right lung base, possibly substantial, is new. Right upper lung clear. Upper esophageal drainage tube ends intrathoracic stomach due to a chronic large hiatus hernia. ET tube in standard placement.

chest x-ray; 'Cardiomegaly'; 'Support Devices'

As compared to the previous radiograph, no relevant change is seen. Moderate to severe cardiomegaly. Left pectoral pacemaker is in unchanged position. Mild fluid overload but no overt pulmonary edema. No pleural effusions. No pneumothorax. No pneumonia.

chest x-ray; 'No Finding'

The cardiomediastinal silhouette and pulmonary vasculature are unremarkable and unchanged since the prior examination. There is no pleural effusion or pneumothorax. Right perihilar linear density is consistent with atelectasis. No free intraperitoneal air.

chest x-ray; 'No Finding'

An orogastric type tube is again seen, extending beneath the diaphragm off the film. A right-sided PICC line is again seen, tip overlying distal SVC. No pneumothorax detected. As before, there is prominent cardiomegaly with slight unfolding of the aorta. The overall cardiac silhouette appears slightly smaller, though this could be accentuated by differences in technique. There is upper zone redistribution, without overt CHF. Considerable interval improvement in previously seen bibasilar atelectasis. No frank consolidation. No effusion.

chest x-ray; 'Cardiomegaly'

No comparison. The lung volumes are normal. Normal size of the cardiac silhouette. Normal hilar and mediastinal contours. Borderline size of the cardiac silhouette. No pulmonary edema. No pneumonia. No pleural effusions.

chest x-ray; 'Cardiomegaly'

The patient has tracheostomy has been repositioned when compared to the prior study. The support lines and tubes are otherwise unchanged in appearance. There has been improved aeration, particular in the right upper lobe. The heart remains enlarged. No definite pleural effusion seen. Left lower lobe atelectasis.

chest x-ray; 'Lung Opacity'

The cardiac silhouette is stably enlarged. Again noted is mild central pulmonary vascular congestion. The previously seen right internal jugular sheath is no longer noted. There is no pneumothorax or definite pleural effusion. No consolidation is identified. Increased conspicuity of opacity is seen at the right lung base, which may represent atelectasis, though consolidation is not excluded. An AICD is in appropriate, unchanged position.

chest x-ray; 'Cardiomegaly'; 'Consolidation'; 'Lung Lesion'; 'Pleural Effusion'

Extensive consolidative abnormalities improved between ___ and ___, particularly in the lower lungs. Since then there has been no change, including a masslike lesion in the right upper lobe, with there is also persistent volume loss. Large bilateral pleural effusions and enlargement of the cardiac silhouette persist. Patient has been extubated. No pneumothorax.

chest x-ray; 'Atelectasis'; 'Cardiomegaly'; 'Consolidation'; 'Edema'; 'Lung Opacity'; 'Support Devices'

Support lines and tubes are unchanged in appearance compared to the prior study. Lung volumes are also unchanged, there is persistent left basilar atelectasis. There is increasing opacification seen at the right lung base suspicious for right middle lobe consolidation. Mild cardiomegaly and prominence of the pulmonary vascular is consistent with congestive heart failure, unchanged compared to the prior study.

chest x-ray; 'Lung Opacity'

Single frontal view of the chest. Endotracheal tube terminates 3.4 cm above the carina. Right PICC terminates in the lower SVC. Single metallic clip along the left heart border is unchanged. Widespread bilateral parenchymal opacities are similar to the prior exam, possibly representing multifocal infection or ARDS. Heart size and cardiomediastinal contours are stable.

chest x-ray; 'Enlarged Cardiomediastinum'; 'Lung Opacity'; 'Pneumonia'

There are extensive bilateral pulmonary opacities most likely representing multifocal pneumonia. This is less likely to be florid pulmonary edema due to lack of concomitant pleural effusions or cardiomegaly. Underlying metastatic disease cannot be excluded. There is widening of the superior aspect of the mediastinum. The heart is normal in size. A left lateral lower rib appears expanded and sclerotic likely due to metastases better evaluated on prior bone scans.

chest x-ray; 'Lung Opacity'; 'Pneumonia'; 'Support Devices'

In comparison with the study of ___, the monitor and support devices remain in place. Cardiac silhouette remains within normal limits and there is no evidence of vascular congestion or pleural effusion. There is a somewhat ill of increased opacification in the right upper zone. In the appropriate clinical setting, this could be a developing area of aspiration pneumonia.

chest x-ray; 'Lung Opacity'; 'Support Devices'

Two right-sided chest tubes are in unchanged position, one oriented vertically and one oriented towards the base. Opacification at the right base is unchanged, consistent with prior surgery and a small amount of residual pleural fluid. Stable subcutaneous emphysema is present in the right upper abdominal wall. There is no definite pneumothorax. A small left pleural effusion and atelectasis is unchanged. There is no new consolidation. The cardiomediastinal silhouette is stable. The aorta is tortuous. A right PICC terminates in the mid SVC and is unchanged.

chest x-ray; 'Atelectasis'; 'Support Devices'

As compared to the previous radiograph, the patient has been extubated. The nasogastric tube has been removed. The left chest tube remains in situ. The atelectatic areas at both lung bases have minimally increased. Unchanged air collection in the left-sided soft tissues.

chest x-ray; 'Cardiomegaly'; 'Edema'; 'Pleural Effusion'; 'Support Devices'

Nasogastric tube terminates within the stomach. The distal tip is not included on the radiograph, but is at least within the body of the stomach. Endotracheal tube has been removed. Cardiac silhouette is mildly enlarged. Lung volumes are lower compared to the recent study. Allowing for this factor, the degree of pulmonary edema is probably similar. There are likely small bilateral pleural effusions present, left greater than right.

chest x-ray; 'Edema'; 'Pleural Effusion'; 'Support Devices'

Left PICC line tip is at the level of mid SVC. Heart size and mediastinum are unchanged. Interval improvement in pulmonary edema is present. Bilateral pleural effusions, right more than left are noted.

chest x-ray; 'No Finding'; 'Support Devices'

AP chest compared to ___: Pleural effusions have resolved. Lungs are clear. Heart size normal. Feeding tube ends in the stomach.

chest x-ray; 'Atelectasis'; 'Consolidation'; 'Lung Opacity'; 'Pleural Effusion'; 'Pneumonia'; 'Support Devices'

Comparison is made to the prior study, ___. Cardiac size is top normal. Bibasilar consolidations, larger on the right side and right perihilar opacities are grossly unchanged. They are due to pneumonia. There is a new area of atelectasis in the left lower lobe. Right pleural effusion is probably unchanged allowing the difference in positioning of the patient. ET tube is in standard position. NG tube tip is out of view, below the diaphragm.

chest x-ray; 'Pneumonia'

Compared to the prior radiograph, the known multifocal pneumonia with diffuse bilateral multi focal parenchymal opacities is largely stable. There is more obscuration of the left heart border. Moderate cardiomegaly is unchanged. No change in the pacemaker leads. No larger pleural effusions.

chest x-ray; 'Lung Opacity'; 'Support Devices'

Comparison is made to previous study from ___. There is an endotracheal tube whose distal tip is appropriately sited, 4.2 cm above the carina. There is a right-sided PICC line with distal lead tip at cavoatrial junction. Heart size is within normal limits. No pleural effusions are seen. There is mild prominence of the pulmonary interstitial markings without overt pulmonary edema or definite consolidation. No pneumothoraces are present.

chest x-ray; 'Atelectasis'; 'Cardiomegaly'; 'Pleural Effusion'

As compared to the previous radiograph, no relevant change is seen. The lung volumes remain low. Right pleural effusion with mild right basal atelectasis. Mild cardiomegaly with signs of mild-to-moderate fluid overload. Moderate enlargement of the right hilus continues to be present. Bilateral apical thickening, symmetrical in distribution.

chest x-ray; 'Atelectasis'; 'Pleural Effusion'; 'Support Devices'

AP chest compared to ___, 4:01 a.m.: Left pleural effusion has been substantially drained following insertion of left pleural tube. There is probably a small-to-moderate volume of pleural air lateral to the partially atelectatic right lung, although aeration of the left lung has moderately improved. Right lung is grossly clear. Small right pleural effusion noted. Pneumoperitoneum left upper abdominal quadrant, reflecting recent abdominal surgery.

chest x-ray; 'No Finding'; 'Support Devices'

Dobbhoff tube in stomach. No other changes.

chest x-ray; 'Cardiomegaly'; 'Support Devices'

In comparison with the earlier study of this date, the tip of the endotracheal tube remains at the upper clavicular level, approximately 6.3 cm above the carina. No change in the appearance of the heart and lungs.

chest x-ray; 'Pleural Effusion'; 'Support Devices'

Endotracheal tube tip terminates approximately 5 cm from the carina. An enteric tube tip is within the stomach. The heart size is normal. Mediastinal and hilar contours are unremarkable. There is mild pulmonary vascular congestion with trace left pleural effusion. Patchy atelectasis is likely present in the lung bases. No pneumothorax is identified. No acute osseous abnormalities are present. Punctate radiopaque densities are seen projecting over the left axilla, not seen on the scout view from the previous head CTA.

chest x-ray; 'Edema'; 'Pleural Effusion'; 'Support Devices'

As compared to the previous radiograph, a new left-sided chest tube was placed. There is a minimal improvement in the grade of expansion of the left lung but a substantial amount of left pleural fluid persists. The lung volumes have decreased, visually emphasizing the diameter of the vasculature. Nonetheless, mild to moderate pleural edema is present.

chest x-ray; 'Pleural Effusion'

Heart size and mediastinum are stable. Vascular congestion is demonstrated, moderate. No definitive pneumonia is seen. Small amount of pleural effusion is present.

chest x-ray; 'No Finding'

The cardiomediastinal and hilar contours are within normal limits. There is no definite evidence of a pneumothorax. Consolidation of the left upper lung corresponds to findings from prior chest CT, consistent with known left apical mass. There is bibasilar atelectasis. There are no pleural effusions.

chest x-ray; 'Cardiomegaly'; 'Support Devices'

Stable cardiac enlargement. Increasing perihilar vasculature and indistinctness favoring developing mild perihilar edema. No pleural effusions. No pneumothorax. Endotracheal tube has its tip 4.5 cm above the carina. Nasogastric tube courses below the diaphragm with the tip not identified.

chest x-ray; 'Edema'; 'Lung Opacity'; 'Pleural Effusion'; 'Pneumonia'

As compared to the previous radiograph, the right pleural effusion has minimally decreased in extent. However, the effusion still occupies about ___% of the right hemithorax. However, on the left, there is a newly appeared relatively severe parenchymal opacity, predominating in the left apex and left perihilar lung zones. The opacity shows multiple air bronchograms and might be caused by a combination of pulmonary edema and pneumonia. There is no left pleural effusion. The left aspects of the cardiac silhouette are unremarkable. At the time of observation and dictation, 9:46 a.m., on ___, the referring physician, ___. ___, was paged for notification. The findings were subsequently discussed over the telephone.

chest x-ray;

One AP portable view of the chest. A left-sided pigtail catheter has been pulled back and the tip now ends in the mid-to-lower hemithorax. No pneumothorax is identified. There are low lung volumes. There is slightly more fluid in the minor fissure on the right. Previously seen left lower lobe contusion is unchanged.