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Allowing for technical differences, the parenchymal findings are similar, possibly slightly worse. No effusions are identified. ET tube and NG tube are similar. The cardiomediastinal silhouette is probably unchanged.
Radiopaque portion of aortic balloon pump now lies slightly higher. Clinical correlation regarding retraction is requested. Diffuse alveolar opacities, with relative sparing of lung bases, are similar, possibly slightly worse.
Slightly rotated positioning. An NG tube an NG type tube is present, tip overlying the gastric fundus, beneath the diaphragm. An IABP is present, extending from an inferior approach. The aortic knob itself is not well-defined, but the radiopaque tip probably lies at or immediately below the lower edge of the aortic knob. There are dense, confluent opacities in both upper zones, extending into the mid/ lower zones, but with sparing of both lung bases. The degree of confluence is greater on the left. No effusion is identified. Cardiomediastinal silhouette is at the upper limits of normal, but not frankly enlarged. No pneumothorax is detected.
ET and NG tubes, as described. IABP radiopaque tip probably lies at or immediately below the inferior edge of the aortic knob. Dense left-greater-than-right opacities, with upper lobe predominance and sparing of the bases. While this could represent an atypical distribution of CHF, including changes associated with valve dysfunction, in the appropriate clinical setting, the upper lobe predominance would also raise the question of infectious or inflammatory etiologies.
Patient is status post coronary artery bypass graft surgery. The cardiac, mediastinal and hilar contours appear unchanged including moderate cardiomegaly. What is new is bilateral opacification of each lung base, which is especially confluent in the retrocardiac region on the left. Particularly on the right, small coinciding pleural effusion is suspected. Indistinct pulmonary vasculature appears mildly distended suggesting coinciding vascular congestion.
Substantial opacities at both lung bases, raising concern for pneumonia. Findings also suggest mild coinciding vascular congestion and possibly small pleural effusions.
AP portable supine view of the chest. Underlying trauma board is in place. Lungs appear clear. No supine evidence of effusion or pneumothorax. The cardiomediastinal silhouette appears grossly within normal limits. No acute bony injury.
No acute cardiopulmonary abnormality. No acute bony injury.
The heart size is normal. The mediastinal and hilar contours are unchanged. The pulmonary vasculature is not engorged. Persistent crescentic focal opacity is noted within the left lower lobe, which could reflect an area of infection or atelectasis. Minimal streaky opacities elsewhere in both lung bases are compatible with areas of atelectasis. No pleural effusion or pneumothorax is seen. Mild paraseptal emphysematous changes are noted in the lung apices. There are no acute osseous abnormalities.
Persistent crescentic area of opacification within the left lower lobe which may reflect an area of infection or atelectasis.
There has been interval increase in the right pleural effusion is layering posteriorly. There content there continues to be dense retrocardiac opacification that has increased in the interval. There is probably a small left effusion as well. NG tube tip is off the film, at least in the stomach. Right-sided PICC line tip is at the cavoatrial junction
Worsened fluid status.
The patient is status post median sternotomy and CABG. Left-sided pacemaker device is noted with leads terminating in the regions of the right atrium and right ventricle. The heart size is at least mild to moderately enlarged. Atherosclerotic calcifications are demonstrated in the aortic knob. Moderate pulmonary edema is demonstrated along with a moderate left and small right pleural effusion. Bibasilar airspace opacities likely reflect compressive atelectasis. No pneumothorax is demonstrated though the lung apices is somewhat obscured by the patient's neck projecting over this area. Multilevel degenerative changes are seen within the thoracic spine.
Moderate congestive heart failure with moderate left and small right bilateral pleural effusions. Bibasilar airspace opacities likely reflect compressive atelectasis.
An enteric tube ends off the inferior portion of the image. A pacemaker is seen in place. There is moderate cardiomegaly. There are bilateral diffuse streaky opacities likely representing atelectasis or aspiration. No pneumothorax or pleural effusion.
Streaky opacities bilaterally, likely from aspiration or atelectasis. Endotracheal tube in appropriate position.
Portable AP upright chest radiograph was obtained. The lungs are clear bilaterally. Prominent epicardial fat pad accounts for the opacity at the left heart border inferiorly. No pleural effusion or pneumothorax is seen, though the left CP angle is partially excluded. Cardiomediastinal silhouette appears stable. Patient is known to have mediastinal lymphadenopathy due to Hodgkin's lymphoma and overall appearance of the mediastinum is stable-to-slightly less thickened along the right paratracheal stripe. Bony structures appear intact. No pneumothorax or pneumomediastinum.
No pneumonia or other acute process in the chest. Mediastinal prominence is compatible with known lymphadenopathy in the setting of lymphoma.
Bibasilar atelectasis is also unchanged. Lungs are otherwise clear without focal consolidations. Heart size and cardiomediastinal silhouette are unchanged. Mild pulmonary edema has resolved.
Unchanged, bilateral, moderate pleural effusions with associated bibasilar atelectasis. Interval resolution of mild pulmonary edema.
A PICC line terminates in the superior vena cava. The patient is status post fusion of the lumbar spine and sternotomy. The base of the chest is not completely included, but cardiac, mediastinal and hilar contours appear unchanged. Hazy opacification projecting over the lower lungs suggests persistent pleural effusions. Otherwise, the lungs appear clear, however. There is no pneumothorax.
Findings consistent with persistent substantial pleural effusions on limited examination.
Dual lead pacer leads terminate in stable position. Post CABG. Cholecystectomy clips. Accessed right porta catheter terminates in the RA. Unchanged cardiomegaly. Overall similar appearance of mild to moderate pulmonary edema. Improved atelectasis of right lung base.
Similar appearance of mild to moderate pulmonary edema. Improved atelectasis of the right lung base.
Portable semi-upright radiograph of the chest demonstrates low lung volumes with resultant bronchovascular crowding. Two chest tubes project over the right hemithorax. There is a small right-sided pleural effusion with adjacent atelectasis. No pneumothorax. Right-sided Port-A-Cath is in unchanged position. The cardiomediastinal and hilar contours are unchanged. The left lung is essentially clear.
Small right-sided pleural effusion with adjacent atelectasis. No pneumothorax.
A portable frontal chest radiograph demonstrates a decreased right pleural effusion after thoracentesis. The small left pleural effusion is unchanged. There is no pneumothorax. The remainder of the exam is unchanged.
Decreased right pleural effusion after thoracentesis. No pneumothorax.
Portable semi upright radiograph of the chest demonstrates low lung volumes with resultant bronchovascular crowding. There is a persistent moderate-sized loculated right pleural collection with adjacent atelectasis. There is stable left apical thickening with volume loss. The cardiomediastinal and hilar contours are unchanged. Mild pulmonary edema is unchanged. A right-sided Port-A-Cath ends at the cavoatrial junction. A dual-chamber pacemaker is again seen over the left chest, with appropriate position of the leads in the right atrium and ventricle.
Persistent moderate size loculated right pleural collection with adjacent atelectasis. CT could be considered for additional evaluation.
There has been interval removal of the femoral Swan-Ganz catheter. The trachea is central. The cardiomediastinal contour is unchanged with moderate cardiomegaly and prominence of the bilateral hila. Prominence of the pulmonary vasculature is consistent with mild pulmonary vascular congestion. No frank pulmonary edema seen. There is persistent left lower lobe atelectasis. No definite pleural effusion seen. No pneumothorax.
Moderate cardiomegaly and pulmonary vascular congestion without frank pulmonary edema.
The pulmonary edema has essentially resolved. There is minimal bilateral costophrenic blunting laterally that could represent small effusions. There is minimal left basilar atelectasis. Cardiomegaly persists. As before there is aortic arch atherosclerosis and a tortuous descending aorta. Degenerative changes are noted within the spine as well as slight sigmoid scoliosis.
Resolved pulmonary edema with persistent cardiomegaly and possibly small bilateral pleural effusions with mild basilar atelectasis.
Heart size is mildly enlarged. The aorta remains tortuous and diffusely calcified. There is no pulmonary vascular congestion. Mild bibasilar atelectasis is seen. A moderate size hiatal hernia is re- demonstrated. No focal consolidation, pleural effusion or pneumothorax is present. There are no acute osseous abnormalities. Multilevel degenerative changes are noted in the thoracic spine with a levoscoliosis centered at the thoracolumbar junction. No free air is identified under the diaphragms.
Moderate size hiatal hernia. Mild bibasilar atelectasis. No free air identified under the diaphragms.
The cardiac, mediastinal and hilar contours appear stable including mild cardiomegaly with a left ventricular configuration. There is again a poorly visualized substantial, possibly large, hiatal hernia with streaky left basilar opacification suggesting associated minor atelectasis. Elsewhere, the lungs remain clear. There are no definite pleural effusions. The bones appear demineralized. Thoracolumbar curvature appears stable with loss in height of one or more upper lumbar vertebral bodies, probably unchanged.
Substantial hiatal hernia. No definite evidence of acute disease.
AP portable upright chest radiograph obtained. Lungs are clear bilaterally without focal consolidation, effusion, or pneumothorax. The heart and mediastinal contours are normal. Bony structures are intact. No displaced rib fractures are seen.
No acute traumatic injuries.
Lungs are low in volume. Nasogastric tube is curved within the stomach. Moderate pulmonary edema is seen with stable moderate cardiomegaly. A small layering right-sided pleural effusion is likely also present. No focal consolidation suspicious for pneumonia is seen.
Moderate pulmonary edema with small right pleural effusion.
Portable AP upright chest radiograph is obtained. Cardiomegaly with moderate pulmonary edema is noted. Evaluation for effusion is limited. No pneumothorax.
Cardiomegaly with pulmonary edema.
Portable semiupright chest radiograph is obtained portably. Patient is rotated to her right, which limits the evaluation. There is persistent pulmonary edema with bilateral pleural effusions noted, size cannot be assessed. No pneumothorax is seen. Degenerative changes of the left shoulder again noted.
Pulmonary edema, small bilateral effusions. If there is oncern for pneumonia, recommend repeat chest radiograph post-diuresis.
An orogastric tube courses towards the stomach. Its tip not visualized. The sidehole, however, appears to lie slightly above the left hemidiaphragm. Superimposed on background elevation of the right hemidiaphragm, there is persistent opacification at the right lung base with right infrahilar opacification and suspected pleural effusion. Aeration is much better in the left lower lung, however, which appears better expanded with reduction in opacification. There is no pneumothorax. Mild congestion appears similar to slightly decreased with enlarged indistinct vessels.
Status post endotracheal tube placement; sidehole of orogastric tube projecting above the gastroesophageal junction. The clinician was aware of the finding and the tube had apparently been replaced by the time of interpretation. Findings suggesting mild vascular congestion. Persistent right basilar opacification suggesting atelectasis associated with elevation of the right hemidiaphragm and suspected pleural effusion. Improved aeration of the left lung base.
Single portable supine chest radiograph was provided. A new right chest tube is present. The subcutaneous gas persists in the right lateral chest wall soft tissues. No pneumothorax is seen. Lung volumes remain low. There is no focal consolidation or pleural effusion. The endotracheal tube projects in the upper trachea. Nasogastric tube courses below the diaphragm within the stomach. Right rib fractures are incompletely visualized. Right clavicular fracture is again seen.
Status post chest tube placement. Right rib fractures and right clavicular fractures.
Single AP view of the chest provided. Lungs are well inflated. No pleural effusion or pneumothorax. Mild cardiomegaly is unchanged. Prominence of pulmonary vasculature and diffuse interstitial lung markings are concerning for volume overload. Multiple old rib fracture deformities are unchanged.
Diffuse, prominent interstitial lung markings in the setting of prominence of pulmonary vasculature and mild cardiomegaly likely represents pulmonary edema.
The cardiomediastinal and hilar contours are within normal limits. The lungs are well expanded and clear. There is no large pleural effusion, pneumothorax or focal consolidation concerning for pneumonia. There is no evidence of free air.
No acute cardiopulmonary process. No evidence of free air.
The NG tube courses into the left upper abdomen. There is bibasilar atelectasis. Heart and mediastinal contour appears grossly unremarkable. The bony structures appear intact.
Appropriately positioned ET and NG tubes. Bibasilar atelectasis.
Severe cardiomegaly, increased since the prior exam. Moderate pulmonary edema is also present. There is a moderate right pleural effusion. A small left pleural effusion is likely present. Right upper and right lower lobe opacities are noted.
Widened mediastinum with increased cardiomegaly, moderate pulmonary edema, right pleural effusion and multifocal opacities in the right lung.
Thoracic aorta is tortuous and contains dense calcifications along the arch. There is moderate deviation of the trachea to the right, likely related to a dilated aorta. Cardiac silhouette is stable. Elevation of the left hemidiaphragm is chronic. The lungs are grossly clear. There is no pulmonary edema. There is no large effusion or pneumothorax.
Deviation of the trachea to the right has increased since and may be due to a dilated aorta.
Bibasilar streaky opacities are similar in appearance most likely atelectasis/scarring. There is no focal consolidation. No definite pleural effusions are seen. There is no pneumothorax. The cardiac and mediastinal contours are unchanged. There is re-demonstration of a large-sized hiatal hernia, not significantly changed. Subchondral cystic change is present in the right humeral head.
Bibasilar scarring/atelectasis. No focal consolidation. Large hiatal hernia.
Bilateral pleural effusions with adjacent volume loss, greater on the left compared to the right. The heart and mediastinum are shifted left secondary to volume loss. The heart appears enlarged. Multiple bilateral anterior rib fractures and right clavicle fracture, most minimally displaced, are better seen on CT. No pneumothorax.
Moderate left pleural effusion and atelectasis and small right pleural effusion and atelectasis. Multiple bilateral anterior rib fractures and right clavicle fracture better seen on CT. No pneumothorax. Moderate cardiomegaly.
The inspiratory lung volumes are appropriate. No focal consolidation concerning for pneumonia, pleural effusion, or pneumothorax is detected. There is faint increased opacity in the medial left lung apex compared to the right. The pulmonary vasculature is not engorged and there is no evidence of pulmonary edema. The cardiac silhouette is normal in size. The mediastinal and hilar contours are within normal limits. Note is made of a healed but non-united fracture of the distal end of the right clavicle, which is unchanged from prior examinations. There is no evidence of bridging callus across the fracture line. Mild degenerative changes are noted in the thoracic spine.
No acute cardiopulmonary process. Faint opacity in the left lung apex. Chronic non-united fracture of the distal right clavicle.
Portable upright chest radiograph was provided. Lungs are hyperinflated. Subtle opacity in the lower lungs is most compatible with scarring, though a dedicated PA and lateral view may be obtained to further assess. No large pleural effusion or pneumothorax is seen. Cardiomediastinal silhouette is stable. Bony structures are intact.
No acute cardiopulmonary process. Scarring in the lower lungs.
Linear opacity identified at the right lung base projecting over the hemidiaphragm is most suggestive of atelectasis. Elsewhere, the lungs are clear. Cardiac silhouette is enlarged but stable given differences in positioning and technique. Atherosclerotic calcifications are noted at the aortic arch. Healed lateral left rib fractures are noted.
No acute cardiopulmonary process. Stable cardiomegaly.
There is no focal consolidation, pleural effusion or pneumothorax. No central vascular congestion or overt pulmonary edema. Mediastinum, hila and pleural surfaces are unremarkable. The cardiomediastinal silhouette is normal. Posterior spinal fusion hardware is noted.
No evidence of pneumonia.
Lung volumes are slightly decreased. This causes exaggeration of the cardiac silhouette size which is likely unchanged and top normal. Mediastinal and hilar contours are unremarkable accounting for low lung volumes. There is crowding of the bronchovascular structures but no overt pulmonary edema is present. Minimal atelectasis is seen in the lung bases. No pleural effusion or pneumothorax is identified. No acute osseous abnormalities seen.
Low lung volumes with mild bibasilar atelectasis.
The heart size is severely enlarged and there is marked pulmonary vascular redistribution. With hazy alveolar infiltrates most marked in the lower lobes there small bilateral pleural effusions have increased.
Increased pulmonary edema.
Frontal radiograph of the chest demonstrates a re-positioned left PICC with the tip terminating in the low portion of the SVC. No pneumothorax is seen. There is a minimal change in bibasilar atelectasis and no change in the cardiac and mediastinal contours.
Satisfactory re-positioning of right PICC with the tip terminating in the low portion of the SVC.
The lungs are relatively well expanded and grossly clear, with the exception of some mild basilar atelectatic changes. The cardiomediastinal silhouette is unremarkable. Median sternotomy wires, valve prosthesis, and AtriClip device are again noted. There is no pneumothorax, pleural effusion, overt pulmonary edema, or focal airspace opacification concerning for pneumonia. A right humeral head anchor screw is noted.
No acute cardiopulmonary pathology.
Large right pleural effusion is unchanged. No appreciable effusion on the left. Lung volumes remain low. Right internal jugular central venous catheter has been removed. Right basilar atelectasis has improved, as well as mild left basilar atelectasis. No new focal consolidation. Heart size is normal. No central vascular congestion or overt pulmonary edema. Right PIC line tip terminates close to the cavoatrial junction.
Persistent large right pleural effusion. Improved bibasilar atelectasis.
The left lung fully opacify for a combination of collapse and pleural fluid. The mediastinal shift towards the opacified lung is increased, likely for more severe collapse. Right lung is still clear, except for parahilar opacity, but without pleural effusion. All the monitoring devices are unchanged.
Increased left mediastinal shift due to increasedleft lung collapse. Unchanged the right hilar opacity.
Cardiac silhouette size is normal. Atherosclerotic calcifications are noted at the aortic arch. There is mild perihilar haziness and vascular indistinctness compatible with mild pulmonary vascular congestion. Additionally moderate size layering bilateral pleural effusions are seen. Bibasilar opacities likely reflect compressive atelectasis. Marked degenerative changes of the left glenohumeral and acromioclavicular joint are noted along with multilevel degenerative changes in the imaged thoracic spine.
Layering moderate size bilateral pleural effusions with bibasilar atelectasis. Mild pulmonary vascular congestion.
The ETT is in good position. The tip of the nasogastric tube is in the body of the stomach. The right-sided PICC line tip is at the cavoatrial junction. There is persistent loculated right basal pneumothorax this has marginally decreased. The right-sided effusion and airspace opacity is also stable. The left lung has minimal nodular airspace opacity in the left lower lobe.
Slight interval decrease in the right loculated basal pneumothorax.
Single portable radiograph of the chest demonstrates low lung volumes, with a mild to moderately enlarged heart. Hazy opacification is noted in the right lung base, with air bronchograms. Mild peribronchial cuffing is also noted, compatible with mild edema. There is no pneumothorax. The cardiomediastinal silhouette is unremarkable. Vascular clips along the left upper mediastinum are unchanged.
Right basilar pneumonia. Mild pulmonary edema. Mild cardiomegaly is stable.
Lung volumes are lower, causing crowding of bronchovascular structures. Bibasilar atelectasis is identified. No focal consolidation. Cardiomediastinal and hilar silhouettes are unchanged. No free intraperitoneal air.
Bibasilar atelectasis. No focal consolidation. No evidence of free intraperitoneal air.
There has been minimal improvement of the right-sided pleural effusion. There is atelectasis at the base of the right lung. There is no pneumothorax. Posttreatment changes of the right middle lobe mass are unchanged. No vascular congestion or acute focal consolidations are noted.
Minimal improvement of right-sided pleural effusion with no pneumothorax.
Large left pleural effusion is increased. Right pleural effusion is small. Cardiomediastinal silhouette is obscured by pleural effusion. There is almost complete collapse of the left lung, sparing left lung apex. Mild pulmonary edema is noted in the right lung. Massive dilated esophagus is unchanged. Left upper abdomen catheter is in unchanged position. Left main stem bronchus is patent but distal branches are not visualized, which may reflect bronchial impaction, possibly due to mucous. Lucency under the right hemidiaphragm likely reflect a loop of colon as seen on prior CT.
Near complete opacification of left hemithorax with large left pleural effusion, increased since . Left main stem bronchus is patent but distal branches are not visualized, which may reflect bronchial impaction, possibly due to mucous. Dilated esophagus is unchanged.
Distended esophagus unchanged. Surgical clips in relation to the gastroesophageal junction. Prominent heart size unchanged. The known loculated left-sided pleural effusion appear slightly decreased in size. Slightly improved aeration of the left lung. No left pneumothorax. No new right lung airspace opacification.
The known loculated left-sided pleural effusion as well as aeration of the left lung shows mild interval improvement.
Single portable upright view of the chest. The lungs are clear. Cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are unremarkable. There is mild lower thoracic dextroscoliosis, as on prior. No free air is seen below the diaphragm.
No free air below the diaphragm, no acute cardiopulmonary process.
Small post-operative pneumopericardium is noted, which is stable in appearance. Median sternotomy wires are in the expected location. Again noted is the left sided chest tube, Swan Ganz catheter, mediastinal drains, endotracheal tube, and a nasogastric tube. No large pleural effusions are noted. No evidence of pneumothorax.
Stable post-operative pneumopericardium.
There is no focal consolidation. Increased interstitial markings are seen throughout the lungs and despite differences in positioning and technique appear to have slightly progressed. No large pleural effusions identified based on this semi supine film. Mild cardiomegaly is noted as on prior as well as atherosclerotic calcifications of the thoracic aorta. No displaced fractures.
Interstitial pulmonary edema, slightly worsen. No focal consolidation.
Moderate pulmonary edema is similar. Blunting of the lateral costophrenic angles suggests pleural effusions, right greater than left. Cardiac silhouette is top-normal. Dense atherosclerotic calcifications are noted in the thoracic aorta. IVC filter is partially visualized. Vertebroplasty changes are noted in the upper lumbar spine.
Moderate pulmonary edema and bilateral pleural effusions.
The ET tube is present in standard position. An enteric tube is present, with distal tip not captured on the current exam. The cardiomediastinal and hilar contours are stable with normal heart size. Digital deviation to the right AC sign of persistent thyroid tissue after thyroidectomy. A new left pleural effusion is small. There is no large right pleural effusion. There is no pneumothorax. The lungs are overexpanded with flattening of the hemidiaphragms, consistent with emphysema. Consolidation at the left lung base may reflect atelectasis or pneumonia. The visualized portion of the upper abdomen is unremarkable in appearance. Median sternotomy wires are not fractured. Bilateral tubular structures in the soft tissues of the neck are consistent with carotid calcifications.
Worsened left base consolidation, which may reflect pneumonia in the correct clinical setting.
The right internal jugular central venous catheter ends in the low SVC. There is evidence of prior midline sternotomy and CABG. Lung volumes remain low. There is subsegmental bilateral lower lung atelectasis, not significantly changed. Moderate enlargement of the cardiac silhouette is slightly increased. There is new mild interstitial pulmonary edema. Small bilateral pleural effusions are more conspicuous than before.
Mild interstitial pulmonary edema. Slight increase in moderate cardiomegaly. Small bilateral pleural effusions.