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no acute cardiopulmonary process.
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pa and lateral chest compared to : very small right pneumothorax, with anterior apical component, decreased since. also improved is right basal atelectasis. upper lungs clear. postoperative widening of the cardiomediastinal silhouette is stable, exaggerated by a heavy pericardial calcification.
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mild cardiomegaly. no evidence of pneumonia.
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mild pulmonary edema.
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no acute cardiopulmonary process. two new compression deformities in the mid to lower thoracic spine, new since but age indeterminate. clinical correlation will be necessary.
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no acute findings in the chest.
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retrocardiac opacity, which likely represents atelectasis, though pneumonia cannot be definitively excluded in the proper clinical setting. stable moderate left pleural effusion with associated left basilar atelectasis. stable mild cardiomegaly.
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low lung volumes. no definite focal consolidation.
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low lung volumes with bibasilar atelectasis. no focal consolidation is identified.
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in comparison with the study of , there is little change and no evidence of acute cardiopulmonary disease. streak of atelectasis or fibrosis is again seen the right base. however, no evidence of acute focal pneumonia or vascular congestion or pleural effusion.
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no acute cardiopulmonary process.
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no evidence of acute disease.
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slight decrease in small bilateral pleural effusions since.
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there is no large right pneumothorax but there may be a growing postsurgical pneumatocele at the lateral margin of the right midlung. right pleural effusion is small if any. moderate bibasilar atelectasis unchanged. greater caliber of the pulmonary and mediastinal vessels suggests increased intravascular volume but heart is not enlarged and there is no edema. severe subcutaneous emphysema in the right neck and chest wall has redistributed but is probably no larger.
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in comparison to radiograph, the patient has been intubated, with tip of endotracheal tube terminating <num> cm above the carina. no other relevant change.
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a left picc line tip is at the level of proximal right atrium. the interval increase in bibasal atelectasis. there is no pulmonary edema. there is no pneumothorax. the pleural effusion is most likely a small to moderate, not increase in the prior study. abnormal appearance of the bowel is re- demonstrated
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no pneumonia, edema, or effusion.
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<num> mm nodule projects over the left lower lung zone on the frontal radiograph for which nonemergent chest ct for further evaluation is advised. no acute intrathoracic abnormality identified.
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right lower lobe pneumonia. follow up radiographs are recommended after treatment to ensure resolution of this finding.
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mild cardiomegaly without acute cardiopulmonary process.
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multi-focal pulmonary opacities, better assessed on concurrent chest ct.
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no acute intrathoracic process.
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left lower lobe opacity with possible associated effusion in the setting of trauma. a chest ct is recommended for further evaluation. these findings were communicated to dr telephone at on
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no acute cardiopulmonary process.
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no acute cardiopulmonary process.
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compared to prior chest radiographs since , most recently. pulmonary fibrosis is severe. slight increase in the severity of severe pulmonary infiltration since suggests new edema or acceleration of interstitial lung disease. a small region of new pneumonia, such as in the left upper lobe laterally could be devastating clinically. heart size is normal. there is no pleural effusion. tracheostomy tube in standard placement.
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ap chest compared to : in the interim, pulmonary vascular engorgement has improved. there is still mild atelectasis at the lung bases, but no edema or appreciable pleural effusion and no evidence of pulmonary edema. the heart is mildly to moderately enlarged, difficult to assess because of patient rotation. left pic and right internal jugular line both meet in the upper svc. no pneumothorax.
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mild cardiomegaly with platelike right lower lung atelectasis. no edema or pneumonia.
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persistent small amount of pleural effusion in the presence of a drainage tube. no major pneumothorax. no new infiltrates.
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in comparison with the study , there is little change. severe scoliosis of the thoracic spine is again seen, predominantly convex to the right in the lower thoracic region. no evidence of cardiomegaly, vascular congestion, or pleural effusion or acute focal pneumonia.
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no acute intrathoracic process.
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no acute intrathoracic process.
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<num>) persistent patchy opacities in the right mid and lower zones. differential diagnosis includes a pneumonic infiltrate or changes related to aspiration pneumonia. <num>) ? new area of cavitation within the right base infiltrate.
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somewhat nodular opacity at the right upper lung thought to be external in nature however if high concern repeat pa can be performed, if desired. otherwise no evidence of acute cardiopulmonary process.
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findings consistent with known obstructive lung disease. equivocal lingular pneumonia. recommend follow-up chest radiograph in weeks to assess resolution.
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ap chest compared to : upper enteric tube ends in the region of the pylorus, in a completely decompressed stomach. the transverse colon in both flexures are filled with stool. there is no pneumoperitoneum. lungs are clear, cardiomediastinal and hilar silhouettes and pleural surfaces unremarkable. elevation of the right hemidiaphragm is new, probably explained by a subphrenic process. a section of tubing, roughly <num> cm long, projects over the right heart on chest radiographs since , presumably a long coronary stent. unfortunately, the lateral view on , does not show it, so i cannot localize it, but unless its identity is known to the clinical service, it needs to be investigated with imaging to exclude a retained catheter fragment in the right atrium. fluoroscopy would be the easiest. a right pic line ends at the origin of the svc and a transvenous right atrial and right ventricular pacer leads follow their courses, unchanged. i discussed the findings at length by telephone with dr at <num>am.
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as compared to the previous image, no relevant change is seen. the tracheostomy tube is in unchanged position. mild cardiomegaly. improved atelectasis at the left lung basis. appearance of the lung parenchyma. no pleural effusions.
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worsening opacities in the lower lungs remain concerning for pneumonia.
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ap chest reviewed in the absence of prior chest radiographs: low lung volumes explain bronchovascular crowding, but make it difficult to exclude mild interstitial edema. it also is likely responsible for atelectasis in the left lower lobe simulating consolidation. there is no pneumothorax or appreciable pleural effusion. heart size is exaggerated by low lung volume. electrode passes from the left low pectoral power pack to the left paraspinal neck.
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no significant interval change in small bilateral pleural effusions with associated bibasilar subsegmental atelectasis. stable mild pulmonary edema.
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no evidence of acute process to explain patient's symptoms.
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no lobar consolidation. bronchial thickening could reflect airways inflammatory process. improved aeration since prior exam.
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low lung volumes with patchy opacities in the lung bases likely reflective of atelectasis.
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ap chest compared to : changing contour of the right lung base is presumably an indication of decreased right pleural effusion due to interval thoracentesis. there is new focal opacity in the right upper chest at the level of the first anterior interspace. this could be loculated pleural fluid seen on the chest cta. i don't see the region well enough to exclude pneumothorax, and therefore when feasible, conventional chest radiographs should be obtained. heart is normal size. left hemithorax unremarkable aside from mild basal atelectasis. the right lower lobe lung lesion, probably focal atelectasis, seen on the chest ct is also barely visible.
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as compared to the previous image, the extent and distribution of the bilateral parenchymal opacities is unchanged. unchanged appearance of the right lung apex. moderate cardiomegaly persists. the patient has been extubated. the nasogastric tube remains in situ.
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no acute cardiopulmonary process.
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stable chest. no evidence of pneumonia or pulmonary edema. left mid lung laterally pleural based density is unchanged since , suggesting benign etiology.
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no acute cardiopulmonary abnormality.
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no acute intrathoracic process.
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no acute cardiopulmonary process.
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new right mid lung atelectasis. otherwise, no significant interval change.
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residual scarring or atelectasis at the left lung base at site of prior pneumonia.
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in comparison with the study of , there may be slight improvement in the diffuse bilateral pulmonary opacification is bilaterally, most consistent with pulmonary edema. widespread pneumonia and even ards could present a similar pattern remainder of the study is unchanged, as is the tracheostomy tube. the right picc line appears to a migrated distally, so that the tip could well be in the superior aspect of the right atrium.
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constellations of findings suggestive of mild acute on chronic heart failure.
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small right apical pneumothorax, increased compared to prior.
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et tube approximately <num> cm above the carina. please see comment. cardiomegaly with suspected pulmonary artery enlargement. findings consistent with chf. compared with at , the chf findings are improved. left lower lobe collapse and/or consolidation. suspected atelectasis at the right base with elevated right hemidiaphragm. this is improved c/w with at am, but interval improvement could be also relate to differences in positioning, as the current film was obtained semi-erect.
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no acute cardiopulmonary process.
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new moderate right hydropneumothorax is indicative of the anastomotic leak demonstrated on the contemporaneous chest ct.
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suboptimal lateral view due the patient's overlying arm. subtle patchy left base opacity could be due to atelectasis and possible small pleural effusion although underlying consolidation is not excluded.
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small bilateral pleural effusions with adjacent atelectasis larger on the left.
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findings suggestive of interstitial edema. no superimposed consolidation.
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mild congestive heart failure with mild pulmonary edema and small bilateral pleural effusions. probable bibasilar atelectasis.
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compared to chest radiographs and read in conjunction with chest ct performed elsewhere. small left pleural effusion has decreased. there is no pneumothorax. small right pleural effusion is new. mediastinal widening is due to extensive adenopathy. left perihilar mass is demonstrated. heart size probably normal.
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vague, posterior retrocardiac opacity which may reflect an early pneumonia. findings were conveyed by dr to dr telephone at on , <num> minutes after discovery.
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severe symmetric widespread pulmonary consolidation unchanged. heart size normal. no pneumothorax or appreciable pleural effusion. et tube tip with the chin down, between <num> and <num> cm from the carina is standard placement. left subclavian line ends in the low svc.
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no acute cardiopulmonary process.
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the pleural effusion on the right has minimally increased in extent. as a consequence, the left basilar atelectasis is also slightly increased. the right upper lobe opacities unchanged. unchanged appearance of the cardiac silhouette and of the left lung.
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linear bibasilar atelectasis.
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mediastinal widening above the cardiac silhouette and hilar enlargement are unchanged since at least due to a combination of adenopathy and pulmonary hypertension. there is no pulmonary edema, consolidation, or pleural effusion. mild cardiomegaly is also stable.
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in comparison with the study of , the monitoring and support devices have been removed. the cardiac silhouette is within normal limits and there is no evidence of vascular congestion, pleural effusion, or acute focal pneumonia.
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no acute cardiopulmonary process.
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no acute cardiopulmonary process.
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satisfactory positioning of left chest wall pacemaker generator, right atrial and ventricular leads with no pneumothorax.
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no acute cardiopulmonary process.
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cardiomediastinal silhouette is within normal limits. diffuse airspace opacities are seen, more confluent within the left mid and upper lung fields. there is slight improved aeration on the left. no pneumothoraces are seen.
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unchanged moderate left pleural effusion. bibasilar atelectasis.
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no evidence of intrathoracic malignancy by radiography. stable right lower lung granuloma.
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no evidence of acute cardiopulmonary process.
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left-sided chest tube is been removed. there is a tiny left apical pneumothorax. otherwise the appearance of the lungs are unchanged
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in comparison with the study of , the monitoring and support devices are essentially unchanged. there are again relatively low lung volumes with worsening retrocardiac opacification consistent with pleural fluid and substantial volume loss in the left lower lobe. minimal atelectatic changes are seen on the right.
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the enteric tube appears to terminate in the distal esophagus and must be advanced. interval worsening of a right mid lung focal consolidation and left perihilar focal consolidation compared to the prior exam. on the day of the exam.
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bibasilar linear opacities, left greater than right, compatible with bronchiectasis with likely atelectasis, although pneumonia is not excluded.
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no acute cardiopulmonary process. known mediastinal lymphadenopathy is better delineated on dedicated ct from
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no previous images. no evidence of acute cardiopulmonary disease or old tuberculous disease.
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in comparison with the earlier study of this date, following the decortication procedure there are <num> chest tubes in place without evidence of pneumothorax. substantial decrease in opacification in the left hemithorax. the right lung remains essentially clear except for some fibrotic or atelectatic changes.
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ap chest compared to at : no appreciable pneumothorax or right pleural effusion following removal of the right basal pleural drain. mild pulmonary edema collected in the right lower lung. left lower lobe atelectasis is moderate-to-severe and small left pleural effusion is stable. normal post-operative cardiomediastinal silhouette including mild-to-moderate cardiomegaly, improved since pre-operative chest radiograph. nasogastric tube passes below the diaphragm and out of view. transvenous right atrial and right ventricular pacer leads are unchanged in their longstanding positions, including a more medial location than generally seen for the tip of the right atrial lead. swan-ganz or other pulmonary arterial line ends in the right pulmonary artery. no pneumothorax.
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right upper lung zone opacity. given the appearance, it is concerning for a possible mass. alternatively, it could be due to continued infection. continued followup is recommended. chest ct pending.
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minimal residual left basilar opacity although prior left lower lung opacities are almostly fully resolved. tiny residual left pleural effusion. persistent mild-to-moderate cardiomegaly.
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no acute cardiopulmonary abnormalities
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left basilar opacity may reflect atelectasis, but infection cannot be excluded. elevated left hemidiaphragm. probable small left pleural effusion. mild pulmonary vascular congestion.
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in comparison to prior radiograph from earlier the same date, there has been little change in the appearance of the chest except for slightly improved aeration at both lung bases.
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severe elevation of the right hemidiaphragm is chronic. lower lung volumes may explain an increase in pulmonary vascular caliber in the lungs and mediastinum and chronic moderate cardiomegaly since. there is also new right basal atelectasis or a new small right pleural effusion. right pic line ends in the mid svc.
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as compared to radiograph, nonspecific bibasilar opacities have worsened on the left and minimally improved on the right. additional heterogeneous opacities persist in the right mid lung. findings are nonspecific but could potentially represent multifocal aspiration pneumonia in the appropriate clinical setting.
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mild failure, evidence of active infection not seen.
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there is increase in patchy consolidation in the left perihilar region. there is stable consolidation in the right and left bases. there is no pneumothorax or chf.
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retrocardiac opacity, which could represent atelectasis but cannot exclude a pneumonia or aspiration right clinical setting.
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cardiomegaly with minimal interstitial edema, improved since the prior study. no large pulmonary mass is seen, however, ct is more sensitive.
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pa and lateral chest compared to through : moderate-to-large left pleural effusion has recurred and atelectasis is presumably responsible for signs of consolidation in the infrahilar left lower lobe. lungs are otherwise clear. heart is normal size, but slightly larger than before. very heavy central granulomatous calcification is noted.
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as compared to the previous radiograph, the tip of the picc line continues to be to low. to be at the level of the cavoatrial junction, the line needs to be pulled back by approximately <num> cm. lung volumes remain low. mild retrocardiac atelectasis. no pneumonia, no pulmonary edema, no pleural effusions.
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heart size and mediastinum are stable. lungs are clear. no pleural effusion or pneumothorax is seen. increased densities projecting over the right acromioclavicular joint, unchanged in the prior study in might represent evidence of prior trauma.