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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. |
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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. |
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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. |
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In comparison to the most recent prior study, there is increased opacification in the medial right lung base which may represent an early developing pneumonia in the appropriate clinical context but could also represent atelectasis. A large left juxtahilar mass is unchanged, corresponding to the patient's biopsy-proven small cell carcinoma, better characterized on recent CT of the chest. Bilateral calcified pleural plaques are present. No significant pleural effusion or pneumothorax is detected. The pulmonary vasculature is not engorged. The cardiac silhouette is top normal in size but stable. The thoracic aorta is tortuous. The trachea is midline. | Slightly increased opacification at the medial right lung base could represent an early developing pneumonia in the appropriate clinical context or, alternatively, atelectasis. Left juxtahilar mass corresponding to known small cell carcinoma, better characterized on recent CT of . Calcified pleural plaques compatible with prior asbestos exposure. |
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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. |
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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. |
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Since prior study, there has been no interval change in position of right chest wall Port-A-Cath, terminating in the upper right atrium, as well as a left chest wall pulse generator, with dual lead pacing wires terminating in the right atrium and right ventricle. Median sternotomy wires are intact. A right pleural effusion has slightly increased compared to the prior study, along with fluid tracking along the horizontal fissure on the right, and subsegmental atelectasis in the right lung base. Left basilar atelectasis is also increased, as has a small left pleural effusion. There is no pneumothorax. Biapical pleural thickening is stable. The overall heart size is unchanged. | Interval increase in size of moderate right and small left pleural effusions, with bibasilar atelectasis. |
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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. |
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Compared to the prior study there is no significant interval change. | No change. |
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Portable semi-upright radiograph of the chest demonstrates low lung volumes which results in bronchovascular crowding. There is a moderate-sized partially loculated right pleural effusion with adjacent atelectasis. A chest tube projects over the right hemi thorax. Median sternotomy wires are in place. The right-sided Port-A-Cath is in unchanged position. There is no pneumothorax . | Moderate-sized partially loculated right pleural effusion with adjacent atelectasis, not significantly changed from the prior radiograph. |
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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. |
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AP single view of the chest has been obtained with patient in semi-upright position. Analysis is performed in direct comparison with the next preceding similar study of . Status post sternotomy, mitral valve prosthesis in place, permanent left-sided pacer with dual intracavitary electrode system, all unchanged. On the right side, the evidence of pleural effusion has again decreased slightly in comparison with the next preceding study of at which time a mild increase of pleural effusion was noted in comparison with an image obtained two days earlier. These variations illustrate difficulties to quantitate pleural effusions on single portable chest views. On the left side, the evidence of pleural effusion is more impressive as it obliterates totally the entire left-sided diaphragm and the density reaches up to the hilar area and beyond. Also noted is an increased amount of pleural density along the mediastinal structures reaching into the left-sided apical area. No pneumothorax is identified. | Further increasing left-sided pleural effusion likely to compromise left side lung function severely. was paged to transmit findings. He had already observed the findings with massive pleural effusion and a pleural tap is planned later this afternoon. |
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A right-sided Port-A-Cath is unchanged in position as is a left chest wall pacer and leads. Sternotomy wires are stable. Mild enlargement of the cardiac silhouette is again demonstrated and stable from the prior studies. Mediastinal contours are similar. There is moderate pulmonary edema, increased from the prior examination done on . The focal opacity seen at the right lung base could represent an area of atelectasis and effusion however infection should be considered. There may be a small left pleural effusion. Visualized osseous structures are stable. | Moderate pulmonary edema, new from the prior exam on . Right basal opacity is increased from the prior exam and infection should be considered in the appropriate clinical setting. Small bilateral pleural effusions, right greater than left. S |
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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. |
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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. |
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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. |
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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. |
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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. |
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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. |
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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. |
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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. |
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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. |
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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. |
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Single AP portable view of the chest is compared to previous exam from . Again seen is eventration of the right hemidiaphragm. Instinct pulmonary vascular markings suggesting pulmonary vascular congestion. Blunting of the left lateral costophrenic angle may be due to overlying soft tissues and technique. Cardiac silhouette is enlarged, but stable compared to prior. Osseous and soft tissue structures are unchanged, noting degenerative changes at the left glenohumeral joint. | Findings suggestive of pulmonary vascular congestion. |
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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. |
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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. |
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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. |
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Compared to the prior study the ET tube has been removed, otherwise there is no significant interval change | No change |
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New collapse of the left upper lobe around a large, obstructing, left hilar mass explains leftward shift of the mediastinum and elevation of the left lung base though subpulmonic pleural effusion is probably also present, and aeration of the left lower lobe is poor, probably also due to bronchial obstruction. Patient has had right upper lobectomy. There may be a small right pleural effusion. There is no evidence for pneumothorax. The visualized osseous structures are unremarkable. | New upper lobe collapse and some lower lobe atelectasis around a large obstructing left hilar mass. Probable small bilateral pleural effusions. on the day of the exam. |
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AP portable upright view of the chest. In this patient with known left lower lobe mass, a fiducial marker projects over the cardiac silhouette. There is interval improvement in overall aeration in the left upper lobe. Mild persistent perihilar opacity persists which may represent residual atelectasis or may be related to known hilar mass. There is stable blunting of the right CP angle which may represent pleural thickening or tiny effusion. The cardiomediastinal silhouette appears grossly unchanged. The imaged osseous structures appear intact. | Improved aeration in the left upper lobe. Persistent perihilar opacity and left lower lobe mass as seen on prior PET-CT. |
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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. |
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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. |
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The NG tube courses below the diaphragm with the tip out of the field of view of the film. There has been interval worsening of the right linear opacification likely secondary to atelectasis. No pneumothorax or definite pleural effusion is seen. The hilar and mediastinal contours are normal. There is mild cardiomegaly, stable compared to the preior exam. | Slight interval worsening of right lower lung atelectasis. |
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