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The lungs are clear of focal consolidation, pleural effusion or pneumothorax. The heart size is normal. The mediastinal contours are normal. Multiple surgical clips project over the left breast, and old left rib fractures are noted.

No acute cardiopulmonary process.

Lung volumes remain low. There are innumerable bilateral scattered small pulmonary nodules which are better demonstrated on recent CT. Mild pulmonary vascular congestion is stable. The cardiomediastinal silhouette and hilar contours are unchanged. Small pleural effusion in the right middle fissure is new. There is no new focal opacity to suggest pneumonia. There is no pneumothorax.

Low lung volumes and mild pulmonary vascular congestion is unchanged. New small right fissural pleural effusion. No new focal opacities to suggest pneumonia.

Lung volumes are low. This results in crowding of the bronchovascular structures. There may be mild pulmonary vascular congestion. The heart size is borderline enlarged. The mediastinal and hilar contours are relatively unremarkable. Innumerable nodules are demonstrated in both lungs, more pronounced in the left upper and lower lung fields compatible with metastatic disease. No new focal consolidation, pleural effusion or pneumothorax is seen, with chronic elevation of right hemidiaphragm again seen. The patient is status post right lower lobectomy. Rib deformities within the right hemithorax is compatible with prior postsurgical changes.

Innumerable pulmonary metastases. Possible mild pulmonary vascular congestion. Low lung volumes.

In comparison to study performed on of there is new mild pulmonary edema with small bilateral pleural effusions. Lung volumes have decreased with crowding of vasculature. No pneumothorax. Severe cardiomegaly is likely accentuated due to low lung volumes and patient positioning.

New mild pulmonary edema with persistent small bilateral pleural effusions. Severe cardiomegaly is likely accentuated due to low lung volumes and patient positioning.

The right costophrenic angle is not imaged. Otherwise, the lungs are clear. The heart size is upper limits of normal. Enteric tube courses below the level of the diaphragm. There is no pneumothorax.

An enteric tube courses below the level of the diaphragm.

NG tube is coiled in the stomach. Right PICC in lower SVC is unchanged in position. Cardiac size is normal. Mild bibasilar opacities consistent with atelectasis, unchanged compared to chest radiograph performed earlier in the same day. There is no pneumothorax or pleural effusion.

NG tube in expected position with tip coiled in the stomach. No other interval change since chest radiograph performed earlier on the same day.

Portable AP chest radiograph. The lungs are relatively well expanded without focal consolidation, pleural effusion or pneumothorax. The heart is normal in size with tortuous aortic contour.

No acute intrathoracic process.

Relative increase in opacity over the lung bases bilaterally is felt due to overlying soft tissue rather than consolidation or pleural effusion. Lateral view may be helpful for confirmation. No large pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No overt pulmonary edema is seen

Relative increase in opacity over the lung bases bilaterally felt due to overlying soft tissue rather than consolidation. Lateral view may be helpful for confirmation.

Patient is status post median sternotomy and CABG. Heart size is normal. Mediastinal and hilar contours are unchanged. Pulmonary vasculature is normal. No focal consolidation, pleural effusion or pneumothorax is seen. No acute osseous abnormality is detected.

No acute cardiopulmonary abnormality.

A moderate left pleural effusion is new since . Associated left basilar opacity likely reflect compressive atelectasis. There is no pneumothorax. There are no new abnormal cardiac or mediastinal contour. Median sternotomy wires and mediastinal clips are in expected positions.

New moderate left pleural effusion with adjacent atelectasis in the left lung base.

A single portable semi-erect chest radiograph was obtained. Small left and moderate layering right pleural effusions have increased in size since the preceding day's exam. The right middle lobe pnemonia seen on recent CT is not clearly differentiated, but the right heart border is obscured. Left basilar atelectasis is stable. No new focal consolidation or pneumothorax is present. Hila remain indistinct. A left-sided PICC line tip remains in the upper SVC.

Interval increase inmoderate to large right and small left pleural effusions. Persistent right basilar pneumonia.

A single portable semi-erect chest radiograph is obtained. There is no significant change in the middle and lower lobe pneumonia, better appreciated on recent CT. There is no increased pulmonary edema, new consolidation, or pneumothorax. Layering left pleural effusion has gotten slightly bigger. Cardiac and mediastinal contours are unchanged.

No significant change in right middle and lower lobe pneumonia. Small increase in left pleural effusion.

A bedside AP radiograph of the chest demonstrates interval improvement in mild pulmonary edema compared to the most recent study from . A moderate right pleural effusion is stable and a small left pleural effusion has also decreased in size. Aside from persistent bibasilar atelectasis, the lungs are clear. The hilar and cardiomediastinal contours are normal. There is no pneumothorax. A left PICC terminates in the mid SVC. A Dobbhoff tube terminates in the stomach and a second enteric tube enters the stomach and courses inferiorly beyond the field of view.

Compared to the most recent study, there is improvement in the mild pulmonary edema and decrease in the small left pleural effusion. Moderate right pleural effusion and bibasilar atelectasis are stable.

Single portable view of the chest is compared to previous exam from . Enteric tube is seen with tip off the inferior field of view. Left PICC is seen; however, tip is not clearly delineated. Persistent bibasilar effusions and a right pigtail catheter projecting over the lower chest. There is possible right apical pneumothorax. Superiorly, the lungs are clear of consolidation. Cardiac silhouette is within normal limits. Osseous and soft tissue structures are unremarkable.

No significant interval change with bilateral pleural effusions with right pigtail catheter in the lower chest. Possible small right apical pneumothorax.

A single portable chest radiograph is obtained. Endotracheal and enteric tubes have been removed. A right internal jugular catheter tip terminates in the right atrium. A right pleural drain remains in the right base. A tiny right effusion and small left effusion are visualized. Cardiac contours are unchanged. No consolidation, pneumothorax or nodules present. A left-sided PICC line tip terminates in the left brachiocephalic vein.

Unchanged appearance of small bilateral pleural effusions status post extubation.

Frontal supine view of the chest was obtained. The heart is of normal size with normal cardiomediastinal contours. The right hemithorax demontrates increased opacity, compatible with a moderate-to-large size layering pleural effusion. A small left pleural effusion is also present. No pneumothorax is seen. A right PICC line terminates in the axilla. A Dobbhoff feeding tube and a gastric tube terminate below the diaphragm. The sidehole of the gastric tube is positioned in the distal esophagus.

Bilateral pleural effusion, right greater than left. Underlying consolidation cannot be completely excluded. Recommend repositioning. NG tube terminates in stomach with sidehole in distal esophagus. Right PICC terminates in the axilla.

Single AP supine portable view of the chest was obtained. Chain sutures are seen overlying the right upper hemithorax. There has been interval removal of a previously seen right-sided port. The cardiac and mediastinal silhouettes are stable. No definite focal consolidation is seen. Rounded opacities projecting over the lower hemithorax bilaterally on the left and right appear possibly external to the patient and could represent nipple shadows. They most likely represent nipple shadows. No discrete pulmonary nodules seen that would correspond at the lung bases on recent prior PET-CT from . No pleural effusion or pneumothorax is seen.

No acute cardiopulmonary process.

A left-sided PICC is unchanged in position. Cardiac and mediastinal contours are unchanged from the prior exam. There is no evidence of pulmonary edema. No effusions are identified. There is no pneumothorax. Surgical chain sutures are again seen in the right upper lobe consistent with prior surgery. Again, fullness to the right suprahilar region likely corresponds to a consolidative fibrotic area seen on recent chest CT dated .

No evidence of pneumonia, edema or effusion.

Single frontal view of the chest was obtained. Free air is present underneath both hemidiaphragms. Lung volumes are low. The vascular pedicle is widened and there is slightly increased rightward shift of the trachea, which may be projectional. Multi focal ill-defined lung opacities are similar to prior and consistent with history of sarcoidosis although superimposed infection cannot be excluded. No pneumothorax or substantial pleural effusion. Chain sutures in the right mid lung are similar to prior.

Pneumoperitoneum. Widening of the vascular pedicle may be related to low lung volumes and intravascular volume status.

Within the interim, the previously seen enteric tube has been removed. A new enteric tube with a weighted tip projects over the stomach. A right central venous catheter is unchanged in position. A right ureteral stent is incompletely imaged. The remainder of the study is not optimized for assessment of the chest and abdomen.

Dobhoff tube terminates within the stomach.

Inflated lung parenchyma appears grossly clear, but is incompletely evaluated due to the substantial pleural effusions. A Dobhoff tube is unchanged in position, terminating in the mid stomach. A right-sided port is unchanged in position.

Substantially increased, large, bilateral pleural effusions.

Moderate right pleural effusion is probably unchanged, taking into account changes in patient positioning. Increased, small left pleural effusion. Substantial bibasilar atelectasis. Moderate cardiomegaly with mild, unchanged pulmonary edema. An enteric tube terminates in the expected location the gastric body. A right-sided port/central venous catheter terminates in the right atrium.

ET tube is appropriately positioned. Moderate right and increased, small left pleural effusion. Mild, unchanged pulmonary edema.

Right-sided Port-A-Cath tip terminates in the proximal right atrium. Moderate enlargement of the cardiac silhouette is unchanged. The mediastinal and hilar contours are similar. Pulmonary vasculature is normal. The lungs are clear. No focal consolidation, pleural effusion or pneumothorax is demonstrated. Partially imaged is a pigtail catheter overlying the right upper quadrant of the abdomen. No acute osseous abnormalities are detected.

No acute cardiopulmonary abnormality.

A chest tube in similar position. Interval decrease in the right-sided pleural effusion which is now small. There is still fluid along the minor fissure and right lower lobe opacification. Moderate to large left pleural effusion and significant opacification of the left lung is unchanged. Feeding tube has been removed. Nasogastric tube is coiled in the stomach region. .

Interval decrease in the right-sided. Stable appearance of the left lung.

Moderate to large bilateral pleural effusions are again seen, likely right greater than left. There is suspected superimposed pulmonary edema may have slightly improved since prior although detailed evaluation is limited given layering pleural effusions. Vasculature appears less engorged. Cardiac silhouette cannot be assessed.

Mild to large bilateral, right greater than left pleural effusions. Degree of pulmonary edema may have slightly improved since prior exam although detailed evaluation is limited.

Heart size is difficult to assess given the presence of moderate to large bilateral pleural effusions, but appears at least moderately enlarged. The mediastinal contours are grossly unremarkable. Perihilar haziness with vascular indistinctness and diffuse alveolar opacities are compatible with moderate pulmonary edema. Bibasilar compressive atelectasis is demonstrated. No pneumothorax is seen. Moderate multilevel degenerative changes are noted in the thoracic spine.

Moderate pulmonary edema with moderate to large bilateral pleural effusions and bibasilar atelectasis.

The bilateral pleural effusions, lower lobe volume loss, and dense lower lobe opacity compatible with a combination of volume loss/infiltrate/effusion. The heart continues to be moderately enlarged. There is mild vascular redistribution.

CHF, slightly worse than on the prior study.

Patient is status post median sternotomy and CABG. Left-sided AICD is noted with single lead terminating in the right ventricle. Heart size is normal. Mediastinal and hilar contours are normal. Lungs are clear. No pleural effusion or pneumothorax. No acute osseous abnormalities are detected.

No acute cardiopulmonary abnormality.

Lines and tubes are grossly unchanged. The NG to cannot be traced through the lower most mediastinum due to underpenetration. The cardiomediastinal silhouette is unchanged. Extensive interstitial and alveolar opacity use in both lungs appear more confluent . Small effusions would be difficult to exclude. No pneumothorax detected.

Progression of bilateral opacities, now more confluent, particularly on the left. suggesting progression of alveolar edema. In the appropriate clinical setting, underlying infectious infiltrate would be difficult to exclude.

An enteric tube courses below the diaphragm with the tip out of the field of view. The lung volumes are low. Bibasilar atelectasis is unchanged. Since the prior exam, there has been a slight interval worsening of the vascular congestion and mild pulmonary edema. There is no opacity to suggest pneumonia. No pleural effusion or pneumothorax is identified. Widening of the mediastinal contours is unchanged, and likely due to mediastinal fat, as seen on the prior CT. The heart appears slightly larger.

Slight interval worsening of vascular congestion and mild pulmonary edema. Additionally, the heart appears slightly larger.

Compared to the prior study, the right IJ line may have been exchanged. The tip overlies the proximal SVC. The ET tube, left IJ line and NG type tube appear unchanged. No pneumothorax is detected. There is some new subtle confluent opacity in the right perihilar region. Otherwise, I doubt significant interval change. Prominent cardiomediastinal silhouette is unchanged. Upper zone redistribution and diffuse vascular blurring is similar to the prior film, allowing for technique. Increased retrocardiac density with air bronchograms is also unchanged. No gross effusion.

Subtle new confluent opacity in the right perihilar region,? related to subtle progression of CHF findings. Otherwise, I doubt significant interval change. Attention to this area on followup films is requested.

Numerous nodular opacities compatible the patient's metastatic disease are again appreciated. In addition, there is worsening pulmonary edema as well as a worsening right lower lobe infiltrate which could represent pneumonia in the correct clinical setting. A right pleural effusion is also increased in size.

Worsening combination of pleural effusion, pulmonary edema and possibly pneumonia particularly in the right lower lobe.

The lungs are clear without infiltrate. The cardiac and mediastinal silhouettes are normal. There is minimal right CP angle blunting compatible with either a tiny effusion or is small amount of pleural thickening the bony thorax appears normal.

Blunting of the right CP angle otherwise normal chest.

Semi-upright portable view of the chest demonstrates small right apical pneumothorax, which has decreased in size since study obtained four hours prior. No appreciable left pneumothorax. Subcutaneous gas of the chest wall is unchanged. Low lung volumes. No focal consolidation or pleural effusion. Hilar and mediastinal silhouettes are unchanged. Heart size is normal. Trace amount of free air is seen under the right hemidiaphragm.

In comparison to study obtained four hours prior, there is interval decrease in right apical pneumothorax, now small.

Two enteric tube tips terminate within the stomach. Heart size is borderline enlarged. Mediastinal and hilar contours are similar. There is mild upper zone vascular redistribution, which suggests mild pulmonary vascular congestion. Additionally, there is a persistent small right pleural effusion with adjacent right basilar opacity, which may reflect atelectasis. Left lung is grossly clear, however, the left costophrenic angle is excluded from the field of view. No large pneumothorax is seen. There are no acute osseous abnormalities.

Persistent small right pleural effusion with patchy right basilar opacity, potentially atelectasis. Mild pulmonary vascular congestion. No large pneumothorax identified on this supine limited exam.

Single portable chest radiograph was provided. A nasogastric tube courses below the diaphragm and terminates within the stomach. A right PICC terminates at the mid SVC. Again seen is plate-like atelectasis at the right base. Retrocardiac and left basilar opacity is similar to the prior radiographs and may represent a combination of pleural effusion and atelectasis. The heart remains enlarged. There is no pneumothorax. The imaged upper abdomen is unremarkable. The bones are intact.

Nasogastric tube below the diaphragm, in the stomach. Persistant right basilar and retrocardiac atelectasis with possible left pleural effusion.

Again seen is a right PICC line with tip terminating in the mid SVC. Cardiomediastinal and hilar contours remain stable. There is improvement in the left basilar opacity. A small left pleural effusion persists. There is no right pleural effusion. There is no pneumothorax. A new right basilar opacity is present, likely atelectasis, although pneumonia cannot be excluded.

New right basilar opacity, which may represent pneumonia in the correct clinical setting. Improvement in left basilar opacity, with persistent small left pleural effusion.

The lung apices are not depicted. NG tube ends in the gastric antrum in appropriate position. The lungs are clear, the cardiomediastinal silhouette and hila are normal. There is no pleural effusion and no pneumothorax. Partially visualized abdomen shows normal bowel gas pattern.

Appropriately placed NG tube.

Mild to moderate cardiomegaly is stable from the prior examination. There has been an interval decrease in adjacent left basal atelectasis. The right lung is clear. No evidence of pneumothorax. Marked thoracolumbar dextroscoliosis is unchanged.

Mild to moderate left pleural effusion is decreased in size from the prior exam has as is adjacent left basal atelectasis. No evidence of pneumothorax.

The lungs remain clear. There is no pneumothorax. The cardiac silhouette and mediastinal contours are within normal limits for technique. There are no concerning bone findings. A right subclavian catheter is in place, as before, terminating at the level of the superior vena cava.

Unremarkable study.

The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Aortic knob calcification is seen.

No acute cardiopulmonary process.

There has been interval removal of the endotracheal tube. The NG tube is seen in appropriate positioning coursing below the diaphragm with the tip and side hole overlying the stomach. There is a right PICC line terminating in the low SVC. The lungs are otherwise clear. Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. No pneumothorax or pleural effusions are visualized.

Interval removal of the endotracheal tube. NG tube and right PICC line in appropriate positioning. Apparent resolution of the small bilateral pleural effusions.

Endotracheal tube is seen with tip in the right mainstem bronchus. Hazy right basilar opacity may be due to atelectasis. Left lung is grossly clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities. Thoracolumbar S-shaped scoliosis is noted.

Right mainstem intubation. , D. by , D.

Enteric tube tip is in the proximal stomach, new since prior. More prominent right basilar opacity and adjacent right pleural effusion. Otherwise stable.

Enteric tube tip in the proximal stomach.

Significant interval worsening of bilateral perihilar, lower lung opacities, with bronchovascular distribution, consider worsening pneumonia, aspiration or edema. Elevated right hemidiaphragm stable. Borderline heart size. Thoracolumbar curve.

Significant interval worsening, consider worsening pneumonia, aspiration or edema.

Compared to chest radiographs from , there is increased vascular congestion with new mild interstitial edema. Lung volumes have decreased. Bibasilar opacities have worsened. Small right pleural effusion persists. No appreciable effusion on the left. Heart is top-normal in size, increased. Endotracheal tube is in standard placement. Right PICC line terminates at the cavoatrial junction. Enteric tube descends below the diaphragm and terminates in the proximal stomach. Prominent right convex scoliosis of the upper thoracic spine and left convex scoliosis of the lower thoracic spine.

Increased central vascular congestion with new mild pulmonary edema. Worsening bibasilar opacities, concerning for worsening atelectasis, though aspiration should be considered in the proper clinical context. Increased small right pleural effusion. Increased heart size, now top-normal.

Mild bibasilar atelectasis is noted without definite focal consolidation. No large pleural effusion or evidence of pneumothorax is seen. The cardiac silhouette is top-normal to mildly enlarged. Mediastinal contours are unremarkable. Slight prominence of the hila suggest pulmonary vascular engorgement without overt pulmonary edema.

Slight prominence of the hila suggest pulmonary vascular engorgement without overt pulmonary edema. Basilar atelectasis without definite focal consolidation.

Endotracheal tube, feeding tube, and right internal jugular central line are unchanged in position. Overall cardiac and mediastinal contours are likely stable. There is persistent volume loss in the left lower lung and the right lung remains hyperexpanded. Overall, however, there is some improved aeration at the left base.

No pulmonary edema. No pneumothorax.

The tip of the Dobhoff tube projects over the expected region of the stomach, slightly advanced compared to the prior exam. Focal opacity with air bronchograms in the left lower lung has increased since but is overall similar to , suggesting aspiration. The lungs remain hyperinflated. The right lung is clear. The linear lucencies projecting over the left lateral hemithorax appears to be a skin full. No pleural effusion, pneumothorax, or edema. The heart is normal in size. Mediastinal contours are unchanged. Slight elevation of the left hemidiaphragm may reflect a combination of atelectasis and gaseous distension of bowel in the left upper quadrant, unchanged. Anterior cervical fixation hardware is unchanged.

Dobhoff tube tip lies within the body of the stomach, slightly advanced from the prior exam. Left lower lobe aspiration.

A tracheostomy tube is seen projecting over the superior mediastinum. Interval development of right lower lobe opacities concerning for pneumonia. Residual opacity in the left lung base is slightly decreased from prior though may represent persistent pneumonia or aspiration. No large effusion is seen. Cardiomediastinal silhouette is stable. Right IJ central venous catheter is been removed.

Interval development of right lower lobe consolidation concerning for pneumonia. Persistent though decreased opacity in the left lung base may represent residual pneumonia/aspiration.

There is persistence of the right medial opacity, concerning for pneumonia. Minimal opacity seen the left lung base are likely due to atelectasis. Tracheostomy tube is in stable position. The heart size is unchanged. There is no pneumothorax or pulmonary edema. There is a prominent line which has vessels continuing beyond it, compatible with skin fold.

Persistence of the right medial opacity since is concerning for pneumonia.

A left lower lobe pneumonia seen better on most recent chest CT is severe. There is atelectasis at the left lung base. Previously seen streaky opacities at the right lung base likely atelectasis have improved. Cardiac, mediastinal, and hilar silhouettes are unremarkable. There is no pneumothorax or pleural effusion.

Left lower lobe pneumonia better seen on chest CT from .

Single portable view of the chest is compared to previous exam from . There are new bibasilar opacities identified compatible with infection, given distribution, aspiration is also possible. Previously identified right upper lung opacity has essentially resolved, although is partially obscured by overlying lead. Cardiac silhouette is enlarged but stable in configuration. Osseous and soft tissue structures are unchanged. Surgical clips are seen at the thoracic inlet on the left.

Bibasilar opacities compatible with pneumonia in the proper clinical setting. Alternatively these could be related to aspiration given distribution. Clinical correlation is suggested. Repeat exam after treatment is recommended to document resolution.

Heart is upper limits of normal in size. Mediastinal hilar contours are normal. Lungs are clear except for linear bibasilar atelectasis and or scarring.

Linear bibasilar atelectasis or scar. No evidence

A single portable AP semi-upright view of the chest was obtained. Heart is mildly enlarged. Calcifications are present in the aortic arch. Deviation of the trachea to the right is probably due to an enlarged thyroid. There are diffuse bilateral opacities with perihilar distribution and more prominent in the lower zone, consistent with moderate-to-severe pulmonary edema. Moderate bilateral pleural effusions are also present. The degree of pulmonary edema limits assessment for focal consolidation. There is no pneumothorax.

Moderate-to-severe pulmonary edema and moderate bilateral pleural effusions.

There small bilateral pleural effusions that are smaller compared to prior. There continues to be pulmonary vascular redistribution and moderate to severe cardiomegaly

Improvement in fluid status both pulmonary edema persist.

Single AP upright portable view of the chest was obtained. There has been interval placement of a left-sided pacer device with a lead seen extending to the expected location of the right ventricle and the coronary sinus. There may also be a lead extending to the right ventricle, although this is not well seen on the current study. Right lower hemithorax opacity is seen which may be due to underlying subpulmonic effusion with overlying atelectasis, although underlying consolidation is not excluded. Findings may also be due to elevation of the right hemidiaphragm. If patient able, suggest dedicated PA and lateral views for better evaluation. There is prominence and indistinctness of the hila. The cardiac silhouette remains enlarged. Patient is status post median sternotomy.

Enlarged cardiac silhouette and engorged pulmonary hila with pulmonary vascular congestion may be due to CHF. Right lower hemithorax opacity could be due to pleural effusions with overlying atelectasis and/or consolidation, elevation of the right hemidiaphragm. If patient able, dedicated PA and lateral views would be helpful for further evaluation.

Portable AP chest radiograph demonstrates a large right-sided pleural effusion with associated basilar atelectasis. Concurrent consolidation cannot be excluded. There is otherwise little change from . Left pectoral pacemaker leads are in stable position. There is no pneumothorax. There is no pulmonary edema. Evaluation of the heart size is limited due to low lung volumes and AP projection.

Enlarging right pleural effusion without pulmonary edema. Recommend obtaining PA and lateral chest radiograph.

Interval removal of the ETT, NGT, and temporary pacemaker. Interval placement of a left-sided two-lead intracardiac device, with one lead terminating in the right atrium and the other in the right ventricle. The aortic valve prosthesis appears unchanged. Bilateral low lung volumes and moderate bibasilar atelectasis. No pneumothorax, focal consolidation, pulmonary edema, or pleural effusion. Stable post-operative appearance of the cardiomediastinal silhouette. Stable scoliosis. Unchanged position of the right catheter sheath with the tip in the approximate upper SVC.

Pacemaker leads in the right atrium and right ventricle. No pneumothorax.

There is a new focal opacity at the left lung base with elevation of the left hemidiaphragm. Diffuse prominence of lung vasculature within upper zone predominance and prominence of interstitial markings likely represents pulmonary edema. There are small bilateral pleural effusions. No pneumothorax. The cardiac silhouette is difficult to assess due to parenchymal abnormalities. Median sternotomy wires are noted.

New left lower zone opacity with elevation of the left hemidiaphragm likely atelectasis and/or pneumonia in the right clinical setting. Cardiomegaly, bilateral small pleural effusions and diffuse interstitial lung marking prominence as well as prominence of upper lobe vessels compatible with pulmonary edema.

The heart is moderately enlarged. There is mild pulmonary vascular redistribution. There is no focal infiltrate or effusion.

No Infiltrate or effusion.

Surgical clips are now present over the left lateral aspect of the thorax from wound debridement and thoracotomy. Surgical drain is present in the soft tissues of the chest wall. A left pleural drain is now seen with decreased effusion relative to yesterday's CT. Pulmonary vascular congestion within the left lung likely represents a component of reexpansion pulmonary edema. The effusion layerings superior to the aortic know, also better seen on prior CT. There is no pneumothorax. The heart size is normal. The right lung is clear.

Small residual pleural effusion with a left pleural pigtail drain in place. No pneumothorax.

There has been interval removal of the chest tube, ET tube, Swan-Ganz catheter, and NG tube. The left apical area is now filled with fluid. There are new bilateral pleural effusions with associated bibasilar atelectasis. Stable opacity is present in the left supra-aortic region at the site of recent surgery. The heart size is normal.

New bilateral pleural effusions with associated bibasilar atelectasis. Fluid in the left apical region after chest tube removal.

The cardiac, mediastinal and hilar contours are normal. Lung volumes are low. No focal consolidation, pleural effusion or pneumothorax is visualized. There are no acute osseous abnormalities. No free air is demonstrated under the diaphragms.

No acute cardiopulmonary abnormality. No free air under the diaphragms.

Prior median sternotomy and mitral valve repair. No pulmonary edema. Asymmetric nodular opacity in the superior segment of the right lower lobe is again demonstrated, may reflect pulmonary infarct given the extensive pulmonary embolism. Small right-sided pleural effusion. Moderate cardiomegaly. No pneumothorax.

No pulmonary edema. Asymmetric right lower lobe superior segment opacity can be pulmonary infarct.

Moderate cardiomegaly is stable. The mediastinum and pleura are unremarkable. Mild pulmonary edema is stable. Mild left lower lobe atelectasis persists. No focal consolidations or pneumothorax are seen.

Stable mild pulmonary edema and moderate cardiomegaly.

Enteric tube tip is in the mid stomach. Left PICC line tip near cavoatrial junction. T AVR. Stable left lower lobe consolidation. Presumed mild left pleural effusion is stable. Increased left lingular opacity, atelectasis versus infiltrate. Borderline heart size, pulmonary vascularity, stable. Right costophrenic angle is not well seen. Distended bowel loops.

Feeding tube tip is in the mid stomach. Lingular atelectasis versus infiltrate.

A right-sided PICC line tip ends in the lower SVC, unchanged since . Bilateral lung volumes persistently remain low. Bibasal opacities could be a function of low lung volumes. Right hemidiaphragm is persistently elevated. Heart size is normal. Mediastinal and hilar contours are unremarkable.

Right-sided PICC line is unchanged in position since prior radiographs and the tip ends in the lower SVC.

A right-sided PICC terminates at the SVC/brachiocephalic junction without evidence of pneumothorax. There are low lung volumes. Mild right base opacity may be due to atelectasis versus aspiration. Cardiac and mediastinal silhouettes are unremarkable. Midline tracheostomy noted.

Right sided PICC terminates at the SVC/brachiocephalic junction without evidence of pneumothorax.

A tracheostomy tube is in place. There are low inspiratory volumes. Again seen are somewhat patchy densities at both lung bases. At the right base, the opacity is slightly more confluent. At the left base, there may be slightly improved aeration. Doubt overt CHF. No gross effusion. No pneumothorax detected. Prominent patchy osteopenia noted in both proximal humeri.

Bibasilar opacities are again seen, overall similar. Possible slight interval improvement at the left base. Patchy osteopenia in both humeri. Is the patient osteoporotic?

Portable semi-upright radiograph of the chest demonstrates low lung volumes which results in bronchovascular crowding. There is bibasilar atelectasis. The cardiomediastinal and hilar contours are unchanged. No pneumothorax, pleural effusion, or consolidation. No evidence of pulmonary edema.

Bibasilar atelectasis. No pulmonary edema.

Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable. No pulmonary edema is seen.

No acute cardiopulmonary process.

The cardiac, mediastinal and hilar contours appear unchanged. There is again borderline cardiomegaly. Allowing for rotation as well as scoliosis, the cardiac, mediastinal and hilar contours are probably unchanged. There is similar mild relative elevation of the left hemidiaphragm. There is no definite pleural effusion or pneumothorax. The lungs appear clear. A PICC line terminates in the lower superior vena cava.

PICC line terminating in the lower superior vena cava. No evidence of acute disease.

The patient remains intubated. An orogastric tube courses into the stomach, its distal course not fully imaged. A right internal jugular catheter terminates at the cavoatrial junction. There is a new focal opacity in the left upper lobe with a geometric appearance, probably compatible with atelectasis; a newly forming area of pneumonia is not excluded, however. Dense extensive retrocardiac opacification with air bronchograms and a probable associated pleural effusion persists without clear change. A pleural effusion is not apparent on the right on this study, which may be due to a true decrease or consequence of differences in positioning.

New left upper lobe opacity, probably due to atelectasis, but a new focus of infection is not excluded; short-term follow-up radiographs may be helpful to help distinguish if clinical concerns may include the possibility of developing infection. Persistent extensive retrocardiac opacification, most commonly due to atelectasis, with a pleural effusion.

An enteric tube descends in an uncomplicated course to the distal esophagus, its end out of view. A right jugular line ends at the low superior vena cava. Allowing for changes in patient positioning, the lungs appear largely unchanged with mildly increased interstitial edema. There is no new focal consolidation. There are likely small bilateral pleural effusions, unchanged. There is no pneumothorax.

Mildly increased interstitial pulmonary edema.

Since the prior CXR, there has been interval placement of a enteric tube that extends to at least the stomach, but the distal tip is beyond the inferior margin of the image. There is a moderate-sized left pleural effusion that appears slightly worse than . A small right-sided pleural effusion is also noted. There is pulmonary vascular congestion with mild pulmonary edema. No evidence of pneumothorax. The previously seen pneumoperitoneum has now resolved. Heart appears mildly enlarged, unchanged from prior. No acute osseous abnormalities.

Interval resolution of small pneumoperitoneum. Worsening left-sided pleural effusion.

A right internal jugular line terminates in the low SVC. An enteric tube descends in in uncomplicated course, its terminal end outside the field of view. Heart size is mildly enlarged, unchanged. New mild interstitial edema in the right lower lobe. The left lung appears grossly clear and better aerated. No pneumothorax.

New mild right lower lobe interstitial edema.

AP single view portable chest x-ray shows Dobbhoff tube with tip ending in mid gastric cavity. Left lung base opacity has worsened since prior chest x-ray due to increased pleural effusion and left lower lobe collapse. In the appropriate clinical setting pneumonia should be considered. Right lung is clear without consolidation, nodules or pleural effusion. There is no pneumothorax. Heart size is partially obscured by left pleural effusion but appears within normal limits.

Correct positioning of Dobbhoff tube ending in mid gastric cavity. Interval increase of left lung base collapse and pleural effusion, is concerning for pneumonia.

Severe cardiomegaly is stable. Widening mediastinum and vascular congestion have markedly improved. There is no evident pneumothorax. Small bilateral effusions are unchanged. Right IJ catheter tip is in unchanged position. Bilateral chest tubes are in place

Resolved vascular congestion. There is stable small bilateral effusions. Improved mediastinal widening

The lungs are hypoinflated with crowding of vasculature, mild vascular congestion, and bibasilar atelectasis. Heterogeneous retrocardiac opacity is present. There is a new small left pleural effusion. No right pleural effusion. Heart size is likely accentuated due to low lung volumes and patient positioning. Mediastinal contour and hila are otherwise unremarkable. Right IJ CVL tip in low SVC.

Right IJ CVL tip in low SVC. Mild vascular congestion. New small retrocardiac opacity with small left pleural effusion is worrisome for pneumonia in the appropriate clinical setting.

Increased opacities is seen in the left lower lung base with left lung volume loss is concerning for aspiration. The right lung appears clear. The heart size is unchanged. No pneumothorax.

Increased left lower lung opacities are concerning for aspiration.

Cardiac size is top normal. Mild pulmonary edema is grossly unchanged. Bibasilar atelectasis larger on the right have minimally improved on the left. Right IJ catheter tip is in the cavoatrial junction. . There is no pneumothorax or pleural effusion.

Mild pulmonary edema

Lungs are well inflated with retrocardiac atelectasis. No pulmonary edema. No pleural effusion or pneumothorax. Heart size, mediastinal contour, and hila are unremarkable.

No pulmonary edema. Retrocardiac atelectasis.

Patchy linear opacities at the right base most likely represent atelectasis. There is no definite focal consolidation or pleural effusion or pneumothorax. Cardiomediastinal silhouette is stable with dense calcifications at the thoracic aorta. There is a right chest wall pacemaker with leads terminating in the right atrium and right ventricle. A fracture of the left fourth posterior rib is likely not acute.

Linear opacities at the right base are likely atelectasis. No definite aspiration or focal consolidation.

Sternotomy. Right IJ central line tip in low SVC. Very shallow inspiration. Left chest tube has been removed. No pneumothorax. Mildly improved left basilar opacity. Probable tiny left pleural effusion, improved. Mild right basilar opacity, likely atelectasis, more prominent.

Mildly improved left basilar opacity. Mildly worsened right basilar opacity.

AP portable supine view of the chest. Underlying trauma board is noted. There has been placement of a left pigtail chest tube with its tip projecting over the left mid lung peripherally. There is opacity abutting the tip of the chest tube which could represent a focal area of atelectasis. There is no supine evidence for pneumothorax or large effusion. Cardiomediastinal silhouette appears normal. Numerous left rib fractures are better assessed on same-day CT chest.

Interval placement of left pigtail chest tube. No residual pneumothorax identified on this supine radiograph.

Upright AP chest radiograph. The tip of the left chest tube is slightly different in position, now lying along the inner surface of the left chest wall, near the site of chest rib fractures. The small focus of atelectasis in left mid lung persists, slightly more linear at this time. No definite pneumothorax is identified. Minimal atelectasis in the left costophrenic angle is new. There is probably also mild atelectasis at the right base accounting for a faint opacity there. No CHF or frank consolidation. No right effusion. The cardiomediastinal silhouette is unchanged, allowing for differences in positioning. Multiple rib fractures are again noted, best depicted on the CT scan. Incidental note made of an old healed right proximal humeral fracture, with soft tissue fixation anchor over the right humeral head.

Slight change in position of left chest tube, with tip now along inner surface of left mid chest wall. Question slight interval retraction. No pneumothorax identified. Faint opacity right base, question atelectasis. Minimal atelectasis at left costophrenic angle and in the left mid zone. Otherwise, no acute pulmonary process identified. Multiple rib fractures again noted.

Enteric tube is noted with tip coursing below the left hemidiaphragm, into the stomach with tip off the inferior borders of the film. Cardiac and mediastinal contours are unchanged. There is mild upper zone vascular redistribution with crowding of bronchovascular structures, likely related to supine AP positioning and low lung volumes. Patchy opacities in the right mid lung field and right lung base may reflect areas of aspiration and/or atelectasis. No pleural effusion or large pneumothorax is detected on this supine exam. There are no acute osseous abnormalities.

Enteric tube in standard position. Low lung volumes with patchy right mid and lower lung field opacities, possibly due to aspiration and/or atelectasis.

The tip of the endotracheal tube projects towards the right mainstem bronchus and should be retracted. Kinking of the right internal jugular sheath is again noted. Left pleural effusion and left lower lobe atelectasis have increased since the prior study. Small right pleural effusion is likely. Heart size and mediastinal contours are within normal limits. Right lower lobe pneumonia has worsened since the prior radiograph.

Low position of the endotracheal tube warrants retraction. Persistent kinking of the right internal jugular sheath. Bilateral pleural effusions, left greater than right, with moderate left lower lobe atelectasis. Right lower lobe pneumonia worsened since the prior radiograph.

Left PICC line terminates in the mid SVC. NG tube terminates in the stomach however its side-port appears to be at the GE junction. Left lower lobe atelectasis has improved. There is new right middle lung atelectasis. A small right pleural effusion is seen.

NG tube's side port is at the GE junction. The ET tube is as a satisfactory location.

Unchanged left PICC. Aeration of the right lung is essentially unchanged. Right lower lobe consolidation which may represent pneumonia, aspiration, or atelectasis, is unchanged. Cardiomediastinal contours are stable.

No significant change since .

Assessment is limited due to rightward rotation of the patient. Allowing for this limitation, there is opacification of the right lower lung, likely due to a combination of atelectasis given volume loss with rightward mediastnal shift to the right and possible pleural effusion. Small nodular opacities are seen in the aerated portion of the right lung, potentially vessels on end. The left lung is clear. There is no left-sided effusion. There is no evidence of pneumothorax. Old bilateral rib fractures are identified. An esophageal tube ends beyond the gastroesophageal junction with the tip out of view. Artifact from external monitoring and supporting devices is present.

Right lower lobe consolidation, likely a combination of atelectasis or consolidation with pleural effusion. Endotracheal and esophageal tubes in appropriate position.

There has been interval removal of the right internal jugular central venous line. The enteric tube, endotracheal tube, and left PICC line are stable. Heart size is enlarged is stable. There is continued partial collapse of the right lower lobes with no new parenchymal opacity.

Continued volume loss at the right lung base with stable support devices. Interval removal of right internal jugular central venous line.

There has been interval extubation and removal of the enteric tube. The left PICC line terminates in the mid SVC. Lung volumes are low and the cardiac size is enlarged. Collapse of the right lower lobe is persistent. There is improvement in pulmonary edema. Small right pleural effusion is unchanged. No pneumothorax.

Continued right lower lobe collapse. Interval extubation and enteric tube removal. Improvement in pulmonary edema.

The heart is probably at the upper limits of normal size allowing for technique. There is mild unfolding of the descending thoracic aorta. There is no pleural effusion or pneumothorax. The lungs appear clear.

No evidence of acute cardiopulmonary disease.

Bilateral lung volumes are low. Increased retrocardiac opacity is better since yesterday. Mild to moderately enlarged heart size is stable, and mediastinal and hilar contours are unremarkable. No discrete opacities in right lung.

Mild retrocardiac opacity, decreased since yesterday, either atelectasis or aspiration. Associated infection cannot be ruled out. No new focal opacities in the right lung.

A single portable semi-erect chest radiograph was obtained. Pulmonary aeration has decreased. Moderate to large layering right pleural effusion has increased. Loculated intra-abdominal air projects over the right lung base. Central pulmonary vascular congestion is similar. Cardiomegaly is unchanged. An enteric tube passes inferiorly below the film. A right subclavian catheter terminates at the cavoatrial junction.

Increasing right pleural effusion since yesterday's exam.

Left lung is well expanded and clear. Right lung demonstrates decreased right-sided pleural effusion with residual atelectasis but no evidence of pneumothorax. Heart remains of normal in size. Normal cardiomediastinal silhouette.

Interval decrease in right pleural effusion with no evidence of pneumothorax after thoracentesis.

Bedside upright AP radiograph of the chest demonstrates clear lungs beside from persistent left infrahilar atelectasis. There is no pneumothorax, pleural effusion, or pulmonary edema. Severe cardiomegaly including a calcified apical ventricular aneurysm is unchanged. The AICD and two leads are unchanged. A nasogastric tube is seen and coursing through the esophagus, into the stomach, and out of field of view.

Stable left infrahilar atelectasis without new airspace opacity concerning for pneumonia.

The gastric tube projects over the body of the stomach. Increasing bilateral diffuse airspace opacities which can be seen in the setting of multifocal pneumonia and pulmonary edema. Small left pleural effusion. No pneumothorax identified. The size of the cardiac silhouette is mildly enlarged.

Increasing and diffuse bilateral airspace opacities, concerning for pulmonary edema however superimposed multifocal pneumonia cannot be excluded.