RRG
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There are low lung volumes. The cardiomediastinal silhouette is within normal limits. There is evidence of trace pulmonary edema with a left pleural effusion. Left retrocardiac atelectasis is noted. There are old bilateral rib fractures.
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The transesophageal echo probe has been removed. A new enteric tube is present. There is otherwise unchanged positioning of supportive medical devices. Mild pulmonary edema and cardiomegaly. Left basilar opacity. No pneumothorax. No acute bony abnormalities are noted.
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Provide a detailed description of the findings in the radiology image.
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Single frontal view of the chest on 12-18 at 2147 hours demonstrates interval removal of a right chest tube with interval development of a large, right sided pneumothorax. Stable positioning of a left sided chest tube with persistent small, left sided pneumothorax. Retrocardiac opacities may represent atelectasis versus consolidation. The cardiomediastinal silhouette is stable. Follow up exam on 12/18/2014 demonstrates interval placement of a right chest tube with tiny, residual pneumothorax. Otherwise, no significant interval change.
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Interval increase in opacity within the lingula and left lung base compared to the prior examination. Interval increase in opacity along the medial portion of the right lung base compared to the prior examination. Unchanged cardiomediastinal silhouette. No evidence of pneumothorax or pulmonary edema.
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Single frontal view of the chest demonstrates interval increase in pulmonary edema with bilateral pleural effusions and bibasilar atelectasis versus consolidation. Cardiomediastinal silhouette is unchanged and significant for vascular calcification and cardiomegaly. Osseous structures are unchanged.
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Single portable AP upright view of the chest with a lordotic projection demonstrates a cardiac silhouette that is mildly enlarged. There is minimal tortuosity of the thoracic aorta. Atherosclerotic calcification of the aortic knob is present. The bilateral hila are within normal limits. The bilateral lung fields are clear, without evidence of frank consolidation. No pneumothorax or pleural effusion is seen. The visualized osseous structures reveal no acute abnormalities.
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Interval removal of right AICD. Interval placement of right IJ approach transvenous pacer. Severe cardiomegaly with enlarged pulmonary arteries reflecting pulmonary hypertension. Mild left basilar opacity. No large pleural effusion. Right costophrenic angle is not included in field of view. No visualized pneumothorax.
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AP semierect view of the chest demonstrates low left lung volume, and a moderate left pleural effusion and associated atelectasis persists, unchanged. Right lung remains clear. Postoperative stabilization of the lower cervical and upper thoracic spine are again noted unchanged. Endotracheal tube has been removed.
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Low lung volumes. Increasing right basilar opacity. Persistent dense left retrocardiac opacity with air bronchograms with some improved aeration noted in the midlung zone. The mid to upper lung zones bilaterally are relatively clear. Decreased left pleural effusion. The cardiomediastinal silhouette is similar in configuration and obscured along the left heart border. Similar perihilar vascular prominence. Degenerative changes of the spine.
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Frontal and lateral views of the chest demonstrate low lung volumes. There is diffuse prominence of the interstitium with indistinct pulmonary vascular markings, further increased from the prior exam.
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The cardiopulmonary silhouette is markedly widened. Although the study is limited by rotation, pericardial effusion cannot be excluded. The lungs show low volume. There is increased prominence of pulmonary vessels bilaterally and increased opacities of both lung fields suggestive for pulmonary edema. No gross abnormalities are noted in the bone or soft tissue.
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The distal tip of a left-sided Mediport catheter projects over the left brachiocephalic vein, unchanged in position as compared with the prior study. Degenerative changes are seen within the thoracic spine. A large amount of subcutaneous emphysema within the left chest wall and neck is increased as compared with the prior study. The heart is normal in size. A persistent small to moderate left basilar pneumothorax is similar in appearance to the prior study. Persistent increased retrocardiac opacification likely represents atelectasis. The right lung is clear. Addendum Begins The left-sided chest tube/drain is unchanged in position as compared with the prior study. "Physician to Physician Radiology Consult Line: (740) 785-9814" Addendum Ends
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Small right pleural effusion has diminished. Prior loculated small pneumothorax at the right lung base has cleared. Post thoracotomy findings appear stable. The heart and vessels are unremarkable. Right humerus hardware again noted.
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Frontal view of the chest from 16:28 on 7/18/2015 demonstrates interval repositioning of the endotracheal tube with the tip approximately 5.8 cm above the carina. Other medical support devices are unchanged in position. Persistent bibasilar opacities, likely atelectasis versus consolidation. Decreased mild pulmonary edema with small bilateral pleural effusions. No pneumothorax. The cardiomediastinal silhouette is within normal limits for size. 7-18-2015 demonstrates interval extubation and interval repositioning of the Swan-Ganz catheter, now terminating in the right pulmonary artery.
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AP semierect chest radiograph demonstrates a nasoenteric tube projecting over the right mediastinum, with the right apical chest drain and epidural catheter, unchanged. Unchanged cardiomegaly. Low lung volumes, with unchanged opacification of the left base and small left pleural effusion. Multilevel osteophytosis of the lower thoracic spine. Mild degenerative change of the right acromioclavicular joint.
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Portable chest shows low lung volumes with crowding of the pulmonary vasculature. The lines and tubes are stable, except the endotracheal tube has been pulled back to 7.9 cm above the carina. There is bilateral lower lobe airspace disease with partial clearing of the right lung base. This is the suggestion of small pleural fluid collections Otherwise, there is no change from the prior examination.
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A single upright AP view of the chest demonstrates a linear focus of opacity in the left lung base with the remainder of the lung parenchyma clear. No significant pulmonary edema. Heart size and cardiomediastinal silhouette are within normal limits. No significant pleural effusions. No bony abnormalities are appreciated.
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Provide a detailed description of the findings in the radiology image.
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2 semisupine frontal views of the chest demonstrate no change in medical support devices. A small right pneumothorax is present increased from most recent prior. Heart size is enlarged and lung volumes are further reduced. There is interval increase in bilateral small-to-moderate pleural effusions, as well as increase in associated bibasilar opacities, as well as increased opacity in the right midlung zone. Superimposed pulmonary edema is also likely present. Addendum Begins The original report for this radiograph referred to films obtained on 9/14/2005 at 1456 hours. The report for the radiograph obtained on September 2005 at 0420 hours should have read: Findings: Single supine frontal view of the chest demonstrates no interval change in medical support devices. No pneumothorax is evident. Aeration of the lungs has improved. There is residual bibasilar opacity, greater on the left. Small bilateral pleural effusions are present, also improved from prior. A background of reticular opacities present in the bilateral perihilar regions likely reflects resolving edema.
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There has been a midline thoracotomy. ET tube is present 4 cm above the carina. Two right IJ lines have their TIPS in the region of the SVC. There is a midline chest tube and a left chest tube. There is a nasogastric tube present. The cardiac silhouette is within normal limits. There is some retrocardiac opacity silhouetting the descending aorta and medial hemidiaphragm. The pulmonary vascularity is normal. No other focal pulmonary parenchymal abnormalities are identified.
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The cardiomediastinal silhouette is normal. Patchy consolidation in the left retrocardiac area which may represent atelectasis and/or early airspace disease. No evidence of pulmonary edema, pneumothorax or pleural effusions. Elevated right hemidiaphragm again noted. Colonic interposition under the right hemidiaphragm also noted. Degenerative changes of the thoracic spine.
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Stable position of cervical fusion hardware. No significant interval change in diffuse mildly prominent fine reticulations in the bilateral lungs with more confluent airspace opacities in the bilateral lung bases, left greater than right with small bilateral pleural effusions. Stable left apical pneumothorax.
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Single view of the chest dated 3-19-2005 00:21 demonstrating stable position of left IJ catheter, feeding tube. Stable cardiomegaly. Low lung volumes. Stable bibasilar opacities right greater than left. Stable small bilateral pleural effusions. Single view of the chest dated 3-19-2005 00:49 demonstrating stable positioning of feeding tube, left IJ catheter with placement of endotracheal tube 5 cm above the carina. Stable bibasilar opacities. Increasing right pleural effusion. Single view of the chest dated 3-19-2005 demonstrating stable medical support devices with placement of NG tube. Increasing pulmonary edema.
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There is a small 2-mm radiopaque density seen within the left peripheral upper lung zone. This appears calcified and most likely represents old granulomatous disease. However, the patient has a history of melanoma, and comparison with old studies, once they are available, is recommended if there is clinical concern for metastatic disease. The remainder of the lungs are clear without focal air-space consolidation. The cardiomediastinal silhouette appears unremarkable. There is an old healing defect at the left clavicle demonstrated. The remainder of the bones appear unremarkable. Axillary clips seen within the right axilla.
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Stable cholecystectomy clips. Interval placement of epidural catheter and left chest tube after resection of left upper lung zone nodule. No pneumothorax. No pleural effusions. Lung fields clear. Heart size normal.
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Lines and tubes unchanged. Low lung volumes. Slight improvement in the aeration of the upper lobes bilaterally. Stable cardiomediastinal silhouette. Bibasilar consolidation, left greater than right, with small left pleural effusion. No evidence of pneumothorax.
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The trachea is midline. The cardiomediastinal silhouette is within normal limits. There is no evidence of pleural effusion. There are prominent interstitial markings with increased linear opacity in the right hemithorax. Interlobular septal thickening with Kerley B-lines. Osseous structures unremarkable.
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Portable chest shows no change in the left subclavian catheter with its tip just reaching the superior vena cava, an electronic device over the left hemithorax with its leads terminating in the left neck. Heart and lungs are within normal limits. Otherwise, there is no change from the prior examination.
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The trachea is midline. There is moderate cardiomegaly. There is a retrocardiac opacity, consistent with atelectasis versus consolidation. There is blunting of the left costophrenic angle which may represent a small pleural effusion. No soft tissue or bony abnormalities.
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Single view of the chest dated 12-6-2007 at 08:48 redemonstrates right apical chest tube. Persistent low lung volumes. Residual small right apical pneumothorax. Band-like atelectasis at the right lung base which has increased since the prior examination. No additional focal opacities or effusions noted. Single view of the chest dated 12-6-2007 at 15:06 demonstrates interval removal of right sided chest tube. Possible tiny residual right apical pneumothorax. Improved aeration of both lung bases with interval decrease in prior noted atelectasis. Redemonstration of distal clavicle resection and sutures within the humeral head of the left shoulder.
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Interval placement of a left arm PICC terminating 5.2 cm below the carina. No evidence of pneumothorax. The cardiomediastinal silhouette is within normal limits. No evidence of effusions or pulmonary edema.
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Very low lung volumes are demonstrated. The right hemidiaphragm is elevated. There is a left retrocardiac opacity likely representing atelectasis. However, cannot entirely exclude an infectious process. Would recommend a repeat chest x-ray with deep inspiration is concern for infection. The pulmonary vasculature is grossly unremarkable. There is an incidental finding of a azygous fissure and lobe. Several prominent bowel loops are noted within the abdomen. These are of unknown clinical significance. Correlate clinically. If concern for abdominal pathology, would recommend a dedicated abdominal series.
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Single semi-upright view of the chest dated 6/6/2009 at 0639 hours is limited as the apices are clipped from the film. No definitive pneumothorax is appreciated. However abutting the right paravertebral stripe at the T6-7 level is a crescentic density which cannot be delineated from the paravertebral stripe. Evaluation is limited on a single view. Low lung volumes. The lungs are clear. Limited visualization of the upper abdomen demonstrates coils in the left upper quadrant consistent with the patient's recent splenic embolization.
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Stable tubes and lines. Improving retrocardiac airspace opacity. Although the diaphragm is more clearly seen now, there is still some faint residual airspace opacity and perhaps a small left pleural effusion. There is persistent air bronchograms at the right medial lung base as well.
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Redemonstration of emphysematous changes of the bilateral lungs. There is extensive right middle and lower lung zone opacities again seen, which have increased compared to prior radiograph on 1-30-09, 9/21/2015. Calcific pleural thickening is seen in the bilateral lung apices. No acute osseous abnormalities.
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4/2/2018 at 2019: Endotracheal tube terminates 5.2 cm above the carina. Left chest wall port terminates in the left brachiocephalic vein. NG/OG tube tip is within the stomach. Cardiomediastinal silhouette is normal in size. Lung volumes are low with bibasilar opacities likely reflecting atelectasis or aspiration. Pneumoperitoneum seen on prior CT not visualized in this study. 4-2-18 at 2125: Right IJ central venous catheter terminates 2.2 cm below the level the carina. Persistent bibasilar opacities. No pneumothorax.
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Interval placement of left PICC line, which terminates at the cavoatrial junction. Unchanged right IJ, NG/OG tube. Suboptimal study due to persistent marked rotation of the patient. Persistent left basilar opacity again seen elevation of the left hemidiaphragm. Low lung volumes. No visualized in the thorax.
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Chest x-ray 4-5-11 at 455: Removal NG tube; right chest tube remains in place. No pneumothorax identified. Persistent bibasilar parenchymal opacities, left greater than right with associated small, left pleural effusion. Chest x-ray 4-2011 at 1020: Interval removal of right chest tube; small right apical pneumothorax seen with this report displaced 1 cm from chest wall. No mediastinal shift. Minimal improved aeration of left base.
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The trachea is midline. The cardiomediastinal silhouette is within normal limits. The pulmonary vasculature is well-defined without evidence of pulmonary edema. The lungs are hyperinflated with associated flattening of the hemidiaphragms and lucency within the lung apices compatible with emphysema. There is mild biapical pleural parenchymal scarring. No focal consolidation. There is a 7-mm nodule which projects over the posterior left 10th rib with a possible correlate on the lateral view. There is blunting of the left costophrenic angle suggestive of a small effusion or pleural thickening. The visualized osseous structures are mildly osteopenic. Degenerative changes are noted involving the thoracic spine.
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The lung volumes are slightly decreased. Atelectasis is noted at the left lung base with increased opacity noted. Surgical clips are noted overlying the region of the right hemidiaphragm. The heart does not appear enlarged. There is no evidence of pulmonary edema. Some mild pleural thickening is noted at the left apex.
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AP erect chest radiograph demonstrates interval left sided thoracotomy, with an osteotomy through the left posterior sixth rib and suture material in the left suprahilar region. A left apical chest drain is seen in place, with a tiny pneumothorax along the left lateral chest wall peripherally, as well as subcutaneous emphysema. The previously noted bulla at the left base is not seen on the current radiograph, but this may be positional. The left lung otherwise appears clear. Moderate atelectasis is seen at the right base, which otherwise appears clear. Moderate osteophytosis in the thoracic spine. Visualized osseous structures otherwise unremarkable.
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There is no change in the right-sided central venous catheter. An NG tube is present. There is no change in the enlargement of the cardiac silhouette. There are bilateral bibasilar opacities compatible with effusions and/or atelectasis that has increased on the right. There is diffuse bronchovascular marking prominence is also present compatible with edema or infection.
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Low lung volumes. There are heterogeneous bibasilar and retrocardiac opacities, which are more likely atelectasis, given the low lung volumes. However, in the appropriate clinical setting, this could also represent early infection. No evidence of pleural effusions or pulmonary edema. Cardiomediastinal silhouette is within normal limits. Visualized osseous structures are intact.
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Medical devices are stable. Tiny right apical pneumothorax is identified; right chest tube remains in place. Persistent left lower lobe consolidation with associated moderate-sized left-sided pleural effusion.
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The three-lead permanent pacemaker overlying the left hemithorax with leads in the right atrium, right ventricle, and coronary sinus is not significant change in position or appearance. The moderate cardiomegaly with left atrial enlargement and pulmonary hypertension is stable. There are increased interstitial markings with small bilateral pleural effusions. There is no pneumothorax. The soft tissues and osseous structures are without significant change.
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A chest wall pacing device with intact leads into the right atrium and right ventricle is unchanged. There is diffuse prominence of the pulmonary vasculature with indistinct margins consistent with mild interstitial pulmonary edema. No air-space pulmonary edema. No segmental consolidation or pleural effusion bilaterally. The cardiomediastinal silhouette is within normal limits and unchanged. Regional osseous structures are unremarkable.
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A single portable AP chest radiograph, dated 11/13/2016 demonstrates midline appearance of the trachea. The cardiomediastinal silhouette is unremarkable. There is a small focal left basilar opacity. Elsewhere, the lungs appear clear. No pleural or bony abnormalities are identified.
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Provide a detailed description of the findings in the radiology image.
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Slight interval decrease in lung volumes. Increased prominence of the pulmonary vasculature, right lung greater than left, may represent asymmetric pulmonary edema versus secondary to decrease in lung volumes. Stable cardiomediastinal silhouette. No focal consolidation. No acute osseous abnormality.
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Single lead cardiac pacer with a residual small left pleural effusion.
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There is straightening of the left heart border with mild splaying of the carina. The cardiac silhouette is mildly enlarged. The pulmonary vessels are unremarkable. No pneumothorax. No focal consolidation or atelectasis.
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Moderate alveolar pulmonary edema, with associated small-to-moderate bilateral pleural effusions. Bibasilar pulmonary opacities are nonspecific, and may reflect atelectasis versus less likely consolidation. No pneumothorax. Unchanged moderate cardiomegaly. No acute osseous abnormality.
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Interval development of moderate bilateral pleural effusions. The heart size remains enlarged, and evaluation is partially obscured by the mildly elevated left hemidiaphragm. Pulmonary vasculature is indistinct, and findings are compatible with mild pulmonary edema. Bibasilar opacities likely also reflect compressive orifices from the bilateral pleural effusions. Fiducial markers projecting over the left lung apex are redemonstrated, with underlying nodule compatible with lesion treated pulmonary malignancy.
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The left subclavian line tip is in the brachiocephalic. There are multiple calcified granulomas on the right. Minimal bibasilar atelectasis. The cardiomediastinal silhouette is within normal limits.
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Consolidation collapse of the right upper lobe is present associated with left to right shift of the left upper lobe across the anterior potential space. An oval slightly calcific opacity is present in the right mid lung. This may represent a pleural based density. There is thickening of the minor fissure. Mild cardiomegaly is present. The pulmonary vascularity is slightly prominent in the upper lobes. Degenerative changes of the osseous structures are noted.
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The heart is within normal limits of size. The lungs are clear without focal opacity or pleural effusion. Deformity of several left sided ribs appears chronic and may be the result of prior trauma.
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AP upright view of the chest demonstrates persistent left pleural effusion and increasing left lower lobe consolidation.
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Slightly prominent breast shadows. Heart shadow slightly globular and borderline in size but unchanged from the prior study.
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Slightly prominent breast shadows. Heart shadow slightly globular and borderline in size but unchanged from the prior study.
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Serial radiographs of the abdomen dated 1/22/02 at 6:31 PM and 11:43 PM demonstrate multiple mildly dilated air-filled loops of small and large bowel in a pattern suggestive of ileus. No evidence of free intraperitoneal air or abnormal abdominal calcification. Midline sternotomy wires project over the midline. A weighted feeding tube tip appears coiled within the stomach and then with the tip in the first duodenum. Chest radiograph dated 1-22-02 at 0525 hours demonstrates a right internal jugular venous catheter with tip projecting over the cavoatrial junction, and the proximal aspect of the feeding tube with tip projecting over the gastroesophageal junction, requiring advancement. Moderate cardiomegaly. Bibasilar airspace opacities. Small left pleural effusion. Moderate pulmonary edema. Abdominal radiograph dated 1-22-02 at 6:28 AM demonstrates a feeding tube which appears coiled within the stomach with the tip near the gastric pylorus.
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Stable appearance of endotracheal tube. Interval placement of a left internal jugular central venous catheter with the tip 3.7 cm below the carina. The catheter appears more lateral than expected but confirmed to be within the left internal jugular vein on the subsequent CT angiogram of the head and neck from 6/10/2016. No visible pneumothorax. There is improved aeration of the left lung base suggestive of improving atelectasis. No significant interval changes with stable cardiomediastinal silhouette. No acute osseous abnormalities.
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Frontal radiograph of the chest demonstrates normal appearance of cardiomediastinal silhouette, pulmonary vascularity, and airspaces. There is a right-sided PICC catheter with its tip projecting 3 cm below the carina. There is a small left pleural effusion. The osseous structures are intact.
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The lungs are underinflated. The visualized lungs are otherwise clear. There is no pneumothorax visualized. The cardiomediastinal silhouette and pulmonary vasculature are unremarkable. There is a two-lead pacer device overlying the right hemithorax, with leads in the right atrium and right ventricle. The visualized osseous structures are unremarkable.
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The trachea is midline. The cardiomediastinal silhouette is within normal limits. The diaphragmatic borders are well visualized. There is no evidence of pneumothorax. There is placement of a left-sided single lead pacemaker. The lungs are clear. New osseous volar soft tissue abnormalities.
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