FINDINGS:
Portable chest radiograph demonstrates interval removal of
 Swan-Ganz catheter and ETT and remaining right-sided central venous sheath
 with tip terminating in the upper SVC.  There is stable cardiomegaly with
 improving postoperative pneumopericardium.  No chest tubes or mediastinal
 drains are evident.  A fold is identified crossing left ribs , possibly a
 pleural fold due to small apical pneumothorax; however, unable to assess for
 lung markings  beyond this fold due to overlying medical devices.  There is
 redemonstration of prominent interstitial markings and hazy vascular
 consistent with pulmonary edema with increased lucency in the left upper lobe.
 However, unclear if this is related to possible pneumothorax or improved
 aeration.  Trace pneumoperitoneum newevident and may be due to previous
 reported pneumopericardium.  Please correlate with any abdominal surgical
 history, instrumentation and clinical exam.  Slightly increased retrocardiac
 opacity may reflect a combination of atelectasis and pleural effusion though
 in the appropriate clinical setting, infectious process cannot be excluded.

IMPRESSION:
1.  Possible left apical pneumothorax.  Recommend repeat upright chest
 radiograph.  Resolving pneumopericardium, though pneumoperitoneum is evident,
 possibly related to air leak.  Please correlate with clinical exam.
 2.  Increased retrocardiac opacity, possibly a combination of effusion and
 atelectasis, though an infectious process cannot be excluded.
 3.  Stable pulmonary edema.
 4.  Interval removal of endotracheal tube.
 
  communicated these findings to , NP at 11:45 via
 telephone on .