FINAL REPORT
 PORTABLE CHEST FILM ___ AT 559
 
 CLINICAL INDICATION:  ___-year-old status post tracheoplasty, evaluate for
 interval change.
 
 Comparison is made to the patient's previous study dated ___, ___ a.m.
 
 A portable upright chest film ___ at 6 a.m. is submitted.
 
 IMPRESSION:
 
 1.  No pneumothorax is seen.
 2.  Lucency adjacent to the aortic knob is again seen, raising the possibility of pneumomediastinum.
 3.  Right internal jugular central line and left chest tube remain in place.
 4.  There is increasing opacification in the left hemithorax which may represent an accumulating effusion.
 5.  Underlying airspace process is also possible and in the setting of effusion would be more consistent with atelectasis, although pneumonia cannot be entirely excluded.
 6.  Multiple right-sided rib fractures are again seen and streaky opacities at the right base likely reflect atelectasis.
 7.  There has been interval improvement in the subcutaneous emphysema within the neck soft tissues as well as the right lateral chest wall.
 8.  Pulmonary edema is less likely as there is only minimal peribronchial cuffing to suggest mild interstitial edema.
 9.  Cardiac and mediastinal contours are difficult to assess due to the increasing opacification of the left hemithorax and patient rotation on the current study.
