Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Again seen are multiple left - sided rib fractures as well as left clavicular fracture . The left - sided pneumothorax has increased in size significantly from initial chest x-ray obtained ___ . It now measures 2 .4 cm from lung apex to apical chest wall . There is no mediastinal shift . There is a stable persistent small left pleural effusion . In comparison to prior study , there is more optimal inspiratory effort . Allowing for changes due to this , the cardiomediastinal silhouettes are stable in appearance . There are no focal lung consolidations . There is no evidence of pulmonary vascular congestion .
    OUTPUT:
    
1 . Increase in size of the left pneumothorax in comparison to radiographs obtained on ___ . No mediastinal shift . 2 . Stable small left pleural effusion .