Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: A tracheostomy is in place . Bullet fracture fragments are again noted bilaterally . Bilateral chest tubes are unchanged in positions . A right - sided pneumothorax has increased and is now small to moderate in size . There is no definite pleural effusion on the left . Vague retrocardiac opacity is similar and suggests atelectasis , but improved substantially .
    OUTPUT:
    
Increase in right - sided pneumothorax , now small to moderate , with mild recurrent leftward shift . Discussed with ___ by telephone .