Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The heart is not enlarged . Cardiomediastinal contours are within normal limits . No CHF , focal infiltrate or effusion is identified . No pneumothorax is detected . No free air seen beneath the diaphragms . No rib fracture is identified on these lung technique films . Limited assessment of the thoracic spine is grossly unremarkable .
    OUTPUT:
    
No acute pulmonary process identified . No pneumothorax detected . If there is high concern for an occult pneumothorax , than frontal chest x-ray obtained with the patient at end - expiration of the respiratory cycle could help for further assessment .