Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Tracheostomy tube again noted . Status post sternotomy , with prosthetic valve . The cardiomediastinal silhouette is probably unchanged allowing for differences in positioning . Again seen is the left chest tube . Also again seen is the left apical pneumothorax . An additional small vertically oblong lucency along the left chest wall adjacent to the chest tube is suggestive of an additional site of a small localized pneumothorax . As before , there is increased retrocardiac density , partial obscuration left hemidiaphragm , and opacity in the left costophrenic angle . Much of this likely represents collapse and / or consolidation . The possibility of a small amount of pleural fluid on the left side can not be excluded . On the right , there is mild vascular blurring . Minimal density in the right midlung likely represents platelike atelectasis . Slight blunting of the right costophrenic angle is compatible with a small amount of pleural fluid , newly visible on the current study . There is atelectasis the right lung base , unchanged . Mild vascular plethora is seen in both upper zones and there is possible minimal vascular blurring , without other evidence of CHF .
    OUTPUT:
    
Small left apical pneumothorax is similar to the prior study . Possible small focus of pneumothorax along the left chest wall , new or slightly larger on today 's study . Attention to this finding on followup films is requested . Mild vascular plethora and possible mild vascular blurring again noted , possibly slightly improved . New blunting of the right costophrenic angle without gross effusion . Persistent opacity at the left base .