Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Portable semi upright radiograph of the chest demonstrates increase in the amount of extensive subcutaneous emphysema in the bilateral chest walls , soft tissues of the neck , and in the pectoral muscles . There is probable pneumomediastinum as well . Bilateral chest tubes are in place . The endotracheal tube is in unchanged position . Nasogastric tube courses into the stomach . A Swan - Ganz catheter is in the expected position . No pneumothorax is identified , although assessment is limited given the extensive subcutaneous emphysema . Increased opacification of the bilateral bases is not significantly changed and is consistent with pleural effusion with compressive adjacent atelectasis and . The cardiomediastinal contours are unchanged .
    OUTPUT:
    
Increase in the amount of extensive subcutaneous emphysema raises concern for air leak . No definite pneumothorax identified , however assessment for pneumothorax is limited given the extensive amount of subcutaneous emphysema .