Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Portable AP semi-erect chest film ___ at 523 is submitted .
    OUTPUT:
    
Two left chest tubes remain in place with interval decrease in size of a layering left effusion . No definite pneumothorax is seen , although assessment is challenging due to positioning . A right subclavian PICC line is unchanged in position . Multiple left - sided rib fractures with associated chest wall deformity is stable . Lung volumes are diminished and patchy bibasilar opacities are again seen likely reflecting atelectasis , although aspiration or pneumonia should also be considered . Given the patient 's marked rotation , assessment of cardiac and mediastinal contours is difficult but they are likely within normal limits . A left humeral prosthesis remains in place . Stents contiguous to surgical clips and a focus of retained contrast are again seen in the left upper quadrant .