Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Single frontal image of the chest demonstrates low lung volumes , likely related to poor inspiration . There are again seen bilateral pleural effusions , which are unchanged from imaging earlier the same day . Bilateral chest tubes are again seen . The lungs are essentially unchanged from earlier imaging . The cardiomediastinal silhouette is unchanged from previous imaging . PICC line is noted to be in the same position as on prior exam . Of note , there is a large area of gas noted overlying the abdomen , which could represent a very distended stomach or possibly a pneumoperitoneum . Given the potential urgency of this finding , a follow up true upright PA and lateral radiographs are recommended .
    OUTPUT:
    
Unchanged pulmonary and cardiac findings . Large amount of air overlying the abdomen , which could represent a distended stomach or possibly pneumoperitoneum . Recommend urgent true upright PA and lateral imaging or , if this is not possible , lateral decubitus position imaging . These findings were made at 10 :56 a .m . on ___ and were communicated to Dr . ___ at 10 :59 a .m . on ___ by telephone .