Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The cardiomediastinal and hilar contours are stable . Sternal wires and an aortic valve replacement are again demonstrated . A left apical pneumothorax is decreased in size from ___ and is small . A small left - sided chest tube projects over the left hemi thorax . A displaced midclavicular fracture on the left is unchanged . A small left pleural effusion is minimally increased in size . Multiple left - sided rib fractures are identified . Of note , there is irregularity of the left eighth rib , suggesting possible osseous lesions / pathologic rib fracture .
    OUTPUT:
    
Small left apical pneumothorax is decreased from the prior exam . Small left pleural effusion is minimally increased in size . No other significant change . Multiple left - sided rib fractures are again seen as mentioned above including a possible osseous lesion affecting the left 8th rib .