Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Frontal and lateral views of the chest were obtained . Again , there is extensive subcutaneous emphysema . Pneumomediastinum is again seen . Small right apical pneumothorax appears minimally increased when compared to the prior study . No interval findings to suggest tension are seen . There is persistent right middle lobe opacity , which likely relates to known right middle lobe collapse seen on CT . Right pleural effusion was better assessed on CT . Cardiac and mediastinal silhouettes are stable .
    OUTPUT:
    
Right apical pneumothorax appears minimally increased as compared to the prior study . No definite signs of tension . These findings were discussed with Dr . ___ at 4 p .m . on ___ via telephone . Persistent pneumomediastinum , extensive subcutaneous emphysema . Right middle lobe opacity most likely relates to right middle lobe collapse , although underlying infection at that location is not excluded .