Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: A portable AP radiograph of the chest is provided . The radiograph was repeated due to positioning of the patient 's left hand over the lower chest . The patient is rotated . There is a tracheostomy tube within the midtrachea . The cuff is inflated such that it distends the trachea . The lungs are clear . There is no pneumothorax or pleural effusion . Pulmonary vascularity is normal . Of note , in the first view , the left hemidiaphragm is elevated raised , and on the subsequent radiograph it has descended . There has been no motion of the right hemidiaphragm . There is a left internal jugular central venous line terminating in the mid SVC .
    OUTPUT:
    
1 . No evidence of aspiration or pneumonia . 2 . Findings suggestive of right hemidiaphragmatic paralysis . Alternatively this appearance could be caused by an abdominal process such as hepatic enlargement .