Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: A tracheostomy is in place . There is also an unchanged chest tube and on the left as well as a right subclavian central venous catheter terminating in the upper superior vena cava . An orogastric tube courses into the stomach . Bullet fragments again project over the chest . On this study there is a large new right - sided pneumothorax . The gap between the outer pleural edge and chest wall measures up to nearly 6 cm . Associated with this is new mild leftward shift suggesting tension . On the left , there is no definite persistent pneumothorax although a tiny one is possible . Increased density in the left lower lung suggests worsening atelectasis , however . There is no pleural effusion .
    OUTPUT:
    
New large right - sided pneumothorax with tension . Findings discussed , at the time of discovery , namely 13 :05 pm , with Dr . ___ by telephone .