Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: PA and lateral views of the chest ___ at 09 :46 are submitted .
    OUTPUT:
    
Multiple right - sided posterior rib fractures are again seen . A focal patchy opacity in the right upper lobe is now again appreciated and may represent focal pulmonary contusion related to one of the rib fractures or an area of atelectasis . The left lung is grossly clear . Lung volumes remain low . There are likely small bilateral effusions , right greater than left . A tiny right apical lateral pneumothorax is now visible . The heart remains enlarged . Mediastinal contours are stable . Marked gaseous distention of the colon continues .