Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: There is a large new right sided pneumothorax , the result of multiple right - sided rib fractures . The mediastium is slightly shifted to the left and the diaphragm is flattened . The right lung is completely collapsed . There may be a left - sided pleural effusion . Cardiac size is unremarkable .
    OUTPUT:
    
Large right sided pneumothorax with some evidence of tension . A second film status post chest tube placement was available prior to communication of this critical result .