Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Right - sided chest tube is noted and slightly pulled back in comparison to the prior study . Right - sided pneumothorax is again noted at the superior and inferiolateral portions of the right lung . Again noted is massive air collection in the soft tissues causing multiple horizontal lines which overlie the entire thorax . Previously noted pneumomediastinum appears stable . There is no change in the appearance of the left lung parenchyma . Multiple bilateral rib fractures are noted .
    OUTPUT:
    
Small persistent right pneumothorax again noted along with extensive subcutaneous air .