Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The lungs are hyperinflated . There is moderate - to - large right - sided pneumothorax . Slight leftward mediastinal shift . Increased interstitial markings are seen in the lungs bilaterally with more spiculated appearance at the right lung apex . Cardiomediastinal silhouette is within normal limits . No acute osseous abnormality is identified .
    OUTPUT:
    
Moderate - to - large right pneumothorax with subtle shift of the mediastinum to the left . Followup exam with pigtail catheter in place had already been performed at time of dictation .