Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Since the prior exam , the pigtail pleural catheter has been removed and replaced with two right - sided chest tubes . There is a moderate - sized apical pneumothorax on the right , measuring 7 .2 cm from the top of the thoracic cage to the top of the collapsed right upper lobe . Right chest wall emphysema has progressed . There is no mediastinal shift or hemidiaphragmatic flattening to suggest tension .
    OUTPUT:
    
Increase in right apical pneumothorax with two chest tubes in place and no evidence of tension .