Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Left - sided pigtail chest tube is again visualized projecting over the left mid chest . There is a large left pneumothorax that is increased in size compared to prior . There is a large amount of left - sided subcutaneous emphysema which has also increased in size . This is a rotated film and therefore it is difficult to assess for mediastinal shift . The ET tube , NG tube and left subclavian line are unchanged . There compressive changes in the right lung and it is difficult to assess for alveolar infiltrate due to the patient positioning and volume loss . There is a small right effusion .
    OUTPUT:
    
Large left pneumothorax despite CT . These findings were called to Dr . ___ at the time of dictating this report by Dr . ___ 9 :00 a .m . on ___ .