Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Portable semi-erect chest film ___ at 04 :38 is submitted .
    OUTPUT:
    
Tracheostomy tube remains in place . There is diffuse bilateral airspace opacity which does not appear to be significantly changed and may represent edema , layering effusions with compressive atelectasis , diffuse pneumonia or ARDS . Clinical correlation is advised . Cardiac and mediastinal contours are difficult to assess given the diffuse airspace process . No large pneumothorax .