Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Portable supine chest radiograph ___ at 07 :44 is submitted . Please note that as the patient was imaged in the supine position , the sensitivity to detect pneumothorax is diminished .
    OUTPUT:
    
The heart remains stably enlarged . Both lungs are overall hyperinflated consistent with underlying emphysema . Pulmonary arteries are prominent raising the possibility of underlying pulmonary arterial hypertension . More focal nodular opacity at the right lung base is unchanged and may reflect a nipple shadow as no corresponding abnormality is seen in this location on the CT dated ___ . There is a stable left - sided apical pneumothorax . Left chest tube remains in place with subcutaneous emphysema in the left lateral chest wall . A left pleural effusion with retrocardiac consolidation is unchanged . Left - sided multiple posterolateral rib fractures are again seen . No pulmonary edema .