Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Portable semi-upright radiograph of the chest demonstrates a tracheostomy tube terminating 2 cm above the carina . Right hemidiaphragm is markedly elevated . In addition there is A moderate right pleural effusion and severe right lower lobe atelectasis . Right hilus is obscured , possibly enlarged . Moderate enlargement of cardiac silhouette has worsened , pulmonary vasculature is still engorged but there is no definite pulmonary edema . No pneumothorax or left pleural effusion .
    OUTPUT:
    
Right pleural effusion with associated atelectasis . Consolidation is not excluded . Moderate cardiomegaly . Severe elevation right hemidiaphragm could be due to phrenic nerve palsy . Mediastinal and even right hilar adenopathy are not excluded . Recommendation : Chest CT , with intravenous contrast if tolerated .