Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Portable semi-erect chest film ___ at 15 21 is submitted .
    OUTPUT:
    
Endotracheal tube has its tip approximately 4 cm above the carina . A left internal jugular central line and nasogastric tube are unchanged in position . There are patchy opacities within both lower lungs which would be concerning for aspiration or pneumonia . In addition , there are layering effusions . Overall , the lungs are hyperinflated suggesting underlying emphysema . No pneumothorax . Deformity of several of the right upper posterior ribs is again seen likely related to old trauma .