Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The previously seen 2 right - sided chest tubes are unchanged in position . The heart is severely enlarged , unchanged compared to prior studies . The mediastinal silhouette is also unchanged . No change in the small right hemorrhagic pleural fluid compared to the most recent prior study . Small right apical pneumothorax appears to have slightly increased compared to the most recent prior study . Multiple right - sided rib fractures are again noted .
    OUTPUT:
    
1 . 2 right - sided chest tubes are unchanged in position . 2 . No change in the small right hemorrhagic pleural effusion . 3 . The small right apical pneumothorax may have slightly increased compared to the most recent prior study .