FINDINGS:
As compared to the previous radiograph, the endotracheal tube is
 still positioned too high.  It currently projects approximately 7 cm above the
 carina.  The nasogastric tube is in unchanged position.
 
 The left PICC line shows an unchanged course.  Also unchanged is the course of
 the ventriculoperitoneal shunt.
 
 The overall appearance of the lung parenchyma is unremarkable.  However, there
 is a newly appeared bilateral soft tissue air collection in the cervical soft
 tissues.  In addition, a lucent line is seen along the left heart border,
 potentially representing a small medial pneumothorax or a pneumopericardium. 
 Further clarification of these findings is required by correlation to the
 clinical history.
 
 At the time of observation and dictation, 8:06 a.m., on the , the
 referring physician, . , covered by Dr.  was paged for
 notification.  The findings were discussed in detail with Dr.  on the
 telephone at 8:08 a.m., on .  Need for endotracheal tube
 advancement was emphasized and a short-term repeat radiograph recommended.