FINDINGS:
There has been no significant interval change in a small left
 apical pneumothorax.  Small left pleural effusion is persistent with adjacent
 mild atelectasis.  The cardiomediastinal silhouette is unremarkable.  No
 displaced rib fractures are identified.  There is no focal airspace opacity.

IMPRESSION:
Persistent small left apical pneumothorax, overall unchanged compared to the
 prior exam.