IMPRESSION:
1.  Left internal jugular central line has its tip in the proximal SVC.  The
 endotracheal tube has its tip approximately 4.5 cm above the carina.  A
 nasogastric tube is seen coursing below the diaphragm with the tip not
 identified.  The pigtail catheter and basilar chest tube are also unchanged in
 position.  There is a layering left effusion with associated airspace opacity
 most likely representing partial lower lobe atelectasis, although a
 superimposed infection cannot be entirely excluded.  No pneumothorax is
 appreciated.  No evidence of pulmonary edema.  Heart remains stably enlarged. 
 Mediastinal contours appear less widened, likely due to differences in
 positioning and inspiration.