FINDINGS:
Pigtail catheter projects over the right lower hemithorax, unchanged.  ETT in
 standard position.  Left IJ approach central venous catheter tip also
 unchanged projecting over the right atrium.  Left PICC tip also unchanged.
 
 Diffuse bilateral airspace opacities are indicated.  Interval increase in
 right lower lobe opacity is concerning for developing pneumonia.  Opacity in
 the left lobe is also unchanged.  No pleural effusion.  No pneumothorax. 
 Cardiomediastinal silhouette unchanged.

IMPRESSION:
1.  Bilateral airspace opacity is consistent with ARDS.
 2.  Interval increase in right lower lobe opacity is concerning for concurrent
 right lower lobe pneumonia.