FINDINGS:
A frontal semi-upright view of the chest was obtained portably. The
 endotracheal tube ends at the level of the inferior clavicular heads and is no
 less than 5.2cm above the carina.  The nasogastric tube follows the expected
 course, although the tip is not visualized.  
 
 Low lung volumes result in bronchovascular crowding.  New opacification of
 both lower lobes despite no change in lung volumes compared to the prior study
 is concerning for pneuomonia. The upper lung zones are clear.  There is no
 large pleural effusion or pneumothorax, although the left lung apex is
 obscured by the chin. The azygous vein is bigger than before with increased
 caliber of the left upper lobe vessels. The right hilus is chronically
 enlarged. Cardiac silhouette is stable. Flattening of the right humeral head
 may be due to avascular necrosis. Degenerative change is seen in the left
 shoulder girdle.

IMPRESSION:
1.  Endotracheal tube is no less than 5.2cm above the carina.  Given that the
 patient's chin is down on the radiograph, the ETT could be advanced 2-3cm for
 better seating.
 2.  Bilateral lower lobe opacification, concerning for pneumonia.
 3.  Mild congestive heart failure.