IMPRESSION:
Severe and somewhat asymmetric bilateral pulmonary consolidation has varied in
 severity and distribution since the admission radiograph on . It is
 less severe today than on  although moderate bilateral pleural
 effusion has been increasing since that time. Combination of findings suggest
 likely concurrent pulmonary edema and pneumonia. The right middle ribs have
 chronic and possibly acute fractures, and there is the question of bone
 destruction in the antero lateral left sixth rib.
 
 Lines and tubes are standard placements. Heart is normal size. Previous
 mediastinal widening has improved suggesting a decrease in distension of
 mediastinal veins. Whether there is mediastinal adenopathy can only be
 resolved by chest CT scanning which would also examine the chest cage
 abnormalities and previously cited cavitation in the right lung, a clear
 indication of pneumonia.