FINDINGS:
In comparison with the study of , there are again areas of
 increased opacification at the bases with poor definition of the
 hemidiaphragms, more prominent on the left.  This is consistent with layering
 pleural effusion and underlying atelectasis.  In the appropriate clinical
 setting, the possibility of supervening pneumonia would have to be considered.
 
 
 Tracheostomy tube remains in place and there is no evidence of vascular
 congestion.