FINDINGS:
Tracheostomy again seen.  A right subclavian PICC line tip overlies the SVC/RA
 junction.  Right-sided chest tube again present.
 
 Compared to the prior film, I doubt significant interval change.  Residual
 contrast noted in the gastric fundus which lies above the level of the left
 hemidiaphragm.  Small right effusion is better seen on today's chest x-ray. 
 Minimal patchy opacity in the right cardiophrenic region is slightly more
 pronounced.  Right upper zone opacity is similar to the prior film.  Increased
 retrocardiac opacity is also similar.  The lateral left hemidiaphragm and
 costophrenic sulcus are excluded from the current film.

IMPRESSION:
Overall similar to the prior film.  Please see comment above.