FINDINGS:
Consistent with the given history, a chest tube is noted and is
 directed medially in the upper mediastinum with a location that is highly
 suggestive of intrafissural placement.  There is increased lucency at the lung
 base, particularly outlining the right hemidiaphragm, which likely indicates a
 residual component of the pneumothorax.  Diffuse bilateral pulmonary nodules
 consistent with widespread metastatic disease are again present.  There is air
 noted around a ray cage device in the lower thoracic spine, surrounded by
 posterior spinal stabilization rods.  Extensive surgical clips are noted
 within the medial left upper quadrant.  It is difficult to discern the left
 hemidiaphragm.  There is increased retrocardiac opacity, although similar to
 the prior exam.  A Port-A-Cath is evident in stable and standard course and
 position.  The osseous structures are difficult to assess, but are grossly
 stable.

IMPRESSION:
The course of the chest tube projecting over the right chest
 suggests an intrafissural position, which may limit the ability to evacuate
 the pneumothorax.  A visceral pleural line remains evident and most apparent
 at the lung base with an extension of the air to the spinal hardware as noted
 on the CT earlier today.  Widespread metastatic disease of the lungs is again
 seen.  There is no radiographic evidence currently of tension physiology.