FINDINGS:
The patient is rotated with his neck turned to the right.  The tip of the
 tracheostomy tube appears appropriately positioned and unchanged.  The
 configuration of the right subclavian vein and brachiocephalic vein stent
 appears similar to the prior chest CT with kinking of the stent at the level
 of the clavicle.  The configuration of the left brachiocephalic vein stent is
 also similar to the prior CT.  Bilateral right worse than left parenchymal
 opacities have progressed from the prior radiograph as well as CT, again
 concerning for multifocal infection and/or metastases.  A right pleural
 effusion may be trace.  The left pleural effusion may have resolved in the
 interim.  No pneumothorax.
 
 The heart is normal in size.  Mild prominence of the right mediastinum may
 correspond to the known mild ascending thoracic aortic aneurysm on prior CT. 
 The size of the mediastinum is similar to the prior exam.  Calcified right
 mediastinal lymph node is unchanged.
 
 Catheter projecting over the lower portion of the SVC is unchanged.  Coils
 projecting over the left upper abdomen are also unchanged.  Coarse
 calcifications projecting over the left upper abdomen are unchanged from the
 prior radiograph in correspond to splenic calcifications on the prior CT. 
 Coarse calcifications in the soft tissue of the neck are unchanged from prior
 CT neck.

IMPRESSION:
1.  Interval progression of bilateral, right worse than left parenchymal
 opacities again concerning for multifocal infection and/or metastases.
 
 2.  Similar appearance of the mediastinum.
 
 3.  Probable small right pleural effusion, new from the prior exam.
 
 4.  Position of vascular stents with kinking of the right
 brachiocephalic/axillary vein stent is similar to the prior chest CT.