nasogastric tube is seen coursing below the diaphragm with the tip projecting over the stomach. the lung apices are not included. there are layering bilateral effusions with associated compressive atelectasis of the lower lobes and stable superimposed pulmonary edema. pneumonia cannot be entirely excluded. overall cardiac and mediastinal contours remain stably enlarged. the tip of the tracheostomy tube lies approximately <num> cm above the carina.