multiple right-sided posterior rib fractures are again seen. a focal patchy opacity in the right upper lobe is now again appreciated and may represent focal pulmonary contusion related to one of the rib fractures or an area of atelectasis. the left lung is grossly clear. lung volumes remain low. there are likely small bilateral effusions, right greater than left. a tiny right apical lateral pneumothorax is now visible. the heart remains enlarged. mediastinal contours are stable. marked gaseous distention of the colon continues.