right subclavian picc line, endotracheal tube, right pleural pigtail catheter, and feeding tube are likely unchanged in position. there are worsening layering effusions with associated patchy airspace disease more likely reflecting atelectasis, although superimposed pneumonia cannot be excluded. no evidence of pulmonary edema. the pulmonary vessels do appear somewhat cephalized which suggests pulmonary venous hypertension. no pneumothorax. overall cardiac and mediastinal contours are likely unchanged given differences in positioning.