Chest radiograph of bilateral pneumothoraces

Patient with ARDS, increased permeability pulmonary edema, and barotrauma. Supine chest radiograph shows right subpulmonic and left apicolateral pneumothorax. Streaky lucencies are permeating the otherwise consolidated lungs as a reflection of interstitial pulmonary emphysema. Subcutaneous air is also seen  in the right hemithorax. The patient has a tracheostomy tube in place with a markedly hyperexpanded cuff, due to tracheomalacia.