Superior mediastinal abscess
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The superior mediastinal collection has reaccumulated since the prior CXR from 4 years prior. This measures up to 8.5 cm transversely, has an air fluid level superiorly and displaces the trachea to the right with mild lateral flattening. This lies in the same location as the initial CXR though is larger. No free pneumomediastinum or gas tracking into the base of neck. Heart size is normal. Lungs and pleural spaces are clear. No pneumothorax or pleural fluid collection.
Findings are consistent with recurrence of para-esophageal abscess.
Abscess drained surgically.