Metal spear has entered the child's right chest and continued though the diaphragm and abdomen, exiting the left lateral abdomen.
Large right pneumothorax with mediastinal shift to the left and herniation of right lung across the midline.
Lateral projection (with horizontal beam) confirms the abdomen is involved and there is a small amount of free gas beneath the diaphragm and anterior abdominal wall, indicating perforation of a hollow viscus.