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.