The ETT and NGT are well-positioned. Tubing through the right side of the neck and over the midline of the chest likely represents VP shunt tubing which is intact.
The heart is enlarged even allowing for projection, and there is abnormal cardiac contour, in keeping with history of mitral valve disease.
There is diffuse air space opacification, more so on the right side, with perihilar infiltrates. No pleural effusion or evidence of pneumothorax. Features are in keeping with asymmetric acute pulmonary oedema.
Posterior ribs are abnormal, in keeping with history of MPS.