Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Left - sided pacer device is stable in position . Left - sided central venous catheter is also stable in position . Enlarged cardiomediastinal silhouette is again seen . Patient is status post median sternotomy and cardiac valve replacement . There is mild pulmonary vascular congestion / interstitial edema and a small left pleural effusion . Trace right pleural effusion is difficult to exclude . Evidence of old left - sided rib fractures is seen .
    OUTPUT:
    
Left - sided pacer device is stable in position . Left - sided central venous catheter is also stable in position . Enlarged cardiomediastinal silhouette is again seen . Patient is status post median sternotomy and cardiac valve replacement . There is mild pulmonary vascular congestion / interstitial edema and a small left pleural effusion . Trace right pleural effusion is difficult to exclude . Evidence of old left - sided rib fractures is seen .