Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: PA and lateral views of the chest and multiple views of the left ribs . Comparison is made to previous chest x-ray from ___ . Small - to - moderate bilateral pleural effusions are again noted . Superiorly , the lungs are clear . The cardiac silhouette is stable . Dual - lead pacing device is again seen with lead tips in the right atrium and right ventricular apex . There are no visualized acute rib fractures . Osseous structures are unremarkable . Surgical clips seen in the mid abdomen . Well - circumscribed round osseous structure projects over the left upper quadrant .
    OUTPUT:
    
No acute cardiopulmonary process . No visualized rib fracture . Persistent moderate - sized bilateral pleural effusions .