Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Previous median sternotomy noted . A dual lead pacemaker and valve prosthesis are unchanged in appearance compared to prior study . A right - sided PICC is unchanged in appearance terminating likely in the right atrium . An endotracheal tube and nasogastric tube are unchanged in appearance . Lung volumes remain low . Probable layering pleural effusion at the left lung base with associated atelectasis . The right lung is clear .
    OUTPUT:
    
No significant interval change when compared to the prior study .