Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: A dual - lead pacemaker / ICD device appears unchanged . The heart is mildly enlarged . The aorta is calcified . The mediastinal and hilar contours appear unchanged . Slight scarring is similar to each lung apex . There is perhaps a trace pleural effusion or scarring at the left lung base noting pleural thickening . A new small right - sided pleural effusion is noted . The lungs are hyperinflated . There is background coarsening of lung markings that is similar to improved without definite focal consolidation . The coarse appearance of the lung architecture probably reflects emphysema . Mid thoracic compression deformities appear unchanged .
    OUTPUT:
    
Emphysema . Very small pleural effusions . No definite evidence for pneumonia .