Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Lungs are hyperinflated , compatible with chronic lung disease . There are small bilateral pleural effusions , unchanged from ___ . Heart is moderately enlarged , also unchanged . There is no strong evidence for pulmonary edema . No pneumothorax or focal airspace consolidation . A right paratracheal opacity with leftward deviation of the trachea is known to be secondary to a tortuous brachiocephalic artery and subclavian vein . A left pectoral pacemaker is constant , with leads in standard position .
    OUTPUT:
    
Unchanged , small bilateral pleural effusions .