Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Patient has a known dual - chamber pacemaker . The atrial and ventricular leads are unchanged in position since ___ . The right pleural effusion is slightly larger with associated minor fissural thickening . No changes in the left lung . Known scarring of the right lung base . The heart is enlarged . No acute osseous abnormalities .
    OUTPUT:
    
No change in position of the left ventricular lead since ___ .