Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Right PICC is no longer visualized . Moderate right - sided pleural effusion is again noted . There is a small left pleural effusion . Irregular interstitial markings seen in the right lung and at the left lung base . While these may be in part due to chronic underlying COPD , possibility of superimposed interstitial edema is possible . Surgical chain sutures project over the right mid lung . Focal nodular opacities projecting over the lung bases likely to represent nipple shadows . There is apparent increase in size of the cardiac silhouette particularly along the right . This could be due to medially loculated effusion but incompletely characterized .
    OUTPUT:
    
Chronic underlying changes in the lungs suggesting COPD with possible superimposed interstitial edema in the right lung and left lung base . Bilateral pleural effusions , right greater than left . New opacity at the right lung base medially could be due to loculated effusion medially .