Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Frontal AP and lateral views of the chest were obtained . A left pectoral pacemaker device partially obscures the left costophrenic angle . Leads end in the expected locations of the right atrium and right ventricle . The right atrial lead courses through the left sided SVC and coronary sinus . A moderate - sized layering left pleural effusion is significantly increased from ___ but similar to ___ . Lungs are otherwise clear without focal consolidation , or pneumothorax . No suspicious mass or nodule is identified . Cardiac and mediastinal silhouettes are stable . Hilar contours are normal , allowing for technique .
    OUTPUT:
    
1 . No nodule or mass identified . 2 . Moderate layering left pleural effusion , recurrent , of unclear etiology . The effusion has the attenuation of non-serous fluid on the CT C - spine from ___ . Clinical evaluation for etiology should be considered , if not already known . Findings initially discussed with Dr . ___ by phone at 1 : 15 a .m . , ___ . After attending review , final findings emailed to the ED QA nurses for communication to the patient 's PCP ___ 7 : 50 am ___ .