Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: There is a small to moderate right pleural effusion with adjacent atelectasis , slightly worse compared to ___ . No left pleural effusion . No pneumothorax . Mild pulmonary vascular engorgement , which has improved . Stable mild to moderate cardiomegaly . Left pectoral pacemaker lead terminates in the right ventricle .
    OUTPUT:
    
Worsening small to moderate right pleural effusion compared to ___ . Given atypical finding of worsening right effusion without other signs of fluid overload such as pulmonary edema or left - sided effusion , would be concerned about alternative etiology such as non-clearing pneumonia or possible underlying malignancy . Chest CT would help to clarify the problem .