Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: There is been interval placement of a right - sided central venous catheter . This catheter courses more midline than would be expected for the superior vena cava and projects over the ascending aorta straightening question of arterial placement . The lungs are hyperexpanded , but grossly clear . Biapical scarring and right hilar retraction are again noted , with together with slight tenting of the right hemidiaphragm . No gross pleural effusion and no pneumothorax . The left lung base lies at the edge of the film is not well visualized . The possibility of a small effusion and atelectasis at the left base would be difficult to exclude on this view . The heart is not enlarged .
    OUTPUT:
    
Interval placement of a right - sided central venous catheter . The atypical course raises the possibility that this terminates in the proximal ascending aorta . The differential could be that the line lies in the SVC and the patient is rotated , creating an artifactual appearance of an arterial line . If confirmation is desired , repeat PA and lateral radiographs could be obtained . Limited visualization of the extreme left lung base . Possibility of a small effusion and atelectasis at the left lung base would be difficult to exclude . Findings consistent with background COPD .