Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Left - sided dual - chamber pacemaker is again noted with leads terminating in unchanged positions in the right atrium and right ventricle . Cardiac silhouette size remains within normal limits . The mediastinal and hilar contours are unchanged , and pulmonary vasculature is normal . Small left pleural effusion and patchy opacity in the left lung base are similar , and the right lung remains clear . There is no pneumothorax . Minimal degenerative changes are seen in the thoracic spine .
    OUTPUT:
    
Similar - appearing small left pleural effusion and left lower lobe atelectasis or scarring . No new focal consolidation to suggest pneumonia .