Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Again appreciated projects over the left upper chest with leads in the right atrium and the right ventricular lead now sits in a more anterior position compared to prior study . Otherwise , the heart and mediastinal contours are within normal limits . The lungs are hyperexpanded and hyperlucent , and the hemidiaphragms are flattenend , raising the likelihood of COPD . Small bilateral blunting of the posterior costophrenic angles represents either pleural effusions or pleural scarring . There is no pneumothorax . The bones demonstrate healed posterolateral rib fractures in the right upper thorax and ossification of the anterior longitudinal ligament .
    OUTPUT:
    
Status post right ventricular pacer lead revision as described above ; COPD and small pleural effusions .