Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The tip of the right PICC line extends into the right atrium . The tip of the endotracheal tube projects over the mid thoracic trachea . A gastric tube projects below the level the diaphragms but beyond the field of view of this radiograph . Unchanged large bilateral layering pleural effusions as well as subjacent atelectasis . There is persisting leftward mediastinal shift .
    OUTPUT:
    
No significant interval change since the prior radiograph .