Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The patient is status post median sternotomy with aortic valve replacement . Sternotomy wires are intact . The lungs are clear . Right apical pleural thickening and calcification is unchanged . A small right pleural effusion has increased since ___ . The left lung is clear . There is no pneumothorax . The heart and mediastinum are within normal limits . Generalized osteopenia and flowing ossification of the anterior longitudinal ligament is again noted .
    OUTPUT:
    
Small right pleural effusion , increased since ___ . Diffuse idiopathic skeletal hyperostosis ( DISH ) .