Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: PA and lateral views of the chest provided . Right chest wall pacer device is again seen with pacer leads extending into the right atrium and right ventricle . Midline sternotomy wires and mediastinal clips are again noted . There is again noted to be evidence of pulmonary fibrosis with basal predominant pattern not significantly changed . No definite signs of a superimposed pneumonia or edema . Small pleural effusions difficult to exclude . No large pneumothorax . Cardiomediastinal silhouette is stable with mild cardiomegaly appearing unchanged . Bony structures are intact .
    OUTPUT:
    
Pulmonary fibrosis , basal predominant pattern with mild cardiomegaly . Possible small bilateral pleural effusions .