Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: A left - sided , single lead ICD is seen in appropriate position . Heart size is top normal . The mediastinal and hilar contours are normal . There is persistent elevation of the left hemidiaphragm , which is grossly unchanged from the prior study . The pulmonary vasculature is normal . Lungs are clear . There may be a meniscal effusion on the left however no large pleural effusion or pneumothorax is seen . There are no acute osseous abnormalities .
    OUTPUT:
    
No evidence of large pleural effusion or focal consolidation . Persistent elevation of the left hemidiaphragm , not significantly changed from the prior study . For further evaluation of left - sided effusion , left lateral decubitus films could be obtained .