Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Portable AP upright chest film ___ at 13 : 19 is submitted .
    OUTPUT:
    
A dual lead left - sided pacemaker remains in place . There is increasing opacity at the left base with a possible associated effusion . Although these findings could reflect atelectasis , an early pneumonia should also be considered in the correct clinical setting . No evidence of pulmonary edema or pneumothorax . Overall cardiac and mediastinal contours are stable . Apparent right sided superior mediastinal soft tissue may be related to patient positioning but also raises the possibility of substernal goiter . Followup imaging with PA and lateral views would be advised .