Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The patient is status post mitral valve replacement . A dual - lead pacemaker / ICD device appears unchanged , with leads terminating in the right atrium and ventricle , respectively . The heart is again enlarged . The main pulmonary artery contour is likewise enlarged , as seen previously . There is dense new opacification of the left mid to lower lung , probably including the left lower lobe and lingula , with a pleural effusion of substantial size , moderate and possibly large . In addition , there is a moderate predominantly central interstitial abnormality with hazy perihilar opacification , consistent with moderate pulmonary edema . There is no pneumothorax or clear evidence for pleural effusion on the right .
    OUTPUT:
    
1 . Dense left basilar opacification with pleural effusion . Differential considerations include atelectasis associated with a substantial pleural effusion versus pneumonia . 2 . Findings suggesting moderate pulmonary vascular congestion .