Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Upright AP and lateral views of the chest provided . Dual lead pacemaker is unchanged in position with leads extending to the region of the right atrium and right ventricle . Bilateral pleural effusions are again seen , right greater than left . Associated compressive lower lobe atelectasis is likely also present . A retrocardiac density containing an air - fluid level likely represents a hiatal hernia . Coarsened curvilinear structures projecting over the heart likely represent mitral annular calcification . No pneumothorax is seen . Pneumonia is difficult to exclude in the lower lungs given effusions and subjacent consolidation . No acute bony abnormality is seen . DISH related changes of the thoracic spine with chronic appearing deformity of the right humeral head .
    OUTPUT:
    
Bilateral pleural effusions , right greater than left with associated compressive lower lobe atelectasis , can not exclude pneumonia .