Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Left chest wall dual lead pacing device is again seen . The lungs are clear of confluent consolidation . There is mild blunting of the left costophrenic angle which could represent a small effusion . There is no overt pulmonary edema . The cardiac silhouette is enlarged but stable in configuration . Atherosclerotic calcifications are noted at the aortic arch . Right shoulder arthroplasty , lumbar spinal fixation hardware and vertebroplasty changes are identified as well as degenerative changes at the left shoulder .
    OUTPUT:
    
Cardiomegaly and possible left pleural effusion . No other acute cardiopulmonary process .