Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: A dual - lead pacemaker / ICD device appears unchanged . The heart is mild to moderately enlarged . The aortic arch is calcified . The mediastinal and hilar contours appear unchanged . There is a mild background interstitial abnormality , possibly due to slight chronic congestion , but improved somewhat since the prior examination . A new right basilar opacity is present . An increasing pleural effusion , potentially with a degree of loculation , is noted on the right , now probably small to moderate in size associated with increasing posterior opacity . A trace pleural effusion is difficult to exclude on the left . There is no pneumothorax . Moderate degenerative changes are noted along the mid to lower thoracic spine .
    OUTPUT:
    
Somewhat improved background vascular congestion but increasing right basilar opacity and effusion . Differential considerations include an increasing effusion associated with congestive heart failure and associated atelectasis , although pneumonia could also be considered in the appropriate clinical setting .