Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: A left - sided dual lead pacemaker is seen in appropriate position . Again seen is a large hiatal hernia with air - fluid level similar in appearance to the prior exam . The heart is top size normal and the aorta is tortuous . There is a small right - sided pleural effusion with some relaxation atelectasis at the right base . There is no evidence of pneumothorax . There is no pulmonary edema .
    OUTPUT:
    
1 . Small right - sided pleural effusion with atelectasis at the right base . 2 . Large hiatal hernia not significantly changed from the prior study .