Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: In comparison to the chest radiograph obtained ___ , the left - sided PICC has changed in position , and now points superiorly in either the upper SVC or in the azygos system . The distal end of the PICC is approximately 4 cm superior to its apex , which lies approximately 6 cm superior to the expected location the superior cavoatrial junction . Otherwise , there is a new , small , right pleural effusion . Lungs are otherwise fully expanded and clear without focal consolidation . Heart size is normal without pulmonary vascular congestion or edema .
    OUTPUT:
    
Malpositioned PICC , which is directed superiorly either the SVC or azygos system . New , small , right pleural effusion .