Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: There is a large left side pleural effusion which has increased markedly since prior examination . A small right pleural effusion is unchanged . The visualized portion of the left lung and right lung are clear , without focal consolidations . There is pulmonary vascular congestion . Heart size is difficult to interpret . Aortic calcifications are noted . Prominence of the right superior mediastinum is compatible with known goiter .
    OUTPUT:
    
Marked increase in size in a now large left pleural effusion with mild pulmonary congestion .