Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: A large left pleural effusion has slightly increased from the prior study . The locule of gas seen projecting over the left hemithorax is consistent with patient 's large hiatus hernia . There is a small left apical pneumothorax which is new from the prior study . Stable small right pleural effusion . Difficult to assess heart size due to overlying effusion . Dual lead left chest wall pacer is standard position with leads in the right atrium and right ventricle . Pulmonary vascular congestion is stable
    OUTPUT:
    
1 . New small left apical pneumothorax 2 . Stable to slightly increased large left pleural effusion and small right pleural effusion .