Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Bilateral low lung volumes . Small left pleural effusion unchanged from previous . Otherwise lungs are clear . Cardiac size is normal . There is no pneumothorax . Again seen is the median sternotomy wires and valve replacements . There is a left pectoral pacemaker with right atrial and right ventricular leads and an epicardial lead . Tip of ET tube unchanged in position and is projecting between the clavicles measuring 6 .4 cm above the carina . Dobbhoff tube with tip in the duodenum . Right PICC with tip in the cavoatrial junction .
    OUTPUT:
    
Small left pleural effusion unchanged from previous ET tube tip 6 .4 cm above the carina