Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Dual - lead left - sided pacer device is again seen with leads extending to the expected position of the right atrium and right ventricle . There is blunting of the bilateral costophrenic angles suggesting small pleural effusions . The cardiac silhouette remains enlarged , similar to prior . There is a subtle rounded opacity , measuring approximately 9 mm projecting over the right lung base , which is subtly present on the prior study and could relate to nipple shadow . This could be confirmed with repeat with nipple markers . Mediastinal and hilar contours are stable . Partially imaged left shoulder prosthesis is again noted .
    OUTPUT:
    
1 . Persistent marked enlargement of the cardiac silhouette . 2 . Small bilateral pleural effusions . 3 . 9 - mm rounded opacity projecting over the right lung base is similar in appearance to that seen on ___ and most likely represents a nipple shadow . This could be confirmed with repeat with nipple markers .