Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Compared with the immediate prior study of ___ , a left - sided dual - chamber pacemaker has been placed with leads in standard position . The moderate left pleural effusion has increased , now moderate to large and layering . There may be a small to moderate layering right pleural effusion . There is no focal consolidation , pneumothorax , or pulmonary edema . There is unchanged moderate to severe cardiomegaly .
    OUTPUT:
    
1 . New left - sided dual chamber pacemaker with leads in standard position . 2 . Increased moderate to large layering left pleural effusion 3 . Probable small to moderate right pleural effusion .