Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: PA and lateral views the chest provided . A left chest wall pacer device is again seen with leads extending to the region of the right atrium and right ventricle . The heart appears mildly enlarged . Mediastinal contour is stable . There is hilar congestion with mild to moderate pulmonary edema . Tiny pleural effusions are present . Hyperinflation of lungs suggest emphysema , and was seen on prior CT chest .
    OUTPUT:
    
COPD with superimposed pulmonary edema . Tiny pleural effusions .