Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The heart size is normal . The aortic knob is calcified . Mediastinal and hilar contours are unremarkable . Within the left upper lobe there is a 5 .2 x 3 .9 cm rounded opacity concerning for malignancy . Small left pleural effusion is noted . No pulmonary vascular congestion is identified . There is no pneumothorax . The right lung is clear . Mild degenerative changes are noted in the acromioclavicular joints as well as within the thoracic spine .
    OUTPUT:
    
Rounded opacity within the left upper lobe concerning for malignancy . Further assessment with chest CT with intravenous contrast is recommended .