Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Right - sided chest tube is been removed . The appearance of the lungs is unchanged compared to prior again seen is a hiatal hernia smaller right than left chest cavity with pleural thickening / effusion right - sided subcutaneous emphysema right - sided skin ___ and a pacemaker
    OUTPUT:
    
Right chest tube removed otherwise no substantive change