Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: There is rotated positioning and the lower left chest wall is excluded from the film . A left - sided pacemaker is present , with lead tips over the right atrium and right ventricle . Of note , the battery pack itself is excluded from these films and the contiguity with the pacemaker wires can not be confirmed on this examination . No additional pacing device is appreciated on this view , but correlation with specifics of the clinical scenario is requested . The carina is not well visualized , but the ET tube appears to lie approximately 5 .4 cm above the carina . There appears to be an NG tube present , but it can not be traced below the level of the diaphragm . Interruption of the uppermost sternal wire again noted . There is increased retrocardiac density , probably similar to the prior film , consistent with left lower lobe collapse and / or consolidation . The presence of a left effusion is difficult to assess due to positioning . Hazy density in the right lung suggests the presence of mild vascular plethora . No definite right effusion . Minimal atelectasis at the right base is similar to prior .
    OUTPUT:
    
1 . Pacemaker lead tips over right atrium can right ventricle , but the battery pack and more proximal portion of the wires are excluded from the film . If clinically indicated , a repeat frontal film could be used to include both the battery pack and lead tips on the same film . If an additional pacing device is present , then an additional film would be required to demonstrate it . 2 . Left lower lobe collapse and / or consolidation unchanged . 3 . Mild vascular plethora / CHF is likely similar to the prior film . 4 . NG tube tip does not clearly pass below the level of the lower mediastinum .