Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: A dual lead pacemaker is in - situ , unchanged in appearance when compared to the prior study . Valve prosthesis also noted . Previous median sternotomy and coronary artery bypass graft clips seen . Smooth widening of the superior mediastinum is likely vascular and unchanged compared the prior study . No lobar consolidation , pleural effusion or pneumothorax seen . The right hilum appears slightly displaced superiorly however this is unchanged compared to multiple prior studies dating back to ___ . Small right pleural effusion .
    OUTPUT:
    
Apparent superior displacement of the right hilum is unchanged compared to multiple prior studies . This does appear slightly enlarged which may reflect pulmonary vascular congestion . Recommend repeat chest radiographs when the patient 's clinical condition improves .