Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The lungs are normally expanded . Mild cardiomegaly is unchanged . Leftward shift of the heart is chronic . The aorta is calcified . The mediastinal and hilar contours are normal . A left pleural effusion is small . There is no pneumothorax . Although partially visualized there are notable degenerative changes in the right shoulder .
    OUTPUT:
    
Chronic leftward shift of the heart . Small left pleural effusion but no evidence of pneumonia . A lateral radiograph would be helpful for more definitive evaluation .