Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The lower left chest wall and left costophrenic angle are excluded from the film . The left base is somewhat obscured by overlying breast tissue . Again seen is a right IJ Swan - Ganz catheter . The tip is in similar position , overlying the distal right pulmonary artery , possibly an inferior lobe range . Better appreciated on the current exam , but unchanged , there is a loop of catheter overlying the right heart which appears represent a loop within the Swan - Ganz catheter . Again noted is a left - sided pacemaker with lead tips over the right atrium and right ventricle and additional leads overlying the upper left heart border . No pneumothorax detected . As before , there is marked cardiomegaly , with extreme left cardiac apex excluded from this film . Again seen is prominent upper zone redistribution and vascular plethora , which appears slightly improved compared with the prior film . There is retrocardiac density , similar to the prior study , possibly very slightly improved . No gross right effusion . Left costophrenic angle excluded from film . Incidental note is made of clips in the right upper quadrant of the abdomen .
    OUTPUT:
    
1 . Right Swan - Ganz catheter tip positioned relatively distal . In addition , there appears to be looping of the catheter overlying the right heart . This appearance is similar to the most recent prior radiograph . Clinical correlation is requested regarding repositioning . ( Note is made of fluoro spot views and radiographs obtained after these radiographs that demonstrate subsequent repositioning of the Swan - Ganz catheter .) 2 . Marked cardiomegaly , unchanged . 3 . Upper zone redistribution and vascular plethora , probably slightly improved . 4 . Possible slight interval improvement in the retrocardiac collapse and / or consolidation .