Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: A dual - lead pacemaker / ICD device appears unchanged , with leads again terminating in the right atrium and ventricle , respectively . The heart is normal in size . The mediastinal and hilar contours appear unchanged . Irregular reticular opacities again project over each central lung region , without significant change . Blunting of the left costophrenic sulcus suggests a very small pleural effusion . The chest is hyperinflated . Moderate emphysema is present . Confluent subpleural opacity along the posterior chest on the left probably suggests nodular pleural thickening . Calcified pleural plaques could be seen with prior asbestos exposure . Bony structures are unremarkable . The findings are quite similar to earlier radiographs from ___ .
    OUTPUT:
    
Findings similar to prior radiographs showing asymmetric reticulation and pleural thickening in the left lung . Persistent small left - sided pleural effusion . Please note recent PET - CT findings suggesting that the pulmonary findings are worrisome for malignancy . Differential considerations include mesothelioma , primary lung cancer , or pleural - based metastases .