Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: A dual - lead pacemaker / ICD device is unchanged . The heart is again moderately enlarged with leftward axis shift . The cardiac , mediastinal and hilar contours are unremarkable . Trace pleural effusions are suspected based on slight blunting of posterior costophrenic sulci . The lungs appear clear . Few suboptimally visualized lower thoracic compression deformities are probably not acute . The bones appear demineralized .
    OUTPUT:
    
Possible trace pleural effusions , otherwise unremarkable .