Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: There is prominence of vessels with somewhat patchy opacity in the left upper zone and right cardiophrenic region . There is worsened opacity at the left base , with new obscuration of the left hemidiaphragm . These findings are new or progressed compared with ___ . Bilateral small effusions would be difficult to exclude . Cardiomediastinal silhouette itself is unchanged . Again noted is a right - sided dual lead pacemaker with lead tips over right atrium and right ventricle . Old left - sided rib fractures again noted .
    OUTPUT:
    
New patchy opacities in left upper zone right cardiophrenic region could reflect changes due to worsening CHF . The differential could include focal pneumonic infiltrates or areas of aspiration . Left lower lobe collapse and / or consolidation , progressed compared with ___ . No free air seen beneath the diaphragm . No dilated loops of air - filled bowel are seen . In fact , there is relative paucity of gas seen in the visualized portion of the upper abdomen .