Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Left - sided dual - chamber pacemaker device leads terminating in the right atrium and right ventricle , unchanged . Heart size remains mildly enlarged . The mediastinal and hilar contours are similar . Pulmonary vasculature is not engorged . Patchy opacities in lung bases may reflect atelectasis , slightly worse in the interval . No new focal consolidation , pleural effusion or pneumothorax is seen . Moderate multilevel degenerative changes are noted in the thoracic spine . Fractures of the left sixth and seventh posterior ribs are subacute , seen on the previous examination . No definite new osseous abnormalities detected . Extensive degenerative changes are present involving both glenohumeral joints .
    OUTPUT:
    
Worsening opacities the lung bases likely reflective of increased atelectasis . Subacute left sixth and seventh posterior rib fractures , as seen previously .