Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Lung volumes are low . There is bilateral diffuse interstitial thickening with vascular cephalization in the setting of moderate - to - severe cardiomegaly . There is an associated left - sided pleural effusion , better assessed in lateral radiograph . There is no right - sided pleural effusion or pneumothorax . A unicameral pacemaker is noted in the left axilla with the lead ending in the left ventricle . Sternotomy wires are intact . Mediastinal surgical clips are noted along the left margin of the heart . Abandoned epicardial leads are seen anterior to the heart .
    OUTPUT:
    
Interstitial edema with associated left - sided pleural effusion in the setting of moderate cardiomegaly . Of note , isolated left sided effusion can occur with pericardial effusion . If there is clinical suspicion or precipitating factor for pericardial effusion such as recent thoracic procedure , further assessment with echocardiogram should be pursued .