Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Frontal and lateral views of the chest are obtained . Dual - lead left - sided pacemaker is seen with leads in the expected positions of the right atrium and right ventricle . The patient is status post median sternotomy and mitral valve replacement . There is a moderate - to - large right pleural effusion , increased since the prior study , which may be partially loculated . There is overlying atelectasis . Underlying consolidation can not be excluded . The left lung is clear . No left pleural effusion is seen . The cardiac silhouette is difficult to adequately assess due to the right pleural effusion , although it appears to be persistently enlarged . Aorta is calcified and tortuous . Anchor screws are partially imaged in the right humeral head .
    OUTPUT:
    
Increased moderate - to - large right pleural effusion which may be partially loculated , with overlying atelectasis , underlying consolidation can not be excluded .