Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Assessment is limited by patient rotation and positioning . Tracheostomy tube terminates in unchanged position . Right - sided pacemaker device is again noted with single lead terminating in the right ventricle . Multiple clips project over the mediastinum . Cardiac and mediastinal contours appear similar with leftward shift of the mediastinal structures , unchanged . Dense retrocardiac opacity likely reflects a combination of known left lower lobe chronic bronchiectasis and collapse , worse when compared to the previous radiograph . Patchy opacities in the left upper lung field and peripheral aspect of the right mid lung field appear relatively similar compared to the previous radiograph . Patchy opacities in the right lung base are new , worrisome for infection or aspiration . Small bilateral pleural effusions are noted .
    OUTPUT:
    
1 . New right basilar patchy opacity concerning for pneumonia or aspiration . 2 . Persistent ill - defined opacities in the left upper lobe and peripheral aspect of the right mid lung field , worrisome for additional sites of infection or aspiration which appear more chronic . 3 . Dense retrocardiac opacity likely reflecting a combination of unknown bronchiectasis and lung collapse . 4 . Small bilateral pleural effusions .