Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Frontal and lateral views of the chest demonstrate left pectoral cardiac pacer in place with leads terminating in the right atrium and right ventricle . Mild cardiomegaly is new . The thoracic aorta is tortuous with calcifications in the arch and along the aorta . Moderate right pleural effusion with an intrafissural component has developed in the interim , could be infectious . The left lung is well aerated and generally clear . Right glenohumeral and acromioclavicular degenerative changes are chronic as is senile thoracic spine kyphosis .
    OUTPUT:
    
Moderate right pleural effusion new since ___ , but actual chronicity is indeterminate . Can not exclude underlying infection .