Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: As compared to prior radiograph from ___ , there has been slight worsening of right - sided pleural effusion , with fluid tracking within the minor fissure . No focal consolidations are identified and there is no pneumothorax . There is increased anteroposterior diameter of the thorax with hyperinflated lungs suggestive of COPD . There is moderate to severe cardiomegaly . Left - sided dual - lead pacemaker leads terminate in the expected positions of the right atrium and right ventricle . There is evidence of kyphosis .
    OUTPUT:
    
Slight worsening of right - sided pleural effusion . Increased anteroposterior diameter of the thorax with hyperinflated lungs suggestive of COPD .