Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Compared to ___ , I doubt significant interval change . There is a small left pleural effusion which could be slightly more pronounced on today 's examination and which is new compared with ___ . Again seen is background COPD and cardiomegaly . Mild background parenchymal scarring is likely present . No CHF , focal infiltrate or right pleural effusion . Old healed right - sided rib fractures noted .
    OUTPUT:
    
1 . COPD and cardiomegaly . 2 . Small left pleural effusion of indeterminate acuity . This is new compared with ___ , but difficult to compare to the most recent prior film . 3 . Otherwise , no acute pulmonary process identified .