Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Portable upright chest radiograph ___ at 03 :00 is submitted .
    OUTPUT:
    
A left sided single lead pacer is seen with the lead terminating over the expected location of the right ventricle , although the tip is not completely imaged . The heart is enlarged likely reflecting cardiomegaly , although a pericardial effusion should also be considered . There is likely a layering left effusion with retrocardiac opacity which could reflect partial lower lobe atelectasis , although pneumonia in this area can not be excluded . The remaining left lung and and right lung are clear . No pulmonary edema . No pneumothorax .