Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: There is a pacemaker overlying the left chest with pacemaker leads in the right atrium and coronary sinus , and a defibrillator lead in the right ventricle . The patient is status post median sternotomy , CABG , and mitral valve replacement , with sternotomy wires that appear intact and well aligned . Heart size is normal . The mediastinal and hilar contours are normal . The pulmonary vasculature is normal . Lungs are clear . There is a moderate left pleural effusion . No pneumothorax is seen . There are no acute osseous abnormalities .
    OUTPUT:
    
1 . No pneumothorax . 2 . Moderate left pleural effusion .