Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Portable semi-erect chest film ___ at 16 42 is submitted .
    OUTPUT:
    
Right subclavian PICC line has its tip at in the proximal SVC . A single lead left - sided pacer is incompletely visualized but the lead appears intact and unchanged in overall position . The heart remains markedly enlarged which may reflect cardiomegaly , although pericardial effusion could also have this appearance . The left costophrenic angle is not entirely included on the current study but there do appear to be layering bilateral effusions with associated patchy airspace disease likely reflecting compressive atelectasis . There has been interval appearance of mild perihilar and interstitial edema . No pneumothorax is seen .