Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Lung volumes remain very low , causing bronchovascular crowding and apparent enlargement of the probably normal sized heart . Substantial left lower lobe atelectasis is unchanged . No new focal opacity . A moderate left pleural effusion is unchanged . Cardiomediastinal hilar silhouettes are unchanged . Mild pulmonary vascular congestion without overt edema . A tracheostomy tube terminates approximately 3 cm above the carina . A right IJ hemodialysis catheter terminates in the right atrium . An additional right IJ central venous catheter terminates in the mid to lower SVC . An enteric tube tube passes below the GE junction and outside the field of view . Incidental note is made of cervical fusion hardware .
    OUTPUT:
    
No significant changes with persistent moderate left pleural effusion and substantial left lower lobe atelectasis .