Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Markedly rotated positioning . An ET tube is present , tip approximately 3 .1 cm above the carina . Left - sided pacemaker device overlies the left shoulder , with lead tip over right ventricle . Right IJ central line tip lies in the region of the cavoatrial junction or upper most right atrium . There is marked enlargement of the cardiomediastinal silhouette , as well as mediastinal venous engorgement , similar to the prior film . Hazy opacity in the left lung could represent atelectasis , possibly accentuated by small amount of layering left pleural fluid . Increased opacity at the right base is compatible with small effusion , with underlying collapse and / or consolidation , and is also similar to the prior study . Probable vascular plethora / mild edema similar to the prior study . Left lung apex is obscured by the device overlying the patient . No new right - sided pneumothorax is detected .
    OUTPUT:
    
Overall similar to the study from ___ at 02 :59