Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: A left sided pigtail catheter is in place . The previously seen basilar pneumothorax is not clearly identified on this film . No obvious pneumothorax is detected at this time . There is a small effusion at the left lung base with underlying collapse and or consolidation which has progressed compared with the prior film . Again seen is some focal density overlying the left lung apex , not fully characterized . Also again seen are sutures in the left upper zone . There is minimal atelectasis at the right base , which is new compared with the prior film . No gross right effusion . There is probable background hyperinflation / COPD . The heart is not enlarged . No CHF There is an apparent hiatal hernia .
    OUTPUT:
    
1 ) No definite left pneumothorax . Interval development of small left effusion with underlying collapse and or consolidation . 2 ) Patchy opacity left apex , not fully characterized . The differential diagnosis includes a focal nodular density , focal scarring , or possibly a focal infiltrate . There are nearby sutures . Clinical correlation with details of the patient 's history and any outside chest CTs is recommended for full assessment . In the absence of a known pathology in this location , further assessment with chest CT would be recommended . 3 ) Background COPD . 4 ) Hiatal hernia . 5 ) Minimal atelectasis right base laterally .