Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: A large left pleural effusion is increased in size from ___ causing contralateral shift of the trachea . The left cardiac border and hemidiaphragm are obscured . The right lung is well expanded . Without pleural effusion or evidence of pneumonia . There is mild vascular congestion . No pneumothorax .
    OUTPUT:
    
1 . Large left pleural effusion grown since ___ . 2 . Given extensive pulmonary changes , pneumonia can not be excluded .