Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Frontal and lateral views of the chest are obtained . There is a dual - lead left - sided pacemaker with leads extending to the expected positions of the right atrium and right ventricle . There is marked elevation of the right hemidiaphragm and a subpulmonic effusion is not excluded . The left lung is clear . No focal consolidation is seen . The cardiac silhouette is mildly enlarged . The aortic knob is calcified .
    OUTPUT:
    
Marked elevation of the right hemidiaphragm , new since ___ , subpulmonic effusion not excluded .