Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Left - sided dual - chamber pacemaker device is re - demonstrated with leads terminating in the right atrium and right ventricle , unchanged . Mild enlargement of the cardiac silhouette is again noted . Mediastinal and hilar contours are stable . Emphysematous changes are again noted . Small bilateral pleural effusions are new since the previous chest radiograph , and there is mild pulmonary vascular engorgement . Nodular opacities within both lung bases and right upper lobe , previously demonstrated on CT , are not as well visualized on the current exam . Right mid lung scarring is again noted . No acute osseous abnormality is seen . There is no pneumothorax .
    OUTPUT:
    
Mild pulmonary vascular congestion and small bilateral pleural effusions , new from the previous study .