Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Single portable view of the chest . Right PICC is no longer visualized . Left chest wall dual lead pacing device is again seen . Left - sided pleural effusion is essentially unchanged . The lungs are otherwise clear . Cardiomediastinal silhouette is stable . Degenerative changes again seen at the right shoulder as well as old healed right rib fractures .
    OUTPUT:
    
Persistent left - sided pleural effusion without superimposed acute cardiopulmonary process .