Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Lordotic positioning , with low inspiratory volumes . The lower lateral left hemidiaphragm and left costophrenic angle are excluded from the film . Compared to the prior study , the right IJ central line has been removed . Again seen is a dual lead pacemaker type device , with 1 lead tip over the right atrium . The second lead does not appear changed , but the distal tip is excluded from the film . Allowing for considerable differences in positioning , no definite change is identified . As noted , the lateral half of the left hemidiaphragm and left costophrenic angle are excluded from the film . Upper zone redistribution is noted , but doubt overt CHF . No focal consolidations seen in the visualized portion of the lung . Minimal blunting of the right costophrenic angle , without gross right effusion . Incidental note made of findings consistent with a chronic left shoulder rotator cuff tear .
    OUTPUT:
    
Lower left chest excluded from film . Allowing for this , doubt significant interval change . If clinically indicated , a repeat AP view to include the lower left chest lateral could be obtained at no additional charge to the patient .