Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: There is an large right - sided pleural effusion . The right lung apex and left lung are essentially clear . Cardiomediastinal silhouette can not be accurately assessed due to silhouetting on the right . Left chest wall dual lead pacing device is noted with lead tips in the right atrium and right ventricular apex . Degenerative changes are noted in the spine .
    OUTPUT:
    
Large right - sided pleural effusion with underlying atelectasis .