Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: There is a dual lead pacemaker / ICD device that is in changed with leads again terminating in the right atrium and ventricle , respectively . The cardiac , mediastinal and hilar contours appear stable . There is persistent suspected pleural effusion on the left , probably at least small to moderate in size in addition to mild diffuse opacification suggestive of pulmonary edema . This appearance is somewhat heterogeneous , however including the possibility of developing focal opacity in the right upper lobe , in addition to persistent focal lower lobe opacities . Possible nodule appears less distinct on this study ; the image is less sharp . There is no pneumothorax .
    OUTPUT:
    
1 . Worsening multifocal opacification , notably with suspicion for developing new right upper lobe opacity . This appearance raises concern for multifocal pneumonia versus a heterogeneous presentation of pulmonary edema , and regardless there is probably an element of fluid overload . 2 . No definite persistent visualization of a nodule which appears more vague on this study in the left upper lobe . However , continued radiographic followup is recommended and if the finding were not to resolve entirely chest CT should then be considered .