Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: There is a dual lead pacemaker , with lead tips over right atrium right ventricle . The cardiac silhouette is prominent , but similar to prior . Of note , there is marked lucency at the right and left lung apices . While this could represent artifact in a the patient with attenuated vessels / COPD , on the left , the lung edge appears visible . However , the appearances similar to the ___ radiograph and targeted review of the chest CT from ___ is more suggestive of an area of apical pleural thickening with overlying calcification ( series 11 b : Image ___ from that study ) . . There is probable background hyperinflation , consistent with COPD . , with background parenchymal scarring . Previously seen CHF appears markedly improved . Again seen is a small left effusion , with underlying collapse and / or consolidation , similar to the prior film . Minimal blunting of the right costophrenic angle and patchy opacity previously seen at the right lung base medially is improved .
    OUTPUT:
    
1 . Cardiomegaly , but doubt overt CHF . Previously seen CHF findings are markedly improved . 2 . Small left effusion and underlying collapse and / or consolidation is similar to ___ . 3 . Right base changes are also improved , with only a small residual pleural effusion . 4 . Marked lucency at both lung apices , of uncertain significance . This is probably artifactual due to a combination of apical pleural thickening and attenuated vessels . No definite pneumothorax . 5 . No displaced rib fracture identified on these lung technique films .