Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: A left - sided pacemaker / defibrillator is seen with 2 leads in appropriate position . Sternotomy wires and vascular clips are projected over the mediastinum . Cardiomediastinal and hilar contours are within normal limits . The heart is top - normal in size . There is a small pleural effusion on the left as well as adjacent pulmonary opacities which could represent atelectasis or pneumonia . The right lung appears clear except for linear right basilar atelectasis . There is no pneumothorax identified . Left apical thickening .
    OUTPUT:
    
Small left pleural effusion . Adjacent lingular and left lower lobe opacities could be due to either atelectasis or pneumonia . Asymmetrical left apical thickening . Consider PA and lateral radiographs for further characterization when the patient is clinically able .