Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: A left - sided pacemaker projecting leads into the left atrium and ventricle is unchanged in position and orientation . The heart size is top - normal . The hilar and mediastinal contours are unchanged . The right lung apex is obscured by the patient 's chin . Mild central pulmonary vascular congestion and pulmonary edema are present . A large hiatal hernia is unchanged . A small left pleural effusion is new .
    OUTPUT:
    
1 . Small left pleural effusion . 2 . Central pulmonary vascular congestion with mild pulmonary edema . 3 . Large hiatal hernia .