Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Left - sided pacemaker device has its leads in unchanged position . A left - sided chest tube has been removed . There has been interval worsening in diffuse subcutaneous emphysema now extending in the bilateral chest walls and neck . There is a small left apical pneumothorax . Left retrocardiac opacity likely represents postsurgical changes . There is persistent blunting of the left costophrenic sulcus likely due to a small pleural effusion . Cardiomediastinal silhouette is unremarkable .
    OUTPUT:
    
1 . Interval removal of a left - sided chest tube with interval worsening of diffuse subcutaneous emphysema extending throughout the chest wall and neck bilaterally . 2 . New small left apical pneumothorax . 3 . Postsurgical changes in the left lung with unchanged small left pleural effusion . Findings were discussed with ___ .