Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Rotated positioning . A left - sided battery pack obscures a portion of left heart border . 3 leads again noted . No pneumothorax detected . Again seen is increased retrocardiac density . This appears similar , but slightly more confluent and dense than on the prior study . The previously seen locule of air projecting over the cardiac silhouette is no longer visualized , the small air bronchograms remain visible . A small right effusion is similar to the prior study . Doubt overt CHF . Nodular pleural thickening again noted at the right lung apex .
    OUTPUT:
    
Based on the available film , it is difficult to confirm interval improvement in a left pleural effusion . The confluence of density at the left lung base is actually slightly greater . However , the position of the left hemidiaphragm is uncertain an much of the density is accounted bite by pleural fluid remains uncertain . No pneumothorax detected . Elsewhere , doubt significant interval change .