Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The lungs are clear without focal consolidation . No pleural effusion or pneumothorax is seen . The cardiac and mediastinal silhouettes are unchanged . Densely calcified lymph nodes and radiation changes are again noted in the left hilum . A mechanical mitral valve is again noted . A small left pleural effusion versus pleural thickening is unchanged . Median sternotomy wires are intact . Again seen are multiple surgical clips projecting in the left upper quadrant . Left apical changes may be related to radiation changes versus sequela of prior granulomatous disease .
    OUTPUT:
    
1 . Stable appearance of the chest . No increase in pleural effusion . 2 . Left apical pleural thickening may be related to radiation changes versus sequela of prior granulomatous disease .