Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: There is a dual lead pacemaker / ICD device whose leads terminate in the right atrium and ventricle , respectively , without significant change . The heart is again moderately enlarged . The mediastinal and hilar contours appear stable . The lungs are clear . There are no pleural effusions or pneumothorax . Calcified enthesopathy projects along the greater tuberosity of the left humerus .
    OUTPUT:
    
No evidence of acute disease .