Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Triple lead pacing device is again seen . Lung volumes are relatively low with secondary crowding of the bronchovascular markings . There is no consolidation or effusion . Cardiomediastinal silhouette is within normal limits . Median sternotomy wires are again noted . Degenerative changes noted at the right AC joint and hypertrophic changes in the spine .
    OUTPUT:
    
No acute cardiopulmonary process .