Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The heart size is normal . Fullness in the right upper mediastinum is again seen and may reflect a goiter . The hilar contours are unremarkable . There is no pleural effusion or pneumothorax . The lungs are well - expanded clear without focal consolidation . Pulmonary vasculature is within normal limits . Left axillary dual lead pacemaker is noted with leads in stable positions . Median sternotomy wires are intact . The upper abdomen is unremarkable .
    OUTPUT:
    
1 . No acute cardiopulmonary process . 2 . Fullness in the right upper mediastinum is noted , which may reflect a goiter . Physical exam is recommended with consideration to additional imaging if clinically indicated .