Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: PA and lateral chest views were obtained with patient in upright position . Comparison is made with the next preceding similar study of ___ . Permanent pacer in left anterior axillary position with dual electrode intracavitary system unchanged . Mild cardiac enlargement as before . No acute pulmonary vascular congestion , pleural effusion , pneumothorax or infiltrates are seen . Mild degree of prominent breast shadows suggestive of gynecomastia . The comparison is extended to the next previous chest examination of ___ . Again , no significant interval change can be identified .
    OUTPUT:
    
Permanent pacer , mild cardiac enlargement , no conclusive evidence for significant pulmonary congestion . Some irregular distribution of pulmonary vasculature consistent with COPD but again acute infiltrates indicating exacerbating infection are not seen .