Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Left - sided dual - chamber pacemaker device is again noted with leads in unchanged positions . No PICC is visualized . Moderate enlargement of the cardiac silhouette is unchanged . The mediastinal and hilar contours are similar . No pulmonary edema is identified . No focal consolidation , pleural effusion or pneumothorax is present . There are no acute osseous abnormalities .
    OUTPUT:
    
1 . No acute cardiopulmonary process . 2 . No PICC identified .