Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: PA and lateral views of the chest were provided . A dual - lead pacer is again seen with leads extending to the region of the right atrium and right ventricle . The heart size is stable and normal . There is hyperinflation and emphysema with post-surgical changes in the left mid lung , better assessed on prior CT . There is no focal consolidation , effusion , or pneumothorax . Mediastinal contour is normal . Bony structures are intact . DISH - related changes of the T - spine again noted .
    OUTPUT:
    
Emphysema without superimposed acute process .