Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: AP portable upright view of the chest . Left chest wall AICD is again seen . There is a tripolar AICD , with leads extending into the right atrium , right ventricle , and azygous vein . An LVAD is in place . Midline sternotomy wires noted . Tricuspid valve prosthesis noted . Lungs appear clear . The heart remains mildly enlarged . No signs of edema , pneumonia , large effusion or pneumothorax . Bony structures are intact .
    OUTPUT:
    
No acute findings . Unchanged position of tripolar pacer leads extending into the azygos vein , right atrium and right ventricle .