Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The heart is again at the upper limits of normal size . The mediastinal and hilar contours appear unchanged . The lungs appear clear . There is no pleural effusion or pneumothorax . A thin flowing osteophyte is present along the anterior mid - to - lower thoracic spine , as before .
    OUTPUT:
    
No evidence of acute disease .