Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: A dual - lead pacemaker / ICD device has leads terminating in the right atrium and ventricle , respectively . The heart is normal in size . The right upper mediastinal border has a smooth convex appearance which is usually due to tortuosity of the great vessels . A moderate hiatal hernia is distended with air . There is no pleural effusion or pneumothorax . The chest is hyperinflated . The lungs appear clear . The right humeral head appears somewhat low - lying compared to the glenoid although this may be due an artifact of how the film was acquired .
    OUTPUT:
    
No evidence of acute cardiopulmonary disease or injury . Hyperinflation . Moderate hiatal hernia . Possible laxity or subluxation of the right glenohumeral joint , although commonly this type appearance is an artifact of positioning . Correlation with physical examination of the shoulder is recommended .