Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Left chest wall dual lead pacing device is again noted . Median sternotomy wires are intact . The lungs are clear without focal consolidation or effusion . There is no pulmonary edema . The cardiomediastinal silhouette is within normal limits . Degenerative changes noted at the acromioclavicular joints .
    OUTPUT:
    
No acute cardiopulmonary process .