Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: AP and lateral views of the chest . Again , relatively low lung volumes are seen . Left chest wall dual - lead pacing device seen with lead tips in the right atrium and right ventricle . The lungs are grossly clear without consolidation , effusion or pulmonary vascular congestion . Cardiomediastinal silhouette is unchanged and accentuated due to low lung volumes . No acute osseous abnormality is identified . Median sternotomy wires and mediastinal clips again noted . There is mild cardiomegaly , likely also accentuated due to low lung volumes .
    OUTPUT:
    
No definite acute cardiopulmonary process .