Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Left - sided pacemaker device with leads terminating in the right atrium and right ventricle is unchanged . Heart size is normal . Mediastinal and hilar contours are similar . Fiducial markers within two adjacent left upper lobe lesions are re - demonstrated , not changed in the interval . No new focal consolidation , pleural effusion or pneumothorax is identified . Lungs remain hyperinflated with emphysematous changes again re - demonstrated , most pronounced in the upper lobes . Pulmonary vasculature is not engorged . Mild multilevel degenerative changes are seen in the thoracic spine .
    OUTPUT:
    
No substantial interval change with re - demonstration of two adjacent left upper lobe lesions containing fiducial markers . Emphysema . No pneumonia .