Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: A dual - lead pacemaker / ICD device appears unchanged with leads again terminating in the right atrium and ventricle , respectively . The heart is mildly enlarged . The mediastinal and hilar contours appear unchanged . A calcified nodule in the right upper lobe suggesting a granuloma appears unchanged . Otherwise , the lungs remain clear . There is no pleural effusion or pneumothorax . Small osteophytes are noted along the mid - to - lower thoracic spine .
    OUTPUT:
    
No evidence of acute disease .