Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Left - sided dual - chamber pacemaker is noted with leads terminating in the right atrium and right ventricle . Moderate enlargement of the cardiac silhouette is unchanged . The aortic knob is calcified . The lungs are hyperinflated with flattening of the diaphragms , suggestive of underlying COPD . Mild pulmonary vascular engorgement is likely present . No focal consolidation , pleural effusion or pneumothorax is detected . Cholecystectomy clips are noted in the right upper quadrant of the abdomen . Diffuse demineralization of the osseous structures is again redemonstrated with loss of height of several mid thoracic vertebral bodies .
    OUTPUT:
    
No significant interval change from the prior study with mild pulmonary vascular engorgement , but no frank pulmonary edema . No pneumonia .