Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: A pacer is seen in the left anterior chest with intact leads in adequate position . Median sternotomy wires and artificial valve are noted . The lungs are hyperinflated but demonstrate slightly decreased volumes compared to prior exams and mild bronchovascular crowding , likely reflecting suboptimal inspiratory effort . Diffuse reticular opacities are seen bilaterally , consistent with known emphysematous changes in the lungs . There is no evidence of pulmonary edema . No consolidative opacity suggestive of pneumonia is seen . There is no pleural effusion or pneumothorax . The cardiomediastinal silhouette is unremarkable .
    OUTPUT:
    
1 . No evidence of pneumonia or pulmonary edema . No acute cardiopulmonary findings . 2 . Hyperinflated lungs and diffuse reticular opacities , consistent with emphysema .