Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: PA and lateral views of the chest provided . There is a dual - lead left - sided cardiac pacing device with one lead in the right atrium and the other in the right ventricle . There is elevation of the left hemidiaphragm , which could represent diaphragmatic paralysis or a severely eventrated left hemidiaphragm . There is no focal consolidation , effusion , or pneumothorax . The cardiomediastinal silhouette is normal . The ascending aorta is either tortuous or dilated , though is unchanged for several years . Imaged osseous structures are intact . No free air below the right hemidiaphragm is seen .
    OUTPUT:
    
1 . No acute intrathoracic process . 2 . Elevation of left hemidiaphragm , which could represent either paralysis or severe eventration .