Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Right - sided dual - chamber pacemaker device is again noted with leads terminating in the right atrium right ventricle . Moderate enlargement of the cardiac silhouette is re - demonstrated . A moderate size hiatal hernia is also unchanged . Atherosclerotic calcifications are demonstrated at the aortic knob . Multiple calcified mediastinal and hilar lymph nodes indicate prior granulomatous disease . No focal consolidation , pleural effusion or pneumothorax is identified . No acute osseous abnormalities detected .
    OUTPUT:
    
Moderate size hiatal hernia . Moderate cardiomegaly without congestive heart failure . Evidence of prior granulomatous disease .