Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Left - sided pacer device is noted with leads in unchanged positions terminating in the regions of the right atrium , right ventricle , and coronary sinus . Cardiac silhouette size appears moderately enlarged but similar . Bilateral hilar enlargement is compatible with pulmonary arterial enlargement , as seen previously . Pulmonary vasculature is not engorged . Bilateral calcified pleural plaques are re- demonstrated . Focal opacity within the left apex is re - demonstrated , and remains concerning for pneumonia . No pneumothorax or pleural effusion is present . No acute osseous abnormality is detected . Marked degenerative changes of both acromioclavicular and glenohumeral joints are re- demonstrated . Additionally , moderate degenerative changes are again noted in the thoracic spine with bridging anterior osteophytes compatible with DISH .
    OUTPUT:
    
1 . No substantial interval change from the previous CT examination with persistent pneumonia in the left upper lobe . 2 . Bilateral calcified pleural plaques indicative of prior asbestos exposure . 3 . Pulmonary arterial hypertension .