Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: A dual - lead permanent pacemaker has been inserted via a left - sided approach , with leads terminating in the expected locations of the right atrium and right ventricle . There is no visible pneumothorax . Heart is mildly enlarged . Mild upper zone vascular redistribution is present as well as a few thickened septal lines within the lower lobes bilaterally . Small pleural effusions are new . Skeletal structures are remarkable for severe degenerative changes at the right shoulder .
    OUTPUT:
    
1 . Permanent pacemaker in standard position with no visible pneumothorax . 2 . Mild interstitial edema and small pleural effusions .