Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: A dual lead pacemaker is again seen with the tips in the right atrium and right ventricle . The heart remains mildly enlarged . Mild pulmonary vascular congestion , is chronic and unchanged . No pleural effusions or pneumothorax no acute focal consolidation . The bone mineral density is diffusely reduced with mild wedging of the lower thoracic vertebral body height and multiple healing rib fractures are seen on the right .
    OUTPUT:
    
A dual lead pacemaker is again seen with the tips in the right atrium and right ventricle The bone mineral density is diffusely reduced with mild wedging of the lower thoracic vertebral body height and multiple healing rib fractures are seen on the right .