Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: PA and lateral chest radiograph demonstrates a dual lead left chest pacer device , its leads which appear intact and in unchanged position relative to prior examination . Patient is status post median sternotomy with aortic valve replacement . Heart size is enlarged though stable relative to prior examination . There is no evidence of pulmonary edema . Lungs appears slightly hyperinflated to suggest underlying emphysematous changes . A nodule in the right upper lung zone is unchanged since ___ , most compatible with granuloma . There is no pleural effusion or pneumothorax .
    OUTPUT:
    
No acute intrathoracic abnormality . Cardiomegaly without pulmonary edema .