Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: A dual - lead pacemaker / ICD device appears unchanged . The heart is again markedly enlarged . The mediastinal and hilar contours appear unchanged . The lungs appear clear . There is no pleural effusion or pneumothorax . There has been no significant change .
    OUTPUT:
    
No evidence of acute disease . Cardiomegaly .