Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Patient is status post median sternotomy and left - sided pacer placement with leads terminating in the right atrium and right ventricle . Cardiac silhouette size remains moderately enlarged , unchanged . The mediastinal hilar contours are similar . Mild pulmonary vascular congestion is not substantially changed in the interval without overt pulmonary edema . No focal consolidation , pleural effusion or pneumothorax is demonstrated . There are mild degenerative changes noted in the thoracic spine . No subdiaphragmatic free air is present .
    OUTPUT:
    
Moderate cardiomegaly and mild pulmonary vascular congestion , likely chronic .