Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Again seen is a dual - lead pacemaker / ICD device with leads terminating in the right atrium and ventricle , respectively . The heart is again moderately enlarged , not necessarily changed , however , allowing for differences in technique . However , some widening of the vascular pedicle including venous distention is suspected in system as well as pulmonary vessels . There is no definite pleural effusion or pneumothorax . No focal opacity is identified aside from streaky mid lung opacity on the right suggesting minor atelectasis along the minor fissure versus fissural thickening .
    OUTPUT:
    
Probably unchanged cardiomegaly allowing for substantial differences in technique including AP versus PA view and low lung volumes . Findings suggest pulmonary venous hypertension which is more striking than before , however without overt pulmonary edema .