Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Again , noted is a prominent epicardial fat pad . Otherwise , the lungs are clear with no evidence of a consolidation , effusion , or pneumothorax . Cardiomediastinal silhouette is stable and within normal limits . No acute fractures are identified but old left sided rib fractures may be present . Multilevel degenerative changes are visualized throughout the thoracic spine with anterior osteophytes and disc space narrowing .
    OUTPUT:
    
No acute cardiopulmonary process .