Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: There is moderate to severe cardiomegaly . Pacer leads are in standard position with tips in the right atrium and right ventricle . The lungs are hyperinflated . There is mild vascular congestion . . There is no pneumothorax or pleural effusion . There are moderate degenerative changes in the thoracic spine .
    OUTPUT:
    
No pneumothorax . Pacer leads in standard position . Mild vascular congestion .