Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Left - sided pacemaker device is noted with leads in unchanged positions within the right atrium and right ventricle . Mild enlargement of the cardiac silhouette persists . The mediastinal and hilar contours are unchanged . Low lung volumes are again noted with chronic elevation of the right hemidiaphragm . There is crowding of the bronchovascular structures with possible mild pulmonary vascular congestion , but no overt pulmonary edema . No focal consolidation , pleural effusion or pneumothorax is visualized . Mild degenerative changes are seen in the thoracic spine .
    OUTPUT:
    
Low lung volumes with possible mild pulmonary vascular congestion .