Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The lungs are clear without consolidation , effusion , or vascular congestion . Cardiomediastinal silhouette is within normal limits . Tortuous descending thoracic aorta is noted . Median sternotomy wires and mediastinal clips are again seen . Chronic changes identified at the shoulders as on prior . No acute osseous abnormalities .
    OUTPUT:
    
No acute cardiopulmonary process .