Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Left chest wall dual lead pacing device is again seen . The lungs are clear without evidence of edema . The cardiomediastinal silhouette is stable . Median sternotomy wires , many of which are fractured , are again noted . Mediastinal clips are also noted . Degenerative changes seen at the shoulders and posttraumatic changes of the proximal left humerus as on prior .
    OUTPUT:
    
No acute cardiopulmonary process .