Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: DUAL LEAD LEFT - SIDED PACEMAKER IS AGAIN SEEN WITH LEADS EXTENDING THE EXPECTED POSITIONS OF THE RIGHT ATRIUM AND RIGHT VENTRICLE . THERE ARE SMALL BILATERAL PLEURAL EFFUSION . THE PATIENT IS STATUS POST MEDIAN STERNOTOMY . THE CARDIAC SILHOUETTE REMAINS MODERATELY ENLARGED . THE AORTA IS CALCIFIED . NO DEFINITE FOCAL CONSOLIDATION IS SEEN . THERE IS NO PNEUMOTHORAX . PROMINENCE OF THE RIGHT HILUM IS GROSSLY STABLE .
    OUTPUT:
    
PERSISTENTLY MODERATELY ENLARGED CARDIAC SILHOUETTE . SMALL BILATERAL PLEURAL EFFUSIONS . NO OVERT PULMONARY EDEMA .